SCARLET FEVER

INTRODUCTION
Scarlet fever is a disease that, for so many years, has been plaguing mankind-- although, in a sporadic basis. Historians believe that the first case of scarlet fever was diagnosed during the time of Hippocrates, but it was only in the year 1884 that the infective organism was discovered and named..

SCARLET FEVER

The organism was a Gram (+), Group A beta-hemolytic bacteria called Streptococcus Pyogenes. S. pyogenes is notorious for its communicability because it can easily be transmitted through a direct contact with any of the host¶s bodily fluid. Once compromised by the organism, the symptoms that will be manifested by the host may includes:

SCARLET FEVER

S Body ache C Headache A High fever R L Sore throat E Nausea, with or without vomiting T Lymphadenopathy F Red rashes (with a sandpaper-like E texture) V ³Strawberry´ tongue E White coating on the back of the throat R

As contagious as it is, scarlet fever is not without cure. In fact, mild cases of it can be cured with bed rest and some antibiotic. But as many diseases are, its precipitation can vary from mild to even fatal.Pneumonia and Rheumatic fever can precipitate from the disease if left untreated.

SCARLET FEVER

SCARLET FEVER . many people. we shoulder the responsibility of disseminating our knowledge to the susceptible population.As was previously stated. scarlet fever is actually very manageable and yet. In light of this statement. still fall as victims to the disease. it is our goal that may the initiation of this study serve as a catalyst to further the right to health of the people to whom this knowledge will be conveyed to. As health care practitioners of the future. especially children.

Project 8..G.M.Name: Age: Address: Gender: DEMOGRAPHIC PROFILE Civil Status: Occupation: Educational Attainment: Date of Admission: Admitting Diagnosis: S C A J. R 6 years old L #24 Finance St. 2011 E Scarlet Fever R . Quezon City E Male T Child F N/A E Elementary (Grade 1) V December 31.

MEDICAL HISTORY Chief Complaint:  Fever with associated dysphagia and rashes on upper extremities History of Present Illness:  4 days PTA. SCARLET FEVER . with spreading rashes all over the body. (+) appearance of rashes on the face  3 days PTA. persistence of the symptoms prompted. consult. (+) fever with colds  Few hours PTC.

Family History:  Mother side: (+) history of breast cancer  Father side: (+) history of hypertension Socio-economic History:  The patient¶s father works as a Framer while the patient¶s mother is a plain housewife.Past Medical History:  The patient has never been hospitalized prior to present hospital admission. SCARLET FEVER .

He calls them psychosocial stages because he believes that the psychological development of individuals depends on the social relations established at various points in life.DEVELOPMENTAL HISTORY Erik Erikson¶s Psychological Stages This theory is a series of eight stages used to characterize development from cradle to grave. SCARLET FEVER .

there are problems or ³crises´ to be confronted.M. SCARLET FEVER . Each stage calls to attention the kind of problems people encounter during life: ³Patient J. Inferiority´ (6-12 years) stage of Psychological development.´ is a 6 years old grade 1 pupil.G. falling under the ³Industry vs.At each stage.

Significant relations include neighborhood and the school.This stage of psychological development is characterized as the stage where children learn from school the social values. These includes not only reading and writing. but also physical skills and the ability to share responsibility and get along with others. Competence in social. SCARLET FEVER . intellectual and physical skills are it¶s favorable outcome.

Success or failure while learning these skills can have a lasting effects on a child¶s feeling of adequacy. If their efforts are succesful. SCARLET FEVER . children develope feelings of competence. while unsuccessful efforts result to feeling of inferiority.

SCARLET FEVER .Sigmund Freud¶s Theory on Psychosexual Development Freud believed that the first few years of life are the most important for the development of a child¶s personality and character. each is concerned with a major biological function and influences personality development. He conceptualized several distinct stages of development and called them ³psychosexual stages´.

As the child starts schooling they become more interested with recreational activities and peer relationships.Under the psychosexual stages of human development. SCARLET FEVER .´ is under the ³Latency Stage ³ (6-puberty). This is often called as the time of quiet and calm.M. This stage of psychosexual development is a stage where the childs libidal energy is suppressed. ³Patient J.G.

PHYSICAL ASSESSMENT Vital Signs: P.R Temp : : : 96bpm 25cpm 37.R. R.9 ÛC S C A R L E T F E V E R .

Skin Inspection Fair complexion. Flushed skin with Macular rashes Itching sensation Sandpaper-like texture Palpation Warm to touch Good skin turgor Warm to touch Good skin turgor Skin intact. absence of rashes.BODY PART ASSESSMENT TECHNIQUE NORMAL FINDINGS ACTUAL FINDINGS 1. scars and lesions. No discharge Skin intact. No discharge. SCARLET FEVER .

Palpation Dry and oily SCARLET FEVER . Scalp Inspection No lice and nits. Evenly distributed black hair. Hair Inspection Evenly distributed hair. 3. No lice and and nits Palpation No lumps and lesion.2. No lumps and lesions. Color varies mostly in black. Smooth in texture and shiny.

Round cornea. Palpebral Conjunctiva is pinkish in color Palpebral conjunctiva is pinkish in color SCARLET FEVER . absence of rashes. White sclera. scars and lesions. with Macular rashes 5) Eyes Inspection Round cornea. White sclera. Black color. Face Inspection Symmetrical face movement Symmetrical face movement Smooth.4. Black color.

Lids able to close symmetrically.6) Eyebrows Inspection Hair evenly Hair evenly distributed with skin distributed with skin intact. aligned with equal movement. No discoloration. Lids able to close symmetrically Puffy eyelids SCARLET FEVER . 7) Eyelids Inspection No discoloration. symmetrically with equal movement. symmetrically aligned intact.

Midline symmetrical to face. no lesions. Able to identify sound Palpation No lesions noted Able to identify sound No lesions noted 9) Nose Inspection Midline symmetrical to face. no nasal discharges or flaring. SCARLET FEVER .8) Ears Inspection Same color as facial skin Proportion to the head and no active discharge. no lesions. Same color as facial skin Proportion to the head and no active discharge. Uniform in color. Uniform in color. no nasal discharges or flaring.

smooth. no lesions. Proportional and symmetrical with face. Dry lips and mucous membrane. Ulcers in the mouth Difficulty opening the mouth With sore throat Difficulty swallowing 11) Lips Inspection Pink in color.10) Mouth/ Throat Inspection Proportional and symmetrical with face. with lesions Red in color SCARLET FEVER .

Tongue floor is in central With strawberry tongue SCARLET FEVER .12) Teeth Inspection Complete without dentures. Tongue floor is in central Red in color. no lesions or swelling. pink in color. moist. Complete without dentures. 13) Tongue Inspection Position. moist. no lesions or swelling.

rhythm. no murmur. Spontaneous non-labored breathing Productive cough: white 15) Chest/ Lungs Inspection Auscultation Wheezing breath sound are present SCARLET FEVER .14) Heart Auscultation Normal rate. Symmetrical during lung expansion and recoil. Normal rate. no murmur. rhythm. Symmetrical during lung expansion and recoil.

16) Abdomen/ GIT Inspection No masses & tenderness No masses & tenderness Auscultation No abnormal bowel sounds Palpation No masses or tenderness No abnormal bowel sounds No masses or tenderness SCARLET FEVER .

no lesions Slightly red in color.17) Upper extremities Inspection Able to move freely without discomfort. Palpable brachial and radial pulse. abduct. flex and extend palpation No tenderness. No tenderness. flex and extend Able to move freely without discomfort Able to adduct. Palpable brachial and radial pulse. no palpable mass noted. 18) Palms Inspection Pink in color. Able to adduct. no palpable mass noted. no lesions. abduct. SCARLET FEVER .

20) Lower extremities Inspection Symmetrically to the body. Palpation No lesions noted muscle appears in equal and good muscle tone. SCARLET FEVER .19) Finger nails Iinspection Nails well-groomed. Symmetrically to the body. Nails well-groomed Symmetrical Symmetrical Pink nail beds Pink nail beds With no present of clubbing Capillary refill: 1-3 secs. With no present of clubbing Capillary refill: 2 secs. No lesions noted muscle appears in equal and good muscle tone.

SCARLET FEVER . Pink nails with capillary refill less than 2secs.21) Toenails Inspection Pink nails with capillary refill less than 2secs.

ANATOMY AND PHYSIOLOGY SCARLET FEVER .

S C A R L E T F E V E R .

MAIN TYPES OF RASHES MACULE PAPULE SCARLET FEVER .

Vesicular Rashes Maculopapular Rash Papulosquamous rash: SCARLET FEVER .

S C A R L E T F E V E R .

SCARLET FEVER .

Non-modifiable factor yAge Modifiable factor yEnvironment Bacterial Invasion Multiplication of bacteria S C A R L E T F E V E R Release of toxins .

S C A R L E T F E V E R Interruption in the body¶s normal homeostasis Immune response Increase WBC subsequent to pus formation Cytokines & Prostaglandins release Tonsillar exudate .

Body induces the action of the cytokines & prostaglandins Inflammation of the buccal membrane The body responds Increased blood flow in tongue papillae Fever Strawberry tongue Macule Rash Increased capillary permeability SCARLET FEVER .

1 PR:140bpm PR:140bpm RR:28cpm RR:28cpm BP:90/60mmH BP:90/60mmH g + flushed skin +strawberry tongue Admit to Pav. . VII Secure consent on admission SCARLET FEVER  The informed consent is used to secure that the procedure was already explained to the patient and also to secure that the patient agreed on the procedure or treatment that will be given to him.MEDICAL MANAGEMENT DATE PHYSICIAN PROGRESS NOTE DOCTOR¶S ORDER RATIONALE 12-31-11 06:00 pm T: 36.

 Monitor v/s  To check and every shift assess patient¶s condition for the time being. Soft foods that are easy to swallow and gentle on your throat are often best tolerated. a dry throat and painful swallowing. All documents must be formally recorded for proper SCARLET FEVER .12-31-11 06:00 pm  Soft diet please  Sore throat may cause difficulty swallowing.

12-31-11 06:00 pm  Monitor I/o every shift and record  D5 0.8 SCARLET FEVER .3 NaCl of 500cc/ hr  To check for the stability of patient.s health status and (+/-) nutritional. fluid and electrolyte imbalances Therapeutics:  Paracetamol 250mg/5ml give 4ml every 4hrs for 37.

12-31-11 06:00 pm  Hydrite 2 sachet in 500ml of distilled water  Pen G 230.000¶u¶ ANST every 6 hrs Diagnostics:  CBC and Platelets  Blood BS/CS  ESR  CRP SCARLET FEVER .

12-31-11 06:00 pm  Dra. VII  Refer 6:40pm T: 38.3 PR:120bpm PR:120bpm RR:28cpm RR:28cpm BP:90/60mmH BP:90/60mmH g SCARLET FEVER . G. informed of admission  Pls. admit to Pav.

1-1-12 6:00 am T: 37. 9:25 am Patient seen asleep (-) appetite SCARLET FEVER .1  For Throat PR:115bpm PR:115bpm swab RR:23cpm RR:23cpm  refer BP:90/60mmH BP:90/60mmH g  to know what is the specific bacteria present in the throat.

1-2-12 6:00 am T: 37.7  Throat swab PR:86bpm PR:86bpm RR:22cpm RR:22cpm BP:90/60mmH BP:90/60mmH g (-)DOB (-) good  Continue appetite antibiotics  refer  to know what is the specific bacteria present in the throat.  to prevent resistance of the drugs SCARLET FEVER .

1-3-12 6:00 am T: 37.3 PR:120bpm PR:120bpm RR:18cpm RR:18cpm BP:90/60mmH BP:90/60mmH g (+) flushed skin (+) strawberry tongue (-) papular rash (+) scarlet fever SCARLET FEVER .

8 109/L 12.8-10.8 RBC Hemoglobin 4.1 1012/L 3.14 13-17g/L Hematocrit 40-52 % 32.LABORATORY RESULTS HEMATOLOGY Normal Values Results Significance Increased indicates infection Decreased indicates anemia Decreased indicates anemia Decreased indicates destruction of RBC WBC 4.01 SCARLET FEVER .98 11.7-6.

MCV MCH MCHC Platelet count (82-98) (28-33) 33-36g\L 150400109/L 80.82 280 Decreased indicates iron deficiency Adequate SCARLET FEVER .42 28 34.

0 % 40-70 % 19-48 % 2-8 % 3-9 % 13.65 78.5 Increased Decreased Monocytes 0-5 % Basophils SCARLET FEVER .7 9 4 7.RDW Neutrophils Lymphocyte s Eosinophil 11.4-14.8 1.

SCARLET FEVER .THROAT SWAB RESULT Date: 01/01/2012 Time: 7:45 am Reveals (+) Group A Streptococci.

meningitis.DRUG STUDY DRUG NAME Generic name: Penicillin G Brand name: Benzyl Penicillin Classification: Anti infective Penicillin Route: IV Dosage: 230. INDICATION Treatment of  respiratory tract infection. Monitor cbc  SCARLET FEVER . fever For IM use.000 ³u´ Frequency: q6   ACTION Inhibits bacterial wall synthesis during bacterial multiplication. Assess for signs and symptoms of infection. Some types of subacute bacterial endocarditis. otitis media and osteomyelitis. perform sensitivity test. give deep into large muscle. skin and soft tissue infections. dental and surgical infections. increased WBC. CONTRAINDICATION hypersensitivity ADVERSE REACTION    Hypersensitivity reactions Sensitizations Mild gastrointestinal tract irritation   NURSING MANAGEMENT Assess patient for hypersensitivity to the medication. injection may also be extremely painful Monitor renal function closely.

Drug name Generic name: Paracetamol Action Indication Contraindication Hypersensitivit  y.tem perature. intolerance to tartrazine.d iaphoresis assess hepatoxici ty monitor liver and renal function check input and output ratio assess chronic positionin g Decreases fever by inhibiting the Brand name: effects of Aeknil pyrogens on the Classification: hypothalamic antipyretics. table sugar saccharin               Adverse effect Stimulation Drowsiness Nausea Vomiting Abdominal pain Hepatotoxicity Hepatic seizure Renal failure Leucopenia Neutropenia Rash Urticaria Jaundice Rash cyanosis Nursing Management  assess patient¶s fever or pain: type of pain. Dosage: 250 mg/5ml Frequency: q4 Relief of mild. alcohol. to-moderate pain. locaton.dur ation. treatment of fear.     SCARLET FEVER .nonopi heat regulating oid analgesics centers and by a hypothalamic Route: action leading IV to a sweating vasodilation.int ensity.

Assess hydration Assess for possible adverse reaction Assess patient¶s and family¶s knowledge of drug therapy. It corrects mild to moderate dehydration during the initial phase of oral rehydration therapy.  SCARLET FEVER . Treatment of  childn & adults w/ dehydration due to diarrhea. It also prevents recurrence of dehydration after initial correction of dehydration. Frequency: OD Action Hydrite is an oral rehydration fluid used to replace fluid and electrolytes lost due to diarrhea and/or vomiting. Replaces fluid & electrolytes  lost due to diarrhea & vomiting.toxic megacolon wih may cause in ulcerative colitis. Indication Contraindication newborn babies or those less than 2 months taking with ongoing IV fluid Adverse effect  Constipatio n  Hypersensit ivity reaction   Flatulence Abdominal pain or discomfort  Dry mouth     Nursing Management Assess patient¶s diarrhea and bowel pattern before starting therapy. Assess for abdominal distention.Drug name Generic name: hydrite Brand name: hydrite Classification: Oral rehydration salts Route: Oral Dosage: 2 sachets in 500 ml.

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It also helps to lower body temperatur Dependent:  Administer antipyretics as prescribed. y Patient¶s body Provides comparativ temperature e baseline. Signs esp.6¶c. y For better circulating volume and tissue perfusion. Shift.CUES SUBJECTIVE : ³Nilalagnat pa nga siya. y y Helps lower body temperatur Within hospitalizatio e. 2nd edition. oxygen consumpti on.  Instructed to Within the Body maintain bed hospitalization. and within normal increase in range.9 µc * With flushed skin * Warm to touch GOAL NURSING SCIENTIFIC NURSING DESIRED DIAGNOSIS REASON INTERVENTIONS OUTCOME Hyperthermia Due to the SHORT TERM Independent: r/t the disease immune GOAL:  Assessed and process response of At the end of monitored Vital (illness) the body from my 6hrs. response. body temperature is experience as  Encouraged body more fluid intake. Patient will To reduce maintain core metabolic temperature demands/ within normal range. interruption of temperature the normal will decrease. Patient body temperature decreases from 37. cytokines & maintain core prostaglandin temperature s. (Communicabl e and infectious disease. pero bumaba na hindi katulad nung naunang araw´ as verbalized by the patient¶s mother. induces the action of the Patient will rest. OBJECTIVE: * T = 37. Body the Patient¶s body Temperature. pg. y SCARLET FEVER .  Provided Tepid sponge bath homeostasis.59) EVALUATION RATIONALE STANDARD CRITERIA GOAL MET. LONG TERM Cytokines & Prostaglandin GOAL: s is released.9 to 37. will decrease. n.

‡ Emphasized ‡ Hydration importance of will improve Erythrogenic * With adequate fluid skin toxins cause Flushe intake.g. thoroughly and barrier to : streptococci pat dry infection.GOAL NURSING SCIENTIFIC NURSING DESIRED CUES RATIONALE DIAGNOSIS REASON INTERVENTIONS OUTCOME Independent: SUBJECTIV Impaired Streptococci SHORT E: Skin may be TERM ‡ Assessed skin. prevention and treatment. the rash of d skin scarlet fever. comparative ang dami the disease hemolytic At the end of sensation. Patient will display timely healing of skin rashes/lesio ns without complication . understandin patient¶s or gammag of the mother. SCARLET FEVER SCARLET FEVER . prevention and treatment. and hygiene (e. condition. dry skin wash provides OBJECTIVE Most treatment. GOAL MET. na siya´ as hemolytic mother will changes. excrete * With carefully) hemolyzing macule enzymes rashes and toxins. measured opportunity nanganagti betapatient¶s rashes and for timely observed intervention. Shift. verbalized (complete verbalize by the hemolysis). hemolytic disease. ‡ Establishes ³eto nga po Integrity r/t alphaGOAL: Note color. EVALUATION STANDARD CRITERIA Patient¶s mother will verbalize understandi ng of the disease. Patient¶s mother verbalized understandi ng of the disease. Described and providing rashes at hemolysis). ‡ Demonstrated ‡ Maintaining (no prevention good skin clean and hemolysis). Within hospitalizati on. baseline niyang processs (partial my 6-hrs.

SCARLET FEVER . Serves as additional information.http://em edicine. Instructed the mother to cut and file nails of the patient regularly.com/art icle/8039 74overview #a0104 LONG TERM GOAL: Within hospitaliza tion. Provided a health teaching about the disease. To promote faster healing. the prevention and treatment Dependent: Administer Medication as prescribed (If any). Patient will display timely healing of skin rashes/les ions without complicati on. Long and rough nails increase risk of skin damage. medscap e.

Within hospitalizatio n. LONG TERM GOAL: modifications (e. soft foods) For easy swallowing of foods. GOAL DESIRED OUTCOME EVALUATION NURSING INTERVENTIONS RATIONALE STANDARD CRITERIA Patient¶s mother will verbalize understanding of causative factor and necessary intervention. Patient¶s mother verbalized understandin g of causative factor and necessary intervention. patient¶s mother strength. socialization if possible and provide foods that are appealing. provide diet Provides comparative baseline OBJECTIV E: With Sore throat Body weakness Loss of appetite. mother to patient will promote continuously pleasant. Shift. good appetite environment medscape. SHORT TERM Independent: GOAL:  Assessed At the end of weight.g. body fluid. Within  Advised hospitalization. tonsillar exudate happens. Cytokines& Prostaglandins is released and thus. age.com/a and good eating including rticle/803974habit overview#a0104 7775) To enhance intake and appetite. my 6-hrs. Maintain a relaxing (http://medicine. And when the tonsil/throat is inflamed. difficulty or dysphagia is usually experience. will verbalize activity/rest understanding level. SUBJECTI VE: ³Medyo hirap pa siyang lununok ngayon´ as verbalized by the patient¶s mother. small feedings. SCARLET FEVER SCARLET FEVER .CUES NURSING SCIENTIFIC DIAGNOSIS REASON Risk for Imbalanced Nutrition: less than body requirements r/t difficulty of swallowing. Due to the immune response of the body from the interruption of the normal homeostasis. of causative factor and  Advised necessary mother to intervention. patient will continuously Maintain a good appetite and good eating habit GOAL MET.

LONG TERM GOAL: Within hospitaliza tion. To know the right food to be given. SCARLET FEVER .g. patient will continuous ly Maintain a good appetite and good eating habit Dependent:  Administer meds as prescribed (e. Penicillin) To promote faster healing and recovery of the affected area of the throat Collaborative:  Consult with the Nutritional/die tician support team as necessary.

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