Page 891 - Saunders Comprehensive Review For NCLEX-RN

extremities.
4. The lesions begin as vesicles or pustules surrounded
by edema and redness (a pustule is similar to a vesicle
except that its fluid content is purulent).

5. The lesions progress to an exudative and

crusting stage; after the crusting of the lesions, the
initially serous vesicular fluid becomes cloudy, and
the vesicles rupture, leaving honey-colored crusts
covering ulcerated bases.
B. Assessment (Fig. 29-1)
1. Blisters and crusts
2. Erythema
3. Pruritus
4. Burning
5. Secondary lymph node involvement can be present
C. Interventions

1. Institute contact isolation; also use standard

precautions and implement agency-specific isolation
procedures for the hospitalized child; strict hygiene
practices are important, because impetigo is a highly
contagious condition.
2. Apply topical antibiotic ointments with a clean/sterile
cotton swab without touching the tube opening with
fingers or skin, and instruct parents in the ointment
and swab use; the infection is still communicable for
24 to 48 hours beyond initiation of antibiotic
treatment.
3. Cover lesions with gauze bandages and tape to
prevent the spread of infection.
4. Assist the child with daily bathing with antibacterial
soap, as prescribed.
5. Apply warm water compresses to the lesions 2 or 3
times daily, followed by mild soap and water rinse to
soften crusts for removal and to promote healing.
6. Oral antibiotics may be prescribed if there is no
response to topical antibiotic treatment; it is extremely
important to comply with the prescribed antibiotic
regimen, because secondary infections such as
glomerulonephritis may result if the infectious agent
is of a streptococcal type that can affect the nephrons.
7. To prevent skin cracking, apply emollients and
instruct parents in the use of emollients.

8. Instruct parents in the methods to prevent the

spread of the infection, especially careful hand-

891