Scarlet Fever

Submitted by: CORCUERA, Dan Ryan O. CORPUZ, Lady Anilin R. CORTEZ, Daserie Rose T. 4bsn1

Submitted to: Mr. Jayson Celerio, RN

Scarlet fever
Definition: Also known as scarlatina, is a disease caused by a toxin (erythrogenic exotoxin) released by Streptococcus pyogenes or group A beta-hemolytic streptococcus - the disease occurs in a small percentage of patients with strep infections, such as strep throat or impetigo. Althoughscarlatina may be used interchangeably with scarlet fever, scarlatina is more commonly used to refer to the less acute form of scarletfever. Causes: It is caused by the streptococcal bacteria, which produce a toxin that leads to the hallmark red rash of the illness. The main risk factor is infection with the bacteria that causes strep throat. A history of strep throat or scarlet fever in the community, neighborhood, or school may increase the risk of infection. Symptoms: A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. Signs and symptoms generally appear about one to four days after initial infection. The first symptoms are usually: A very sore and red throat (sometimes with white or yellowish patches). A fever of 101 F (38.3 C) or higher, frequently with chills. 12 to 48 hours later the rash will appear. Rash - red blotches appear on the skin; they then turn into a fine pink-red rash that looks like sunburn. The skin feels rough, like sandpaper, when touched. Scarlet fever may also have the following signs and symptoms: Difficulty swallowing General malaise Headache Itching Loss of appetite Nausea Pastia's lines - broken blood vessels in the folds of the body, for example the armpits, groin, elbows, knees and neck. Stomachache Swollen neck glands (lymph nodes) that are tender to the touch Tongue - a white coating forms on the tongue. This eventually peels away leaving a strawberry tongue; the tongue is red and swollen. Vomiting If the patients has other symptoms, such as severe muscle aches, vomiting ordiarrhea the doctor will have to rule out other possible causes, such as toxic shock syndrome. The skin of the hands and feet will usually peel for up to six weeks after the rash has gone. Exams and Tests: Physical examination Throat culture positive for group A strep Rapid antigen detection (throat swab)

Pathophysiology: Treatment Options: According to the National Health Service (NHS), UK, the majority of mild cases of scarlet fever resolve themselves within a week without treatment. The NHS advises people to get treatment anyway, as this will accelerate recovery and reduce the risk of complications. Patients generally recover about four to five days after treatment begins. Antibiotics - a 10-day course of antibiotics is the most common treatment for scarlet fever. In the UK, and many other countries this involves taking oral penicillin. Patients who are allergic to penicillin may take erythromycin instead. Patients are advised to stay at home during the course of the antibiotic treatment. The fever will usually go away within 12 to 24 hours of taking the first antibiotic medication. According to the Mayo Clinic, USA, a child with scarlet fever may be prescribed one of the following antibiotics: Penicillin, in pill form or by injection Amoxicillin (Amoxil, Trimox) Azithromycin (Zithromax) Clarithromycin (clarithromycin extended-release tablets). External link" target="_blank">Biaxin) Clindamycin (clindamycin phosphate). External link" target="_blank">Cleocin) A cephalosporin such as cephalexin (Keflex) It is important to complete the full course of antibiotics, even if symptoms go away before it is finished. Otherwise, the infection may not be completely eradicated, raising the risk of subsequent post-strep disorders. If the patient does not start feeling better within 24 to 48 hours after starting the antibiotic treatment, call the doctor. Within 24 hours of starting the antibiotics the patient will no longer be contagious. Other treatments - it is important to drink plenty of liquids, especially if there is no appetite. The room should be kept cool. Tylenol (paracetamol) may help relieve aches and pains, as well as bringing the fever down. Calamine lotion may help with itchy skin. Prevention: Best prevention strategies for scarlet fever, as with all highly infectious diseases, are: Isolation - keep the patient away from other people. Keep the child away from school. Handkerchiefs or tissues that the patient has used should be washed or disposed of immediately. If you have touched any of these wash your hands thoroughly with warm water and soap. Handwashing - the patient, usually a child, should be taught to wash his/her hands thoroughly and frequently. Dining utensils - do not share drinking glasses or eating utensils with the patient. Coughing and sneezing - the patient should be taught to cover his/her mouth and nose when coughing and sneezing. This should be done into a tissue or handkerchief. If one is not available it is better to cough/sneeze into the inside of the elbow - coughing into one's hands raises the risk of contaminating things when they are touched. Nursing Assessment:

In acute sudden onset: (toxin from the site of infection is absorbed into blood stream). Prodromal signs: Vomiting. High fever then it drops when rash appears. Headache. Rapid pulse. Tongue: white tongue coating desquamates and red strawberry tongue results. Tonsils are red, enlarged, swallow, and may have a patchy whitish exudates on their surface. Then, rash appears within the first 5 days of the disease. The rash will be all over the body but not on the face. The chest and back are affected first, and then the rash moves down-wards involving the legs last. The rash fades upon pressure. Distinct odor of the skin. Desquamation i.e., peeling of the skin, is the typical of scarlet fever. Desquamation could occur early at 4-5-6 day or later to 4th week of the disease. It starts at the top of the body and proceeds downwards. Nursing Considerations: 1. Isolation. 2. Bed rest for 12 days and good ventilated room. 3. Keep patient warm, dry and comfortable as possible. 4. For the distinct odor which associates with scarlet fever: daily bath and change linen frequently. 5. For skin: - Lubricate skin well with oil (daily) as Dr. order. - Protect skin under and around the nose and lips with ointment. (When nasal discharge is constant). 6. Nasal aspiration by gentle suction or soft rubber ear syringe is essential. 7. If the child is less than 2 years, elevate head and shoulders to prevent danger of otitis media. 8. Accurate intake and output chart is important. 9. Diet in the first week: High caloric liquids then soft diet. Avoid irritant liquid juice citrus. 10. For constipation, which accompanies scarlet fever enema or mild cathartics is needed. 11. If there is pain in cervical lymph nodes, treat with heat in the form of hot packs or cold in the form of ice collar according to doctors order. 12. Observe for complications.