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Impetigo Nursing Guide

Content Creator: Andrea Powell, RN, BSN

Overview: Impetigo

This course is intended as a Quick Reference for impetigo and will provide an overview as well as nursing considerations utilizing the nursing process.

Impetigo Etiology and Epidemiology

Impetigo is a bacterial skin infection responsible for 10% of skin complaints in children (DynaMed, 2018a). It is mainly caused by one or a combination of two bacteria: Staphylococcus aureus (S. aureus) and group A beta-hemolytic Streptococcus pyogenes (GABHS) (Hartman-Adams et al., 2014). In rare cases, anaerobic bacteria can be the source of infection.

Impetigo has two classifications:

  • Primary impetigo results from direct contact on minor breaks in normal skin.
  • Secondary impetigo derives from skin trauma or an underlying skin condition (e.g., eczema or scabies).

Regardless of the classification, impetigo can spread rapidly from person to person via direct contact (e.g., two children holding hands on the playground) or indirect contact (e.g., handling linen contaminated from an open lesion). Although most cases occur in the pediatric population, there are other risk factors for impetigo (Hartman-Adams et al., 2014; DynaMed, 2018a):

  • Skin trauma
  • Diabetes mellitus
  • Poor hygiene
  • Malnutrition
  • Hot, humid climates
  • Crowded living conditions
  • Childcare facilities
  • Colonization of the bacteria (i.e., nasal colonization of S. aureus)

There are three clinical presentations of impetigo (DynaMed, 2018a):

  • Nonbullous
  • Bullous
  • Ecthyma

Nonbullous impetigo is the most common form and accounts for approximately 70% of impetigo cases (DynaMed, 2018a). It is characterized by maculopapular lesions that evolve into thin-walled vesicles. These vesicles quickly rupture and become erosions. Leftover skin erosions are often:

  • Itchy
  • Painful
  • Honey-colored and crusty in appearance

Common body areas affected with nonbullous impetigo include the face (i.e., mouth and nostrils) and extremities (DynaMed, 2018a).

Bullous impetigo is caused by S. aureus (Hartman-Adams et al., 2014). It is characterized by large, fluid filled vesicles and blisters, which rupture and become erosions. It can occur on non-traumatized skin. Other characteristics include:

  • Painful sites of infection
  • Thin, brown crusts

Common body sites of bullous impetigo include (DynaMed, 2018a):

  • Axilla
  • Trunk
  • Extremities
  • Areas covered by a diaper

Ecthyma impetigo presents as deep tissue ulcerations (DynaMed, 2018a). It is usually caused by GABHS. Ulcers typically have the following characteristics:

  • Honey-colored crust
  • Brown-black crust
  • Purulent drainage

Impetigo Diagnosis

Healthcare providers diagnose impetigo based on the physical examination and past medical history (DynaMed, 2018a; Nardi et al., 2021). Lab cultures are not routine, but may be drawn in the following circumstances:

  • Treatment failure
  • Possible methicillin-resistant staphylococcus aureus (MRSA) infection
  • Community outbreak

Impetigo Management

Healthcare providers may prescribe topical antibiotics, oral antibiotics, or a combination of both for treatment of impetigo (DynaMed, 2018a). Prescribed antibiotics should be effective against S. aureus and GABHS (Nardi et al., 2021). Topical antibiotics are the recommended treatment for someone with localized, nonbullous impetigo. Certain scenarios warrant oral antibiotics:

  • Non-bullous impetigo with over five lesions
  • Deep tissue involvement (i.e., ecthyma impetigo)
  • Signs and symptoms of systemic infection
  • Oral cavity lesions
  • Swollen lymph nodes

 

Impetigo Nursing Care Plan & Considerations

Assessment

The nursing assessment for a person with impetigo should include a complete physical and a focused evaluation of their medical history (DynaMed, 2018a). While assessing and interviewing the individual with suspected impetigo, consider the following (Lawton, 2014; DynaMed, 2018b; DynaMed, 2018c):

  • Symptoms of impetigo, such as:
    • Pruritis
    • Pain
    • Presence of and characteristics of lesions
  • Symptoms of a systemic infection, such as:
    • Fever
    • Elevated white blood cell count
    • Increased respiratory rate
  • History of a pre-existing skin disorder (i.e., scabies or eczema)
  • History of skin trauma
  • Familial history of impetigo
  • Hygienic practices

When presenting with a recent history of impetigo, you should ask the person if they have received treatment (Lawton, 2014). If the treatment was prescribed, ask:

  • “Was it treated with an over-the-counter medication or a prescribed medication?”
  • “How long was it treated?”
  • “Was the treatment effective?”

Answers to these questions may assist in determining treatment of refractory impetigo.

Impetigo Nursing Diagnosis/Risk For

  • Deficient diversional activity related to imposed isolation from peers
  • Disruption in usual play activities
  • Impaired comfort related to infection of the skin
  • Impaired skin integrity related to infectious disease
  • Risk for infection transmission to others

Interventions

Nursing interventions for a person with impetigo may include (Nardi et al., 2021):

  • Following isolation precautions
  • Assessing medical history
  • Completing a physical assessment
  • Administering medications as ordered
  • Educating them and their family

Expected Outcomes

In general, impetigo is self-limited, and lesions heal without scarring (DynaMed, 2018a). Treatment speeds the healing process and aids in faster symptom relief. When treated, impetigo resolves within 10 days. Untreated impetigo typically resolves within 21 days.

Complications of impetigo are rare and usually related to antibiotic treatment failure or untreated impetigo. However, post-streptococcal glomerulonephritis is possible after completing antibiotic therapy. Other complications include:

  • Systemic infection
  • Cellulitis
  • Inflammation or infection of the lymphatic system

Patient/Caregiver Education

Education is imperative to prevent the spread of infection to others (Nardi et al., 2021). Provide instruction about:

  • The disease process
  • Signs and symptoms of complications (e.g., decreased renal function)
  • Isolation precautions
  • The importance of handwashing and good hygiene
  • Care of the site of infection
  • The importance of avoiding touching or scratching lesions
  • Following the provider’s instructions regarding staying home from school/work

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2026

Content Contributor

The content was created by Andrea Powell, RN, BSN. Andrea Powell, RN, BSN is a SME writer for Relias with a focus on acute care. She has over 11 years of clinical nursing experience, spanning across multiple nursing specialties. Her primary focus has been in critical care, with an affinity to surgical nursing. She also has experience in intraoperative nursing and post-anesthesia care. Andrea has served as a clinical team leader, preceptor, and charge nurse to colleagues throughout her nursing career. She has a passion for the education of healthcare professionals and an aspiration for excellence in the healthcare delivery system.

References

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