Nursing Guide to Scarlet Fever: Nursing Diagnosis, Interventions, & Care Plans

Scarlet Fever Etiology and Epidemiology 

Scarlet fever (SF) is a condition that includes fever, pharyngitis, and a rash. SF is caused by group A beta-hemolytic streptococci (GABHS) that produces erythrogenic toxin. It is named after the characteristic flush on the child's skin, particularly the cheeks. SF is typically a mild illness that, if left untreated, can lead to major, long-term health problems. 

The incubation period for this disease is 3 to 5 days, with symptoms often appearing on the second day of the condition and lasting between 4 to 10 days (Domino, 2017). 

The rash commonly manifests itself on the 2nd day of illness and begins first on the upper chest and flexural creases (Domino, 2017). It then spreads quickly across the body then disappears towards the end of the first week. After the fever and rash subside, peeling of the face and body skin occurs, most often on the palms of the hands and soles of the feet. 

Incidence and Prevalence 

• SF is uncommon in infancy due to the presence of maternal antitoxin antibodies. SF occurs between 4 to 12 years old and predominately affects males more than females (Domino, 2017).
• This condition is uncommon in the U.S. in individuals over the age of 12 because of high rates (>80%) of lifetime protective antibodies to erythrogenic toxins (Domino, 2017).
• It occurs most often in winter and spring months.
• The most common cause of pharyngitis in children is due to GABHS. However, SF affects <10% of children with streptococcal pharyngitis (Domino, 2017).
• Children are the most affected by this condition because it is very contagious and is spread through:
  • Sneezing
  • Coughing
  • Direct contact 

Scarlet Fever Diagnosis 

Diagnosis involves performing a rapid antigen detection test (RADT) and/or culture using a pharyngeal swab to test for GABHS and (Dynamed, 2018): 

• If the RADT is negative, a throat culture, which is the gold standard for confirming streptococcal infection, is recommended to establish the absence of GABHS.
• Positive RADTs do not necessitate the use of a backup culture. 

Scarlet Fever Management 

Most children with SF can be managed at home. Supportive care includes (Domino, 2017): 

• Encouraging increased intake of fluids.
• Providing pain or fever relief with acetaminophen (Tylenol®) or NSAIDs such as ibuprofen (Advil®).
• Using oral benzydamine (Tantum Oral Rinse®) or mouth sprays may help to relieve pain and discomfort.
• Gargling with warm saltwater.
• Using throat lozenges, soft foods, or cold, thick drinks.
• Utilizing a humidifier. 

In addition, a 10-day course of penicillin (PC Pen VK®) is indicated to lessen the risk of complications because it has been found to reduce the incidence of acute rheumatic fever (Dynamed, 2018). 

If the child is allergic to penicillin, the use of cephalosporins is indicated and includes (Domino, 2017): 

• Clindamycin (Cleocin Phosphate®)
• Azithromycin (Zithromax®)
• Clarithromycin (Biaxin®) 

Tetracyclines and sulfonamides are not recommended for the treatment of SF (Dynamed, 2018). 

Unless the child is symptomatic, a follow-up throat culture is not required. 

Tonsillectomy is advised in cases of recurrent pharyngitis (six positive strep cultures in 1 year) (Domino, 2017). 

Scarlet Fever Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for scarlet fever are listed below. 

Assessment 

The following are used for assessment: 

• History
  • Fever with a sudden onset (100° to 103°F)
  • Throat soreness
  • Chills
  • Lethargy
  • Decreased appetite
  • Vomiting and nausea
  • Abdominal pain
  • Scarlatiniform erythematous punctate rash
• Physical Examination
  • A fine, scarlet-colored rash with pinhead size eruptions on upper chest and back, later progressing to the neck, abdomen, and extremities
  • The rash has a texture of red goosebumps that blanches with pressure
  • “Pastia’s sign” (petechiae in a linear pattern along skin folds, especially in the axilla and antecubital fossa)
  • The face is flushed with circumoral pallor
  • Strawberry tongue with a thick white coating during first 4 to 5 days of illness
  • Peeling, swollen, erythematous tongue after day 5 (returns to normal by 2 weeks)
  • Red, swollen uvula, tonsils, and posterior pharynx with purulent exudates
  • Tachycardia
  • Generalized lymphadenopathy 

 Nursing Diagnosis/Risk For 

• Hyperthermia
• Acute pain/impaired comfort
• Risk for deficient fluid volume
• Activity intolerance
• Risk for noncompliance
• Deficient knowledge
• Impaired oral mucous membrane
• Impaired swallowing 

Interventions 

Nursing interventions for SF include: 

• Provide comfort and reduce pain.
• Offer frequent oral fluids and oral hygiene.
• Give prescribed medications such as antibiotics, antipyretics, and analgesics.
• Provide skin care to relieve discomfort from the rash.
• Provide warm liquids or cold foods to ease sore throat pain.
• Use a cool mist humidifier to keep the air moist and prevent the throat from getting too dry and sore.
• Assist with respiratory hygiene care measures to reduce the risk for transmission.
• Inspect the skin for signs of secondary infection.
• Monitor:
  • Vital signs
  • Skin integrity
  • Pain level and relief
  • Swallowing ability
  • Nutritional status and fluid balance
  • Response to treatment 

Scarlet Fever Expected Outcomes 

• Express feelings of increased comfort or absence of pain at rest
• Remain afebrile
• Have moist, pink mucous membranes without lesions
• Maintain skin integrity
• Chew and swallow without discomfort
• Experience no further signs or symptoms of infection

Individual/Caregiver Education 

• Discuss the disorder, underlying causes, diagnosis, and treatment, including the need for antibiotic therapy.
• Instruct on the prescribed drug therapy, including name, dosage, frequency, and duration of therapy.
• Reinforce the need to take oral antibiotics for the prescribed length of time to prevent serious complications.
• Discuss the possible adverse effects of antibiotic therapy, such as:
  • Nausea
  • Vomiting
  • Diarrhea
  • Gastritis
  • Stomatitis
• Instruct the caregiver to keep the child hydrated with liquids such as water or electrolyte solutions such as Pedialyte®.
• Review the signs and symptoms of hypersensitivity reaction to penicillin and the need to notify the child's provider immediately.
• Emphasize respiratory hygiene and infection-prevention measures, such as proper disposal of purulent discharge.
• Discuss methods of transmission, including how it is spread from person to person.
• Advise that the rash may take several weeks to resolve
• Discuss further prevention of scarlet fever and strep throat.
• Instruct that children should not return to school/daycare until they have received >24 hours of antibiotic therapy.
• Review what symptoms that the caregiver should seek immediate medical attention for:
  • Adverse effects of drugs
  • Worsening signs and symptoms

Content Release Date

4/1/2022

Content Expiration

12/31/2025

Course Contributor 

The content for this course was created by Stephanie L. Whitfield, B.S.N., R.N. Stephanie has over 15 years of clinical and teaching experience. Her areas of expertise are in neonatal intensive care, general pediatrics, home health, and children with medical complexities. She earned her Bachelor of Science in nursing from Chamberlain University in 2013. Her professional practice is guided by Jean Watson’s philosophy that, “Caring is the essence of nursing.” 

References 

• Domino, F. (2017). The 5-Minute Clinical Consult Premium. (25th ed.). Lippincott Williams & Wilkins. https://www-r2library-com.chamberlainuniversity.idm.oclc.org/Resource/Title/1496339975 
• DynaMed. (2018). Streptococcal Pharyngitis. EBSCO Information Services. https://www.dynamed.com/condition/streptococcal-pharyngitis#GUID-C4EF96CA-631F-4D43-9516-507AC63B5225