Nursing Guide to Strep Throat: Nursing Diagnosis, Interventions, & Care Plans

Strep throat is an acute bacterial infection that affects the throat and tonsils. This is caused by Streptococcus pyogenes, also known as group A Streptococcus (GAS). This infection is most common in school-age children but can affect people of all ages. It’s characterized by a sore throat, pain while swallowing, and fever. Known for being highly contagious, strep throat can be spread through respiratory droplets from coughing or sneezing, as well as direct contact with contaminated surfaces. 

Prompt treatment with antibiotics is important to prevent complications such as rheumatic fever. Early recognition and appropriate nursing care are critical to prevent these complications and to manage the symptoms effectively. 

Etiology and epidemiology 

Strep throat is caused by Streptococcus pyogenes, a gram-positive bacterium known for its role in pharyngitis and other infections like scarlet fever. The bacteria spread through direct contact with respiratory droplets or by touching objects contaminated with the bacteria, such as door handles or utensils. 

Strep throat is most common among children from age five to 15, particularly in crowded environments like schools and daycare centers. Although strep throat can occur year-round, it’s more common in late fall, winter, and early spring. 

Key risk factors 

• Close contact with an infected individual
• Living or working in crowded environments (schools, dormitories, military barracks)
• Weakened immune system
• Age (five to 15 years old) 

ICD-10 code for strep throat  

• ICD-10 code for strep throat: J02.0 (Acute pharyngitis due to streptococcus) 

Diagnosis 

The diagnosis of strep throat involves an assessment of clinical symptoms as well as laboratory testing. 

Common strep throat symptoms 

• Sudden start of a sore throat
• Painful swallowing
• Fever (usually greater than 101°F or 38.3°C)
• Red, swollen tonsils, sometimes with the appearance of white patches or streaks of pus
• Swollen lymph nodes in the front of neck
• Absence of cough (distinguishing it from viral causes of sore throat) 

Diagnostic tests 

• Rapid antigen detection test (RADT): A quick test that can detect group A streptococcus within minutes. A positive result confirms strep throat.
• Throat culture: If the RADT is negative but suspicion remains, a throat culture may be done to confirm the diagnosis. Results take 24 to 48 hours. 

Differential diagnosis includes viral pharyngitis, infectious mononucleosis, and diphtheria. 

Management 

The management of strep throat primarily involves antibiotic therapy to eradicate bacteria, relieve symptoms, and prevent complications. 

Treatment options 

• Antibiotics:
  • Penicillin or amoxicillin is the first-line treatment.
  • For penicillin-allergic patients, alternatives like cephalexin, clindamycin, or azithromycin may be prescribed.
  • Treatment duration is typically 10 days for penicillin or amoxicillin and five days for azithromycin.
• Symptomatic treatment:
  • Analgesics/antipyretics (e.g., acetaminophen or ibuprofen) for pain and fever management.
  • Saltwater gargles and throat lozenges for sore throat relief.
  • Encouraging adequate hydration can help prevent dehydration. 

Preventive measures 

• Good hand hygiene: Promote frequent handwashing with soap and water.
• Avoiding close contact: Encourage infected individuals to stay home until 24 hours after starting antibiotics.
• Disinfection: Regular cleaning of surfaces in households or classrooms can prevent the spread of infection. 

Strep throat nursing care plan 

Nursing considerations 

Nurses help provide supportive care and education for patients and their caregivers. Key considerations include promoting comfort, ensuring adherence to the prescribed antibiotic regimen, and educating on infection control practices. 

Assessment 

• Throat and respiratory status: Assess for signs of severe pharyngeal erythema, tonsillar exudate, and enlarged cervical lymph nodes.
• Pain level: Evaluate throat pain, especially during swallowing.
• Fever monitoring: Regularly monitor temperature to manage fever.
• Fluid intake: Assess for dehydration, especially in children who may refuse fluids due to throat pain. 

Nursing diagnosis/risk for 

• Acute pain related to throat inflammation and infection
• Risk for deficient fluid volume related to fever and reduced oral intake
• Risk for infection transmission related to contagiousness of strep throat
• Anxiety (parental or patient) related to diagnosis and symptom severity 

Interventions 

• Administer prescribed antibiotics. Ensure timely administration and complete the full course of therapy to prevent recurrence and complications.
• Manage pain.  Provide analgesics as prescribed to reduce throat pain and fever. Encourage the use of non-pharmacologic methods like warm teas or throat gargles.
• Promote hydration. Encourage intake of fluids, such as water, broth, or ice chips. Use straws to minimize discomfort during swallowing.
• Practice infection control. Educate on the importance of hand hygiene, using tissues when coughing or sneezing, and disinfecting common surfaces. 

Expected outcomes 

• The patient will report reduced throat pain and fever after 24 to 48 hours of antibiotic therapy.
• The patient will demonstrate improved oral intake and hydration status.
• The patient and family will verbalize understanding of infection control practices to prevent the spread of strep throat.
• The patient will complete the full course of prescribed antibiotics, reducing the risk of complications. 

Individual/caregiver education 

Education is a necessary step to prevent the spread of strep throat and ensure successful treatment. Emphasize the following points: 

• Importance of completing antibiotics: Even if symptoms improve, completing the full course of antibiotics helps prevent relapse and complications.
• Infection control: Instruct on practicing proper hand hygiene and respiratory etiquette (e.g., covering coughs, using tissues). Infected individuals should stay home for at least 24 hours after starting antibiotics.
• Symptom relief: Teach caregivers and patients how to manage throat pain with over-the-counter medications, warm fluids, and saltwater gargles.
• When to seek further medical care: Educate families on recognizing signs of complications like difficulty breathing, persistent fever, or severe swelling. 

Resources 

• Centers for Disease Control and Prevention (CDC) — Strep Throat Information
• American Academy of Family Physicians –— Diagnosis and Treatment of Strep Throat 

References 

1. Centers for Disease Control and Prevention. (2023). Strep throat (group A strep). Retrieved from https://www.cdc.gov/group-a-strep/about/strep-throat.html
2. ICD-10 Data. (2023). J02.0 - Acute pharyngitis due to streptococcus. Retrieved from https://www.icd10data.com/ICD10CM/Codes/J00-J99/J00-J06/J02-/J02.0