What is the primary reason for prescribing an antibiotic, such as penicillin or amoxicillin, to a patient with a streptococcal throat infection?

C) To eliminate the bacterial cause of the infection

A) To reduce throat pain immediately

B) To prevent the spread of infection to others

C) To eliminate the bacterial cause of the infection

D) To alleviate fever instantly

What is the primary reason for prescribing antibiotics such as penicillin or amoxicillin for a patient diagnosed with streptococcal pharyngitis?

C) To effectively eradicate the bacterial infection

A) To immediately relieve throat pain

B) To prevent the spread of infection to others

C) To effectively eradicate the bacterial infection

D) To reduce the size of swollen lymph nodes

What is the primary reason the nurse emphasizes the importance of completing the full course of antibiotics for the patient?

C) To ensure the infection is fully eradicated and prevent complications

A) To save unused medication for future infections

B) To prevent the development of antibiotic resistance

C) To ensure the infection is fully eradicated and prevent complications

D) To reduce the cost of future medical treatments

What is the most appropriate action for the nurse to take after observing the patient's positive response to antibiotic therapy for strep throat?

A) Discontinue the antibiotic therapy immediately

C) Advise the patient to stop taking the medication if she feels better

D) Prescribe a different antibiotic to ensure full recovery

A nurse is assessing a pediatric patient with joint pain and a rash following a recent strep throat infection. Which additional diagnostic test is most appropriate to confirm a suspected diagnosis of rheumatic fever?

B) Antistreptolysin O (ASO) titer

Which of the following is the primary reason for prescribing anti-inflammatory medication to a patient diagnosed with rheumatic fever?

B) To alleviate joint pain and reduce inflammation

A) To cure the underlying streptococcal infection

B) To alleviate joint pain and reduce inflammation

C) To prevent the spread of the rash

D) To lower the patient's blood pressure

What is the primary reason for prescribing anti-inflammatory medication to a patient suspected of having rheumatic fever?

B) To alleviate joint pain and prevent complications

A) To cure the underlying infection

B) To alleviate joint pain and prevent complications

C) To reduce the rash on the torso and arms

D) To stabilize the patient's vital signs

What is the most appropriate reason for the nurse to schedule a follow-up appointment for the patient in two weeks?

B) To monitor the patient's progress and ensure full recovery

A) To ensure the patient completes the full course of medication

B) To monitor the patient's progress and ensure full recovery

C) To evaluate the need for additional anti-inflammatory medication

D) To assess for potential new symptoms related to rheumatic fever

What is the primary purpose of monitoring inflammatory markers such as CRP and ESR in a patient recovering from rheumatic fever?

B) To assess the effectiveness of anti-inflammatory treatment

A) To diagnose a new bacterial infection

B) To assess the effectiveness of anti-inflammatory treatment

D) To monitor for signs of anemia

strep throat - Nursing Case Study

Pathophysiology

• Primary mechanism: Strep throat is primarily caused by the Group A Streptococcus bacteria, which invade the throat tissues, leading to inflammation and pain as the body's immune response activates to fight off the infection.

• Secondary mechanism: The bacteria produce toxins and enzymes that damage the mucosal lining of the throat, exacerbating the inflammatory response and causing symptoms such as redness, swelling, and the characteristic sore throat.

• Key complication: If untreated, the infection can lead to minor complications such as ear infections or sinusitis, where the bacteria spread to nearby areas, causing additional discomfort and prolonged illness.

Patient Profile

Demographics:

16-year-old female, high school student

History:

• Key past medical history: No significant past medical history

• Current medications: None

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Sore throat

• Key symptoms: Mild sore throat, low-grade fever, mild headache, slight fatigue

• Vital signs: Temperature 99.2°F, heart rate 78 bpm, blood pressure 110/70 mmHg, respiratory rate 16 breaths per minute

Section 1

Initial Assessment Findings:

Upon arrival at the clinic, the 16-year-old female patient presents with mild discomfort due to her sore throat and low-grade fever. During the initial assessment, a focused examination of the throat reveals mild erythema and swelling of the tonsils, with the presence of white exudate, which is characteristic of a streptococcal infection. The patient rates her throat pain as a 3 on a scale of 1 to 10, indicating mild discomfort. Her cervical lymph nodes are palpated and found to be slightly enlarged and tender, which aligns with her body's immune response to the bacterial infection.

The patient’s vital signs remain stable, with a temperature of 99.2°F, heart rate of 78 bpm, blood pressure of 110/70 mmHg, and respiratory rate of 16 breaths per minute, indicating that she is in a stable condition despite her symptoms. The patient denies any difficulty swallowing or breathing, which suggests that the infection is still in its early stages without significant complications.

The nurse discusses the importance of hydration, rest, and adherence to the prescribed antibiotic regimen, which will likely include penicillin or amoxicillin, to effectively combat the bacterial infection and prevent potential complications such as ear infections or sinusitis. Education is also provided on recognizing signs of worsening symptoms, such as increasing fever, severe throat pain, or difficulty swallowing, which would warrant further medical evaluation. The patient is scheduled for a follow-up appointment in one week to assess her response to the treatment and ensure resolution of the infection.

Section 2

Response to Interventions:

At the one-week follow-up appointment, the patient returns to the clinic for reassessment. She reports a significant improvement in her symptoms, noting that her throat pain has reduced to a 1 on a scale of 1 to 10, indicating minimal discomfort. Her mother confirms that the patient has been compliant with her antibiotic regimen, taking amoxicillin as prescribed, and has been diligent about maintaining adequate hydration and rest. The patient mentions that her energy levels have improved and she feels more like herself.

The nurse conducts a thorough reassessment and observes that the erythema and swelling of the tonsils have subsided considerably, and the white exudate is no longer present. The cervical lymph nodes, although still slightly palpable, are less tender and reduced in size, suggesting a positive response to the antibiotic therapy. The patient's vital signs remain stable, with a temperature of 98.6°F, heart rate of 76 bpm, blood pressure of 112/72 mmHg, and respiratory rate of 16 breaths per minute. These findings indicate that the patient is recovering well and her body is effectively responding to treatment.

Given the patient's positive response to interventions, the nurse takes the opportunity to reinforce the importance of completing the full course of antibiotics to prevent a recurrence or development of rheumatic fever, a potential complication of untreated strep throat. Additionally, the nurse reviews preventive measures to avoid future infections, such as practicing good hand hygiene and avoiding close contact with individuals who have respiratory infections. The patient is advised to return to the clinic if any symptoms recur or if she experiences new symptoms such as joint pain or a rash, which would require further evaluation. With these instructions and her improved condition, the patient is cleared to resume her usual activities, including returning to school.

Section 3

New Complications:

Two days after the follow-up appointment, the patient’s mother contacts the clinic, concerned about new symptoms that have developed. The patient has started experiencing mild joint pain in her knees and ankles, and she noticed a faint, pink rash on her torso and arms. Although her throat remains pain-free, these new symptoms have prompted her mother to seek additional medical advice. The nurse asks the mother to bring the patient in for an evaluation to determine if these symptoms could be related to a complication of strep throat, such as rheumatic fever.

Upon reassessment in the clinic, the nurse notes that the patient's vital signs are stable, with a temperature of 98.8°F, heart rate of 80 bpm, blood pressure of 110/70 mmHg, and respiratory rate of 18 breaths per minute. The patient appears well-hydrated and alert, but she reports mild discomfort in her joints, particularly when moving. The nurse conducts a careful inspection of the rash and observes that it is indeed a pink, non-itchy, and slightly raised rash, consistent with erythema marginatum, which can be associated with rheumatic fever. Given these findings, the nurse consults with the attending physician to discuss the possibility of rheumatic fever and the need for further diagnostic workup, including blood tests such as an antistreptolysin O (ASO) titer and inflammatory markers to confirm the diagnosis.

The physician advises that while the likelihood of rheumatic fever needs to be considered, other causes for the symptoms should also be ruled out. The nurse uses this as an opportunity to educate the patient and her mother on the importance of prompt medical evaluation when new symptoms arise following an infection, reinforcing the need to adhere to follow-up recommendations. The patient is scheduled for the necessary lab tests and asked to monitor her symptoms closely, with instructions to return to the clinic if the joint pain worsens or if she develops a fever.

Section 4

Two days later, the patient returns to the clinic for a follow-up appointment to review her lab results and assess her current condition. The nurse performs a thorough assessment and notes that the patient's vital signs remain stable, with a temperature of 99.1°F, heart rate of 82 bpm, blood pressure of 112/72 mmHg, and respiratory rate of 18 breaths per minute. The patient reports that the joint pain has not worsened, but it still persists, particularly in her knees and ankles. The rash has not expanded but remains visible on her torso and arms.

The lab results are reviewed with the attending physician, revealing an elevated antistreptolysin O (ASO) titer, which suggests a recent streptococcal infection. Additionally, there are mildly elevated inflammatory markers, including a C-reactive protein (CRP) level of 2.5 mg/L and an erythrocyte sedimentation rate (ESR) of 30 mm/hr. These findings support the suspicion of rheumatic fever as a post-streptococcal complication, though it appears to be in its early stages given the mild nature of the symptoms.

In response to these findings, the physician prescribes a course of anti-inflammatory medication to address the joint pain and prevent further complications. The nurse takes this opportunity to educate the patient and her mother about the importance of completing the full course of prescribed medications and continuing monitoring for any new or worsening symptoms. The patient is advised to maintain adequate hydration and rest, and a follow-up appointment is scheduled to ensure that the symptoms are resolving and no new issues arise. This proactive approach aims to manage the current symptoms effectively and prevent any progression of the condition.

Section 5

A week later, the patient returns for her scheduled follow-up appointment. The nurse begins with a thorough assessment, noting that the patient's vital signs have remained stable: temperature is 98.8°F, heart rate is 80 bpm, blood pressure is 110/70 mmHg, and respiratory rate is 16 breaths per minute. The patient reports that the joint pain has significantly reduced, and she is experiencing less stiffness in her knees and ankles. The rash on her torso and arms has faded, indicating a positive response to the prescribed anti-inflammatory medication.

The nurse reviews the new lab results with the patient and her mother. The repeat ASO titer shows a slight decrease, suggesting that the body's response to the streptococcal infection is subsiding. Inflammatory markers have also improved, with the CRP level dropping to 1.0 mg/L and ESR decreasing to 20 mm/hr. These findings indicate that the inflammation associated with the rheumatic fever is resolving, aligning with the patient's reported improvement in symptoms.

The nurse takes this opportunity to reinforce the importance of completing the full course of medication and continuing to monitor for any new symptoms. She advises the patient to gradually resume normal activities, ensuring she listens to her body and does not overexert herself. Additionally, the nurse schedules another follow-up appointment in two weeks to continue monitoring the patient's progress and ensure full recovery. This approach aims to maintain the positive trajectory of the patient's recovery and prevent any potential relapse or new complications.