Diphtheria: Signs and Diagnosis (Pediatric Nursing)

00:00 Here you see certain signs and symptoms when we assess the throat and the nose of a patient.

00:05 Now, on the top left, you'll see the throat is pretty mild.

00:08 You do see some exudative tonsils.

00:10 And this is what a throat can look like with strep throat or mononucleosis or even in some patients with thrush.

00:16 So you really wanna have diphtheria on your differential.

00:19 I have seen patients with throats that look similar to the one on the top left.

00:22 And I've attempted to scrape away at this and it does scrape away, so it's not been diphtheria.

00:26 But you always wanna keep that on your differential.

00:29 The next picture over, you can see there's almost a complete obstruction by the pseudomembrane.

00:33 You can see down that it's progressed on the top right picture down toward the trachea and the voice box.

00:40 And you could see on the bottom picture that they're spread into the nose and all over the nasal turbinates.

00:46 Signs and symptoms. Your patients can have fever, chills and fatigue.

00:51 They're going to have a sore throat. They may have hoarseness.

00:54 And remember, this involves the bacteria settling on to the larynx.

00:58 The patient can cough and they're gonna have difficult and painful swallowing.

01:03 The patient can also develop difficulty breathing, and this is due to the pseudomembrane and the localized inflammation.

01:09 The patient will have lymphadenopathy and this is pronounced.

01:12 You're gonna do a full lymph exam.

01:15 When you look in the throat or in the nose, you're gonna see this gray pseudomembrane.

01:19 The patient may have signs and symptoms of Croup.

01:23 And remember, this is just a tightened airway.

01:25 They may have a barking cough and stridor due to their decreased airway size.

01:29 This can also present on the skin.

01:32 And the patient can have skin ulcers that are gonna be covered by a gray membrane.

01:36 Here you can see on exam. You wanna obtain a complete medical history of your patient and this is really important to ask about their vaccination status.

01:44 Have they received their DT, their DTaP, their TD, or their TDaP vaccines? And when did they receive these? Because we know that this protection will wane.

01:54 On physical exam, you're going to assess your patient's vital signs.

01:58 You're also going to do a full head, eyes, ears, nose and throat exam.

02:03 You're gonna do a cardiac exam.

02:05 Do a respiratory exam and examine their skin.

02:09 Here, we see a lesion on a patient with diphtheria.

02:12 So there are ways to diagnose this clinically and via lab criteria.

02:17 Regarding the clinical criteria, you're gonna look for a patient with an upper respiratory tract illness and having a sore throat.

02:24 But remember, this is a lot of other things too.

02:27 Your patient may have a cold. They may have strep throat.

02:29 They may have other viral causes of sore throat. They may have mono.

02:34 So this is just step one. Your patients can also have a low-grade fever.

02:39 A high fever is rare with diphtheria. This is the key. This is the difference on exam.

02:44 You look in the throat and you're gonna see an adherent, dense gray pseudomembrane, and this is atypical, covering the posterior aspect of the pharynx.

02:53 We don't see this in any of the common conditions. We only see this with diphtheria.

02:59 So, lab criteria. You can isolate the bacteria from a gram stain or a throat culture.

03:04 But remember, a gram stain, you can get this information pretty quickly.

03:08 But a throat culture is going to take 48 to 72 hours.

03:12 You can also do a wound culture from a patient's skin on their ulcer.