Strep Throat (Pediatric Nursing)

00:00 Now, let's talk about strep throat.

00:02 It's also called streptococcal pharyngitis.

00:05 This accounts for a small percentage of sore throats.

00:08 It's a bacterial infection.

00:10 This is transmitted by direct contact with mucous or sores of someone else with a strep bacteria.

00:16 This can be via kissing, droplets, sharing water bottles and utensils or from fomites which are inanimate objects that are covered in the strep bacteria.

00:28 This is caused by strep pyogenes which is a Group A beta-hemolytic strep or GABHS.

00:34 and this is a gram-positive cocci that is present in chains.

00:38 The strep bacteria is going to adhere to the specific receptors on the host cells and the bacteria will adhere to the pharyngeal and dermal epithelial cells.

00:47 Then, it will start to invade the host tissues.

00:50 The bacteria will start to release these pyogenic exotoxins and that will cause your patient to fever.

00:57 Signs and symptoms of strep throat usually include: a sore throat that starts pretty rapidly.

01:03 Healthy patients come in and they'll say, "I felt fine yesterday and now I can barely swallow." They'll have the pain when they swallow and usually a fever is present unless they're on antipyretics or medications to decrease their fever.

01:16 They will have red and swollen tonsils sometimes with white patches and streaks and this is called exudative tonsils.

01:22 They may have tiny red spots on the roof of their mouth and these are palatal petechiae.

01:28 The lymph nodes in the neck in the front may be swollen at the tonsillar level and the anterior cervical lymph node chain.

01:35 And when patients come in, they wanna know, do they have strep throat? and so you have to discern, could they maybe have a virus? Signs and symptoms of strep usually do not include a cough, and a cough is usually present when your patient has a cold.

01:49 Strep doesn't usually have a runny nose but patients with a cold usually will have a runny nose.

01:54 Strep doesn't usually cause hoarseness or laryngitis.

01:57 This is also usually present with viral illnesses like colds.

02:01 And conjunctivitis is usually not present when a patient has strep throat.

02:06 Now let's look in.

02:07 On exam, your patient will open their mouth and often, you'll use your light to took at the back of the throat.

02:12 You're looking for a few characteristics.

02:14 The first is the soft palate, it's going to look red.

02:16 The uvula may be red and enlarged.

02:20 You're gonna be looking at the tonsils and remember you're gonna be grading those according to size.

02:24 There may be these tiny, red, pinpoint hemorrhages on the soft palate and the patient may have the white or yellow patches on their tonsils.

02:32 These are all of the classic signs and symptoms of strep throat.

02:35 Remember, you're looking for throat redness, pus or exudate on the tonsils, anterior cervical or tonsillar lymph node adenopathy, palatal petechiae which are the small, pinpoint hemorrhages.

02:49 Your patient will have a fever unless they're on antipyretics.

02:53 Abdominal pain, now this seems like an atypical symptom of strep throat but let's talk about this a little bit.

02:59 So strep throat makes the lymph nodes swell in the neck, we know this.

03:02 But it also makes the lymph nodes in the abdomen swell and these are the mesenteric lymph nodes.

03:07 Often in kids under 5 who present with abdominal pain for no other cause, we will run a strep test because this can be due to the swollen lymph nodes in the abdomen.

03:16 Your patient can have a fine, raised rash on the trunk and this is the scarlatina rash.

03:21 Remember, your patient with strep throat typically does not have a cough.

03:25 If your patient has a cough, they usually have a viral illness.

03:29 Now when the patient presents with a sore throat, the clinician needs to decide if the patient needs a strep test.

03:34 We don't test every patient who presents to the clinic with a sore throat.

03:37 They way to do this is with a diagnostic criteria called either the Centor criteria or the McIsaac criteria.

03:43 Here's an example.

03:44 You score the points based on the patient's symptoms.

03:47 They get a point if they have a fever.

03:50 The patient will get another point if they have absence of cough.

03:54 The patient will get another point if they have tender lymphadenopathy in either their tonsillar or anterior cervical chains.

04:01 They will earn another point if they have tonsillar swelling or exudates.

04:04 So the maximum for this is 4 points.

04:07 That's the Centor criteria.

04:08 Next, you can adjust this based on the patient's age and this is the McIsaac criteria.

04:14 So we know that strep is most prevalent in the 3 to 14-year old population, so kids will gain another point.

04:20 If your patient is 15 to 44 years old, they won't add or subtract any points and strep is less common in the older adult population, so if your patient is older that 45 years, you will actually subtract a point in their score.

04:32 Next, the clinician will total the points.

04:35 If the patient scores 0 to 1 point, it's unlikely to be strep pharyngitis causing their symptoms.

04:41 It could be from a virus or a cold and no further testing or antibiotic treatment is recommended.

04:47 If the patient scores 2 to 3 points, it is recommended to do a rapid antigen test and this is a rapid strep test.

04:53 You can also do a follow up throat culture.

04:56 Now in these patients, we would only treat if the rapid strep test is positive or the throat culture is positive.

05:02 If your patient receives 4+ points, meaning they have every single sign of strep throat, and/or adjusted for age, they only have a 52% chance of having a strep throat.

05:14 The other 48% of the time, it's going to be viral.

05:18 So these patients, you can treat emperically while you wait on their results but this is a discussion to have with your patients because that's not without risk.

05:26 Here you can see a positive test result.

05:28 This can be a dark positive line in addition to the control line or a faint positive line.

05:33 With strep testing, any line is considered positive.

05:37 Here you'll find a negative.

05:38 This means there's only the control line present.

05:41 This is an invalid test.

05:43 This means the control line didn't show up as it should and this patient should either be re-swabbed or re-tested.

05:49 So how do you manage strep throat? Well, strep throats typically are gonna away in 3 to 7 days with or without antibiotic treatment.

05:56 Although, if strep throat is not treated with antibiotics, the patient can remain contagious for 2 to 3 weeks and there's a higher risk for complications such as rheumatic fever.

06:05 Remember, your patient would be contagious with strep throat until they're on antibiotics for 24 hours.

06:10 So they need to stay out of school, work and community activities.

06:14 Patients with strep throat should be treated with an antibiotic that is likely to eradicate the organism and they're typically on 10 days of treatment.

06:22 Penicillin or amoxicillin are commonly recommended because they're effective, they have few adverse effects and they're affordable.

06:29 It's important to remind the patient to complete the treatment and not save any extra antibiotics.

06:35 Patients can also treat their symptoms with acetaminophen or ibuprofen and this can help them manage their pain and their fever.

06:42 and warm salt water gargles are also a great option for controlling their throat pain.