Strep Throat: Complications (Pediatric Nursing)

00:01 Complications of strep.

00:03 There are unfortunately a lot of potential complications of partially treated or untreated strep throat infection.

00:09 We're gonna go through some of these in greater detail.

00:12 The first is rheumatic fever.

00:15 This is a serious complication of strep throat.

00:18 It is that if the strep bacteria is not completely eradicated, it can remain in the tonsils and promote a persistent immune response from the body.

00:26 This ongoing immune response to the strep bacteria can trigger the immune system to mistakenly attack the other organs in the body including the patient's joints and heart valves.

00:37 Patients with rheumatic fever will typically have a fever.

00:40 They will also have painful, hot, swollen and tender joints.

00:44 They may have small, painless bumps beneath their skin and these are called nodules.

00:49 The patient can develop a heart murmur as the valves get damaged.

00:54 And they may have flat or slightly raised, painless rash on their chest or abdomen called erythema marginatum.

01:02 The patient can also develop jerky, uncontrollable body movements called chorea.

01:06 Treatment with the appropriate antibiotics even if started several days after the resolution of the infection can prevent acute rheumatic fever.

01:14 Fortunately, Scarlet fever or rheumatic fever is now less common than in the pre-antibiotic era.

01:21 Another complication of strep throat is called glomerulonephritis.

01:26 Similar to acute rheumatic fever, an immune response in the kidneys can result in kidney inflammation called post strep glomerulonephritis.

01:34 Unlike rheumatic fever though, there is no evidence that shows that the treatment of the strep throat will prevent this condition.

01:41 Therefore, a patient who has been perfectly treated for their strep throat can still develop this complication.

01:47 This condition is more common than rheumatic fever and it typically resolves after a few weeks and it does not usually cause permanent damage to the kidneys.

01:55 Remember, your kidneys are your filters.

01:57 They filter your total blood volume about 60 times per day.

02:01 In glomerulonephritis, the glomeruli which are these tiny filters, become inflammed.

02:06 The glomeruli are responsible for removing excess fluid, electrolytes and wastes from the bloodstream and they pass them into the urine for removal from the body.

02:16 These are signs and symptoms of post strep glomerulonephritis.

02:20 The patient can have a microscopic hematuria which means, when you look at the urine in a cup, it's not visible.

02:26 Another potential sign of glomerulonephritis is called gross hematuria and this is blood that you can see.

02:31 When you look in the urine cup, it can look like cola, it's a dark brown hue and this is due to the blood.

02:37 The patient can also have a decreased urine output and this is called oliguria.

02:41 This is defined as a urine output less than 1 ml/kg/hr in infants, less than 0.5 ml/kg/hr in children and less than about 30 ml/hr in adults, although the criteria could vary.

02:56 Your patient with glomerulonephritis may also have edema.

02:59 This may be mild, moderate or severe.

03:02 And this can be found on the feet, so pedal edema and periorbital, on the face around the eyes.

03:08 Patients with glomerulonephritis may also present with hypertension and this is because of the kidney's involvement in controlling the blood pressure.

03:15 This may be mild, moderate or severe.

03:18 Patients can also develop otitis media, meningitis, pneumonia and toxic shock syndrome as complications of strep throat.

03:26 A more common complication is the formation of an abscess in the peritonsillar or retropharyngeal space.

03:33 Here we see a healthy throat, it's symmetric bilaterally.

03:37 If the strep throat infection can break out of the tonsillar region and into the surrounding areas, an abscess can form and this is an encapsulated pocket of pus.

03:46 The formation of an abscess behind the throat or in the retropharyngeal space due to untreated strep can lead to severe illness causing pain in the throat and the neck, problem swallowing and respiratory compromise.

03:59 These abscesses are in the peritonsillar or retropharyngeal space.

04:03 And how do we treat these? Well, antibiotics can be used but really, truly, definitive treatment involves an incision of the abscess.

04:11 This is done by lancing or cutting the abscess to release the fluids.

04:14 The contents can also be aspirated with a needle and typically this is done by an ear, nose and throat specialist or an emergency department provider because the patient usually needs pain control and rehydration.

04:27 Here we see an abscess.

04:29 This patient is gonna present with a classic symptom of a unilateral sore throat.

04:33 So with typical viruses and typical strep throat infection, the patient comes in and they have an equal sore throat on both sides, it is bilateral.

04:42 But when the patient presents and they say, "My throat only hurts on the right." or "My throat only hurts on the left," You need to have a high index of suspicion for the patient having an abscess.

04:51 The patient may have dysphagia which is difficulty swallowing and this can make it difficult or impossible for them to swallow food or fluids or even their own saliva.

05:01 The patient may be drooling and have fever or chills.

05:06 Trismus may be present and this is difficulty opening the mouth fully.

05:09 And this can be due to the pressure of the abscess actually pushing on the muscles.

05:14 The patient may have swelling of the face or neck and may have a muffled voice.

05:20 The clinician's going to feel for lymphadenopathy as well and you wanna be sure not to confuse the feeling of an abscess with the feeling of an enlarged lymph node.

05:28 So what's a tonsillectomy? A tonsillectomy is a surgical procedure in which both of the palatine tonsils are fully removed from the back of the throat.

05:37 While the surgeon is there, they may also remove the adenoids.

05:40 There are a few reasons why the tonsils and adenoids may be removed.

05:44 The first is patients who get recurrent strep throat.

05:47 We know that strep throat can cause problems with school and work as the patient needs to stay out of the community for 24 hours and these patients are on constant antibiotic therapy, so they might take their tonsils out.

05:59 Another would be recurrent tonsillitis and patients with snoring or sleep apnea may also have their tonsils removed.

06:06 So what are the nursing implications when you're taking care of a patient who's had a tonsillectomy? Well, you wanna monitor their vital signs closely.

06:14 These patients have had surgery in their throat and they can have post op surgical complications that may only be seen with a change in vital signs.

06:22 You're gonna need to manage the patient's pain and this is in the acute phase and then in the post op a couple of days after.

06:29 You're gonna want to monitor bleeding and this involves looking in the back of the throat and actually observing for bleeding in the posterior oropharynx.

06:36 Slowly as the patient's pain gets under control, they're gonna be able to advance their diet from a clear liquid diet, to soft foods and on to a regular diet.