Nursing Management for Patients with Diphtheria

Nursing Management for Diphtheria

Diphtheria is a bacterial infection that spreads easily and occurs quickly. Diphtheria is an infectious disease caused by the bacterium Corynebacterium diphtheriae. This disease primarily affects the mucous membranes of the respiratory tract (respiratory diphtheria), although it may also affect the skin (cutaneous diphtheria) and lining tissues in the ear, eye, and the genital areas.

Diphtheria is caused by toxin-producing strains of the gram-positive bacillus Corynebacterium diphtheriae. There are four biotypes of the bacterium (gravis, mitis, intermedius, and belfanti), and each differs in the severity of disease it produces. Nontoxigenic strains are usually responsible for less severe cutaneous diphtheria.

The symptoms and signs of respiratory diphtheria may include the following : sore throat, fever, hoarseness, difficulty swallowing, malaise, weakness, headache, cough, nasal discharge (that may contain pus or blood-tinged fluid), enlarged lymph nodes in the neck and neck swelling (producing a "bull neck" appearance), difficulty breathing

Diphtheria patients must be treated in isolation rooms closed. Health care workers should wear special dresses (aprons) and masks should be replaced every turn of duty or at any time when dirty. Instead, the keeper of the patient must also wear an apron to prevent transmission to the outdoors. Hand-washing equipment should be provided: disinfectant, soap, washcloth, or towels are always dry, clean water, if there is also a place to soak faucet cutlery filled with disinfectant. The risk of complications of airway obstruction, myocarditis, pneumonia. Patients with diphtheria, although mild illness need to be hospitalized because of potential life-threatening complications are caused by pseudomembranous and exotoxin released by the diphtheria bacillus.

Airway obstruction

This disorder occurs because of edema of the larynx and trachea, and the pseudomembranous. Symptoms of blockage is hoarseness and stridor inspiratoir. When more severe shortness of breath occurs, cyanosis, muscle retraction looks, sounds stridor:
  • Give oxygenation.
  • Lay half sitting.
  • Call the doctor.
  • Install an infusion (if not already installed).
  • Contact the parents let the situation of children and the dangers that can occur.


Exotoxin released by the bacillus of diphtheria, when absorbed by the heart, will cause myocarditis this disorder usually occurs in the second week to the third. To know the symptoms of myocarditis need continuous observation and the patient should rest for at least 3 weeks, or until the results of the ECG two consecutive normal. During the treatment, observation pulse, respiration and temperature recorded in special care.

If no ECG equipment:

Monitoring the pulse is very important and should be done every hour and recorded on a regular basis. If there is a change in pulse rate continues to drop (bradycardia) should immediately contact a doctor. Treatments other than vital signs and general condition:
Patients should not be a lot of moves, but recumbency must often be changed, for example, every 3 hours to prevent complications of bronchopneumonia (hypostatic pneumonia).
Keep the skin on the body to prevent pressure sores (remember, the patient bed rest for 3 weeks, can not wake up).

The complications of the nervous

The complications of the nerve can occur in the first week and the second. If the soft palate nerve (nerve swallow) with the patient's symptoms when drinking water / milk will come out through the nose. If this occurs:
  • How to give a drink to be careful, while the patient is seated.
  • If the patient is eating a liquid that is slightly thicker and given little by little.

Complications in renal

During the diphtheria patients in care, the state of the urine, in addition to be aware of color, too much is normal or not.
Impaired nutrient inputs. Impaired nutrient inputs diphtheria patients, in addition to pain caused by swallowing, as well as anorexia. If the child is willing to swallow persuade him to want to eat little by little and give a liquid or pureed diet solution and give more milk. If the patient does not eat at all or very little, or in a state of shortness of breath, infusion needs to be installed. After 2-3 days, then shortness of breath have decreased, before the infusion was stopped trying to eat by mouth and apbila children have to eat infusion is stopped. Give drink frequently to maintain oral hygiene and help smooth elimination.

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