[NP-Clinical] Re: NP-strep question
Carla Anderson
carla_rayne at yahoo.com
Fri May 4 11:01:24 PDT 2007
I also would call the lab if the information is not clear. The in clinic rapid tests, test for
Group A only, and actually some people have gotten very ill from Group C, and A, C, and F does colonize in the pharynx. If the rapid strep comes back negative, there is a 20 % chance that the patient still did have group A, there can be false negatives. In addition, there can be strep C or F. So I would send the cx to the lab if in doubt and if the patient is sick enough, treat empirically if you feel the patient should not wait for the results. If there is a suspicion of Mono, treat with Zithromax or another drug other than Amoxicillin, as they may get a rash. The Reference "Up to Date" has excellent descriptions of the pathophysiology of these different types of strep and how to treat them. Carla Anderson/Portland
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Today's Topics:
1. strep (Nila Dickman)
2. Re: strep (Stephanie Walker)
3. RE: strep (Cherie Wright)
4. RE: strep (Donna Alden-Bugden, RN(EP), MN)
5. VENETIAN VIOLET - ORAL ULCERS (chrisbsmith at mindspring.com)
6. Re: VENETIAN VIOLET - ORAL ULCERS (Maggie Garancosky)
----------------------------------------------------------------------
Message: 1
Date: Thu, 03 May 2007 22:12:21 +0000
From: "Nila Dickman"
Subject: [NP-Clinical] strep
To: np-clinical at nurse.net
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Message: 2
Date: Thu, 03 May 2007 20:23:01 -0400
From: Stephanie Walker
Subject: Re: [NP-Clinical] strep
To: NP Clinical
Message-ID:
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If the patient has a sore throat and especially if s/he has a fever, I
would treat with antibiotics. Strictly speaking, only group A is
rheumatogenic & needs to be treated, but the community standard of care
most places is to give them antibiotics so they can feel better sooner.
I would use a broader spectrum than penicillin-something simple like
Keflex--since I would have no idea what the sensitivity of the unknown
strep is. Augmentin seems like overkill--very expensive and gives a lot
of people diarrhea.
I don't know about anyone else, but it's not clear to me exactly what
that lab report means. Perhaps the lab uses a method that only
identifies strep A, C and G, with the implication that the type of
strep in the specimen was not a medically significant group. But in
situations where I don't understand a report, I often call up the lab
that issued the report, and ask to speak with the lab director. I ask
the lab director to clarify the report. They're usually very nice about
it.
Stephanie Walker, RN, FNP
On May 3, 2007, at 6:12 PM, Nila Dickman wrote:
> Hello all,
>
> I am a very green NP, and although I looked High and low for the
> answer, I could not find any clear info.
>
> I got a throat culture back that stated--"" Heavy growth of beta
> hemolytic streptococcus. NOT group A, C, or G. ""
>
> THis may be a no brainer for most NPs.....but I have been here for 10
> hours and can't find a clear answer and I think I must have missed the
> discussion in class. Please don't laugh ..but the question is
> ........ SO do we treat with Pen VK??? And where can I find some
> good info that would explain the the different strep groups and the
> recommended treatments?
>
> Thanks..
>
> Nila FNP
>
> Watch free concerts with Pink, Rod Stewart, Oasis and more. Visit MSN
> In Concert today. _______________________________________________
> NP-Clinical mailing list
> NP-Clinical at nurse.net
> http://lists.nurse.net/mailman/listinfo/np-clinical
>
------------------------------
Message: 3
Date: Thu, 3 May 2007 20:52:00 -0400
From: "Cherie Wright"
Subject: RE: [NP-Clinical] strep
To: "'NP Clinical'"
Message-ID:
Content-Type: text/plain; charset="iso-8859-1"
One reason I feel that it is important to treat other groups of strep is
that even if they aren't rheumatogenic, they can abscess, etc. I usually go
with Amoxil.
Cherie Wright, FNP
-----Original Message-----
From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Stephanie Walker
Sent: Thursday, May 03, 2007 8:23 PM
To: NP Clinical
Subject: Re: [NP-Clinical] strep
If the patient has a sore throat and especially if s/he has a fever, I
would treat with antibiotics. Strictly speaking, only group A is
rheumatogenic & needs to be treated, but the community standard of care
most places is to give them antibiotics so they can feel better sooner.
I would use a broader spectrum than penicillin-something simple like
Keflex--since I would have no idea what the sensitivity of the unknown
strep is. Augmentin seems like overkill--very expensive and gives a lot
of people diarrhea.
I don't know about anyone else, but it's not clear to me exactly what
that lab report means. Perhaps the lab uses a method that only
identifies strep A, C and G, with the implication that the type of
strep in the specimen was not a medically significant group. But in
situations where I don't understand a report, I often call up the lab
that issued the report, and ask to speak with the lab director. I ask
the lab director to clarify the report. They're usually very nice about
it.
Stephanie Walker, RN, FNP
On May 3, 2007, at 6:12 PM, Nila Dickman wrote:
> Hello all,
>
> I am a very green NP, and although I looked High and low for the
> answer, I could not find any clear info.
>
> I got a throat culture back that stated--"" Heavy growth of beta
> hemolytic streptococcus. NOT group A, C, or G. ""
>
> THis may be a no brainer for most NPs.....but I have been here for 10
> hours and can't find a clear answer and I think I must have missed the
> discussion in class. Please don't laugh ..but the question is
> ........ SO do we treat with Pen VK??? And where can I find some
> good info that would explain the the different strep groups and the
> recommended treatments?
>
> Thanks..
>
> Nila FNP
>
> Watch free concerts with Pink, Rod Stewart, Oasis and more. Visit MSN
> In Concert today. _______________________________________________
> NP-Clinical mailing list
> NP-Clinical at nurse.net
> http://lists.nurse.net/mailman/listinfo/np-clinical
>
_______________________________________________
NP-Clinical mailing list
NP-Clinical at nurse.net
http://lists.nurse.net/mailman/listinfo/np-clinical
------------------------------
Message: 4
Date: Thu, 3 May 2007 21:54:21 -0500
From: "Donna Alden-Bugden, RN\(EP\), MN"
Subject: RE: [NP-Clinical] strep
To: "'NP Clinical'"
Message-ID: <000f01c78df7$885ca540$6400a8c0 at Donna>
Content-Type: text/plain; charset="us-ascii"
If it is not A, C, or G, then it must be beta hemolytic group B....or
Streptococcus agalactiae
take a look here
http://www.emedicine.com/MED/topic2185.htm
*******************************************************************
Donna L. Alden-Bugden, BScN, RN(EP), MN (ANP)
NPCanada.ca - Promoting Nurse Practitioners in Canada
Nurse Practitioner & Emergency Nurse
Winnipeg, Manitoba
Donna at Alden-Bugden.ca
Alternate E-mail:
Donna at NPCanada.ca
http://www.NPCanada.ca
*******************************************************************
-----Original Message-----
From: Cherie Wright [mailto:wright_cherie at hotmail.com]
Sent: May 3, 2007 19:52
To: 'NP Clinical'
Subject: RE: [NP-Clinical] strep
One reason I feel that it is important to treat other groups of strep is
that even if they aren't rheumatogenic, they can abscess, etc. I usually go
with Amoxil.
Cherie Wright, FNP
-----Original Message-----
From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Stephanie Walker
Sent: Thursday, May 03, 2007 8:23 PM
To: NP Clinical
Subject: Re: [NP-Clinical] strep
If the patient has a sore throat and especially if s/he has a fever, I
would treat with antibiotics. Strictly speaking, only group A is
rheumatogenic & needs to be treated, but the community standard of care
most places is to give them antibiotics so they can feel better sooner.
I would use a broader spectrum than penicillin-something simple like
Keflex--since I would have no idea what the sensitivity of the unknown
strep is. Augmentin seems like overkill--very expensive and gives a lot
of people diarrhea.
I don't know about anyone else, but it's not clear to me exactly what
that lab report means. Perhaps the lab uses a method that only
identifies strep A, C and G, with the implication that the type of
strep in the specimen was not a medically significant group. But in
situations where I don't understand a report, I often call up the lab
that issued the report, and ask to speak with the lab director. I ask
the lab director to clarify the report. They're usually very nice about
it.
Stephanie Walker, RN, FNP
On May 3, 2007, at 6:12 PM, Nila Dickman wrote:
> Hello all,
>
> I am a very green NP, and although I looked High and low for the
> answer, I could not find any clear info.
>
> I got a throat culture back that stated--"" Heavy growth of beta
> hemolytic streptococcus. NOT group A, C, or G. ""
>
> THis may be a no brainer for most NPs.....but I have been here for 10
> hours and can't find a clear answer and I think I must have missed the
> discussion in class. Please don't laugh ..but the question is
> ........ SO do we treat with Pen VK??? And where can I find some
> good info that would explain the the different strep groups and the
> recommended treatments?
>
> Thanks..
>
> Nila FNP
>
> Watch free concerts with Pink, Rod Stewart, Oasis and more. Visit MSN
> In Concert today. _______________________________________________
> NP-Clinical mailing list
> NP-Clinical at nurse.net
> http://lists.nurse.net/mailman/listinfo/np-clinical
>
_______________________________________________
NP-Clinical mailing list
NP-Clinical at nurse.net
http://lists.nurse.net/mailman/listinfo/np-clinical
_______________________________________________
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Message: 5
Date: Thu, 3 May 2007 22:24:20 -0700 (GMT-07:00)
From: chrisbsmith at mindspring.com
Subject: [NP-Clinical] VENETIAN VIOLET - ORAL ULCERS
To: "np-clinical at nurse.net" ,
"acc-circle-request at listserve.com"
Message-ID:
<29848521.1178256260453.JavaMail.root at mswamui-blood.atl.sa.earthlink.net>
Content-Type: text/plain; charset=UTF-8
Hi,
Saw a 7yo Latina tonight who I saw two days ago for viral syndrome with some tongue ulcers. Grandmother opted to try and put Venetian Violet on them at home toda. Kid fought like hell and wound up looking like Verruca Salt on Charlie and the Chocolate Factory. The kids teeth - every single one are deep purple, lips, tongue, all around mouth, nose. chin. and splashes to cheeks and neck.
Actually quite funny to me but then I am not the parent of this poor kid that is doing her first communion on Sunday and will be sticking out a deep purple tongue at the priest. Ulcers themselves do not seem to be too bad. Child well hydrated.
Mother is hysterical about her purple kid. Any ideas on how to get this off the skin. From my internet search, it says this is used in tattoos too so I am a bit concerned.
Christine Smith, NP
Antioch, CA
------------------------------
Message: 6
Date: Fri, 04 May 2007 05:43:02 -0400
From: Maggie Garancosky
Subject: Re: [NP-Clinical] VENETIAN VIOLET - ORAL ULCERS
To: chrisbsmith at mindspring.com, NP Clinical
Message-ID: <463B0026.5020703 at mindspring.com>
Content-Type: text/plain; charset="us-ascii"
Alcohol sounds like the best bet. Give mom some too I think. ---Maggie
Gentian violet is an outstanding preparation for candidiasis in the
groin, penis, inframammary, umbilical, and diaper areas. It is an
effective nonstinging antiseptic and fungistatic agent with a startling
color that's difficult to remove. Dr. Litt said aromatic spirits of
ammonia will remove skin stains, but for clothing stains, "forget
it!" http://www.healthyawareness.com/_Archives/_disc2/00000100.htm
----------
a cotton swab/ball with vodka can get stains off baby's face. Rinse
vodka off immediately after cleaning stain. Rubbing alcohol will work on
baby's face. too. One mom reported that baby wipes worked pretty well,
too (she used Huggies Supreme Natural Care Unscented wipes).
http://www.breastfeed-essentials.com/gvstains.html
--------
If it's too late and your skin got stained, don't worry, the gentian
violet thrust treatment stain will come off in a few days. Or, if you
act fast, here're some ways you can get rid of the stain --
* Alcoholic liquids such as rubbing alcohol and vodka will typically
work to removed the stain on skin, counter tops, and most flooring
if used before the gentian violet dries. Be sure to rinse off with
warm water after the skin is cleaned with alcohol.
* Bleaching will typically get most gentian violet thrush treatment
stains off clothing, if the article of clothing can be bleached.
* If clothing cannot be bleached, try using a stain remover right
away. I've had good results with those oxygen-based cleaners,
particularly if used when stain hasn't dried.
* If you're fast on the draw, spray the gentian violet thrush
treatment stained garment with hair spray, then wash as usual.
This trick also works with other stains such as magic markers, etc.
http://www.yeast-infection-remedies.com/gentian-violet-thrush.html
chrisbsmith at mindspring.com wrote:
>Hi,
>
>Saw a 7yo Latina tonight who I saw two days ago for viral syndrome with some tongue ulcers. Grandmother opted to try and put Venetian Violet on them at home toda. Kid fought like hell and wound up looking like Verruca Salt on Charlie and the Chocolate Factory. The kids teeth - every single one are deep purple, lips, tongue, all around mouth, nose. chin. and splashes to cheeks and neck.
>
>Actually quite funny to me but then I am not the parent of this poor kid that is doing her first communion on Sunday and will be sticking out a deep purple tongue at the priest. Ulcers themselves do not seem to be too bad. Child well hydrated.
>
>Mother is hysterical about her purple kid. Any ideas on how to get this off the skin. From my internet search, it says this is used in tattoos too so I am a bit concerned.
>
>Christine Smith, NP
>Antioch, CA
>_______________________________________________
>NP-Clinical mailing list
>NP-Clinical at nurse.net
>http://lists.nurse.net/mailman/listinfo/np-clinical
>
>
>
>
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