Diphtheria
Key Points
- Diphtheria is caused by Corynebacterium diphtheriae and spreads through respiratory secretions.
- A gray pharyngeal pseudomembrane that bleeds with attempted removal is a hallmark finding.
- Priority risks are airway obstruction, myocarditis, dysrhythmias, and neurologic injury.
- Diagnosis uses throat culture/PCR with supportive CBC and imaging findings.
- Treatment requires antibiotics plus diphtheria antitoxin, close airway-cardiac monitoring, and isolation.
Pathophysiology
After inhalation, C. diphtheriae produces toxin-mediated local inflammation in the upper airway. Tissue injury supports formation of a thick pseudomembrane over throat and tonsillar surfaces.
Systemic toxin effects can extend beyond the airway and injure cardiac and neurologic tissues, creating high-acuity complications even after initial throat symptoms.
Classification
- Respiratory diphtheria: Upper-airway infection with pseudomembrane and potential obstruction.
- Systemic-toxic complication pattern: Cardiac or neurologic involvement.
Nursing Assessment
NCLEX Focus
Prioritize airway patency and early recognition of toxic cardiac-neurologic complications.
- Assess sore throat, fever, dysphagia, cervical lymph-node swelling, and malaise.
- Inspect for pseudomembrane presence and avoid trauma/manipulation that can provoke bleeding.
- Monitor respiratory effort, stridor, and signs of airway narrowing.
- Track ECG/cardiac status for myocarditis or dysrhythmia clues.
- Review diagnostic findings: throat culture, PCR, CBC leukocytosis, and soft-tissue neck/chest imaging.
- Assess immunization status (DTaP/Tdap history) and exposure risk context.
Nursing Interventions
- Implement ordered isolation and transmission-control workflows.
- Administer prescribed antibiotics and diphtheria antitoxin promptly.
- Maintain continuous airway and cardiac monitoring in unstable presentations.
- Prepare escalation for intubation and mechanical ventilation if obstruction worsens.
- Reinforce vaccination counseling for prevention and future risk reduction.
- Reevaluate frequently and revise care plans with new assessment and diagnostic data.
Airway Obstruction Emergency
Progressive pseudomembrane-related obstruction can rapidly become fatal without immediate escalation.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| antibiotics | Culture-directed antibacterial regimens | Reduce organism burden and transmission risk. |
| Antitoxins | Diphtheria antitoxin products | Neutralize circulating toxin; monitor for reaction per protocol. |
Clinical Judgment Application
Clinical Scenario
A child with fever and severe sore throat develops worsening dysphagia and visible gray membrane over tonsillar tissue.
- Recognize Cues: Classic diphtheria pattern with airway threat.
- Analyze Cues: Toxin-mediated disease may progress to airway and cardiac complications.
- Prioritize Hypotheses: Immediate priorities are airway protection and antitoxin-antibiotic therapy.
- Take Action: Start isolation workflow, implement ordered therapies, and intensify cardiorespiratory monitoring.
- Evaluate Outcomes: Airway remains patent, hemodynamics stay stable, and no new systemic complications develop.
Related Concepts
- transmission-based-precautions - Isolation framework for respiratory spread control.
- advanced-airways-and-intubation - Escalation pathway when obstruction progresses.
- active-and-passive-immunity - Vaccine-driven prevention context for toxin-mediated disease.
- pharyngitis-tonsillitis-and-adenoiditis - Differential sore-throat framework.
Self-Check
- Why is pseudomembrane manipulation dangerous in diphtheria?
- Which complications require continuous cardiac surveillance?
- Why are antitoxin and antibiotics used together?