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Lymphadenitis
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FindingsChoose one
Likely causeChoose one
AntibioticChoose one
Cat scratch planChoose oneNot in the note with these choices
NTM planChoose oneNot in the note with these choices
TestingChoose any
Follow-upChoose one
Follow-up (cat scratch or NTM)Choose oneNot in the note with these choices
Follow-up reasonChoose anyJoins the line aboveNot in the note with these choices
Counseling
The swollen gland should become less tender within a few days of starting the antibiotic, though it can take a few weeks to shrink completely. Recommended supportive care with tylenol or motrin as needed for pain, with an emphasis on warm compresses. Return precautions given including redness spreading over the skin, a soft or squishy feel to the gland, fever that does not improve, trouble swallowing or opening the mouth, neck stiffness, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.
CounselingNot in the note with these choices
The gland has collected pus, and draining it with a needle or a small procedure helps it heal faster. Keep taking the antibiotic. Recommended supportive care with tylenol or motrin as needed for pain, with an emphasis on warm compresses. Return precautions given including redness spreading over the skin, fever that does not improve, trouble swallowing or opening the mouth, neck stiffness, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.
CounselingNot in the note with these choices
Cat scratch disease usually goes away on its own over 2-4 months without antibiotics. Do not let the area be cut open, because that can cause a draining wound. Recommended supportive care with tylenol or motrin as needed for pain, with an emphasis on warm compresses. Avoid rough play with kittens, and wash scratches promptly. Return precautions given including high fever, a gland that becomes very painful or soft, belly pain, vision changes, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.
CounselingNot in the note with these choices
This kind of gland infection comes from germs in soil and water and is not contagious. It does not respond well to usual antibiotics and is often cured by removing the gland. Recommended supportive care with an emphasis on leaving the gland alone and not squeezing it. Return precautions given including the skin over the gland breaking open or draining, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.
What the sources cover
- Tenderness, warmth, fluctuance
- Bacterial, cat scratch, NTM
- Keflex for S aureus and GAS
- Clindamycin for MRSA or Penicillin allergy
- CSD: no antibiotics usually; Azithromycin for painful adenitis; aspirate, avoid I&D
- NTM: complete excision
- Bartonella serology, ultrasound, TB testing