Chapter 15: Infectious Diseases

When providing care for a child with herpes zoster (shingles), the parents ask the nurse how the child contracted this infectious disorder. Which response by the nurse is most appropriate?

"Herpes zoster is a reactivation of a previous varicella zoster infection." Explanation: Herpes zoster (shingles) is reactivation of the latent varicella zoster (chickenpox) infection that occurs during times of immunosuppression and aging. Although it is possible to contract the varicella zoster virus from a person with herpes zoster or varicella zoster, a child diagnosed with herpes zoster has already been exposed to varicella zoster. Handwashing will not directly prevent herpes zoster.

The parents of a 3-year-old child report he was exposed to pertussis 2 days ago. They are concerned and ask the nurse how long it will take until he becomes ill if he indeed contracted the infection. What response by the nurse is indicated?

"The signs of disease will be noted in 1 to 3 weeks." Explanation: Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. The disease is caused by Bordetella pertussis. The incubation period is 6 to 21 days, usually 7 to 10 days.

The nurse is telephone triaging multiple pediatric calls. Which telephone call will the nurse return first?

An infant with hand-foot-mouth disease is at risk for dehydration. Lethargy is not a typical sign/symptom of hand-foot-mouth disease; however, it is a sign of dehydration. A child with scarlet fever would be expected to have a strawberry tongue. A child with current cat-scratch disease is unlikely to contract this again from another cat. Abdominal pain is a common symptom of mononucleosis.

A child who developed parotid gland swelling on March 5 was diagnosed with mumps. The nurse determines that the child will no longer be contagious at which time?

March 14 Explanation: Children with mumps are no longer considered contagious 9 days following the onset of parotid swelling.

The nurse is caring for a 10-year-old child with a skin rash. The nurse should include which intervention to manage the associated pruritis?

Press the pruritic area. Explanation: Pruritis may be managed by pressing on the area instead of scratching. Increases in temperature will result in vasodilation and increase the pruritis. Warm baths and hot compresses should be avoided. Rubbing may result in increased itching.

A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102°F (38.9°C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect?

Scarlet fever Explanation: Scarlet fever typically is associated with a sore throat, fever greater than 101° F (38.9° C), and the characteristic rash on the face, trunk, and extremities that looks like sunburn but feels like sandpaper. CAMRSA is typically manifested by skin and tissue infections. Diphtheria is characterized by a sore throat and difficulty swallowing but fever is usually below 102°F (38.9°C). Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions.

What is a true statement regarding varicella zoster virus infection

Secondary bacterial infections of the skin can occur. Explanation: Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The lesions are intensely pruritic, making the child want to scratch the lesions and opening them to a variety of organisms to invade. The incubation period is 10 to 21 days. It is transmitted by direct contact with the vesicles and by airborne route. It tends to be more severe in adolescents and adults.

After teaching nursing students about childhood exanthems, the instructor determines that the teaching was successful when the students identify what as the primary cause?

Viruses Explanation: Most childhood exanthems are caused by viruses.

A chief danger of scarlet fever is that children may develop

acute glomerulonephritis. Use Penicillin to prevent Explanation: Scarlet fever infection is the result of group A streptococci. It generally starts with a throat infection (strep throat). The bacteria produce a toxin that causes the rash over the body. Because this is a streptococci-based infection, the child will need to be monitored for the development of rheumatic fever or glomerulonephritis following the illness. Scarlet fever does not cause respiratory symptoms, attack the liver, or have open lesions.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes pustule?

small elevation of epidermis filled with a viscous fluid

The nurse is assessing a child with a varicella infection. The nurse would be alert for which possible complication(s)? Select all that apply.

Secondary bacterial infection Pneumonia Scarring Encephalitis Explanation: The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis. Scarlet fever is a complication associated with group A streptococcal infection

The nurse is caring for a 5-year-old girl with scarlet fever. Which intervention will most likely be part of her care?

Teaching proper administration of penicillin V. Explanation: Penicillin V or erythromycin is the preferred antibiotic for treatment of scarlet fever. Scarlet fever transmission is airborne, not via droplet. Lymphadenopathy occurs with cat scratch disease and diphtheria. Close monitoring of airway status is critical with diphtheria because the upper airway becomes swollen.

What is the leading cause of neonatal sepsis and death?

Group B streptococcus Explanation: Sepsis is a systemic overresponse to infection. It is very serious and can produce septic shock and death. In infants under the 3 months of age the most causative agents are group B streptococcus, Escherichia coli, Staphylococcus aureus, enteroviruses, and the herpes simplex virus. Any time a febrile, ill-appearing neonate is seen, a full septic work-up is done. Neonates have the poorest outcomes from sepsis. Neisseria meningitidis is one cause of sepsis in older children. The Epstein-Barr virus is a herpes virus that causes mononucleosis. The cytomegalovirus is a common herpes virus. It is spread through bodily fluids and is not necessarily a concern unless the person is immunocompromised or is pregnant.

Which collaborative intervention will the nurse provide when caring for an infant diagnosed with pertussis? Select all that apply.

Have suction available in the room. Encourage small, frequent feedings. Administer erythromycin for 10 days. Utilize droplet and standard precautions. Explanation: Infants with pertussis are generally admitted to the hospital for at least 48 hours to see how the disease course is progressing. Droplet precautions are used until 5 days after a child starts antibiotic therapy, and visitors may be restricted during this time (5 days). Standard precautions will be used throughout the hospitalization. Frequent small meals are vomited less than larger meals, making it easier for the infant to maintain nutritional status. A full 10-day course of erythromycin or azithromycin may be prescribed because these drugs have the potential to shorten the period of communicability and may shorten the duration of symptoms. Infants with pertussis may need airway suction for thick secretions

The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old girl. Which technique would most likely be used?

Puncturing a vein on the dorsal side of the hand. Explanation: The usual sites for obtaining blood specimens are veins on the dorsal side of the hand or the antecubital fossa. Administration of sucrose prior to beginning helps control pain for young infants. Accessing an indwelling venous access device may be appropriate if the child is in an acute care setting. An automatic lancet device is used for capillary puncture of an infant's heel.

Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital.

Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital.

A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions require placing a client in an isolated room with limited access, wearing gloves during contact with the client and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between clients?

Contact precautions Explanation: Contact precautions means placing the client in an isolation room with limited access, wearing gloves during contact with the client and all body fluids, wearing two layers of protective clothing, limiting movement of the client from the room, and avoiding sharing equipment between clients. Standard precautions are used with every client. They involve good handwashing and the use of gloves for client contact. Airborne precautions are used for diseases where small particles are dispersed in the air. They require that the client be in a negative-pressure room and, in addition to standard personal protective equipment, the mask should be N95 or higher. Varicella would need airborne precautions. Droplet precautions are used for diseases such as pertussis, which produce large droplets. They require standard precautions plus a surgical mask, preferably with a face shield.

A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The parent informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The health care provider diagnoses the child with erythema infectiosum. The nurse tells the parent that this is also known

fifth disease. Explanation: Erythema infectiosum is also known as "fifth disease." It starts with a fever, headache, and malaise. One week later, a rash appears on the face. A day later, the rash appears on the extensor surfaces of the extremities. One more day later, the rash appears on the trunk and flexor surfaces of the extremities. Pityriasis rosea is a skin rash that begins with a large spot on the chest, abdomen, or back that is followed by a pattern of small lesions. It is self-limiting and can be treated with steroid creams. Rosacea is a chronic inflammatory skin condition that causes redness to the face. An enterovirus infection can many times cause the same symptoms as the common cold or it can include the respiratory system. It is contagious.

The nurse is caring for a child diagnosed with hand-foot-mouth disease. When educating the family about this disease, which education by the nurse is most important?

"Make sure your child drinks plenty of nonirritating fluid." Explanation: Children with hand-foot-mouth disease can experience dehydration related to the high fever, anorexia, and painful mouth lesions. The nurse should educate the family to provide nonirritating fluids to encourage the child to drink to avoid dehydration. Hand-foot-mouth disease is associated with a high fever, and parents can provide acetaminophen. The lesions should disappear in a few days; however, the most important education is aimed at prevention of dehydration.

A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent?

"Your child may return to school when all of the lesions have crusted over." Explanation: Varicella is a highly communicable disease. It is spread via airborne transmission or by direct contact with the nasopharyngeal secretions of an infected person. Varicella is communicable from 1 to 2 days before the rash occurs until all the vesicles have crusted over. The nurse would be correct in telling the parent the child cannot return to school, even though the child is feeling better, until all the vesicles have crusted over. The child does not have to be free of lesions. Being free of fever does not make the child less communicable. The child would not need a permission slip from the health care provider unless this is a specific requirement by the child's school district.

The nurse is preparing to administer acetaminophen to a 4-year-old child to provide comfort. Which precaution is specific to antipyretics?

Ensure proper dose and interval. Explanation: It is very important to ensure that the proper dose is given at the proper interval because an overdose can be toxic to the child. Concerns with allergies and taking the entire, prescribed dose are precautions when administering antibiotics and all medications. Drowsiness is not a side effect of antipyretics.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided?

Explanation: Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to antipyretics and analgesics. Antibiotic and antiviral therapies are not normally included in the plan of treatment. Range of motion is not needed as mobility of the client is not limited.

A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition?

Mumps Explanation: Initial symptoms of mumps include fever, headache, anorexia, and malaise. Within 24 hours, pain on chewing and an "earache" occurs. When the child points to the site of the earache, however, he points to the jawline just in front of the ear lobe, the site of the parotid gland. By the next day, the gland appears swollen and feels tender; the ear becomes displaced upward and backward. Boys may also develop testicular pain and swelling (orchitis). None of the other conditions listed matches the symptoms indicated.

A 7-year-old child with an earache comes to the clinic. The child's parent reports that 1 day ago the child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis will be for this child?

Mumps Explanation: Mumps begins with a fever, headache, anorexia, and malaise. Within 24 hours an earache occurs. When pointing to the site of pain, however, the child points to the jawline just in front of the earlobe. Mumps is contagious 1 to 7 days prior to the onset of symptoms and 4 to 9 days after the parotid swelling begins. Fifth disease is also known as the "slapping disease," as the rash on the cheeks look like someone slapped the child's face. Measles does not involve parotid swelling or earaches. Mononucleosis does involve swollen lymph nodes but they are in the neck and the axillary area.

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease?

Mumps Explanation: Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis is a respiratory disorder that causes severe paroxysmal coughing, which produces a whooping sound. Measles is recognized by Koplik spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very pruritic and is seen on the hands, feet, and folds of the skin.

A nurse practitioner suspects that a child has scarlet fever based on which assessment finding?

Red, strawberry tongue Explanation: The characteristic assessment finding that distinguishes scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis.

What information should be included in the teaching plan for a child with varicella?

Remind the child not to scratch the lesions. Explanation: Varicella lesions appear first on the scalp. They spread to the face, the trunk, and to the extremities. There may be various stages of the lesions present at any one time. The lesions are intensely pruritic. The teaching plan for varicella should include that the child not scratch the lesions. Opening the lesions gives access for secondary infection to occur and causes scarring. Acetaminophen, not aspirin, should be administered for fever due to the link with Reye syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. Warm baths cause more itching and dry the skin.

The parents of a 4-month-old diagnosed with sepsis tell the nurse that the physician explained sepsis to them but they don't really understand it. The parents state, "Could you please explain it to us?" What is the best response by the nurse?

The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys." Explanation: Keeping the answer to what sepsis is will help the parents understand the pathophysiology. While all answers are correct, the response: "The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys" provides the most understandable explanation and addresses the parent's question.

The nurse is caring for a child hospitalized with pertussis. Which nursing intervention would be the highest priority for this child?

The nurse will administer oxygen. Explanation: The major complication of pertussis (whooping cough) is pneumonia and respiratory complications. Oxygen, bed rest, and monitoring for airway obstruction are nursing interventions. The highest priority is administering oxygen to maintain adequate oxygenation of cells.

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first?

a child with erythema infectiosum experiencing fatigue and confusion Explanation: A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.

A 6-year-old child is being treated for a parasitic infection. When reviewing results from the child's white blood cell count, which finding would be anticipated?

increased eosinophil levels Explanation: Eosinophils are the first line of defense against parasitic infections and allergic reactions and will be elevated. Monocytes are a second line of defense and will be elevated in response to leukemias, lymphomas, and chronic inflammation. Basophils respond to allergic disorders and hypersensitivity reactions. Neutrophils are the first line of defense upon invasion of bacteria, fungus, cell debris, and other foreign substances.

A child is diagnosed with scarlet fever. History reveals that the child has no known drug allergies. When preparing the child's plan of care, the nurse would anticipate administering which agent as the drug of choice?

penicillin V Explanation: Penicillin V is the antibiotic of choice. In those sensitive to penicillin, erythromycin may be used. Trimethoprim-sulfamethoxazole and clarithromycin are not used.

After teaching a class to a group of nursing students about reporting infectious diseases to the Centers for Disease Control and Prevention, the instructor determines a need for additional discussion when the students identify which infection as being reportable:

pinworm Explanation: Pinworm infections are not required to be reported. Gonorrhea, Lyme disease, and pertussis are all reportable infectious diseases.

The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning?

urine output of 10 ml over 3 hours Explanation: Children with sepsis will show alteration in temperature, heart rate, respiratory rate, and white blood cell count. Septic shock with organ dysfunction is more serious and can be manifested by decreased urine output.