307: Communicable Diseases
1m 27s The nurse is providing education to the parents of a 5-year-old with a fever. Which statements indicate the need for further instruction? Select all that apply.
"I can administer two baby aspirin tablets to my child every 4 to 6 hours for the fever." "Sponging my child with cold water can be a soothing way to manage the fever." "I should use a cooling fan in my child's room to keep the fever down." Explanation: Aspirin should be avoided in children with fever. It may be associated with Reye sndrome. Activities that result in over-cooling or chilling such as using fans and cold baths should be avoided.
Which diagnostic tool is used to identify children who may have an infection or inflammatory process?
Erythrocyte sedimentation rate (ESR) Explanation: The ESR is a screening procedure to identify children who may have an infectious or inflammatory process. A blood culture is utilized to confirm sepsis. Gastric lavage is used to identify TB in a child when bronchoscopy cannot be performed.
The nurse is caring for a child newly diagnosed with diphtheria. Which nursing interventions would the nurse include in the child's plan of care? Select all that apply.
Administering antitoxin intravenously Monitoring for airway obstruction Adhering to droplet precautions Ensuring complete bedrest Explanation: Treatment of diphtheria involves intravenous administration of antitoxin in large doses. In addition, children are given penicillin or erythromycin intravenously. Complete bedrest is crucial during the acute stage of the illness. Droplet precautions must be followed until cultures are negative. Children need careful observation at all times to prevent airway obstruction. If obstruction occurs, endotracheal intubation may be necessary.
The parent of a child with mumps calls the clinic to find out how long the child needs to stay home from school. The nurse would instruct the parent to allow the child to return to school at which time?
After 9 days from the onset of swelling Explanation: In the home, educate the family to keep the child with mumps from attending school or daycare until 9 days after the onset of swelling. Mumps involves swelling of the salivary glands; no lesions are present. Therapy for mumps is primarily supportive; antiviral agents are not used.
A 3-week-old infant is diagnosed with pertussis. Which antimicrobial agent would the nurse expect the physician to prescribe?
Azithromycin Explanation: The macrolides (erythromycin, azithromycin, and clarithromycin) are the drugs of choice for pertussis in children older than 6 months of age. Azithromycin and clarithromycin are not FDA approved for use in infants younger than 6 months; however, infants younger than 1 month old should be treated with azithromycin because erythromycin is associated with increased risk of infantile hypertrophic pyloric stenosis. Trimethoprim-sulfamethoxazole is an alternative antibiotic for children who cannot tolerate erythromycin.
A nurse is preparing a presentation for a local mothers' group about common viral infections associated with a rash during childhood. When describing rubella, what information would the nurse include? Select all that apply.
Incubation period usually ranges from 16 to 18 days. The infection is communicable for a week before to a week after the rash appears. Any itching with the rash is usually mild. Explanation: Rubella has an incubation period ranging from 12 to 23 days, but usually 14 days. It is communicable for 7 days before the rash to 7 days after the onset of the rash. Itching is usually mild. It occurs most commonly during late winter and early spring and the rash typically begins on the face and spreads down the neck, trunk, and extremities
A child is brought to the clinic with fever, cough, and coryza. The nurse inspects the child's mouth and observes what look like tiny grains of white sand with red rings. How would the nurse document these findings?
Koplik spots Explanation: Koplik spots are bright red spots with blue-white centers appearing primarily on the buccal mucosa and indicate rubeola (measles). They are often described as tiny grains of white sand surrounded by red rings. Lymphadenopathy is used to document enlargement of the lymph nodes. Slapped cheek appearance refers to the erythematous flushing associated with fifth disease. Nits refer to the adult eggs of pediculosis.
A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them.
Low-grade fever Macular rash Papular rash Vesicle formation Crusting Explanation: The disease is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a rash. The lesion begins as a macula, then progresses rapidly within 6 to 8 hours to a papule, then to a vesicle that first becomes umbilicated and then forms a crust.
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.
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 nurse is providing care to an infant who develops roseola during hospitalization. The nurse would institute which infection control precaution?
Standard Explanation: If an infant develops roseola infantum in the hospital, the nurse would follow standard precautions. There is no need for airborne, droplet, or contact precautions.
1m 11s 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.
39s The nurse is caring for a 10-year-old boy with diphtheria. What would the nurse institute as a tier 2 precaution?
Use of a protective mask Explanation: Use of a protective mask if within 3 feet of the child is a tier 2 precaution with diphtheria, which is transmitted through contact with droplets. Use of a protective gown is a tier 2 precaution for contact transmission. Negative air pressure ventilation is a tier 2 precaution for airborne transmission. Face shields are part of tier 1 precautions against contaminated splashes.
A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The mother 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 physician diagnoses the child with erythema infectiosum. The nurse tells the mother that this is also known as:
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.
A group of nursing students are reviewing the six links in the chain of infection and the nursing implications for each. The students demonstrate understanding of the information when they identify which precaution as helping to break the chain of infection to the susceptible host?
Maintaining skin integrity Explanation: Maintaining the integrity of the child's skin and mucous membranes is a precaution that will break the chain of infection at the susceptible host. Keeping linens dry and clean is a precaution to take at the reservoir link. Washing hands frequently breaks the chain at the mode of transmission. Coughing into a handkerchief is a precaution for the portal of exit.
The nurse determines that it is necessary to implement airborne precautions for children with which infection?
Measles Explanation: Airborne precautions are designed to reduce the risk of infectious agents transmitted by airborne droplet nuclei or dust particles such as for children with measles, varicella, or tuberculosis. Droplet precautions would be used for children with streptococcal group A infections, rubella, and scarlet fever.
A young client in the clinic has a rash, cough, and fever that the mother says spiked on day 5 of the rash. The client also had conjunctivitis. What would the nurse expect the physician to tell the family that the child has?
Measles Explanation: Measles are diagnosed based on the symptoms of a rash, Koplik spots, conjunctivitis, coryza, cough, and a fever that usually spikes on day 5.