PEDS: Chapter 47 Nursing Care of the Child with an Infection
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." 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.
A 10-year-old girl with long hair is brought to the emergency room because she began acting irritable, reported a headache, and was very sleepy. Which question is most appropriate for the nurse to ask the parents?
"What were you doing prior to her beginning to feel sick?" If the family had been camping or in a wooded area, the girl could have been bitten by a tick which would not be easy to discover because of her long hair. Ticks like dark, hair-covered areas and the signs and symptoms presented are neurological, with a rapid onset, which can be characteristic of a tick bite. The other questions are important but are not focusing on the causative agent.
A nurse is assessing a child with a tick-borne disease. What finding would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain spotted fever?
Absence of rash Both Rocky Mountain spotted fever and ehrlichiosis are manifested by fever, headache, and malaise. However, there is rarely a rash with ehrlichiosis, which helps to differentiate it from Rocky Mountain spotted fever.
A 6-year-old boy is suspected of having late-stage Lyme disease. Which assessment should the nurse use to produce findings supporting this concern?
Asking the child if his knees hurt Recurrent arthritis in large joints such as the knees is an indication of late-stage Lyme disease. The appearance of erythema migraines would suggest early-localized stage of the disease. Facial palsy or conjunctivitis would suggest the child is in the early disseminated stage of the disease.
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 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.
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?
Encourage rest and relaxation. communicable period for rubeola ranges from 4 days before to 5 days after the rash appears, mainly during the prodromal stage.communicable period of 10 to 15 days describes rubella
A group of nursing students are reviewing the functions of white blood cells. The students demonstrate an understanding of the information when they identify which white blood cell as responsible for combating allergic disorders?
Eosinophils Eosinophils function to combat allergic disorders and parasitic infestations. Neutrophils function to combat bacterial infections. Lymphocytes function to combat viral infections. Monocytes function to combat severe infections.
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 eosinophils levels 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 nurse is preparing a presentation for parents about common childhood infectious diseases. What conditions would the nurse include as being caused by a tick bite? Select all that apply.
Lyme disease Rocky Mountain spotted fever Infectious diseases caused by tick bites include Lyme disease and Rocky Mountain spotted fever. Psittacosis is transmitted to children by birds. Ascariasis is a roundworm infection.
A 7-year-old with an earache comes to the clinic. The child's mother reports that 1 day ago her 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 to be for this child?
Mumps Mumps begin 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. Droplet precautions are indicated during the period of communicability (immediately before and after swelling begins
The nurse is caring for an adolescent diagnosed with syphilis. The drug of choice for treating syphilis is:
Penicillin Syphilis responds to one intramuscular injection of penicillin G benzathine; if the child is sensitive to penicillin, oral doxycycline, tetracycline, or erythromycin can be administered as alternative treatment.
A nursing instructor is teaching students about the chain of infection. What does the instructor tell students is responsible for allowing the pathogen to enter?
Portal of entry The portal of entry, or the opening through which a pathogen can enter a child's body, can be inhalation, ingestion, or breaks in the skin.
The skin of a newborn infant plays a significant role in thermoregulation and as a barrier against infection.
The skin of a preterm newborn is thin and gelatinous, with decreased amounts of subcutaneous fat, brown fat, and glycogen stores and lose heat because of their large body surface area in relation to their weight and because their posture is more relaxed with less flexion. at risk for increased heat loss and increased fluid requirements.
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 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 communicable period ranging from 2 weeks or less to 4 weeks describes diphtheria
Parents usually ask when their child can return to school after having chickenpox. The correct answer would be:
as soon as all lesions are crusted. Chickenpox lesions are infectious until they crust.
On occasion, tenderness, redness, or swelling may occur at the site of the DTaP injection. This can be relieved with cold packs for the first 24 hours, followed by warm or cold compresses if the inflammation persists.
fant receives a diphtheria, tetanus, and acellular pertussis (DTaP) immunization nfant has developed swelling and redness at the site of injection
A young child who has been reporting fatigue and running a low-grade fever for 4 days begins to have pustules over the entire body. The physician diagnoses chickenpox. The period before the pustules developed is referred to as the:
prodromal period The prodromal period is between the beginning of nonspecific symptoms and disease-specific ones. Chickenpox is transmitted via direct contact, droplet (airborne) spread, and contaminated objects. The communicable period for chickenpox is 1 to 2 days before the onset of the rash to 6 days after the first crop of vesicles, when crusts have formed, highly pruritic, profuse macule-to-papule rash
A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of:
scarlet fever. Group A streptococcal pharyngitis can progress to scarlet fever with the rash appearing in about 12 hours after the onset of the disease. Group A streptococcal pharyngitis is not associated with pneumonia. Impetigo is a group A strep infection involving the skin. Osteomyelitis can occur with an infection by group B streptococcus.
A mother voices concern to the nurse that her child should not be using alcohol-based hand gels to help prevent the spread of infection. How should the nurse respond?
"Hand gels are actually very effective in preventing the spread of infection." Hand hygiene includes both hand washing with soap and water and the use of alcohol-based products (gels, rinses, foams) that do not require water. If there is no visible soiling of the hands, approved alcohol-based products are preferred because of their superior microbicidal activity, reduced drying of the skin, and convenience.
The father of a child with mononucleosis is concerned with his child's fever and cough. The father asks when antibiotic therapy will begin. What is the best response by the nurse?
"Mononucleosis is a viral infection so an antibiotic isn't used. We address the symptoms with appropriate therapy." tx for viral infections aimed at treating the client's symptoms. Infectious mononucleosis is caused by Epstein-Barr virus. The parents need to be instructed to notify the PHCP if abdominal pain, especially in the left upper quadrant, or left shoulder pain occurs because this may indicate splenic rupture. Children with enlarged spleens also are instructed to avoid contact sports until splenomegaly resolves. transmission can occur via direct intimate contact or contact with infected blood. Fever is treated with acetaminophen or ibuprofen per PHCP preference.
A neonate is brought to the emergency department by her mother because she "just doesn't look right." The neonate is suspected of having sepsis. Which statement by the mother would help to confirm this suspicion?
"My water broke quite a while before I actually delivered her." Prolonged or premature rupture of membranes increases a neonate's risk for sepsis. A weak cry or lack of smile or facial expression may be present with sepsis. A significant increase in breathing rate (tachypnea) or increased work of breathing evidenced by nasal flaring, grunting, and a retraction is noted with sepsis. Neonates with sepsis do not have a fever. In fact, they may have below-normal temperature.
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." 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.
What is a true statement regarding varicella zoster virus infection?
A complication of this infection includes secondary bacterial infections of the skin. Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. 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.
The rash in roseola is pruritic. Which measure would you teach the father to provide comfort?
Apply cool compresses to the skin to stop local itching. The discrete rose-pink maculopapular rash is the rash of exanthema subitum (roseola . Aspirin should not be given
A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves:
Bacteria Neonatal sepsis can be caused by viruses such as herpes simplex or enteroviruses and by protozoa (e.g., Toxoplasma gondii). However, bacteria are typically the culprits.
When developing the plan of care for a 5-year-old boy with Rocky Mountain spotted fever, the nurse knows the cause of the illness is:
Bite of a tick Rocky Mountain spotted fever is a tick-borne infection. Rabies is due to the bite of an animal. Community-acquired methicillin-resistant Staphylococcus aureus is transmitted through direct person-to-person contact, respiratory droplets, blood, or sharing of personal items and touching surfaces or items contaminated with methicillin-resistant S. aureus. Scarlet fever is an infection resulting from group A streptococcus.
The nurse is talking to the parents of an 2-month-old infant who has been admitted to the hospital with sepsis. The parents report being confused since their older children also had the flu but they recovered without incident. What information can the nurse provide to the parents?
Children this young do not have mature immune systems to fight infection. Sepsis can affect any age group but infants less than 3 months of age have a higher risk. Neonates and young infants have a higher susceptibility due to their immature immune system, inability to localize infections, and lack of immunoglobulin M (IgM), which is necessary to protect against bacterial infections.
A child is diagnosed with an enterovirus infection. Which type of infection control precaution would be most important for the nurse to use?
Contact For the child with an enterovirus infection, contact precautions are used during the illness. Standard precautions are followed at all times and are appropriate for any child. Droplet precautions would be used for a child infected with pertussis. Airborne precautions would be indicated for the child with varicella.
The nurse is teaching a group of parents about head lice. Which statement is essential to include during the presentation?
Head lice are becoming very resistant to treatment. The accurate advice is that head lice are becoming resistant to treatment. Children with head lice do not need to stay home, but parents should follow school policies regarding whether children are allowed in school until they are nit-free. Children should be allowed to participate in sleepovers, preferably bringing their own pillows. Head lice do not survive long once they have fallen off. Most children can be treated effectively without treating their bedding and clothing.
A nursing instructor has presented a class on the stages of an infectious disease to a group of students and asks the students to place the stages in their proper sequence from beginning to end. Place the stages in their proper sequence.
Incubation Prodrome Illness Convalescence An infectious disease begins with incubation, then progresses to the prodrome stage, then to illness, and finally to convalescence.
Put the following stages of infectious disease in correct order:
Incubation period Prodromal period Illness Convalescent period Infectious diseases follow certain stages during which the communicability (ability to be spread to others) or severity of the illness can be predicted: 1) incubation period, 2) prodromal period, 3) illness, and 4) convalescent period.
Rheumatic fever characteristically presents 2 to 6 weeks after an untreated or partially treated group A beta-hemolytic streptococcal infection of the respiratory tract.
Initially the nurse determines whether any family member has had a sore throat or unexplained fever within the past few weeks.
The student nurse is discussing the plan of care for a child admitted to the hospital for treatment of an infection. Which action should be taken first?
Obtain blood cultures When treating a child suspected of having an infection, the blood cultures must be obtained first. The administration of antibiotics may impact the culture's results. A urine specimen may be obtained but is not the priority action. Intravenous fluids will likely be included in the plan of care but are not the priority action.
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 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.
treated with topical application of permethrin. The medication is applied to the body and head, avoiding the eyes and mouth. The lotion is left in place for 8 to 14 hours, and then the child is bathed. Retreatment for most skin alterations is in 1 week, and all bedding and clothing are washed in hot water
Scabies is a parasitic infection caused by a female mite. permethrin- one application and has residual activity for 10 days. It is applied to the hair after shampooing and left for 10 minutes before rinsing out. The hair should not be shampooed for 24 hours after the rinsing treatment.
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 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 . Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions
The nurse at the pediatrician's office receives a call from the mother of a child who has just been bitten by the neighbor's dog. What action would be the priority?
Tell the mother to seek medical help immediately. The mother should seek medical help for her child immediately. Once the child has been seen by a physician, it can be determined whether immunoprophylaxis is necessary. Education about animals is important to prevent any recurrent bites, but this is appropriate only after the child has been seen and a plan has been determined. Flu-like symptoms such as fever occur early in rabies infection. However, the child must be seen first. Explaining how to care for the bite would be done only after the child is seen and an appropriate plan is determined.
What is a true statement regarding measles?
The incubation period is 10 to 12 days. The typical incubation period is 10 to 12 days. Outbreaks peak in the winter and spring. It is highly contagious and is transmitted by airborne suspended droplets
A 5-year-old girl catches the flu from a friend at day care after the friend sneezed and wiped mucus on a toy that the girl played then with. In this case, what is the portal of exit in the chain of infection?
Upper respiratory excretion The portal of exit is the route by which an organism leaves an infected child's body to be spread to others. Organism can be carried out of the body by upper respiratory excretions, feces, vomitus, saliva, urine, vaginal secretions, blood, or lesion secretions. The friend would be the reservoir, which is the container or place in which an organism grows and reproduces. The toy would be the means of transmission. The 5-year-old girl would be the susceptible host.
The nurse is caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is:
Valcyclovir The drug valcyclovir is useful in relieving or suppressing the symptoms of genital herpes.
Cellulitis is an infection of the dermis and the underlying hypodermis of the skin. The child with cellulitis should rest in bed, and the affected extremity should be elevated and immobilized.
Warm, moist soaks applied every 4 hours increase circulation to the infected area, relieve pain, and promote healing. Frequent hand washing is essential to prevent the spread of infection. The child should be carefully monitored for signs of sepsis, increased fever, chills, and confusion, or for the spread of infection. (pt had cat starch)
A chief danger of scarlet fever is that children may develop:
acute glomerulonephritis. Because this is a streptococci-based infection, there is a chance the child will develop rheumatic fever or glomerulonephritis following the illness.
Rubella infection -child usually has photophobia, so the nurse should suggest that the parent keep the child out of brightly lit areas. Warm baths and sunlight will aggravate itching. Additionally, the child needs to rest.
apperance: discrete pinkish-red maculopapular rash is the rash Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to anti-pyretics 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 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. 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.
igns and symptoms of congenital neonatal syphilis may be nonspecific initially, including poor feedings, slight hyperthermia, and "snuffles." By the end of the first week of life, a copper-colored maculopapular dermal rash typically is observed on the palms of the hands, on the soles of the feet, in the diaper area, and around the mouth and anus.
igns and symptoms of congenital neonatal syphilis
The most common complication of varicella is:
secondary bacterial infections. The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.
Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be the:
Incubation period The incubation period is the first stage of the infectious disease. It is the time between the invasion of an organism and the onset of symptoms of infection.
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 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 or rash of erythema infectiosum is associated with fifth disease. Nits refer to the adult eggs of pediculosis.
The appearance of which hallmark clinical manifestation occurs in measles?
Koplik spots The hallmark of measles is the appearance of Koplik spots. Other typical symptoms include fever, conjunctivitis, and a cough.
Impetigo is a contagious bacterial infection of the skin caused by β-hemolytic streptococci or staphylococci, or both. Impetigo is most common during hot, humid summer months. Impetigo may begin in an area of broken skin, such as an insect bite or atopic dermatitis. Impetigo is extremely contagious.
Lesions usually are located around the mouth and nose, but may be present on the hands and extremities, and can appear on any part of the body.The infection is communicable for 48 hours beyond initiation of antibiotic treatment.
A group of camp nurses is discussing various types of tick bites. One of the nurses states that deer ticks are carried by white-footed mice and white-tailed deer, and can carry the organism that causes which disease?
Lyme disease Deer ticks, carried by white-footed mice and white-tailed deer, can carry the organism that causes Lyme disease.
A nurse is assessing a child who was recently adopted from a foreign country and has not yet received any immunizations. The child has a high fever, rhinitis, and sore throat. The nurse also notes small, irregular, bright red spots on the buccal membrane. What would the nurse suspect?
Rubeola--Airborne droplet precautions are required, and persons in contact with the child should wear masks. The child is placed in a private room if hospitalized, and the hospital room door remains closed. Small,small blue-white spot irregular, bright red spots on the buccal membrane , begins on the face and spreads down = suggest Koplik spots and, together with the child's other assessment findings, suggest rubeola. Koplik spots distinguish the disease because none of the other exanthems has this finding. Rubella is characterized by a (low-grade fever, mild cough, runny nose occur before the development of a rash), sore throat, and then red maculopapular rash. begins on the face and spreads down Varicella is characterized by a low-grade fever, malaise, and rash that begins as a macule and progresses to a papule and then a vesicle. Variola is characterized by chills, fever, headache, vomiting, and the appearance of a rash and high fever after 3 to 4 days.
Permethrin is massaged thoroughly and gently into all skin surfaces (not just the areas that have the rash) from the head to the soles of the feet. Care should be taken to avoid contact with the eyes. The lotion should not be applied until at least 30 minutes after bathing and should be applied only to cool, dry skin. The lotion should be kept on for 8 to 14 hours, and then the child should be given a bath. The child should be clothed during the 8 to 14 hours of treatment contact time.
Scabies is a parasitic skin disorder caused by an infestation of Sarcoptes scabiei (itch mite). Scabies appears as burrows or fine, grayish red, thread-like lines. They may be difficult to see if they are obscured by excoriation and inflammation. Purple-colored lesions may indicate various disorders, including systemic conditions. Thick, honey-colored crusts are characteristic of impetigo or secondary infection in eczema. Clusters of fluid-filled vesicles are seen in herpesvirus infection.
A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder?
The child has had 8 ounces of formula in the past 24 hours. Sepsis is a systemic overresponse to infection resulting from bacteria and viruses, which are the most common fungi, viruses, rickettsia, or parasites. It can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure. Signs of sepsis include a lack of appetite, letheragy, hypotonia, and temperature elevations.
The nurse is taking a health history for an 8-year-old boy who is hospitalized. Which is a risk factor for sepsis in a hospitalized child?
Use of immunosuppression drugs The use of immunosuppression drugs is a risk factor for the hospitalized child. Maternal infection or fever and resuscitation or invasive procedures are sepsis risk factors related to pregnancy and labor. Lack of juvenile immunizations is a risk factor affecting the overall health of the child but does not impact the chance of sepsis.
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 Most childhood exanthems are caused by viruses.
The nurse is preparing to administer acetaminophen to a 4-year-old girl to provide comfort to the child. Which precaution is specific to antipyretics?
Ensure proper dose and interval 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 nurse is attempting to control the infectious process while caring for a client. The nurse changes the client's wound dressing when the dressing becomes soiled. Which link of the chain of infection is the nurse interrupting with this intervention?
Reservoir The reservoir is the place where a microorganism grows and reproduces. Dressings left unchanged leave a dark, warm, moist environment for microorganisms to thrive. Covering the mouth and using personal protective equipment are ways to control portals of exit. Modes of transmission can be controlled with hand washing and personal protective equipment. The susceptible host is the person who is susceptible to develop an infection. Promotion of natural defenses is a good way to prevent infection.
An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. Which action by the nurse would be most appropriate?
Take the child to a private room and interview her regarding her sexual history and partners. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Pelvic inflammatory disease can cause sterility in the female, primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. A tubal pregnancy may be the consequence of a chlamydial infection. In the male, sterility may result from epididymitis caused by a chlamydial infection. All sexual partners must be treated.
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. 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 communicable period occurs primarily during the catarrhal stage. Respiratory precautions are not required during the convalescent phase.
The nurse is discussing fever with the parents of a child who is in the emergency department with a temperature of 101 degrees Fahrenheit. Which statement by a parent indicates an understanding about fevers and their management in the ill child?
"Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection." Fevers can be protective and can help the body fight the infection. Fevers slow down bacterial or viral growth. Mismanaging fevers include inappropriate dosing of antipyretics, awakening a child at night to administer antipyretics, and using cold water or sponging the child with alcohol to reduce the temperature
The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions?
"We need to make sure that he washes his hands frequently." The child with varicella needs to wash his hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may help the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection.
What is one of the most commonly reported communicable diseases in the United States?
Gonorrhea Gonorrhea is one of the most commonly reported communicable diseases in the United States.
When the physician looks in a child's mouth during a sick-visit exam, the mother exclaims: "Her tongue is bright red! It was not like that yesterday." The physician would most likely order which medication based on the probable diagnosis of scarlet fever?
Penicillin to prevent acute glomerulonephritis A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to prevent the complications of acute glomerulonephritis and rheumatic fever associated with beta-hemolytic group A streptococcal infections.
Mupirocin is a topical antibacterial agent active against impetigo caused by staphylococci or streptococci. Cortisone would not be effective in treating impetigo.
Acyclovir is a topical antiviral agent that inhibits DNA replication in the virus It inhibits the activity of herpes simplex types 1 and 2, varicella zoster, Epstein-Barr virus, and cytomegalovirus.
When obtaining the history of a child diagnosed with West Nile virus, the nurse would expect to find exposure to what cause of this illness?
Mosquito bite West Nile virus is transmitted to humans primarily through the bite of infected mosquitoes. Deer ticks are associated with the transmission of Lyme disease. Exposure to cat feces can increase the risk for toxoplasmosis. Poor sanitation can lead to several infections such as roundworm infestation.
Which diagnostic tool is used to identify children who may have an infection or inflammatory process?
Erythrocyte sedimentation rate (ESR) 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.
What is the leading cause of neonatal sepsis and death?
Group B streptococcus Group B streptococcus is the leading cause of neonatal sepsis and death.
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 Mumps is an infectious disease with a primary symptom of a swollen parotid gland
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--Diagnosis is confirmed by direct visualization of the worms. Parents can view the sleeping child's anus with a flashlight. The worm is white, thin, and about ½ to 1 in (1.3 to 2.5 cm) long, and it moves. A tape test, is used to capture worms and eggs. Transparent tape is lightly touched to the anus and then applied to a slide for microscopic examination. obtained as the child awakens, before toileting or bathing. Pinworm infections are not required to be reported. Gonorrhea is a reportable infectious disease. Lyme disease is a reportable infectious disease. Pertussis is a reportable infectious disease.
The nurse is reviewing the assessment data from a 4-year-old admitted to the hospital for management of early onset sepsis. Which finding supports the diagnosis?
The child is irritable Sepsis may be associated with lethargy, irritability, or changes in level of consciousness. The septic child will likely not be anxious to have a high activity level and would prefer to remain in bed. The temperature elevation of 98.8 °F (37.11°C) is not significant and does not confirm the presence of sepsis.
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 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 10-year-old boy has an unknown infection and will need to provide a urine specimen for culture and sensitivity. To assure that the sensitivity results are accurate, which step is most important?
Obtain specimen before antibiotics are given In order to ensure a successful culture, the nurse must determine if the child is taking antibiotics. Throat cultures require specimens taken from the pharyngeal or tonsilar area. Stool cultures may require three specimens, each on a different day. The nurse would use aseptic technique when getting a blood specimen as well as the urine, but antibiotics cannot be received by the child prior to the test being done.
When the physician looks in a child's mouth during a sick-visit exam, the mother exclaims: "Her tongue is bright red! It was not like that yesterday." The physician would most likely order which medication based on the probable diagnosis of scarlet fever?
Penicillin to prevent acute glomerulonephritis A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to prevent the complications of acute glomerulonephritis and rheumatic fever associated with beta-hemolytic group A streptococcal infections. Pastia's sign describes a rash seen in scarlet fever that will blanch with pressure except in areas of deep creases and the folds of joints.The tongue initially is coated with a white furry covering, with red projecting papillae (white strawberry tongue). By the fourth to fifth day, the white strawberry tongue sloughs off, leaving a red swollen tongue (strawberry tongue) The pharynx is edematous and beefy red.
A nurse is providing care to an infant who develops roseola during hospitalization. The nurse would institute which infection control precaution?
Standard If an infant develops roseola infantum in the hospital, the nurse would follow standard precautions. There is no need for airborne, droplet, or contact communicable period is unknownprecautions.
Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply.
Wearing protective clothing when playing in wooded areas. Inspecting the skin closely for ticks after the child plays in wooded areas. Contacting the health care provider if there is any area of inflammation that might be a bite. The nurse should teach the parents to have the child wear protective clothing and dress the child in light clothing when playing in wooded areas or going outdoors. The parents should inspect the child's skin closely for ticks after being outside in wooded areas and if any ticks are found, remove them with a tweezer, not rub them with a credit card. The parents also should be instructed to contact their health care provider if they notice any area of inflammation that might be a tick bite
The nurse is caring for a 7-year-old child in droplet precautions due to the diagnosis of pertussis. While visiting the child, which actions by the parents require the nurse to intervene? Select all that apply.
The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection." The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing." All close contacts who are younger than 7 years of age and who are unimmunized or underimmunized should have pertussis immunization initiated or the series completed according to the recommended dosing schedule. Fluids should be increased in order to help thin secretions and prevent dehydration during the infection. The parents are correct in removing their PPE at the door and washing their hands when leaving the room, and wearing a mask. All antibiotics should be finished in order to treat the infection adequately and prevent immunity to antibiotics.
The physician has ordered ibuprofen 150 mg every 6 hours as needed for a 3-year-old child for a fever greater than 38 Celsius. The label of the ibuprofen bottle reads "ibuprofen oral suspension 100 mg/5 mL." How much ibuprofen liquid will the nurse administer if the child's temperature goes above 38 C? Record your answer using one decimal place.
7.5 ml The dose ordered (150 mg) is divided by the available dosage (100 mg) then multiplied by 5 mL
A 16-year-old is seen in the emergency department with symptoms including a high fever, chills, headache, nausea and vomiting, and painful joints. During the nursing history the teenager reports recently returning from a trip to a rain forest in South America. What infectious disease does the nurse suspect the client has contracted?
Malaria Malaria comes from a bite of Anopheles species of mosquito and is mostly found in Africa, Asia and South America. Anaplasmosis comes from a tick and occurs mostly in the upper Midwest and northeast United States. West Nile disease comes from a mosquito and is found throughout United States, with higher rates found in Great Plains and mountain regions. Rabies is a viral infection that comes from close contact with the saliva of a rabid animal.
The nurse is caring for a 16-year-old child with a diagnosis of acquired immunodeficiency syndrome (AIDS). What treatment goal has the highest priority for this child?
Preventing spread of infection Major goals for the child include maintaining the highest level of wellness possible by preventing infection and the spread of the infection. Because the adolescent has the belief that nothing can hurt him or her, and because of the increasing rate of sexual activity in this age group which often involves multiple partners, the highest priority is teaching and preventing the spread of the infection. Othe goals include maintaining skin integrity, minimizing pain, improving nutrition, alleviating social isolation, and diminishing a feeling of hopelessness. The primary goal for the family is improving coping skills and helping the teen cope with the illness.
A nurse practitioner suspects that a child has scarlet fever based on which assessment finding?
Red, strawberry tongue. 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.
