Chapter 37: Nursing Care of the Child With an Infectious or Communicable Disorder
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: infection with group A streptococcus. the bite of a tick. contact with contaminated sports equipment. an animal bite.
the bite of a tick. Explanation: Rocky Mountain spotted fever is a tick-borne infection. Rabies is due to the bite of an animal. Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is transmitted through direct person-to-person contact, respiratory droplets, blood, or sharing of personal items and touching surfaces or items contaminated with MRSA. Scarlet fever is an infection resulting from group A streptococcus.
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. Antibiotic therapy may be initiated. Range of motion to prevent contractures. Antiviral medications can be prescribed.
Encourage rest and relaxation. 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.
The nurse is assessing a child who presents with a history of fever, malaise, fatigue, and headache. The nurse notes a bulls-eye rash on the child's right leg. Which action will the nurse take? Clean the rash with rubbing alcohol. Notify the primary health care provider. Obtain an electrocardiography (ECG). Place the child on contact precautions.
Notify the primary health care provider. Explanation: The nurse would suspect the child has Lyme disease and notify the health care provider for additional testing and potential antibiotic therapy. Precautions are not indicated for clients with Lyme disease. An ECG would only be needed if cardiac symptoms were noted. It is recommended to clean the site of the tick bite with rubbing alcohol when the tick is removed, not at a later time.
When caring for a child diagnosed with West Nile virus, the nurse will question which prescription from the primary health care provider? acetaminophen every 4 to 6 hours PRN fever amoxicillin 40 mg/kg/day orally every 8 hours Monitor the client's cardiac status. Place client on fall precautions.
amoxicillin 40 mg/kg/day orally every 8 hours Explanation: West Nile virus is transmitted to humans primarily through the bite of infected mosquitoes and manifestations include: fever, weakness, fatigue, balance problems, memory impairment, headache, myocarditis, hepatitis, myositis and orchitis, and rhabdomyolysis. Treatment is symptomatic. Since this is a viral illness, antibiotics would not be given and the nurse would question such prescriptions. It is appropriate to give acetaminophen for the fever or pain; place on fall precautions due to fatigue, balance problems, and weakness; and monitor the cardiac status for the development of myocarditis.
While hospitalized, a child develops scarlet fever. Isolation has been prescribed by the health care provider. The nurse would place this child in what type of isolation? droplet contact reverse airborne
droplet Explanation: Scarlet fever is produced by group A streptococcus. It is most seen in children ages 5 years to 15 years. It is spread by droplets from respiratory secretions by talking, coughing, or sneezing. These droplets can travel 3 feet (1 meter). Isolation recommendations require the use of a mask for care of the child. Airborne isolation is required for illness that also produce droplets but these are smaller, can travel further and stay suspended in the air. An N95 mask and negative pressure room is required for this type of isolation. Contact isolation requires the use of gowns, masks and gloves for direct contact with an infected person. Reverse isolation occurs if the client is neutropenic.
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? erythromycin clarithromycin trimethoprim-sulfamethoxazole penicillin V
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.
The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old girl. Which technique would most likely be used? Accessing an indwelling venous access device. Puncturing a vein on the dorsal side of the hand. Administering sucrose prior to beginning. Using an automatic lancet device on the heel.
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.
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? lack of juvenile immunizations use of immunosuppression drugs resuscitation or invasive procedures maternal infection or fever
use of immunosuppression drugs Explanation: 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.
The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed? "Acetaminophen or ibuprofen can be given to help with pain." "Antibiotics are needed to help our child recover from rubella." "Our child is contagious for 1 week after the rash appeared." "Family members should wear a mask when coming to visit us."
"Antibiotics are needed to help our child recover from rubella." Explanation: 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.
The nurse is discussing fever with the parents of a child who is in the emergency department with a temperature of 101°F (38.3°C). Which statement by a parent indicates an understanding of fevers and their management in the ill child? "My wife and I have been using cold water and washcloths on him because of the fever." "Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection." "We've had to wake him up in the night to give him more medicine to reduce his temperature." "We've been giving him a little extra acetaminophen to help bring his fever down."
"Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection." Explanation: 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.
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? "As long as your child washes his hands with soap and water a couple of times a day along with the hand gel, it is effective." "Hand gels are actually very effective in preventing the spread of infection." "At least your child is using some form of hand hygiene." "Alcohol-based hand gels are not as effective as washing the hands with water."
"Hand gels are actually very effective in preventing the spread of infection." Explanation: 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.
After teaching nursing students about childhood exanthems, the instructor determines that the teaching was successful when the students identify what as the primary cause? Parasites Fungi Viruses Bacteria
Viruses Explanation: Most childhood exanthems are caused by viruses.
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? monocytes eosinophils neutrophils lymphocytes
eosinophils Explanation: 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.
The most common complication of varicella is: scarring. secondary bacterial infections. encephalitis. pneumonia.
secondary bacterial infections. Explanation: Varicella starts with lesions that appear first on the scalp, face, trunk, and then extremities. The lesions begin as macules then develop into papules and finally clear, fluid-filled vesicles. These lesions are intensely pruritic. The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.
What is the leading cause of neonatal sepsis and death? Group B streptococcus cytomegalovirus infection Neisseria meningitidis Epstein-Barr virus infection
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.
The nurse is reviewing the assessment data from a 4-year-old child admitted to the hospital for management of early onset sepsis. Which finding supports the diagnosis? The child is unhappy about having to stay in bed. The child is hypertensive. The child's tympanic temperature is 98.8°F (37.11°C). The child is irritable.
The child is irritable. Explanation: Sepsis may be associated with lethargy, irritability, or changes in level of consciousness. The septic child will likely not desire 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.
The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first? a child diagnosed with measles experiencing photophobia and coryza a child with herpes simplex who is reporting mouth pain and pruritis a child diagnosed with chicken pox reporting nausea and malaise a child with erythema infectiosum experiencing fatigue and confusion
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.
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? mode of transmission portal of exit susceptible host reservoir
reservoir Explanation: 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 handwashing and personal protective equipment. The susceptible host is the person who is susceptible to developing an infection. Promotion of natural defenses is a good way to prevent infection.
What is a true statement regarding measles? The incubation period is 10 to 12 days. Peak outbreaks are in the summer. It is transmitted by the fecal-oral route. It is not contagious.
The incubation period is 10 to 12 days. Explanation: Measles is a highly contagious disease spread via droplets from the nasopharyngeal secretions. The typical incubation period is 10 to 12 days. Outbreaks peak in the winter and spring. It is communicable 1 to 2 days before the onset of symptoms. The initial symptoms are fever, cough, coryza and conjunctivitis. These symptoms are followed by Koplik spots seen in the mouth. A rash develops on the head and spreads downward and outward.
A 10-year-old child 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? Use aseptic technique when getting the specimen. Collect three specimens on three different days. Obtain specimen before antibiotics are given. Ensure that the specimen is obtained from proper area.
Obtain specimen before antibiotics are given. Explanation: 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 tonsillar 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.
The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes pustule? discolored skin spot not elevated at the surface small elevation of epidermis filled with a viscous fluid redness of the skin produced by congestion of the capillaries small, circumscribed, solid elevation of the skin
small elevation of epidermis filled with a viscous fluid Explanation: A pustule is a small elevation of epidermis filled with pus.
The nursing is caring for a hospitalized child diagnosed with varicella-zoster virus. The child's parents ask how to prevent the child's siblings from contracting the virus. Which response by the nurse is best? "We will place your child on contact and airborne precautions. It is best for the other children not to visit." "Since this is a virus, there is nothing you can do to prevent your other children from getting it." "Vaccinating your other children is the only way to prevent them from contracting the virus." "As long as your other children wash their hands, they should not contract the virus."
"We will place your child on contact and airborne precautions. It is best for the other children not to visit." Explanation: The causative agent for chickenpox is the varicella-zoster virus, which is spread through contact and airborne methods. The client should be placed on precautions and limit visitors who are at risk. Vaccinating is the best way to prevent the spread of varicella; however, it is not the only way. Preventing exposure will work as well. Stating there is nothing that can be done is incorrect. Handwashing is not effective against varicella.
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 as: rosacea. enterovirus. fifth disease. pityriasis rosea.
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.
A parent calls the nurse triage line at the clinic. The parent is concerned and believes the preschool-aged child may have contracted rubeola. Which question(s) should the nurse ask the parent to aid in making this diagnosis? Select all that apply. "Has your child been around any other children with measles?" "Can you describe what your child's rash looks like?" "How long has your child had the cough and runny nose?" "Has your child completed the measles vaccine series?" "When you look in your child's mouth can you see any spots or anything unusual?"
"How long has your child had the cough and runny nose?" "Has your child been around any other children with measles?" "When you look in your child's mouth can you see any spots or anything unusual?" "Can you describe what your child's rash looks like?" Explanation: Rubeola is caused by the rubeola virus and is spread through droplet transmission. Symptoms generally start with a cough, coryza, conjunctivitis and fever. This stage can last 2 to 4 days. A classic sign is Koplik spots. These are bright red spots with blue-white centers on the buccal mucosa. The rash begins to appear 3 to 4 days after the prodromal symptoms. It is erythematous and maculopapular in nature. The rash starts on the head and expands downward and outward. If the preschool-aged child received a measles vaccine, it should have been administered between 12 to 15 months of age. The second dose would not be due until 4 to 6 years of age, so this preschooler may be too young for the second dose. It would be important to know if the child had been around anyone else with measles. The virus could have been via another child's coughing and sneezing, and the preschool-aged child may not be thoroughly protected with only one dose of the vaccine.
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? "Sepsis results in systemic inflammatory response syndrome (SIRS) due to infection." "The pathophysiology of sepsis is complex." "The pathogens cause an overproduction of proinflammatory cytokines. These cytokines are responsible for the clinically observable effects of the sepsis." "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."
"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.
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 medications is she currently taking?" "Has she done this before?" "How long has she been acting like this?" "What were you doing prior to her beginning to feel sick?"
"What were you doing prior to her beginning to feel sick?" Explanation: 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.
The rash in roseola is pruritic. Which measure would you teach the parent to provide comfort? Apply cool compresses to the skin to stop local itching. Discuss with the child the importance of not scratching lesions. Dress the child warmly to bring out the rash so that it fades quickly. Administer infant aspirin every 4 hours as necessary for comfort.
Apply cool compresses to the skin to stop local itching. Explanation: Rashes can be uncomfortable and irritating. Parents need to be educated on ways to relieve discomfort and to protect and maintain skin integrity. Cool compresses or cool baths will help to relieve the itching associated with the rash. Antipruritics may be necessary to help with itching. To protect the skin, the child should be instructed not to scratch the skin to alleviate itching. The child's fingernails should be kept short. Keeping the child dressed warmly will not bring out the rash any sooner. Being warm will, however, cause increased body temperature and intensify the itching. Aspirin should not be used in children as an antipyretic. There is an increased risk of developing Reye syndrome.
Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be which period? Illness period Prodromal period Convalescent period Incubation period
Incubation period Explanation: Infection occurs when an organism invades the body and multiplies, causing damage to the tissue and cells. The infectious process goes through four stages. 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. The prodromal period is the time from the onset of nonspecific symptoms to specific symptoms, for example, cold/flu-like symptoms before Koplik spots occur in measles. The illness is the time during which symptoms of the specific illness occur. The convalescent stage is the time when the acute symptoms disappear.
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? Initiate antibiotic therapy. Obtain blood cultures. Obtain urine specimen for analysis. Initiate intravenous therapy.
Obtain blood cultures. Explanation: 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.
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. The child's birth history indicates he was born at 42 weeks' gestation. The child cries when his mother is not in sight. The child has had 7 wet diapers in the past 24 hours.
The child has had 8 ounces of formula in the past 24 hours. Explanation: 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, lethargy, hypotonia, and temperature elevations.
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 subsequently played with. In this case, what is the portal of exit in the chain of infection? The friend Upper respiratory excretion Toy The 5-year-old girl
Upper respiratory excretion Explanation: The portal of exit is the route by which an organism leaves an infected child's body to be spread to others. An 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.
Parents usually ask when their child can return to school after having chickenpox. The correct answer would be: as soon as the temperature is normal. as soon as all lesions are crusted. not until all lesions have completely faded. 10 days after the initial lesions appear.
as soon as all lesions are crusted. Explanation: Chickenpox lesions are infectious until they crust.
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. impetigo. pneumonia. osteomyelitis.
scarlet fever. Explanation: 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.
The nurse is assessing a 8-month-old infant who has symptoms of poor feeding, a poor gag reflex, listlessness and a weak cry. What is the most important question the nurse should ask the parent about these symptoms? "Have you given your infant any honey?" "Has your infant had any unpasteurized milk to drink?" "What is the source of your family's water supply?" "When did these symptoms begin?"
"Have you given your infant any honey?" Explanation: Infant botulism occurs when the infant ingests the spores of Clostridium botulinum. These multiply in the intestinal track and produce toxins. The disease is caused by the ingestion of spores from dust, improperly preserved home-canned foods and feeding an infant under 1 year of age raw honey. The infant has poor feeding, is listless, has a weak cry, and has a poor gag reflex—a distinguishing symptom. The nurse would ask about the water supply and unpasteurized milk if food poisonings or parasites were suspected. Asking about the date of the infant's illness is important, but this information does not take priority over the question about honey.
An adolescent comes to the emergency room with high fevers, chills, rigors and sweats. Malaria is suspected. When taking the health history, what question should the nurse ask first? "Is anyone else in your household sick?" "Have you traveled outside North America?" "When did your symptoms begin?" "Are there days your symptoms are worse?"
"Have you traveled outside North America?" Explanation: Malaria comes from a bite of Anopheles species of mosquito. The infection produces high fevers, chills, rigors, sweats, headaches and arthralgia. If the disease is suspected, it would be most important for the nurse to know if the adolescent had traveled to any areas in Africa, Asia or South America, where the type of mosquitoes are found that produce malaria. All of the other questions are appropriate, but they are not as important as the travel, which could help lead to a definitive diagnosis.
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 a health care provider has given written permission." "Your child may return to school when all of the lesions have crusted over." "Your child may return to school when there has been no fever for 48 hours." "Your child may return to school when free of any lesions."
"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.
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? Droplet precautions Standard precautions Contact precautions Airborne precautions
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 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 Ascariasis Scabies Rocky Mountain spotted fever Psittacosis
Lyme disease Rocky Mountain spotted fever Explanation: 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. Scabies is a parasitic infection caused by a female mite.
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? Mononucleosis Mumps Fifth disease Measles
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.
When the health care provider looks in a child's mouth during a sick-visit examination, the parent exclaims: "The tongue is bright strawberry red! It was not like that yesterday." The health care provider would most likely prescribe which medication based on the probable diagnosis? Erythromycin to prevent the spread to siblings Steroids to decrease the inflammation Penicillin to prevent acute glomerulonephritis Acetaminophen to decrease the throat pain
Penicillin to prevent acute glomerulonephritis Explanation: A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to treat the beta-hemolytic group A streptococcal infection and to prevent the complication of developing acute glomerulonephritis and rheumatic fever. Erythromycin can be used to treat the disease if the child is allergic to penicillin. Antibiotics are not given prophylactically to siblings. The disease is spread via droplets, so keeping the siblings away from the infected child and handwashing are the best preventive measures. Acetaminophen can be administered for fever control. It works systemically and has very little, if any, affect locally. Antibiotics are the mainstay of treatment. Steroids are used infrequently.
A 6-month-old boy is brought to the doctor's office with a high fever. The physician diagnoses the child as having a viral infection of some kind and recommends acetaminophen to reduce the fever. After 3 days, the mother returns with the child. The fever is gone, but a rash of discrete, rose-pink macules approximately 2 to 3 mm and flat with the skin surface appears. Which condition should the nurse suspect? Measles (rubeola) Rubella (German measles) Chickenpox (varicella) Roseola
Roseola Explanation: Roseola begins with a high fever; after 3 or 4 days, the fever falls abruptly and a distinctive rash of discrete, rose-pink macules approximately 2 to 3 mm in size and flat with the skin surface appears. With rubella, after the 1 to 5 days of prodromal signs, a discrete pink-red maculopapular rash begins on the face, then spreads downward to the trunk and extremities. On the third day, the rash disappears. Measles feature Koplik spots (small, irregular, bright-red spots with a blue-white center point), which appear on the buccal membrane. Chickenpox is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a distinctive rash. Varicella lesions first begin as a macula, then progress rapidly within 6 to 8 hours to a papule, then a vesicle that becomes umbilicated and then forms a crust.
What is a true statement regarding varicella zoster virus infection? The incubation period is 7 days. It tends to be more severe in children. It is transmitted by fecal-oral route. Secondary bacterial infections of the skin can occur.
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.
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 nurse will administer antibiotics. The nurse will encourage bed rest. The nurse will monitor caloric intake.
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 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 remove their personal protective equipment (PPE) at the door before exiting, then wash their hands. The parents wear a respiratory mask when entering their child's room. The parents state, "We will be sure to finish any antibiotic if our child is sent home with a prescription." The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing."
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." Explanation: 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.
Assessment of a child reveals black burrows of about 1-inch long between the fingers and toes and in the axilla. A diagnosis of scabies is made. When planning this child's care, the nurse anticipates which medication being prescribed? oral albendazole topical permethrin oral pyrantel pamoate oral nitazoxanide
topical permethrin Explanation: Topical permethrin 5% cream is the drug of choice for treating scabies. The oral medications albendazole, pyrantel pamoate and nitazoxanide are used to treat helminthic (parasitic worm) infections.