PEDS: Chapter 15 Nursing Care of the Child with an Infection

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

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.

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 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.

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.

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. Cool compresses can minimize pruritus. Aspirin should not be given with increased temperature (flu-like symptoms).

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.

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.

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.

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.

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. 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 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.

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 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.

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.

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.

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.

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.

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.

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 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 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.

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.

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 Small, irregular, bright red spots on the buccal membrane 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, sore throat, and red maculopapular rash. 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.

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 precautions.

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.

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

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

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 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

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.

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.

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.

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.

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.

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.

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 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.

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.

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 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.

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.

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.

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.