Peds communicable diseases
rubella - german measles
!!!Most Benign of All Childhood Comm Diseases! -get cataracts if exposed in utero! keep away from pregnant women! prodromal - asbent in kids. h/a, malaise, sore throat, coryza, lymphadenopathy. -rash - first on face, then down and out, gone in 3 days. -tx: supportive -complication: arthritis, encephalitis
erythema infectiosum - 5th disease
!!!fetal death if mom is infected during pregnancy!!!! -3 stages of rash: slapped cheek, maculopapular lacy rash, rash leaves but may reappear. -tx: supportive, antipyretics, analgesics. -complications: rare, but aplastic crisis, arthritis arthralgia.
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?
"Antibiotics are needed to help our child recover from rubella."
Incubation of Varicella
14-16 days but can be as long as 18-21 day
Varicella-Treatment
Acyclovir and Varicella Zoster Immune Globin in High Risk Children After Transmission Strict Isolation Skin care-Comfort, Cool Bath, Calamine Avoid use of aspirin/salicylates Manage itching w/distraction, benadryl in moderation
How is Pertussis treated?
Antibiotics
German Measles-Contracted during Pregnancy
Benign course for affected child, but more serious when acquired in pregnancy; teratogenic effects noted on fetus (congenital heart disease, hearing loss, growth delay, learning disablities, mental retardation, eye/neurologic/endocrine abnormalities); also can cause stillbirths, miscarriages Immune status always checked in pregnancy
What is Varicella?
Chicken Pox
Rubeola-Complications
Complications include otitis media, pneumonia, bronchiolitis, obstructive laryngitis/laryngotracheitis, encephalitis
The nurse working at the child community clinic must administer the influenza vaccine to the high-risk kids first. Which child would she choose? a) 12-month-old Sally who is very healthy b) 22-month-old Jared who has a wound from touching a hot pan at home c) 21-month-old Chris who has a cold d) 23-month-old Ava who had heart surgery as an infant for a defect
D. Children who are considered high risk and could benefit from the influenza vaccine are: immunocompromised; have a chronic pulmonary disease; have had a congenital abnormality, chronic renal or metabolic diseases, sickle-cell disease, HIV, and any type of neurological disorder (seizures). The other choices would be considered normal and the child is not at high risk.
Which Vaccines have five series?
DTaP
How is Varicella Transmitted?
Droplet (Airborne) and Contact
How is Rubeola transmitted?
Droplet from respiratory tract, blood, urine
What is Erythema Infectiosum?
Fifth Disease Caused by Parvovirus B19
What is Scarlet Fever?
Group A beta-hemolytic strep
Which Vaccines have four series?
Hib PCV IPV
Exanthem Subitum-Characteristics
High fever with unknown etiology for several days Followed by rash once fever is resolved may have lymphadenopathy, inflamed pharynx, cough, coryza
Rubeola-What does the rash look like?
Initially erythematous maculopapular progressing to brownish with desquemation
Question: A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them.
Low-grade fever Macular rash Papular rash Vesicle formation Crusting Explanation: The disease is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a rash. The lesion begins as a macula, then progresses rapidly within 6 to 8 hours to a papule, then to a vesicle that first becomes umbilicated and then forms a crust.
Which Vaccines have two series?
MMR Varicella Hep A
What is Rubeola?
Measles Viral Infection
Erythema Infectiosum-Manifestations
Mild Fever Joint Pain Lethargy Rash-3 stages
Prodromal Period of Varicella
Mild fever Malaise x 24 hours prior onset of rash MOST CONTAGIOUS AT THIS TIME
The home care nurse is observing a mother prepare mupirocin to treat a preschool-age child's skin rash. At which point should the nurse stop the mother during the preparation of the medication?
Mother measures out a teaspoon of the medication for the child to take orally.
German Measles-Characteristics
No prodromal symptoms in children; in adults, adolescents: low grade fever, headache, malaise, anorexia, conjunctivitis, coryza, sore throat, cough, lymphadenopathy; followed by rash, starting on face and progressing downward, by end of 1st day body is covered
What is Mumps? How is it Transmitted?
Paramyxovirus Transmitted by contact or droplet spread of infected saliva
What is the complication of Pertussis?
Pneumonia
German Measles-Complications
Rare-but include arthritis, encephalitis, purpura
Varicella-Manifestations
Rash erupts 1 day after prodromal period Very itchy Begins as a macule and progresses to a papule Then becomes a fluid filled vesicle resembling a dew drop, which breaks and forms a crust starts in trunk and progress to proximal extremities and face
German Measles-What does the rash look like?
Rash is maculopapular, pinkish red; usually disappears in same order that it appeared
Erythema Infectiosum-Risk during Pregnancy
Risk of fetal hydrops and death May need serologic testing if exposed to monitor immune status
What is Exanthem Subitum?
Roseola Human herpes virus type 6
What is German Measles?
Rubella Virus
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.
Varicella-Complications
Secondary bacterial infections Encephalitis Pneumonia Hemorrhagic Varicella Chronic or transient thrombocytopenia
Erythema Infectiosum-Management
Self Limiting, can only manage symptoms *anti-pyretics *analgesics
German Measles-Treatment
Self limiting, treatment includes antipyretics, analgesics
Exanthem Subitum-Treatment
Self limiting. Treat the symptoms!
Pertussis-Characteristics
Short, rapid coughs followed up a crowing or "whoop" sound
Mumps-Treatment
Supportive: analgesics, antipyretics; IV fluids if unable to drink/vomiting due to meningoencephalitis Maintain isolation
A group of nurses is reviewing the diagnosis of cystic fibrosis. With regard to the effect of this disease on the body, in addition to the lungs which of the following are most affected by this disease? a) Kidney and bladder b) Pancreas and liver c) Brain and spinal cord d) Heart and blood vessels
The major organs affected are the lungs, pancreas, and liver. The brain, spinal cord, heart, blood vessels, kidney and bladder are not the most affected organs.
How is Scarlet Fever transmitted?
Transmitted by direct contact/droplet spread from infected nasopharyngeal secretions
How is German Measles Transmitted?
Transmitted by nasopharyngeal secretions, blood, urine, stool
Rubeola-Treatment
Treatment includes supplementation w/vitamin A; supportive care Maintain isolation until 5th day of rash, bedrest
How is Exanthem Subitum transmitted?
Unknown transmission and source
How is Erythema Infectiosum Transmitted?
Unknown-? respiratory secretions and blood
What is Pertussis?
Whooping Cough Caused by bordetella pertussis
A 6-year-old has had a viral infection for the past 5 days and is now having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which of the following questions? a) "Did you use any medications like aspirin for the fever?" b) "What type of fluids did your child take when he had a fever?" c) "How high did his temperature rise when he was ill?" d) "Did you give your child any acetaminophen, such as Tylenol?"
a) "Did you use any medications like aspirin for the fever?" Explanation: Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child.
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. The nurse documents this as which of the following? a) Koplik spots b) Nits c) Slapped cheek appearance d) Lymphadenopathy
a) Koplik spots Explanation: Koplik spots are bright red spots with blue-white centers appearing primarily on the buccal mucosa and indicate rubeola (measles). They are often described as tiny grains of white sand surrounded by red rings. Lymphadenopathy is used to document enlargement of the lymph nodes. Slapped cheek appearance refers to the erythematous flushing associated with fifth disease. Nits refer to the adult eggs of pediculosis.
Which of the following is a true statement regarding measles?
a) The incubation period is 8 to 12 days. Explanation: The typical incubation period is 8 to 12 days. Outbreaks peak in the winter and spring. It is highly contagious and is transmitted by airborne suspended droplets.
After teaching nursing students about childhood exanthems, the instructor determines that the teaching was successful when the students identify which of the following as the primary cause? a) Viruses b) Parasites c) Fungi d) Bacteria
a) Viruses Explanation: Most childhood exanthems are caused by viruses.
Scarlet Fever-Treatment
antibiotics (penicillin, erythromycin) x 10 days, analgesics, antipyretics.
A nursing instructor is teaching students about normal childhood infectious diseases. Which disease does the teacher tell students is transferred by the varicella-zoster virus? a) Mumps b) Chickenpox c) Rubella d) Measles
b) Chickenpox Explanation: The causative agent for chickenpox is the varicella-zoster virus.
Which of the following would the nurse include in the teaching plan for parents and their child with a pruritic rash? Select all that apply. a) Using warm baths to soothe the skin b) Keeping fingernails trimmed short c) Encouraging pressure on the skin rather than scratching d) Using distraction to prevent scratching e) Making sure the child's hands are clean
b) Keeping fingernails trimmed short c) Encouraging pressure on the skin rather than scratching d) Using distraction to prevent scratching e) Making sure the child's hands are clean Explanation: To reduce pruritus, teaching would include keeping the child's nails trimmed short, using distraction to prevent scratching, using pressure on the skin rather than scratching, and making sure the child's hands are clean. Cool baths and compresses would help relieve itching.
Which of the following begins as an upper respiratory illness and progresses to a persistent cough characterized by an inspiratory whoop? a) Sepsis b) Pertussis c) HIV d) TB
b) Pertussis Explanation: Pertussis, also known as whooping cough, begins as an upper respiratory illness and progresses to a persistent cough characterized by an inspiratory whoop. TB is not characterized by an inspiratory whoop. Sepsis and HIV are not associated with an inspiratory whoop.
A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of which of the following?
b) 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 caring for a child diagnosed with Haemophilus Influenzae type B. Which of the following nursing interventions would be the highest priority in the prevention of complications seen with this disorder? a) The nurse will monitor fluid intake. b) The nurse will administer antibiotics. c) The nurse will monitor for seizure activity. d) The nurse will elevate the head of the bed.
b) The nurse will administer antibiotics. Rationale: A serious complication of Haemophilus Influenzae type B is meningitis. Antibiotics are administered to treat the bacterium infection caused by Haemophilus Influenzae type B.
A chief danger of scarlet fever is that children may develop a) local areas of skin necrosis. b) acute glomerulonephritis. c) respiratory obstruction. d) liver destruction.
b) acute glomerulonephritis. Explanation: Because this is a streptococci-based infection, there is a chance the child will develop rheumatic fever or glomerulonephritis following the illness.
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 of the following infectious diseases?
b) mumps Explanation: Mumps is an infectious disease with a primary symptom of a swollen parotid gland.
Pertussis
before 2 months. -URI sx for 1-2 weeks, dry hacking cough. -then for 4-6 weeks see whooping cough on inspiration, cyanosis, vomiting, 100 day cough, worse at night -tx: erythromycin, immunoglobulin, supportive tx-bedrest, o2, fluids. -complications: pneumonia, atelectasis, OM, seizures, hernia, *Hemorrhage. -isolate, maintain BR, encourage PO, observe for signs of airway obstruction.
The rash in roseola is pruritic. Which of the following measures would you teach the father to provide comfort? a) Discuss with the child the importance of not scratching lesions. b) Dress the child warmly to bring out the rash so that it fades quickly. c) Apply cool compresses to the skin to stop local itching. d) Administer infant aspirin every 4 hours as necessary for comfort.
c) Apply cool compresses to the skin to stop local itching. Explanation: Cool compresses can minimize pruritus. Aspirin should not be given with increased temperature (flu-like symptoms).
A nurse is assessing a 3-year-old child with nuchal rigidity. Which sign would be documented on the chart to support this condition? a) Positive Homans' sign b) Negative Kernig's sign c) Positive Kernig's sign d) Negative Brudzinski's sign
c) Positive Kernig's sign Explanation: A positive Kernig's sign indicates nuchal rigidity, caused by an irritative lesion of the subarachnoid space. A positive Brudzinski's sign also is indicative of the condition. A positive Homans' sign may indicate venous inflammation of the lower leg.
A nurse practitioner suspects that a child has scarlet fever based on which of the following assessment findings? a) An enanthematous rash b) White exudate on the tonsils c) Red, strawberry tongue d) Severity of the sore throat
c) Red, strawberry tongue Explanation: The characteristic assessment finding that distinguishes scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis.
Which of the following should be included in the teaching plan for a child with varicella? a) Administer aspirin for fever. b) Place the child in a warm bath for skin discomfort. c) Remind the child not to scratch the lesions. d) Utilize salt solutions to assist in healing oral lesions.
c) Remind the child not to scratch the lesions. Explanation: The teaching plan for varicella should include that the child not scratch the lesions. Acetaminophen should be administered for fever, not aspirin, due to the link with Reye syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. The child should avoid citrus, spicy, or salty foods.
A 6-month-old baby 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? a) Rubella (German measles) b) Chickenpox (Varicella) c) Roseola d) Measles (Rubeola)
c) 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's 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.
The most common complication of varicella includes which of the following? a) Scarring b) Pneumonia c) Secondary bacterial infections d) Encephalitis
c) Secondary bacterial infections Explanation: The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.
A nurse is providing care to an infant who develops roseola during hospitalization. The nurse would institute which of the following infection control precautions.
c) Standard Explanation: If an infant develops roseola infantum in the hospital, the nurse would follow standard precautions. There is no need for airborne, droplet, or contact precautions.
The nurse is caring for a child hospitalized with pertussis. Which of the following nursing interventions would be the highest priority for this child?
c) The nurse will administer oxygen. Explanation: The major complication of pertussis (whooping cough) is pneumonia and respiratory complications. Oxygen, bed rest, and monitor for airway obstruction are nursing interventions. The highest priority is administering oxygen to maintain adequate oxygenation of cells.
The nurse is assessing a toddler for motor function. Which of the following activities will be most valuable? a) Give the child some potato chips. b) Have the child catch a ball. c) Watch the child playing with a pull-toy. d) Let the child look at a picture book.
c) Watch the child playing with a pull-toy. Explanation: Watching the child playing with a pull-toy would be most valuable for assessing motor function. Catching a ball is too advanced for a toddler to accomplish. Looking at a picture book would help assess visual acuity and eye movement. Eating potato chips would help assess sensor function for taste.
Erythema Infectiosum-Complications
chronic joint pain aplastic crisis myocarditis
A 3-week-old infant is diagnosed with pertussis. Which antimicrobial agent would the nurse expect the physician to prescribe?
d) Azithromycin Explanation: The macrolides (erythromycin, azithromycin, and clarithromycin) are the drugs of choice for pertussis in children over 6 months of age. Azithromycin and clarithromycin are not FDA approved for use in infants younger than 6 months; however, infants younger than 1 month old should be treated with azithromycin because erythromycin is associated with increased risk of infantile hypertrophic pyloric stenosis. Trimethoprim-sulfamethoxazole is an alternative antibiotic for children who cannot tolerate erythromycin.
A child is diagnosed with aseptic meningitis. The child's mother states, "I don't know where she would have picked this up." The nurse prepares to respond to the mother, based on the understanding that this disorder is most likely caused by which of the following? a) Haemophilus influenza type B b) Escherichia coli c) Streptococcus group B d) Enterovirus
d) Enterovirus Explanation: Aseptic meningitis is the most common type of meningitis, and if a causative organism can be identified, it is usually a virus such as enterovirus. E. coli is a cause of bacterial meningitis. H. influenza type B is a cause of bacterial meningitis. Streptococcus group B is a cause of bacterial meningitis.
The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for? a) Jaundice, drowsiness, and refusal to eat b) Negative Kernig's sign c) Flat fontanel d) Irritability, fever, and vomiting
d) Irritability, fever, and vomiting Explanation: Findings associated with acute bacterial meningitis may include irritability, fever, and vomiting along with seizure activity. Fontanels would be bulging as intracranial pressure rises, and Kernig's sign would be present due to meningeal irritation. Jaundice, drowsiness, and refusal to eat indicate a GI disturbance rather than meningitis.
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 of the following conditions? a) Infectious mononucleosis b) Poliomyelitis c) Herpes zoster d) Mumps
d) Mumps Explanation: Initial symptoms of mumps include fever, headache, anorexia, and malaise. Within 24 hours, pain on chewing and an "earache" occurs. When the child points to the site of the earache, however, the child points, not to the ear, but 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
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? a) Acetaminophen to decrease the throat pain b) Steroids to decrease the inflammation c) Erythromycin to prevent the spread to siblings d) Penicillin to prevent acute glomerulonephritis
d) Penicillin to prevent acute glomerulonephritis Explanation: 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.
Mumps-Characterized
fever, headache, malaise, anorexia, earache w/chewing; parotitis w/enlargement, pain and tenderness; may have submaxillary/sublingual infection, orchitis, meningoencephalitis
Scarlet Fever-Complications
otitis media, peritonsillar/retropharyngeal abcess, sinusitis, glomerulonephritis, carditis/polyarthritis
Mumps
prodromal- fever, ha, malaise, earache. -parotitis! - by 3rd day. painful & tender, jaw & ear pain. -tx: supportive - analgesics, antipyretics, IVF if poor PO. -complications: sensorineural deafness, postinfections encephalitis, myocarditis, arthritis, hepatitis, sterility in men, meningitis, epididymoorchitis. -bedrest, analgesics, encourage PO, tight underwear to provide warmth & support for orchitis
Mumps-Complications
sensorineural deafness, postinfectious encephalitis, myocarditis, arthritis, hepatitis, epididymo-orchitis, sterility in adult males (rare)
measles - rubeola
-3 C's IS THE MEAS!!! - cough, coryza, conjunctivitis. Koplik spots as well. also fever, malaise at first. -rash- 24 hrs later. erythematous maculopapular eruption on face spreading downward ; fine desquamation. -rash starts on face and down. confluent areas -tx: abx, vitamin A, bedrest, antipyretics , cool mist vaporizor. -complications: otitis media, pneumonia, bronchiolitis, encephalitis, obstructive laryngitis and laryngotracheitis
Varicella
-3 stages- macule, papule, crust. starts on trunk, spreads to face and proximal extremities. -complications: bacterial infex, varicella pneumo, thrombocytopenia. -isolate in hospital, stay at home a week, calamine, gloves, avoid aspirin
Roseola - exanthema subitum
-FEVER then RASH -from herpesvirus type 6 -high fever for 3-4 days, then it goes away and the rash comes -macular maculopapular on trunk then neck face extremities. non puritic, fades w pressure, lasts 1-2 days. -tx : supportive. -complications: febrile seizures
How is Pertussis Transmitted?
Droplet or Direct Contact Incubation: 6-20 days
Rubeola-Characteristics
Fever and Malaise Followed by coryza, cough, conjunctivitis, Koplik spots, anorexia, lymphadenopathy then rash
Scarlet Fever-Characteristics
Fever, malaise, headache, lymphadenopathy, vomiting, chills, abdominal pain, enlarged tonsils w/exudate, erythematous pharynx, strawberry tongue, and RASH
The nurse is providing teaching to the parents of child with varicella. Which of the following statements indicates that the parents have understood the instructions? a) "We need to make sure that he washes his hands frequently." b) "We should apply alcohol to the lesions every four hours." c) "If he has a fever, we can give him some aspirin." d) "The lesions should eventually form soft crusts that drain."
a) "We need to make sure that he washes his hands frequently." Explanation: The child with varicella needs to wash his hand 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.
scarlet fever
-prodromal: high fever, tachycardia, malaise, abd pain -enanthema- enlarged tonsils with exudates, *white strawberry tongue to red strawberry tongue! -exanthema- sandpaper rash, not on face, more in folds of joints. -tx: supportive, bedrest, analgesics, abx (PCN, erythro), abx for carriers -complications: OM, abscess, carditis, polyarthritis
What are the 3 stages of a fifths disease rash?
1) Slapped face appearance on cheeks 2) Maculopapular rash on extremities; resembles lace 3) Skin Appears Irritated
A 6-month-old boy develops roseola. When obtaining information from his father, which of the following information would you expect him to report? a) The infant's temperature fell when the rash appeared. b) The infant is lethargic and not interested in playing. c) The infant's temperature rose at the same time as the rash appeared. d) The rash is a mixture of papules and pustules.
a) The infant's temperature fell when the rash appeared. Explanation: The mark of roseola is that the rash appears as the initial temperature decreases.
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.
The parent of a child with mumps calls the clinic to find out how long the child needs to stay home from school. The nurse would instruct the parent to allow the child to return to school at which time? a) After 9 days from the onset of swelling b) Within 3 days of starting antiviral therapy c) Usually 7 days after the last lesion appears d) In about 5 days, once the lesions crust
a) After 9 days from the onset of swelling Explanation: In the home, educate the family to keep the child with mumps from attending school or daycare until 9 days after the onset of swelling. Mumps involves swelling of the salivary glands; no lesions are present. Therapy for mumps is primarily supportive; antiviral agents are not used.
A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of which of the following? a) Scarlet fever b) Osteomyelitis c) Pneumonia d) Impetigo
a) 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.
Which of the following would you expect to observe about the rash associated with chickenpox (varicella)? a) Various stages of lesions present at the same time b) Dark red color (red hen marks) c) Noticeable crusts but no pruritus d) Dark red, macular, very pruritic lesions
a) Various stages of lesions present at the same time Explanation: Chickenpox lesions appear "in waves," so many stages of lesions are present at the same time.
Parents usually ask when their child can return to school after having chickenpox. The correct answer would be a) as soon as all lesions are crusted. b) as soon as the temperature is normal. c) 10 days after the initial lesions appear. d) not until all lesions have completely faded.
a) as soon as all lesions are crusted. Explanation: Chickenpox lesions are infectious until they crust.
The nurse is caring for a 6-year-old boy with mumps. Which of the following statements by the child would cause the nurse to suspect the boy is experiencing a complication of mumps? a) "I keep coughing up mucus." b) "Please talk a little louder." c) "I feel wobbly when I walk." d) "My knees are sore and stiff."
b) "Please talk a little louder." Rationale: Complications of mumps include meningoencephalitis with seizures and auditory neuritis, which can result in deafness. Joint complaints, which might suggest arthritis, are a complication of erythema infectiosum. Difficulty walking, which might suggest cerebellar ataxia, is a complication of chickenpox. Coughing, which might suggest bronchopneumonia, is a complication of rubeola.
To detect complications as early as possible in a child with meningitis who's receiving I.V. fluids, monitoring for which condition should be the nurse's priority? a) Left-sided heart failure b) Cerebral edema c) Cardiogenic shock d) Renal failure
b) Cerebral edema Explanation: The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of I.V. therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.
A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)? a) Decreased leukocytes b) Decreased pressure c) Cloudy appearance d) Elevated sugar
c) Cloudy appearance Explanation: In the CSF of clients diagnosed with bacterial meningitis, the pressure is elevated, the appearance is cloudy, and the leukocytes are elevated. A decreased sugar content is noted.
Antibiotic therapy to treat meningitis should be instituted immediately after which event? a) Initiation of I.V. therapy b) Admission to the nursing unit c) Collection of cerebrospinal fluid (CSF) and blood for culture d) Identification of the causative organism
c) Collection of cerebrospinal fluid (CSF) and blood for culture Explanation: Antibiotic therapy should always begin immediately after the collection of CSF and blood cultures. After the specific organism is identified, bacteria-specific antibiotics can be administered if the initial choice of antibiotic therapy isn't appropriate. Admission and initiation of I.V. therapy aren't, by themselves, appropriate times to begin antibiotic therapy.
A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which of the following interventions should the nurse take initially? a) Encourage the mother to hold and comfort the infant. b) Palpate the child's fontanels. c) Institute droplet precautions in addition to standard precautions. d) Educate the family about preventing bacterial meningitis.
c) Institute droplet precautions in addition to standard precautions. Explanation: Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one: the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later on once the initial infection has been controlled. Palpating the fontanels is used to assess for hydrocephalus.
Scarlet Fever-What does the rash look like?
red, pinpoint w/sandpaper texture
Seven-year old Isabelle has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when Isabelle first complained of a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which of the following statements would be best for the nurse to say to this mother? a) "This is a serious problem. Aspirin is likely to cause Reye syndrome, and Isabelle should be admitted to the hospital for observation as a precaution." b) "This might or might not be a problem. Watch Isabelle for signs of nasal discharge, sneezing, itching of the nose, or dark circles under the eyes. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." c) "This is unlikely to be a problem. Half an aspirin is not enough to cause harm. Reye syndrome generally only develops from prolonged use of aspirin in connection with a virus." d) "This might or might not be a problem. Watch Isabelle for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome."
d) "This might or might not be a problem. Watch Isabelle for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." Explanation: Reye syndrome usually occurs after a viral illness, particularly after an upper respiratory infection or varicella (chickenpox). Administration of aspirin during the viral illness has been implicated as a contributing factor. As a result, the American Academy of Pediatrics recommends that aspirin or aspirin compounds not be given to children with viral infections. The symptoms appear within three to five days after the initial illness: The child is recuperating unremarkably when symptoms of severe vomiting, irritability, lethargy, and confusion occur. Immediate intervention is needed to prevent serious insult to the brain including respiratory arrest.
In caring for the child with meningitis, the nurse recognizes that which of the following nursing diagnoses would be the most important to include in this child's plan of care? a) Delayed growth and development related to physical restrictions b) Risk for acute pain related to surgical procedure c) Ineffective airway clearance related to history of seizures d) Risk for injury related to seizure activity
d) Risk for injury related to seizure activity Explanation: Keeping the child free of injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and the history of seizures does not impact the airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis.
Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? a) Occurrence of urine and fecal contamination b) Degree and extent of nuchal rigidity c) Onset and character of fever d) Signs of increased intracranial pressure (ICP)
d) Signs of increased intracranial pressure (ICP) Explanation: Assessment of fever and evaluation of nuchal rigidity are important aspects of care, but assessment for signs of increasing ICP should be the highest priority due to the life-threatening implications. Urinary and fecal incontinence can occur in a child who's ill from nearly any cause but doesn't pose a great danger to life.
A young patient in the clinic has a rash, cough, and fever that the mother says spiked on day 5 of the rash. The patient also had conjunctivitis. What would the nurse expect the physician to tell the family that the child has? a) Measles b) Scarlet fever c) Chickenpox d) Rubella
a) Measles Explanation: Measles are diagnosed based on the symptoms of a rash, Koplik spots, conjunctivitis, coryza, cough, and a fever that usually spikes on day 5.
A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan? a) Decrease environmental stimulation b) Take vital signs every 4 hours c) Encourage the parents to hold the child d) Monitor temperature every 4 hours
a) Decrease environmental stimulation Explanation: A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure. Vital signs would be taken initially every hour and temperature monitored every 2 hours. Children with bacterial meningitis are usually much more comfortable if allowed to lie flat because this position doesn't cause increased meningeal irritation.
The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for which of the following? a) Intracranial hemorrhaging b) Closed head injury c) Congenital hydrocephalus d) Positional plagiocephaly
b) Closed head injury Explanation: A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for closed head injury. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long.
An 11-year-old girl arrives at the doctor's office with fever, a sore throat, chills, and malaise. A throat culture indicates scarlet fever. Which other symptom should the nurse notice in this patient that clearly indicates scarlet fever? a) There is pain along the jawline just in front of the ear lobe b) Fever blisters on the lips c) The tongue has a white or red "strawberry" appearance d) Vesicles that become purulent, ooze, and form honey-colored crusts
c) The tongue has a white or red "strawberry" appearance Explanation: A "strawberry tongue" is a hallmark symptom of scarlet fever and helps to differentiate the disease from other rashes or pharyngeal infections. Pain along the jawline in front of the ear lobe indicates mumps. Vesicles that become purulent, ooze, and form honey-colored crusts are associated with impetigo. Fever blisters on the lips are caused by a herpes simplex infection.
Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a) Avoid making noise when in the child's room b) Rock the child frequently c) Have the child's 2-year-old brother stay in the room d) Keep the lights on brightly so that he can see his mother
a) Avoid making noise when in the child's room Explanation: Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation.
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 has been over 102°F. He has this rash on his face and chest that looks like sunburn but feels really rough." Which of the following would the nurse suspect? a) Scarlet fever b) Pertussis c) Diphtheria d) Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA)
a) Scarlet fever Explanation: Scarlet fever typically is associated with a sore throat, fever greater than 101°F, 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.
A nurse is preparing a presentation for a local mothers group about common viral infections associated with a rash during childhood. When describing rubella, which of the following would the nurse include? Select all that apply. a) The disease most often occurs during late summer and early fall. b) Any itching with the rash is usually mild. c) The rash typically begins on the trunk and spreads to the face. d) Incubation period usually ranges from 16 to 18 days. e) The infection is communicable for a week before to a week after the rash appears.
b) Any itching with the rash is usually mild. d) Incubation period usually ranges from 16 to 18 days. e) The infection is communicable for a week before to a week after the rash appears. Explanation: Rubella has an incubation period ranging from 12 to 23 days, but usually 16 to 18 days. It is communicable for 7 days before the rash to 7 days after the onset of the rash. Itching is usually mild. It occurs most commonly during late winter and early spring and the rash typically begins on the face and spreads down the neck, trunk, and extremities.
A young patient 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 which of the following? a) Pityriasis rosea b) Enterovirus c) Fifth disease d) Rosacea
c) 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.
