Chapter 37: Nursing Care of the Child With an Infectious or Communicable Disorder

Transmission-Based Precautions (Tier Two)

Designed for children with known or suspected infection with pathogens for which additional precautions are warranted to interrupt transmission.

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." Rationale:Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. The disease is caused by Bordetella pertussis. The incubation period is 6 to 21 days, usually 7 to 10 days.

A child is diagnosed with a helminthic infection. Which of the following would the nurse expect to be prescribed? Select all answers that apply.

1. Albendazole 2. Pyrantel pamoate

Sepsis

Hand-washing is the most effective intervention.

Lymphocytes ( B cells and T cells and Natural Killer cells)

Main source of producing an immune response; respond to viral infections (measles, rubella, chickenpox, infectious mononucleosis); tumors

A group of nursing students are reviewing the six links in the chain of infection and the nursing implications for each. The students demonstrate understanding of the information when they identify which precaution as helping to break the chain of infection to the susceptible host?

Maintaining skin integrity

After teaching a class on the role of white blood cells in infection, the instructor determines that the teaching was successful when the class identifies which type of white blood cells as important in combating bacterial infections?

Neutrophils

General Guideline of Fever Based on Measurement Route:

Oral: (mouth): > 37.8 (100) F. Rectal: (butt): >38 (100.4) F. Axillary (armpit): >37.2 (99) F. Tympanic (ear): >38 (100.4) F. Temporal (forehead) <38 (100.4) F.

Granulocytes

Phagocytic Cells: cells that protect the body by ingesting harmful foreign particles, bacteria, and dead or dying cells.

Group B Streptococcus

To reduce in neonates, screen pregnant women. If positive administer intrapartum antibiotics.

Neutrophils (polymorphonuclear leukocytes)

First line of defense upon invasion of bacteria, fungus, cell debris, and other foreign substances.

The nurse is caring for a neonate who is suspected of having sepsis. Which of the following assessment findings would the nurse interpret as most indicative of sepsis?

Hypothermia

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?

Notify the primary health care provider. Rationale: 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.

A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease?

Playing in the woods about a week ago.

Standard Precautions (Tier One): 1. Apply to all children 2.Apply to all body fluids, secretions, and excretions except sweat, nonintact skin, and mucous membranes. 3. Designed to reduce the risk of transmission of microorganisms from recognized and unrecognized sources.

Proper Hand Hygiene. Use of Gloves. Masks, Eye Protection & Face Shields.

The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old girl. Which technique would most likely be used?

Puncturing a vein on the dorsal side of the hand. Rationale: 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.

While reviewing various studies about the use of antipyretics possibly prolonging illness, the nurse notes that there are benefits to their use for the child with fever. Which of the following would the nurse identify as the best explanation related to the benefit of antipyretics?

They help decrease fluid requirements.

A nurse is assessing a child with a tick-borne disease. What finding would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain spotted fever?

absence of rash Rationale: Both Rocky Mountain spotted fever and ehrlichiosis are manifested by fever, headache, and malaise. However, there is rarely a rash with ehrlichiosis, which helps to differentiate it from Rocky Mountain spotted fever.

Which child will the nurse identify as at greatest risk for developing a urinary tract infection?

an 8-month-old bottle-fed female with HIV Rationale: Factors that make an individual more prone to a urinary tract infection include young age, female gender, and immunosuppression. Infants who are formula-fed are at greater risk than infants who are breastfed. To determine the child at greatest risk, the nurse should count risk factors and determine which child has the most risk factors.

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 Rationale: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 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 Rationale: Use of a protective mask if within 3 feet of the child is a tier 2 precaution with diphtheria, which is transmitted through contact with droplets. Use of a protective gown is a tier 2 precaution for contact transmission. Negative air pressure ventilation is a tier 2 precaution for airborne transmission. Face shields are part of tier 1 precautions against contaminated splashes.

A group of grade-school children is going camping. As a school nurse, you would offer them which advice to prevent Lyme disease?

"Wear jeans tucked inside your socks when in the woods." Rationale: Lyme disease is prevented by measures to reduce the possibility of tick bites.

Stages of Infectious Disease:

1st: Incubation (entrance into body to first symptoms) 2nd: Prodrome (time from onset of nonspecific symptoms such as fever, malaise (uncomfortable, lack of energy) and fatigue to more specific symptoms. 3rd: Illness (child demonstrates signs and symptoms specific to an infection type) 4th: Convalescence (acute symptoms of illness disappear).

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. Rationale: 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.

Droplet Precautions: Private Room if available or group children with same disease.

Coughing, Sneezing, Talking, Suctioning. Diphtheria, Pertussis, Streptococcal group A, Influenza, Mumps, Rubella, and Scarlet Fever.

A nursing instructor is teaching a group of students about the action of antipyretic agents in children. The instructor determines that the teaching has been successful when the students identify which of the following as the primary action?

Decrease the temperature set point

Contact Precautions: Private Room if available.

Diphtheria, Pediculosis, Scabies, Multidrug-resistant bacteria.

IMPORTANT:

Dramatic reduction in invasive Haemophilus influenzae type B diseases since the widespread use of Hib vaccine.

A woman gives birth to a healthy newborn. As part of the newborn's care, the nurse instills erythromycin ophthalmic ointment as a preventive measure for which sexually transmitted infection (STI)?

Gonorrhea

IMPORTANT:

Never give ASPIRIN to children to reduce fever, due to risk of Reye Syndrome.

A nurse is conducting a health history for a 1-month-old with an infectious disorder. Which segment of the health history would be most helpful for the nurse when determining if the infant developed the infection from the mother?

Past medical history

The nurse is preparing a plan of care for a 5-year-old boy with chickenpox. Which of the following nursing interventions should be questioned?

Provide alcohol baths as needed.

What is a true statement regarding varicella zoster virus infection?

Secondary bacterial infections of the skin can occur. Rationale: 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.

Fever Management:

Sign of Illness (not a disease) bodies weapon to fight infection. First step in management: ^ fluid intake, decrease activity. Antipyretics (ibuprofen) are used if the child demonstrates discomfort. Never given aspirin to child younger than 19 years of age (reye syndrome) some children fever can be associated with seizure or dehydration but this will not lead to brain damage or death. Dress child lightly and avoid warm, binding clothing or blankets. Call provider: 1. Younger than 3 months with rectal temp above 38 c (100.4) 2. Child who is lethargic or listless, regardless of temp. 3. Fever lasting more than 3-5 days. 4. Fever greater than 40.6 c (105) 5. Any child who is immunocompromised by illness such as cancer, or HIV as they will need further evaluation and treatment.

What is a true statement regarding measles?

The incubation period is 10 to 12 days. Rationale: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 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?

Upper respiratory excretion Rationale: 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.

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 Rationale: 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 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?" Rationale: 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 a has poor gag reflex--a distinguishing symptom.

After teaching a mother how to remove a tick from her 6-year-old boy's arm, the nurse determines that additional teaching is needed when the mother states which of the following?

"I'll grasp the tick and pull it away quickly."

A nurse is instructing a parent on how to obtain a stool culture for ova and parasites from a child with diarrhea. Which of the following would the nurse include in the teaching plan?

"Keep the specimen from coming into contact with any urine."

Which of the following would be most important to include in the teaching plan for parents of a child with pinworm?

"Make sure the child washes his hands after using the bathroom."

A 3-year-old boy has been on chemotherapy for cancer. He complains about a sore throat, is experiencing malaise, and has a temperature of 99.8°F orally. His mother calls the child's physician. What is the appropriate information for the nurse to tell his mother at this time?

"Plan to bring the child into the physician's office today."

While obtaining a health history from a male adolescent during a well check-up, the nurse assesses his sexual behavior and risk for sexually transmitted infections. Based on the information, the nurse plans to teach the adolescent about using a condom. Which of the following would the nurse include in the teaching plan?

"Put the condom on before engaging in any genital contact."

A nurse suspects that an adolescent may have community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). Which of the following would the nurse expect to assess? Select all answers that apply.

1. Participation in contact sport 2. Recent cut on the lower leg 3. Raised fluctuant lesions

The nurse is assessing the tympanic temperature of several children. The nurse documents that the child with which temperature reading has a fever?

100.8 F.

The physician has ordered ibuprofen 150 mg every 6 hours as needed for a 3-year-old child for a fever greater than 38°C (100.4°F). The label of the ibuprofen bottle reads "ibuprofen oral suspension 100 mg/5 ml." How much ibuprofen liquid will the nurse administer if the child's temperature goes above 38°C (100.4°F)? Record your answer using one decimal place.

7.5 Rationale: The dose ordered (150 mg) is divided by the available dosage (100 mg) then multiplied by 5 mL.

The nurse is caring for a child whose family recently emigrated from a developing country. While completing the admission history, the parents report all the child's immunizations are up to date. Which nursing action is most appropriate?

Ask parents which immunizations have been given. Rationale: When caring for a child recently emigrated from a developing country, the nurse should be aware that WHO recommended vaccinations and U.S. recommended vaccinations may be different. The most appropriate action is for the nurse to determine which vaccinations have been given to decide if additional immunizations may be needed.

The nurse is triaging a child diagnosed with poliomyelitis. After ensuring appropriate precautions are in place, what will the nurse do next?

Auscultate the child's lungs. Rationale: Because poliomyelitis can cause motor paralysis of the respiratory muscles, assessing respiratory status is priority. Once the nurse has ensured respiratory function is intact, the nurse can place the child on bed rest, administer an antipyretic, and begin physical therapy.

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 Rationale: 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 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.

Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be which period?

Incubation Period Rationale: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.

Air-Borne Precautions: 1. Negative Air Pressure Room 2. Wear mask or respirator

Measles, Varicella, Tuberculosis.

The nurse is performing a physical examination on a 9-year-old boy who has experienced a tick bite on his lower leg and is suspected of having Lyme disease. Which assessment finding would the nurse expect to find?

Ring-like rash on lower leg

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease?

Mumps Rationale: Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis is a respiratory disorder that causes severe paroxysmal coughing, which produces a whooping sound. Measles is recognized by Koplik spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very pruritic and is seen on the hands, feet, and folds of the skin.

A child is brought to the emergency department by his parents. The parents report that he stepped on a rusty nail about a week and a half ago. The child is complaining of cramping in his jaw and some difficulty swallowing. The nurse suspects tetanus. When assessing the child, the nurse would be alert to which muscle groups being affected next?

Neck Rationale: Tetanus progresses in a descending fashion to other muscle groups, causing spasms of the neck, arms, legs, and stomach.

A pregnant woman diagnosed with syphilis comes to the clinic for a visit. The nurse discusses the risk of transmitting the infection to her newborn, explaining that this infection is transmitted to the newborn through which of the following?

Placenta

A nurse practitioner suspects that a child has scarlet fever based on which assessment finding?

Red, Strawberry Tongue Rationale: 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.

The client has a heavily draining wound for which there is an order to change the dressing every 4 hours. The nurse becomes busy and does not change the dressing as ordered. Which link in the chain of infection has the nurse allowed to flourish?

Reservoir Rationale: The reservoir is the area where a pathogen grows and reproduces. Leaving the dressing unchanged allows for a dark, warm, nutrient rich, and moist environment where many organisms will thrive. A susceptible host is a person who cannot fight off an infection. The portal of exit is the way a pathogen exits the host. The mode of transmission is the way the pathogen travels.

Basophils

Respond to allergic disorders and hypersensitivity reactions; used to study chronic inflammation.

Eosinophils

Respond to allergic disorders, parasitic infections, and chronic immune responses.

Monocytes

Second line of defense; respond to larger and more severe infections than neutrophils by phagocytosis; leukemias and lymphomas; chronic inflammation.

The nurse is performing a physical examination of an 8-year-old girl who was bitten by her kitten. Which of the following assessments would lead the nurse to suspect catscratch disease?

Swollen lymph nodes

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 Rationale: Most childhood exanthems are caused by viruses.

The nurse is preparing to obtain a blood specimen via capillary heel puncture. Which of the following would be most appropriate for the nurse to do?

Wipe away the first drop of blood with dry gauze

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 Rationale: Recurrent arthritis in large joints such as the knees is an indication of late-stage Lyme disease. The appearance of erythema migraines would suggest early-localized stage of the disease. Facial palsy or conjunctivitis would suggest the child is in the early disseminated stage of the disease.

A 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 eosinophil levels Rationale: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.

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 Rationale:Pinworm infections are not required to be reported. Gonorrhea, Lyme disease, and pertussis are all reportable infectious diseases.

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 Rationale: 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.

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?

"Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection." Rationale: Fevers can be protective and can help the body fight the infection. Fevers slow down bacterial or viral growth. Mismanaging fevers include inappropriate dosing of antipyretics, awakening a child at night to administer antipyretics, and using cold water or sponging the child with alcohol to reduce the temperature.

The nurse is developing a teaching plan for the mother of a 4-year-old girl with cold and fever. Which of the following would the nurse include in this teaching plan?

Ensuring fluid intake to prevent dehydration

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?

penicillin V Rationale:Penicillin V is the antibiotic of choice. In those sensitive to penicillin, erythromycin may be used. Trimethoprim-sulfamethoxazole and clarithromycin are not used.

The parents of a 5-year-old have just found out that their child has head lice. Which statement by the parents would support the nursing diagnosis of deficient knowledge?

"I can't believe it. We're not unclean, poor people."

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:

Fifth Disease Rationale: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 child is diagnosed with scarlet fever. The nurse is reviewing the child's medical record, expecting which medication to be prescribed for this child?

Penicillin V

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." Rationale: 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.

The nurse determines that it is necessary to implement airborne precautions for children with which of the following infections?

Measles

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 all of the lesions have crusted over." Rationale: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.

The nurse is caring for a school-aged child hospitalized with an infectious disease. The child is placed on transmission-based precautions. What would the nurse include in the plan of care? Select all that apply.

1. Allow the child to view the staff's face through the door window before entering the room. 2. Encourage the parents to contact friends and classmates so cards can be sent and displayed. 3. Monitor the child for changes in mood or level of aggression. 4. Provide the child with age-appropriate games and toys for his or her room. 5. Plan for extra time to visit the child throughout the shift between assessments and procedures. Rationale: The child in transmission-based isolation may experience feelings of isolation and sensory deprivation because of restricted visiting and the use of personal protective gear (gown, mask and gloves) by those in the child's hospital room. The use of age appropriate toys and games dedicated to the child's room, extra time spent with the child by staff, the display of cards from friends and classmates, and allowing the child to view staff members' faces from outside the room all promote sensory stimulation and lessen the feeling of isolation. The family would be taught to follow the same precautions as the staff. Sensory overload is not a concern for a child in transmission-based precautions.

The mother of an 8-year-old boy with mumps tells the nurse that she does not understand how her son could have gotten mumps since he was immunized according to her physician's recommendations. What is the best response by the nurse?

"While immunizations are highly effective they aren't 100% effective at preventing infectious diseases." Rationale: According to the CDC (2014d), one dose of MMR prevents 78% of cases and two doses prevent approximately 88% of cases. Questioning where the immunizations were given, if the immunization was given, and if the physician followed the guidelines correctly is accusatory and unlikely to be the cause of the child contracting the infection.

A child has been diagnosed with hookworm. The nurse is teaching the parent about the treatment for the condition. Which statement made by the parent confirms that further education is needed?

"My child can play outside bare footed when treatment is done." Rationale:Hookworms are found in soil, especially in areas with warmer climates. They enter the body through the skin, pores and hair follicles. The treatment is with the drug albendazole. The duration is from 7 to 14 days of treatment. Most importantly, besides medication, good handwashing and sanitation practices are needed. Children should wear shoes and not go barefoot outside since the worms can enter through the soles of the feet. The worms attach themselves to the walls of the small intestine where they feed and reproduce. This can cause anemia. The child's diet should include foods high in iron or iron supplements. All children who are suspected or at high risk should be evaluated for hookworms.

Which interventions will the nurse include when caring for a child with an infectious disorder? Select all that apply.

1. Ensure immunization status is current. 2. Use appropriate personal protective equipment. 3. Provide information about disease transmission. 4. Educate the child and family about infection control. Rationale: Nursing interventions for care of children with infectious disorders center around preventing disease through immunization and preventing further spread by practicing good infection control measures. Educating parents about infection control measures and teaching them about how the particular infectious agent is spread remains critical to preventing the spread of disease once the child leaves the hospital. Although antibiotics are used for bacterial infections, antibiotics are not needed for other types of infections (viral, fungal, etc.).

Preventing and Controlling Infection:

1. Monitor ^ in temp (indicate infection) 2. Monitor skin lesions (redness, warmth, drainage, swelling, and pain at lesions (indicate infection) 3. Maintain aseptic technique, practice good handwashing (prevent further infections and transmission.) 4. Administer Antibiotics as prescribed (to prevent and treat bacterial infection). 5. Encourage nutritious diet and proper hydration. (natural defense against infection). 6. Isolate child (to prevent spread) 7. Teach child good hand-washing, covering mouth and nose with cough or sneeze, proper disposal of used tissues (to prevent spread of infection).

The nurse is caring for a hospitalized, 1-week-old infant who appears very ill. Which assessment finding(s) will the nurse report to the health care provider? Select All That Apply

1. Petchiae 2. Heart rate of 100 beats/min 3. Respiratory rate of 60 breaths/min 4. Axillary temperature of 97.6 F (36.5) C 5. Characteristic of cry Rationale: Sepsis is suspected in any infant under 3 months of age until laboratory findings return. In an infant, the most important findings are hypothermia, bradycardia, and apnea. Tachypnea care be present in both infants and children. The nurse would be concerned with the infant's weak cry, lethargy, and an increased work of breathing such as rate, nasal flaring, grunting, and retractions. The child with sepsis generally has an elevated temperature, but hypothermia is seen in infants. The nurse should perform a good skin assessment. If petechiae are present, it is indicative of a very serious infection caused by Neisseriam eningitidis.

Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply.

1. Wear protective clothing when playing in wooded areas. 2. Inspecting skin closely for ticks after the child plays in wooded areas. 3. Contacting the health care provider if there is any area of inflammation that might be a bite. Rationale: The nurse should teach the parents to have the child wear protective clothing and dress the child in light clothing when playing in wooded areas or going outdoors. The parents should inspect the child's skin closely for ticks after being outside in wooded areas and if any ticks are found, remove them with a tweezer, not rub them with a credit card. The parents also should be instructed to contact their health care provider if they notice any area of inflammation that might be a tick bite.

The nurse is obtaining a health history and assessment for a child being admitted who is suspected of having measles. What signs and symptoms does the nurse expect to find during the assessment? Select all that apply.

1. maculopapular rash that began on the face and has spread to the rest of the body. 2. fever. 3. upper respiratory infection symptoms. Rationale:Maculopapular rash that began on the face and has spread to the rest of the body, fever, and upper respiratory infection symptoms are characteristic of both rubella (German measles) and rubeola (measles). Clear, fluid-filled vesicles are characteristic of chickenpox (varicella zoster). Erythematous flushing is common with erythema infectiosum (fifth disease).

A toddler has a fever. The parent calls the clinic wanting to know the appropriate dosage of acetaminophen to give the child. The parents say the child weighs 26 lb (11.8 kg). What is the lowest dose the nurse would instruct the parent to administer to the child?

118 mg Rationale: The normal range for the dosage of acetaminophen is 10 to 15 mg/kg. The child weighs 11.8 kg. Using the lowest dose at 10 mg/kg, the child would need 118 mg. At 12 mg/kg, the dose would be 142 mg. At 14 mg/kg, the dose would be 165 mg. The highest dose at 15 mg/kg would equal 177 mg.

A child is diagnosed with early disseminated Lyme disease. The nurse informs the parents the child will most likely receive antibiotic therapy for which length of time?

14 to 28 days Rationale: For early disseminated or late Lyme disease, intravenous penicillin or ceftriaxone is used for 14 to 28 days. Early Lyme disease is treated for 14 to 21 days; treatment for Rocky Mountain spotted fever is usually 7 to 10 days.

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.

1st: Incubation 2nd: Prodrome 3rd: Illness 4th: Convalescence Rationale: An infectious disease begins with incubation, then progresses to the prodrome stage, then to illness, and finally to convalescence.

The nurse is providing instructions to parents of a 2-year-old child with a fever. The child weighs 33 pounds. Based on the recommended dose for ibuprofen, how much would the nurse instruct the parents to give as the lowest amount per dose?

75mg

After teaching the parents of a child with varicella zoster, the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time?

After the lesions have crusted.

A child is being treated for pertussis and is prescribed azithromycin by the health care provider. Which finding is most important for the nurse to report to the health care provider before administering this drug?

Child has had previous episodes of supra-ventricular tachycardia (SVT) Rationale: Azithromycin is recommended for use to treat pertussis in infants older than 1 month of age and children. It should, however, not be used in children at risk for cardiovascular events. It may cause a potentially fatal heart rhythm, because it can lead in changes in the electrical activity of the heart. It is especially important in children with prolonged QT intervals. The finding of SVT should be reported to the health care provider before administration of the drug. The potassium level is within a normal range and it has no effect on the drug. Azithromycin should not be given with any aluminum or magnesium antacids. The PPI should be safe. A rash may indicate an allergy to the drug and should be reported, but it is not the most important finding. The health care provider would make a determination for the drug administration based on risks versus benefits.

The pediatric nurse knows that there are a number of anatomic and physiologic differences between children and adults. Which statement about the immune systems of infants and young children is true?

Children have an immature immune response. Rationale: Infants and young children are more susceptible to infection due to the immature responses of their immune systems. Cellular immunity is generally functional at birth; humoral immunity develops after the child is born. Newborns have a decreased inflammatory response. Young infants lose the passive immunity from their mothers, but disease protection from immunizations is not complete.

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 Rationale: 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.

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. Rationale: 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.

IMPORTANT:

Infants younger than 3 months of age with a rectal temp greater than 38 C (100.4) F should be seen by the HCP.

A young client in the clinic has a rash, cough, and fever that the parent says spiked on day 5 of the rash. The client also had conjunctivitis. What illness would the nurse expect the health care provider to diagnose?

Measles Rationale: Measles are diagnosed based on the symptoms. Measles is a viral illness. The prodromal period includes 2 to 4 days of rising fevers, cough, coryza, and conjunctivitis. Following this, Koplik spots develop followed by an erythematous maculopapular rash. The rash starts on the head and spreads downward and outward. Rubella, also viral, begins with the rash starting first and the child will have a low-grade fever. Scarlet fever is a bacterial illness generally occurring after strep throat. It is accompanied by high fevers and a generalized rash over the entire body. Varicella is also caused by a virus but the rash differs in that it has fluid-filled vesicles.

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. Rationale: 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 group of nursing students are reviewing information about childhood infectious diseases. The students demonstrate understanding of this information when they identify which of the following as a common childhood exanthema?

Rubella

A school-aged child with an infectious disease is placed on transmission-based precautions. Which nursing diagnosis would most likely be a priority?

Social isolation related to infectivity and inability to go to the playroom

Atraumatic Care:

The Young Infant will benefit from the use or oral sucrose (Oral sucrose is a simple sugar solution given as a liquid by mouth. It can comfort infants and toddlers during brief medical procedures that could cause pain.) and nonnutritive sucking (pacifiers) before and during the capillary puncture.

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. Rationale: 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.

The nurse is administering a chickenpox vaccination to a 12-month-old girl. Which concern is unique to varicella?

This disease can reactivate years later and cause shingles. Rationale:Varicella zoster results in a lifelong latent infection. It can reactivate later in life resulting in shingles. The American Academy of Pediatrics recommends consideration of vitamin A supplementation in children 6 months to 2 years hospitalized for measles. Dehydration caused by mouth lesions is a concern with foot and mouth disease. Avoiding exposure to pregnant women is a concern with rubella, rubeola, and erythema infectiosum.

The nurse has received the morning report on a group of pediatric clients. Which pediatric client will the nurse see first?

a child reporting dark brown urine and a fine sandpaper rash Rationale: The child with a fine sandpaper rash and dark brown urine may be experiencing renal complications secondary to scarlet fever (group A streptococcus), and will be seen first. Treatment with penicillin or another antibiotic is needed. Pharyngitis is an expected symptom of mononucleosis, and treatment for mononucleosis consists of supportive measures. A child with a rash with honey-colored crusts most likely has impetigo (a skin infection). Headache, fever, and arthralgia are expected symptoms of Zika virus. Treatment for Zika virus consists of supportive measures.

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first?

a child with erythema infectiosum experiencing fatigue and confusion Rationale: 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.

When caring for a child diagnosed with West Nile virus, the nurse will question which prescription from the primary health care provider?

amoxicillin 40 mg/kg/day orally every 8 hours Rationale: 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.