Chapter 43: Nursing Care of a Family when a Child has an Infectious Disorder

A nurse is instructing the parents of a child who is suspected of having pinworms on how to check their child. Which instruction is appropriate?

*Inspect the child's anus with a flashlight 2 to 3 hours after the child is asleep.* Diagnosis is confirmed by direct visualization of worms by the parents or by microscopy. The nurse will tell parents to view the child's anus with a flashlight 2 to 3 hours after the child is asleep. The worm is white, thin, and about 1/2 inch (1.25 cm) long, and it moves. Pinworms are not identified as black dots on bed linens. Specimens are best obtained as the child awakens before toileting or bathing. Checking the washcloth would be of no benefit. Pinworms do not change the appearance of the stool.

A parent of a 6-year-old client states, "I have heard of cases of West Nile virus in the area. What can I do to protect my child?" Which recommendation by the nurse is appropriate?

*"Be sure to drain any standing water in your yard."* The nurse is correct to provide instruction to the parent for the child's safety. The best recommendation is to eliminate a place for mosquito breeding. Overall, parents can help prevent the spread of West Nile disease by adhering to the "5D's": Instruct children to stay inside between dusk and dawn (not 11 am to 3 pm) when mosquitoes are most prevalent. Drain standing water so there are few opportunities for mosquitoes to breed. Dress should include long pants and long sleeves when outside (not light-colored clothing). Apply mosquito repellant that contains DEET (use a concentration under 30% and apply only once a day. Don't place it on children's hands in case they ingest it, and don't use it with infants under 2 months of age).

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* 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.

Which collaborative intervention will the nurse provide when caring for an infant diagnosed with pertussis? Select all that apply.

*Administer erythromycin for 10 days. Have suction available in the room. Encourage small, frequent feedings. Utilize droplet and standard precautions.* Infants with pertussis are generally admitted to the hospital for at least 48 hours to see how the disease course is progressing. Droplet precautions are used until 5 days after a child starts antibiotic therapy, and visitors may be restricted during this time (5 days). Standard precautions will be used throughout the hospitalization. Frequent small meals are vomited less than larger meals, making it easier for the infant to maintain nutritional status. A full 10-day course of erythromycin or azithromycin may be prescribed because these drugs have the potential to shorten the period of communicability and may shorten the duration of symptoms. Infants with pertussis may need airway suction for thick secretions.

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* 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.

A 13-year-old boy who recently immigrated to the United States from India is found to be infected by a strain of the poliovirus. After initial symptoms of fever, headache, nausea, vomiting and abdominal pain subside, the virus proceeds to his central nervous system. Which of the following would be the best intervention for this client at this point?

*bed rest, analgesia* Treatment for poliomyelitis is bed rest with analgesia. Vaccination would be too late at this point, as the infection has already occurred. Antibiotics would be ineffective as this is a viral, not a bacterial, infection. Salicylic acid solution is used to treat warts.

A high school football player presents to the school nurse with malaise, fever, headache, and anorexia that have been present for the last few days. Upon physical examination, the nurse notes the cervical lymph nodes are firm and tender, and the tonsils are red and enlarged and appear to have a white covering. After advising the client to see their primary health care provider, what other information is a priority?

*discontinue all contact sports* Infectious mononucleosis occurs most commonly in adolescents and young adults. Beginning symptoms include chills, fever, headache, anorexia, and malaise. Clients develop enlarged lymph nodes and a severe sore throat. The cervical lymph nodes feel tender and firm. The tonsils feel painful and are enlarged and erythematous. A thick, white membrane may cover the tonsils; often, petechiae appear on the palate. Although all of the instructions by the nurse are important, the priority instruction is to discontinue contact sports. The spleen may enlarge, which places the client at risk for spontaneous rupture

A 6-month-old boy is brought to the doctor's office with a high fever. The physician diagnoses the child as having a viral infection of some kind and recommends acetaminophen to reduce the fever. After 3 days, the mother returns with the child. The fever is gone, but a rash of discrete, rose-pink macules approximately 2 to 3 mm and flat with the skin surface appears. Which condition should the nurse suspect?

*roseola* Roseola begins with a high fever; after 3 or 4 days, the fever falls abruptly and a distinctive rash of discrete, rose-pink macules approximately 2 to 3 mm in size and flat with the skin surface appears. With rubella, after the 1 to 5 days of prodromal signs, a discrete pink-red maculopapular rash begins on the face, then spreads downward to the trunk and extremities. On the third day, the rash disappears. Measles feature Koplik spots (small, irregular, bright-red spots with a blue-white center point), which appear on the buccal membrane. Chickenpox is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a distinctive rash. Varicella lesions first begin as a macula, then progress rapidly within 6 to 8 hours to a papule, then a vesicle that becomes umbilicated and then forms a crust.

Assessment of a child reveals black burrows of about 1-inch long between the fingers and toes and in the axilla. A diagnosis of scabies is made. When planning this child's care, the nurse anticipates which medication being prescribed?

*topical permethrin* Topical permethrin 5% cream is the drug of choice for treating scabies. The oral medications albendazole, pyrantel pamoate and nitazoxanide are used to treat helminthic (parasitic worm) infections.