A nurse is assessing a patient with suspected Severe Acute Respiratory Syndrome (SARS). Which assessment finding would be most characteristic of SARS in the early stage?
1High fever (>38°C/100.4°F) with dry cough and shortness of breath✓ 정답
2Productive cough with purulent sputum and chest pain
3Wheezing and prolonged expiratory phase with accessory muscle use
4Hemoptysis with night sweats and weight loss
해설
SARS typically presents with high fever (>38°C), dry cough, and dyspnea in early stages, making this the most characteristic finding. Other options represent symptoms more typical of bacterial pneumonia (productive cough), asthma (wheezing), or tuberculosis (hemoptysis).
Clinical Judgment
This question assesses the ability to distinguish between early detection of infectious diseases and characteristic symptom patterns. The key is to understand how the initial symptoms of SARS differ from typical bacterial pneumonia or other respiratory illnesses. The correct answer, option 1's high fever, dry cough, dyspnea, is the classic early triad of SARS. This reflects a non-productive inflammatory response caused by the virus directly damaging the respiratory epithelium. The other options present symptoms more characteristic of different diseases (bacterial pneumonia, asthma, tuberculosis), which should be ruled out through clinical judgment.
Memory Tip
A mnemonic for remembering the initial symptoms of SARS: Fever, Dry cough, Dyspnea = "First Defense Down". Alternatively, associate it with the Korean keywords "38 degrees, cough, shortness of breath."
KR vs US
In Korea, there is a tendency to administer antipyretics first for febrile patients, but from a US/NGN perspective, an unexplained high fever is an important diagnostic clue, and if an infectious disease is suspected, evaluation and isolation measures must be prioritized before administering antipyretics. Especially if there is a history of overseas travel, the level of suspicion and isolation protocols for novel respiratory infections like SARS or MERS may be applied more rapidly and strictly than in Korea.
Clinical Practice Guide
The first and most important nursing action when encountering a patient suspected of having SARS is to immediately initiate isolation. In addition to Standard Precautions, Airborne and Contact precautions must be implemented (wearing an N95 mask, gown, gloves, and eye protection). Accurately documenting the patient's detailed travel history (city, duration, contacts) and the time of symptom onset is essential for epidemiological investigation.
Caution
In SATA (Select All That Apply) questions asking about the "initial symptoms of SARS," you should select "high fever," "dry cough," and "shortness of breath," but not include "purulent sputum" or "bloody sputum." The latter may appear as the disease progresses or when other complications arise, but they are not the most characteristic early symptoms. "Chest pain" also appears more in later stages or with severe lung damage rather than initially.
Severe Acute Respiratory Syndrome — Severe Acute Respiratory Syndrome. A highly contagious viral pneumonia caused by the SARS-CoV virus, which was prevalent in 2002-2003.
Dry Cough / Non-productive Cough — Dry cough / non-productive cough. A cough not accompanied by sputum or secretions, which is an early characteristic of viral upper respiratory infections or certain viral pneumonias such as SARS and COVID-19.
Dyspnea — Dyspnea. A subjective feeling of difficulty or discomfort in breathing, which in SARS occurs due to impaired gas exchange caused by damage to the alveolar-capillary membrane.
Airborne Precautions — Airborne precautions. These are infection control measures applied to diseases transmitted through tiny droplet nuclei (less than 5 microns) that spread via the air (e.g., tuberculosis, chickenpox, SARS, COVID-19), requiring the use of N95 masks and negative pressure isolation rooms.
Prodrome — Prodromal symptoms. These are early, non-specific symptoms (e.g., malaise, muscle pain, headache) that occur before the full-blown symptoms of a specific disease appear. In the case of SARS, high fever is the initial full-blown symptom that appears after the prodromal symptoms.