A 4-year-old preschooler with varicella (chickenpox) is being cared for at home. The child's mother asks the nurse about appropriate care measures. Which nursing intervention should the nurse prioritize in the teaching plan?
1Apply topical antibiotics to all lesions to prevent secondary bacterial infection
2Give aspirin every 4 hours to reduce fever and discomfort
3Keep the child's fingernails short and clean to prevent scratching and secondary infection✓ 정답
4Encourage the child to return to school once the fever subsides
해설
Keeping fingernails short and clean prevents scratching, which reduces the risk of secondary bacterial infections and scarring. Other options are incorrect: topical antibiotics are not routine, aspirin is contraindicated, and returning to school too early can spread infection.
Clinical Judgment
This question asks for the highest priority nursing intervention in the home care of a child with varicella (chickenpox). The core is prevention of complications. The most common complication of chickenpox is secondary bacterial infection from scratching. Therefore, the intervention that directly blocks this cause is most important. Keeping fingernails short and clean does not eliminate itching, but it is a preventive measure that minimizes skin damage and bacterial invasion that can result from the act of scratching due to itching. This corresponds to 'prioritizing interventions' and 'recognizing risks' in the Clinical Judgment Model (CJMM).
Memory TipNo Scratching, No Scars! Nail care is the key to preventing both.
KR vs US
In Korea, antiviral medication (acyclovir) for chickenpox may be prescribed more actively than in the US. However, the basic principles of home care (nail care, choice of antipyretics, isolation period) are the same. In the US, the fact that aspirin use is absolutely contraindicated is heavily emphasized.
Clinical Practice Guide
Home care education checklist for a child with chickenpox: 1) Keep fingernails trimmed short, 2) Cool baths (with colloidal oatmeal added), 3) Dress in loose cotton clothing, 4) Use acetaminophen or ibuprofen for fever, 5) Maintain isolation until all lesions have crusted over (usually at least 5-7 days after the rash starts).
Caution
In SATA (Select All That Apply) questions, "keeping fingernails short" is almost always a correct answer. "Applying antibiotic ointment" is not recommended as a preventive measure on all lesions; it should only be used on specific lesions where secondary infection is suspected, following a doctor's instructions.
Varicella — Chickenpox is a highly contagious infectious disease caused by the varicella-zoster virus (VZV). A characteristic blistering rash appears all over the body.
Secondary Bacterial Infection — An infection that occurs when existing viral skin lesions are scratched and damaged, allowing bacteria (mainly Staphylococcus and Streptococcus) to invade. It can cause cellulitis, impetigo, and other conditions.
Reye's Syndrome — Acute, fatal condition that can occur in children who take aspirin during viral infections (chickenpox, influenza, etc.). Characterized by cerebral edema and hepatic steatosis.
Infection Control / Isolation — Measures to prevent the spread of infectious diseases. For chickenpox, airborne and contact isolation is required, and it continues until all lesions have crusted over.
Pruritus — Itching. A primary symptom of chickenpox, and scratching due to this is a major cause of complications.