An 8-year-old child is diagnosed with scarlet fever. Which nursing intervention is most appropriate for this child?
A 6-year-old child presents with a high fever, sore throat, and a characteristic sandpaper-like rash that began on the chest and spread to other parts of the body. The child has been diagnosed with scarlet fever caused by group A streptococcus.
1Encourage the child to gargle with warm salt water every 2 hours
2Apply cool compresses to the rash areas to reduce itching
3Administer acetaminophen for fever reduction and comfort
4Implement droplet precautions and ensure antibiotic compliance✓ 정답
해설
Droplet precautions and antibiotic compliance are critical to prevent transmission and complications. Other options (gargling, cool compresses, aspirin) are less priority or inappropriate.
Scarlet fever is a pyogenic infection caused by group A Streptococcus (GAS), the same bacterium responsible for strep throat. The characteristic sandpaper-like rash is a result of an erythrogenic exotoxin produced by the bacteria. While most GAS infections in children are mild and respond well to treatment, the primary clinical concern is preventing transmission and ensuring the complete eradication of the bacteria to avoid serious suppurative and non-suppurative complications, such as sepsis, acute rheumatic fever, or post-streptococcal glomerulonephritis .
Analyzing the Options
Option 1: Gargling with warm salt water is a comfort measure for a sore throat but does not address the underlying bacterial infection or prevent its spread. It is an ancillary intervention, not the priority.
Option 2: The rash in scarlet fever is typically not pruritic. Cool compresses are not a standard or necessary intervention and do not address the infectious etiology or transmission risk.
Option 3: Administering acetaminophen is appropriate for managing fever and discomfort. However, this is a supportive measure. The most critical nursing action must first address the infectious process and safety of others.
Option 4: This option combines two essential components of care: infection control and definitive treatment. Because GAS is transmitted via respiratory droplets, implementing droplet precautions is necessary to protect other patients and healthcare staff. Furthermore, ensuring antibiotic compliance is vital. Prompt and complete antibiotic therapy not only resolves the acute illness but is the key strategy to prevent severe complications, including the deterioration into invasive GAS infection that may require intensive care .
Priority Nursing Intervention
The most appropriate intervention is to implement droplet precautions and ensure antibiotic compliance. The nurse's role extends beyond treating the individual child to protecting the public health. A child with a suspected or confirmed GAS infection must be placed on droplet precautions immediately. Simultaneously, the nurse must prioritize the initiation and completion of the prescribed antibiotic regimen. This directly targets the source of infection and mitigates the risk of the child developing severe, life-threatening complications such as sepsis, which may necessitate invasive ventilation or vasoactive agents .
Clinical Practice Guide: Pediatric Scarlet Fever
Priority Nursing Interventions
Infection Control: Immediately implement droplet precautions for any child with suspected or confirmed group A streptococcal pharyngitis or scarlet fever. This includes placing the child in a private room and ensuring all healthcare personnel wear a surgical mask for close contact.
Antibiotic Compliance: The cornerstone of treatment is a full course of antibiotics, typically penicillin or amoxicillin. The nurse must educate the family on the critical importance of completing the entire prescription, even if symptoms improve, to prevent serious complications such as acute rheumatic fever and post-streptococcal glomerulonephritis.
Transmission Prevention: Advise that the child is considered infectious until they have been on appropriate antibiotic therapy for at least 24 hours. The child should stay home from school or daycare during this period. Emphasize hand hygiene and avoid sharing utensils, cups, and personal items.
Supportive Care and Monitoring
Fever and Pain Management: Administer antipyretics such as acetaminophen or ibuprofen as prescribed for fever and sore throat discomfort. Monitor temperature and pain levels regularly.
Hydration and Nutrition: Encourage increased fluid intake to prevent dehydration from fever. Offer soft, bland foods that are easy to swallow if the child has significant throat pain.
Complication Surveillance: Monitor for signs of suppurative complications (e.g., peritonsillar abscess, otitis media) and educate caregivers to return for evaluation if the child develops worsening symptoms, difficulty breathing, or decreased oral intake. Long-term follow-up education should include signs of non-suppurative complications like joint pain, chest pain, or dark urine, which may appear weeks later.
Caregiver Education Points
Explain that the sandpaper-like rash is a result of a bacterial toxin and will fade, often with peeling of the skin on the fingers and toes, which is a normal part of the recovery process.
Instruct caregivers to replace the child's toothbrush after the first 24 hours of antibiotic therapy to prevent reinfection.
Reinforce that a return to the healthcare provider is necessary if a full course of antibiotics is not tolerated or if any new symptoms develop.
Scarlet Fever — A pyogenic infection caused by group A Streptococcus, characterized by a sandpaper-like rash due to an erythrogenic exotoxin.
Droplet Precautions — Infection control measures used for organisms transmitted via respiratory droplets, requiring the use of a mask and patient isolation.
Group A Streptococcus (GAS) — A bacterium that causes strep throat and scarlet fever, which can lead to complications like acute rheumatic fever if not fully eradicated.