A nurse is caring for a 6-year-old child diagnosed with impetigo. Which nursing intervention should be the priority?
1Apply warm compresses to the affected areas three times daily
2Encourage the child to scratch gently to remove crusts
3Keep the child's fingernails long to prevent further skin damage
4Implement strict isolation precautions and teach proper hand hygiene✓ 정답
해설
Impetigo is highly contagious, so strict isolation and hand hygiene are the priority to prevent spread. Other options (warm compresses, scratching, long nails) are incorrect as they may worsen infection or transmission.
Core Nursing Explanation
This question tests the priority nursing intervention for a child with Impetigo, a common and highly contagious bacterial skin infection. The core principle is Infection Control. In nursing, the priority is always safety, and in this case, the safety of the patient and others from the spread of infection is paramount.
Key Concept Analysis
Impetigo is caused primarily by Staphylococcus aureus or Streptococcus pyogenes. It presents with honey-colored crusts or bullae. The pathophysiology involves bacteria entering through breaks in the skin, multiplying, and causing localized infection. The exudate from the lesions is teeming with bacteria, making it extremely contagious through direct contact or via contaminated items (fomites).
Answer RationaleKey Point! The priority nursing intervention is Implement strict isolation precautions and teach proper hand hygiene. This directly addresses the greatest risk: transmission of infection to other children, family members, or healthcare workers. Strict contact precautions (a component of standard precautions) are required until 24-48 hours after antibiotic therapy is initiated. Hand hygiene is the single most effective measure to prevent the spread of infection.
Distractor AnalysisWatch out for confusion! While some interventions might be part of care, they are not the priority and some are harmful.
① Apply warm compresses: This might be used to gently soften crusts after initiating treatment, but it is not the priority. Overuse can macerate the skin, creating a better environment for bacteria.
② Encourage the child to scratch gently: This is absolutely contraindicated. Scratching disrupts the skin barrier, spreads bacteria to other body parts (auto-inoculation), and to the environment.
③ Keep the child's fingernails long: This is the opposite of correct care. Fingernails should be kept short and clean to minimize harboring bacteria and to reduce trauma from scratching.
Related Concepts
This question integrates Chain of Infection concepts. The nurse's role is to break the chain by isolating the reservoir (the child's lesions) and interrupting the mode of transmission (contact). Patient and family education on not sharing towels, bedding, and toys is also crucial.
Concept Summary
• Disease: Impetigo – Contagious superficial skin infection.
• Pathogens: Staph. aureus, Strep. pyogenes.
• Hallmark Sign: Honey-colored crusts.
• Priority Nursing Focus: Infection control (Contact Precautions).
• Treatment: Topical (e.g., mupirocin) or oral antibiotics.
• Key Patient Education: Hand hygiene, no scratching, no sharing personal items.
Side-by-Side Comparison!
Skin Condition
Contagious?
Key Feature
Priority Nursing Intervention
Impetigo
Highly Contagious
Honey-colored crusts
Contact Precautions & Hand Hygiene
Atopic Dermatitis (Eczema)
Not Contagious
Dry, itchy, inflamed skin
Skin Hydration & Itch Control
Cellulitis
Not Typically Contagious*
Red, warm, swollen, painful area
Administer Antibiotics & Monitor for Sepsis
*Cellulitis is an infection of deeper skin layers, not usually spread by casual contact like impetigo.
Anatomy, Physiology & Pharmacology Points
• Skin Barrier: The stratum corneum is the first line of defense. Impetigo breaches this barrier.
• Bacterial Transmission: Direct contact (skin-to-skin) or indirect contact (via fomites).
• Pharmacology: First-line treatment is often topical Mupirocin 2% ointment. For widespread cases, oral antibiotics like cephalexin or dicloxacillin are used.
Memory Tips
• H.I.P. for Impetigo Priority: Hand hygiene, Isolation (Contact Precautions), Prevent scratching.
• Think: "Honey is sticky" – Honey-colored crusts mean the infection STICKs to others easily (contagious).
High-Frequency NCLEX Topics
NCLEX loves to test priority-setting and infection control for contagious conditions. Impetigo is a classic pediatric example. Remember: Safety and prevention of harm (spread of infection) come before comfort measures.Watch Out for Question Variations!
• Instead of "priority intervention," the question could ask: "Which statement by the parent indicates understanding of teaching?" Correct answer would relate to hand hygiene or not sharing towels.
• It could be combined with medication administration: "The nurse is applying mupirocin ointment. What action is essential?" Answer: Wear gloves.
• It could shift to complications: "The nurse should monitor for which potential complication of untreated impetigo?" Answer: Post-streptococcal glomerulonephritis (PSGN).
Nursing Clinical Practice GuideClinical Scenario: You are a school nurse. A 6-year-old boy, Leo, is sent to your office with several red sores around his nose and mouth that have developed golden-yellow crusts overnight. Two other children in his class had similar rashes last week.
Nursing Intervention Strategy
1AssessmentDon gloves immediately. Assess lesions (location, number, presence of bullae or crusts). Take a history (onset, itching, recent skin injury). Check for fever (less common).
2Immediate Action (Priority)Place Leo in a separate room/area. Notify parents to pick him up. He cannot return to class until he has been on antibiotics for at least 24 hours. This is a Contact Precautions scenario.
3Care & Education• Educate parents on medication administration (apply topical antibiotic with glove/cotton swab).
• Teach proper hand hygiene with soap and water (alcohol-based rub is less effective against C. diff and some non-enveloped viruses, but for impetigo, thorough washing is key).
• Instruct to keep child's nails short and clean.
• Advise using separate towels, bedding, and washcloths, washed in hot water.
• Discourage scratching; consider mittens at night if needed.
4Environmental CleaningDisinfect surfaces in your office and inform the classroom teacher to clean shared items.
Patient Safety and Precautions
• Key Point! Always use gloves when touching the patient or their lesions. A gown may be needed if soiling is likely.
• Never pop blisters or forcibly remove crusts; this increases spread and pain.
• Monitor for signs of worsening infection (increased redness, swelling, fever) which may indicate need for systemic antibiotics.
Nursing Procedure & Medication FlowApplying Topical Antibiotic (e.g., Mupirocin):
1. Perform hand hygiene. Don non-sterile gloves.
2. Gently cleanse area with warm water and mild soap to remove loose crusts (pat dry, do not rub).
3. Apply a thin layer of ointment to affected areas.
4. Remove gloves and perform hand hygiene.
5. Educate parent/caregiver to repeat 3 times daily for 7-10 days as prescribed.
Precautions: For use on skin only. Avoid eyes. Complete the full course even if lesions look better.
A Word from Your Senior Nurse
"In pediatrics, infections like impetigo spread like wildfire. Your quick action to isolate and educate is what stops an outbreak in a classroom or household. Remember, your role isn't just to treat the one child in front of you; it's to protect the community. When you see those golden crusts, think 'CONTACT PRECAUTIONS' immediately. This proactive, prevention-minded thinking is exactly what the NCLEX tests and what makes an outstanding nurse."
Impetigo — A highly contagious superficial bacterial skin infection, most commonly caused by Staphylococcus aureus or Streptococcus pyogenes, characterized by erythematous lesions that progress to honey-colored crusts or bullae.
Contact Precautions — A type of transmission-based precaution used for patients with infections spread by direct contact with the patient or indirect contact with contaminated items in the patient's environment (e.g., MRSA, VRE, impetigo). Requires gloves and gown.
Autoinoculation — The process by which a person spreads an infection from one part of their own body to another, often via touching or scratching (e.g., spreading impetigo from the face to the arm).
Mupirocin — A topical antibiotic ointment commonly used as first-line treatment for impetigo. It works by inhibiting bacterial protein synthesis. Brand name: Bactroban.
Poststreptococcal Glomerulonephritis — A potential non-suppurative complication following a streptococcal infection (like impetigo caused by Strep. pyogenes). It involves inflammation of the kidney glomeruli, leading to hematuria, edema, and hypertension.