A nurse is assessing a 6-year-old child who has been brought to the clinic by their parents with complaints of abdominal pain and changes in bowel habits. Which assessment finding would be most indicative of a possible intestinal parasitic infection?
1Perianal itching that worsens at night✓ 정답
2Projectile vomiting after meals
3High fever with chills
4Severe dehydration with sunken fontanelles
해설
Perianal itching that worsens at night is the classic sign of pinworm infection, the most common intestinal parasite in children. Other options represent symptoms of different conditions like pyloric stenosis, systemic infection, or severe dehydration.
Core Nursing ExplanationKey Concept Analysis: This question assesses the ability to identify the hallmark symptom of the most common intestinal parasitic infection in children: Enterobiasis (pinworm infection). The pathophysiology involves the female pinworm (Enterobius vermicularis) migrating to the perianal region at night to lay eggs, which causes intense local itching. This leads to the classic symptom of nocturnal perianal pruritus. While abdominal pain and bowel changes are common in many pediatric GI issues, the specific timing and location of the itching are pathognomonic for pinworms.
Answer Rationale: Key Point!Perianal itching that worsens at night is the single most indicative finding for a pinworm infection. The "Scotch tape test" (pressing clear adhesive tape to the perianal skin in the morning to collect eggs for microscopic examination) is the definitive diagnostic method based on this symptom.
Distractor Analysis:
Watch out for confusion!Projectile vomiting after meals is the classic sign of Hypertrophic Pyloric Stenosis, typically seen in infants aged 2-8 weeks, not a parasitic infection.
Watch out for confusion!High fever with chills suggests a systemic bacterial infection (e.g., sepsis, pyelonephritis) or a severe inflammatory process, not a localized intestinal parasite.
Watch out for confusion!Severe dehydration with sunken fontanelles is a critical sign of fluid volume deficit, often seen with severe gastroenteritis (like rotavirus) causing profuse diarrhea and vomiting. The mention of "sunken fontanelles" indicates this is more relevant to an infant (fontanelles typically close by 18-24 months), not a 6-year-old child.
Related Concepts: Pinworm infection is highly contagious in group settings (daycare, school). Treatment involves anthelmintic medication (e.g., mebendazole, pyrantel pamoate) for the entire household and meticulous hygiene to prevent reinfection. Abdominal pain and changes in bowel habits (like intermittent diarrhea) can occur but are non-specific.
Nursing Clinical Practice GuideClinical Scenario: You are a nurse in a pediatric clinic. The parents of a 6-year-old boy report he has been complaining of stomach aches for a week and has had some loose stools. He has been scratching his bottom frequently, especially at bedtime, and has been having trouble sleeping.
Nursing Intervention Strategy:
1AssessmentConduct a focused interview. Ask specifically: "Does the itching around his bottom get worse at night?" Inquire about symptoms in other family members. Visually inspect the perianal area (with parent present) for signs of excoriation from scratching.
2Diagnostic CoordinationEducate the parents on how to perform the "Scotch tape test" at home. Instruct them to apply clear tape to the child's perianal area first thing in the morning, before bathing or using the toilet, and to bring the tape to the clinic for microscopic analysis.
3Care & Education- If diagnosed, administer or prescribe the anthelmintic medication as ordered. Emphasize that all household members must be treated simultaneously to prevent a ping-pong effect.
- Teach meticulous hygiene: Keep fingernails short and clean, encourage thorough handwashing after using the toilet and before eating, discourage scratching.
- Change and wash underwear, pajamas, and bed linens in hot water daily during treatment.
- Reinforce that this is a common childhood infection, not a reflection of poor hygiene, to reduce parental guilt or stigma.
Patient Safety and Precautions: Ensure the medication dose is calculated correctly by weight. Monitor for potential, though rare, side effects like abdominal pain or diarrhea. The primary precaution is preventing reinfection through environmental control and hygiene.
1ActionAntihelminthic; inhibits glucose uptake in the parasite.
2DoseA single chewable tablet (100 mg) is often prescribed, repeated in 2 weeks.
3Nursing PointsCan be taken with or without food. Tablet may be chewed, crushed, or swallowed whole. Stress the importance of the second dose to kill any newly hatched worms.
A Word from Your Senior Nurse
"In pediatrics, parents often come in worried about vague 'tummy aches.' Your job is to be a detective. Asking that one specific question—'Is the itching worse at night?'—can instantly point you toward the likely culprit. Pinworms are incredibly common and nothing to be embarrassed about. Your calm, educational approach can turn an anxious visit into an empowering one for the family. Remember, your teaching on hygiene and simultaneous household treatment is just as critical as the medication itself for curing the infection!"
Enterobiasis — Infection with the pinworm *Enterobius vermicularis*, characterized by nocturnal perianal itching. It is the most common helminthic infection in temperate climates, especially in children.
Nocturnal Perianal Pruritus — Itching in the anal region that intensifies at night. This is the hallmark symptom of pinworm infection, caused by the female worm migrating to lay eggs on perianal skin.
Scotch Tape Test — A diagnostic test for pinworms. Clear adhesive tape is pressed against the perianal skin in the morning to collect eggs, which are then identified under a microscope.
Antihelminthic — A medication that expels or destroys parasitic worms (helminths). Examples for pinworms include mebendazole and pyrantel pamoate.
Hypertrophic Pyloric Stenosis — A condition in infants where the pyloric muscle thickens, causing gastric outlet obstruction. Presents with non-bilious, projectile vomiting after feeds, typically at 2-8 weeks of age.