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.
Core Nursing ExplanationKey Concept Analysis: This question assesses the priority nursing interventions for a child with Scarlet fever. Scarlet fever is a bacterial infection caused by Group A Streptococcus (GAS), characterized by a sore throat, fever, and a distinctive "sandpaper" rash. The core nursing priorities are twofold: Key Point! 1) Preventing transmission to others, and 2) Ensuring effective treatment to prevent serious complications like Acute rheumatic fever (ARF) or Post-streptococcal glomerulonephritis (PSGN).
Answer Rationale: The correct answer is Implement droplet precautions and ensure antibiotic compliance. This intervention directly addresses the two most critical aspects of care for this communicable disease.
Key Point!Droplet precautions (wearing a mask, placing the patient in a private room or cohorting) are essential because the bacteria spread through respiratory droplets from coughing or sneezing. This is a primary infection control measure.
Key Point! Ensuring antibiotic compliance (typically with penicillin or amoxicillin) is non-negotiable. A full course of antibiotics is required not just to resolve symptoms, but to eradicate the bacteria, prevent transmission, and most importantly, to avoid the autoimmune complications (ARF, PSGN) that can occur even after the initial infection seems to have cleared.
Distractor Analysis:
Watch out for confusion!Option 1 (Encourage gargling): While warm salt water gargles can provide symptomatic relief for a sore throat, this is a comfort measure, not a priority intervention for disease management or transmission control.
Watch out for confusion!Option 2 (Apply cool compresses): This is a supportive measure for pruritus (itching) associated with the rash. It is appropriate but secondary to infection control and definitive treatment.
Watch out for confusion!Option 3 (Administer acetaminophen): Fever reduction and pain management (with acetaminophen or ibuprofen) are important for patient comfort and are standard supportive care. However, they do not address the root cause (infection) or prevent its spread, making them lower priority than the actions in option 4.
Related Concepts: The management of scarlet fever perfectly illustrates the nursing principle of prioritizing interventions that address the etiology of the problem and safety risks (transmission, complications) over those that merely manage symptoms. Always consider the mode of transmission and the purpose of prescribed medications when planning care.
Nursing Clinical Practice GuideClinical Scenario: You are a nurse on a pediatric unit. An 8-year-old, "Mia," is admitted with a diagnosis of scarlet fever. She has a fever of 39°C (102.2°F), a bright red "strawberry" tongue, and a fine, red rash on her trunk and extremities that feels like sandpaper. Her mother is worried and asks, "How long will she be contagious? Can her little brother catch this?"
Nursing Intervention Strategy:
1AssessmentPerform a focused assessment: monitor vital signs (especially fever), assess the rash's progression/desquamation (peeling, which occurs later), evaluate hydration status (due to fever and sore throat affecting oral intake), and assess for pain (throat, headache).
2Infection Control (Priority Action)Immediately place Mia on Droplet Precautions. Don a mask upon entering the room. If possible, assign her to a private room. Educate the family that precautions are needed until she has been on antibiotics for at least 24 hours and is afebrile.
3Medication Administration & EducationAdminister the first dose of prescribed antibiotics (e.g., penicillin) promptly. Stress the absolute importance of completing the entire course (usually 10 days), even if she feels better in a few days. Explain to the parents that this is to prevent heart or kidney problems later.
4Supportive CareImplement the other options as part of comprehensive care: administer acetaminophen as ordered for fever/pain, offer cool compresses or calamine lotion for itch relief, and encourage soothing fluids and soft foods.
5EvaluationMonitor for resolution of fever and rash, assess for signs of complications (e.g., joint pain, dark urine, edema), and confirm understanding of discharge instructions regarding medication and when the child can return to school.
Patient Safety and Precautions:
1Medication AlertNever administer aspirin to a child with a viral or bacterial infection due to the risk of Reye's syndrome. Use acetaminophen or ibuprofen instead.
2Complication MonitoringBe vigilant for symptoms suggesting complications 1-3 weeks after infection: new-onset joint swelling/pain (ARF) or facial/periorbital edema, hypertension, and tea-colored urine (PSGN).
Nursing Procedure & Medication FlowProcedure: Implementing Droplet Precautions
1. Place patient in a private room. If not available, cohort with another patient with the same infection.
2. Wear a surgical mask upon entry into the patient's room or within 3 feet of the patient.
3. Limit transport of the patient. If transport is necessary, have the patient wear a surgical mask.
4. Maintain precautions until criteria are met (e.g., 24 hours of effective antibiotic therapy).Medication: Penicillin Administration for Scarlet Fever
1ActionBactericidal; eradicates Group A Streptococcus.
2Key Nursing PointAdminister on time to maintain therapeutic blood levels. Complete the full course.
3Patient Education"Even if the fever is gone and the rash is better in 3 days, you must finish all 10 days of this medicine. Stopping early could let the germs come back and cause more serious problems."
A Word from Your Senior Nurse
"In pediatrics, we care for the child and the whole family. With infections like scarlet fever, your role as an educator is just as vital as your clinical skills. Clearly explaining *why* the antibiotics must be finished and *how* to prevent spread at home turns worried parents into empowered partners in care. On the NCLEX, they love to test your ability to sift through a list of 'good' nursing actions and pick the one that is most critical for safety and outcomes. Think: 'What prevents harm first?'"
Scarlet Fever — An infectious disease caused by Group A Streptococcus, characterized by sore throat, fever, a "strawberry" tongue, and a diffuse, sandpaper-like rash.
Group A Streptococcus — The bacteria responsible for streptococcal pharyngitis ("strep throat"), scarlet fever, and some skin infections. Can lead to serious post-infection complications.
Droplet Precautions — Infection control measures used for diseases spread through large respiratory droplets (e.g., from coughing, sneezing). Requires a private room or cohorting and mask use by healthcare workers.
Acute Rheumatic Fever — A serious inflammatory complication that can develop 2-4 weeks after an untreated or inadequately treated Group A Streptococcal infection, potentially affecting the heart, joints, brain, and skin.
Post-streptococcal Glomerulonephritis — A kidney complication that can occur after a streptococcal infection, leading to inflammation of the glomeruli, presenting with hematuria, edema, and hypertension.