A 6-year-old child is admitted to the pediatric unit with varicella (chickenpox). The child has vesicular lesions in various stages of healing on the face, trunk, and extremities. Which nursing intervention is the priority for this child?
1Apply topical antibiotics to all lesions to prevent secondary bacterial infection
2Implement strict isolation precautions to prevent transmission to other patients and staff✓ 정답
3Administer aspirin for fever reduction and comfort management
4Encourage the child to scratch lesions gently to promote faster healing
해설
Varicella is highly contagious and requires strict isolation precautions to prevent transmission through airborne and contact routes. Other options are incorrect: topical antibiotics are not routine, aspirin is contraindicated due to Reye's syndrome risk, and scratching should be discouraged.
Core Nursing ExplanationKey Concept Analysis: This question tests the priority nursing intervention for a hospitalized child with varicella (chickenpox). The core principle is infection control and patient safety. Varicella is caused by the varicella-zoster virus (VZV) and is highly contagious, spreading via airborne and contact transmission. The presence of lesions in various stages (papules, vesicles, crusts) confirms active infection. In a hospital setting, the primary nursing responsibility is to protect other vulnerable patients and healthcare workers from exposure.
Answer Rationale: Key Point! The priority is Implement strict isolation precautions. According to standard and transmission-based precautions, varicella requires Airborne Precautions (negative pressure room, N95 respirator for susceptible personnel) and Contact Precautions (gown and gloves) due to the risk of transmission from respiratory droplets and direct contact with fluid from lesions. This intervention addresses the most immediate risk: a hospital-wide outbreak.
Distractor Analysis:
Watch out for confusion! Option ①: Applying topical antibiotics is not a routine or priority intervention. It may be considered only if a secondary bacterial infection (e.g., from *Staphylococcus aureus* or *Streptococcus pyogenes*) is diagnosed, not prophylactically. The priority is containment, not treatment of a non-existent complication.
Option ③: Administering aspirin is absolutely contraindicated in children and adolescents with viral illnesses due to the strong association with Reye's syndrome, a rare but severe condition causing acute encephalopathy and liver failure. Acetaminophen or ibuprofen are appropriate antipyretics.
Option ④: Encouraging scratching is harmful. Scratching can rupture vesicles, increasing the risk of secondary bacterial infection, causing scarring, and further spreading the virus. Nursing interventions should focus on preventing scratching (e.g., mittens, trimming nails, administering antihistamines for pruritus).
Related Concepts: The nursing process dictates that safety (preventing disease transmission) takes precedence. Other important care aspects include managing pruritus, maintaining hydration, monitoring for complications (e.g., pneumonia, encephalitis), and providing family education on home care and the importance of vaccination.
Concept Summary
Concept
Key Points
Varicella Transmission
Airborne & Contact. Highly contagious from 1-2 days before rash until all lesions are crusted.
Negative pressure room. N95 respirator or higher. Keep door closed.
Droplet Precautions
Influenza, Pertussis, Mumps, Rubella
Private room or cohort. Surgical mask within 3 feet (1 meter).
Contact Precautions
MRSA, VRE, C. diff, RSV, Varicella (for lesion contact)
Gown & gloves for room entry. Dedicated equipment.
Anatomy, Physiology & Pharmacology PointsPathophysiology: VZV infects the respiratory mucosa, replicates, enters the bloodstream (primary viremia), and then causes a widespread vesicular rash upon secondary viremia. Lesions appear in crops and can affect mucous membranes.
Pharmacology Alert: Key Point!Aspirin/Salicylates are contraindicated in children with viral illnesses due to Reye's syndrome risk. Use acetaminophen or ibuprofen for fever/pain. Antiviral agents (e.g., acyclovir) may be used for immunocompromised or severe cases.
Memory TipsMnemonic for Varicella Precautions: "AVoid Contact With Air" – Airborne & Contact precautions for Varicella.
Reye's Syndrome Reminder: "No ASSpirin for Kids' VirASSes" – Avoid Aspirin/Salicylates for viral illnesses in children.
High-Frequency NCLEX Topics
NCLEX frequently tests: 1) Prioritization of infection control (ABCs – Airway, Breathing, Contagion), 2) Correct application of transmission-based precautions, 3) Pediatric medication safety (aspirin contraindication), and 4) Identifying appropriate patient education for communicable diseases.
Watch Out for Question Variations!
* Instead of "priority intervention," the question could ask: "Which precaution sign should be placed on the door?" (Answer: Airborne & Contact).
* It could shift to patient education: "What should the nurse teach the parents about when the child can return to school?" (Answer: When all lesions are crusted over).
* It could be a safety question: "The child has a fever of 38.9°C (102°F). Which medication should the nurse prepare to administer?" (Answer: Acetaminophen or Ibuprofen – NOT aspirin).
Nursing Clinical Practice GuideClinical Scenario: You are the nurse on a pediatric medical-surgical unit. A new admission, a 6-year-old named Leo, is being transported from the ED. The report states "varicella, lesions on face and trunk." The unit has other immunocompromised children (e.g., oncology patients).
Nursing Intervention Strategy:
1Pre-Admission/Immediate ActionConfirm a negative pressure airborne infection isolation room (AIIR) is available. If not, delay admission until one is ready. Notify infection control.
2Transport & AdmissionLeo should wear a surgical mask during transport. Upon arrival, escort him directly to the isolation room. Post appropriate precaution signs.
3Assessment & CareDon appropriate PPE (N95 respirator, gown, gloves) before entering. Assess lesions, vital signs, hydration status, and level of discomfort. Implement comfort measures: cool baths, loose cotton clothing, prescribed antipruritic medication (e.g., diphenhydramine).
4Family EducationTeach parents about transmission, home isolation criteria, comfort care, danger signs (trouble breathing, high fever, lethargy, stiff neck), and the importance of the varicella vaccine for susceptible siblings.
Patient Safety and Precautions:
* Staff Safety: All healthcare personnel must verify immunity to varicella (vaccination or proven disease history). Non-immune staff should not care for this patient.
* Visitor Restrictions: Limit visitors to immune individuals. Visitors must wear PPE as instructed.
* Medication Safety: Double-check all medication orders against the contraindication list (NO aspirin).
Nursing Procedure & Medication FlowEntering Isolation Room Procedure: 1. Perform hand hygiene. 2. Don N95 respirator (perform seal check). 3. Don gown (tie at neck and waist). 4. Don gloves (extend over gown cuffs).Exiting Isolation Room Procedure: 1. Remove gloves (peel off, discard). 2. Remove gown (unfasten ties, roll inside out, discard). 3. Exit room. 4. Remove N95 respirator (by straps, discard or store). 5. Perform hand hygiene.Medication Administration: For fever >38.5°C (101.3°F), calculate appropriate dose of acetaminophen (10-15 mg/kg/dose) or ibuprofen (5-10 mg/kg/dose). Verify no allergy. Administer with fluids.
A Word from Your Senior Nurse
"In the real world, an admission like this sets off a chain of logistical and safety actions. Your first thought isn't just about the patient in front of you, but about every other child on that unit. That's what 'priority' means in nursing—seeing the whole picture. Mastering these infection control principles isn't just for the NCLEX; it's what prevents outbreaks and protects your most vulnerable patients. Always think: 'Isolate first, treat second.' And remember, never, ever give aspirin to a kid with a viral rash. That one piece of knowledge can save a life."
Varicella — A highly contagious viral infection caused by the varicella-zoster virus (VZV), characterized by a generalized, pruritic, vesicular rash that appears in crops.
Airborne Precautions — Infection control measures used for diseases transmitted via airborne droplet nuclei (small particles) that remain infectious over long distances. Requires a negative pressure room and N95 respirator.
Contact Precautions — Infection control measures used for diseases transmitted by direct contact with the patient or indirect contact with contaminated items in the patient's environment. Requires gown and gloves.
Reye's Syndrome — A rare but severe condition characterized by acute encephalopathy and fatty liver degeneration, strongly associated with aspirin use in children and adolescents recovering from viral illnesses like influenza or varicella.
Secondary Bacterial Infection — A bacterial infection (commonly Staphylococcus or Streptococcus) that occurs on top of a primary viral infection, often due to skin breakdown from scratching. Manifests as increased redness, warmth, pus, or fever.