# A 4-year-old child is admitted to the pediatric unit with a diagnosis of measles. Which nursing intervention should be the priority?

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> subject: Infectious Diseases

## 문제

A 4-year-old child is admitted to the pediatric unit with a diagnosis of measles. Which nursing intervention should be the priority?

## 보기

1. Implement strict isolation precautions immediately **✔ 정답**
2. Administer acetaminophen for fever reduction
3. Encourage increased fluid intake
4. Provide comfort measures for itching

**정답: 1**

## 해설

Strict isolation precautions are the priority for measles due to its high contagiousness via airborne transmission. Other interventions like fever reduction and comfort measures are supportive but secondary to infection control.

## 심화 해설

Priority Nursing Intervention for Pediatric Measles

When a child is admitted with a diagnosis of measles, the immediate priority is to implement strict isolation precautions. Measles is one of the most highly contagious infectious diseases, transmitted via respiratory droplets that can remain suspended in the air for up to two hours after an infected person leaves the area . The virus's exceptional transmissibility means that a single case can rapidly lead to an outbreak, especially in a pediatric unit where other patients may be immunocompromised or unvaccinated. The critical importance of this intervention is underscored by recent large-scale resurgences; declining vaccination rates have increased susceptibility among children, making early and rigorous isolation the cornerstone of outbreak prevention in health care settings [2].

The rationale for prioritizing isolation over symptomatic interventions is rooted in the chain of infection and public safety. While administering acetaminophen for fever, encouraging fluids, and providing comfort for itching are all important components of care, they address individual symptoms and do not prevent the spread of the pathogen. The nurse's first duty is to protect other patients, visitors, and staff by immediately placing the child on airborne precautions. This includes placement in a negative-pressure isolation room and the use of an N95 respirator or higher-level respiratory protection for all health care personnel entering the room [2]. Delaying this step, even to perform a brief initial assessment, could expose the entire unit. Acute and critical care nurses are central to this early recognition and management to ensure optimal outcomes not just for the infected child, but for the entire patient population [2].

The pathophysiology of measles further explains why droplet nuclei are the primary vector. The virus initially infects the respiratory epithelium before spreading to the lymphatic system, causing a robust inflammatory response and the characteristic high fever and rash. During the prodromal phase, when the child is highly contagious, symptoms like cough and coryza generate a massive aerosol of virus-laden particles . Therefore, the isolation must be implemented at the very first suspicion of the diagnosis, before laboratory confirmation, to contain the infection. The other supportive interventions, such as maintaining hydration to manage insensible fluid losses from fever, can be safely and effectively initiated only after the child is appropriately isolated and the environment is secured.

References (research sources)

- [2]Pediatric Measles Resurgence: Implications for Acute and Critical Care Nursing Practice.Research articleRameswaran J, Farber JS, Atlas K, Shields K. (2026) · DOI: 10.4037/ccn2026877

## 임상 시나리오

Clinical Practice Guide: Pediatric Measles Admission

**Priority Action Sequence:**

- **Immediate Airborne Isolation:** Place the child in a single-occupancy negative-pressure room with the door closed. Post airborne precaution signage immediately upon admission.

- **Respiratory Protection:** All healthcare personnel must don an N95 respirator or powered air-purifying respirator (PAPR) before entering the room. Susceptible staff should not enter if immune personnel are available.

- **Notification:** Alert infection control and local public health authorities per facility protocol and state reporting requirements for this vaccine-preventable disease.

- **Symptom Management:** Once isolation is secured, administer antipyretics (acetaminophen) for fever, encourage oral fluids to maintain hydration, and provide tepid baths or antipruritics for skin discomfort.

**Key Clinical Considerations:**

- Measles virus remains viable in the air for up to 2 hours after the patient leaves the room; terminal cleaning with standard disinfectants is sufficient as the virus is enveloped.

- Exposed susceptible contacts (unvaccinated, no prior infection) should receive post-exposure prophylaxis with MMR vaccine within 72 hours or immunoglobulin within 6 days.

- Monitor for complications such as otitis media, pneumonia, and encephalitis, which are more common in children under 5 years of age.

## 핵심 개념

- **Measles (Rubeola)** — A highly contagious viral illness transmitted via airborne respiratory droplets, characterized by fever, cough, coryza, conjunctivitis, and a maculopapular rash.
- **Airborne Precautions** — Infection control measures used for pathogens that remain infectious over long distances when suspended in air, requiring a negative-pressure room and N95 respirator.
- **Negative-Pressure Isolation Room** — A single-occupancy room where air pressure is lower than the corridor, preventing contaminated air from flowing out when the door is opened.
- **N95 Respirator** — A particulate-filtering facepiece respirator that filters at least 95% of airborne particles, required for healthcare personnel entering airborne isolation rooms.

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