# A 7-year-old child is diagnosed with scarlet fever. Which nursing intervention should be implemented first? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541899 > language: ko > subject: Infectious Diseases ## 문제 A 7-year-old child is diagnosed with scarlet fever. Which nursing intervention should be implemented first? A 6-year-old child presents to the pediatric unit with a high fever, sore throat, and a characteristic sandpaper-like rash covering the body. The child has been diagnosed with scarlet fever caused by group A streptococcus. ## 보기 1. Initiate contact precautions and droplet precautions **✔ 정답** 2. Administer acetaminophen for fever reduction 3. Encourage increased fluid intake 4. Apply cool compresses to reduce skin irritation **정답: 1** ## 해설 Contact and droplet precautions are priority to prevent transmission of group A streptococcus. Other interventions (fever reduction, fluids, skin care) are supportive but secondary. ## 심화 해설 Clinical Context A 6-year-old child presents with high fever, sore throat, and a sandpaper-like rash—the hallmark triad of scarlet fever caused by group A Streptococcus (GAS). While most GAS infections in children are mild and respond to antibiotics, some progress rapidly to severe, life-threatening complications such as sepsis, requiring urgent interventions including ventilation and vasoactive agents [1]. This potential for rapid deterioration makes early recognition and immediate, appropriate nursing action critical. Why the Correct Answer is Priority The correct first intervention is to initiate contact precautions and droplet precautions. In the NCLEX-RN prioritization framework, actions addressing safety and infection transmission risk to others take precedence over comfort or supportive measures. GAS is highly contagious and spreads via respiratory droplets and direct contact with skin lesions. A child with scarlet fever remains infectious until 24 hours after the initiation of appropriate antibiotic therapy. Implementing both contact and droplet precautions immediately upon suspicion of the diagnosis protects other patients, visitors, and healthcare staff. This aligns with the safety and infection control priority, which is a core component of the NCLEX-RN Safe and Effective Care Environment category. Pathophysiology and Clinical Reasoning Group A Streptococcus produces pyrogenic exotoxins that cause the characteristic rash and systemic symptoms. The infection primarily colonizes the pharynx and tonsils, making droplet transmission the primary route. Simultaneously, the bacteria can be present on skin and contaminated surfaces, necessitating contact precautions. The article by Kempsell-Smith and Fitzsimons underscores that while most infections are mild, the potential for severe deterioration exists [1]. Before administering antipyretics, encouraging fluids, or applying comfort measures, the nurse must first establish a safe environment by containing the infectious agent. This prevents a localized infection from becoming a unit-wide outbreak. The other options—administering acetaminophen, encouraging fluids, and applying cool compresses—are all appropriate and important nursing interventions for the individual patient's comfort and recovery, but they are secondary to the immediate safety need of preventing transmission.References (research sources) - [1]Managing the deteriorating child with suspected group A Streptococcus infection.Research articleKempsell-Smith M, Fitzsimons C. (2023) · DOI: 10.7748/ncyp.2023.e1467 ## 임상 시나리오 Clinical Practice Guide: Scarlet Fever in a Pediatric Patient Immediate Isolation Protocol - Precautions: Implement Contact and Droplet Precautions immediately upon clinical suspicion of scarlet fever. This requires a private room, and healthcare staff must wear a surgical mask, gown, and gloves for all patient interactions. - Duration: Maintain precautions until the child has completed at least 24 hours of effective antibiotic therapy and clinical improvement is evident. Key Nursing Interventions - Antibiotic Administration: Administer prescribed antibiotics (e.g., penicillin or amoxicillin) promptly to eradicate the infection, reduce symptom duration, and prevent complications like acute rheumatic fever. - Symptom Management: After isolation is established, provide comfort measures such as acetaminophen for fever and pain, encourage oral fluid intake to prevent dehydration, and apply cool compresses for skin irritation. - Monitoring for Deterioration: Perform frequent vital sign assessments and monitor for signs of invasive GAS disease, including worsening fever, hypotension, altered mental status, or respiratory distress, which may indicate sepsis or streptococcal toxic shock syndrome. Family Education and Discharge Planning - Infection Control at Home: Educate caregivers that the child is contagious until 24 hours of antibiotic treatment is completed. Emphasize hand hygiene, avoiding sharing utensils or cups, and proper disposal of tissues. - Medication Adherence: Stress the critical importance of completing the full course of antibiotics, even if the child feels better, to prevent long-term cardiac and renal complications. - Return Precautions: Instruct parents to seek immediate medical attention if the child develops worsening symptoms, difficulty breathing, chest pain, or decreased urine output. ## 핵심 개념 - **Scarlet Fever** — A bacterial illness caused by group A Streptococcus that presents with a high fever, sore throat, and a characteristic sandpaper-like rash. - **Droplet Precautions** — Measures used to prevent the spread of pathogens transmitted through large respiratory droplets, including wearing a surgical mask. - **Contact Precautions** — Measures used to prevent the spread of pathogens transmitted through direct or indirect contact, including wearing gloves and a gown. - **Group A Streptococcus (GAS)** — A bacterium commonly found in the throat and on the skin that can cause various infections, including strep throat and scarlet fever. - **NCLEX Prioritization Framework** — A decision-making model that guides nurses to address safety and infection control risks before comfort or supportive measures. ## 같은 주제 문제 - [A 6-year-old child is brought to the pediatric clinic with a high fever, sore throat, and …](https://mymerci.kr/pages/nclex_q.php?qn_id=541896) - [A 7-year-old school-age child is brought to the pediatric clinic with a rash that started …](https://mymerci.kr/pages/nclex_q.php?qn_id=541897) - [A 6-year-old child is brought to the pediatric clinic with a high fever and sore throat. 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