# A nurse is caring for a 5-year-old child with HIV infection who has developed oral candidiasis. The child's CD4+ count is 200 cells/mm³. Which nursing intervention is the highest priority?

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> subject: Child Health

## 문제

A nurse is caring for a 5-year-old child with HIV infection who has developed oral candidiasis. The child's CD4+ count is 200 cells/mm³. Which nursing intervention is the highest priority?

## 보기

1. Administer prescribed antifungal medication and monitor for therapeutic response **✔ 정답**
2. Encourage increased fluid intake to prevent dehydration from oral pain
3. Provide soft, bland foods to minimize oral discomfort during eating
4. Teach the family about proper oral hygiene techniques for infection prevention

**정답: 1**

## 해설

Administering antifungal medication is the highest priority to treat active oral candidiasis and prevent systemic spread in a child with severe immunocompromise (CD4+ 200 cells/mm³). Other interventions like fluid intake, soft foods, or oral hygiene are supportive but secondary.

## 심화 해설

Clinical Context and Priority Setting

This question presents a 5-year-old child with HIV infection, oral candidiasis, and a critically low CD4+ count of 200 cells/mm³. In pediatric patients, a CD4+ count below 500 cells/mm³ in children aged 1–5 years indicates severe immunosuppression [1]. This level of immune compromise means the child has minimal endogenous defense against fungal overgrowth, making pharmacologic intervention the cornerstone of management.

Why Antifungal Administration Is the Highest Priority

The systematic review by Carvalho et al. confirms that Candida species, particularly C. albicans, are the predominant cause of oral candidiasis in high-risk populations, and that infections caused by non-albicans Candida (NAC) species are increasing [1]. In an HIV-positive child with a CD4+ count of only 200 cells/mm³, the fungal infection will not resolve without targeted antifungal therapy. The case report by Filippatos et al. further illustrates this principle: a child with profound CD4+ lymphopenia and severe oral candidiasis caused by Candida parapsilosis showed rapid clinical improvement only after intravenous fluconazole was initiated [2]. This demonstrates that when the immune system is severely depleted, source control through antimicrobial therapy takes precedence over supportive measures.

Applying Maslow’s Hierarchy and the ABC Framework

In NCLEX-RN priority-setting, physiological needs and direct treatment of the underlying pathology rank above comfort or teaching interventions. Administering the prescribed antifungal medication directly addresses the infectious process that, if left unchecked in a severely immunocompromised child, can progress to systemic candidiasis—a life-threatening complication. Monitoring for therapeutic response allows the nurse to detect treatment failure early, which is especially critical given the rising prevalence of NAC species that may exhibit variable antifungal susceptibility patterns [1].

Why the Other Options Are Lower Priority

Encouraging fluid intake (Option 2) and providing soft, bland foods (Option 3) are important comfort and hydration measures, but they do not treat the infection itself. These supportive interventions can be implemented concurrently or after medication administration. Teaching the family about oral hygiene (Option 4) is a valuable long-term prevention strategy, but it is not the immediate priority when an active, symptomatic infection is present in a child with severe immunosuppression. The NCLEX-RN expects the nurse to recognize that pharmacologic treatment of the active infection must occur before preventive education or symptom management alone.References (research sources)

- [1]Distribution of <i>Candida</i> Species Causing Oral Candidiasis in High-Risk Populations: A Systematic Review.Meta-analysis/systematic reviewCarvalho JP, Rodrigues J, Rodrigues CF, Andrade JC, Rajão A. (2026) · DOI: 10.3390/healthcare14020159

- [2]Candida parapsilosis Oral Infection in an HIV-Negative Infant With Profound CD4+ Lymphopenia: Unveiling a Rare Immunodeficiency Scenario.Research articleFilippatos F, Karava V, Kakleas K, Santou A, Michos A. (2025) · DOI: 10.7759/cureus.87740

## 임상 시나리오

Managing Oral Candidiasis in Severe Pediatric HIVPrioritizing Pharmacologic Source Control
In a child with HIV and a CD4+ count of 200 cells/mm³, the immune system cannot clear Candida on its own. Administering the prescribed antifungal medication is the highest priority to achieve source control.

Supportive measures like providing soft, bland foods and encouraging fluids are important for comfort but are secondary to treating the underlying infection. Without antifungal therapy, the infection will persist and worsen.

CautionA CD4+ count below 500 cells/mm³ in a child aged 1-5 years defines severe immunosuppression. In this state, always prioritize direct pharmacologic treatment of opportunistic infections over supportive or preventive interventions.

## 핵심 개념

- **CD4+ Count 200 cells/mm³ in Pediatric HIV** — Indicates severe immunosuppression in children, defining AIDS and signifying a profound inability to fight opportunistic infections like Candida.
- **Oral Candidiasis as Sentinel Event** — In an immunocompromised host, a localized fungal infection is a marker of failing immune surveillance and a warning sign for potential systemic dissemination.
- **Priority Setting Framework** — In this scenario, the physiological need to treat an active infection takes precedence over comfort measures and health teaching, following the ABCs and safety/risk reduction principles.

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