# A 7-year-old child with varicella (chickenpox) is being cared for at home. The child's mother calls the clinic reporting that the child has developed new vesicles and is experiencing intense itching, with several lesions opened by scratching. Which nursing intervention should the nurse recommend as the priority? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542255 > language: ko > subject: Child Health ## 문제 A 7-year-old child with varicella (chickenpox) is being cared for at home. The child's mother calls the clinic reporting that the child has developed new vesicles and is experiencing intense itching, with several lesions opened by scratching. Which nursing intervention should the nurse recommend as the priority? ## 보기 1. Apply topical antibiotic ointment to all lesions twice daily 2. Give the child warm baths with soap to cleanse the lesions 3. Encourage the child to stay in bed until all lesions have crusted over 4. Keep the child's fingernails short and consider using mittens at night **✔ 정답** **정답: 4** ## 해설 The priority is to prevent secondary bacterial infection from scratching by keeping nails short and using mittens. Other options may increase infection risk (antibiotic ointment without indication, warm baths with soap) or are less immediate (bed rest). ## 심화 해설 Understanding the Priority: Preventing Secondary Infection in Varicella The core of this question lies in identifying the most immediate risk for a child with varicella who is scratching. While varicella itself is a viral infection that is typically self-limiting in immunocompetent children, the act of scratching introduces a significant complication: secondary bacterial infection of the skin lesions. The provided case study by Marupudi et al. [1] explicitly highlights this risk, describing a pediatric patient with varicella whose clinical course was complicated by "secondary cellulitis" resulting from the excoriated vesicles. This directly illustrates the pathophysiological cascade we must interrupt as a priority. The intense pruritus, a hallmark of varicella as noted across the literature [1,3,4], drives the scratching behavior that breaks the skin's protective barrier, allowing common skin flora like Staphylococcus aureus or Streptococcus pyogenes to invade. Analyzing the Recommended Intervention The correct answer, keeping the child's fingernails short and considering mittens at night, is a mechanical, non-pharmacological strategy that directly targets the mechanism of injury. It does not rely on the child's ability to resist the urge to scratch, which is often futile, especially during sleep. This intervention is the cornerstone of preventing the progression from a pruritic vesicular rash to impetiginized lesions and, in more severe cases, cellulitis, as was the case in the breakthrough varicella patient whose initial presentation was a diagnostic challenge partly due to the atypical appearance of scratched lesions [1]. Why Other Options Are Not the Priority - Option 1 (Topical antibiotic ointment): This is a reactive measure for a complication that has not yet occurred. While some lesions are "opened by scratching," applying a topical antibiotic to all lesions is not standard primary prevention for intact or newly scratched vesicles and does not address the root cause—the scratching itself. Overuse can also contribute to resistance and contact dermatitis. The priority is to stop the mechanical damage first. - Option 2 (Warm baths with soap): This can be counterproductive. Soap can be drying and further irritate the already inflamed and intensely pruritic skin, potentially worsening the itching cycle. Current supportive care typically recommends soothing baths with colloidal oatmeal or baking soda, not soap, to cleanse and relieve pruritus without causing additional irritation. - Option 3 (Strict bed rest until crusting): This is an outdated and unnecessarily restrictive recommendation. While isolation is required until all lesions have crusted over to prevent viral transmission, strict bed rest is not indicated. A child who feels well enough to play quietly should be allowed to do so. This intervention does not address the immediate problem of itching and scratching, which can occur whether the child is in bed or not. The clinical significance of this preventive measure is underscored by the diagnostic challenges of atypical varicella presentations. As noted in the literature, breakthrough infections in vaccinated children can present with a confusing rash that may be mistaken for other conditions like scabies [1]. When scratching further alters the primary lesion morphology, it creates a "diagnostic pitfall." By minimizing excoriation, you not only prevent secondary bacterial infections but also help preserve the characteristic "lesions at various stages of evolution" that are key to clinical diagnosis [1]. For an immunocompromised patient or an adult, such as the patient with diabetes described by Hendrie et al. , the risk of severe disease from a secondary infection is even more profound, making this simple intervention universally critical across all populations.References (research sources) - [1]Atypical High-Burden Breakthrough Varicella: A Diagnostic Pitfall in the Two-Dose Vaccine Era.Research articleMarupudi S, Hensley J, Vezzetti R. (2026) · DOI: 10.7759/cureus.104369 ## 임상 시나리오 Preventing Secondary Infection in VaricellaMechanical Strategies to Break the Scratch-Itch Cycle The priority for a child with varicella and intense pruritus is preventing secondary bacterial infections like impetigo or cellulitis. Scratching breaks the skin barrier, allowing pathogens such as Staphylococcus aureus to invade. The most effective initial intervention is mechanical prevention. Instruct caregivers to keep the child's fingernails short and clean and to use cotton mittens or socks over the hands, especially during sleep when scratching is involuntary. CautionDo not apply topical antibiotic ointments to uncomplicated viral lesions as this does not prevent scratching and may cause irritation. Avoid warm baths with soap, which can exacerbate pruritus. Bed rest is not a primary intervention for infection prevention. ## 핵심 개념 - **Varicella (Chickenpox)** — A highly contagious viral infection caused by varicella-zoster virus, characterized by a pruritic vesicular rash. - **Secondary Bacterial Infection** — A common complication of varicella where scratching introduces bacteria like S. aureus into broken skin, leading to impetigo or cellulitis. - **Pruritus** — Intense itching, a hallmark symptom of varicella that triggers the scratch-itch cycle and increases infection risk. - **Mechanical Prevention** — A non-pharmacological strategy using physical barriers (mittens) or nail trimming to prevent skin damage from scratching. - **Cellulitis** — A deeper bacterial skin infection that can arise from excoriated varicella lesions, requiring systemic antibiotic treatment. ## 같은 주제 문제 - [A 3-year-old toddler is brought to the pediatric clinic with a 2-day history of fever and …](https://mymerci.kr/pages/nclex_q.php?qn_id=542253) - [A 6-year-old child is brought to the pediatric clinic with a 2-day history of fever and th…](https://mymerci.kr/pages/nclex_q.php?qn_id=542254) - [A 6-year-old child with varicella (chickenpox) is being cared for at home. The child's mot…](https://mymerci.kr/pages/nclex_q.php?qn_id=542256) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._