# A 6-year-old child is admitted to the pediatric unit with suspected diphtheria. The child presents with a characteristic grayish-white membrane covering the throat and difficulty swallowing. Which nursing intervention should be the highest priority?

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## 문제

A 6-year-old child is admitted to the pediatric unit with suspected diphtheria. The child presents with a characteristic grayish-white membrane covering the throat and difficulty swallowing. Which nursing intervention should be the highest priority?

## 보기

1. Administer the prescribed intravenous antibiotics as soon as possible
2. Encourage increased oral fluid intake to maintain hydration status
3. Provide comfort measures including pain management and rest
4. Prepare for emergency airway management and have tracheostomy equipment readily available **✔ 정답**

**정답: 4**

## 해설

Emergency airway management is the highest priority due to the risk of complete airway obstruction from the diphtheria pseudomembrane. Other interventions like antibiotics are secondary until the airway is secured.

## 심화 해설

Understanding the Priority: Airway Management in Diphtheria

The correct answer is to prepare for emergency airway management and have tracheostomy equipment readily available. In the NCLEX-RN framework, this scenario directly tests the "Management of Care" and "Physiological Integrity" categories, specifically applying the ABC (Airway, Breathing, Circulation) priority-setting framework. For a child with suspected diphtheria and a characteristic grayish-white membrane, maintaining a patent airway is the most immediate life-threatening concern.

The pathophysiology of diphtheria involves the bacterium Corynebacterium diphtheriae producing a potent exotoxin. This toxin causes local tissue necrosis and inflammation in the upper respiratory tract, leading to the formation of a dense, fibrinous, grayish-white pseudomembrane. This membrane is tightly adherent to the underlying tissues and can rapidly extend, posing a direct and severe risk of complete airway obstruction [1]. The child's presenting symptom of difficulty swallowing indicates significant pharyngeal involvement and swelling, which can quickly progress to respiratory distress and asphyxiation. Therefore, proactive preparation for a surgical airway is a critical nursing action. A case report on a pediatric patient with diphtheria highlights that emergency airway interventions, such as tracheostomy, may be necessary in the acute phase, and failure to manage the airway promptly can lead to fatal complications [3].

While the other interventions are important components of care, they do not take precedence over airway security. Administering intravenous antibiotics (Option 1) is essential to halt toxin production and eliminate the bacteria, but their effect is not immediate enough to address an evolving airway obstruction. Encouraging oral fluid intake (Option 2) is contraindicated in a patient with a compromised airway and significant dysphagia due to the high risk of aspiration. Providing comfort measures (Option 3) is always a valuable nursing function, but it is secondary to a physiological crisis like airway compromise. A clinical study on pediatric diphtheria in a resource-limited setting reinforces that the disease remains life-threatening, and clinical recognition of its potential to cause severe airway morbidity is paramount for early intervention and survival [2]. The differential diagnosis for a condition like croup, which can mimic diphtheria, should be reconsidered when a patient fails to improve with standard treatment and develops a membrane, underscoring the unique and urgent airway threat diphtheria represents .References (research sources)

- [1]Severe Respiratory Diphtheria Complicated by Myocarditis-Induced Dilated Cardiomyopathy and Peripheral Neuropathy in a Non-Immunized Two-Year-Old Child from Rural Somalia: A Case Report.Case reportFarah SA, Hassan Orey FA, Elmi AH. (2026) · DOI: 10.2147/imcrj.s615193

- [2]Clinical recognition of pediatric diphtheria in a resource-limited Somali hospital: a prospective observational study.Research articleAhmed FA, Ali MN, Hassan MY, Gahnug M, Ali YK, Ismail FA, Jama AA, Fujeyra AMH, Mohamed MM, Ahmed SA. (2026) · DOI: 10.1186/s41182-026-01016-3

- [3]Iatrogenic Pneumothorax Complicating Airway Management of Post-diphtheritic Tracheal Stenosis in a Pediatric Patient: A Case Report.Case reportPrabha R, Raman R, Kumar A, Raza SM, Gupta K. (2026) · DOI: 10.7759/cureus.102999

## 임상 시나리오

Diphtheria Airway EmergencyPrioritizing the ABCs in Pediatric Respiratory Obstruction
The pseudomembrane in diphtheria is tightly adherent and can cause sudden, complete airway obstruction. Any sign of difficulty swallowing or stridor requires immediate preparation for emergency airway management.

Keep tracheostomy equipment and a qualified provider readily available at the bedside. The airway can be lost within minutes, making proactive setup a critical nursing safety intervention.

CautionDo not attempt to dislodge or swab the membrane, as this can trigger bleeding and severe laryngospasm. Avoid oral intake and maintain the patient in a position of comfort, often sitting upright, to maximize airflow.

## 핵심 개념

- **Diphtheria Pseudomembrane** — A dense, fibrinous, grayish-white exudate formed in the upper respiratory tract due to Corynebacterium diphtheriae exotoxin, which adheres tightly to tissue and can cause airway obstruction.
- **ABC Priority Framework** — A nursing triage model prioritizing Airway, Breathing, and Circulation; airway management always takes precedence over other interventions in life-threatening situations.
- **Tracheostomy Readiness** — The proactive preparation of emergency tracheostomy equipment at the bedside for patients with conditions like diphtheria where rapid airway compromise is anticipated.

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