# A 7-year-old child is admitted to the pediatric unit with suspected diphtheria. Which nursing action is the highest priority to ensure safety for other patients and healthcare workers?

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> subject: Child Health

## 문제

A 7-year-old child is admitted to the pediatric unit with suspected diphtheria. Which nursing action is the highest priority to ensure safety for other patients and healthcare workers?

## 보기

1. Administer diphtheria antitoxin as prescribed to the child
2. Monitor the child for signs of airway obstruction
3. Implement strict droplet and contact isolation precautions immediately **✔ 정답**
4. Obtain a throat culture for laboratory confirmation of diphtheria

**정답: 3**

## 해설

Immediate implementation of strict droplet and contact isolation precautions is the highest priority to prevent transmission of this highly contagious disease. Other actions like antitoxin administration are important but secondary for infection control.

## 심화 해설

Understanding the Priority: Infection Control in Diphtheria

When a child is admitted with suspected diphtheria, the clinical presentation triggers a cascade of nursing actions. However, the NCLEX-RN examination tests your ability to prioritize based on the most immediate safety needs for a group of clients. Diphtheria, caused by toxigenic strains of Corynebacterium diphtheriae, is a vaccine-preventable disease that can spread rapidly in congregate settings, as highlighted in recent outbreak investigations [1,2]. The highest priority is always to contain the pathogen at the point of entry into the healthcare system to prevent a facility-based outbreak.

Why Immediate Isolation is the Priority

The rationale for implementing strict droplet and contact isolation precautions immediately is rooted in the transmission characteristics of the bacterium. C. diphtheriae can manifest as respiratory or cutaneous disease, both of which are infectious [1]. Respiratory diphtheria spreads through large respiratory droplets during coughing or sneezing, while cutaneous diphtheria, often presenting as chronic, non-healing ulcers, spreads through direct contact with wound exudate [1,2]. A single patient can even present with simultaneous respiratory and cutaneous infection [1]. By placing the child on both droplet and contact precautions upon suspicion—before laboratory confirmation—you create a barrier that protects other vulnerable patients, visitors, and healthcare workers from exposure. This action directly aligns with the core epidemiological finding that schools and similar close-contact environments are ideal for the transmission of such diseases, a principle that extends to a pediatric hospital unit [2].

Analyzing the Other Options in the Clinical Context

While the other listed actions are critical components of care, they are secondary to the immediate containment of a highly communicable disease.

- Administering diphtheria antitoxin: This is a life-saving, definitive treatment that neutralizes circulating toxin. However, it addresses the individual patient's disease progression, not the immediate threat of transmission to others. The safety of the unit must be established first.

- Monitoring for airway obstruction: This is the most critical direct physiological risk for the child, as the hallmark pseudomembrane can cause fatal airway compromise. In a scenario focused solely on the individual patient, this would be the priority. However, the question specifically asks for the action that ensures safety for other patients and healthcare workers, shifting the priority from the individual to the collective.

- Obtaining a throat culture: Laboratory confirmation is essential for public health reporting and guiding ongoing management. However, culture results take time, and the risk of transmission begins the moment the patient enters the unit. Isolation must be initiated based on the clinical suspicion, not delayed until laboratory confirmation is received [1].

The systematic approach to managing such a case involves immediate isolation, followed by diagnostic testing, specific treatment (antitoxin and antibiotics), and supportive care with vigilant monitoring for complications like airway obstruction or myocarditis. The NCLEX correctly identifies the first link in this chain—source control—as the highest priority for community safety.References (research sources)

- [1]Diphtheria in a Swiss Asylum Seeker Reception Centre: Outbreak Investigation and Evaluation of Testing and Vaccination Strategies.Research articleBrockhaus L, Urwyler P, Leutwyler U, Würfel E, Kohns Vasconcelos M, Goldenberger D, Keller PM, Tschudin Sutter S, Labhardt ND. (2024) · DOI: 10.3389/ijph.2024.1606791

- [2]Vaccine-preventable disease outbreaks in schools, part 2: pertussis, meningococcal disease, diphtheria, poliomyelitis, hepatitis A, and rotavirus infection.Research articleCassimos DC, Effraimidou E, Irakleidou I, Medic S, Maltezou HC. (2026) · DOI: 10.1016/j.vaccine.2026.128750

## 임상 시나리오

Diphtheria Infection ControlImmediate Isolation Protocol for Suspected Cases
Upon clinical suspicion of diphtheria, immediately implement Droplet Precautions and Contact Precautions. The pathogen spreads via respiratory droplets and direct contact with wound exudate, and patients can have concurrent respiratory and cutaneous infection.

Place the patient in a single room with a door. Healthcare workers must wear a gown, gloves, and a surgical mask upon entry. Dedicate non-critical patient-care equipment to this patient to prevent cross-contamination.

CautionMaintain strict isolation until 2 negative cultures are obtained from both the nasopharynx and oropharynx (or skin lesions) taken at least 24 hours apart and collected at least 24 hours after completion of antimicrobial therapy. Do not rely on a single culture or clinical improvement alone to discontinue precautions.

## 핵심 개념

- **Diphtheria** — An infectious disease caused by toxigenic Corynebacterium diphtheriae, presenting as respiratory or cutaneous infection, spread by droplets and contact.
- **Droplet Precautions** — Measures to prevent transmission of pathogens spread through large respiratory droplets, requiring a mask for close contact.
- **Contact Precautions** — Measures to prevent transmission of pathogens spread by direct or indirect contact, requiring gloves and a gown.
- **Diphtheria Antitoxin** — A medication derived from horse serum that neutralizes circulating diphtheria toxin, administered early in treatment.
- **Corynebacterium diphtheriae** — A gram-positive, non-spore-forming bacillus that causes diphtheria, producing a potent exotoxin.

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