# A 7-year-old child with suspected poliomyelitis presents with fever, headache, and progressive muscle weakness in the lower extremities, starting 3 days ago with flu-like symptoms. The child is admitted to the pediatric unit, and the physician has ordered isolation precautions. Which nursing intervention should be the priority during the acute phase of the illness? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542273 > language: ko > subject: Child Health ## 문제 A 7-year-old child with suspected poliomyelitis presents with fever, headache, and progressive muscle weakness in the lower extremities, starting 3 days ago with flu-like symptoms. The child is admitted to the pediatric unit, and the physician has ordered isolation precautions. Which nursing intervention should be the priority during the acute phase of the illness? A 5-year-old child presents with fever, headache, and muscle weakness in the lower extremities. The child's parents report that the symptoms began 3 days ago with flu-like symptoms, and the muscle weakness has progressively worsened. The physician suspects poliomyelitis and has ordered isolation precautions. ## 보기 1. Maintain strict contact and droplet precautions with proper isolation techniques **✔ 정답** 2. Encourage active range of motion exercises to prevent muscle atrophy 3. Administer high-dose corticosteroids to reduce inflammation 4. Position the child in Trendelenburg position to improve circulation **정답: 1** ## 해설 Strict isolation precautions are the priority to prevent transmission via respiratory droplets and fecal-oral routes during the acute phase. Other interventions like exercise or corticosteroids are not appropriate initially. ## 심화 해설 Understanding Poliomyelitis Transmission and Isolation Poliomyelitis is a highly contagious viral infection primarily transmitted via the fecal-oral route, and occasionally through the oral-oral (respiratory droplet) route. During the acute phase, the virus is present in the oropharynx and is heavily shed in the stool. The immediate priority in a pediatric unit is to prevent nosocomial spread to other vulnerable children and healthcare workers. While the provided scoping review on musculoskeletal infections discusses the controversy and evolution of isolation policies for bacterial infections in orthopedics, it reinforces the fundamental principle that isolation is a cornerstone of infection control when dealing with transmissible pathogens. For a suspected or confirmed viral illness like polio, strict adherence to transmission-based precautions is non-negotiable. Why Contact and Droplet Precautions are the Priority The physician’s order for isolation is the critical cue. Poliovirus requires a combination of precautions. Contact precautions are essential because the virus spreads through direct contact with infected stool or contaminated surfaces. Droplet precautions are necessary to protect against infectious respiratory secretions during close contact. This dual approach directly addresses the known routes of transmission. The bundled intervention approach described by Spyridopoulou et al. for containing carbapenemase-producing organisms highlights the effectiveness of combining active surveillance with the physical separation of carriers from non-carriers. Applying this logic to a highly infectious viral illness, immediately implementing proper isolation techniques upon clinical suspicion is the most effective measure to break the chain of infection and protect the wider hospital population. Analysis of Incorrect Options The remaining options are not appropriate priorities during the acute, febrile phase of poliomyelitis. - **Option 2: Encourage active range of motion exercises.** During the acute phase with fever and progressive muscle weakness, the priority is rest and pain management. Aggressive active exercises can exacerbate muscle pain and are contraindicated. The focus should be on proper body alignment and preventing contractures with gentle, passive support, not active movement. - **Option 3: Administer high-dose corticosteroids.** Corticosteroids are not a standard treatment for poliomyelitis and have no proven benefit in altering the course of the viral infection. Their use could potentially cause immunosuppression and mask signs of infection, which is harmful. - **Option 4: Position the child in Trendelenburg position.** The Trendelenburg position (head lower than feet) is used for hypotensive emergencies to promote venous return. It has no therapeutic role in managing polio-related muscle weakness and could increase intracranial pressure, worsening the child's headache. Connecting Infection Control Principles to Practice The qualitative study on digital contact tracing implementation underscores the immense pressure on healthcare systems to rapidly adopt infection control strategies to sustain their workforce during a pandemic. This principle applies directly to managing a single case of a re-emerging, vaccine-preventable disease like polio within a pediatric unit. The immediate, correct application of isolation is a frontline defense mechanism. The case of primary measles encephalitis serves as a parallel example; it describes measles as a "highly infectious" virus with increasing prevalence, where prompt recognition and isolation are critical components of emergency management. Similarly, for a child with suspected polio, the nurse's priority is to immediately institute the correct transmission-based precautions—contact and droplet—to prevent a potential outbreak, ensuring the safety of all patients and staff before focusing on other aspects of care. ## 임상 시나리오 Acute Poliomyelitis Infection ControlPrioritizing Dual Isolation Precautions During the acute phase, poliovirus is shed in stool and oropharyngeal secretions. The highest priority nursing intervention is to implement strict contact and droplet precautions immediately upon admission to prevent nosocomial spread. Key clinical management includes enforcing complete bed rest in a neutral body alignment using a firm mattress and footboard. Active range of motion exercises are contraindicated during the febrile period to avoid exacerbating pain and muscle damage. CautionDo not place the patient in Trendelenburg position or administer corticosteroids. The focus is supportive care: managing fever, pain, and preventing contractures through proper positioning and strict infection control. ## 핵심 개념 - **Poliomyelitis Transmission** — A highly contagious enterovirus spread primarily via the fecal-oral route and occasionally through respiratory droplets, requiring both contact and droplet precautions. - **Contact Precautions** — Infection control measures including gloves and gown to prevent transmission of pathogens spread by direct or indirect contact with the patient or their environment. - **Droplet Precautions** — Infection control measures including a surgical mask to prevent transmission of pathogens spread through large respiratory droplets generated during coughing, sneezing, or talking. - **Acute Phase of Poliomyelitis** — The initial symptomatic period characterized by fever, headache, and progressive muscle weakness, during which viral shedding is highest and strict rest is essential. ## 같은 주제 문제 - [A nurse is assessing a 4-year-old child who was brought to the emergency department with s…](https://mymerci.kr/pages/nclex_q.php?qn_id=542271) - [A nurse is assessing a 4-year-old child who was recently diagnosed with poliomyelitis. 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