# A 4-year-old child is admitted to the pediatric unit with a diagnosis of scarlet fever. Which nursing intervention should be the priority during the acute phase of the illness?

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> subject: Child Health

## 문제

A 4-year-old child is admitted to the pediatric unit with a diagnosis of scarlet fever. Which nursing intervention should be the priority during the acute phase of the illness?

## 보기

1. Encourage increased fluid intake and monitor for dehydration
2. Apply cool compresses to reduce fever and provide comfort measures
3. Administer prescribed analgesics for throat pain and headache
4. Implement strict isolation precautions and monitor for complications **✔ 정답**

**정답: 4**

## 해설

Strict isolation precautions are the priority to prevent transmission of scarlet fever, a highly contagious infection. Monitoring for complications like rheumatic fever is also critical during the acute phase.

## 심화 해설

Understanding the Pathogen and Transmission

Scarlet fever is caused by Group A Streptococcus (GAS), specifically Streptococcus pyogenes, a Gram-positive bacterium known for its high virulence due to the production of various enzymes and toxins [2]. A key feature of its virulence is the release of erythrogenic exotoxins, which cause the characteristic sandpaper-like rash. Critically, a recent systematic review and meta-analysis has confirmed that while respiratory droplets are a dominant mode of transmission, they are not the only one. The evidence highlights that transmission can also occur through direct contact with infected skin lesions, contaminated fomites, and potentially other routes [1]. This broader understanding of transmission directly informs the highest-priority nursing action: controlling the spread of the infection.

Priority Nursing Intervention: Rationale for Strict Isolation

In the acute phase of scarlet fever, the child is highly contagious. Given the multiple potential modes of transmission, including droplets and contact [1], the priority nursing intervention is to implement strict isolation precautions. This is not merely a routine task but a critical safety measure to protect other vulnerable children on the pediatric unit from acquiring the infection. The standard of care involves a combination of droplet precautions for respiratory secretions and contact precautions for any draining lesions or contaminated surfaces, continuing for at least 24 hours after the initiation of effective antibiotic therapy. Simultaneously, the nurse must vigilantly monitor for complications, as GAS has the potential to cause severe, invasive disease (iGAS), including bacteremia, necrotizing fasciitis, and streptococcal toxic shock syndrome, as well as serious post-infectious, immune-mediated sequelae such as rheumatic fever and post-streptococcal glomerulonephritis [2][3]. A recent nationwide multicenter study underscores the clinical burden of these invasive infections, making early detection of systemic deterioration a core nursing responsibility [3].

Why Other Interventions Are Secondary

While encouraging fluid intake, applying cool compresses, and administering analgesics are all important comfort and supportive care measures for the individual patient, they address the symptoms rather than the primary public health and safety risk. Dehydration is a concern with fever and painful swallowing, and pain management improves oral intake and comfort. However, these interventions can be safely implemented *after* transmission-based precautions are in place. The failure to immediately initiate isolation could lead to an outbreak, causing more harm than a temporary delay in symptom relief for one patient. The hierarchical priority is to first contain the biological hazard to prevent harm to others, then address the individual’s symptomatic needs.

References (research sources)

- [1]It's not just droplets: a systematic review and meta-analysis of the modes of transmission of Group A <i>Streptococcus</i>.Meta-analysis/systematic reviewBarth DD, Daw J, Enkel SL, McRae T, Carapetis JR, Wyber R, Bowen AC, Engel ME. (2025) · DOI: 10.3389/fpubh.2025.1630054

- [2]Invasive group A Streptococcus infection (Streptococcus pyogenes): Current situation in Spain.Research articleMartín-Delgado MC, De Lucas Ramos P, García-Botella A, Cantón R, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Burillo A, Muñoz P, Calvo Rey C, Catalán-González M, Cendejas-Bueno E, Halperin-Benito V, Recio R, Viñuela-Benítez C, Bouza E. (2024) · DOI: 10.37201/req/067.2024

- [3]Epidemiology and clinical characteristics of invasive group A streptococcal infection in the Republic of Korea, 2015-2024: a nationwide multicenter study.Research articleKim YK, Yun KW, Choi EH, Kang JM, Kang HM, Kim HW, Kwak BO, Kim DH, Kim D, Lee J, Choe YJ, Jo DS, Park E, Cho EY, Yoon Y, Jo KJ, Park SE, Choi SH, Lee S, Kim G, Lee JK, Cho HK, Lee T, Eun BW, So H, Choi UY, Lee JH, Shin DW, Park JS, Song KH, Kim J, Kim H, Lee H. (2026) · DOI: 10.1016/j.lanwpc.2026.101885

## 임상 시나리오

Scarlet Fever Infection ControlPrioritizing Isolation in the Pediatric Acute Phase
The priority for a child with scarlet fever is implementing strict isolation precautions to prevent transmission. The causative agent, Group A Streptococcus, spreads via respiratory droplets and direct contact with contaminated items.

Combine droplet precautions (private room, mask within 3 feet) and contact precautions (gloves, gown). Maintain isolation for at least 24 hours after effective antibiotic therapy is initiated.

CautionDo not delay isolation for comfort measures. A child remains highly contagious in the acute phase, and failure to isolate immediately endangers other vulnerable patients on the unit.

## 핵심 개념

- **Scarlet Fever** — An infectious disease caused by Group A Streptococcus pyogenes, characterized by a sandpaper-like rash from erythrogenic exotoxins.
- **Group A Streptococcus (GAS)** — A Gram-positive bacterium (Streptococcus pyogenes) that causes various infections and is transmitted via respiratory droplets and direct contact.
- **Droplet Precautions** — Infection control measures used for pathogens transmitted through large respiratory droplets, requiring a private room and mask within 3 feet of the patient.
- **Contact Precautions** — Infection control measures for pathogens spread by direct or indirect contact, requiring gloves and gown upon room entry.
- **Erythrogenic Exotoxins** — Toxins produced by Group A Streptococcus that cause the characteristic red rash of scarlet fever by damaging capillaries.

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