# A nurse is caring for a 7-year-old child diagnosed with Rocky Mountain spotted fever (RMSF). Which nursing intervention should be the priority? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542293 > language: ko > subject: Child Health ## 문제 A nurse is caring for a 7-year-old child diagnosed with Rocky Mountain spotted fever (RMSF). Which nursing intervention should be the priority? ## 보기 1. Monitor for signs of increased intracranial pressure and neurological changes **✔ 정답** 2. Encourage increased fluid intake to prevent dehydration 3. Apply cool compresses to reduce fever and promote comfort 4. Educate parents about tick prevention measures for the future **정답: 1** ## 해설 Monitoring for neurological changes is the priority due to high risk of CNS involvement in RMSF, which can lead to severe complications like increased ICP. Other interventions are supportive but secondary. ## 심화 해설 Understanding the Priority: The Pathophysiology of RMSF Rocky Mountain spotted fever (RMSF) is a tick-borne illness caused by Rickettsia rickettsii. The primary pathophysiological mechanism is a widespread bacterial vasculitis, where the organism invades and destroys the endothelial lining of small blood vessels [1]. This vascular damage leads to increased permeability, microhemorrhages, and the formation of microthrombi. In the central nervous system, this process can cause cerebral edema, focal ischemic lesions, and a clinical picture consistent with meningoencephalitis. Therefore, the most immediate and life-threatening complications stem directly from this vascular inflammation, particularly when it affects the brain. Why Option 1 is the Priority Monitoring for signs of increased intracranial pressure (ICP) and neurological changes addresses the most lethal complication of RMSF: central nervous system involvement. The vasculitis and associated thrombosis, as described in the context of bacterial vasculitis, can directly lead to infarction and tissue damage [1]. In a pediatric patient, signs of increased ICP (such as altered level of consciousness, vomiting, bradycardia, and hypertension) and other neurological changes (such as seizures, ataxia, or cranial nerve palsies) indicate that the disease is progressing to a critical stage. Early detection of these signs allows for prompt medical intervention, which is crucial because neurological deterioration can be rapid and irreversible. The nurse's role in continuous neurological assessment is the cornerstone of preventing death or long-term disability from this disease. Why the Other Options Are Not the Priority While the other interventions are components of holistic care, they do not address the immediate threat to life. The clinical practice guidelines for severe infections like sepsis emphasize the prioritization of life-threatening organ dysfunction, which in RMSF is often neurological [2, 3]. - Option 2 (Encourage increased fluid intake): Maintaining hydration is important to support perfusion and manage fever, but it is a supportive measure. It does not directly prevent or detect the catastrophic neurological progression caused by cerebral vasculitis. In a patient with potential cerebral edema, fluid management requires careful medical guidance and is not a simple independent nursing action to increase intake. - Option 3 (Apply cool compresses): Fever management is a comfort measure. While high fever can exacerbate neurological symptoms, simply applying cool compresses does not halt the underlying vasculitic process or monitor for its most dangerous effects. Antipyretics, not external cooling alone, are the pharmacological intervention for fever, but even this is secondary to neurological protection. - Option 4 (Educate parents about tick prevention): This is an important public health and discharge teaching intervention, but it is not an acute care priority. The immediate focus for a hospitalized child with active RMSF must be on managing the current, potentially fatal infection and its complications. Prevention education is appropriate once the patient is stabilized and preparing for discharge. The priority nursing action is to directly monitor for the most dangerous consequence of the disease's core pathophysiology. In RMSF, the bacterial vasculitis [1] makes the central nervous system a primary target for life-threatening injury, making neurological assessment the clear priority.References (research sources) - [1]Case report: In vivo detection of neutrophil extracellular traps in a dog with thrombosis induced by bacterial vasculitis.Case reportKim JY, Han HJ. (2025) · DOI: 10.3389/fvets.2025.1470605 ## 임상 시나리오 RMSF Priority: Neurological AssessmentEarly Detection of CNS Vasculitis The priority for a child with Rocky Mountain spotted fever is monitoring for increased intracranial pressure. The underlying bacterial vasculitis can rapidly cause cerebral edema and meningoencephalitis, which are the most immediate life-threatening complications. Assess neurological status at least every 2 hours. Watch for signs of increased ICP: altered level of consciousness, severe headache, vomiting, Cushing's triad (bradycardia, hypertension, irregular respirations), and pupillary changes. CautionDo not delay neurological checks for comfort measures like fever reduction. A sudden change in mental status or onset of seizures requires immediate escalation to prevent irreversible brain injury. ## 핵심 개념 - **Rocky Mountain Spotted Fever (RMSF)** — A tick-borne illness caused by Rickettsia rickettsii, characterized by bacterial vasculitis leading to increased vascular permeability and microthrombi formation. - **Bacterial Vasculitis** — Inflammation and destruction of the endothelial lining of blood vessels by bacteria, the primary pathophysiological mechanism in RMSF causing end-organ damage. - **Increased Intracranial Pressure (ICP)** — A life-threatening complication of RMSF resulting from cerebral edema and vasculitis, manifesting as altered consciousness, vomiting, and Cushing's triad. - **Meningoencephalitis** — Inflammation of the brain and meninges, a severe CNS manifestation of RMSF that can lead to seizures, focal deficits, and permanent neurological damage. ## 같은 주제 문제 - [A 7-year-old child is brought to the emergency department with a 3-day history of fever, h…](https://mymerci.kr/pages/nclex_q.php?qn_id=542289) - [A 10-year-old child presents to the emergency department with a 4-day history of fever, he…](https://mymerci.kr/pages/nclex_q.php?qn_id=542290) - [A 7-year-old child is brought to the emergency department with a 4-day history of fever, h…](https://mymerci.kr/pages/nclex_q.php?qn_id=542291) - [A 10-year-old child is diagnosed with Rocky Mountain spotted fever after developing a char…](https://mymerci.kr/pages/nclex_q.php?qn_id=542292) - [A 10-year-old child is admitted to the pediatric unit with a diagnosis of Rocky Mountain s…](https://mymerci.kr/pages/nclex_q.php?qn_id=542294) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._