A 6-year-old patient has been diagnosed with impetigo secondary to chigger bites and is prescribed oral cephalexin. The nurse is educating the patient's father on the care plan. Which of the following instructions is most important to emphasize to ensure effective management of the patient's condition?

A) Administer the full course of antibiotics as prescribed, even if symptoms improve.

B) Apply the antihistamine cream only when itching is severe.

C) Use cool compresses to reduce redness and swelling.

D) Encourage the child to scratch the area lightly to relieve itching.

A 7-year-old patient presents with a secondary bacterial infection following chigger bites, diagnosed as impetigo. The nurse practitioner has prescribed a course of oral cephalexin. Which nursing action is most important to prevent further complications of the skin infection in this patient?

B) Reinforce the importance of proper skin hygiene and handwashing.

A) Encourage the use of cool compresses to reduce swelling and redness.

B) Reinforce the importance of proper skin hygiene and handwashing.

C) Advise the parent to administer antihistamine cream more frequently.

D) Suggest increasing the patient's fluid intake to promote hydration.

A 10-year-old patient returns to the clinic with a mild fever and sore throat two days after starting antibiotic treatment for a skin infection. Considering the patient's symptoms and current treatment plan, what is the most appropriate nursing action?

B) Recommend increasing the fluid intake and monitor for any new symptoms.

A) Advise the father to stop the antibiotic immediately and switch to acetaminophen only.

B) Recommend increasing the fluid intake and monitor for any new symptoms.

C) Suggest switching to a different antibiotic due to a suspected allergic reaction.

D) Instruct the father to apply a cool compress to reduce the fever and avoid further medications.

A 7-year-old patient is being evaluated following antibiotic treatment for an infection. The patient's father reports a decrease in leg redness and swelling, but a new mild fever and sore throat have developed. The nurse practitioner suspects either an adverse reaction to the antibiotic or a separate viral infection. Which clinical action should the nurse prioritize to best manage the patient's care?

B) Advise the father to increase fluid intake and use acetaminophen, while monitoring for worsening symptoms.

A) Immediately discontinue the antibiotic and switch to a different class of medication.

B) Advise the father to increase fluid intake and use acetaminophen, while monitoring for worsening symptoms.

C) Initiate a new antibiotic regimen to cover potential streptococcal infection.

D) Refer the patient to the emergency department for further evaluation and treatment.

A pediatric patient presents with a persistent fever, sore throat, fatigue, and a new rash after recently starting an antibiotic. The rapid strep test was negative, and the antibiotic was discontinued. What should be the nurse's priority action?

D) Advise the parents to immediately seek medical attention if the child develops difficulty breathing.

A) Encourage frequent fluid intake and monitor for signs of dehydration.

B) Reassure the parents that viral exanthems are common and usually resolve on their own.

C) Instruct the parents to administer the prescribed antihistamines and antipyretics as needed.

D) Advise the parents to immediately seek medical attention if the child develops difficulty breathing.

A child presents with a persistent fever, a new diffuse rash, and a negative rapid strep test. The nurse practitioner discontinued the antibiotic due to a suspected drug reaction. Which nursing intervention is the most appropriate based on this clinical scenario?

C) Advise the parent to administer over-the-counter antihistamines and monitor for improvement.

A) Initiate isolation precautions to prevent the spread of a possible viral infection.

B) Educate the parent on the importance of completing the antibiotic course despite the new rash.

C) Advise the parent to administer over-the-counter antihistamines and monitor for improvement.

D) Encourage the parent to apply topical antibiotics to the rash to prevent secondary infection.

A 7-year-old child presents with a diffuse rash, abdominal pain, diarrhea, and lethargy, with laboratory findings indicating an elevated white blood cell count with increased eosinophils. The nurse practitioner considers the possibility of a post-infectious or inflammatory syndrome. Which of the following actions should the nurse prioritize to address the child's current condition?

A) Administer intravenous fluids to prevent dehydration.

B) Initiate corticosteroid therapy to reduce inflammation.

C) Educate the parents on the importance of completing the prescribed course of antibiotics.

D) Prepare the child for a skin biopsy to identify the rash's etiology.

A pediatric patient returns with worsening symptoms including fever, abdominal pain, diarrhea, a pronounced rash, lethargy, and increased heart rate. Based on the provided case, which nursing intervention is most appropriate to prioritize after ensuring the patient's hydration status?

C) Prepare the patient for laboratory tests to assess electrolyte imbalances and further infection markers.

A) Initiate contact precautions to prevent the spread of a potential infectious disease.

B) Educate the parent on the importance of administering antipyretics regularly to manage fever.

C) Prepare the patient for laboratory tests to assess electrolyte imbalances and further infection markers.

D) Administer antihistamines to alleviate the child's rash and associated discomfort.

A 7-year-old child is admitted to the pediatric unit with increased lethargy, a low-grade fever, intensified abdominal pain, frequent diarrhea, a spreading rash, and signs of dehydration. The laboratory results show mild hypokalemia and elevated eosinophil count. Based on this information, what is the most appropriate immediate nursing intervention?

B) Initiate intravenous fluid therapy to address dehydration.

A) Administer oral potassium supplements to correct hypokalemia.

B) Initiate intravenous fluid therapy to address dehydration.

C) Apply topical corticosteroids to manage the spreading rash.

D) Provide antipyretics to control the child's fever.

A 6-year-old girl presents with increased lethargy, low-grade fever, abdominal pain, frequent diarrhea, and a spreading rash. Her vital signs show an increased heart rate and signs of dehydration. Laboratory results reveal mild hypokalemia and elevated eosinophil count. Which of the following interventions should be prioritized by the nurse to address the patient's current condition?

B) Initiate intravenous fluid therapy to address dehydration and support electrolyte balance.

A) Administer oral potassium supplements to correct hypokalemia.

B) Initiate intravenous fluid therapy to address dehydration and support electrolyte balance.

C) Apply topical corticosteroids to reduce the rash and excoriation.

D) Administer antipyretics to manage the child's fever.

During the summer, an 8-year old female was brought to a local clinic in Hattiesburg with an itchy rash on her lower legs. Clusters of small red bumps were concentrated around her ankles on skin usually covered by her socks. There was no bleeding, but the patient’s itching had opened some of the papules on her ankles and clear fluid has seeped out. A doctor continued his examination by taking a patient's history. The patient and her father reported that she had recently taken a trip to a beach in Pensacola with her family, and that she enjoys playing in the fields behind their house with her siblings. Hearing this, the doctor determined that the condition was likely trombiculosis, caused by the feeding of trombiculid mites commonly known as chiggers. The doctor noted that although the papules were clearly irritated by the patient’s itching, she didn’t see signs of infection. She recommended that the patient apply an over-the-counter antihistamine cream to reduce the irritation and to monitor the area for signs of infection, but that no other treatments were necessary - Nursing Case Study

Pathophysiology

• Primary mechanism: Trombiculid mites, or chiggers, attach to the skin and inject saliva containing digestive enzymes, which break down skin cells and cause localized irritation and inflammation.

• Secondary mechanism: The body's immune response to the mite's saliva leads to the formation of papules, characterized by clusters of itchy, red bumps as part of an allergic reaction.

• Key complication: Excessive scratching can damage the skin barrier, leading to potential secondary bacterial infections, although no current signs of infection were noted.

Patient Profile

Demographics:

8-year-old female, student

History:

• No significant past medical history

• No current medications

• No known allergies

Current Presentation:

• Chief complaint: Itchy rash on lower legs

• Key symptoms: Clusters of small red bumps around ankles, clear fluid seeping from some papules, itching

• Vital signs: Elevated heart rate, slightly elevated temperature, normal blood pressure

Section 1

Three days after the initial assessment, the patient returned to the clinic with her father. Her father reported that while the itching had slightly decreased with the use of the antihistamine cream, new symptoms had emerged. The patient now complained of increased redness and warmth around the affected area, as well as mild swelling. Additionally, the father noted a slight increase in her irritability and fatigue over the last day. The nurse practitioner conducted a thorough examination and observed that the rash had extended to the upper calves and that several papules now had a crusty, yellowish appearance, suggesting possible secondary bacterial infection.

The nurse practitioner ordered a complete blood count (CBC) and a culture of the fluid from the papules to identify any bacterial presence. The CBC revealed a mild leukocytosis, indicating an immune response possibly due to infection. The culture results, available two days later, confirmed the presence of Staphylococcus aureus, a common culprit in secondary skin infections. In light of these findings, the nurse practitioner concluded that the patient's condition had evolved into a mild case of impetigo, a bacterial skin infection secondary to the initial chigger bites.

Given the patient's new diagnosis, the nurse practitioner adjusted the treatment plan to include a course of oral antibiotics, specifically a child-appropriate formulation of cephalexin, to address the bacterial infection. Additionally, the patient was advised to continue using the antihistamine cream to manage itching and apply warm compresses to alleviate discomfort. The nurse practitioner emphasized the importance of avoiding scratching and maintaining proper skin hygiene to prevent further complications. The father was instructed to monitor the patient's temperature and return to the clinic if the symptoms worsened or if new symptoms, such as fever or increased lethargy, developed. This updated care strategy aimed to resolve the infection while preventing further skin damage and discomfort.

Section 2

Two days after starting the antibiotic treatment, the patient returned to the clinic for a follow-up visit. During this visit, the nurse practitioner assessed the patient’s response to the interventions. The patient’s father reported that the girl had been taking her medications as prescribed, and there was a noticeable decrease in the redness and swelling on her legs. The itching had also reduced, allowing for better rest at night. However, the father noted a new development: the patient had developed a mild fever of 100.4°F (38°C) the previous evening and complained of a sore throat this morning.

Upon examination, the nurse practitioner observed that while the rash on the lower legs appeared less inflamed, the crusty lesions were still present but not worsening. Palpation revealed that the area was cooler to the touch, indicating a reduction in inflammation. However, the patient's vital signs indicated a mild tachycardia with a heart rate of 110 beats per minute and a slightly elevated respiratory rate of 24 breaths per minute. A throat examination revealed mild erythema but no exudate. Considering these findings, the nurse practitioner suspected that the mild fever and sore throat could potentially be a reaction to the antibiotic or a separate viral infection coinciding with the current condition.

To investigate further, the nurse practitioner ordered a throat swab for a rapid strep test to rule out streptococcal pharyngitis and recommended monitoring the patient's symptoms closely. The father was advised to ensure the patient remained hydrated and to use acetaminophen as needed for fever management. This careful monitoring aimed to distinguish between an adverse drug reaction and a concurrent viral illness, ensuring appropriate modifications to the treatment plan if necessary. The nurse practitioner emphasized the need to return to the clinic if the fever persisted or if the patient experienced any difficulty breathing, further fatigue, or rash spread.

Section 3

Two days after the follow-up visit, the patient returned to the clinic as advised due to a persistent fever and new symptoms. The father expressed concern as the child's fever had escalated to 101.8°F (38.8°C) and she had developed a mild, diffuse rash on her torso. The sore throat persisted, and the patient now reported feeling more fatigued. During the clinical assessment, the nurse practitioner noted an increase in the patient's heart rate to 120 beats per minute and a respiratory rate of 26 breaths per minute, suggesting an elevated physiological response. The child's blood pressure was stable at 100/60 mmHg. The rash on her legs was significantly less inflamed, with the crusting lesions starting to heal, indicating that the initial rash was improving despite the new symptoms.

The rapid strep test results from the previous visit returned negative, eliminating streptococcal pharyngitis as a cause for the sore throat and fever. Given the new rash presentation and the negative strep test, the nurse practitioner considered the possibility of a viral exanthem or an adverse drug reaction. Laboratory tests were ordered, including a complete blood count (CBC) to evaluate for potential infection or allergic reaction, and liver function tests to assess for any drug-induced liver injury. The nurse practitioner also decided to discontinue the antibiotic as a precautionary measure against a suspected drug reaction and prescribed supportive care, including antipyretics and antihistamines, to manage the fever and rash.

The nurse practitioner emphasized the importance of continued monitoring for any new or worsening symptoms. The father was instructed to maintain hydration and to return if the patient’s condition did not improve within 48 hours or if she developed any new symptoms, such as difficulty breathing or increased rash severity. This careful approach aimed to balance the management of potential drug reactions with the assessment for an underlying viral cause, ensuring the patient's safety and guiding further clinical decisions.

Section 4

Two days later, the patient returned to the clinic with her father, who reported that while the fever had decreased slightly, the child was now experiencing episodes of abdominal pain and diarrhea. The nurse practitioner performed a thorough assessment and noted that the diffuse rash on the torso had become slightly more pronounced, with some areas appearing erythematous and raised. The child appeared more lethargic, and her heart rate had increased to 130 beats per minute, while her respiratory rate remained elevated at 28 breaths per minute. Her blood pressure was stable at 98/58 mmHg. These signs, combined with the gastrointestinal symptoms, suggested a more systemic involvement.

The laboratory results from the previous visit showed a mildly elevated white blood cell count at 13,000 cells/μL, with an increase in eosinophils, suggesting a potential allergic reaction or parasitic involvement. Liver function tests were within normal limits, indicating no hepatic involvement at this stage. Given the persistence of symptoms and the new gastrointestinal manifestations, the nurse practitioner considered the possibility of a post-infectious or inflammatory syndrome, potentially triggered by a viral exanthem or an allergic response.

In response to these findings, the nurse practitioner decided to initiate a more comprehensive management plan, including a referral to a pediatric infectious disease specialist for further evaluation. The patient was advised to continue antipyretics for fever management and antihistamines for rash relief. The father was instructed to maintain a hydration-focused diet and to monitor for any further gastrointestinal symptoms. This plan aimed to address the current symptoms while exploring deeper underlying causes, ensuring a thorough evaluation of the child's evolving condition.

Section 5

Three days after the initial follow-up visit, the patient returned to the clinic with her father, expressing concern over new developments in her condition. The child now exhibited increased lethargy and had developed a low-grade fever of 100.8°F (38.2°C) that persisted despite the use of antipyretics. Her abdominal pain had intensified, and her diarrhea was more frequent, occurring four to five times daily. Upon examination, the nurse practitioner observed that the rash had spread further, now covering significant portions of the child's torso and arms, with some areas showing evidence of excoriation due to scratching.

Vital signs displayed a subtle change: the heart rate had increased to 135 beats per minute, and while her respiratory rate had decreased slightly to 26 breaths per minute, there was a noted concern about dehydration, as her mucous membranes appeared dry. The child's blood pressure remained stable at 96/56 mmHg. Given these observations, the nurse practitioner decided to order additional laboratory tests, including a comprehensive metabolic panel to assess electrolyte balance, particularly given the ongoing diarrhea and potential dehydration.

The laboratory results revealed a mild hypokalemia with a potassium level of 3.2 mEq/L, indicating the need for careful electrolyte management. Additionally, the eosinophil count remained elevated, reinforcing the suspicion of an allergic or parasitic process. With these findings, the nurse practitioner considered the possibility of an evolving hypersensitivity reaction or a systemic inflammatory response. The decision was made to admit the child to the pediatric unit for intravenous fluid therapy and close monitoring, while awaiting further evaluation by the pediatric infectious disease specialist. This step aimed to stabilize the patient's condition and prevent any further complications while continuing to explore the underlying cause of her symptoms.