Pediatric infections are a major area of focus in nursing, especially when preparing for the NCLEX. As children have developing immune systems, they are particularly vulnerable to certain infections, which can present unique challenges in care. This blog post will cover key pediatric infections, including Respiratory Syncytial Virus (RSV), Rotavirus, and others that are commonly encountered in clinical practice. Understanding these infections is vital for NCLEX success and ensuring the best care for pediatric patients.

1. Respiratory Syncytial Virus (RSV)

Overview:
RSV is one of the most common causes of respiratory infections in young children and infants, particularly during the winter months. It can lead to conditions such as bronchiolitis and pneumonia, which are especially dangerous for infants, premature babies, and children with underlying health issues.

Transmission:
RSV is spread through respiratory droplets, direct contact with an infected person, or touching contaminated surfaces.

Symptoms:

• Nasal congestion or runny nose
• Coughing and sneezing
• Wheezing
• Fever
• Difficulty breathing
• Poor feeding (especially in infants)

Nursing Care:

• Monitor respiratory status: Watch for signs of respiratory distress (e.g., nasal flaring, grunting, or retractions).
• Provide supportive care: Humidified oxygen, hydration, suctioning of nasal secretions, and maintaining adequate nutrition are critical.
• Educate parents: Emphasize hand hygiene, keeping infants away from sick contacts, and recognizing symptoms of worsening respiratory distress.
• Medication: Administer bronchodilators if prescribed and consider corticosteroids in severe cases. Palivizumab may be given prophylactically to high-risk infants.

2. Rotavirus

Overview:
Rotavirus is a highly contagious virus that primarily affects infants and young children. It is the leading cause of severe diarrhea and dehydration in children under 5 years of age. The introduction of the rotavirus vaccine has significantly reduced the number of cases, but it is still a notable cause of hospitalization.

Transmission:
Rotavirus is transmitted through the fecal-oral route, meaning it can spread through contaminated hands, surfaces, food, or water.

Symptoms:

• Watery diarrhea (often profuse and frequent)
• Vomiting
• Fever
• Abdominal pain
• Dehydration (dry mouth, decreased urination, lethargy)

Nursing Care:

• Monitor hydration status: Watch for signs of dehydration, such as dry mucous membranes, decreased skin turgor, and reduced urine output.
• Administer oral rehydration solutions (ORS): This is crucial to prevent and treat dehydration. In severe cases, IV fluids may be necessary.
• Educate parents: Encourage proper hand hygiene, the importance of completing the rotavirus vaccination series, and monitoring for signs of dehydration.
• Prevent transmission: Ensure proper sanitation and diaper-changing practices, especially in daycare or hospital settings.

3. Hand, Foot, and Mouth Disease (HFMD)

Overview:
Hand, Foot, and Mouth Disease is a common viral infection in young children, caused by the coxsackievirus. It is typically mild, though it can cause discomfort due to painful sores in the mouth, on the hands, and on the feet.

Transmission:
HFMD is spread through close contact with infected secretions such as saliva, mucus, or stool.

Symptoms:

• Fever
• Sore throat
• Painful, red spots in the mouth, hands, feet, and sometimes buttocks
• Irritability in infants and toddlers
• Loss of appetite

Nursing Care:

• Provide pain relief: Administer age-appropriate analgesics like acetaminophen or ibuprofen to manage discomfort.
• Ensure hydration: Due to painful mouth sores, children may refuse to drink, increasing the risk of dehydration. Offer cold fluids, popsicles, or ice chips.
• Educate parents: HFMD usually resolves on its own, but ensure parents know how to manage symptoms and prevent spread, particularly in daycare settings.

4. Streptococcal Pharyngitis (Strep Throat)

Overview:
Strep throat is a bacterial infection caused by Group A Streptococcus. It is most common in school-aged children and, if untreated, can lead to complications like rheumatic fever or post-streptococcal glomerulonephritis.

Transmission:
Strep throat is spread via respiratory droplets from an infected person.

Symptoms:

• Sore throat (often severe and sudden onset)
• Fever
• Painful swallowing
• Swollen lymph nodes
• Red and swollen tonsils, sometimes with white patches or streaks of pus
• Headache, nausea, and vomiting in younger children

Nursing Care:

• Administer antibiotics: Penicillin or amoxicillin is the first-line treatment. Ensure full course completion.
• Encourage hydration and rest: Provide cool liquids and soft foods to soothe the throat.
• Educate parents: Stress the importance of finishing the prescribed antibiotics and when to seek further care (e.g., if the child develops a rash or joint pain).

5. Otitis Media

Overview:
Otitis media is a middle ear infection that is common in young children due to their shorter and more horizontal Eustachian tubes. It can cause pain, irritability, and temporary hearing loss, and may lead to complications like tympanic membrane rupture if not treated.

Transmission:
Otitis media is often secondary to upper respiratory infections (e.g., from RSV or influenza) and is not directly contagious.

Symptoms:

• Ear pain (especially when lying down)
• Tugging or pulling at the ear
• Difficulty sleeping
• Crying more than usual
• Fever
• Fluid drainage from the ear
• Difficulty hearing or responding to sounds

Nursing Care:

• Pain management: Provide acetaminophen or ibuprofen for pain relief.
• Administer antibiotics if prescribed: Not all cases require antibiotics; guidelines suggest watchful waiting in mild cases.
• Educate parents: Teach signs of worsening infection and the importance of follow-up visits if the child has recurrent ear infections.

6. Impetigo

Overview:
Impetigo is a highly contagious bacterial skin infection caused by Staphylococcus or Streptococcus. It commonly affects toddlers and school-aged children and is characterized by red sores that burst and develop honey-colored crusts.

Transmission:
Impetigo spreads through direct contact with infected sores or items like towels, clothing, or toys.

Symptoms:

• Red sores that quickly rupture, ooze, and form a yellow-brown crust
• Itchy rash
• Lesions typically around the mouth, nose, hands, and feet

Nursing Care:

• Administer topical or oral antibiotics: Mupirocin ointment is often used for localized infections, while oral antibiotics may be required for widespread cases.
• Prevent spread: Emphasize handwashing, keeping the child’s nails short, and avoiding scratching the sores.
• Educate parents: Teach them how to clean and care for the infected area and the importance of completing the full course of antibiotics.

Sample NCLEX Questions

Question 1

A 3-month-old infant is diagnosed with RSV and is admitted for bronchiolitis. Which intervention should the nurse prioritize?
A. Administer antibiotics as prescribed
B. Provide cool, humidified oxygen
C. Restrict fluids to prevent fluid overload
D. Perform chest physiotherapy every 4 hours

Answer: B. Provide cool, humidified oxygen.

Question 2

A nurse is educating the parents of a child diagnosed with rotavirus. Which statement indicates a need for further teaching?
A. “We should encourage our child to drink plenty of fluids to prevent dehydration.”
B. “We will make sure our child finishes the entire course of antibiotics.”
C. “We will practice good hand hygiene to prevent the spread of the virus.”
D. “We will avoid giving our child sugary drinks, as they can worsen diarrhea.”

Answer: B. “We will make sure our child finishes the entire course of antibiotics.” (Antibiotics are not effective against viral infections like rotavirus.)

Question 3

A child is diagnosed with strep throat. The nurse explains that completing the full course of antibiotics is important to prevent which complication?
A. Scarlet fever
B. Rheumatic fever
C. Impetigo
D. Asthma

Answer: B. Rheumatic fever.

NCLEX Preparation Tips for Pediatric Infections

1. Know the common pediatric infections: RSV, rotavirus, and others are frequently tested on the NCLEX. Understand their transmission, symptoms, and nursing care.
2. Focus on nursing care and prevention: Pay attention to key interventions like hydration, monitoring respiratory status, and infection control practices.
3. Practice therapeutic communication: Be prepared to educate parents about infection prevention, symptom management, and the importance of vaccinations.
4. Understand the medications: Be aware of the role of antibiotics, antiviral agents, and other supportive care treatments commonly used in pediatric infections.

Conclusion

Pediatric infections such as RSV, rotavirus, and others present unique challenges for nurses, particularly when caring for vulnerable populations like infants and young children. By understanding the causes, symptoms, and nursing interventions for these infections, you will be better prepared to provide excellent care and succeed on the NCLEX exam.