A nurse in a provider's office is caring for a group of clients who have communicable diseases. Which of the following infections should the nurse report to the state health department?

A. Facial erythema is not a primary diagnostic feature of this specific respiratory bacterial infection. While intense coughing fits may cause temporary facial flushing or venous congestion, it is not a hallmark finding. Conditions like fifth disease or slapped-cheek syndrome are more likely to present with persistent malar rashes. This sign lacks the specificity required for a pertussis diagnosis.

B. Peeling of the skin on the extremities, known as desquamation, is classically associated with Kawasaki disease or scarlet fever. Bordetella pertussis does not typically produce the exotoxin profile necessary to cause significant integumentary shedding or widespread dermatological involvement. The pathology of pertussis is primarily localized to the ciliated epithelium of the respiratory tract. It is not an exfoliative disease.

C. In the catarrhal phase of the infection, a low-grade temperature is a standard clinical finding as the immune system responds to the initial bacterial colonization. The presence of systemic inflammation results in mild pyrexia alongside coryza. This manifestation is most prominent before the onset of the characteristic paroxysmal cough. Fever helps differentiate early pertussis from non-inflammatory conditions.

D. A beefy, red tongue, often described as a strawberry tongue, is a classic sign of scarlet fever or toxic shock syndrome. This manifestation occurs due to capillary permeability and inflammation of the lingual papillae caused by Streptococcus pyogenes. Pertussis involves the respiratory mucosa rather than the oral structures or the tongue. This symptom indicates a different bacterial or inflammatory etiology.

A) "I will make sure that my baby's diaper is applied snugly":
A snug diaper could potentially cause irritation or pressure on the circumcision site, increasing the risk of complications such as discomfort or delayed healing. Diapers should be fitted appropriately but not excessively tight around the area to avoid friction on the circumcised site.

B) "I will wipe away yellow crusts that form around the incision":
Yellow crusts are a normal part of the healing process following a Plastibell circumcision, and they should not be wiped away. These crusts form as part of the natural healing process, and removing them prematurely can disrupt the healing tissue or cause unnecessary bleeding or infection.

C) "I will apply antibiotic ointment to my baby's penis":
Antibiotic ointment is generally not recommended for use after a Plastibell circumcision, as it can interfere with the healing process. The Plastibell procedure typically heals with just proper care and the use of a clean diaper. Applying ointments can cause excess moisture that might lead to infection.

D) "I will apply pressure with gauze if I see bleeding":
This is the correct response. If bleeding occurs after a Plastibell circumcision, the appropriate action is to apply gentle pressure with sterile gauze to control the bleeding. Excessive bleeding or uncontrolled bleeding after the procedure may require medical attention, but applying pressure is the first step in addressing this issue.