A nurse in the clinic is providing information to a client who has mastitis of the left breast. The client asks the nurse. "Does this mean that I must stop nursing my baby?" Which of the following is an appropriate statement by the nurse?

A. Wear an N95 respiratory mask while caring for the toddler: RSV is transmitted via droplet and direct contact, not airborne particles. An N95 mask is not required; a standard surgical mask is sufficient when indicated. Using an N95 would be unnecessary and does not align with standard RSV precautions.

B. Place the toddler in a room with negative air pressure: Negative pressure rooms are reserved for airborne infections, such as tuberculosis or measles. RSV does not require airborne isolation, so a standard private room with contact and droplet precautions is appropriate.

C. Use a designated stethoscope when caring for the toddler: RSV spreads via direct contact and contaminated surfaces. Using a stethoscope dedicated to the infected child helps prevent transmission to other clients, aligning with contact precaution protocols and reducing the risk of cross-contamination.

D. Remove the disposable gown after leaving the toddler's room: Gowns should be removed before leaving the room, not after, to prevent contamination of other areas. Removing the gown inside the room maintains infection control.

Rationale for correct choices

• Kawasaki disease: The child presents with prolonged fever, conjunctival injection without exudate, inflamed oral mucosa, cracked lips, maculopapular rash, and edema with peeling of hands and feet. Laboratory findings include elevated WBC, CRP, ESR, and platelets, consistent with systemic inflammation. These clinical and lab features strongly indicate Kawasaki disease, a medium-vessel vasculitis primarily affecting children under 5–6 years of age.

• Assess for neurological changes: Neurological assessment is important because Kawasaki disease can involve the central nervous system, leading to irritability, lethargy, or aseptic meningitis. Continuous monitoring of neurological status helps identify complications early and guides supportive interventions.

• Plan to administer high dose of aspirin: High-dose aspirin is a standard treatment in the acute phase of Kawasaki disease to reduce inflammation and prevent coronary artery complications. It helps mitigate fever and vascular inflammation. This intervention is central to managing the inflammatory process and reducing the risk of long-term cardiac sequelae.

• Reports of chest pain or pressure: Monitoring for chest pain or pressure is essential because Kawasaki disease can lead to coronary artery aneurysms or myocardial ischemia. These symptoms may indicate cardiac involvement requiring immediate attention. Ongoing assessment helps detect early signs of cardiovascular complications, which are the most serious consequences of the disease.

• Daily weights: Daily weights help monitor fluid balance and detect edema, which may develop as part of systemic inflammation or as a response to treatment. Tracking weight changes assists in identifying fluid retention or loss, guiding interventions such as fluid management. Weight monitoring provides an objective measure of the child’s overall clinical status.

Rationale for incorrect choices

• Reyes syndrome: Reye’s syndrome is associated with post-viral illness and aspirin use, presenting with hepatic dysfunction and encephalopathy. The child’s symptoms of conjunctivitis, rash, and extremity changes do not align with Reye’s syndrome. Liver function tests and neurological deterioration would be more prominent, making this diagnosis unlikely.

• Varicella: Varicella (chickenpox) typically presents with vesicular lesions in different stages of healing, starting on the trunk and face. This child has maculopapular rash, not vesicular lesions, and systemic signs such as conjunctival injection and oral mucosa changes are not typical of varicella. The lab findings further support an inflammatory rather than viral etiology.

• Rheumatic fever: Rheumatic fever usually develops after untreated streptococcal pharyngitis and affects joints, heart valves, skin, and CNS (Sydenham chorea). This child’s current symptoms of rash, edema, conjunctivitis, and mucous membrane involvement do not fit the classic Jones criteria for rheumatic fever. Cardiac murmurs or migratory polyarthritis are absent, making this unlikely.

• Restrict fluid and salt intake: Fluid restriction is not a standard intervention in Kawasaki disease unless cardiac complications arise. Restricting fluids prematurely could risk dehydration and worsen systemic inflammation. Immediate priority is anti-inflammatory therapy and monitoring for cardiovascular involvement.

• Provide soft food: Providing soft food addresses oral discomfort but does not treat the underlying inflammatory vasculitis. While it may improve comfort, it does not impact disease progression or prevent cardiac complications, making it a lower-priority intervention.

• Implement airborne precautions: Airborne precautions are indicated for infections such as measles, varicella, or tuberculosis. Kawasaki disease is not contagious, so airborne precautions are unnecessary. Standard precautions suffice, allowing focus on managing inflammation and monitoring cardiac status.

• Prolonged bleeding time: Bleeding time is not a primary concern in Kawasaki disease and does not guide treatment or monitoring. The child’s labs indicate thrombocytosis rather than coagulopathy. This parameter is more relevant for platelet disorders or anticoagulant therapy.

• Lesion bruising: Bruising is not a feature of Kawasaki disease; the child’s rash is maculopapular, not hemorrhagic. Lesion bruising would suggest a hematologic or coagulation disorder, which is not indicated in this case.

• Chorea: Chorea is a hallmark of Sydenham chorea, a manifestation of rheumatic fever. The child exhibits irritability but not involuntary movements. Absence of chorea helps differentiate Kawasaki disease from post-streptococcal neurological complications.