A nurse is assessing a 24-month-old toddler. Which of the following findings should the nurse report to the provider?

Impetigo contagiosa is a highly contagious superficial bacterial skin infection commonly caused by Staphylococcus aureus or Streptococcus pyogenes. It is characterized by honey-colored crusted lesions and spreads easily through direct contact with infected skin or contaminated objects. In the hospital setting, preventing transmission is a priority to protect other patients and healthcare workers. Infection control measures are essential alongside antibiotic therapy to limit spread.

Rationale:
A. Initiating contact isolation precautions is correct because impetigo is spread through direct skin-to-skin contact and contaminated surfaces. Contact precautions include gloves, gown use, and proper hand hygiene to prevent transmission. This is essential in a hospital setting to control nosocomial spread of the infection.

B. Amphotericin B IV is an antifungal medication used for severe systemic fungal infections, not bacterial skin infections like impetigo. Since impetigo is caused by bacteria, antifungal therapy is ineffective and inappropriate. Antibiotics, either topical or systemic, are the correct treatment approach.

C. Reporting the disease to the state health department is not required for impetigo contagiosa because it is a common, non-reportable skin infection. It requires infection control measures within the hospital, but it does not meet criteria for mandatory public health reporting.

D. Applying lidocaine ointment topically is not appropriate because impetigo does not typically cause pain requiring local anesthetic treatment. The condition is managed with antibacterial therapy rather than symptomatic anesthetic relief. Additionally, topical anesthetics may irritate broken skin and are not indicated.

MCNS causes increased permeability of the glomerular membrane, leading to massive protein loss in the urine, hypoalbuminemia, edema, and hyperlipidemia. The major nursing concerns involve maintaining fluid balance and preventing progression of renal complications. Because children with nephrotic syndrome can rapidly develop severe edema, intravascular volume depletion, and long-term renal impairment if complications occur, these findings require close monitoring and prompt intervention.

Rationale for correct choices:

• Fluid imbalance is a major concern because severe protein loss decreases plasma oncotic pressure, causing fluid to shift from the intravascular space into the interstitial tissues. This leads to edema, periorbital swelling, ascites, and decreased circulating blood volume despite visible swelling. The child already shows pitting edema, delayed capillary refill, and poor skin turgor, indicating altered fluid distribution. Strict intake and output, daily weights, and abdominal girth monitoring are prescribed to assess and manage this complication.

• Although MCNS often responds well to corticosteroid therapy, repeated relapses or complications can lead to progressive renal damage and increase the risk for chronic kidney disease. Persistent proteinuria and prolonged glomerular dysfunction may impair long-term kidney function if not effectively managed. Monitoring renal status and preventing complications are important nursing priorities.

Rationale for incorrect choices:

• Growth restriction can occur in children with chronic illness, especially with prolonged corticosteroid therapy such as prednisone, but it is not the greatest immediate concern during the acute phase of nephrotic syndrome. The priority is stabilizing fluid status and preventing renal complications first. Growth changes are usually a longer-term concern that develops over time rather than an urgent complication.

• Mood changes may occur as a side effect of corticosteroid therapy, particularly with prednisone, and children may become irritable, restless, or emotionally labile. However, this is not considered a life-threatening complication and does not take priority over fluid shifts or renal dysfunction. While psychosocial monitoring is important, it is secondary to preventing hypovolemia and kidney damage.