The nurse in the emergency department (ED) is caring for a 10-year-old client.
Item 3 of 5
- Nurses' Notes
1322: 10-year-old client and his parents report an 8-day history of a brownish-raised lesion over the back of his left leg. The parents report that the size of the rash has increased. The parents report returning from a one-week camping trip three weeks ago. The parents deny efficacy with over-the-counter antihistamine creams. The client's parents deny that the child has had a fever but has felt 'warm' occasionally and endorsed an intermittent headache. They report an area of firmness in the child's groin. On assessment, there was an erythematous, raised, nonpainful, oval patch on the back of his left leg. This was an enlargement of an inguinal lymph node. The child is alert and fully oriented and denies any pain. Peripheral pulses palpable 2+. No cyanosis or edema in the extremities. Lung sounds clear bilaterally. The parents report that the child did not receive the seasonal influenza vaccine. He currently takes a multivitamin for iron deficiency anemia and was hospitalized one year ago for an appendectomy. The parents state that the child’s sibling had influenza one month ago. Vital signs: T 98.8°F (37.1°C); HR 78 beats/min; RR 16 breaths/min; BP 110/76 mm Hg. SpO2 97% on room air.
Complete the following sentence by choosing from the list of options.
Complete the following sentence by choosing from the list of options.
The client is demonstrating manifestations consistent with
influenza.
Rocky Mountain spotted fever.
Lyme disease.
Statistics
Subject/Lesson
Subject
Child Health
Lesson
Infectious Disease
Client Need
Test Plan
Physiological Adaptation
Related Topic
Alterations in Body Systems
Item Type
Item Type
PrioritizeHypothesis
Explanation
- The child presents with a brownish-raised lesion that has increased in size over eight days and is oval, erythematous, and nonpainful, which is highly suggestive of erythema migrans, the classic rash associated with Lyme disease.
- Recent camping trip (three weeks ago) raises suspicion for a tick-borne illness, particularly Lyme disease, which is transmitted by the deer tick.
- Inguinal lymphadenopathy suggests a localized immune response, a common finding in early Lyme disease.
- RMSF typically presents with a petechial rash that begins on the wrists and ankles and spreads centrally, not a localized lesion. RMSF is usually accompanied by high fever, severe headache, and myalgia, none of which are reported here.
- Influenza is characterized by high fever, fatigue, myalgia, cough, and respiratory symptoms, none of which are present in this case. While the sibling had influenza, there is no evidence that this child has respiratory symptoms or systemic viral illness.
Related Videos
2 Key Topics
Transmission based precautions- Immune System
