Clinical Manifestations	Therapeutic Management Complications/	Nursing Considerations
Prodromal stage: Absent in children, present in adults and adolescents; consists of lowgrade fever, headache, malaise, anorexia, mild conjunctivitis, coryza, sore throat, cough, and lymphadenopathy; lasts for 1-5 days, subsides 1 day after appearance of rash Rash: First appears on face and rapidly spreads downward to neck, arms, trunk, and legs; by end of first day, body is covered with a discrete, pinkish red maculopapular exanthema; disappears in same order as it began and is usually gone by third day Constitutional signs and symptoms: Occasionally low-grade fever, headache, malaise, and lymphadenopathy	No treatment necessary other than antipyretics for low-grade fever and analgesics for discomfort Complications:Rare (arthritis, encephalitis, or purpura); most benign of all childhood communicable diseases; greatest danger is teratogenic effect on fetus	Reassure parents of benign nature of illness in affected child Use comfort measures as necessary Isolate child from pregnant women
Prodromal stage: Abrupt high fever, pulse increased out of proportion to fever, vomiting, headache, chills, malaise, abdominal pain Enanthema: Tonsils enlarged, edematous, reddened, and covered with patches of exudate; in severe cases appearance resembles membrane seen in diphtheria; pharynx is edematous and beefy red; during first 1-2 days tongue is coated and papillae become red and swollen (white strawberry tongue); by fourth or fifth day white coat sloughs off, leaving prominent papillae (red strawberry tongue); palate is covered with erythematous punctate lesions Exanthema: Rash appears within 12 hours after prodromal stage; red pinhead-sized punctate lesions rapidly become generalized but are absent on face, which becomes flushed with striking circumoral pallor; rash is more intense in folds of joints; by end of first week desquamation begins (fine, sandpaper-like on torso; sheetlike sloughing on palms and soles), which may be complete by 3 weeks or longer	Treatment of choice is a full course of penicillin (or erythromycin in penicillin-sensitive children); fever should subside 24 hr after beginning therapy Antibiotic therapy for newly diagnosed carriers (nose or throat cultures positive for streptococci) Supportive measures: Bed rest during febrile phase, analgesics for sore throat Complications: Otitis media Peritonsillar abscess Sinusitis Glomerulonephritis Carditis, polyarthritis (uncommon)	Institute respiratory precautions until 24 hr after initiation of treatment Ensure compliance with oral antibiotic therapy (intramuscular benzathine penicillin G [Bicillin] may be given if parents’ reliability in giving oral drugs is questionable) Maintain bed rest during febrile phase; provide quiet activity during convalescent period Relieve discomfort of sore throat with analgesics, gargles, lozenges, antiseptic throat sprays (Chloraseptic), and inhalation of cool mist Encourage fluids during febrile phase; avoid irritating liquids (citrus juices) or rough foods; when child is able to eat, begin with soft diet Advise parents to consult practitioner if fever persists after beginning therapy Discuss procedures for preventing spread of infection

Clinical Manifestations

Therapeutic Management Complications/

Nursing Considerations

Prodromal stage: Absent in children, present in adults and adolescents; consists of lowgrade fever, headache, malaise, anorexia, mild conjunctivitis, coryza, sore throat, cough, and lymphadenopathy; lasts for 1-5 days, subsides 1 day after appearance of rash

Rash: First appears on face and rapidly spreads downward to neck, arms, trunk, and legs; by end of first day, body is covered with a discrete, pinkish red maculopapular exanthema; disappears in same order as it began and is usually gone by third day

Constitutional signs and symptoms: Occasionally low-grade fever, headache, malaise, and lymphadenopathy

No treatment necessary other than antipyretics for low-grade fever and analgesics for discomfort

Complications:Rare (arthritis, encephalitis, or purpura); most benign of all childhood communicable diseases; greatest danger is teratogenic effect on fetus

Reassure parents of benign nature of illness in affected child

Use comfort measures as necessary

Isolate child from pregnant women

Prodromal stage: Abrupt high fever, pulse increased out of proportion to fever, vomiting, headache, chills, malaise, abdominal pain

Enanthema: Tonsils enlarged, edematous, reddened, and covered with patches of exudate; in severe cases appearance resembles membrane seen in diphtheria; pharynx is edematous and beefy red; during first 1-2 days tongue is coated and papillae become red and swollen (white strawberry tongue); by fourth or fifth day white coat sloughs off, leaving prominent papillae (red strawberry tongue); palate is covered with erythematous punctate lesions

Exanthema: Rash appears within 12 hours after prodromal stage; red pinhead-sized punctate lesions rapidly become generalized but are absent on face, which becomes flushed with striking circumoral pallor; rash is more intense in folds of joints; by end of first week desquamation begins (fine, sandpaper-like on torso; sheetlike sloughing on palms and soles), which may be complete by 3 weeks or longer

Treatment of choice is a full course of penicillin (or erythromycin in penicillin-sensitive children); fever should subside 24 hr after beginning therapy

Antibiotic therapy for newly diagnosed carriers (nose or throat cultures positive for streptococci)

Supportive measures: Bed rest during febrile phase, analgesics for sore throat

Complications:

Otitis media

Peritonsillar abscess Sinusitis

Glomerulonephritis

Carditis, polyarthritis (uncommon)

Institute respiratory precautions until 24 hr after initiation of treatment

Ensure compliance with oral antibiotic therapy (intramuscular benzathine penicillin G [Bicillin] may be given if parents’ reliability in giving oral drugs is questionable)

Maintain bed rest during febrile phase; provide quiet activity during convalescent period

Relieve discomfort of sore throat with analgesics, gargles, lozenges, antiseptic throat sprays (Chloraseptic), and inhalation of cool mist

Encourage fluids during febrile phase; avoid irritating liquids (citrus juices) or rough foods; when child is able to eat, begin with soft diet

Advise parents to consult practitioner if fever persists after beginning therapy

Discuss procedures for preventing spread of infection