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Assignment NR 602 Grand Rounds W2 

Assignment: NR 602 Grand Rounds W2 


Every parent worries about their child getting sick. Teaching children proper hand hygiene is vital to the prevention of many illnesses. Hand, foot and mouth (HFM) disease is a common contagious illness caused by viruses in the enterovirus family, most commonly the coxsackievirus. HFMD and herpangina occur worldwide. Outbreaks involving daycare centers, schools, summer camps, hospital wards, military installations, communities, large geographic areas, and entire countries have been reported. HFM is a self-limiting illness that typically resolves in seven to ten days, with individuals being most contagious during the first week (Puenpa, et al., 2014). Human enterovirus infection occurs after oral ingestion of virus that is shed from the gastrointestinal or upper respiratory tract of infected individuals. The infection is spread by direct contact with nasal discharge, saliva, blister fluid or stool.  The individual may be asymptomatic and still be contagious with the virus persisting for several weeks, most commonly in stool. HFM is not the same as foot and mouth disease which is found in cattle and there is no cross species infectious concern. The most common virus is the coxsakievirus A16, however it may be caused by other coxsackieviruses or enterovirus 71 (Stewart, Chu, Introcaso, Schaffer, & James, 2013). Risk factors for contracting the virus include age less than ten years old, high risk exposure location, such as a daycare or preschool, poor hand hygiene and a compromised immune system.

NR 602 Grand Rounds W2 Assignment

Clinical Assessment

HFM typically presents with one to two days of fever, sore throat, …

Nail shedding may occur weeks after the other symptoms have resolved.

Differential Diagnoses

  1. Herpes Simplex 1-Nongenital herpes simplex virus type 1 (HSV-1) is a common infection that most often involves the oral mucosa or lips. The primary oral infection may range from asymptomatic to very painful, …. It occurs in children who suck their thumbs (Usatine & Tinitigan, 2010).
  2. Varicella-Chickenpox is usually acquired by the inhalation of airborne respiratory droplets from an infected host. After initial inhalation of contaminated respiratory droplets, … diagnostic clue (Papadopoulos, Janniger, & Schwartz, 2017).
  3. Aphthous ulcers-Aphthous ulcers can be classified into three different types: minor, major and herpetiform.1,2Minor aphthae are generally located on labial or buccal mucosa, the soft palate and the floor of the mouth. They can be singular or multiple, and tend to be small. The pathophysiology of aphthous ulcers is poorly understood. Histologically, they contain a mononuclear infiltrate with a fibrin coating. More commonly affect young adults, and a familial tendency may exist. Smoking offers a somewhat protective effect against recurrent aphthae.2 Other etiologic factors such as stress, physical or chemical trauma, food sensitivity and infection have been proposed (Akintoye & Greenberg, 2014).

Diagnostic Studies/Labs

HFM is typically diagnosed clinically.  However, cultures for virus isolation can be obtained from oral lesions, cutaneous vesicles, nasopharyngeal swabs, stool or cerebrospinal fluid. Throat swabs and vesicle fluid is the most efficient test if enterovirus 71 is suspected. A CBC is not routinely needed however it may reveal an elevated WBC and atypical lymphocytes (American Academy of Pediatrics, 2013).



NR 602 Grand Rounds W2 Assignment

Treatment and Prevention

Both the CDC and The American Academy of Pediatrics recommend that treatment options focus primarily on symptom management (American Academy of Pediatrics, 2013) (Centers for Disease Control and Prevention, 2015).

For fevers in a child under age 12: Acetaminophen 15 mg/kg orally every 4-6 hours as needed (max dose of 90 mg/kg/day). Alternatively Ibuprofen 5-10 mg/kg orally every 6-8 hours as needed (max does of 40 mg/kg/day).

Assignment NR 602 Grand Rounds W2 

Assignment NR 602 Grand Rounds W2

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Topical anesthetics may also be used. These may include: Lidocaine oropharynegeal viscous solution (2%) applied to the affected areas with a cotton tipped applicator up to three times per day as needed. In addition a solution of diphenhydramine, lidocaine, aluminum magnesium and sulcrafate may be applied to affected areas in the mouth or swished around in the mouths of older children and spit out up to four times per day in place of the lidocaine solution (Roy & Contino, 2015).

Oral hydration is important to maintain as children with painful oral lesions may restrict their oral intake.

Hand washing is essential in the prevention of HFM. It is especially important to practice proper hand hygiene before and after personal care activities. To prevent further spread of the disease, any surfaces contaminated with body fluids should be cleaned with a diluted bleach solution. The infected person should have limited contact with other individuals.


Hand hygiene is vital to prevent the further spread of the disease. Be sure to wash your hands after contact with the child, including changing diapers.

Limit exposure to other individuals, especially during the first week of the illness.

Certain foods and drinks may cause stinging in the mouth when consumed.  Avoid food and drinks that are hot, spicy, salty or acidic.  Drinks such as milk or ice water tend to be soothing. Suck on ice pops. Avoid sharing of food and drinks.

Rinse the mouth with warm water after meals.

Clean and disinfect any surfaces the child may have had contact with including toys.

Best Outcomes

Best outcomes for the patient are achieved by promoting oral hydration to prevent dehydration which is the most common complication is resulting from HFM (American Academy of Pediatrics, 2013). The child should also be monitored for neck stiffness, lethargy, or severe irritability which may indicate meningitis.

NR 602 Grand Rounds W2 Assignment

Discussion Questions

  1. HFM is more common during three seasons. Which three seasons and why is more common during this time of year?
  2. When is it “safe” for a child to return to daycare or school?

Bonus Question: How did the coxsackievirus get its name?

Akintoye, S. O., & Greenberg, M. S. (2014, April). Recurrent aphthous stomatitis. Dental Clinics, 58(2), 281-297. doi:http://dx.doi.org/10.1016/j.cden.2013.12.002

American Academy of Pediatrics. (2013, Sept 27). Hand-foot-and-mouth disease (HFMD)/herpangina. Retrieved from American Academy of Pediatrics: https://pediatriccare.solutions.aap.org/content.aspx?resultClick=1&gbosid=189710

Centers for Disease Control and Prevention. (2015, Aug 18). Hand, foot, and mouth disease (HFMD). Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/hand-foot-mouth/about/index.html

Papadopoulos, A. J., Janniger, C. K., & Schwartz, R. A. (2017, April 14). Chickenpox. Retrieved from Medscape: https://emedicine.medscape.com/article/1131785-overview#a1

Puenpa, J., Mauleekoonphairoj, J., Linsuwanon, P., Suwannakam, K., Chieochansin, T., Korkong, S., . . . Poovorawan, Y. (2014, June 2). Prevalence and characterization of enterovirus infections among pediatric patients with hand foot mouth disease, herpangina and influenza like illness in Thailand, 2012. Plos One, 9(6), e98888. doi:https://doi.org/10.1371/journal.pone.0098888

Roy, S., & Contino, K. (2015, Sept 15). Rapidly progressing rash in an adult. American Family Physician, 92(6), 525-526. Retrieved from https://www.aafp.org/afp/2015/0915/p525.html

Stewart, C. L., Chu, E. Y., Introcaso, C. E., Schaffer, A., & James, W. (2013, Dec). Coxsackievirus A6–Induced hand-foot-mouth disease. JAMA Dermatol, 149(12), 1419-1421. doi:10.1001/jamadermatol.2013.6777

Usatine, R. P., & Tinitigan, R. (2010, Nov 1). Nongenital herpes simplex virus. American Family Physician, 82(9), 1075-1082. Retrieved from https://www.aafp.org/afp/2010/1101/p1075.html

Important information for writing discussion questions and participation

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to.

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

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