Chapter 6 Communicable Disease Fall 2024.pptx

CHAPTER 6 Childhood Communicable and Infectious Diseases  INFECTION CONTROL CONCEPTS  Standard precautions  Barrier protection from blood & body fluids  Respiratory hygiene/cough etiquette  Safe injection practices  Hand hygiene  Transmission-based precautions  Airborne  Small p...

CHAPTER 6 Childhood Communicable and Infectious Diseases  INFECTION CONTROL CONCEPTS  Standard precautions  Barrier protection from blood & body fluids  Respiratory hygiene/cough etiquette  Safe injection practices  Hand hygiene  Transmission-based precautions  Airborne  Small particle or evaporated droplets or dust  Negative pressure isolation room  Droplet  Large-particle droplets (sneeze, cough, speech, cry)  Contact  Exercise judgment with gloves, gowns, masks 2  IMMUNIZATIONS: NURSE’S ROLE  Be familiar with the schedule (annually updated)  Be prepared for adverse reactions  Be aware of contraindications & precautions  Ensure parental consent prior to administration  vaccine information statement (VIS)  Provide safe administration  Provide vaccine information & anticipatory guidance to parents and caregivers  Ensure documentation is complete  Resource for review: Immunization Action Coalition www.immunize.org/vis 3 RECOMMENDATIONS FOR ROUTINE IMMUNIZATIONS  Mumps Rubella  Hepatitis B Virus  Haemophilus  Hepatitis A Virus influenzae Type B  Diphtheria  Varicella  Tetanus  Pneumococcal  Pertussis disease  Polio  Influenza  Measles  Meningococcal disease  Rotavirus  Human Papillomavirus 4 REACTIONS TO IMMUNIZATIONS  Side effects from inactive components  preservatives  Vial stoppers with synthetic rubber  prevent latex allergy reactions  Allergies to eggs problematic  Inactivated antigens  reaction few hours or days  Local versus severe reactions 5 ATRAUMATIC CARE  Correct needle length & injection technique  Correct site  Techniques to minimize pain  EMLA  Use of distraction  Maintain calm approach  Proper positioning of child  Emergency management for anaphylaxis 6  CONTRAINDI CATIONS  Contraindication  condition in an individual that increases the risk for a serious adverse reaction (e.g., not administering a live virus vaccine to a severely immunocompromised child)  General  severe febrile illness  Do not administer a live vaccine to immunocompromised patients  When there is a known allergic response to a prior substance 7  ADMINISTRATION  Proper storage of vaccine  Proper technique  Rotation of sites  Administer as painless as possible  Accurate documentation 8 SUSPECT COMMUNICABLE DISEASE?  Obtain careful history:  Type of exposure  Known or community?  Prodromal symptoms  Early signs/symptoms  fatigue, headache, stomach ache  Early evidence of disease  Immunization  History of having disease/ co-morbidity/risk factors  Provide comfort & support, document findings  Primary prevention  immunizations  Handwashing  Reduce transmission  Prevent complications  Care & treatment of immunocompromised patients 9 CHICKEN POX (VARICELLA)  Agent: Varicella-zoster virus  Transmission: Direct contact and respiratory secretions  Clinical manifestations:  Prodromal stage—slight fever, malaise.  Pruritic rash begins a macule vesicle then erupts  Rash is typically centripetal extremities, face  Treatment: Supportive  Precautions: Respiratory and Contact  Child is contagious a day before rash appears and until vesicles are crusted  Prevention: Secondary skin infection and complications 10 ERYTHEMA INFECTIOSUM (FIFTH DISEASE)  Agent: Human herpesvirus type 6  Transmission: Probably droplet or direct contact  Clinical manifestations:  Persistent fever for 3 to 7 days in child who is otherwise well appearing  “Slapped Cheek” appearance  Mild URI symptoms, cough  Treatment: Supportive care  Precautions: Standard/Droplet 11 MEASLES (RUBEOLA)  Agent: Viral  Transmission: Direct contact from respiratory system  Clinical manifestations:  Prodromal state: fever, malaise coryza, cough, conjunctivitis  “Koplick Spots” on mucosa  Rash appears on day 3 to 4 of illness  Treatment: Antibiotics, bed rest, and support  Precautions: Airborne if in hospital until day 5 of rash 12 PERTUSSIS (WHOOPING COUGH)  Agent: Bordetella pertussis  Transmission: Direct contact from droplets  Clinical manifestations:  Catarrhal stage: URI symptoms 1 to 2 weeks  Paroxysmal stage: short, rapid cough bought followed by high-pitched crowing, “whoop” or gasp 4 to 6 weeks cyanosis may occur during episode  Treatment: Prevention  Supportive during hospitalization with suction, humidity, careful oral feeding, and hydration  Precautions: Droplet 13 RUBELLA (GERMAN MEASLES)  Agent: Rubella virus  Transmission: Direct contact from droplets  Clinical manifestations: Low-grade fever, headache, malaise, sore throat, RASH  Treatment: Supportive care  Precautions: Droplet Th BY-NC-ND 14 SCARLET FEVER  Agent: Group A Beta-hemolytic streptococci  Transmission: Direct contact from droplets  Clinical manifestations:  Prodromal stage: Abrupt high fever, halitosis  Enanthema: Tonsils large, edematous, covered with exudate  “Strawberry tongue”  Exanthema: Sandpaper-like pink rash  Treatment: Penicillin and supportive care  Precautions: Droplet until 24 hr of ABX 15 16 INFLUENZA (FLU)  Agent: Influenza Virus (varies from year to year)  Transmission: Direct contact  Clinical manifestations:  Abrupt Fever  URI-like symptoms which progress  Malaise, anorexia  Treatment: Prevention, antiviral treatment if detected early, supportive care  Precautions: Droplet 17  PNEUMOCOCCAL DISEASE  Agent: Streptococcal pneumococci  Transmission: Direct contact affecting children under 2 years most commonly  Clinical manifestations:  Pneumonia, otitis media, sinusitis, localized infections.  Treatment: Prevention, antibiotics  Precautions: Droplet 18 This Photo by Unknown Author is licensed under CC BY-SA-NC NONVACCINE COMMUNICABLE DISEASES  Conjunctivitis  Nursing management  Contact precautions  Keep eye clean & dry  Administer ophthalmic medications  Comfort and supportive care  Educate caregivers  Prevent spread of infection 19 INTESTINAL PARASITES (1OF 2)  Most frequent infections worldwide  Young children at highest risk  Most common in the United States:  Giardiasis  Pinworms  Nursing Management:  Assist with identification, treatment &prevention  Fecal smears are diagnostic  Treat family members  Provide education & support to prevent reinfection 20 INTESTINAL PARASITES (2 OF 2) Enterobiasis Giardiasis (Pinworms)  Agent: Protozoan Giardia  Agent: nematode Enterobius intestinalis vermicularis  Transmission: Inhalation or  Transmission: Direct ingestion of eggs from contact with contaminated hands contaminated water or  DX: Tape test food  Treatment:  Treatment: Flagyl or  Pyrantel Pamoate or Tindamax and prevention Albendazole × 1, then again in 2 weeks. of reoccurrence  Treat family members  Prevention of reoccurrence 21 SKIN INFECTIONS— BACTERIAL  Bacterial Agents:  Disorders include: Staphylococci &  Impetigo (common) streptococci  Folliculitis  MRSA on the rise  Cellulitis  Transmission: Invasion &  Scalded skin syndrome toxicity in susceptible skin (self-inoculation is common)  Treatment:  Topical or systemic ABX  Hand washing & hygiene  Dilute bleach baths  May require hospitalization 22 SKIN INFECTIONS—VIRAL  Viral Agents: Viruses  Disorders include:  Verruca (warts)  Transmission: Invasion &  Herpes simplex I and II toxicity in susceptible skin or oropharyngeal  Varicella mucosa following contact  Molluscum with droplets  Treatment:  Antiviral medications for HSV  Hand washing & hygiene to prevent spread  Destruction of warts 23 SKIN INFECTIONS—FUNGAL  Fungal Agents: Typically,  Disorders include: dermatophystoses; tinea  Tinea capitis (scalp) or candidia  Tinea corporis (body or  Transmission: Invasion in nails) susceptible skin,  Tinea cruris (groin) corneum, hair, or nails  Tinea pedis (feet)  May be transmitted from  Thrush (oral) infected animals  Candidiasis (vaginal,  DX: Microscopic exam diaper dermatitis)  Treatment:  Topical or systemic antifungal 24 SKIN INFESTATIONS— SCABIES  Infestation agent: Sarcoptes scabiei  Transmission: Prolonged close personal contact where the mite burrows into the epidermis & deposits eggs  Clinical manifestations:  Intense pruritus  Excoriation & burrows  Discrete inflammation between finger webs, neck folds, groin  Treatment:  Scabicide: Older than 2 mo.  Permethrin 5% cream × 8 to14 hr  Hygiene of linens & clothing with high heat This Photo by Unknown Author is licensed under CC BY-SA  Supportive care for pruritus 2 to 3 weeks. 25 SKIN INFESTATIONS— PEDICULOSIS CAPITIS AKA LICE  Infestation agent:  Transmission: Prolonged close contact when a female louse can obtain blood meal at scalp & deposit eggs on hair shaft at night  Clinical manifestations:  Intense pruritus of scalp (behind ears or nape of neck)  Nits attached to hair shaft  Treatment: This Photo by Unknown Author is licensed under CC BY-SA  Pediculicide & removal of nits:  Permethrin 1% cream (OTC), repeat in a week, treat affected family  Family may attempt other treatment regimens  Education & support to families  Advocacy & support for school attendance 26 SKIN INFESTATIONS— BEDBUGS  Infestation agent: Cimex lectularius  Transmission: Contact/sleep in infested mattress  mite burrows into the epidermis to feed on blood  Clinical manifestations:  Intense pruritus, inflammation/rash  May progress to folliculitis/cellulitis  May trigger asthma exacerbation, anaphylaxis  Treatment:  Identification & eradication of bedbug (professional extermination)  Topical application of steroids  Hygiene of linens & clothing  Supportive care for pruritus 2 to 3 weeks. 27  RICKETTSIAL INFECTION  Disorders transmitted to humans via arthropods  Ticks, infected fleas, mites  More common in temperate & tropical climates  Bite or exposure may occur without knowledge to family and child  Illness ranges from self-limiting to fatal 28 LYME DISEASE  Agent: Spirochete Borrelia  Diagnosis: History & burgdorferi serologic testing  Transmission: Infected deer  Treatment: tick bite  Doxycycline >8 years  Clinical manifestations:  Amox < 8 years  Stage 1: “Bull’s Eye”  Fever, HA, malaise  Nursing implications:  Stage 2: rash on hands &  Prevention feet 3 to 10 weeks after  Tick removal & insect inoculation repellent  Fever, fatigue, lymphadenopathy, cough  Supportive care  Stage 3: Systemic  Completion of ABX involvement 2 to 12 mo. 29 CHAPTER 6 QUESTIONS Childhood Communicable and Infectious Diseases 30 QUESTION 1 1. An infant arrives at the clinic with a persistent cough. Mother reports the infant has not been feeding well for the past day. What nursing interventions would be appropriate? A. Provide oxygen to the infant via cannula B. Undress the infant to do a complete assessment C. Suction the infant’s nose with a bulb syringe D. Start an IV 31 QUESTION 1 1. An infant arrives at the clinic with a persistent cough. Mother reports the infant has not been feeding well for the past day. What nursing interventions would be appropriate? A. Provide oxygen to the infant via cannula B. Undress the infant to do a complete assessment C. Suction the infant’s nose with a bulb syringe D. Start an IV 32 QUESTION 2 2. A young child is being treated for giardiasis. Which of the following should the nurse recommend to the child’s parent? A. The parasite is difficult to transmit, so no special precautions are indicated. B. The child can swim in a pool if wearing diapers. C. Diapers must be changed as soon as soiled and disposed of in a closed receptacle. D. Cloth diapers should be rinsed in the toilet before washing. 33 QUESTION 2 2. A young child is being treated for giardiasis. Which of the following should the nurse recommend to the child’s parent? A. The parasite is difficult to transmit, so no special precautions are indicated. B. The child can swim in a pool if wearing diapers. C. Diapers must be changed as soon as soiled and disposed of in a closed receptacle. D. Cloth diapers should be rinsed in the toilet before washing. 34