CHILDHOOD DISEASES.pdf

COMMON CHILDHOOD DISEASES CONTINUED TUBERCULOSIS  It is spread through aerosols, not contact  Pulmonary TB occurs in the lungs 85% of all TB cases are pulmonary Extrapulmonary TB occurs in places other than the lungs, including the: Larynx Lymph nodes Brain and s...

COMMON CHILDHOOD DISEASES CONTINUED TUBERCULOSIS  It is spread through aerosols, not contact  Pulmonary TB occurs in the lungs 85% of all TB cases are pulmonary Extrapulmonary TB occurs in places other than the lungs, including the: Larynx Lymph nodes Brain and spine Kidneys Bones and joints Miliary TB occurs when tubercle bacilli enter the bloodstream and are carried to all parts of the body LATENT TB INFECTION Occurs when person breathes in bacteria and it reaches the air sacs (alveoli) of lung Immune system keeps bacilli contained and under control. The bacilli therefore do not multiply Person is not infectious and has no symptoms ACTIVE TUBERCULOSIS Occurs when immune system cannot keep bacilli contained and Bacilli begin to multiply rapidly Person develops TB symptoms NB: Latent TB in a previously healthy patient who has now become immunocompromised can now progress to active TB patient Latent TB when reactivated can quickly spread and become Miliary TB which involves other parts of the body such as the brain, kidney, bones. Etc  The bacteria destroys some of the tissues affected. The body may try to heal it and may end up developing pleural effusion/ empyema MILIARY TB RISK FACTORS OF TUBERCULOSIS Immunosupression: HIV/AIDS or Patients receiving chemotherapy Recent travel from endemic areas  Exposure to individual with active TB Resident /employee of: Prison Homeless Health facility CLINICAL MANIFESTATIONS OF ACTIVE PULMONARY Productive prolonged cough with/out Hemoptysis Chest pain Fever and chills Night sweats/drenching Fatigue/malaise Loss of appetite Weight loss *Commonly seen in cases of pulmonary TB  Patients will have abnormal chest X-ray Positive AFB sputum smear ( Acid fast bacilli test) and mycobacterium sputum culture  For latent TB, they are asymptomatic and non –infectious DIAGNOSIS Positive tuberculin skin test and/interferon gamma release assay(IGRA) A tuberculin skin test (also called a Mantoux tuberculin test) is done to see exposure to tuberculosis (TB). The test is done by putting a small amount of TB protein (antigens) intradermally in the inner forearm. The skin will react to the antigens by developing a firm red bump/wheel at the site within 2 or 3 days. SKIN TUBERCULIN TEST The TB antigens used in a tuberculin skin test are called purified protein derivative (PPD) A tuberculin skin test cannot tell how long you have been infected with TB. It also cannot tell if the infection is latent (inactive) or if you have active TB that can be passed to others. Results of the test depend on your risk for TB. If you are at higher risk, a smaller bump is considered a sign of infection. People at lower risk for having TB need to have a larger bump to be diagnosed with a TB infection.  Patient immunocompromised, an area of 5mm is enough for diagnosis Patient with moderately risk need 10mm of reading to confirm And those with no risk need 15mm to confirm positivity Normal chest X-ray VACCINATION The BCG vaccination is given intradermally in the upper part of the left arm. The vaccination is given soon after birth, usually by 28 days after birth. TREATMENT OF TUBERCULOSIS Include four 1st-line drugs in initial regimen Isoniazid (INH) Rifampin (RIF) Pyrazinamide (PZA) Ethambutol (EMB) Adjust regimen when drug susceptibility results become available or if patient has difficulty with any of the medications Promote adherence and ensure treatment completion NB: Treatment is mostly months to years DIRECTLY OBSERVED THERAPY Health care worker watches patient swallow each dose of medication DOT is the best way to ensure adherence Should be used with all intermittent regimens Reduces relapse of TB disease and acquired drug resistance NURSING INTERVENTIONS Sputum culture collection Airborne precautions Negative airflow pressure in the hospital Put on the appropriate respirator mask Patient should wear surgical mask when being transported outside High protein and carbohydrate diet with frequent small meals CLINICAL MONITORING Instruct patients taking TB medications to immediately report the following: Rash Nausea, loss of appetite, vomiting, abdominal pain Persistently dark urine Fatigue or weakness Persistent numbness in hands or feet Monitor for signs of hepatoxicity( jaundice) because isoniazid Advice on back birth control/non hormonal contraceptive since rifampicin interferes with how these drugs works Collect sputum culture every 4 weeks to monitor for progress BARRIERS TO ADHERENCE Stigma Extensive duration of treatment Adverse reactions to medications Concerns of toxicity Lack of knowledge about TB and its treatment MENINGITIS This is a life threatening inflammation or infection of the meninges( membranes that cover the brain and spinal cord). It can be fatal and requires immediate medical care. Meningitis can be caused by several species of bacteria, viruses, fungi and parasites. Most infections can be transmitted from person to person. Bacterial meningitis is the most common dangerous type of meningitis and can be fatal within 24 hours.. NORMAL AND MENINGITIC BRAIN CAUSES OF BACTERIAL MENINGITIS There are four main causes of acute bacterial meningitis: Neisseria meningitidis (meningococcus) Streptococcus pneumoniae (pneumococcus) Haemophilus influenza Streptococcus agalactiae (group B streptococcus) Mycobacterium tuberculosis, CAUSES OF VIRAL MENINGITIS Mumps. Herpesviruses (including those that cause mononucleosis, chickenpox and shingles). Measles. Influenza. Arboviruses, such as West Nile virus. Lymphocytic choriomeningitis virus. Enteroviruses fungi, especially Cryptococcus, and parasites like Amoeba are also important causes of meningitis Causes of non-infectious meningitis Certain medications, like NSAIDs and antibiotics. Head injuries. Brain surgery. Systemic lupus erythematosus Mode of Transmission The route of transmission varies by organism. Most bacteria that cause meningitis such as meningococcus, pneumococcus and Haemophilus influenzae are carried in the human nose and throat. They spread from person to person by respiratory droplets or throat secretions. Group B streptococcus is often carried in the human gut or vagina and can spread from mother to child around the time of birth. CLINICAL MANIFESTATION OF MENINGITIS CLINICAL MANIFESTATIONS Neck stiffness/ Nuchal rigidity Nausea or vomiting. Sensitivity to light (photophobia).Confusion or altered mental state. Lack of energy (lethargy), extreme sleepiness or trouble waking up. Lack of appetite. Positive kerning’s sign Positive Brudzinski’s sign KERNING AND BRUDZINSKI’S SIGNS Meningitis signs and symptoms in babies Babies might not experience the same meningitis symptoms as adults (like headache, neck stiffness and nausea) and it can be hard to tell even if they are. Some signs of meningitis to look for in babies include: Bulging “soft spot” (fontanelle) on baby’s head. Poor feeding. Sleepiness or trouble waking up from sleep. Fever Irritabity BULGING AND SOFT FONTANELLES  NB: Most of the early signs in adult are fever, severe headache and vomiting, with neck stiffness and other signs like positive kerning’s and Brudzinski’s signs being late ones. Bulging fontanelles in the neonate mostly is also a late sign DIAGNOSIS OF MENINGITIS Lumbar puncture to collect CSF Abnormal findings will be: Cloudy colour High opening pressure High WBC count High protein counts ( inflammation produces protein) Low glucose( bacterial consumes glucose) Positive culture NURSING INTERVENTIONS Assist in lumbar puncture Administer prescribed medications Observe droplet precautions Decrease environmental stimuli Cluster nursing activities as much as possible Frequent neurological assessment. Educate on future prevention. Vaccination Observe seizure preacutions COMPLICATIONS Increased intracranial pressure Brain tissue ischaemia Brain herniation Permanent functional impairment Intellectual and behavioral difficulties Seizures Hearing loss Death WORM INFESTATION  Soil-transmitted helminth infections are among the most common infections in humans, caused by a group of parasites commonly referred to as worms, including roundworms, whipworms and hookworms. Those living in poverty are most vulnerable to infection which can impair nutritional status by causing: Internal bleeding which can lead to loss of iron and anaemia; Intestinal inflammation and obstruction; Diarrhoea; and Impairment of nutrient intake, digestion and absorption. VARIOUS HELMINTHS/WORMS PINWORMS/ENTEROBIASIS The most commonest parasitic worm infestation in the intestine and the rectum is caused by enterobius vermicularis Eggs are transmitted to the hands and underneath the fingers during scratching and then spraed to common objects. Swallowed or inhaled eggs hatch in the intestines Common among daycare settings/classrooms PERI-ANAL AND ANAL PINWORMS Clinical manifestations  Intense Peri-anal itching leading excoriations Disturbed sleep  Irritability  Enuresis/bed wetting Diagnosis Tape test Antihelminthic medications Albendazole, pyrantel palmoate  All members of the household should be treated when a child is confirmed of infections. They should repeat the dose in next two weeks to ensure complete eradication Reinfection can occurs hence patient teaching is key. Patient’s teaching Encourage patient on the needs to keep fingernails short and avoid nail-biting Washing the hands thoroughly after using the washroom and before eating  Washing of linens, clothing in warm water is encouraged One piece sleeping outfit is encouraged NB: The eggs can live on infected surfaces for two weeks. Contaminated surfaces may include: furniture, bedclothes, bedding, towels, toilets, doorknobs, or other objects. COMPLICATIONS Scratching the itchy area may cause eczema or a bacterial infection around the rectum. In girls, pinworm infection can spread to the vagina and may cause a vaginal discharge. E vermicularis can mimic other disease processes and, although rare, can lead to serious infectious complications such as tubo-ovarian abscesses The following complications have also been noted: appendicitis, endometritis, salpingitis, urethritis, urinary tract infection, and vulvovaginitis. PNEUMONIA This refers to an inflammatory reaction in the lungs. This leads to cellular debris and increased secretions, which impairs gas exchange. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia. Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems. THE RESPIRATORY SYSTEM WITH TRACHEOBRONCHIAL TREE TYPES OF PNEUMONIA: CLASSIFICATION BASED ON THE SOURCE OF UNFECTION Community acquired Hospital acquired Ventilator associated Aspiration pneumonia CLASSIFICATION BASED ON THE ANATOMY Lobar pneumonia affects one or more sections (lobes) of the lungs. Bronchial pneumonia (also known as bronchopneumonia) affects patches throughout both lungs. RISK FACTORS Adults older than age 65, especially with chronic ill ness Children younger than age 2 People with an underlying health condition or weakened immune system. Eg HIV/AIDS People receiving chemotherapy or taking medication that suppresses the immune Pre-existing lung disease like COPD(Chronic obstructive pulmonary disease), Atelectasis Impaired ability to protect the airway(depressed mental status) Smoking CAUSES OF PNEUMONIA Bacterial pneumonia. This type is caused by various bacteria. The most common is Streptococcus pneumoniae. It usually occurs when the body is weakened in some way, such as by illness, poor nutrition, old age, or impaired immunity, and the bacteria are able to work their way into the lungs. Bacterial pneumonia can affect all ages, but you are at greater risk if you abuse alcohol, smoke cigarettes, are debilitated, have recently had surgery, have a respiratory disease. Viral pneumonia. This type is caused by various viruses, including the flu (influenza), and is responsible for about one-third of all pneumonia cases. Common bacterial causes of bronchopneumonia include: Staphylococcus aureus Haemophilus influenza Pseudomonas aeruginosa Escherichia coli Klebsiella pneumoniae CLINICAL FEATURES Difficulty in breathing Productive cough with purulent sputum Increased respiratory rate Chest pain on breathing Fever, chills and malaise Tachycardia Crackle on auscultation due to fluid build up Older adults may present with confusion  Infant and children may be lethargic, irritable, poor feeding, the use of accessory muscles DIAGNOSTIC INVESTIGATIONS Chest X-ray (infiltrate), thus anything denser than air FBC, showing leukocytosis Sputum culture and sensitivity Blood culture and sensitivity test( blood C/S) NORMAL CHEST X-RAY CHEST X-RAY WITH BRONCHOPNEUMONIA COMPLICATIONS Pleural effusion Empyema(lung abscess) Acute respiratory distress syndrome Sepsis NURSING MANAGEMENT Ensure patent airway by suctioning PRN Administer prescribed oxygen Monitor and record vital signs closely NURSING MANAGEMENT/INTERVENTIONS CONT’D Promote hydration to liquefy secretions Teach patient how to use incentive spirometer Coughing and deep breathing exercise Administer prescribed medications such as IV Antibiotics Antipyretics IV Fluids Encourage patient to get the influenza and pneumococcal vaccine Assist patient in the upright position(semi fowler’s ) or as rquired INCENSITIVE SPIROMETER The World Health Organization (WHO) respiratory rate thresholds for identifying children with pneumonia are as follows: Children younger than 2 months: Greater than or equal to 60 breaths/min Children aged 2-12 months: Greater than or equal to 50 breaths/min Children aged 1-5 years: Greater than or equal to 40 breaths/min BRONCHIOLITIS Bronchiolitis is a common lung infection in young children and infants. It causes swelling and irritation and a buildup of mucus in the small airways of the lung. These small airways are called bronchioles. Bronchiolitis is almost always caused by a virus. Bronchiolitis starts out with symptoms much like a common cold. But then it gets worse, causing coughing and a high-pitched whistling sound THE RESPIRATORY SYSTEM PATHOPHYSIOLOGY OF BRONCHIOLITIS DIARRHOEAL DISEASES Diarrhoea is defined as the passage of 3 or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not diarrhea. Children who are malnourished or have impaired immunity, as well as people living with HIV, are most at risk of life-threatening diarrhoea. Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking- water, or from person-to-person as a result of poor hygiene. Diarrhoeal disease is the second leading cause of death in children under five years old, and was responsible for the deaths of 370,000 children in 2019. The most severe threat posed by diarrhoea is dehydration. During an episode of diarrhoea, water and electrolytes including sodium, chloride, potassium and bicarbonate are lost through liquid stools,. A person with diarrhoea becomes dehydrated when these losses are not replaced. There are three clinical types of diarrhoea, each with its specific treatments:. Acute watery diarrhoea, which may last several hours or days, and includes cholera. Acute bloody diarrhoea, also called dysentery. Persistent diarrhoea, lasting 14 days or longer. CAUSES Viruses are the most common cause of gastroenteritis in children. Rotavirus, norovirus, adenovirus and astrovirus Bacterial gastroenteritis is an infection of the bowel caused by bacteria such as salmonella, E. coli, shigella and campylobacter. Long term use/over abuse of Antibiotics A course of antibiotics can sometimes wipe out 'good' bacteria as well as 'bad'. This leaves an imbalance of bacteria in the bowel, which can cause diarrhoea. This is called antibiotic-associated diarrhoea. Clostridium difficile (also known as C. diff) is an example of a bacteria that can overgrow after a course of antibiotics. CAUSES CONT’D Lactose intolerance Lactose intolerance is when one can't digest lactose (a sugar found in milk and dairy products). Inflammatory bowel disease (IBD) Crohn's disease and ulcerative colitis are 2 conditions collectively known as inflammatory bowel disease. The symptoms, including diarrhoea, can flare up and then die down (remit) POOR CAPILLARY REFIL AS ASIGNS OF DEHYDRATION AND SUNKEN EYES  Breastfeeding babies older than 6 months should continue to be breastfed but they should be fed more often. Administer oral rehydration solution and then continue feeding in small amounts, more often than normal feeding. Maintain personal hygiene Rehydration with intravenous fluids in case of severe dehydration or shock. Nutrient-rich foods. The vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods – including breast milk – during an episode, and by giving a nutritious diet Prevention and treatment Key measures to prevent diarrhoea include: Access to safe drinking-water Use of improved sanitation Hand washing with soap Exclusive breastfeeding for the first 6 months of life Good personal and food hygiene Health education about how infections spread Rotavirus vaccination.