MB4 peds infectious dz Sellers

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mthompson17
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214649
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MB4 peds infectious dz Sellers
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2013-04-20 16:48:00
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Infectious diseases children nursing
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nursing pediatric infectious diseases
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  1. How do we know a child has an infectious dz? (7)
    • 1. fever
    • 2. malaise
    • 3. aches
    • 4. sore throat
    • 5. anorexia
    • 6. nausea
    • 7. rash
  2. Interventions for infectious dz s/s? (10)
    • 1. cool,dark atmosphere
    • 2. rest
    • 3. encourage fluids
    • 4. acet/ibup
    • 5. minimal clothing
    • 6. oatmeal baths
    • 7. baking soda baths (1/2 c)
    • 8. shorten nails
    • 9. cool humidifier for cough
    • 10. soft, bland foods
  3. Why cool, darkened area?
    may have photophobia

    may have fever

    need non-stimulating env
  4. Why increase fluids with infectious dz/
    FEVER
  5. Why minimal clothing with inf dz?
    fever and may be itchy with rash
  6. How to use oatmeal for bath?

    Another intervention?
    grind in a blender and put in bath

    baking soda
  7. Non-med intervention for cough?
    cool humidifier
  8. Primary way to stop the spread of inf. dz?
    universal precautions
  9. Who do we use universal precautions for and what is included?
    use for everyone

    1. wash hands before and after pt contact, blood or body fluid contact, contact with objects in pt area, & after gloving

    2. gloves gowns, goggles as app.

    3. treat all pt as if infectious
  10. To prevent the spread of inf dz use universal precautions and more restrictive forms of isolation including___? (3)
    • 1. contact
    • 2. droplet
    • 3. airborne
  11. Contact precautions?
    • 1. gloves and gown for any entry into room
    • 2. Remove before leaving room
    • 3. Use disposable or pt-dedicated equipment and disinfect before returning to general pt use
    • 4. Limited pt-transfer with assurance that infected areas are covered
    • 5. Remove PPE and wash hands prior to transfer and reapply at destination
  12. EX of a dz that requires contact isoloation?
    C diff
  13. Droplet isolation?
    • 1. gown, glove, & mask prior to entry to pt room
    • 2. private room or 3' seperation
    • 3. limited pt-transfer with pt wearing mask
  14. EX of a dz that will have droplet precautions?
    influenza
  15. Diff. b/t droplet and airborne precautions?
    droplets can only travel up to 3 ft.  airborne can float through the air
  16. Airborne precautions?
    • 1. negative pressure room with door closed. (check daily with flutter strips)
    • 2. out of room pt must wear surgical mask
    • 3. staff don NIOSH N95 mask before entering (have to be fit-tested for the mask)
    • 4. gloves and gown also
  17. EX of a dz that requires airborn precautions?
    TB, varicella, rubeola
  18. 4 bacterial infections?
    diptheria, scarlatina/scarlet fever, pertussis, tetanus
  19. Diphtheria clinical manifestations?
    • 1. excessive nasal drainage - mucupurulent and foul smelling
    • 2. thin, grey membrane on the pharynx (can be with strep or others also
  20. What causes diptheria?

    How is it prevented?
    bacterial

    Tdap
  21. Tx of diptheria?

    Specific Tx for diptheria?
    ABX

    IV diphtheria antitoxin that contains preformed antibodies from animal serum
  22. 3 complications of diptheria?
    • 1. sepsis
    • 2. peripheral nerve paralysis
    • 3. multiorgan involvement
  23. Pertussis AKA?
    whooping cough
  24. Major concern with pertussis?
    infants do not receive maternal immunity to pertussis

    it is highly contagious and has high infant mortality rate
  25. Vaccine for pertussis?
    Tdap?
  26. Complications ass. with pertussis? (4)

    What causes them?
    • 1. pneumonia
    • 2. malnutrition - burning calories when cough
    • 3. dehydration- can't eat/drink b/c severe coughing
    • 4. rectal prolapse - cough so hard
  27. 8 nursing interventions for babies with pertussis?
    • 1. droplet precautions
    • 2. closely monitor resp and cardiac status
    • 3. monitor O2 sat during coughing episodes
    • 4. closely monitor fluid status
    • 5. provide small, frequent feedings - may need tube feedings
    • 6. frequent oral care
    • 7. quiet environment
    • 8. medical Tx - ABX
  28. 3 ways to monitor fluid status?
    • 1. daily weights
    • 2. I&O
    • 3. MM, skin turgor
  29. Why monitor resp,cardiac with pertussis?
    oxygenation due to coughing
  30. Scarlatina caused by?

    AKA?
    group A beta-hemolytic strep

    scarlet fever
  31. s/s of scarlatina?
    • 1. fine, raised, red rash that feels rough - will eventually peel off
    • 2. desquamation that begins on face and spreads - may take up to 6 weeks to complete
    • 3. edematous tonsils with grayish exudate (strep)
    • 4. strawberry tongue - white furry coating with red papillae that will slough off by 4th day leaving red, swollen tongue
  32. 4 complications of scarlet fever?
    • 1.pneumonia
    • 2. meningitis
    • 3. glomerulonephritis
    • 4. rheumatic heart disease
  33. Tx of child with scarlet fever?
    • 1. ABX
    • 2. fever reduction with acet
    • 3. encourage fluids
    • 4. soft, bland oral intake
    • 5. pt teaching
  34. When is a person no longer contagious with scarlet fever?
    when they have been on ABX for 24 hours

    can go back to school
  35. Tetanus caused by?

    Incubation?
    clostridium tetanii through a wound (may not be aware of the wound or remember how it occurred)

    3 days to 3 weeks
  36. Prevention of tetanus?
    immunization
  37. When may rheumatic fever occur?
    may affect person in older age if not treated in childhood
  38. Important teaching with a strep infection?
    finish the ABX or can cause glomerulonephritis
  39. Clinical manifestations of tetanus?
    • 1. painful muscular rigidity of masseter and neck muscles - locked jaw
    • 2. sardonic grin
    • 3. facial spasms
    • 4. dysphagia
    • 5. severe pain
    • 6. laryngospasm
    • 7. muscular rigidity of trunk and extremeities
    • 8. back becomes arched/ opisthotonos
  40. Best thing for tetanus?
    prevention - has very high mortality rate
  41. Priority assessment in tetanus?
    assess resp b/c can affect breathing muscles
  42. Opisthotonos?
    back arched r/t muscle rigidity
  43. Therapeutic management of tetanus? (7)
    • 1. ICU
    • 2. ventalatory and resp support
    • 3. quiet, stimulation free environment
    • 4. admin of tetanus immune globulin
    • 5. passive antibodies to eradicate organism
    • 6. parenteral penicillin G or erythromycin
    • 7. admin of a sedative and muscle relaxant
  44. Interventions to provide quiet, stimulation free env. for tetanus pt?
    time care so can do together and give plenty of time alone
  45. Why sedative and mus relaxant in tetanus?
    MUSCLE RIGIDITY
  46. Rubeola AKA?

    Precautions?

    When is it infectious?
    AKA measles (true measles)

    airborne precautions

    infectious 3 to 5 days prior to exanthem
  47. 7 char of rubeola?
    • 1. fever >100
    • 2. coryz
    • 3. cough
    • 4. conjunctivitis
    • 5. Koplik's spots - bluish white spot on MM of mouth (ind to rubeola)
    • 6. red, macular rash on face spreading to trunk, limbs, and feet
    • 7. rash will fade to brown before resolving and lasts about a week
  48. S/S unique to rubeola?
    Koplik spots
  49. Koplik spots?

    When do they appear?
    small red spots with blue-white center on oral mucosa or buccal area

    appear before rash

    slough off after 3 days
  50. 4 complications of measles?
    • 1. bronchopneumonia
    • 2. laryngotraceobronchitis/croup
    • 3. acute encephalitis
    • 4. otitis media
    • 5. acute encephalitis
  51. What causes rubeola?
    virus
  52. Tx for rubeola?
    symptomatic:  fever, itching, and fatigue

    oral or parenteral vitamin A supplement
  53. Roseala AKA?
    6th disease
  54. S/S of roseala?
    • 1. high fever - 103-106 with malaise for 3 to 5 days then fever breaks and exanthem appears
    • 2. exanthem mainly on neck and trunk, pink, macular/flat, maculopapular/flat & raised mix
    • 3. cough
    • 4. coryza
    • 5. NV
    • 6. HA occurring with fever
  55. Main danger/Complicatons of roseola infantum?
    febrile seizures
  56. Difference b/t rubeola and roseola?
    • higher fever in roseola
    • lighter rash with roseola
    • major risks with rubeola
  57. Rubella AKA?
    german measles
  58. Rubella precautions?
    droplet precautions
  59. Important consideration with rubella in pregnancy?

    Why?
    teratogenic

    crosses uteroplacental barrier
  60. When is rubella contagious?
    7 days prior to exanthem through 7 days afterward
  61. Clinical manifestations of rubella? (5)
    • 1. pink maculopapular rash to face spreading to trunk, limbs - will fade from upper as it spreads lower
    • 2. polyarthritis
    • 3. eye pain
    • 4. forschheimer's sign - petechiae to soft palate
  62. Forchheimer's sign?
    petechiae to soft palate
  63. 3 complications of rubella?
    • 1. arthritis and arthralgia
    • 2. fetal death if pregnant
    • 3. encephalitis
  64. Who is arthritis and arthralgia ass. with rubella more common in ?
    more common in adult women than CH
  65. Congenital rubella is considered contagious until _____ or ______.
    • 1. 1 year of age
    • 2. nasopharyngeal & urine cultures are repeatedly negative
  66. 9 complications/sequalae of congenital rubella?
    • 1. growth retardation
    • 2. cataracts
    • 3. retinopathy
    • 4. cardiac anomalies
    • 5. encephalopathy
    • 6. sensorineural deafness
    • 7. learning disabilities
    • 8. diabetes mellitus
    • 9. thyroid disorder
  67. Most common complication of congenital rubella?
    sensorineural deafness
  68. Erythema infectiosum cause?

    AKA?
    caused by parvovirus B19

    AKA 5th disease
  69. S/S of erythema infectiosum?
    • 1. slapped face appearance then a maculopapular rash to trunk and limbs
    • 2. rash fades by clearing the center of the lesions first - leaves a lacy design
    • 3. may have mild fever, malaise, HA
  70. 2 complications of erythema infectiosum?
    • 1. can cause fetal death in pregnant females but is not ass. with anomalies in baby
    • 2. can cause crisis in sickle cell pt
  71. When in 5th disease infectious?
    no longer infectious upon appearance of rash
  72. If a sickle cell pt has s/s of infection which would be very likely to cause crisis to occur?
    erythema infectiosum
  73. Hand foot and mouth dz?
    form of coxsackie virus
  74. How is HFM disease transmitted?
    fecal excretion
  75. Precautions with HFM dz?
    contact
  76. S/S of HFM dz?
    vesicular lesions to palms, soles, and mouth that are painful
  77. 4 complications of HFM dz?
    • 1. dehydration
    • 2. hemorrhagic conjunctivitis
    • 3. encephalitis
    • 4. myopericarditis
  78. Why can HFM dz lead to dehydration?
    refusal to eat or drink due to pain
  79. 2 Therapeutic management of HFM dz?
    • 1. 1 tsp salt to quart of water
    • 2. mixture rinse ordered by MD containing lidocaine, benadryl, and maalox
  80. Myopericarditis?
    inflammation of pericardium & cardiac muscular wall
  81. Varicella?
    chicken pox
  82. Infectious period with varicella?
    1 to 2 days before rash onset until all lesions are dried or crusted over
  83. S/S of chicken pox?
    • 1. low grade fever
    • 2. malaise
    • 3. anorexia
    • 4. rash
  84. Important nursing consideration for chicken pox?

    Why?
    teach pt not to scratch - can push on the area

    prevent scarring
  85. 4 stages of chicken pox?
    • 1. macule- unraised red rash
    • 2. papule
    • 3. fluid-filled vesicle
    • 4. crusting

    when all are crusting no longer contagious
  86. 5 complications of varicella?
    • 1. secondary infection - cellulitis
    • 2. encephalitis
    • 3. reye syndrome
    • 4. corneal involvement
    • 5. deadly for the immuno-compromised
  87. Tx for immunocompromised?

    Important considerations?
    acyclovir IV (zovirax)

    • 1. limited window of opportunity
    • 2. must start a soon as s/s appear
    • 3. prevention is much better- immunize!!
  88. Critical priority in chicken pox?
    prevent secondary infection and scarring by stopping itching
  89. Can you still get chicken pox if you have been vaccinated?
    yes, but it is much less severe
  90. If child will not stop scratching?
    • 1. cover hands
    • 2. trim nails
  91. Env for child with varicella?
    dark, quiet room

    keep it cool to decrease itching
  92. Med to avoid when child has varicella?
    no aspirin- both can cause Reye's syndrome
  93. Important consideration when giving acyclovir?

    Intervention?
    SE- crystalluria

    increase fluids to 2000 - 3000 ml/day
  94. Tx for a child who had steroids or chemo if get varicella?
    acyclovir
  95. Precautions for varicella?
    airborne isolation
  96. Variola AKA?
    small pox
  97. Transmission of variola?
    • 1. droplets via direct and prolonged face-toface contact with infected person
    • 2. contact with contaminated objects
  98. Precautions for smallpox?
    airborne isolation b/c of high mortality rate
  99. Contagious period with smallpox?
    from appearance of mouth lesions until ALL lesions scabbed over and dried and fallen off
  100. Prodromal period of smallpox/onset?
    • will have abrupt onset/no warning
    • fever 38.3/101
    • prostration - absolute exhaustion (cannot function because so sick)
  101. Progresion of smallpox lesions?
    red spots in mouth an on tongue (first) -> dev into sores and break open

    macules on face esp forehead - "herald spots"

    generalized vesicular rash then pustules -> scabs
  102. Post-exposure protection?
    vaccination will have some protection against disease and mortaility even if it occurs after exposure to the illness

    anybody exposed should imm. be vaccinated ASAP
  103. Herald spots?
    warning that a viral infection is on board and coming
  104. When is mumps infectious?
    7 days before swelling to 9 days after onset of parotid swelling (saliva glands)
  105. Parotid glands
    saliva glands
  106. Precautions with mumps?
    droplet isolation
  107. S/S of mumps?
    • earache
    • swollen & tender parotid glands (parotitis)
  108. Parotitis
    swollen parotid glands
  109. Complications of mumps?
    • 1. meningitis
    • 2. orchitis
    • 3. sensorineural hearing impairment (rare)
  110. Most common complication of mumps?
    meningitis
  111. Can mumps cause infertility in men?
    yes, but it is uncommon
  112. Epstein-Barr virus AKA?
    mono
  113. How is Epstein-barr virus transmitted?
    contact with blood and body fluids

    mostly through saliva - kissing disease
  114. How is mumps transmitted?
    droplets
  115. S/S of Epstein-Barr?
    • 1. malaise
    • 2. HA
    • 3. fatigue
    • 4. nausea
    • 5. abd pain
    • 6. exudative pharyngitis
    • 7. lymphadenopathy
  116. Main s/s of Epstein-Barr?
    fatigue
  117. How may CH present with Epstein Barr?
    child just keeps feeling bad with sore throat and fatigue and doesn't get better
  118. Main complication with Epstein-Barr?
    hepatosplenomegaly
  119. Tx of Epstein-Barr?
    • No specific Tx
    • 1. activity as tolerated - may need prolonged rest
    • 2. NO CONTACT SPORTS until spleen back to normal size
  120. Most important consideration with Epstein-Barr?
    Don't do anything that could rupture the spleen
  121. When is greatest chance of splenic rupture during Epstein-Barr?
    during second week of illness
  122. Nursing consideration with a pt with Epstein-Barr?
    NO DEEP ABD PALPATION
  123. When can person with Epstein-Barr have visitors/become non-infectious?

    Consideration?
    6 months after onset of disease

    may become asymptomatic carriers
  124. Poliomyelitis?
    polio
  125. S/S of polio?
    • 1. same as most viruses in prodromal then progresses:
    • 2. soreness and stiffness of trunk, neck, and limbs
    • 3. paralysis
    • 4. flaccid paralysis - esp lower extremeities and large muscle groups
    • respiratory paralysis
  126. Complications of polio?
    • 1. permenant paralysis
    • 2. resp arrest
  127. Complication of polio that may occur later in life long after illness is over?

    S/S?
    post-polio syndrome

    • 1. not infectious
    • 2. occurs 10-40 years after illness
    • 3. new muscle weakness in arms & legs
    • 4. exhaustin after any normal activity
    • 5. muscle and joint pain
    • 6. breathing or swallowing probs
    • 7. sleep apnea
    • 8. sensitivity to cold temps
  128. How is post-polio Dx?

    Main S/S?
    process of elimination

    fatigue and muscle weakness
  129. 5 assessments that may indicate a polio or post-polio pt's resp system is being affected?

    Nursing intervention?
    • 1. difficulty talking
    • 2. ineffective cough
    • 3. inability to hold breath
    • 4. shallow and rapid resp

    Tell someone immediately!!!
  130. Therapeutic management of polio?
    • 1. supportive care - resp managment
    • 2. complete bedrest during acute phase
    • 3. physical therapy for muscles following acute phase
  131. Will everyone with polio be paralyzed?
    no= depends on amnt of nerve damage
  132. Outcome of rabies?
    almost always death
  133. 4 Types of helminths?
    • 1. round
    • 2. tape
    • 3. hook
    • 4. pin
  134. S/S of worm infection?
    • 1. abd pain
    • 2. anemia
    • 3. wt loss
    • 4. rectal irritation/itching
  135. Dx of worm infections?
    fecal smears and/or tape test
  136. Why anemia in worm infestations?
    worms may feed on blood in GI tract
  137. Why anorexia in worm infestations?
    may be r/t upset stomach or fullness of stomach due to presence of worm mass
  138. Why rectal irritation/itching with worm infestation?
    mother worm lays eggs and her moving can cause rectal itching/burning sensation
  139. Fecal smears will contain ____ with worm infestations.
    larvae or ova
  140. Tape test for worm infestations?
    put tape around anus will have tiny white threads when pulled off
  141. Complications of worm infestations?
    • 1. intestinal obstruction
    • 2. nutritional malabsorption
    • 3. lung infection with resp distress
    • 4. brain involvement
  142. Why can lung infection & brain involvement occur in worm infestation?
    worms can move to lungs and brain
  143. Tx of worm infestation?
    anti-helminth:  mebendazole

    depends on type of infection

    families must be treated together
  144. Route of transmission with helminthes?
    oral/fecal
  145. Nursing consideration for Helminthes?
    teaching!!!
  146. Pt teaching for helminths?
    • 1. no barefoot outside- can enter through soles
    • 2. handwashing
    • 3. avoid oral contact with pets
    • 4. no hands in mouth/nail biting
    • 5. use toilets/bathroom for elimination
    • 6. no scratching you anus!
    • 7. keep dogs/cats out of sandbox or play area and/or cover when not using
    • 8. wash fruits/veg
    • 9. change diapers frequently and dispose properly
    • 10. swimming facilites that allow diapered CH should be avoided
    • 11. only bottled water during camping
  147. When are vaccinations reviewed?
    annually
  148. Admin nursing consideration?
    • read package insert carefully:
    • 1. handling
    • 2. storage
    • 3. admin site
    • 4. dosage
    • 5. route
  149. What inf dz can be Dx with Forchheimer's sign?
    rubella/german measles
  150. 3 considerations for admin of vaccines?
    • 1. use separate syringe for each vaccination
    • 2. use diff sites - document which one went where so can see which causes reaction
    • 3. give DTaP in separate leg from others b/c has highest possibiliy of a reaction
    • 4. record lot number & manufacturer & exp date for each vaccine
    • 5. aspirate
  151. IM sites for vaccines?
    if < 18 mo anterolateral thigh

    if 18 mo or older deltoid muscle
  152. If miss a vaccination dose?
    pick up where left off - give next dose and go from there

    admin only missed doses
  153. What is required before giving vaccinations?
    must give VIS to CG that tells about the vaccine (from CDC)
  154. 3 immunization SE?
    • 1. fever
    • 2. local irritation
    • 3. rash
    • 4. feel bad for a few days
  155. Interventions for immunization SE?
    • 1. acet - first 24 h
    • 2. cold first 24 h then warm (mus soreness) or cold prn
  156. Why do you write lot/manufacterer for vaccines?
    can cause anaphylactic reactions and need to track it
  157. Why not live vius vaccination before 12 months?
    b/c maternal antibodies are passed onto infant & will neutrolzie the antibodies resulting from the vaccination
  158. maternal antibodies passed onto infant is an example of _____ immunity.
    passive
  159. Nasal flu vaccine consideration?
    live flue virus - possibility of getting flue
  160. 3 live flu viruses?
    • 1. MMR
    • 2. varicella
    • 3. nasal flu
  161. Consideration with live immunizations?
    if a child/person is immunocompromised they SHOULD NOT get live vaccines
  162. Flu vaccine consideration for children under the age of 9?
    must get 2 doses about one month apart if it is the first year they are getting the vaccine

    only the first year - they only need one thereafter even if they are under 9
  163. Who cannot have the flu vaccine?

    Who is recommended to get flu vaccine?
    children under the age of 6 months

    recommended for all babies over 6 months
  164. Who cannot get flumist?
    children <2years old and ppl with asthma due to risk of developing the flu from the live virus

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