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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
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
Why cool, darkened area?
may have photophobia
may have fever
need non-stimulating env
Why increase fluids with infectious dz/
Why minimal clothing with inf dz?
fever and may be itchy with rash
How to use oatmeal for bath?
grind in a blender and put in bath
Non-med intervention for cough?
Primary way to stop the spread of inf. dz?
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
To prevent the spread of inf dz use universal precautions and more restrictive forms of isolation including___? (3)
- 1. contact
- 2. droplet
- 3. airborne
- 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
EX of a dz that requires contact isoloation?
- 1. gown, glove, & mask prior to entry to pt room
- 2. private room or 3' seperation
- 3. limited pt-transfer with pt wearing mask
EX of a dz that will have droplet precautions?
Diff. b/t droplet and airborne precautions?
droplets can only travel up to 3 ft. airborne can float through the air
- 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
EX of a dz that requires airborn precautions?
TB, varicella, rubeola
4 bacterial infections?
diptheria, scarlatina/scarlet fever, pertussis, tetanus
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
What causes diptheria?
How is it prevented?
Tx of diptheria?
Specific Tx for diptheria?
IV diphtheria antitoxin that contains preformed antibodies from animal serum
3 complications of diptheria?
- 1. sepsis
- 2. peripheral nerve paralysis
- 3. multiorgan involvement
Major concern with pertussis?
infants do not receive maternal immunity to pertussis
it is highly contagious and has high infant mortality rate
Vaccine for pertussis?
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
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
3 ways to monitor fluid status?
- 1. daily weights
- 2. I&O
- 3. MM, skin turgor
Why monitor resp,cardiac with pertussis?
oxygenation due to coughing
Scarlatina caused by?
group A beta-hemolytic strep
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
4 complications of scarlet fever?
- 2. meningitis
- 3. glomerulonephritis
- 4. rheumatic heart disease
Tx of child with scarlet fever?
- 1. ABX
- 2. fever reduction with acet
- 3. encourage fluids
- 4. soft, bland oral intake
- 5. pt teaching
When is a person no longer contagious with scarlet fever?
when they have been on ABX for 24 hours
can go back to school
Tetanus caused by?
clostridium tetanii through a wound (may not be aware of the wound or remember how it occurred)
3 days to 3 weeks
Prevention of tetanus?
When may rheumatic fever occur?
may affect person in older age if not treated in childhood
Important teaching with a strep infection?
finish the ABX or can cause glomerulonephritis
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
Best thing for tetanus?
prevention - has very high mortality rate
Priority assessment in tetanus?
assess resp b/c can affect breathing muscles
back arched r/t muscle rigidity
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
Interventions to provide quiet, stimulation free env. for tetanus pt?
time care so can do together and give plenty of time alone
Why sedative and mus relaxant in tetanus?
When is it infectious?
AKA measles (true measles)
infectious 3 to 5 days prior to exanthem
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
S/S unique to rubeola?
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
4 complications of measles?
- 1. bronchopneumonia
- 2. laryngotraceobronchitis/croup
- 3. acute encephalitis
- 4. otitis media
- 5. acute encephalitis
What causes rubeola?
Tx for rubeola?
symptomatic: fever, itching, and fatigue
oral or parenteral vitamin A supplement
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
Main danger/Complicatons of roseola infantum?
Difference b/t rubeola and roseola?
- higher fever in roseola
- lighter rash with roseola
- major risks with rubeola
Important consideration with rubella in pregnancy?
crosses uteroplacental barrier
When is rubella contagious?
7 days prior to exanthem through 7 days afterward
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
petechiae to soft palate
3 complications of rubella?
- 1. arthritis and arthralgia
- 2. fetal death if pregnant
- 3. encephalitis
Who is arthritis and arthralgia ass. with rubella more common in ?
more common in adult women than CH
Congenital rubella is considered contagious until _____ or ______.
- 1. 1 year of age
- 2. nasopharyngeal & urine cultures are repeatedly negative
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
Most common complication of congenital rubella?
Erythema infectiosum cause?
caused by parvovirus B19
AKA 5th disease
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
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
When in 5th disease infectious?
no longer infectious upon appearance of rash
If a sickle cell pt has s/s of infection which would be very likely to cause crisis to occur?
Hand foot and mouth dz?
form of coxsackie virus
How is HFM disease transmitted?
Precautions with HFM dz?
S/S of HFM dz?
vesicular lesions to palms, soles, and mouth that are painful
4 complications of HFM dz?
- 1. dehydration
- 2. hemorrhagic conjunctivitis
- 3. encephalitis
- 4. myopericarditis
Why can HFM dz lead to dehydration?
refusal to eat or drink due to pain
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
inflammation of pericardium & cardiac muscular wall
Infectious period with varicella?
1 to 2 days before rash onset until all lesions are dried or crusted over
S/S of chicken pox?
- 1. low grade fever
- 2. malaise
- 3. anorexia
- 4. rash
Important nursing consideration for chicken pox?
teach pt not to scratch - can push on the area
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
5 complications of varicella?
- 1. secondary infection - cellulitis
- 2. encephalitis
- 3. reye syndrome
- 4. corneal involvement
- 5. deadly for the immuno-compromised
Tx for immunocompromised?
acyclovir IV (zovirax)
- 1. limited window of opportunity
- 2. must start a soon as s/s appear
- 3. prevention is much better- immunize!!
Critical priority in chicken pox?
prevent secondary infection and scarring by stopping itching
Can you still get chicken pox if you have been vaccinated?
yes, but it is much less severe
If child will not stop scratching?
- 1. cover hands
- 2. trim nails
Env for child with varicella?
dark, quiet room
keep it cool to decrease itching
Med to avoid when child has varicella?
no aspirin- both can cause Reye's syndrome
Important consideration when giving acyclovir?
increase fluids to 2000 - 3000 ml/day
Tx for a child who had steroids or chemo if get varicella?
Precautions for varicella?
Transmission of variola?
- 1. droplets via direct and prolonged face-toface contact with infected person
- 2. contact with contaminated objects
Precautions for smallpox?
airborne isolation b/c of high mortality rate
Contagious period with smallpox?
from appearance of mouth lesions until ALL lesions scabbed over and dried and fallen off
Prodromal period of smallpox/onset?
- will have abrupt onset/no warning
- fever 38.3/101
- prostration - absolute exhaustion (cannot function because so sick)
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
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
warning that a viral infection is on board and coming
When is mumps infectious?
7 days before swelling to 9 days after onset of parotid swelling (saliva glands)
Precautions with mumps?
S/S of mumps?
- swollen & tender parotid glands (parotitis)
swollen parotid glands
Complications of mumps?
- 1. meningitis
- 2. orchitis
- 3. sensorineural hearing impairment (rare)
Most common complication of mumps?
Can mumps cause infertility in men?
yes, but it is uncommon
Epstein-Barr virus AKA?
How is Epstein-barr virus transmitted?
contact with blood and body fluids
mostly through saliva - kissing disease
How is mumps transmitted?
S/S of Epstein-Barr?
- 1. malaise
- 2. HA
- 3. fatigue
- 4. nausea
- 5. abd pain
- 6. exudative pharyngitis
- 7. lymphadenopathy
Main s/s of Epstein-Barr?
How may CH present with Epstein Barr?
child just keeps feeling bad with sore throat and fatigue and doesn't get better
Main complication with Epstein-Barr?
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
Most important consideration with Epstein-Barr?
Don't do anything that could rupture the spleen
When is greatest chance of splenic rupture during Epstein-Barr?
during second week of illness
Nursing consideration with a pt with Epstein-Barr?
NO DEEP ABD PALPATION
When can person with Epstein-Barr have visitors/become non-infectious?
6 months after onset of disease
may become asymptomatic carriers
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
Complications of polio?
- 1. permenant paralysis
- 2. resp arrest
Complication of polio that may occur later in life long after illness is over?
- 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
How is post-polio Dx?
process of elimination
fatigue and muscle weakness
5 assessments that may indicate a polio or post-polio pt's resp system is being affected?
- 1. difficulty talking
- 2. ineffective cough
- 3. inability to hold breath
- 4. shallow and rapid resp
Tell someone immediately!!!
Therapeutic management of polio?
- 1. supportive care - resp managment
- 2. complete bedrest during acute phase
- 3. physical therapy for muscles following acute phase
Will everyone with polio be paralyzed?
no= depends on amnt of nerve damage
Outcome of rabies?
almost always death
4 Types of helminths?
- 1. round
- 2. tape
- 3. hook
- 4. pin
S/S of worm infection?
- 1. abd pain
- 2. anemia
- 3. wt loss
- 4. rectal irritation/itching
Dx of worm infections?
fecal smears and/or tape test
Why anemia in worm infestations?
worms may feed on blood in GI tract
Why anorexia in worm infestations?
may be r/t upset stomach or fullness of stomach due to presence of worm mass
Why rectal irritation/itching with worm infestation?
mother worm lays eggs and her moving can cause rectal itching/burning sensation
Fecal smears will contain ____ with worm infestations.
larvae or ova
Tape test for worm infestations?
put tape around anus will have tiny white threads when pulled off
Complications of worm infestations?
- 1. intestinal obstruction
- 2. nutritional malabsorption
- 3. lung infection with resp distress
- 4. brain involvement
Why can lung infection & brain involvement occur in worm infestation?
worms can move to lungs and brain
Tx of worm infestation?
depends on type of infection
families must be treated together
Route of transmission with helminthes?
Nursing consideration for Helminthes?
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
When are vaccinations reviewed?
Admin nursing consideration?
- read package insert carefully:
- 1. handling
- 2. storage
- 3. admin site
- 4. dosage
- 5. route
What inf dz can be Dx with Forchheimer's sign?
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
IM sites for vaccines?
if < 18 mo anterolateral thigh
if 18 mo or older deltoid muscle
If miss a vaccination dose?
pick up where left off - give next dose and go from there
admin only missed doses
What is required before giving vaccinations?
must give VIS to CG that tells about the vaccine (from CDC)
3 immunization SE?
- 1. fever
- 2. local irritation
- 3. rash
- 4. feel bad for a few days
Interventions for immunization SE?
- 1. acet - first 24 h
- 2. cold first 24 h then warm (mus soreness) or cold prn
Why do you write lot/manufacterer for vaccines?
can cause anaphylactic reactions and need to track it
Why not live vius vaccination before 12 months?
b/c maternal antibodies are passed onto infant & will neutrolzie the antibodies resulting from the vaccination
maternal antibodies passed onto infant is an example of _____ immunity.
Nasal flu vaccine consideration?
live flue virus - possibility of getting flue
3 live flu viruses?
- 1. MMR
- 2. varicella
- 3. nasal flu
Consideration with live immunizations?
if a child/person is immunocompromised they SHOULD NOT get live vaccines
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
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
Who cannot get flumist?
children <2years old and ppl with asthma due to risk of developing the flu from the live virus