Communicable Diseases PEDS

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NurseFaith
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296259
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Communicable Diseases PEDS
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2015-02-23 21:21:44
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Communicable Diseases PEDS
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Communicable Diseases PEDS
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  1. Stages of Infectious Disease
    Incubation- time between entrance and appearance of sx

    • Prodromal- time from nonspecific sx to more specific sx
    •  
    • Illness- pt demonstrates s/s

    Convalescence- acute sx of illness disappear
  2. Time between entrance of pathogen and appearance of first sx
    Incubation
  3. Time from nonspecific sx (Fever, Malaise) to more specific sx
    Prodromal
  4. Stage of disease where pt demonstrates full s/s
    Illness
  5. Stage of disease where acute sx of illness disappear
    Convalescence
  6. Non-Specific Sx of a Disease
    Fever, Malaise
  7. Why are infants and children at an increased risk for infection and communicable diseases?
    Infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies

    Infant demonstrates an increased inflammatory response (decreased response)

    Cellular immunity is not functional at birth (cellular immunity functional, humoral immunity is not)

    Infants are at an increased risk for infection until they receive their first set of immunizations
  8. Infants are at an increased risk for infection until they:
    receive their first set of immunizations
  9. Common medications and treatments for communicable infections:
    • Antibiotics
    • Antivirals
    • Antipyretics
    • Antipruritics

    • Hydration
    • Fever Reduction
  10. Fever management of infant/child:
    Acetaminophen (10-15mg/kg/dose every 4-6 hours)

    Ibuprofen (5-10mg/kg/dose every 6-8 hours)
  11. ___ should not be used for fever management in infants < 6 months of age
    Ibuprofen (aspirin)
  12. ___ is not generally used in children because of the potential risk of Reye's syndrome
    Aspirin
  13. Communicable Bacterial Infections in infants/children
    • Scarlet Fever
    • Diptheria
    • Pertussis
    • Tetanus
  14. Scarlet fever is caused by:
    Group A Beta Hemolytic Streptococcus
  15. A ____ is usually seen in children under 18 years old with Scarlet Fever
    Rash (on chest and abdomen-- like a piece of sandpaper...redder in armpits and groin)

    • *rash lasts about 2-5 days 
    • *fingers/toes begin to peel
    • *face is flushed with pale area around lips
  16. The bacterial causing scarlett fever, Group A Beta hemolytic Strep, can cause ____ if it isn't treated
    Carditis and ultimate heart failure
  17. Management of Scarlet Fever
    Respiratory precautions for 24 hours

    Oral antibiotic in the penicillin family for 10 days

    Treat sore throat with analgesics, gargles, lozenges, and antiseptic throat spray

    Encourage fluids

    See HCP if fever persists
  18. Agent that causes Pertussis (whooping cough)
    Bordetella Pertussis (respiratory)
  19. Transmission of Pertussis:
    Droplet spread or contact with contaminated article (incubation of 10 days)
  20. Period of communicability of Pertussis (whooping cough)
    Before onset of paroxysms to 4 weeks after onset
  21. Management of Pertussis
    Provide humidity (mobilizes secretions)

    Encourage fluids (secretions thin and hydrates)

    Observe for airway obstruction

    Provide reassurance during coughing spells (child will be anxious)

    Administer antibiotics (macrolides, erythromycin, azithromycin all in children > 1 year)
  22. Types of viral communicable infections:
    • Viral Exanthems
    •   -Rubella
    •   -Rubeola (measles)
    •   -Varicella zoster
    •   -Roseola
    •   -Erythema infectiousum (5th disease)

    Mumps

    Poliomyelitis
  23. Agent/Source of German Measles:
    Rubella virus-- nasopharyngeal secretions, secretions in blood, stool, and urine
  24. Transmission of Rubella/German Measles is by:
    • Direct Contact
    • (incubation period of 14-21 days)
  25. Period of communicability of Rubella/Measles:
    7 days before to 5 days after appearance of rash
  26. Rash of rubella (measles) appears:
    Face first and rapidly spreads downward
  27. ____ rubella from pregnant women
    ISOLATE!
  28. TORCH (affect fetus)
    toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex
  29. Type of measles seen in Disney from unimmunized child
    Rubeola- Measles
  30. "Big Red Measles"
    Rubeola
  31. "3 day measles" or "German Measles"
    Rubella
  32. Transmission of Rubeola/Measles
    Respiratory, blood, urine (10-20 days incubation)
  33. Signs during prodromal stage of Rubeola/Measles
    Fever, Cough, Conjunctivitis, Koplik Spots
  34. Small irregular bright red spots with bluish white specks at the center
    Koplik Spots (seen in Rubeola Measles)
  35. Rash of Rubeola looks like:
    Large, flat red to brown blotches that often flow into one another to completely cover the skin (especially the face and shoulders)
  36. Management of Rubeola:
    ***Vitamin A (100,000 for children 6-12 months; 200,000 for children >1 year)

    • Antipyretics
    • Bed Rest
    • Adequate fluids
    • Cool-Mist humidification
    • Dimly-lit room/Sunglasses (if photophobic)
    • Isolation DROPLET precautions
  37. What causes chicken pox
    Varicella Zoster Viruses
  38. When does chicken pox generally occur?
    Late winter/Early Spring
  39. How is chicken pox spread?
    Direct contact and droplet transmission
  40. Chicken pox can be spread ____ before eruption of lesions and until the time when all lesions have crusted
    1-2 days
  41. When can a child return to school/day care after chicken pox?
    *Not until ALL lesions have CRUSTED (usually about 1 week)

    ...it is not necessary to wait until scabs fall off to let the child return to normal schedule
  42. S/S of Chicken Pox
    Lesions erupt in successive crops (usually beginning on the trunk and spreading to face and scalp)

    Characteristic rash involves crops of teardrop vesicles on an erythematous base

    Lesions can be in ALL stages of development simultaneously

    FEVER > 102
  43. Incubation period of Chicken Pox
    10-21 days after exposure (mostly within 14-17 days....ie: sibling will show sx within 2 weeks)
  44. Treatment for Chickenpox:
    • RELIEVE THE ITCH
    • --cool, tepid oatmeal baths q3-4 hours prn
    • --calamine lotion (avoid face)
    • --antihistamines, such as benadryl

    Soft/Bland foods as indicated as there may be painful pox lesions in the mouth

    Acetaminophen or Ibuprofen for fever/aches

    Antiviral meds (acyclovir) may be prescribed...usually recommended for children who are immunocompromised (decreases number of lesions, shortens duration of fever, decreases itching, lethargy, and anorexia)
  45. Ways to relieve the itch from chicken pox:
    • Cool, tepid oatmeal baths every 3-4 hours PRN
    • (Baths do NOT spread chicken pox)

    Calamine lotion (avoid face/eyes)

    Antihistamines (benadryl)
  46. Complications of Chicken Pox
    • Viral Pneumonia
    • Encephalitis
    • Secondary Skin Infection
  47. How is Chicken Pox related to Shingles?
    Anyone who has had chickenpox is at risk

    Varicella Zoster may remain inactive in the nerve cells near the spinal cord

    Virus can reactivate and surface as shingles, affecting nerves to the skin

    Sx: tingling, itching, pain with rash and bumps/blisters
  48. Cause of Mumps
    Paramyxovirus (spread through saliva of infected individuals)
  49. Incubation period of mumps:
    14-21 days
  50. Incidence of mumps:
    1,000 per year
  51. Treatment of Mumps
    Nonspecific, Symptomatic
  52. Complications of Mumps:
    Encephalitis and Orchitis (testicle inflammation)
  53. In mumps, the _____ swell and obscure the angle of the jaw
    Parotid Glands
  54. Sx of Pinworms
    • Perianal Itching
    • Perianal dermatitis and excoriation
    • Possible vaginal itching/infection
  55. Dx of Pinworms:
    Tape test (page 469)
  56. Drug Treatment of Pinworms:
    • Mebendazole (Vermox)
    • -single dose and repeat in 2 weeks
    • -weigh risk/benefits in child <2yrs old

    ***ALL family members should be treated
  57. Most effective preventative measure for pinworms:
    Good hand hygiene
  58. Causes of Conjunctivitis
    • Bacterial
    • Viral
    • Allergic
    • Foreign Body
  59. Manifestations of Bacterial Conjunctivitis:
    • PINK EYE
    • purulent eye drainage
    • eye crusting
    • eyes matted together after sleeping
  60. Manifestations of Viral Conjunctivitis
    Watery eye discharge
  61. Manifestations of Allergic Conjunctivitis
    Red, Itching eyes
  62. Clinical Manifestations of Foreign Body Conjunctivitis
    Painful eye (usually only one eye affected)
  63. Treatment of bacterial conjunctivitis:
    • Antibiotic Ointment
    • Removal of Drainage
    • Universal precaution to prevent spread
    • (VERY CONTAGIOUS)
  64. Self-limiting forms of conjunctivitis
    Viral, Allergic
  65. A 2yo child has temp of 100F...What advice should the nurse give the mother?
    In a normal healthy child, if your child is not uncomfortable fevers less than 102.2F do not require medication
  66. Pertussis is characterized by what symptom?
    • Paroxysmal Cough 
    • (spells 10-30 times followed by whooping sound...redness of face, cyanosis)
  67. When explaining measles to a mother, what information is accurate?
    White, pinpoint lesions will appear on the inside of the cheek...usually 3-5 days after fever, cough and conjunctivitis

    Koplik spots have an erythematous base
  68. There has been an outbreak of chicken pox in the 1st grade classroom. A parent of one of the children wants to know if their child has been exposed. Your answer should be:
    Yes, the sick child could have been contagious a day before she broke out in lesions
  69. When working in an outpatient clinic, the nurse would recognize the need to clarify which order given for a healthy child diagnosed with chicken pox?
    Cefazolin (antibiotic) 

    Chickenpox is a viral illness not made better by antibiotics.
  70. Which statement by the mother of a child diagnosed with chicken pox indicates the need for further teaching?
    I will send her back to school as soon as she feels better
  71. When administering an antipyretic to a child, the nurse knows that aspirin is contraindicated for children with viral syndromes because of the possibility for the development of what???
    Reye's Syndrome
  72. Children with pinworm infections present with the principal sx of:
    Night Time Perianal itching
  73. The 5-year old is being tested for enterobiasis (pinworms)...to collect a specimen for assessment, the nurse should teach what:
    Examine the perianal area with flashlight 2-3 hours after child is asleep

    ***Teach tape test! 3 specimens first thing in morning)
  74. The nurse is teaching the mother regarding treatment for pinworms...Which instruction should be given regarding the medication?
    The entire family should be treated
  75. A parent reports that her child has inflamed conjunctivas of both eyes with purulent drainage and crusting. The nurse knows this is likely:
    Bacterial
  76. Common Accidental Poisonings:
    • Lead
    • Acetominophen
  77. All houses built before ____ are likely to contain some lead-based pain
    1978
  78. Symptoms of Lead Poisoning
    • Weakness in fingers, wrists, ankles
    • Increased BP
    • Anemia
    • Brain Damage
    • IN CHILDREN:
    • --irritability
    • --loss of appetite
    • --weight loss
    • --sluggishness
    • --abdominal pain
    • --vomiting
    • --constipation
    • --unusual paleness (pallor) from anemia
    • --learning difficulty
  79. Treatment for Lead Poisoning:
    • (Chelation Therapy)
    • ...treatment starts with levels >45 (class 4/5)
    • EDTA is administered through veins and combined with BAL...

    Children may be iron deficient and need iron supplements
  80. Management of Elevated Lead Levels:
    <10 = Rescreen in 1 year

    10-14 = after confirming with venous blood, child dx poisoned...environment needs evaluation

    15-44 = Health Department needs to assess home

    45 = Retest within 48 hours

    >70 = MEDICAL EMERGENCY

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