Ch 48: Peds Infectious Diseases Flashcards
Rubeola (Measles)
Agent: Paramyxovirus
Incubation Period: 10 - 20 dys
Communicable Period: 4 dys before - 5 dys after rash appears, mainly during prodromal stage.
source: respiratory tract secretions, blood, or urine of infected person
transmission: airborne particle or direct contact with infectious droplets; transplacental
prodromal
pertaining to early sxs that may mark the onset of disease
Rubeola (Measles) 3 C’s of assessment
coryza (inflammation of nasal cavity mucous membranes)
cough
conjunctivitis
Koplik’s spots (small red spots with a bluish white center and red base - buccal mucosa, last 3 dys)
Rubeola (Measles) rash
red, erythematous maculopapular eruption
starts on the face and spreads downward to the feet
blanches easily w pressure and gradually turns a brownish color (lasts 6-7 dys)
may have desquamation
Rubeola (Measles) interventions
droplet precautions in the hospital
Roseola (exanthema subitum)
agent: human herpesvirus type 6 incubation period: 5 - 15 dys communicable period: unk. (thought to be from febrile stage - rash appearance) source: unk transmission: unk
Roseola (exanthema subitum) assessment
sudden high (>102) fever of 3 - 5 dys duration in a child who appears well, followed by a rash (rose pink macules that blanch w pressure) rash appears several hrs - 2 dys afte rthe fever subsides, lasts 1 - 2 dys
Rubella (German Measles)
agent: rubella virus
incubation period: 14 - 21 dys
communicable period: from 7 dys before to 5 dys after rash appears
source: nasopharyngeal secretion; virus is also present in blood, stool, and urine
transmission: airborne / direct contact w infection droplets; indirectly via articles freshly contaminated with nasopharyngeal secretions, feces, or urine; transplacental
Rubeola
Measles
Rubella
German Measles
Rubella (German Measles) assessment
low grade fever
malaise
pinkish red maculopapular rash: begins on the face and spread to the entire body w/in 1 -3 dys
petechial red, pinpoint spots may occur on the spots palate
Rubella (German Measles) interventions
airborne droplet precautions if the child is hospitalized
isolate infected child from pregnant women
Mumps
AGENT: paramyxovirus
INCUBATION PERIOD: 14 - 21 dys
COMMUNICABLE PERIOD: immediately before and after parotid gland swelling begins
SOURCE: saliva of infected person and possibly urine
TRANSMISSION: direct contact or droplet spread from an infected person
Mumps assessment
fever headache and malaise anorexia jaw or ear pain aggravated by chewing, followed by parotid glandular swelling orchitis (swelling of testicles)
Mumps interventions
airborne droplet precautions
bedrest until parotid gland swelling subsides
avoid food you need to chew
hot/cold compresses as prescribed to the neck
warmth and local support with snug underpants to relieve orchitis
Chickenpox (varicella)
AGENT: varicella-zoster virus
INCUBATION PERIOD: 13 - 17 dys
COMMUNICABLE PERIOD: 1 - 2 dys before the onset of the rash to 6 dys after the first crop of vesicles, when crusts have formed
SOURCE: respiratory tract secretions of infected peron; skin lesions
TRANSMISSION: direct contact, droplet (airborne) spread, and contaminated objects
Chickenpox (varicella) assessment
slight fever, malaise, and anorexia
followed by macular rash that first appears on the trunk and scalp and moves to the face and extremities
lesions become pustules, begin to dry, and develop a crust
lesions may appear on the mucous membranes of the mouth, the genital area, and the rectal area
Chickenpox (varicella) interventions
strict isolation (contact and droplet precautions)
Pertussis (whooping cough)
AGENT: Bordetella pertussis
INCUBATION PERIOD: 5 - 21 dys (usually 10)
COMMUNICABLE PERIOD: greatest during catarrhal stage (when discharge from resp secretions occurs)
SOURCE: discharge from the resp tract of the infected person
TRANSMISSION: direct contact or droplet spread from infected person; indirect contact with freshly contaminated articles
catarrhal stage (pertussis)
when discharge from respiratory secretions occurs
Pertussis (whooping cough) assessment
sxs of resp infection followed by increased severity of cough, with a loud whooping inspiration
may experience cyanosis, resp distress, and tongue protrusion
listlessness, irritability, anorexia
Pertussis (whooping cough) interventions
isolate child during catarrhal stage
airborne droplet precautions
admin antimicrobial therapy as rx.
reduce environmental factors that cause coughing
ensure adequate nutrition / hydration
provide suction + humidified oxygen if needed
monitor cardiopulmonary status and pulse oximetry
infants do not receive maternal immunity to pertussis
Diphtheria
AGENT: Corynebacterium diphtheriae
INCUBATION PERIOD: 2 - 5 dys
COMMUNICABLE PERIOD: variable, until virulent bacilli are no longer present (3 negative cultures of discharge fromt he nose and nasopharynx, skin, and other lesions) - usually 2 wks, can be 4 wks
SOURCE: dischargef romt he mucous membrane of the nose and nasopharynx, skin, and other lesions of the infected person
TRANSMISSION: direct contact w infected person, carrier, or contaminated articles
Diphtheria assessment
low grade fever, malaise, sore throat
foul smelling, mucopurulent nasal discharge
dense pseudomembrane formation of the throat that may interfere w eating, drinking, and breathing
lymphadenitis, neck edema, “bull neck”
Diphtheria interventions
strict isolation
admin diphtheria antitoxin as prescribed (after a skin or conjunctival test to rule out sensitivity to horse serum)
bedrest
admin abx as prescribed
provide suction and humidified oxygen as needed
provide tracheostomy care if necessary
Poliomyelitis
AGENT: Enteroviruses
INCUBATION PERIOD: unk; the virus is present in the throat and feces shortly after infection and persists for about 1 wk in the throat and 4 - 6 wks in the feces
SOURCE: oropharyngeal secretions and feces of the infected person
TRANSMISSION: direct contact w infected person; fecal oral and oropharyngeal routes
Poliomyelitis assessment
fever, malaise, anorexia, nausea, HA, sore throat
abdominal pain followed by soreness and stiffness of the trunk, neck and limbs that may progress to CNS paralysis
Poliomyelitis interventions
enteric precautions supportive tx bedrest monitoring for respiratory paralysis physical therapy
Scarlet Fever
AGENT: Group A beta hemolytic streptococci
INCUBATION PERIOD: 1 - 7 dys
COMMUNICABLE PERIOD: ~10 dys during indubation period and clinical illness; during the first 2 wks of the carrier stage (may persist for months)
SOURCE: nasopharyngeal secretions of infected person and carriers
TRANSMISSION: direct contact w infected person or droplet spread; indirectly by contact w contaminated articles, ingestion of contaminated milk, or other foods
Scarlet Fever first day of rash
flushed cheeks white strawberry tongue increased density on neck transverse lines (pastia sign) increased density in groin
Scarlet Fever third day of rash
circumoral pallor
red strawberry tongue
increased density in axilla
positive blanching test (Schultz-Charlton)
Scarlet Fever assessment
abrupt high fever, flushed cheeks, vomiting, HA, enlarged lymph nodes in neck, malaise, ab pain
rash: red, fine sandpape like rash in teh axilla, groin, and neck –> spreads to cover entire body except face
rash blanches w pressure (Schultz Charlton rxn) except in areas of deep creases and folds of joints (Pastia’s sign)
desquamation on palms and soles by wks 1 -3
tongue initially coated with a white, furring covering with red projecting paillae, by 3-5 dys white coat sloughs off, leaving red, swollen tongue
tonsils are reddened, edematous, and covered with exudate
pharynx is edematous and beefy red
Schultz - Charlton rxn
Scarlet Fever rash blanches with pressure
Scarlet Fever Interventions
respiratory precautions until 24 hrs after initiation of abx therapy
bedrest
Erythema Infectiosum (fifth disease)
AGENT: Human parvovirus B19
INCUBATION PERIOD: 4 - 14 dys; may be 20 dys
COMMUNICABLE PERIOD: uncertain, before the onset of sxs in most children
SOURCE: infected person
TRANSMISSION: unk; possibly respiratory secretions and blood
Erythema Infectiosum (fifth disease) assessment
before rash: asymptomatic or mild fever, malaise, HA, runny nose
rash stages
Erythema Infectiosum (fifth disease) Rash stages
- erythema of the face (slapped cheek appearance) develops and disappears by 1 - 4 dys
- about 1 dy after the rash appears on face, maculopapular red spots appear, symmetrically distributed ont eh extremities; the rash progresses from proximal to distal surfaces and may last a wk or more
- rash subsides but may reappear if the skin becomes irritated by sun, heat, cold, exercise, or friction
Erythema Infectiosum (fifth disease) interventions
child is not usually hospitalized
pregnant women should avoid the infected
Infectious mononucleosis
AGENT: Epstein-Barr virus INCUBATION PERIOD: 4 - 6 wks COMMUNICABLE PERIOD: unk SOURCE: oral secretions TRANSMISSION: direct intimate contact
Infectious mononucleosis assessment
fever, malaise, ha, fatigue, nausea, abdominal pain, sore throat, enlarged red tonsils
lymphadenopathy and hepatosplenomegaly
discrete macular rash most prominent over the trunk may occur
*monitor for signs of splenic rupture
Rocky Mountain Spotted Fever
AGENT: Rickettsia rickettsii
INCUBATION PERIOD: 2 - 14 dys
SOURCE: tick from a mammal, most often wild rodents and dogs
TRANSMISSION: bite of infected tick
Rocky Mountain Spotted Fever assessment/intervention
fever, malaise, anorexia, vomiting, ha, myalgia (muscle pain)
maculopapular or petechial rash mostly on extremities (palms and soles characteristically)
vigorous supportive care, abx as rx
Community Associated MRSA
Staph aureus present w/o symptoms = colonization
present w/ symptoms = infection
assessment: skin infection - red, swollen area, warmth around the area, drainage of pus, pain at site, fever
H1N1 influenza
viral infection, affects the resp system, highly contagious
H1N1 vaccine
children 6mo and older need it
9yrs and younger need 2 doses 3 wks apart
10 yrs and older need one dose
takes 2 wks after final dose to develop immunity
nasal spray may be given to 2 - 49 yr olds who do not have chronic health condition
Priority Nursing Actions IMMUNIZATIONS
- verify the rx for the vaccine
- obtain an immunization hx from the parents and assess for allergies
- provide info to the parents about the vaccine
- obtain parental consent
- check the lot number and expiration date and prepare the injection
- select the appropriate site for administration
- administer the vaccine
- document the admin and site of admin and lot number and expiration date of the vaccine.
- provide a vaccination record to the parents
Immunizations
children who do not receive all doses in a series do not need to begin again, they need to receive only the missed doses
if there is a suspicion that the child will not be back for follow up immunizations any of the recommended immunizations may be admined simultaneously
vaccine contraindications / precautions
live virus vaccines, not admined to indvs w/ severely deficient immune systems, indv w a severe sensitivity to gelatin or pregnant women
Recommended childhood / adolescent immunizations
HepB rotavirus (RV) Diptheria, tetanus, acellular pertussis (DTaP) Haemophilus influenzae type b (Hib) influenza inactivated poliovirus (IPV) measles, mumps, rubella (MMR) varicella pneumococcal conjugate (PCV) HepA Meningococcal (MCV) Human papillomavirus (HPV)
HepB
IM route 1. soon after birth 2. 1-2 mo 3. 6 - 18 mo HBsAg positive mothers: infant should receive HeptB vaccine and hepatitis B immunoglobulin (HBIG) w/in 12 hrs of birth
RV
oral route
causes serious gastroenteritis and is a nosocomial pathogen
most severe in children 3 - 24 mo
<3 mo have some protection from maternal antibodies
2 vaccines available (RotaTeq and Rotarix) admined orally to replicate in the gut
RotaTeq: 3 doses needed
1. 6 - 14 wks
2. 4 - 10 wks
3. 4 - 10 wks after the second dose (no later than 32 wks of age)
Rotarix: 2 doses needed
1. 6 - 14 wks
2. 4 wks after the first (by 24 wks of age)
IM injection - peds
vastus lateralis muscle (best site)
ventrogluteal muscle
(deltoid can be used for cihldren 3 yrs and older)
dorsogluteal site (buttocks) AVOIDED
needles
IM: 1 inch, 23 - 25 gauge
SC: 5/8 inch, 25 gauge
DTaP
IM route 5 doses 1. 2 mo 2. 4 mo 3. 6 mo 4. between 15 - 18 mo 5. between 4 - 6 yrs
Tdap recommended at age 11 - 12 for children who have not received a tetanus and diphtheria toxoid booster dose
encephalopathy is a complication
Haemophilus influenzae type b conjugate vaccine (Hib)
IM route
protects against numerous serious infections causes by H. influenzae type b (bacterial pneumonia, septic arthritis, and sepsis)
@ 2, 4, and 6 mo, and between 12 - 15 mo
influenza vaccine
recommended annualy for children 6 mo - 18 yrs
IPV (inactivated polio vaccine)
SC route (may be given IM) @ 2, 4, 6-18 mo, and 4-6 yrs
MMR
SC route
- 12 - 15 mo
- 4 - 6 yrs
varicella vaccine
SC route
@12 mo, 15 mo, and 4 - 6 yrs
children > 13 yrs (no chickenpox or vaccine) need 2 doses at least 28 dys apart
children receiving the vaccine should avoid aspiring bc of the risk of Reye’s syndrome
PCV (pneumococcal conjugate vaccine)
IM route
prevents infection with Streptococcus pneumoniae (may cause meningitis, pneumonia, septicemia, sinusitis, and otitis media)
@ 2, 4, 6, and 12 - 15 mo
PPSV recommended in addition to PCV for high risk groups (given 8 wks after last dose of PCV)
HepA vaccine
IM route
@ 1 yr (12-23 mo), 2 doses at least 6 mo apart
MCV (meningococcal vaccine)
IM route (MCV4 - preferred type of vaccine)
protects against Neisseria meningitidis
MCV4 should be admined to all children at 11-12 yrs and to unvaccinated adolescents at high school entry (15 yrs), all college freshman living in dorms should be vaccinated
contraindicated in children w hx of Guillain Barre syndrome
HPV (human papillomavirus)
HPV vaccine guards against HPV types 6, 11, 16, and 18 (diseases such as cervical cancer, cervical abnomalities, and genital warts)
most effective if admined before exposure to HPV
3 injections over 6 mo
1. age 11 - 12
2. 2 mo after first dose
3. 6 mo after first dose
may be admined to boys to reduce their chances of genital warts
Pastia’s sign
Scarlet Fever
a rash that will blanch with pressure except in areas of deep creases and the folds of joints
