Ch. 6 & 32 Flashcards
CDC transmission based precautions
- standard
- contact
- droplet
- airborne
contact precautions
anyone in the room must wear
- gloves
- gown
droplet precautions
any in the room must wear
- surgical mask
airborne precautions
any in the room must wear
- N95 respirator
communicable disease: definition
an infectious disease transmissible by direct or indirect contact (ie a surface it could be on)
nursing goals with communicable diseases
- assist in the identification of the infectious agent (assessments, history, etc.)
- identify potentially infectious cases
- recognize diseases that require medical intervention
- implement appropriate nursing interventions
- educate patients and families
prodromal symptoms: definition
s/sx of an illness that appear before the characteristic s/sx of the disease
constitutional symtoms: definition
symptoms that can affect multiple body systems
incubation period: definition
time between exposure and onset of symptoms
examples of prodromal symptoms
fever
malaise
anorexia
examples of constitutional symptoms
fever
irritability
examples of incubation period
2-3 weeks
several days
agent
the causative organism
source
where it came from
where it can be found
transmission
how it is spread
what is needed during the incubation period?
quarantine needed
precautions needed
period of communicability
how long a person is considered contagious
distribution
how it appears on a human
- rash (pattern)
- sx (order of sx)
specific management
using a particular medication to treat a specific organism/infection
ie antibiotic for infection
support management medication is
medication that is not specific to illness, but resolves general non-specifc symptoms
ie tylenol for fever
complications
signs of decline
worsening of condition
- may put patient at risk for hospitalization or death
prevention
teach family and patient so that they can prevent illness from occurring again
nursing care of communicable disease
- nursing interventions: what we do to promote/improve health
- anticipatory guidance: how to prevent, follow-up appt, more tests
- patient and family education: how to use thermometer, how to set up humidifier
subjective data collection
- known exposure?
- community exposure?
- prodromal symptoms?
- constitutional symptoms?
- immunization?
- history of having disease?
- history of comorbidity/risk factors?
timeline of communicable disease
- stage of susceptibility
- exposure
- stage of subclinical disease
- pathologic changes
- onset of symptoms
- stage of clinical disease
- usual time of diagnosis
- stage of recovery, disability or death
nursing care management: prevent spread
- institute precautions
- HW
- primary prevention (immunization)
- antibiotics
nursing management: prevent complications
- immunocompromised
- immunoglobulin
- booster vaccine
- antivirals
- antibiotics
- vit A supplementation
nursing care management: providing comfort and support
- calm skin manifestations (cool compress, bath, lotion, creams)
- antipyretics
- oral symptoms (lozenges, gargling, rinses, magic mouthwash)
- quiet activity/distraction vs. bedrest
varicella: source
- primary secretions of respiratory tract
- skin lesions
varicella: transmission
- direct contact
- droplet (airborne),
- contaminated objects
varicella: incubation
2-3 weeks
varicella: period of communicability
1 day before eruption of lesions (prodromal) until 6 days after first crop of crusts form
varicella: prodromal s/sx
- slight fever
- malaise
- anorexia
- macule to papule to vesicle (varying stages at once)
varicella: distribution
- centripetal (starts in center of body)
- spreads to face and extremities
- less on distal limbs
varicella: constitutional s/sx
- fever from lymphadenopathy
- irritability from pruritis
varicella: specific management
- antiviral treatment (Zovirax)
- immune globulins
varicella: supportive management
- antihistamines
- skin care to prevent secondary infection
varicella: complications
- secondary infections (cellulitis, PNA: pneumonia, sepsis)
- skin infections from itching
- scarring
- pneumonia
- encephalitis
- arthritis
- ataxia
- thrombocytopenia
varicella: nursing interventions
- standard, airborne, and contact precautions until crusted
- skin care
- nail care
- watch for respiratory symptoms
varicella: anticipatory guidance
- keep environment cool (decreases # lesions)
- pressure vs scratching
varicella: patient and family education
avoid ASA: aspirin (Reye syndrome)
varicella: prevention
- immunizations
- antiviral therapy for immunocompromised patients, pregnant women, and newborns
- no longer contagious after all lesions have scabbed
- usually managed at home (limit exposure)
varicella: nursing management
- supportive management
- VS
- antipyretics, antipruritics prn
- airborne and contact precautions
- encourage fluids
- distraction (to prevent itching)
- calamine lotion; oatmeal baths, oatmeal soap
- head to toe assessment includes lungs, cardiac, neuro
varicella is a ____ disease
self-limiting
measles is also known as
rubella
varicella: agent
varicella
varicella is also known as
chicken pox
measles: agent
virus
measles: source
- resp tract secretions
- blood and urine of infected person
measles: transmission
- direct contact
- more common in winter months
measles: incubation
10-20 days
measles: period of communicability
- 4-5 days prior to rash
- prodromal phase
measles: prodromal s/sx
- fever
- malaise
- after 24 hours coryza, cough, conjunctivitis, Koplik spots
measles: distribution
-rash appears 3-4 days after start of prodromal stage
- begins as maculopapular on face and gradually spreads down body (confluent initially then discrete
measles: constitutional s/sx
- anorexia
- abdominal pain
- malaise
- lymphadenopathy (generalized)
measles: specific management
none
- prevention
measles: supportive management
- bed rest while febrile,
- antipyretics,
- antibiotics to prevent secondary infection in susceptible children
measles: complications
- OM,
- bacterial PNA,
- obstructive laryngitis,
- laryngotracheitis;
- encephalitis (rare but often fatal)
- croup
- diarrhea
measles: prevention
childhood immunizations
- cannot begin until 12 months of age
measles: nursing interventions
- Vitamin A supplementation (dose is age dependent);
- isolation until day 5 of rash;
- airborne precautions,
- rest during fever;
- quiet play;
- eye care;
- vaporizer
measles: anticipatory guidance
- petroleum to nares and lips;
- skin barrier ointment;
- bland foods;
- fluids;
- dim lights (photophobia)
measles: patient and family education
- clean skin
- tepid baths
can measles resolve without treatment?
yes
how contagious is measles?
highly contagious
koplik’s spots
small red spots with blue/white centers appear inside mouth
first s/sx of measles
- hacking cough
- watery eyes
- rhinitis
- high fever
measles rash
appears red/brown
- begins on forehead then spreads downward covering the whole body
measles: nursing care
- Teaching re: prevention and transmission and contractibility
- Encourage fluids (clears)
- IVF
- I/O
- Periods of rest
- Isolation: airborne (per CDC) until 5th day of rash
- Comfort measures: antipyretics, antipruritics (NO ASPIRIN)
- Eye care: moist cloths to remove crusting
- Cool mist humidifier
- Vitamin A supplementation
- 2-week recovery time
impetago contagiosa: agent
bacterial (staphylococci or streptococcus)
impetago contagiosa: transmission
contact (self-inoculation)
impetago contagiosa: incubation
7-10 days
impetago contagiosa: clinical manifestations
- Quick onset of red macule that becomes vesicular
- Spreads peripherally
- Honey exudate that dries into a heavy thick crust
- Pruritus
- Regional lymphadenopathy
impetago contagiosa: precautions
contact
- child is contagious until healed and without drainage
- MRSA
impetago contagiosa: treatment
- Topical or systemic ABX
- Hand washing and hygiene
- Dilute bleach baths
- May require hospitalization
impetago contagiosa: prevention
- Handwashing
- avoid touching the area
- wash clothes, linen and items child uses (ex. toys)
- wash bug bites and cuts immediately
- short nails
cellulitis: agent
bacterial (streptococci, staphylococci), also haemophilus influenza
cellulitis: transmission
- not typically contagious
- self-inoculate
cellulitis: clinical manifestations
- Erythema, pain, edema at site
- Firm infiltration
- Lymphangitis “streaking”
- Regional lymphadenopathy
- Fever, malaise
- Can abscess
cellulitis: treatment
- oral or parenteral antibiotics
- Rest
- Hospitalization if systemic
cellulitis: prevention
- Skin and hand hygiene
- Minimize risk factors
cellulitis: treatment (if symptomatic…)
- warmth
- antipyretics
cellulitis: risk factors
- Skin openings
- Underlying skin condition
- Contact sports
- Decreased immunity
- IV drug use
conjunctivitis
non-vaccine communicable disease, not always communicable
- inflammation of the conjunctiva
causes of conjunctivitis
- viral
- bacteria
- chemical
- allergic
- foreign body
“pink eye” is caused by
bacterium
s/sx of “pink eye”
- purulent drainage: green/yellow
- crusting of lids
- swelling and inflammation
(bacterial form)
conjunctivitis: treatment
based on cause
- antibiotics (bacterial)
- eye drops (bacterial/foreign body)
- antihistamine (if allergic reaction)
- nothing if viral
*needs to be on medication for 24hr before returning to daycare/school
conjunctivitis: prevention
- prevent complications
- hand and eye hygiene
- not spreading infection from one eye to other eye
- not spreading infection from child to child/child to parent, etc.
conjunctivitis: nursing care
- comfort and supportive care
- encourage eye and hand hygiene
- should not be touching medication directly to infected eye- can spread
viral infections are
- communicable
- symptomatic treatment
- often associated with rashes
- rashes have unique characteristics
- some viruses are preventable with vaccines
bacterial infections
- increased risk with autoimmunity concerns
- may be caused by staph or strep (common flora on skin)
- often due to break in skin integrity
- role of nurse- prevent spread and complications
- education (ie. not to break follicles, hygiene, antibiotics, comfort measures)
fungal skin infections: agents
- Typically dermatophystoses;
- tinea or candidia
fungal skin infections: transmission
- Contact, Invasion in susceptible skin, corneum, hair, or nails
- May be transmitted from infected animals or people
fungal skin infections: diagnosis
microscopic exam
fungal skin infections: treatment
topical or systemic anti-fungal
fungal skin infections: types
- Tinea capitis (scalp)
- Tinea corporis (body or nails)
- Tinea cruris (groin)
- Tinea pedis (feet)
- Thrush (oral)
- Candidiasis (vaginal, diaper dermatitis)
dermatophytoses is a ___ infection
fungal infection
dermatophytoses: clinical manifestations
- Dry flaky rash-scaly
- Inflamed border
- Pruritus
- When in scalp may present with alopecia
dermatophytoses: precautions
contact
- child is contagious until resolved
dermatophytoses: prevention
- avoid contact
- good hygiene
- wash clothes in hot water
- At risk of contracting from public sources (gym mats, seatbelts)
fungal infections: locations
can exist in various locations
- scalp: tinnea capitis
- around armpit
- foot: tinnea pedis
- groin area: tinnea curus
scabies: agent
scabies mite
Sarcoptes scabiei
scabies: transmission
contact (prolonged)
scabies: clinical manifestations
Maculopapular lesions often located in folds of skin or where skin touches other skin
Pruritus (intense)
Inflammation
Excoriation and burrows
Discrete inflammation between finger webs, neck folds, groin
scabies: precautions
avoid contact
scabies: treatment
- wear goves
- Scabicide: Older than 2 mo. Permethrin 5% cream × 8 to 14 hr.
- Hygiene of linens and clothing with high heat
- Supportive care for pruritus 2 to 3 weeks.
- Treat all in close contact.
scabies: prevention
avoid contact
good hygiene
wash clothes/linens in hot water
At risk of contracting from public sources (gym mats, seatbelts)
most frequent infections worldwide
intestinal parasites
who is at the highest risk for intestinal parasites
young children
most common intestinal parasites in the US
- pinworms
- giardiasis (diarrheal presentation)
intestinal parasites: nursing management
Assist with identification, treatment, and prevention
Fecal smears are diagnostic
Treat family members
Provide education and support to prevent reinfection
intestinal parasites: manifestations
- stomach pains
- constant hunger
- malnutrition
- wasting
- stunting
- little or no energy
- vomiting
- diarrhea
- lack of focus
enterobiasis is
pinworms
enterobiasis: agent
nematode Enterobius vermicularis
enterobiasis: transmission
Inhalation or ingestion of eggs from contaminated hands
enterobiasis: overview
oral-fecal transmission by contaminated hands, shared toys, bedding, clothing, toilet seats
enterobiasis: incubation
1-2 months
enterobiasis: diagnosis
tape test (early AM)
enterobiasis: clinical manifestations
- intense perineal itching*
- general irritability
- restlessness
- poor sleep
- bed-wetting
- distractibility
- short attention span
- perianal dermatitis and excoriation secondary to itching
- if worms migrate, possible vaginal (vulvovaginitis) and urethral infection
pinworms: clinical manifestations
May be asymptomatic
Anal itching esp. at night
Weight loss
Enuresis
pinworms: diagnosis
visualization
pinworms: treatment
Pyrantel pamoate OR
Single oral dose of albendazole. Repeat in 2 weeks (age restrictions under age 2)
pinworms: prevention of reinfection
Am bathing (recommended)
Freq. underwear changes
Freq. bedding changes
Personal hygiene: short nails, no nail biting or thumb sucking
Handwashing!!
Treat all family members
pediculosis capitis: agent
Pediculus humanus capitis
pediculosis capitis: transmission
Prolonged close contact when a female louse is able to obtain blood meal at scalp and deposit eggs on hair shaft at night.
pediculosis capitis: clinical manifestations
Intense pruritus of scalp (behind ears or nape of neck)
Nits attached to hair shaft
pediculosis capitis is
head lice
pediculosis capitis: treatment
Pediculicide shampoo and removal of nits (comb)
Family may attempt homeopathic treatment regimens
Education and support to families
Advocacy and support for school attendance
pediculosis capitis: prevention of reinfection
Soak hairbrushes
Hot water linen washes
Vacuuming
Seal non washables in a plastic bag x 10-14 days
Bedmates must be treated
**Not a sign of poor hygiene or poverty
coxsackie virus is
common viral illness
- children <5 years are most commonly infected
- may be asymptomatic (older children and adults) but are still contagious
- easy to dehydrate (enc. fluids)
HFMD
hand-foot and mouth disease
- rash on bottom of feet and inside mouth
- highly contagious
coxsackie virus: agent
enterovirus group of viruses (Coxsackievirus A16 is the most common cause; also Enterovirus 71)
coxsackie virus: transmission
nose and throat secretions (such as saliva, sputum, or nasal mucus),
blister fluid
feces (stool)
coxsackie virus: prodromal s/x
fever; anorexia; sore throat; malaise (unwell feeling)
coxsackie virus: contagious
Contagious during 1st week of illness but can continue to be even after s/sx disappear
coxsackie virus: distribution
1-2 days after fever begins painful oral sores develop (herpangina);
- begin as small red spots that blister and become ulcerated;
- skin rash with red spots (and blisters) may develop over 1-2 days on palms and soles;
- may also appear on knees, elbows, buttocks, & genitalia
coxsackie virus: complications
*uncommon but may include:
Viral or “aseptic” meningitis
Encephalitis
polio-like paralysis can occur, but this is even rarer
coxsackie virus: prevention
HW
Disinfect contaminated surfaces
Avoid kissing/close contact/sharing utensils with infected persons
coxsackie virus: treatment
Symptom mgmt.
Avoid aspirin; pain relievers PRN
Magic mouthwash; numbing sprays
diaper dermatitis: principle factors in development
- acute inflammatory
diaper dermatitis: therapeutic management (presentation)
- compound presentation (yeast)
diaper dermatitis: nursing considerations
do’s and don’ts
seborrheic dermatitis: cause, type
- unknown cause
- chronic, recurrent, inflammatory
diaper dermatitis: manifestation
pruritis leads to irritability
diaper dermatitis: locations
Scalp—cradle cap (most common location)
Eyelids—blepharitis
External ear—otitis externa
Nasolabial folds
Inguinal region
atopic dermatitis is also called
eczema
atopic dermatitis is a ____ of dermatologic diseases
- category
*not a specific etiology
atopic dermatitis
Chronic, recurrent, inflammatory
Usually associated with allergy or hypersensitivity
Seasonal flare-ups
Hereditary tendency (atopy)
atopic dermatitis: diagnostic criteria
(pruritus and 3 of the following:)
Hx of generalized dry skin
Asthma or allergic rhinitis
Flexural involvement
Rash before age 2
atopic dermatitis: therapeutic management
Hydrate the skin
Relieve pruritus
Reduce inflammation
Prevent and control secondary infection (impetigo)
most common adolescent skin disorder
acne
- more common in M vs. F
- Self-limiting
acne: pattern of development
Midface (mid-forehead, nose, chin)
Lateral cheeks, lower jaw, back, chest
acne: severity
ranges from several comedones (open=whitehead; closed=blackhead) to severe outbreaks (including pustules, and cysts)
acne: causes
Hereditary
Hormonal changes (ex. Premenstrual flare-ups)
Dietary triggers (dairy, high glycemic, oils)
Cosmetics
what is adolescent’s concern about acne?
- social acceptance
acne: nursing management
- adolescent concerns
- discuss triggers: stress
- Discourage manipulation of acne to avoid secondary infection and scaring
- Pediatrician/APRN can manage most cases
acne: improvement
6-8 weeks before improvement if compliance with treatment
- Abrasives can damage skin and worsen condition
acne: treatments
Treatments include: gentle cleanser, topical products and systemic antibiotics depending upon type of lesions and severity, and diet changes
acne treatment: isotretinoin (accutane)
- requires contraception contract
Treatment x 20 weeks
Numerous side effects including photosensitivity and dry skin
Monitor for depression and suicidal ideation
the Ipledge Program
for patients considering taking accutane
all patients must:
- sign consent forms
- keep appointments
- agree to follow
the Ipledge Program goals
- prevent fetal exposure to isotretinoin **
- inform prescribers, pharmacists, patients about isotretinoin’s serious risks and safe-use conditions
