Chapter 45

Question 1

Mode of transmission

Direct

Answer 1

•Direct: Physical contact between source of infection and new host

Question 2

Mode of transmission

Indirect

Answer 2

Pathogens survive outside humans before causing infection

Question 3

Antigen

Answer 3

Foreign substance – triggers immune response

Question 4

Antibody

Answer 4

Protein made by the body in response to antigen

Question 5

Active

Answer 5

Body makes antibodies without presence of clinical disease (example: tetanus vaccine

Question 6

Passive

Answer 6

Antibodies made by another human or animal and given to another person – does not confer long-term immunity (example: tetanus immunoglobulin)

Question 7

Killed virus vaccine example

Answer 7

inactivated polio/IPV)

Question 8

Toxoid example

Answer 8

•Tetanus is a bacterial exotoxin

Question 9

Live virus vaccine

Answer 9

MMR, varicella, what else?)

Question 10

Recombinant form

Answer 10

(hepatitis B, pertussis) – DNA alteration of the organism

Question 11

•Conjugated (Hib) – antigen/carrier protein

Answer 11

antigen/carrier protein

Question 12

Reasons why parents don’t vaccinate

Answer 12

•Concern that vaccine is dangerous (autism, SIDS)
•Vaccine might not fully prevent disease
•Does not want government to monitor vaccination status
•The disease is not a threat anymore
•Side effects from vaccine do not justify benefit
•Belief that they can control child’s susceptibility to disease
•Poor experience prior – d/t:
–Procedure – site update
–Poor education on side effects and believe of reaction

Question 13

Chicken pox varicella

Answer 13

• Agent: Herpes Varicella
• Transmission: Airborne, direct contact
• Systemic manifestations: Fever, malaise, headache, abdominal pain
• Skin manifestations: Clear, fluid-filled vesicles all over the body
• Treatment: Supportive
• Nursing: Isolation, symptom management

Question 14

Cox hand foot and mouth disease

Answer 14

•Agent: Coxsackievirus A16, Enterovirus 71
•Transmission: Fecal-oral and respiratory routes
•Systemic manifestations: Fever, sore throat
•Skin manifestations
–Herpangina: Papulovesicular lesions in pharynx only
–Hand, foot, and mouth disease: Papulovesicular lesions on inside of cheek, gums, tongue, as well as hands and feet
•Treatment: Supportive
•Nursing: Isolation, topical lotions, cool drinks

Question 15

Diphtheria

Answer 15

• Agent: Corynebacterium diphtheriae
• Transmission: Contact with nasal or eye discharge
• Systemic manifestations: Fever, anorexia, rhinorrhea, cough, stridor
• Oral manifestations: Tonsils, pharynx covered in thick, bluish-white patch
• Treatment: Antibiotics, IV antitoxin
• Nursing: Isolation, monitor for respiratory distress, administer antibiotics

Question 16

Erythema Infectiosum (Fifth Disease)

Answer 16

• Agent: Human parvovirus B19
• Transmission: Respiratory secretions and blood
• Systemic manifestations: Flu-like illness
• Skin manifestations: Fiery-red rash on cheeks (“slapped face” appearance) – lace-like rash on trunk and limbs
• Treatment: Supportive
• Nursing: Isolation, fever control, antipruritics, soothing baths (oatmeal)

Question 17

Haemophilus Influenzae Type B

Answer 17

• Agent: H. influenzae bacteria (several serotypes exist)
• Transmission: Direct contact or droplet inhalation
• Systemic manifestations: Viral upper respiratory tract infection that invades bloodstream – may cause meningitis, cellulitis, epiglottitis, pneumonia, or sepsis
• Skin manifestations: None specific
• Treatment: Antibiotics
• Nursing: Isolation, prophylaxis for close contacts, antipyretics

Question 18

Measles (Rubeola)

Answer 18

• Agent: Morbillivirus – “Hard Measles”
• Transmission: Airborne, droplet, and contact
• Systemic manifestations: High fever, conjunctivitis, cough, anorexia, malaise
• Koplik spots – clustered white lesions on buccal mucosa – prodromal 2-3 days before rash – red, blotchy, maculopapular
• Treatment: Supportive – antibiotics for secondary infections
• Nursing: Isolation, antipyretics, antitussives, monitor respiratory status

Question 19

Mono

Answer 19

• Agent: Epstein-Barr virus
• Transmission: Direct contact with secretions
• Systemic manifestations: Malaise, headache, fatigue, fever, posterior lymphadenopathy – weakness and lethargy may persist for months
• Skin manifestations: None specific
• Treatment: Supportive
• Nursing: Antipyretics, bed rest during acute phase

Question 20

Mumps parotitis

Answer 20

• Agent: Rubulavirus
• Transmission: Contact with respiratory secretions
• Systemic manifestations: Malaise, fever, pain with chewing, parotid gland swelling
• Skin manifestations: None specific
• Treatment: Supportive – disease is usually self-limiting
• Nursing: Isolation, comfort

Question 21

Pneumococcal Infection

Answer 21

• Agent: Streptococcus pneumoniae
• Transmission: Respiratory secretions, droplet
• Systemic manifestations: Related to area of infection (otitis, sinusitis, bacteremia, pneumonia, meningitis)
• Skin manifestations: None specific
• Treatment: Antibiotics (many resistant strains exist)
• Nursing: Isolation, antipyretics, encourage fluids

Question 22

Poliomyelitis

Answer 22

• Agent: Poliovirus
• Transmission: Fecal-oral, possibly respiratory
• Systemic manifestations: May be mild or severe – CNS symptoms, respiratory weakness, paralysis
• Skin manifestations: None specific
• Treatment: Supportive
• Nursing: Monitor respiratory status, comfort

Question 23

Roseola Infantum (Exanthem Subitum, Sixth Disease)

Answer 23

• Agent: Herpesvirus type 6

* Transmission: Possibly respiratory secretions of healthy individuals -

Question 24

Rotaviru

Answer 24

• Agent: Reoviridae family of rotaviruses
• Transmission: Fecal-oral route
• Infants/young children
• Systemic manifestations: Fever (acute onset), vomiting, diarrhea (10-20 stools per day)
• Skin manifestations: None
• Treatment: Rehydration (oral or IV); no antiviral therapy is available, but is preventable by vaccine
• Nursing: Hand hygiene; monitor intake and output

Question 25

Rubella German measles

Answer 25

* Agent: Rubella (Latin for “little red”) RNA Virus * Transmission: Droplet or direct contact * Systemic manifestations: Low-grade fever, headache, malaise, anorexia * Skin manifestations: Pink, nonconfluent, maculopapular rash that starts on face. * Treatment: Supportive – disease usually mild. Prenatal exposure causes birth defects * Nursing: Isolation, especially from pregnant women – comfort measures

Question 26

Strep A

Answer 26

•Agent: Group A streptococci (GAS) •Transmission: Contact with respiratory secretions – direct contact •Systemic manifestations: Pharyngeal (sore throat, fever) •Skin manifestations: Pyodermal impetigo – honey-colored lesions •Treatment: Antibiotics – uncomplicated impetigo treated topically •Nursing: Usually cared for at home – fever management, warm fluids

Question 27

Tetanus

Answer 27

* Agent: Clostridium tetani or tetanus bacillus * Transmission: Via wounds in the skin * Systemic manifestations: Neck or jaw stiffness, facial spasms, prolonged muscle contraction * Skin manifestations: None specific * Treatment: Tetanus immune globulin – respiratory monitoring and ventilation * Nursing: Wound care, monitor respiratory status, hydration

Question 28

Lyme disease

Answer 28

* Agent: Borrelia burgdorferi, a spirochete * Transmission: Tick bite (infected spirochete transmitted when tick draws blood) * Systemic manifestations: Malaise, headache, mild fever, joint aches * Skin manifestations: Red, “bulls-eye” rash around tick bite * Treatment: Antibiotics * Nursing: Discuss prevention of tick bites and proper tick removal – treatment usually occurs at home, rest and completion of antibiotics

Question 29

Malaria

Answer 29

* Agent: Plasmodium (four species exist) * Transmission: Via infected female mosquito bite * Systemic manifestations: Malaise, headache, vomiting, diarrhea, high fever spike every 48 to 72 hours * Skin manifestations: None specific

Question 30

Rabies

Answer 30

* Agent: Rhabdoviridae (two types-one in dogs, one in wildlife) * Transmission: Infected saliva from bite of rabid animal * Systemic manifestations: Long incubation period – headache, fever, malaise, difficulty swallowing (leads to hydrophobia) – untreated, leads to coma and death * Skin manifestations: None specific * Treatment: Human rabies immune globulin for passive immunity – rabies vaccine for active immunity * Nursing: Administration of vaccine and education about side effects

Question 31

Rocky Mountain spotted fever

Answer 31

* Agent: Rickettsia rickettsii * Transmission: Transmitted by infected ticks * Systemic manifestations: May be mild (malaise, fever) to severe (encephalitis, shock) * Skin manifestations: Maculopapular rash (extremities, then trunk) * Treatment: Doxycycline * Nursing: Prevention of tick bites – standard precautions, administer antibiotics, monitor for worsening symptoms

Question 32

you will never get the same what virus

Answer 32

rhinovirus

Question 33

allergies to

Answer 33

eggs, gellantin, neomycn

Question 34

required elements of documented immunizatons

Answer 34

Date of administration Vaccine given Manufacturer, lot number, and expiration date Site and route of administration Name, title, and address of nurse administering vaccine

Question 35

storage

Answer 35

Store frozen vaccines (Varicella, MMRV, and Zoster) in a freezer between -58°F and +5°F (-50°C and -15°C). Store all other routinely recommended vaccines in a refrigerator between 35°F and 46°F (2°C and 8°C). The desired average refrigerator vaccine storage temperature is 40°F (5°C).