Childhood communicable, infectious disease and integumentary conditions Flashcards
Standard precautions
-Barrier protection from blood and body fluids
-Respiratory hygiene/cough etiquette
-Safe injection practices
-Hand hygiene
Transmission-based precautions
-Airborne: small particle or evaporated droplets or dust
-Droplet: large-particle droplets (sneeze, cough, speech, cry)
-Contact: exercise judgment w/ gloves, gowns, masks
Immunizations
-Be familiar w/ schedule (annually updated)
-Be prepared for adverse rxns
-Be aware of contraindications and precautions
-Be aware of allergy/allergic rxn
-Provide safe administration (be mindful of vaccine pulled out of fridge)
-Provide vaccine info and anticipatory guidance to parents and caregivers
-Ensure documentation is complete
Routine immunizations recommendations
-Birth: hepatitis B
-2 months: hepatitis B, Dtap, hib, polio (IPV), PCV13, RV
-4 months: Dtap, hib, IPV, PCV13, RV
-6 months: same as 2 months, influenza
-12-18 months: Dtap, hib, PCV13, MMR, varicella, hepatitis A (6 months apart), influenza
-4-6 y/o: Dtap, IPV, MMR, varicella, influenza
Rxns to immunizations
-Side effects from inactive components –> preservatives
-Vial stoppers w/ synthetic rubber –> prevent latex allergy rxns
-Allergies to eggs problematic
-Inactivated antigens –> rxn few hours or days
-Local vs severe rxns
Contraindications and precautions
-Contraindication –> condition in an individual that increases risk for adverse rxn
-Don’t administer a live virus vaccine to a severely immunocompromised child
-General –> severe febrile illness (high risk for seizure if under 5 y)
-When there is a known allergic response to a prior substance
-Pregnancy may prevent certain immunizations from being administered
-Precaution –> condition in a recipient that might increase risk for adverse rxn or might compromise ability of vaccine to produce immunity
Atraumatic care
-Correct needle length and injection technique
-Correct site (thigh is safest for under 5 y; deltoid when 5 +)
-Techniques to minimize pain –> EMLA
-Use of distraction
-Maintain calm approach
-Proper positioning of child
-Emergency management of anaphylaxis
Suspect communicable disease?
-Type of exposure –> known or community
-Prodromal s/s: evidence of constitutional s/s –> fever or rash; early evidence of disease
-Immunization
-Hx of having disease/comorbidity/risk factors
-Provide comfort, support, document findings: primary prevention –> immunizations, handwashing, reduce transmission
-Prevent complications: care and tx of immunocompromised pts
Managing fever in a child w/ an infectious disease
-Assess temp q4-6h, 30-60 min after antipyretic is given and with any change in condition
-Use same site and device for temp measurement
-Administer antipyretics per physician order when child is experiencing discomfort or cannot keep up w/ the metabolic demands of the fever
-Notify physician of temp (100.5+)
-Assess fluid intake and encourage oral intake or administer IV fluids
-Keep linens and clothing clean and dry
Acetaminophen and ibuprofen
-Toxicity d/t incorrect dosing: misunderstanding label, incorrect measuring or timing of doses, combo meds, alternating acetaminophen and ibuprofen-confusing
-Acetaminophen is drug of choice (10-15 mg/kg/dose/ at least q4h)
-Ibuprofen (4-10 mg/kg/dose/ at least q6-8h)
-No ibuprofen under 6 months of age
Diphtheria
-Agent: corynebacterium diphtheriae
-Transmission: direct contact
-Clinical manifestations: URI-like s/s which progress (bull’s neck, white or gray mucous membranes, fever, cough)
-Tx: abx, bed rest, support
-Precautions: droplet
Tetanus
-Severe illness of CNS caused by bacteria
-NOT contagious but can be prevented by vaccine
-Common s/s: lockjaw (jaw stiffness), stiff of abdominal and back muscles, contraction (tightening) of facial muscles, convulsions, tachy, fever, sweating, painful muscle spasms near wound area, if spasms affect larynx or chest –> inability to breath properly, trouble swallowing
-Complications: vocal cord spasms, broken bones from severe muscle spasms, breathing problems, lung infection (pneumonia), HTN, abnormal heart rhythms, blood clot in lung (pulmonary embolism)
-Tx: vaccine
Chicken pox (varicella)
-Agent: varicella-zoster virus
-Transmission: direct contact and respiratory secretions
-Clinical manifestations: prodromal stage –> slight fever, malaise, pruritic rash begins a macule –> vesicle then erupts, rash is typically centripetal –> extremities, face, tx: supportive
-Precautions: airborne/contact –> remains on contact until lesions are crusted over
-Child is contagious a day before rash appears until vesicles are crusted
-Prevention: 2ndary skin infection and complications
Erythema infectiosum (fifth disease)
-Agent: human parvo 19
-Transmission: droplet or direct contact w/ blood
-Clinical s/s: persistent fever for 3-7 days in child who is otherwise well appearing, “slapped cheek” appearance, mild URI s/s, cough
-Tx: supportive care
-Precautions: standard
Measles (rubeola)
-Agent: virus in paramyxovirus family
-Transmission: direct contact from respiratory system
-Clinical s/s: prodromal state (fever, malaise, coryza, cough, conjunctivitis) “koplick spots” on mucosa, rash appears on day 3-4 of illness
-Tx: abx, bed rest, and support
-Precautions: airborne if in hospital until day 5 of rash
Pertussis (whooping cough)
-Agent: bordetella pertussis
-Transmission: direct contact from droplets (paroxysmal cough, copious nasal and oral secretions, mild fever)
-Clinical s/s: catarrhal stage (URI s/s 1-2 weeks), paroxysmal stage (short, rapid cough bought followed by high-pitched crowning, “whoop” or gasp 4-6 weeks cyanosis may occur during episode
-Tx: prevention, supportive during hospitalization w/ suction, humidity, careful oral feeding, hydration, often abx bc 2ndary pneumonia develops
-Precautions: droplet
Mumps
-Spread: contact and droplet
-Parotitis
-Fever and pain mgmt
-Ice packs
-Hearing loss (rare), meningitis (rare)
-Can cause boys to become sterile
Roseola infantum (sixth’s disease) aka exanthem subitum
-Agent: human herpes virus type 6
-Transmission: “possibly” acquired from saliva of healthy adult person, entry via nasal, buccal, or conjunctiva mucosa
-Clinical s/s: inflamed pharynx, persistent high fever > 39.5 for 3-7 days in a child who otherwise appears well, rash - discrete rose-pink macules or maculopapules 1st appearing on the trunk, then spreading to the neck, face, extremities, nonpruritic, fades on pressure, lasts 1-2 days
-Tx: antipyretics *if prone to seizures discuss possibility of febrile seizures
-Precautions: standard
Rubella (german measles)
-Agent: rubella virus
-Transmission: direct contact from droplets
-Clinical s/s: low-grade fever, headache, malaise, sore throat, RASH
-Tx: supportive care
-Precautions: droplet
Influenza (flu)
-Agent: influenza virus (varies from year to year)
-Transmission: direct contact
-Clinical manifestations: abrupt fever, URI-like s/s which progress, malaise, anorexia
-Tx: prevention, antiviral tx if detected early, supportive care
-Precautions: droplet
Pneumococcal disease
-Agent: streptococcal pneumococci
-Transmission: direct contact affecting children under 2 years most commonly
-Clinical s/s: pneumonia, otitis media, sinusitis, localized infections
-Tx: prevention, abx, supportive care
-Precautions: droplet
COVID-19
-Etiology: severe acute respiratory syndrome coronavirus 2
-Tx: vaccination, hospitalization –> ventilation
Rotavirus
-Causes common s/s like diarrhea and vomiting
-No specific medicine to treat but medicine can alleviate s/s
-s/s usually start 2 days after exposure
-Vomiting and diarrhea can last 3-8 days
-Common s/s: fever, stomach pain
-Tx: vaccination (prevention), monitor for dehydration, isolation (contact precautions)
Nonvaccine communicable disease
-Conjunctivitis
-Nursing mgmt: contact precautions, keep eye clean and dry, administer ophthalmic medications, prevent spread of infection
Conjunctivitis
-Viral: watery drainage, URI
-Bacterial: “pink eye”, crusting, purulent drainage
-Allergic: stringy discharge
-Foreign body: tearing, pain, usually 1 eye
Scarlet fever
-Agent: group A beta-hemolytic streptococci
-Transmission: direct contact from droplets
-Clinical s/s: prodromal (abrupt high fever, halitosis aka bad breath), enanthema (large tonsils, edematous, covered w/ exudate, sandpaper-like pink rash) strawberry tongue
-Tx: penicillin and supportive care
-Precautions: droplet until 24hr of ABX
Stomatitis
-Types: aphthous ulcers, herpetic gingivostomatitis
-Tx: NSAIDs, topical anesthetics
-Prevent spread: oral transmission, hand hygiene
Communicable diseases w/o vaccines
-Zika virus –> no current tx
-Supportive care: rest and hydration, analgesic and antipyretics
-Prevent spread: avoidance of mosquito bites
Intestinal parasites: pinworms
-Helminths (worms)
-Agent: nematode enterobius vermicularis
-Transmission: inhalation or ingestion of eggs from contaminated hands
-Dx: tape test
-Tx: pyrantel pamoate or albendazole x 1, then again in 2 weeks, treat family members, prevention of reoccurrence
Skin infections
-Bacterial
-Viral
-Fungal
Skin infections: bacterial
-Agents: staphylococci and streptococci
-MRSA on rise
-Transmission: invasion and toxicity in susceptible skin (self-inoculation is common)
-Tx: topical or systemic ABX, hand hygiene, dilute bleach baths, may require hospitalizations
-Disorders: impetigo (common), folliculitis, cellulitis, scalded skin syndrome
Skin infections: viral
-Agents: viruses
-Transmission: invasion and toxicity in susceptible skin or oropharyngeal mucosa following contact w/ droplets
-Tx: antiviral meds for HSV, hand hygiene, destruction of warts
-Disorders: verruca (warts), herpes simplex 1 and 2, varicella, molluscum
Skin infections: fungal
-Agents: dermatophytosis, tinea or candida
-Transmission: invasion in susceptible skin, corneum, hair, or nails; may come from infected animals
-Dx: microscopic exam
-Tx: topical or systemic antifungal
-Disorders: tinea capitis (scalp), tinea corporis (body or nails), tinea cruris (groin), tinea pedis (feet), thrush (oral), candidiasis (vaginal, diaper dermatitis)
Skin lesions
-Etiology: contact w/ injurious agents, genetic factors, allergens, systemic disease
-Age can play a role
-Social environment and seasonal variation of environment
-Skin of younger children –> embryologic origins –> preemies
Skin lesions: dx
-Hx and s/s: pruritus, pain or tenderness, tingling
-Objective findings: lesion distribution, size, location, morphology
-Lab studies: biopsy or scraping (cultures), microscopic analysis/cytodiagnosis/patch testing, blood work (CBC and sed rate, specific testing, autoimmune testing), wood light exam, allergy skin test
Skin lesion terminology
-Type: erythema, ecchymoses, petechiae; primary or secondary
-Size
-Morphology: flat, raises
-Distribution pattern: Bilateral or unilateral; Localized or systemic
-Configuration and arrangement: Discrete, clustered, diffuse or confluent
Wounds: types
-Classification: (Acute: health within 2-3 weeks; Chronic: do not heal in expected time frame or complications)
-Types: abrasion –> removal of the superficial layers of the skin by rubbing or scraping, Avulsion –>forcible pulling out or extraction of tissue, Laceration –> torn or jagged wound, accidental cut wound, Incision –> division of skin made with a sharp object, cut, Puncture –> disruption of the skin surface that extends into underlying tissue or body cavity, Penetrating wound –> wound with a relatively small opening compared to the depth
Wounds: healing types
-Primary intention: healing takes place when all layers of the wound margins are neatly approximated, minimal scarring results if the wound heals correctly (ie: as with a surgical incision)
-Secondary intention: wounds that occur from ulceration and lacerations in which the edges cannot be approximated,
more granulation and larger scar are formed (ie: avulsion, third degree burn)
-Tertiary intention: takes place when suturing is delayed after injury or the wound later breaks down and is re-sutured
when granulation is present, there is greater chance microorganisms will invade the wound
Wounds: medical mgmt
-Dressings: traditional or moist –> may require debridement (ie: varies depending on wound)
-Compression: anticipated bleeding or swelling
-Topical therapy: corticosteroids, chemical cautery, cryosurgery, UV light, immunomodulators
-Systemic therapy: corticosteroids, abx
Wounds: types of dressings
-Occlusive = nonpermeable
-Semiocclusive = semipermeable
-Nonocclusive = permeable
-Impregnated
Wounds: nursing mgmt
-Wound care: DO NOT put anything in a wound that you wouldn’t put in the eye!, Normal saline is the safest solution
-Relief of symptoms: NOTE! application of heat tends to aggravate most skin conditions
-Home care and family support: most care delivered at home, provide
appropriate teaching
Factors that influence wound healing
-Understanding of wound healing revolutionized: Shifting of interventions from dry environment –> promote a moist, crust-free environment; Interference of eschar –> wound healing; Process of autolysis –> Repeated application of occlusive dressings mobilizes the body’s own enzymes to lyse the eschar
-Adequate nutrition: Sufficient protein, calories, vitamins C, D & zinc; Supplemental nutrition –> integral part of treatment of severe wounds
Signs of wound infection
-Increased erythema at site, especially beyond margins
-Edema
-Purulent exudate
-Pain at site or beyond margins
-Increased temp
Symptom relief and healing of wounds
-Pruritus: short fingernails or mittens, antipruritics, wet compresses or cleansing solutions
-Pain: distraction, positioning, analgesics
-Improving healing: recombinant growth factor, wound vacuum –> VAC
Contact dermatitis
-Inflammatory reaction to chemical substances (natural or synthetic)
-Peak age is 9-12 m
-Cause: primary irritant –> one that irritates any skin; sensitizing agent –> produces irritation on ppl who have encountered the irritant or something chemically related to it and have undergone immunologic changes and have become sensitized (prior exposure is not necessary)
-Common sources: plant –> poison ivy, oak, sumac (substance is urushiol), animal –> wool, features, furs, metal –> nickel, other: fabrics, dyes, perfumes, soaps
-Limit exposure to offending agent
-Medication symptom relief & to reduce inflammation
Contact dermatitis: mgmt
-Medical: prevent further exposure, symptomatic care
-Nursing: identify offending agent
-Address 3 factors: wetness, pH, fecal irritants, cleanse skin (if urushiol exposure) aka an oil in plants w/ full blown rxn in 2 days; symptomatic tx –> calamine lotion, aveeno baths, corticosteroids
Poison ivy, oak, sumac
-Exposure/contact to offending agent –> urushiol
-Classic lesion presentation: Itching, Localized, Oozing, Painful, Streaked or spotty
-Remove offending agent, Cleansing skin, Prevent secondary infection
Dermatitis
-Most common is pruritus
-Pain or tenderness
-Alterations in local feelings –> anesthesia, hyperesthesia, hypoesthesia/hypesthesia & paresthesia
-Important to determine –> history of allergic condition, asthma, triggers, contact activity & or if other members of the family have similar conditions
Drug rxns of skin
-Skin reactions to medications most common adverse reaction: Due to toxicity, individual tolerance or an allergic reaction
-Can present as localized or systemic effect: Drug eruption - same reactions in susceptible individuals -ie: mild hives
after antibiotics steven johnson syndrome; Fixed eruption - recurrent eruption at the same site with each
administration of the offending drug (ie: lesion, purplish red round or
oval plaque with a sharp border seen frequently on the extremities,
disappears slowly and pigmentation deepens with each episode
Atopic dermatitis
-AKA eczema
-Chronic relapsing skin disorder (results in itching and lesions)
-Infantile: 2-6 m, often resolves at 3 y
-Childhood: 2-3 y
-Preadolescent and adolescent: 12 y+
Atopic dermatitis: mgmt
-Medical: hydrate skin, relieve pruritus, reduce flare-ups, prevent secondary infection
-Nursing: hygiene, symptom relief, prevent itching and infection, family support
Seborrheic dermatitis
-Chronic, recurrent, inflammatory rxn of skin
-s/s: scalp (cradle cap), eyelids (blepharitis), external ear canal (otitis externa), nasolabial folds, inguinal region
-Mgmt: hygiene, supportive care
-Usually grown out of it
Acne
-Caused by testosterone that stimulates sebaceous glands of skin
-Mild, moderate, severe
-Rest, exercise, diet, reduce emotional stress, eliminate foci of infection
-Gentle cleansing (no antibacterial soaps)
-Meds: topical –> tretinoin, benzoyl peroxide, systemic –> minocycline, oral contraceptives, accutane (severe cases)
-Nursing mgmt: assess level of distress, ongoing support and education
Scabies
-Agent: sarcoptes scabiei
-Transmission: prolonged close personal contact where mite burrows into epidermis and deposits eggs (burrows into stratum corneum of epidermis and deposits eggs and feces)
-Multiple dots in line w/ blue center
-s/s: intense pruritus, excoriation and burrows, discrete inflammation between finger webs, neck folds, groin
-Tx: scabicide (older than 2 m, 5% elimite cream or oral ivermectin for those w/ secondary excoriation or unable to tolerate topical), hygiene of linens and clothing w/ high heat, supportive care for pruritus for 2-3 weeks
Pediculosis capitis
-Agent: pediculus humanus capitis (female lays eggs at jxn of hair shaft, nits hatch in 7-10 days)
-s/s: itching to occiput, behind ears, nape of neck
-Dx: observations of nits attached to hair shaft
-Mgmt: pediculicide, removal of nits, permethrin 1% cream –> repeat in a week –> treat affected family
Prevent spread of lice
-Continued inspection
-Isolation of self-care products for the individual
-Machine wash hot water and hot dryer for involved contact products (sheets, pillowcases, blankets)
-Removal of nonwashable items or sealing in plastic bag for at least 14 days
Bedbugs
-Agent: cimex lectularius
-Transmission: contact/sleep in infested mattress –> mite burrows into epidermis to feed on blood
-Not caused from poor hygiene, prevent kids from sharing things
-s/s: intense pruritus, rash, folliculitis/cellulitis, may trigger asthma attack
-Tx: removal, topical steroids, hygiene of linens and clothing, support pruritus 2-3 weeks
Arthropod bites and stings
-Insect and arachnids: mites, ticks, spiders, scorpions, bee stings
-s/s: from malaise and local rxn to anaphylaxis
-Medical mgmt: antipruritics, steroids for expensive bites, antivenin (ex: black widow), remove stinger or tick
-Nursing mgmt: educate on prevention, medical attention bracelet if child has severe allergies
Rickettsial infection
-Transmitted via arthropods
-Ticks, infected fleas, mites
-More common in temperate and tropical climates
-Bite or exposure may occur w/o knowledge to family and child
-Illness ranges from self-limiting to fatal
Lyme disease
-Agent: spirochete borrelia burgdorferi
-Transmission: infected deer tick bite
-Stage 1: bull’s eye, fever, HA, malaise, within 3-30 days erythema migrans
-Stage 2: rash on hands and feet 3-10 weeks after inoculation, fever, fatigue, cough, multiple annular lesions w/o indurated center, fatigue, anorexia, stiff neck
-Step 3: systemic involvement 2-12 m
-Painful swollen joints (most commonly knees), AV conduction abnormalities, meningitis, encephalitis
-Dx: lab immunoassay, western immunoblot testing
-Tx: doxycycline > 8 y, amox > 8 y, alternate cefuroxime or erythromycin for allergies
Lyme disease: nursing mgmt
-Tick removal education (grasp tick firmly w/ tweezers and pull straight out, make sure head is removed), completion of abx
-Use of insect repellent (contain DEET and permethrin)
-Use of permethrin-treated clothing has shown to be effective
-Wash bite area: iodine scrub, rubbing alc, plain soap or water
Rocky mountain spotted fever
-Agent: spirochete rickettsia rickettsii
-Transmission: infected tick bite, rodent, dog
-s/s: fever, malaise, HA, rash on palms or soles of feet
-Tx: tetracycline
Mammal bites and scratches
-Common in boys 5-9 y
-Known family or neighborhood dog vs stray
-Potentially serious d/t puncture wound
-Mgmt: wound care, abx
-Rabies concern
Bites
-Pet: education abt approaching animals, cleansing and medical tx for rabies
-Human: cleansing and medical tx when indicated, tetanus toxoid
-Cat scratch: self limiting –> bacterial, abx
Avoiding animal bites education
-Never provoke a dog with teasing or roughhousing
-Get adult permission before interacting with a dog, cat, or other animal that is not your pet
-Do not bother an eating, sleeping, or nursing dog
-Avoid high-pitched talking or screaming around dogs
-Display a closed fist first for the dog to sniff
-Keep ferrets away from the face
-f a cat hisses or lashes out with the paw, leave it alone
Pet bites
-Dog bites most common
-Tx: rinsing wound w/ saline or LR under pressure via large syringe, abx, tetanus toxoid for rabies
Cat scratch disease
-Agent: bacteria bartonella henselae
-Transmission: scratch from kitten or cat
-s/s: painless nonpruritic papule, regional lymphadenitis
-Tx: usually supportive w/o abx
Sunburn
-Overexposure to UV lights: UVA and UVB
-Mgmt: Stop burning process, decrease inflammation, rehydrate skin, psychosocial support, prevention of sunburn
-Tx: primary excision, wound hygiene, topical antimicrobials, temporary skin substitutes, synthetic dressings, dermal replacements, permanent skin coverings, cultured epithelial grafts
Cold injury
-Rxs to exposure to cold stressors
-Chilblain: redness/swelling, when hands are exposed to 30-60 F, intense vasodilation
-Frostbite: tissue damage when excessive heat loss to local tissues allows ice crystal to form in tissues, appears white or blanched, feels solid and has no sensation
