[Exam 4] Chapter 37 – Infectious or Communicable Disorder Flashcards
What do Phagocytic cells do?
First line of defense upon invasion of bacteria
Function of Lymphocytes?
Main source of producing an immune response, responds to viral infections
Function of Monocytes?
SEcond line of defense, and responds to larger and more severe infections
Infectious Process: What does the cellular response involve?
Arrivial of WBCs to the are.
Infectious Process: WBCs use phagocytosis for what?
Ingesting and destroying pathogen.
Infectious Process: What happens if bacteria escapes phagocytosis?
Enters blood stream and immune system activated.
Infectious Process: What to B / T cells do?
B: Produce antibodies
T: Attack the antigen directly.
They both will rememebr teh antigen.
Infectious Process, Fever: Infection by bacteria triggers endogenous pyrogens, what does what?
Trigger prostaglandin production and increases bodies temp set point. Results in shiver, that allows body temp to rise.
Infectious Process, Fever: What is used to decrease fevers?
Antipyretics to lower fever and increase comfort. Temp lower by inhibiting production of prostaglandin. Sweating results.
Infectious Process, Fever: When does hyperthermia occur?
When norml thermoregulation fails, with unregulated rise in core temp. CNS impaired here.
Infectious Process, Fever: Bodi produces a natural antipyretic, called what
Cryogen. Without this, body will rise above 105.8
Infectious Process, Chain of Infection: Poor hygiene habits include
lack of handwashing, placing toys in mouth, drooling, and leaking diapers
Infectious Process, Chain of Infection: What is incubation?
Time from entrance of pathogen into the body to appearance of first symptoms
Infectious Process, Chain of Infection: What is Prodrome?
Time of onset of nonspecific symptoms such as fever, fatigue
Infectious Process, Chain of Infection: What is Convalescence?
Time when acute symptoms of illness disappear
Infectious Process, Chain of Infection: What is a reservoir?
Place where pathogens can thrive and reproduce, such as human body or animals
Infectious Process, Chain of Infection: What is portal of exit?
Way for pathogen to exit the reservoir, such as skin or mucous membranes
Infectious Process, Chain of Infection: what is mode of transmission?
Direct transmission, such as body to body or indirect, such as through droplets
Infectious Process, Chain of Infection: Tier 1 for Hospital Infection Control?
Stand precautions, which is made for all children regardless of conditions
Infectious Process, Chain of Infection: Tier 2 for Hospital Infection Control?
Transmision based precautions, designed for children who are known or suspected to be infected.
Infectious Process, Health Hx: When eliciting history of present illness, inquire about what?
Exposure to infection
Immunization hx
Fever
Sore Throat
Lethargy
Vomiting
Infectious Process, Health Hx: Why would hydration be used?
Child who is vomiting or has diarrhea. They can replace these losses
Infectious Process, Health Hx: Why would fever reduction eb done?
Feibrile child who can’t keep up with increased metabolic demands
Infectious Process, Health Hx: Examples of Antipyretics?
Acetaminophen and Ibuprofen
Infectious Process, Inspection/Observation: Lethargy can indicate what?
Serious infection or sepsis.
Infectious Process, Inspection/Observation: How to assess hydration status?
Inspect oral mucosa, dry and pale mucous membranes, and observe for sunken eyes
Infectious Process, Palpation: Palpation of what shows dehydration
Tugor, and if the fontanels are sunken.
Infectious Process, Labs: Where should blood draws be done?
Area other that child’s bed, such as treatment room. Bed should be kept as an “Safe” area.
Infectious Process, Labs: What does C-Reactive Protein (CRP) test for?
Measures for type of protein produced in livere present during acute inflammation
Infectious Process, Labs: Why is stool culture done?
To determine if bacteria or parasite has infected the intestines
Infectious Process, Labs: Usual sites for obtaining blood ?
Superficial veins of the dorsal surface of the hand or the antecubital fossa. Jugular/Femoral vein may also be used.
Infectious Process, Labs: What to know for fingerprint puncture?
Directed to the sides of the fingertop. Great toe puncture done the same way.
Infectious Process, Managing Fever: Fears of fever can lead to mismanagement of fever, including?
Inappropriate dosing of antipyretics, awakening at night to give pyretics, or inappropriate use of nonpharmacologic treatment
Infectious Process, Managing Fever: Infants younger than 3 months with rectal temperature greater than 38 degrees C should be seen why?
Considered at risk for sepsis until proven otherwise, due to immature immune system
Infectious Process, Managing Fever: Major benefit of decreasing fever is what?
Increasing comfort in child and decreasing fluid requirements.
Infectious Process, Managing Fever: Why should you never give Aspirin to child?
Due to risk of Reye Syndrome
Infectious Process, Managing Fever: Causes of acetaminophen toxicity include?
Overdosing or incorrect dosing due to failure to understand label.
Infectious Process, Managing Fever: Why may there be an issue with alternating Ibuprofen/Acetaminophen?
Parents forget which medication is given every 4 hour, and which one is given every 6 hours.
Infectious Process, Managing Skin Rashes: What can relieve itching?
Cool compresses or cool baths
Sepsis: What is this?
Systemic overresponse to infection resulting from bacteria and viruses.
Sepsis: This leads to septic shock, which causes what?
Hypotension, low blood flow, and multisystem organ failure.
Sepsis: What causes this in younger and older children?
Younger <3 Months: E. Coli. Group B Strep, S. Aureus. Herpes
Older: N Meningitidis, S. Pneumoniae, S. Aureus
Sepsis: Who’s at risk for this
Infants < 3 months, immunocompromised children, and children with indwelling vascular catheter
Sepsis - Patho: How does this occur?
Results from floating toxins, mediated by cytokine release. Causes overproduction of proinflammatory cytokines
Sepsis - Patho: What results from excessive cytokine release?
Impaired pulmonary, hepatic, or renal function
Sepsis - Therapeutic Mx: How are infants treated?
In hospital. Admitted for close monitoring with antibiotic therapy. IV Antibiotics started immediately after blood, urine, and CSF.
Sepsis - Therapeutic Mx: How long is treatment done for?
When negative results occur. Usually after 72 hours. If not responding to treatment, sepsis may be progressing to shock.
Sepsis - Health Hx: Common signs and symptoms?
Child may not lok like
Crying more than usual
FEver
Lethargic
Poor feeding
Rash
Difficulty breathing
Seizures
Sepsis - Health Hx: Risk factors to look at?
Prematurity, lack of immunizations, immunocompromise
Sepsis - Health Hx: In young infants, pregnancy and labor risk factors to look at include?
Premature rupture of membranes
Difficult delivery
Maternal infection
Sepsis - Health Hx: Sepsis may occur in hospitalized child, with risk factors including what?
Intensive care unit stay
Presence of central line
Sepsis - Physical Exam, Inspection/Observation: How will they appear?
Lethargic, pale, and show signs of dehydration
Sepsis - Physical Exam, Inspection/Observation: What to notice in infants?
Quality of their cry and reaction to parental stimulation, noting weak cry or lack of smile.
Sepsis - Physical Exam, Inspection/Observation: Petechiae may indicate what?
Serious bacterial infection,
Sepsis - Physical Exam, Inspection/Observation: How does this affect respiratory?
May demonstrate tachypnea and increased work of breathing, such as nasal flaring and retractions
Sepsis - Physical Exam, Inspection/Observation: What to document for VS?
Elevation in temperature or hypothermia
Hypoptension, along with poor perfusion, cna be worsening sign of sepsis.
Sepsis - Labs: What labs will be done
CBC (WBC decreased in severe case)
C-REative Protein (Elevated)
Blood culture (Septicemia positive)
Urine culture
CSF ( reveal wbc and protein)
Stool Culture
Culture of catheters
Chest X-Ray, may reveal pneumonia
Sepsis - Nursing Mx, Preventing Infection: What is the best way to prevent infection?
Handwashing. and ensuring that all equipment is clean and disposing of soiled linens.
Sepsis - Nursing Mx, Educating Family: When should they contact provider?
When the infant or neonate has a fever. Especially when lethargy, poor responsiveness or lack of facial expressions occurs.
Scarlet Fever: What is this?
Infection from Group A Streptococci. Usually from Throat infection (strep throat) or skin infection
Scarlet Fever: Bacteria here produces what type of response?
Toxin that causes a rash. .
Scarlet Fever: Who will develop scarlet fever?
Those who are infected with streptococci that produce pyrogenic exotoxins that do not have antitoxin antibodies
Scarlet Fever: What age does this affect?
Those are 5-12 years old, and rare in children younger than 2
Scarlet Fever: Transmission?
Through droplets and follows contact with respiratory tract secretions]
Typically seen in schools and child care centers
Scarlet Fever: What to know about food-borne?
Occur due to contamination of food. Incubation period is 2-5 days. No longer contagious after 24 hours.
Scarlet Fever: Complications of this?
rheumatic fever, glomerulonephritis, skin infections, abscess of throat, pneumonia and arthritis.
Scarlet Fever, Nursing Assessment: Health hx would reveal what?
Fever greater than 101, body aches, loss of appetite, nausea and vomiting.
Scarlet Fever, Nursing Assessment: How will pharynx and tonsils appear?
Pharyn: Very red and swollen
Tonsils: Yellow or white specks of pus, and lymph nodes may be swollen
Scarlet Fever, Nursing Assessment: Inspect skin for most striking symptom of scarlet fever, which is?
Erythematous rash appearing on the face, trunk, and extremities. Absent from soles and feet. Looks like sunburn but feels like sandpaper.
Scarlet Fever, Nursing Assessment: How long does rash last?
5 days, following by desquamation (peeling) on toes and fingers
Scarlet Fever, Nursing Assessment: Appearance of tongue?
Will have a strawberry appearance. Later loses coating and becomes bright red
Scarlet Fever, Nursing Assessment: How is diagnosis made?
Identification of Group A Strep through throat culture. Important secretions obtained are pharyngeal or tonsillar
Scarlet Fever, Nursing Mx: Cared for how and with what treatment?
At home with antibiotics, mostly Penicillin V.
Scarlet Fever, Nursing Mx: What is used in severe cases?
Erythromycin.
Pertussis: What is this?
Acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions
Pertussis: What age sees this the most?
Those younger than 1 year, and those younger than 3 months are at greatest risk
Pertussis: What organism causes this
Bordetella Pertussis
Pertussis: Incubation period?
Usually starts with 7-10 days of cold symtpoms.
Pertussis: How long to recover?
Cough can last 1-4 weeks and then recovery takes weeks to months
Pertussis: Compliations of this?
Hypoxia, Apnea, Pneumonia, SEizures, Encephalopathy, Death
Pertussis, Therapeutic Mx: What does this focus on?
Eradicating bacterial infection and providing respiratory support
Pertussis, Therapeutic Mx: Treatment for this?
Antimicrobial treatment. >1 month = Macrolide drugs like erythromycin and azithromycin
< 1 month , azithromycin only.
Pertussis, Therapeutic Mx: What cardio problems can azithromycin cause?
Potentially fatal heart rhythm for those at risk for cardiovascular events
Pertussis, Nursing Assess: Most important risk factor?
Lack of immunization.
Pertussis, Nursing Assess: History may reveal what symptpoms?
Cold and cough symptoms, progressing to paroxysmal coughing spells. Might cough 10-30 times in a row, followed by whooping sound.
Pertussis, Nursing Assess: How will they appear during cough spells?
Redness in face, progressive cyanosis, and protrusion of tongue.
Pertussis, Nursing Assess: How is this diagnosed?
Clinical history. Culture is gold standard.
Pertussis, Nursing Mx: This focuses on what/
Providing high-humidity environment and frequent suctioning to mobilize secretions. Maintain adequate hydration and droplet precautions.
Osteomyelitis: What is this?
Bacterial infection of the bone and soft tissue surrounding the bone.
Osteomyelitis: Most common infecting organisms?
S. Aureus and MRSA.
Osteomyelitis: How is this acquired?
Through the blood. Triggers inflamamtory response and formation of pus and edema. Small vessels thrombose and infection extends into marrow cavity. Blood supply disrupted and death of bone tissue.
Osteomyelitis - Therapeutic Mx: How to confirm this?
Aspiration
Osteomyelitis - Therapeutic Mx: Treatment?
4-6 week course of anti-biotics. 1-2 weeks of IV antibiotics and then oral antibiotics for rest of time.
Osteomyelitis - Therapeutic Mx: Complications of this?
Bone destruction, fracture.
Recurrent infection, septic arthritis, and systemic infection
Osteomyelitis - Nursing Assess: Risk factors for this?
Impetigo, infected varicella lesions, and recent trauma or infected burns.
Osteomyelitis - Nursing Assess: What signs may they be displaying?
Irritability, lethargy, possible fever, and onset of pain. Refuses to walk or has decreased range of motion.
Osteomyelitis - Nursing Assess: Lab testing for this will reveal what?
WBC elevated
Positive Blood Culture
Deep soft tissue swelling
Changes on Ultrasound
Osteomyelitis, Nursing Mx: Nursing management focuses on what?
Assessment, pain management, and mainttenance of IV access for administration of antibodies
Osteomyelitis, Nursing Mx: How active should child be?
Should be on bedrest to prevent injury.
Rubella (German Measles): Transmission here?
By direct or indirect contact with droplets, primarily bby nasopharyngeal secretions.
Rubella (German Measles): What season does this occur
Late winter to early spring
Rubella (German Measles): Incubation period?
12-23 days
Rubella (German Measles): Communicable when?
7 days before to 7 days after the rash
Rubella (German Measles): Clinical Manifestation of this?
Rash is first sign. BEgins on face and spreads head to foot. Disappears in same order it spread, usually by third day. May appear pinpoint
Rubella (German Measles): Clinical manifestations in older children?
Lymphadenopathy (enlarged lymph nodes) 24 hours before onset of rash, lasting up to one-week with low grade fever.
Rubella (German Measles): Complications?
Encephalitis (inflammation of the brain)
Thrombocytopenia (low platelet count)
Rubella (German Measles): Maternal rubella during pregnancy can cause what?
miscarriage, fetal death, or congenital malformations
Rubella (German Measles): Nursing implications here?
Comfort measures ike antipyretics and antipruritics, and analgesics for joint pain
Rubeola (Measles): Tranmission here?
Direct or indirect contact with droplets, primarily by nasopharyngeal secretions. Highly contagious
Rubeola (Measles): What season does this occur most often
winter to spring
Rubeola (Measles): Incubation period?
10-12 days
Rubeola (Measles): When is this communicable?
1-2 days before onset of symtpoms (3-5 days before onset of rash) until 4-6 days after rash has appeared
Rubeola (Measles): First stage here?
Prodromal phase. 2-4 days consisting of fever, cough, coryza and conjnunctivitis
Rubeola (Measles): What occurs in the second stage?
Koplik spots (bright red spots with blue white centers on mucuous membranes)
Erythematous maculopapular rash after 3-4 days after prodromal phase. Head to toe fashion.
Rubeola (Measles): Treatment?
Supporitive, including antipyretics, bed rest, and fluid intake
Rubeola (Measles): What would kids 6 months to 2 years take?
Possible Vit. A
Rubeola (Measles): Complications of this?
Diarrhea, otitis media, and pneumonia
Rubeola (Measles): Comfort measures?
Antipyretics and antipruiritics
Clean eyes with warm cloth
Cool mist to relieve cough
Rubeola (Measles): What precautions need to be taken?
Air-borne until 4 days after onset of rash
Varicella Zoster (Chickenpox): Tranmission?
Direct contact with infected person, nasopharyngeal secretions or via air-borne spread.
Varicella Zoster (Chickenpox): Communicable when?
1-2 days before onset of rash until all vesicle crusted over (3-7 days after onset of rash)
Varicella Zoster (Chickenpox): Symptoms present before onset of rash?
24-48 hours before. Fever, malaise, anorexia, headache, and mild abdominal pain.
Varicella Zoster (Chickenpox): What are the main signs ?
Lesions appear ons calp, face, trunk adn then extremities. Vesicles eventually erupt and lesions scab and crust.
Varicella Zoster (Chickenpox): Supporitve treamtent for this?
feveer reduction, antipruiritics, and skin care to prevent infections of lesions
Varicella Zoster (Chickenpox): Tx?
Antiviral therapy and varicella zoster immune globulin may be used for those considered high risk.
Varicella Zoster (Chickenpox): Complications of this?
Bacterial superinfection of skin lesions, thrombocytopenia, arthritis, hepatitis, and pneumonia
Varicella Zoster (Chickenpox): What happens if you get this later in life?
Herpes Zoster (Shingles)
Varicella Zoster (Chickenpox): Comfort measures?
Antipyretics and antipruritics
Varicella Zoster (Chickenpox): Precautions here?
Airborne and contact for minimum of 5 days after onset of rash adn as long as lesions present
Varicella Zoster (Chickenpox): What should you do if you come into exposure with someone with this?
Airborne and contact precautions for 8-21 das after exposure
Varicella Zoster (Chickenpox): When can child return to school?
Once lesions have crusted
