Infectious disease Flashcards
The Psychological and Social Determinants of Vaccine Hesitancy
(confidence, complacency, convenience)
Religious views
Misinformation
Education
Perceived risk of disease
Side effects of vaccine
Geographic barriers
Personal/familial experience with vaccination
Disgust government and of healthcare system
Political views
Cost (free for children)
Historical context of discrimination
Review vaccine administration techniques including age, site, and parent involvement.
Infants and toddlers best held in parent’s arms—make sure the parent or HCP is HOLDING all the child’s limbs
Always be sure to verify and document
Older children best held in parents’ lap
Explain what is happening but also move confidently!
For older children distraction and calming techniques are helpful
Be prepared for vaso-vagal responses (from children and parents)
Ensure that you are comfortable and practicing proper technique—DO NOT PUT THE NEEDLE THROUGH YOUR HAND!
–Get the needling in, get the medicine/vaccine in, pull the needle out, SAFETY NEEDLE!!!!
Identify injection site based on age and appropriate landmark
younger than 12months?
older than 12 months?
adolescents?
Younger than 12 months- Vastas Lateralis (anterolateral thigh)
Older than 12 months- Vastas Lateralis (anterolateral thigh) or IF WALKING preferably Deltoid muscle
Adolescents-Deltoid muscle
Review common adverse effects with vaccine administration mild
Redness
Swelling
Pain
Fever Defined as (>100.4F)
Mild to Moderate Reaction of reactions
Treatment?
Medications for children less than 6 months and older than 6 months?
Soreness
Redness
Itching
Swelling
Treatment: Cool, damp cloth to help reduce redness, soreness, and/or swelling at the injection site.
Children < 6months: Acetaminophen (tylenol)
Children > 6mo Ibuprofen (Motrin).
Severe Anaphylaxis Reactions:
Hoarseness,
wheezing,
airway constriction,
difficulty breathing,
pale or mottled skin,
hypotension,
altered mental status,
fever,
redness,
rash.
Treatment: call 911, administer cardiopulmonary resuscitation (CPR), provide epinephrine or equivalent (e.g., EpiPen), immediate transfer to hospital
Differentiate between contraindication and precaution to vaccination.
-Precautions
Moderate or severe acute illness with or without fever
-Contraindications
–Severe allergic reaction (i.e., anaphylaxis)
–Severe immunodeficiency (CD4 < 200)
–Live vaccines and pregnancy
Identify age-appropriate immunizations (Birth, 12 months, 4-6 years, 11-12 years).
Birth: Hepatitis B
12 months:
Hepatitis A
Varicella
MMR
4-6 years:
DTaP
Inactivated poliovirus (IPV)
Varicella
MMR
11- 12 years
Tdap
HPV
Meningococcal
Identify vaccine-preventable diseases.
Pertussis?
Epiglottis?
Measles -MMR (Measles, Mumps, Rubella)
Varicella (Rubeola) -Varicella vaccine
Pertussis -DTap or Tdap
Influenza -Influenza vaccine
Pneumonia -Pneumoccal (PCV vaccine)
Rotavirus -Rotavirus vaccine
Epiglottis- Haemophilus Influenzae B (Hib)
Respiratory Syncytial Virus- RSV vaccine
Identify live vaccines and populations who should not receive live vaccines.
MMR
Varicella
Intranasal influenza
Rotavirus
Severe immunodeficiency and pregnancy
Measles
Agent:
Transmission:
Isolation:
Prevention:
Agent: Paramyxovirus
Transmission: Nasopharynx droplets
Isolation Precautions: Airborne
Prevention: MMR vaccine
(2-dose series beginning at 12-15 months of age. Second dose at 4-6 years of age)
Measles Clinical Features
3 C’S?
Other prodrome symptoms? 2
rash emerges when and persists for how long?
begins where and goes where?
Prodrome
-3 “Cs” - cough, coryza, and conjunctivitis
(Coryza - inflammation and congestion of mucous membranes in the nose)
-Fever (103°F-105°F)
-Koplik spots (blue-white spots) on buccal mucosa in the mouth
Rash
-Emerges 14 days after exposure and persists 5-6 days
-Begins at hairline, then involves face and upper neck
-Progresses downward and outward to hands and feet
People At High Risk For Severe Illness and complications from Measles?
-Infants and children younger than 5 years
-Adults older than 20 years
-Pregnant women
-People with compromised immune systems (e.g., leukemia, HIV infection)
Measles Complications
mostcommon cause of death from measles?
Otitis media
Diarrhea and related dehydration
Pneumonia
Encephalitis
Most common cause of death is from respiratory and/or neurological complications
Measles management
maintain what?
administer what vitamin?
assess what?
- Maintain strict I and O
- Administer Vitamin A - supports the immune system- decreases complications and mortality
- Assess neuro signs
- Assess lungs sounds
- Encourage fluids- intravenous fluids if needed
- Acetaminophen or ibuprofen for fever.
- Antibiotics for secondary infections (pneumonia, otitis media)
Varicella (Chickenpox)
Agent:
Transmission:
Isolation:
Prevention:
a. Agent: varicella-zoster virus
b. Transmission: Direct contact, droplet secretions
c. Precautions: Contact and Airborne
d. Prevention: Varicella vaccine
Symptoms of varicella
prodromal stage?
contagious when?
- Prodromal stage— fever, malaise
- Pruritic rash begins a macule vesicle then erupts
Contagious a day before rash appears and until vesicles are crusted
treatment of varicella
Supportive, prevent skin infections
varicella complications
Secondary bacterial infection of skin lesions
Pneumonia
Central nervous system manifestations
ꟷ Meningitis
ꟷ Encephalitis
ꟷ Seizures
Erythema Infectiosum (Fifth disease)
agent
transmission
Isolation
Agent: Parvovirus B19
Transmission: Respiratory secretions
Precautions: Contact/Droplet
–Avoid exposure to pregnant mothers
symptoms of fifth disease
-Persistent fever for 3-7 days
“Slapped Cheek” appearance
-Mild URI symptoms, cough
Pertussis (whooping cough)
agent
transmission/precaution
prevention
Agent: Bordetella pertussis
Transmission/Precautions: Droplet
Prevention (Vaccines: DTaP, Tdap)
symptoms of pertussis
Upper respiratory infection symptoms 1-2 weeks
Paroxysmal, short, rapid cough followed by high-pitched “whoop” or gasp. Cyanosis may occur
treatment of pertussis
Supportive during hospitalization with oxygen, rest, hydration, careful feedings, and antibiotics
complications of pertussis
respiratory distress
Scarlet fever
agent:
transmission/precaution:
Agent: Group A Beta-hemolytic streptococci
Transmission/Precautions: Droplets
scarlet fever complications
Acute rheumatic fever - heart, brain, joints
Acute glomerulonephritis
Pneumonia
scarlet fever symtoms
5
Abrupt high fever,
halitosis (bad breath)
Tonsils large, edematous, covered with exudate
“Strawberry tongue”
Sandpaper-like pink rash to body
Treatment of scarlet fever
medication?
Penicillin (if allergic Azithromycin) and supportive care
Lyme disease
agent
transmission
Agent: Spirochete Borrelia burgdorferi
Transmission: Infected deer tick
clinical manifestations of lyme disease
Fever
Headache
Rash (Erythema migrans)
Malaise
Lymphadenopathy
Diagnosis of lyme disease
Complications of Lyme disease
treatment of Lyme disease
history and serologic testing
Carditis
Arthritis
Doxycycline >8 yrs
Amoxicillin < 8 yrs
Rocky Mountain Spotted Fever.
Agent:
transmission:
Agent: Spirochete Rickettsia rickettsii
Transmission: Infected tick bite
Clinical manifestations of rocky mountain spotted fever
Fever, malaise
Severe headache
Petechial rash on palms, soles of feet
treatment of rocky mountain
IV Doxycylcine 1st line therapy
Infectious Mononucleosis
agent
transmission/precautions
Agent: Epstein Barr Virus or “EBV” (90% of cases)
Transmission/Precautions: Oral secretions; shed for >6 months after acute infection and then intermittently throughout life
Clinical manifestations of mono
Look for “Triad”
Fatigue, pharyngitis, generalized
lymphadenopathy Splenomegaly (~50%)
treatment of mono
Rest and symptomatic therapy
Avoid contact sports and strenuous activities for 4 weeks or while splenomegaly is present
Transmission-Based Precaution
Airborne
Droplet
Contact
Airborne
Small particle
Negative pressure isolation room
Droplet
Large-particle droplets (sneeze, cough, speech, cry)
Contact
Gloves and gowns
