Pediatric Nursing: Immune Problems and Infectious Diseases

Question 1

HIV and AIDS

Answer 1

• AIDS is a disorder caused by HIV and characterized by generalized dysfunction of the immune system.
• HIV infects CD4+T cells; a gradual decrease occurs and this results in a progressive immunodeficiency; the risk for opportunistic infections is present.
• transmitted through blood, semen, vaginal secretions, and breast milk; the incubation period is months to years.
• the most common opportunistic infection that occurs in children is Pneumocystis jiroveci pneumonia; most frequently occurs between the ages of 3 and 6 months.
  Common assessment finding in children:
• chronic cough, chronic or recurrent diarrhea, developmental delay or regression of developmental milestones, failure to thrive, hepatosplenomegaly, lymphadenopathy, malaise and fatigue, night sweats, oral candidiasis, parotitis, weight loss.
  Caregiver important instructions:
• monitor the child’s weight and provide a high-calorie and high-protein diet (adm appetite stimulants as needed).
• keep the child home when sick and immunizations up to date.
• clean up any of the child’s body fluid spills with a bleach solution (10:1)

Question 2

Immunizations and HIV

Answer 2

If a child has symptomatic HIV infection or has severe immunosuppresion:

• only the inactivated influenza vaccine that is given IM should be used (yearly).
• measles vaccine should NOT be given; immunoglobulin may be prescribed after measles exposure.
• only the inactivated polio vaccine that is given IM should be used.
• rotavirus vaccine should NOT be given.
• varicella-zoster virus vaccine should NOT be given; the immunoglobulin may be prescribed after chickenpox exposure.
• tetanus immunoglobulin may be prescribed for tetanus-prone wounds.

Question 3

Rubeola (Measles)

“Sarampo”

Answer 3

• agent: Paramyxovirus
• incubation period: 10-20 days
• communicable period: from 4 days before to 5 days after rash appears, mainly during the prodromal stage.
• source: respiratory tract secretions, blood, or urine of infected person.
• transmission: airbone particles or direct contact with infectious droplets; transplacental.
• assessment: fever, malaise, the 3”C”s (coryza, cough, conjunctivitis), rash appears as red erythematous maculopapular eruption starting on the face and spreading downward to the feet; blanches easily with pressure and gradually turns a brownish color (lasts 6-7 days); may be desquamation. Koplik’s spots (small red spots with a bluish white center and a red base, located on the bucal mucosa and lasts 3 days).
• interventions: use airborne, droplet, and contact precautions, restrict child to quite activities and bed rest, use a cool mist vaporizer for cough and coryza, dim lights if photophobia is present, adm antipyretics for fever and vit A supplementation as prescribed.

Question 4

Roseola (Exanthema Subitum)

Answer 4

• agent: human herpesvirus type 6
• incubation period: 5-15 days
• communicable period: unknown, but though to extend from the febrile stage to the time the rash first appears.
• source: unknown
• transmission: unknown
• assessment: sudden high fever (>38.8C [>102F]) of 3-5 days’ duration in a child that appears well, followed by a rash (rose-pink macules that blanch with pressure); febrile seizures may occur. Rash appears several hours to 2 days after the fever subsides and lasts 1-2 days.
• interventions: supportive

Question 5

Rubella (German Measles)

Answer 5

• agent: rubella virus
• incubation period: 14-21 days
• communicable period: from 7 days before to about 5 days after rash appears.
• source: nasopharyngeal secretions, blood, stool, and urine.
• transmission: airborne or direct contact with infectious droplets; indirectly via articles freshly contaminated with nasopharyngeal secretions, feces, or urine; transplacental.
• assessment: low-grade fever, malaise, pinkish red maculopapular rash that begins on the face and spreads to the entire body within 1-3 days, petechiae (red, pinpoint spots) may occur on the soft palate.
• interventions: use airborne, droplet, and contact precautions; provide supportive treatment. Isolate child from pregnant women.

Question 6

Mumps (caxumba)

Answer 6

• agent: paramyxovirus
• incubation period: 14-21 days
• communicable period: immediately before and after parotid gland swelling begins.
• source: saliva of infected person and possibly urine.
• transmission: direct contact or droplet spread from an infected person.
• assessment: fever, headache, malaise, anorexia, jaw or ear pain aggravated by chewing, followed by parotid glandular swelling. Orchitis or oophoritis may occur, deafness and aseptic meningitis may occur.
• interventions: institute airborne, droplet, and contact precautions, provide bed rest (until swelling subsides), avoid foods that require chewing, apply hot or cold compresses as prescribed to the neck, apply warmth and local support with snugfitting underpants to relieve orchitis. Monitor for signs of aseptic meningitis.

Question 7

Chickenpox (Varicella)

Answer 7

• agent: varicella-zoster (VCZ) virus
• incubation period: 13-17 days
• communicable period: from 1-2 days before the onset of the rash to 6 days after the first crop os vesicles, when crusts have formed.
• source: respiratory tract secretions and skin lesions.
• transmission: direct contact, airborne, droplet spread, and contaminated objects.
• assessment: slight fever, malaise, and anorexia are followed by a macular rash that first appears on the trunk and scalp and moves to the face and extremities. Lesions become pustules, begin to dry, and develop a crust. Lesions may appear on the mucous membranes of the mouth, genital, and rectal area.
• interventions: ensure strict isolation (contact and droplet). Antiviral agent may be used in susceptible immunocompromised persons. The use of immunoglobulin is recommended for children who are immunocompromised and have no previous history of varicella. Provide supportive care.

Question 8

Pertussis (whooping cough)

Answer 8

• agent: Bordetella pertussis
• incubation period: 5-21 days (usually 10 days)
• communicable period: greatest during the catarrhal stage.
• source: discharge from the respiratory tract
• transmission: direct contact or droplet spread from infected person; indirect contact with freshly contaminated articles.
• assessment: symptoms of respiratory infection followed by increased severity of cough, with a loud whooping inspiration. May experience cyanosis, respiratory distress, and tongue protusion.
• interventions: institute airborne, droplet, and contact precautions. Adm antimicrobial therapy, reduce environmental factors that cause coughing spasms (dust, smoke), provide suction and humidified oxygen, monitor CP status.
• infants do not receive maternal immunity to pertussis.

Question 9

Diphtheria

Answer 9

• agent: corynebacterium diphtheriae
• incubation period: 2-5 days
• communicable period: variable, until virulent bacilli are no longer present (3 negative cultures of discharge); usually 2 weeks, but can be 4 weeks.
• source: discharge from the mucous membrane of the nose and nasopharynx, skin, and other lesions.
• transmission: direct contact with the infected person, carrier, or contaminated articles.
• assessment: low-grade fever, malaise, sore throat, foul-smelling mucopurulent nasal discharge, dense pseudomembrane formation in the throat tha may interfere with eating, drinking, and breathing. Lymphadenitis, neck edema, “bull neck”.
• interventions: strict isolation, adm ATB and antitoxin as prescribed, provide bed rest, suction, and humidified oxygen.

Question 10

Poliomyelitis

Answer 10

• agent: enteroviruses
• incubation period: 7-14 days
• communicable period: unknown; the virus is present in the throat and feces shortly after infection and persists for about 1 week in the throat and 4-6 weeks in the feces.
• source: oropharyngeal secretions and feces.
• transmission: direct contact; fecal-oral and oropharyngeal routes.
• assessment: fever, malaise, anorexia, nausea, headache, sore throat, abd pain followed by soreness and stiffness of the trunk, neck, and limbs that may progress to CNS paralysis.
• interventions: enteric and contact precautions, supportive treatment, bed rest, monitoring for respiratory paralysis, physical therapy.

Question 11

Scarlet Fever

Answer 11

• agent: group A B-hemolytic streptococci
• incubation period: 1-7days
• communicable period: about 10 days during the incubation period and clinical illness; during the first 2 weeks of the carrier stage, although may persist for months.
• source: nasopharyngeal secretions of infected person and carriers.
• transmission: direct contact with infected person or droplet spread; indirectly by contact with contaminated articles, ingestion of contaminated milk, or other foods.
• assessment: abrupt fever, flushed cheeks, vomiting, headache, enlarged lymph nodes in the neck, malaise, abd pain. A red, fine sandpaper-like rash develops in the axilla, groin, and neck that spreads to cover the entire body except face. Rash bleaches with pressure; pink or red lines of petechiae are noted in areas of deep creases and folds of the joints (Pastia’s sign). Desquamation, sheet-like sloughing of the skin on palms and soles, appears by weeks 1-3. The tongue is initially coated with a white, furry covering with red projecting papillae; by the third to fifth day, the white coat sloughs off, leaving a red swollen tongue. Tonsils are reddened, edematous, and covered with exudate, pharynx is edematous and beefy red.
• interventions: contact, airborne and droplet precautions until 24h after ATB, provide supportive therapy, bed rest, and encourage fluid intake.

Question 12

Erythema Infectiosum (Fifth Disease)

Answer 12

• agent: human parvovirus B19
• incubation period: 4-14 days; may be 20
• communicable period: uncertain but before the onset of symptoms in most children.
• source: infected person
• transmission: unknown; possibly respiratory, secretions and blood.
• assessment: before rash is asymptomatic or mild fever, malaise, headache, runny nose. Erythema of the face develops and disappears by 1-4 days. About 1 day after the rash appears on the face, maculopapular red spots appear, symmetrically distributed on the extremities; the rash progresses from proximal to distal surfaces and may last a week or more. The rash subsides but may reappear if the skin becomes irritated by the sun, heat, cold, exercise, or friction.
• interventions: child is not usually hospitalized. Pregnant women should avoid the infected individual. Provide supportive care, adm antipyretics, analgesics, and antiinflammatory meds as prescribed.

Question 13

Infectious Mononucleosis

Answer 13

• agent: epstein-barr virus
• incubation period:4-6 weeks
• communicable period: unknown
• source: oral secretions
• transmission: direct intimate contact
• assessment: fever, malaise, headache, fatigue, nausea, abd pain, sore throat, enlarged red tonsils, lymphadenopathy and hepatosplenomegaly, discrete macular rash most prominent over the trunk may occur.
• interventions: provide supportive care, monitor for signs of splenic rupture.

Question 14

Rocky Mountain Spotted Fever

Answer 14

• agent: Rickettsia rickettsii
• incubation period: 2-14 days
• source: tick from a mammal
• transmission: bite of infected tick
• assessment: fever, malaise, anorexia, vomiting, headache, myalgia, maculopapular or petechial rash primarily on the extremities (ankles and wrists), but may spread to other areas, characteristically on the palms and soles.
• interventions: provide vigorous supportive care, adm ATB as prescribed.

Question 15

Influenza

Answer 15

• various strains
• affects the respiratory system and is highly contagious.
• children, pregnant women, people with existing condition or immuno-compromised are at high risk for developing complications.
• caused by contact with a infected person or by touching infected articles.
• flu vaccine is the best prevention.
• keep child from school and away from others until after a 24h fever-free period.
• assessment: suddenly high fever, headache, body aches, fatigue, chills, cough, congestion, sore throat, loss of appetite, vomiting, diarrhea.
• interventions: antiviral meds, fluids, rest, and pain relievers as prescribed.