Unit 37 Pediatric Infectious Disease Flashcards
What are the side effects of “killed” inactivated vaccines and live vaccines?
“killed” inactivated vaccines side effects:
- Local soreness at injection site
- Mild fever
Live vaccine side effects:
-Can obtain mild form of disease that would appear in a week or two, not the day vaccine is given
Overal usually the side effects are MILD
What is VAERS and who can active it?
Vaccine Adverse Event Reporting System
Anyone
What is the epidemiology triangle of disease?
Host
Pathogen
Environment
Why are children more vulnerable to infection? What age is especially at risk?
- Thinner skin
- Immunoglobulin A not at adult levels till age 5
- Sweat glands are immature till age 3 - less able to regulate temp
- Especially under 6 months at risk
What are macules, papules, and vesicles?
Macules - flat red spots
Papules - Raised red spots
Vesicles - blisters
When is septic work-up performed on infants?
- When fever is approx 100.5 in infants less than 6 months of age
- Includes hospital admission and pan-culture including lumbar puncture
How can infections be prevented?
Vaccines creating herd immunity
Handwashing
Sneezing/Coughing Hygiene
Keeping surfaces clean
Less contact with sick kids
What are general interventions for infection?
- Fever management (treat symptoms then fever if discomfort, Ibuprofen cannot be give until 6 months old)
- Avoid Aspirin
- Encourage fluids
- Provide comfort/manage pruritus (itching)
- Keep rashes clean, dry, avoid rubbing (exudate contains the offending organism)
What are ways to manage pruritus?
- Encourage participation in diversional activity
- Apply cool, moist compresses to pruritic areas
- Add emollients, cornstarch, or baking soda to bath water
- Use tepid water and mild soaps for bathing
- If not contraindicated, apply emollient creams or ointments frequently to prevent dryness
- Encourage client to wear loose cotton garments and avoid clothes or blankets made from wool
-Administer antihistamines if ordered:
Diphenhydramine [Benadryl], hydroxyzine [Atarax]
GI illness has mainly what kind of precautions? Respiratory?
Contact - GI
Airborne - Respiratory
Describe the aspects of Chicken pox such as: the agent, source, transmission, incubation period, and if there is a vaccine.
Agent- Varicella zoster VIRUS
Source - Rash?
Transmission - Airborne! (also contact)
Incubation period - 2-3 weeks
There is a live vaccine that is 80% effective
what is the prodromal stage of chickenpox? what is the Infectious stage of chickenpox? during what time frame is it contagious? when is it no longer contagious?
Prodromal stage (before stage): slight fever, malaise (general ill feeling), anorexia
Contagious in first 24 hours
Infection stage:
-Macules progressing to papules to vesicle to crusted over
- When spots are crusted over, no longer contagious
- Pruritus can be intense
What immunoglobulin and antiviral can be given to a child before or with Chicken Pox? What are the complications of chicken pox?
If child is immunosuppressed and been exposed to virus can give [VariZIG] an immunoglobulin recently approved drug that pools antibodies to chicken pox.
-acyclovir(Zovirax) a general antiviral can be given as well
Complications: secondary bacterial infections, encephalitis (infection of brain)
What are the nursing interventions for chicken pox?
- Strict [airborne] isolation and contact precautions when hospitalized
- Isolate child in home until vesicles have dried
Describe Rotavirus. symptoms, care, immunity, and vaccine.
- Serious cause of severe diarrhea in children
- Symptoms: fever, abdominal pain, vomiting, watery diarrhea 3-8 days
Care: Supportive, oral and IV hydration*
Immunity: After infection immunity is incomplete but subsequent bouts are less severe
Live vaccine that ca be given at 1 month old unlike other vaccines
Describe Measles.
- A virus
- One of the most contagious illnesses in humans
- From respiratory tract secretions, and blood urine
Transmission: airborne, direct contact
Live vaccine: When 12-15 months old given in MMR pack (Measles, Mumps, Rubella)
What are the defining characteristics of measles in the prodromal and infectious stages?
-Prodromal stage: fever, malaise, cough, conjunctivitis, KOPLIK SPOTS**
Infection Stage: rash, erythematous rash on face that spreads downward after 3-4 days rash is brownish
-Generalized lymphadenopathy, anorexia
What are Koplik spots?
- White dots in mouth cheek area
- Occurs 2 days before the measles rash
What is the therapeutic management of Measles?What vitamin would you give? What are the complications?
- Vitamin A supplementation to decrease mortality and morbidity
- Hospitalization for infants or any immunocompromised patients with measles
- Supportive care, monitoring, bedrest
- Antipyrectics
Complications: Otitis*, encephalitis (brain infection), pneumonia, obstructive laryngitis
What are nursing interventions for Measles?
- Isolate child until 5th day of rash if hospitalized
- Respiratory airborne precautions**
- Cool mist vaporizer
Describe Mumps.
ParamyxoVIRIS
Source: saliva
Transmission: DROPLET, and contact
Live vaccine given at 12-15 months old as MMR pack.
What are the defining characteristics of Mumps?
Prodromal stage: fever, malaise, headache, anorexia, earache (24hrs before infection stage)
Infection stage: Parotitis (large swollen side of neck, parotid gland enlarged), painful and tender, max size in 1-3 days.
What are the severe complications of Mumps?
- Inflammation of the brain and/or tissue covering the brain and spinal cord. (encephalitis/meningitis)
- Inflammation of testicles (orchitis) that could lead to sterility
- Deafness, usually permanent
- Inflammation of breasts/ovaries
- Spontaneous abortion
What is the therapeutic management of Mumps?
- Analgesics
- Antipyretics
- Watch for complications - encephalitis, hepatitis
What are nursing interventions for Mumps?
- Droplet and contact precautions
- Bedrest
- Encourage fluids and soft bland diet
- Warm or cool compress to the neck
Describe Rubella (german measles).
- rubella VIRUS
- BIG problem for fetus if mother has
Source: nasopharyngeal secretions, blood, stool, urine
Transmission: DROPLET precautions and contact
Live vaccine given at 12-15 months and to women 3 months prior to getting pregnant
What are the defining the characteristics of Rubella?
- Low grade fever
- Headache
- Malaise
- Sore throat, anorexia
- Rash: pink-red maculo-papular first on face then progresses downward, by third day usually gone
What is the therapeutic management for Rubella? What is the biggest complication?
Antipyretics
Supportive care/symptom management
Isolate from pregnant
Complication: danger to fetus
Describe Pertussis (whooping cough). Pathogen? Source? Transmission? Vaccine?
- Bacteria
- Source: Respiratory secretions
Transmission: DROPLET and contact
-NOT a live vaccine; Dtap and TdaP (ok for immunosuppressed patients)
- Given around 2 months to babies
- Women should have it in 3rd trimester
-Boosters ever 5-10 years
Most dangerous < 6 months of age
What are the defining characteristics of Pertussis?
Prodromal stage: URI symptoms, low grade fever
Infection stage: dry hacking cough, continues for 1-2 weeks
What is the therapeutic management of Pertussis?
Antimicrobial therapy (azithromycin)
Supportive therapy: hospitalization for all infants and children who are dehydrated
Bedrest, oxygen, humidity, adequate fluids
What are the nursing interventions for Pertussis?
- Isolate child
- Droplet and contact precautions
- Restful environment
- Encourage fluids in small amounts
- Suction as needed
- Observe for signs of airway obstruction
Describe Streptococcal Pharyngitis. What is the agent? Signs and symptoms? How it is treated?
Agent: Group A Beta hemolytic strep
-Cause by same organism as scarlet fever
- Razor like pain in throat
- Highly contagious
- White spots on tonsils
- Ruby Red oral cavity
- Must be treated with antibiotics to prevent immune response - antibodies can attack own tissue (heart valves, kidneys, joints)
- After 24 hrs can go back to school, etc.
Describe Scarlet Fever. Agent? source? transmission? treated how?
Agent: Group A Beta hemolytic strep
Source: Naso-pharyngeal secretions
Transmission: Droplet and contact
- antibodies can attack own tissue (heart valves, kidneys, joints)
- Treated with antibiotics (penicillin)
What are the defining characteristics of Scarlet Fever?
- Strawberry tongue and rash! (picture tongue like strawberry with little bumps)
- Rash appears ~12 hrs after fever: pin head red lesions
- Abrupt fever, possibly vomiting
- Headache, chills, abdominal pain
- Tonsils enlarged, reddened
What are the nursing interventions and therapeutic management for both Scarlet Fever and Streptococcal Pharyngitis? Complications?
Droplet precautions for first 24 hrs
Administer oral antibiotic therapy (Penicillin)
Contagious until antibiotic given for 24 hrs
Relieve throat discomfort
Bedrest during febrile phase
Fluids during febrile period
Complications: glomerulonephritis, carditis, otitis media, peri-tonsilar abscess
Describe Infectious Mononucleosis (“Mono”) including characteristics.
Agent: Epstein-Barr Virus
Source: Oropharyngeal secretions
Stand precautions only
Incubation period of 1-2 months
No vaccine
Characteristics: Malaise, sore throat, fever *splenomegaly, *fatigue, generalized lymphadenopathy
-Symptoms persist for 10 days - 6 weeks
What are the nursing interventions and the therapeutic management of Mononucleosis?
- Provide supportive care/comfort measures
- Possible short use of penicillin
- Analgesics
- Rest and injury prevention** (for enlarged spleen)
- Teach about adequate rest, injury prevention, and activity modification
Describe Bacterial meningitis. When are vaccines recommended?
-Infection of membranes surrounding brain and spinal cord
- Pneumococcal and HIB vaccines are recommended routinely starting infancy
- Meningococcal vaccine is recommended routinely with one dose at adolescence
What are the defining characteristics of bacterial meningitis and the complications?
- Fever, chills, headache, vomiting
- Seizures, irritability, photophobia
- Nuchal rigidity (Pain or resistance when bending neck)
- Possible altered LOC
- Petechial pupular rash (bad sign that’s basically sepsis)
- Joint pain
In infants - 2 years: Poor feeding, high pitched cry, seizures, fever, bulging fontanel
Complications: seizures, deafness, paralysis, sepsis
What is the therapeutic management of Bacterial meningitis?
- Droplet/contact precautions for at least 24 hrs
- Prompt initiation of anti-microbial therapy AFTER lumbar puncture (after cultures)
- Maintain hydration
- Control seizures
- Control temp
- Early management of sepsis shock
What are the nursing interventions for Bacterial meningitis?
- Administer fluids and IV antibiotics
- Droplet precautions
- Dim lights for (photophobia), quiet environment
- Analgesics for pain
- Antipyretics
- Perform neurological assessment and sepsis signs
- I and O’s
Describe Yeast infection and Tinea (ringworm) infection. Both funguses.
Yeast:
- prevent with probiotics/acidophilus (good bacteria)
- if thrush develops (oral candidias) use nystatin/mycostatin “swish and swallow”
- Vaginal use the “azoles”
- Infants use the “azoles”
Tinea (ringworm):
- Contagious
- Keep area dry clean
- DON’T share clothes, towels, bed lines
- Use topicals or flucanozole
For what disease/virus would you give vitamin A supplementation too?
Measles
How is meningitis Dx’d?
lumbar puncture
