Week 2 Chapter 37 Flashcards
Types of Infectious Diseases
Bacterial
Viral
Zoonotic and Vector Borne
Parasitic and helminthic
STIs
Infectious process
Organism Enters and multiplies
Causes damage to tissues and cells
Body response -1. Vascular -2. Cellular
1st line of defense and phagocytic cells
Granulocytes
Neutrophils including
Bands, segs, and PMNs
Eosinophils, basophils
Produce and maintain immune response, respond to viral infections
Lymphocytes
Produce antibodies and bind to neutralize antigen
B Cell
T Cell
Attack antigen directly
NK cells (innate immunity)
Destroy foreign material
Second line of defense and responds to larger and more severe infections
Monocytes
Infection stimulates the release of the endogenous pyrogens
Fever
(interleukins, tumor necrosis factor, and interferon)
Pyrogens act on the hypothalamus and trigger prostaglandin production, which increases the body set of temperature
True
Vasoconstriction is response
Cold
Vasodilation is heat response
Decrease heat loss and allow the body’s temperature ….
Rise to the new set point resulting in fever
General Guidelines of fever
Any temperature above 38.1 C
Infants younger than 3 months >38C < 36C SEE DOCTOR!!!
How many times do you asses temperature?
Every 4-6 hours
Use same site and device
Assess I and Os
Keep linens and clothing clean and dry
Acetaminophen recommended dose
10-15 mg/ kg
Every 4-6 hours
Ibuprofen 5-10 mg/ kg dose
Every 6-8 hours
No more than 4 doses in 24 hour period
Stages of Infectious Diseases
Incubation - Entrance
Prodrome- Nonspecific symptoms
Illness- S/S of disease
Convalescence - Acute symptoms begin to disappear
Methods of Preventing Infectious Disease
Hand Washing
Adequate Immunizations
Proper Handling of food
Judicious Antibiotic
Chain of Infection
Infectious Agent
Reservoir
Portal of Exit
Mode of Transmission
Portal of Entry
Susceptible Host
Limiting Spread of Infections
Standard - Tier 1
Transmission based- Tier 2
Airborne
Droplet
Contact
Pediatric physiology and Immune System
More susceptible of infection
Newborns display decreased inflammatory response to invading organisms, contributing increased risk for infection
Infant limited exposure and loses passive immunity=Higher risk of infection
Cellular immunity is generally functional at birth
True
Humoral occurs when body encounters and then develops immunity to new disease
Disease protection from immunization is incomplete
Common Treatments and Medications for Infectious Disorders
Tx
Hydration and Fever Reduction
Medications
Antibiotics
Antivirals
Antipyretics
Antipruritic
What information is obtained in health Hx?
Past medical Hx, birth hx, family hx, previous illness or surgery
Hx of current illness
S/S
Any changes in usual behaviors
Any known exposure
Assessments made during a physical exam include
Inspection and observation
Skin, mouth, throat, and hair lesions or wounds
Hydration status and vital signs
Palpation
Skin
rash
lymph nodes
Common Labs for Infections
CBC
ESR
CRP
Blood Culture Sensitivity
Stool Culture
Urine Culture
Wound Culture
Throat Culture
Nasal Swabs
LP
Chest X Ray
Sepsis
Systemic overresponse to infection from bacteria and viruses and can lead to septic shock
Septic Shock can lead to
Hypotension, low blood flow, and multisystem organ failure
Most common causative agents
- E Coli, Group Strep, Staph A, Nessieria Meningitiidis
Infants less than 1 month of age, immunocompromised children, children with chronic condition, and children with an indwelling catheter are at a higher risk
True
Therapeutic Management of Sepsis
Admitted for close monitoring
IV antibiotics started immediately (after cultures obtained)
Lab and Diagnostic Tests for Sepsis
CBC Count: WBC Usually elevated
C Reactive Protein: Elevated
Blood Culture: Positive in Septicemia
Urine Culture: May be positive
CSF Analysis: May reveal increased WBCs and protein and low glucose
Stool Culture: May be positive for bacteria or other infectious organisms
Culture of tubes, catheters, or shunts suspected to be infected
Chest Radiograph: May reveal signs of pneumonia
Bacterial Infections
Children are at high risk of developing bacterial infections, which can result in life threatening illness
Community Acquired MRSA
Scarlet Fever
Diphtheria
Pertussis
Tetanus
Pertussis
Tetanus
Botulism
Osteomyelitis
Septic Arthritis
Minor skin rashes to abscesses to serious, life- threatening infections
- Sepsis, necrotizing pneumonia, osteomyelitis
CAMRSA
Direct person to person contact, resp. droplets, blood or sharing personal items (hairbrushes, towels, sports equipment)
CAMRSA
Best Barriers for CAMRSA
Intact Skin and mucous membranes
Proper hand hygiene
Diagnosis of CAMRSA
Through culture
I & D, aspiration, culture
Tx with antibiotics
Group A streptococci
Throat Infection (strep)
Scarlet Fever
Streptococcal skin infection (rare)
Bacteria produces a toxin that causes a rash
5-15 years of age, rare in children less than 3
Scarlet Fever
S/S of Scarlet Fever
Fever >101, chills, body aches, loss of appetite, N/V, sore throat, strawberry tongue, sandpaper rash
Complications: Rheumatic Fever, glomerulonephritis
Therapeutic management of Scarlet Fever
PCN, erythromycin
Hydration, comfort measures (cool mist humidifier, popsicles, soup)
Diphtheria Nursing Management
Administration of antibiotics and antitoxin
Droplet Precautions
Corynebacterium diphtheriae bacteria in airway
Diphtheria
S/S of Diphtheria
Nasal discharge, sore throat, weakness, fever, headache, bluish skin, swollen neck “Barking “ cough. Painful swallowing and difficulty breathing.
Prevention of Diphtheria
DtaP vaccine injections plus TdaP adult booster
Complications of Diphtheria
Airway blockage, pneumonia, heart damage, nerve damage, paralysis, death.
Epidemiology of Diphtheria
Spread via direct contact or through the air
Bacteria produce diphtheria toxin which prevents normal cell function
outbreaks are rare but still occur among unvaccinated populations
6-7 avg. number of people are infected person will infect while contagious
5-20 % rate of fatality depending on age
50% rate of fatality prior to vaccine and modern medication
Pertussis
Whooping cough. Bordetella Pertussis bacteria in upper respiratory.
Symptoms Pertussis
Low fever
Runny nose
Mild Cough
Apnea
Coughing fits ending in a “whoop” vomiting exhaustion
Prevention of Pertussis
DTaP vaccine injections plus Tdap adult booster
Complications of Pertussis
Earache, pneumonia, encephalopathy, seizures, cerebral hypoxia, fractured ribs, failure to thrive, death.
Therapeutic Management Pertussis
Infants< 1 month
-azithromycin
Infants> 1 month
- erythromycin
- clarithromycin
- azithromycin
Nursing management
- High humidity
- Suctioning
- Observe for airway obstruction
- Encourage fluids
- Droplet Precautions
Epidemiology
Spread via coughing, sneezing, and other close contact
Tetanus
Lockjaw cause clostridium tetani bacteria and its toxin
Symptoms of Tetanus
Muscle Spasms in jaw, face, throat, chest, neck, back, abdomen, buttocks, fever, trouble swallowing, rapid heart rate, incontinence
Prevention of tetanus
DTaP vaccine or tetanus toxoid vaccine
Complications of Tetanus
Prolonged muscle contractions and tears , fractures, suffocation, heart attack, death.
Epidemiology of Tetanus
Bacteria in soil enter flesh via a wound from contaminated object
Therapeutic Management of Tetanus
Support Respiratory and CV function
Stopping toxin production
Neutralizing unbound toxins
Controlling muscle spasms
Administer tetanus immunoglobulin and tetanus vaccine
IV antibiotics
- Standard precautions
Toxin is produced in the immature intestines of young children resulting from infection of Clostridium Botulinum
Botulism
Rare but can cause serious paralytic illness of arms, legs, trunk, and respiratory system if left untreated
Botulism
Infant botulism is the most common in the United States and result from the ingestion of bacterial spores in environmental dust/ soil
Botulism
S/ S of Botulism
Infants- constipation, poor feeding, listlessness, generalized weakness, weak cry
Older Children- Double blurred vision, drooping eyelids, difficulty swallowing, slurred speech, muscle weakness
Therapeutic Management of Botulism
Supportive- maintaining respiratory and nutritional status
- Administration of botulinum immune globulin or botulism antitoxin
Bacterial infection of the bone and soft tissue
Osteomyelitis
S. Aureus most common, MRSA on the rise
Spread through the blood
S/S Osteomyelitis
Irritability, lethargy, fever, onset of pain, refusal to walk, decreased ROM, swelling, warmth and tenderness to affected bone.
Therapeutic Management of Osteomyelitis
Therapeutic management
Aspiration is necessary to confirm diagnosis and identify microbes
4-6 week course of antibiotics
Pain assessment and management
Condition in which bacteria invade the joint space, most often the hip or knee
Septic Arthritis
Usually occurs in children younger than 3 years old
Bacteria gain access to the joint through the bloodstream or direct puncture from injections, venipuncture, wound infection, surgery or injury
S. Aureus is the most common
Septic Arthritis
When is Septic Arthritis considered a medical emergency?
Destruction of the joint cartilage can occur within a few days
S/S Septic Arthritis
Ill- appearing, fever, pain, refusal to bear weight or straighten the affected extremity, joint swelling and warmth
Complications of Septic Arthritis
Permanent deformity, leg length discrepancy, long term decreased ROM
Therapeutic Management
- Pain management
-IV antibiotics
- PT, crutch teaching
Viral Infections Occurring in Children
Viral Exanthems- characteristic rashes found in certain viral illnesses
Rubella (German)
Rubeola ( measles, has Koplik spots)
Varcella Zoster
Parvovirus B19 (slapped cheek or 5th disease)
Roseola Infantum ( exanthem subitum or sixth disease)
German measles caused by virus
Rubella Virus
S/S Rubella
Low fever
rash
swollen glands
joint pains
headache
Prevention with MMR Vaccine and injection
Complications of Rubella
Congenital rubella syndrome in fetus
Blindness, deafness, heart disease, intellectual disability, death
Spread via coughing, sneezing, and other close contact
Epidemiology
Typically mild and short of duration
Measles
Grows in cells that line lungs and back of throat
Spread via coughing, sneezing, and other close contact
Prevention with routine MMR vaccine
Complications of Measles
Pneumonia bronchitis
Deafness
Brain inflammation ( Encephalitis)
Corneal Ulceration ( Blindness )
Death
- Leading cause of vaccine preventable deaths worldwide
Rash appears on the hairline and spreads cephalocaudally over 3 days
Kolpik spots on oral mucosa
Conjunctivitis cough
coryza
Fever
Rubeola Ordinary Measles
Headache
Low grade fever
Sore throat
Coryza
Lymphadenopathy
Rash begins on face and spreads cephalocaudally
Forehammer spots on soft palate
Rubella German Measles
Varicella
Cause varicella zoster virus in nerve fibers
Symptoms of Varicella
Rash
Burning pain
itchy blisters
high fever
tiredness
loss of appetite
headache
Prevent with varicella vaccine at 12 months and 4 years
Complications of Varicella
Dehydration
Permanent scarring
Pneumonia
Brain inflammation
Skin bone, joint and infections
Death
Spread via coughing, sneezing, and physical contact and highly contagious
Varicella
Remains in nervous system and likely to lead to shingles outbreaks later in life
5th Disease Rash
Erythema infectious is sometimes called “ slapped cheek disease”
2-3 distinct phases
- Bright red rash occurs on the side of the face and sometimes on the forehead and chin. Gone in 5 days.
- Then appears on the neck, trunk, forearms, upper legs, and buttocks. Rash starts as round red spots and begins to take on lacy look. Itchy and older children.
- Body rash fades. It may come back if the person is out in the sun, gets too warm, or is under stress. 1-3 weeks. Even though a rash comes back does not illness is worse.
Virus that grows in parotid glands
Mumps
Prevention MMR Vaccine at 12 months and 4 years
Symptoms and Complications of Mumps
Low fever
Headache
Malaise
Dry mouth
Swollen salivary
Sore face
Earache
Complications
Testicular Swelling
Meningitis Encephalitis
Pancreatitis
Hearing loss
Death ( rare in US)
Many childhood diseases both viral and bacterial can be prevented with adequate
Immunization
Many vaccinations require multiple doses
True
Immunizations can prevent
DTP
MMR
Varicella
Poliomyelitis
Others
Diseases caused by infectious agents that are transmitted directly or indirectly from animals or vectors, such as ticks, mosquitos, or other insect vectors to humans
Zoonotic and Vector Borne Infections
Types of Zoonotic and Vector Borne Infections
Rabies
- 4 doses rabies vaccine, rabies immune globulin
Cat Scratch Disease- Cats carry bacteria in their saliva
- Lymphadenopathy- antibiotics
Lyme Disease- Bite from deer tick
- Less than 8 years amoxicillin
- More than 8 years doxycycline
Rocky Mountain Spotted Fever- dog and wood tick
Teaching guidelines for Tick Removal
Use fine tipped tweezers
Protect fingers with tissues, paper towel, or latex
Grasp as close to skin as possible and pull upward with steady, even pressure
Do not twist and jerk
Once removed, clean site with soap and water and wash your hands
Save the tick for identification in case the child becomes sick. Note date of tock bite
Parasitic and Helminthic Infections
Parasitic Infections
- Pediculosis capitis- Pediculicide
- Pediculosis pubis
Scabies- Peremetherin
Heleminthic
Pinworm- anal itching- mebendazole
Hookworm- Cats and dogs; albendazole
Acariasis- Unsanitary conditions; mebendazole
Key Teaching Points for a Child with an Infectious Disease
Assess child’s and family willingness to learn
Provide time for family to adjust
Repeat information
Teach in short sessions
Gear teaching to level of understanding to child
Provide rewards and reinforcement
Use multiple modes of learning involving many cases
