Week 4: Caring for the Child and their Family with Communicable Diseases and Resp Dysfunction Flashcards
describe communicable diseases
- incidence has declined with introduction of vaccines
- complications decreased with use of antibiotics and antitoxins
Protest, despair and detachment causes children to have troubles forming relationships true or false
false
what do u do if parents don’t want their child vaccinated
- show benefits
- science
- validate feelings
- talk it out
- give them validated resources
when does a kid get diptheria, tetanus, pertussis, polio, haemophilu influenzae
2, 4, 6, 18 mos, 4 yrs
when do kids get pneumococcal vaccine
2, 4, 12 mos
when do kids get rotavirus vaccine
2, 4 mos
when do kids get MMR (measles, mumps, rubella) vaccine
12 mos, 4 yrs
when do kids get varicella vaccine
15 mos, 4 yrs
when do kids get meningococcal vaccine
12 mos, grade 7
when do kids get HPV (human papillomavirus) vaccine
grade 7
when do kids get Hep B vaccine
grade 7
Varicella (zoster virus)
- causes chicken pox
- acute, highly contagious: airborne and contact
- occurs in kids under 15 yrs
- virus remains latent in dorsal root ganglia
- reactivation causes Herpes Zoster Infection (shingles)
how to manage varicella (zoster virus)
-antihistamines
-calamine lotion
-pain management
-not itching
how to treat varicella (zoster virus)
-antiviral (acyl beer)
-Vzig also given especially if they have cancer
S/S of varicella
-fever
-tired
-then legions
why is varicella so contagious
-airborne isolation
-skin care is big piece
-contagious before rash starts
-contagious 1-2 days before rash
-not contagious when all legions crusted over
education for varicella
-watch for infection
-worsening
-vaccinate 12-15 months
-again 4-6 years
erythema infectiosum (5th disease)
- caused by human parvovirus B19
- prodromal phase symptoms are mild: low grade fever, headache, symptoms of URTI
- macular rash spreads quickly to trunk and proximal extremities
- centre of macule fades which gives rash a lacy appearance
- resolves spontaneously in 1-3 wks
- rash subsides but reappears if skin irritated or traumatized by heat, cold, friction, etc
initial description of erythema infectiosum (5th disease)*
rash is like a “slapped face” appearance
roseola
- caused by human herpes virus type 6
- incubation: 5-15 days
- after fever subsides, rash appears
- rash first on trunk and neck, then spreads to face, arms, and legs
- duration 3-6 days
how does roseola appear**
persistent high fever (39-41 C) for 3 or 4 days; otherwise appears well
parent education for roseola
-SUPPORTIVE MANAGEMENT
-SYMPTOMS
-WATCH IF SYMPTOMS GET WORSe
erythema infectiosum (5th disease) education
-Tylenol
-make them feel comfortable
mumps
- caused by paramyxovirus
- transmitted via respiratory droplets or direct contact or fomites
- incubation time of 16-18 days
- fever, headache, malaise, neck pain, painful chewing followed by salivary gland swelling within 48 hrs
- parotitis - unilateral or bilateral that may last up to 10 days
- complications may cause orchitis, pancreatitis, deafness, and meningoencephalitis
INFLAMMATION OF THE CAROTID GLANDS
rubeola (measles)
- caused by rubeola virus
- outbreaks occur mostly in unimmunized or immunocompromised children
- transmitted thru airborne resp droplets or by direct contact w contaminated articles
- incubation time of 6-21 days
- prodrome: 2-4 days phase characterized by fever, malaise, anorexia, conjunctivitis, and cough
- koplik spots appear 2 days before rash
- during acute phase of illness, appearance of a red, blotchy, flat rash begins on face and spreads to trunk and extremities
can see in mucous look deeply in mouth
rubella
(german measles)
- caused by rubella virus
- transmitted by direct or indirect contact w article freshly contaminated w nasopharyngeal secretions, blood, stool, or urine
- incubation period is 14-21 days
- period of communicability is few days b4 onset of rash until 7 days after appearance of rash
- rash 1st appears on face then spreads to neck, trunk, and legs
- complications: are rare, greatest danger is intrauterine death, spontaneous abortion
hand, foot, and mouth disease
- caused by coxsackie viruses
- s/s: fever, sore throat, smell greyish blisters in mouth lasting 4-6 days. blisters can appear on palms, fingers, and soles for 7-10 days
- transmission: contact/droplet
- incubation: 3-6 days from date of contact
- period of communicability: 1st week of illness
- enterovirus family
- NO VACCINE!
pertussis (whooping cough)
- caused by Bordetella pertussis
- transmission is through inhalation of contaminated respiratory droplets or direct contact (i.e. soiled bed linen)
- incubation: 7-10 days
- period of communicability is greatest after catarrhal stage and the 1st 2 weeks after cough onset
- begins w more benign symptoms
- short, rapid coughs followed by crowing or “whoop” sound; symptoms of choking/gasping for air
complications: pneumonia (usual cause of death) - treated w erythromycin
- can’t go home till 5 days no intervention
- under 2 months is most vulnerable
nursing considerations for whooping cough
- use droplet precautions for suspected and documented cases
- closely monitor cardioresp function and o2 sat. maintain patent airway; keep suctioning equipment available
- create quiet environment; will decrease coughing stim
- offer small amount of fluid frequently
- report to PHU
- may treat close contacts of infected child prophylactically (if not immunized)
scarlet fever
- agent: group A hemolytic streptococci
- transmission: droplet or direct contact
- incubation: 1-7 days
- period of communicability: during incubation period and clinical illness, approx 10 days; during 1st 2 weeks of carrier phase, although may persist for months
- treatment: Abx and supportive therapy
- penicillin
mononucleosis (mono)
- agent: epstein barr virus (EBV)
- s/s: fatigue, fever, sore throat, swollen lymph glands, fatigue, enlarged liver and spleen, jaundice
- transmission: droplet
- incubation: usually 4-6 weeks
- period of communicability: when symptomatic, up to a yr following
- treatment: supportive
-teenage this population target
-admitted for dehydration
host resistance
ability of the host to hinder or arrest growth/development of the pathogen
- immunity: natural, acquired, active, passive, carrier, maternal antibiotics
- nutrition
- physical and mental health
- intact skin and mucus membranes
- functioning immune system
- age
- size
- hygiene
- comorbidities
what effects the immune system
-what effects the immune system:
-steroids
-chemo
-sleep
-stress
-certain meds
-age like younger cant be immunized for things
-size of airways
-comorbidities: Asthma, CF, Prematurity (didn’t get third tri mother antibodies), friable skin
seasonal variations
- most common during winter and spring
- mycoplasmal infections more common in fall and winter
- asthmatic bronchitis more frequent in cold weather
- RSV season considered winter and spring
clinical manifestations of respiratory infections
What tells you your child/patient is unwell:
-coughing
-trouble breathing
-resp tract sounds
-fever
-mucus
-increased resp rate
-dehydration
-increased work to breath
-Cyanosis/hypoxia black people gray or ash colour not blue
-Gi symptoms
Severity of illness:
-when interventions where started
-current health status
-spo2 lower, resp rate
-already have comorbidities Asthma, CF
-is there actually air entering the lungs…
nursing care management in resp illnesses
- ease resp effort
- promote rest and comfort
- prevent spread of infection
- reduce temp
- promote hydration and nutrition
- family support and home
-Hydration very important !!!
-Need Cals to get better
-most resp illness don’t go to hospital
-but if need resp therapy, what they cant get at home
upper rest tract infections
- nasopharyngitis: “common cold”
- pharyngitis - 80-90% viral
- tonsilitis
- otitis media
- COVID-19
Bacterial pharyngitis super concerning can cause rheumatic fever
otitis media (OM)
Common children 6mo-3 yrs
Children have short euchastian tubes
Pharmacological treatments:
-Antibiotics
-surgical if recurrent otitis media
Don’t want water in ears
Keep earplugs in
Bad for ear infection:
-Bottle propping (make sure when sitting up when feeding from bottle)
-Breast feeding
-smoking
COVID-19
- severe acute respiratory syndrome coronavirus 2
- incubation: as long as 14 days; most occuring 4-5 days after exposure
- pneumonia most frequent serious manifestation of infection
- fever, cough, dyspnea, URT symptoms, diarrhea, loss of senses of smell and taste
s/s of Covid-19
- fever and cough
- SOB, myalgia, rhinorrhea, headache, abdominal pain, diarrhea, sore throat, fatigue, and loss of smell or taste
lab findings in Covid-19
often normal
may include leukopenia, elevated C-reactive protein
manifestations of croup
inspiratory stridor
suprasternal retractions
barking or “seal like” cough; worse at night
increasing resp distress and hypoxia
can progress to respiratory acidosis (inability to exhale carbon dioxide), resp failure, and death
croup
self limiting upper airway obstructive disease: usually from viral infection. preceded by URI to laryngitis that descends to trachea, causing inflammation and narrowing of airway
characterized by hoarseness, “barking” cough, inspiratory stridor, and varying degrees of resp distress
inflammation of larynx, and subglottic airway
Usually not admitted unless severe
BARKING or seal like COUGH
common in toddlers
Get worse when laying down
treatment of croup
vaporizers, oral fluids, antipyretics
therapeutic management of croup
- airway management
- maintain hydration, orally, or intravenously
- high humidity w cool mist
- medication treatment?
most important:
- continuous observation
- accurate assessment
infections of lower airways
- considered the “reactive” portion of the lower respiratory tract
- includes bronchi and bronchioles
- cartilaginous support not fully development until adolescence
- constriction of airways
bronchitis
- AKA tracheobronchitis
- inflammation of the large airways characterized by: cough, with or without sputum production, self limiting - resolves in 1-3 weeks
- causative agents: viruses - such as rhinovirus, coronavirus, influenza, and RSV
what is the #1 leading cause of bronchiolitis
RSV
bronchiolitis pathophysiology
- virus invades mucosal cells lining bronchi and bronchioles
- causes cells to die
- results in cell debris clogging and obstructing bronchioles and irritates the airways
- airway swells and produces excessive mucous resulting in airway obstruction bronchospasm
- process continues and both lungs are invaded
- obstructed airways allow air in, but edematous airways and mucous buildup don’t allow for expulsion of air
- wheezes and crackles develop
RSV bronchiolitis in infants and young children
- present w LRTI
- apnea can be presenting symptom
DON’T KISS BABieS
Babies cant blow their nose so we need to clean it out for them with suction
RSV bronchiolitis in older children
- secondary infections typically have URT symptoms
- may develop LRTI (especially in immunocompromised)
RSV bronchiolitis diagnostic evaluation
- CXR - show inflammation
- aspiration of nasal secretion or nasopharyngeal washings may indicate RSV
therapeutic management for RSV bronchiolitis
supportive management
what is pneumonia
acute inflammation or infection of respiratory bronchioles, alveolar ducts, and sacs, and alveoli of the lungs that impair gas exchange
etiology of pneumonias
bacterial, viral, mycoplasmal, aspiration of foreign substance, histomycosis, coccidioidomycosis, other fungi
aspiration pneumonia
- risk for child with feeding difficulties
- prevention of aspiration
- feeding techniques, positioning
- avoid aspiration risks: hydrocarbons, lipids, solvents, talcum powder
asthma
- chronic inflammatory disorder of airways
- bronchial hyperresponsiveness
- episodic
- limited airflow or obstruction that reverses spontaneously or w treatment
cystic fibrosis
- exocrine gland dysfunction that produces multisystem involvement
- most common lethal genetic illness among white children
- autosomal recessive trait; located on chromosome 7q
- inherits defective gene from both parents with an overall incidence of 1:4
respiratory manifestations of CF
- present in almost all CF pts, but onset/extent is variable
- stagnation of mucus and bacterial colonization result in destruction of lung tissue
- tenacious secretions are difficult to expectorate - obstruct bronchi/bronchioles
- decreased O2/CO2 exchange
- results in hypoxia, hypercapnia, acidosis
- compression of pulmonary blood vessels and progressive lung dysfunction lead to pulmonary hypertension, cor pulmonale, respiratory failure, and death
GI tract CF manifestations
- thick secretions block ducts, cystic dilation, degeneration, diffuse fibrosis
- prevent pancreatic enzymes from reaching duodenum
- impaired digestion/absorption of fat, steatorrhea, impaired digestion/absorption of protein
- endocrine function of pancreas initially stays unchanged
- eventually pancreatic fibrosis occurs
- may result in diabetes mellitus
- focal biliary obstruction results in multilobular biliary cirrhosis
- impaired salivation
presentation of CF
- wheezing respiration, dry nonproductive cough
- generalized obstructive emphysema
- patchy atelectasis
- cyanosis
- clubbing of fingers and toes
- repeated bronchitis and pneumonia
- meconium ileus
- distal intestinal obstruction syndrome
- excretion of undigested food in stool; increased bulk, frothy, and foul
- prolapse of the rectum
- delayed puberty in females
- sterility in males
- parents report children taste “salty”
- dehydration
- hypoalbuminemia
Nursing management of CF
- nursing care dependent on where they are in child’s disease process
- prevent/minimize pulmonary complications: IV antibiotics, CPTx, puffers, aerosol treatment
- adequate nutrition for growth
- assist in adapting to chronic illness
prognosis of CF
- median age of survival is 61 yrs (for those born between 2019 and 2023)
- maximize health potential: nutrition, prevention/early aggressive treatment of infection, pulmonary hygiene
- hope for the future: gene therapy, bilateral lung transplants, improved pharmacologic agent-Trikafta
Difficulty breathing and barking cough
croup
what is the most common cause of illness in the infant and child
acute infection of the resp tract
8 year old dry cough worse at night following a 2 day URTI
bronchitis
Child with asthma we hear what in lungs
wheezes
Steatorrhea is sign of what
CF
Steatorrhea
Fatty stool you see mucus
bronchitis vs bronchiolitis
OLDER kids GET BRONCHITIS, Only baby get bronchiolitis
