Transcript Communicable Diseases

Communicable
Diseases
Rubella, Rubeola, Roseola,
Fifth’s Disease, Chicken Pox, Scarlet Fever, Mononucleosis
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Review terminology r/t communicable
diseases:
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Incubation period
Prodromal symptoms
Period of communicability
Types of Isolation: contact, respiratory
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Immunizations can prevent many of these
diseases—primary prevention strategy
Careful handwashing to prevent transmission
in essential for healthcare practitioners and
for families
Infection Control: pp. 1019-1020 & Box 27-3
Early identification of symptoms so that
treatment can be initiated is also paramount
to a good outcome.
Prevention
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If a child is admitted to the hospital with an
UNDIAGNOSED EXANTHEMA, strict isolation is
instituted until a diagnosis is confirmed.
These are a few communicable diseases that require isolation:
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diphtheria
chickenpox
Measles, mumps, rubella
tuberculosis
adenovirus
Haemophilus influenzae type B
influenza
meningitis
Mycoplasma pneumonia, pseudomonas aeroginosa pneumonia
pertussis
RSV
streptococcal pharyngitis, scarlet fever
Clostridium difficile, e.coli, shigella
pneumonia / pneumonic plague /
 (AAP, Committee on Infectious Diseases, 2003)
 Reportable Communicable Dz list for Cook County
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Any immunocompromised children—those
receiving steroid or immunosuppressive
therapy, are always at risk for viremia,
especially from viruses like herpes zoster.
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Children with sickle cell anemia may develop
aplastic anemia from erythema infectiosum
(EI)[Fifth’s Dz]. The human parvovirus
(HPV) infects and lyses RBC precursors.
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Diphtheria and Scarlet Fever are bacterial
and prevention of complications requires
compliance with antibiotic therapy.
Prevent complications
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High-risk children exposed to chickenpox
should receive VZIG (varicella zoster immune
globulin).
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Acyclovir (Zovirax) may be used to treat
varicella infections in high risk children with
the disease.
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Vitamin A supplementation in high doses has
recently been shown to decrease morbidity
and mortality rates in measles. Careful
instruction to parents on safe storage of
Vitamin A is essential.
Prevent complications
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Alleviate itching that is one of the most
common discomforts of rashes
◦ Cool/tepid baths without soap, may use oatmeal
◦ Calamine/Caladryl lotions must be applied sparingly
to prevent toxic levels being absorbed. They
contain diphenhydramine.
◦ Wear lightweight, loose clothing, keep cool
◦ Keep nails short, wear mittens on young children
◦ Suggest po. Diphenhydramine (Benadryl)
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Offer antipyretics (acetominophen or
ibuprofen) for fever and general malaise
Lozenges, saline rinses for sore throats
Suggest quiet activities
Provide comfort
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Provide accurate information re: period of
communicability and period of recovery.
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Provide support and encouragement.
Review importance of compliance with
therapy.
 No Salicylate products with all viral
diseases because of link to Reye
Syndrome
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Support family and child
Review Table 16-1 Communicable Diseases of
Childhood pp. 608-614 (Hockenberry et al, 9th ed.)
 Know association of high fever and febrile seizures
with Roseola and importance of careful antipyretic
management.
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Know common sx of Rubeola (measles) including
koplik’s spots, photophobia.
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Know period of communicability of
Varicella/chickenpox and appropriate counsel to
parents re: when child can return to school
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Know etiology of Scarlet Fever, common sx,
management, and when to return to school
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Know risks to fetus if Rubella is contracted in the
mother’s first trimester of pregnancy
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Know appearance of rash for Fifth Disease (HPV)
Which is which??
Fifth Disease
Roseola
Chicken pox
Scarlet Fever
Etiology: Epstein Barr Virus
 Natural Hx:
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Typically self-limiting & uncomplicated
Incubation period: 30-60 days
Preclinical stage: 3-5 days
Acute illness: 7-20 days
Convalescence: 2-6 weeks
Viral excretion may occur many months after
infection
◦ Often asymptomatic and difficult to diagnose
Mononucleosis
Transmission: through saliva (usually
intimate contact, thus the nickname,
‘Kissing Disease’)
 Pathophysiology
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◦ EBV infects B-lymphocytes lymphoproliferation
◦ Lab results: atypical lymphocytes called Downey cells
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 WBC’s especially lymphs and
 liver enzymes
EBV antibody titer 
+ Monospot test
Mononucleosis (cont’d)
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Signs and Symptoms
◦ General malaise
◦ Sore throat, gelatinous film over palate and
uvula, red macules on palate
◦ Tonsillar enlargement, white exudate on
tonsils, red pharynx
◦ Fever
◦ Macular rash (trunk)
◦ Abdominal pain
◦ Cervical lymphadenopathy
◦ Splenomegaly
◦ Hepatomegaly
Mononucleosis (Cont’d)
Population most affected:12-26 yr olds
 Nursing concerns
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Potential for secondary infection
Potential for injury
School absenteeism
Possible complications:
 Aseptic meningitis
 Encephalitis
 Guillian Barré Syndrome
 Splenic rupture
Mononucleosis (cont’d)
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Primary prevention
◦ General health promotion measures
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Secondary prevention
◦ Prompt medical attention for sore throats to r/o strep
throat
◦ Screening to r/o secondary bacterial infection
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Tertiary prevention
◦ Palliative:
 Fever (rest,  calories,  fluids, Acetominophen
 Saline gargles
 Soft foods
◦ No contact sports
◦ Referral for home-bound teacher, if pt has to
stay home for lack of energy and malaise
◦ Can go to school if feels up to it
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That should do it!
Wash your hands and stop the
spread of these communicable
diseases!