Transcript Nursing Care - rivier.instructure.com.

Essentials of
Pediatric Nursing
Chapter 15: Nursing Care of
the Child With an Infectious
or Communicable Disorder
Infectious Process

Preventing the spread of infection
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
Read pages 446 – 449 in Kyle & Carman to review
this information
Also review Box 15.3 page 450 in Kyle & Carman
on Standard and Isolation Precautions(AirbornDroplet-Contact) which are commonly used caring
for children with infectious diseases.
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Nurses are responsible for following these precautions
and teaching children and families about these standards
Many children hospitalized will be put on isolation –
ALWAYS follow requirements for PPE.
Variations in Pediatric A&P
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Immature immune systems of infants and
children make them more susceptible to
infections
Newborns display a decreased inflamatory
response to invading organisms
Once infected, more difficult for child to fight
infection
Immunizations in young children not complete
Infants and toddlers are curious and handle/put
into mouth objects that may be contaminated
Nursing Process Overview of Child
with Communicable Disorder
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Assessment
Nursing Diagnoses
Goals
Interventions
Evaluation
GENERAL CONCEPTS WHEN
PROVIDING CARE
Managing Fever (read page 451-52
Boxes 15.1 in Kyle & Carman)
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Fever is a sign of illness, not a disease, and is
body’s weapon to fight infections
Teach parents about fever and how to manage them
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Infants < 3 months with rectal temp >38 degrees
Centigrade or 100 degrees F should contact PCP
Infants > 3 months temp >39 degrees C or 102 F contact
PCP
Plan ahead and give parents directions/doses BEFORE
event
Managing Fever (cont.)

Home management if child
uncomfortable:
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Hydrate, dress lightly, tepid bath if child
tolerates, cooling blanket
Antipyretics:
 acetaminophen: Recommended dose 1015 mg/kg/dose every 4 hours. Don’t
exceed 5 doses/24 hours
 Ibuprofen: Recommended dose 5-10
mg/kg/dose in children more than 6
months. Maximum 4 doses daily
 NEVER give Aspirin to reduce fever in
children < 19 y.o. – risk of Reye
syndrome
Managing Skin Rashes
http://www.medicinenet.com/skin_pictures_child_pictures_slideshow/article.htm
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Teach parents ways to manage discomfort and
maintain skin integrity
Management includes:
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Antipyretics/antihistamines like Benadryl, oral and topical.
Consult PCP before giving for dose
 Diphenhydramine (Benadryl)Give 0.5 mg per pound
every 4-6 hours. (See dosing chart) The package doesn't
give a dose for under 2 years of age; not recommend for
children under the age of one.
Cool compresses, running cool water or baths with
soothing additives like oatmeal
Topical: aloe vera, Caladryl, Calamine lotion
Managing Rashes (cont.)
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Discourage scratching
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Keep nails short
Cover infants/young child’s hands with mittens or gloves
Sepsis
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Systemic overresponse to infection resulting from
various organisms
Can lead to septic shock, a medical emergency that
may lead to organ failure and death
May affect any age group but more common in
neonates and young infants due to immature
immune system
Treated in NICU or PICU with antibiotics, symptom
management, support vital signs
Prognosis variable so AIM is to PREVENT!

Mortality rate range 40-60%
Managing Infections
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Thorough Nursing Assessment
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History: especially exposure to someone with
contagious or infectious disease
VS, skin, respiratory or GI signs and symptoms
Laboratory and Diagnostic Tests
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Blood tests: complete count.
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WBC elevated (low in severe cases)
Elevated C-reactive protein
Positive blood culture with septicemia
Tests (cont.)
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Urine Cultures: positive if bacteria present
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Remember how to obtain specimens in
infants/children
Cerebral Spinal Fluid: increased WBC’s and
protein, low glucose
Stool Cultures: positive for bacteria or other
organisms, including worms
Cultures of wounds, tube sites, nares,
sputum
X-rays or Scans: lung infections
Infectious Disorders

Communicable diseases:
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Incidence has declined with increase of
immunizations
Further decreased with use of antibiotics and
antitoxins
Nursing Assessment in
Identification of Infection
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Recent exposure to infectious agents
Prodromal symptoms: symptoms that occur between
early manifestations of the disease and its overt clinical
syndrome
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Immunization history
History of having the disease
Caution for Compromised
Children
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Children with immunodeficiency:
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Receiving steroid therapy
Other immunosuppressive therapies
Generalized malignancies
Immunologic disorder
Chronic diseases like sickle-cell
Prevent Spread of Disease
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Primary prevention of the disease:
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Immunization
Control spread of disease to others:
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Reduce risk of cross-transmission of organisms
Infection control policies
Hand washing
Nursing Process and Care
Plan
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The following slides include guidelines to
care for children with communicable diseases
Individualize the plan of care based on
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Child’s age and developmental needs
Type of infection, mode of transmission
Signs and symptoms of disease
Nursing Management of Child with
Communicable Disease
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ASSESSMENT: Identify S&S of disease. Nurses in schools,
ambulatory care settings and child care centers often first to observe.

Diagnoses (Problems):
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Risk for infection r/t susceptable host and infectious agent
Pain/discomfort r/t skin lesions, malaise
Impaired social interactions r/t isolation
Risk for Impaired skin integrity r/t scratching from pruritis/itching
Interrupted Family Processes r/t sick child
Planning:
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Expected patient outcomes. Child will:
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Not spread infection to others
Not experience complications
Have minimum discomfort
With family, receive adequate emotional support
Implementation
(Refer to pgs. 469-473 & 482-85 for each disease)
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Maintain and teach proper precautions with hospitalized child based
on disease: standard, airborne, droplet, contact
Keep children at home away from susceptible individuals: high risk
children and elderly, pregnant women
Obtain any cultures if ordered
Encourage rest and decreased activity. Children with poliomyelitis will
need physiotherapy, positioning and added skin care
Manage symptoms to provide comfort:
 Fever:
 antipyretic like acetaminophen, NSAIDS like ibuprophen. Avoid
aspirin with children > Reyes syndrome (toxic encephalopathy
with cerebral edema and fatty liver changes). Teach parent
correct dosage for child’s weight and age.
 Keep child cool but not cold enough to shiver
 Added precautions if child prone to seizures
Implementation (cont.)
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Pain
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Itching/Skin Care
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Analgesics like acetaminophen, ibuprophen (NO ASA).
Children usually prefer liquid form
Apply hot or cold compresses to affected area (neck with
mumps)
Keep skin clean, change clothes and linens daily
Apply topical calamine lotion
Keep child’s nails short (mittens if child scratches). Teach child
to press not scratch itchy lesions > may lead to secondary
infections
Eye Care
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Dim lights if photophobia present
Clean eyes with warm saline solution to remove secretions or
crusts
Keep child from rubbing eyes
More Interventions
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Cough/Airway/Breathing
 Observe for signs of airway obstruction or paralysis (pertussis &
poliomyelitis)
 Ensure adequate oxygenation. During spasms keep infant/child
on side to minimize chances of aspiration with vomitting
 Provide humidified oxygen if needed and ordered to maintain
O2 sats.
 Oral suctioning to prevent choking on secretions
 Relieve sore throat with analgesic gargles, lozenges, throat
sprays and inhaled cool mist. Consider child’s age when
selecting method
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Nutrition and Fluids
 Encourage fluids, small amounts at a time. Avoid irritating
liquids
 Soft diet, offer foods child likes
Other Therapies
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Additional Medications
 Antibiotics (oral or IM) for children with scarlet fever,
diptheria and pertussis to prevent complications
 Varicella-Zoster immune globulin (VariZIG) or immune
globulin intravenous (IGIV) for immunocompromised
children who may be exposed to varicella
 Antivirals:Acyclovir (Zovirax) for
at risk newborns, children, pregnant women
- Vitamin A suppliments with measles to reduce morbidity and
mortality
- Mild sedatives as needed to relieve anxiety and promote rest
Bacterial Infections
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One-celled organisms that exist everywhere
Children at risk for developing bacterial
infections
Sanitation, avoidance and immunizations
ways to PREVENT INFECTIONS
Community-Acquired MethicillinResistant Staphylococcus Aureus
(CAMRSA)
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Increasing in incidence in USA
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Before 1990’s mainly hospital acquired
Varies from mild( skin rash, abscesses) to
serious (sepsis, pneumonia, osteomyelitis)
Transmission by direct contact with person,
blood, sputum or sharing personal items
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Clusters seen in day care centers and athletic
teams
CAMRSA Dx. And Management
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S&S:
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Skin: Bump (resembles insect bite); or
red, swollen, painful or warm area
Lesion or abscess,
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purulent drainage
Fever
Cellulitis
Diagnosis
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Culture: may need to incise and drain
area
Antimicrobial susceptibility essential to
test
Nursing Management
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Home or Inpatient – depends on severity
Antibiotics with microbial susceptibility
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Comprehensive wound care
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Oral: teach to complete prescription
IV: hospitalize or IV home therapy
Warm soaks to abscess/bump/pimple
May require I&D – incision and drainage
Child and family education
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Medications; wound care; hand washing; risk
factors; S&S of MRSA
Communicable Diseases
Scarlet Fever
FIG. 14-6
Scarlet fever.
Scarlet Fever
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Agent: group A β-hemolytic
streptococci
Transmission: droplet or direct
contact
Incubation period: 1-7 days
Complications: carditis, peritonsillar
abscess, glomerulonephritis
Pertussis (Whooping Cough)
Agent: Bordetella pertussis
 Transmission: droplet or direct
contact
 Incubation period: 6-20 days
 Short rapid coughs followed by
crowing or “whoop” sound
 Complications: pneumonia (usual
cause of death)
2010 - Pertussis Outbreak in California
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http://www.youtube.com/watch?v=0GKiB
YuzpL0
Diphtheria
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Caused by Corynebacterium diphtheriae
May affect nose, larynx, tonsils or
pharynx
Occurs in unimmunized children under 15
years
S&S: Sore throat, fever,edematous neck
and lymphadenopathy, pseudomembrane
may cause airway obstruction and
suffocation
Treatment: antibiotics and antitoxin,
airway management, strict droplet
precautions, bedrest
Tetanus
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Acute, often fatal caused by
toxins produced by Clostridium tetani
Rare in USA due to immunization
4 Types: Neonatal most common worldwide
Spores found in soil, dust feces and enters
body through wound
S&S: Affects muscles of back and neck.
Complications include: breathing problems,
fractures, elevated BP, dysrhymias, blood
clotting and coma
Treatment: support breathing an
cardiovascular function, tetanus
immunoglobulin, debride wound, antibiotics.
Severe may need mechanical ventilation
Nursing Care: Teaching about prevention and
immunization
Viral Infections
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Microscopic organisms that
cannot multipy on their own
and require a living host
Children highly sensitive to
viruses due to their immune
system
Best to PREVENT by
immunizing children
Treatment includes symptom
management
Common Viral Exanthems (rash or skin
eruption) of Childhood
Refer to pages 440-444 in Kyle
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Usually cared for at home
Hospitalized if child very ill
Use appropriate transmission-based
precautions
Management and plan of care focuses on
fever management and relief of symptoms
Varicella zoster (Chicken Pox)
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The virus that causes chickenpox is varicella-zoster, a member of
the herpes virus family. The same virus also causes herpes zoster
(shingles) in adults.
An airborne disease spread easily through coughing or sneezing of
ill individuals or through direct contact with secretions from the rash.
A person with chickenpox is infectious one to two days before the
rash appears.[2] The contagious period continues for 4 to 5 days
after the appearance of the rash, or until all lesions have crusted
over.
A child with chickenpox should be kept out of school until all blisters
have dried, usually about 1 week.
A varicella vaccine was first developed by Michiaki Takahashi in
1974 derived from the Oka strain. It has been available in the U.S.
since 1995.
Varicella zoster
(Chicken Pox)
 Symptoms
 Most children with chickenpox act sick, with
symptoms such as a fever, headache, tummy
ache, or loss of appetite for a day or two
before breaking out in the classic pox rash.
These symptoms last 2 to 4 days after
breaking out.
 The average child develops 250 to 500 small,
itchy, fluid-filled blisters over red spots on the
skin.
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The blisters often appear first on the face, trunk, or
scalp and spread from there. Appearance of the small
blisters on the scalp usually confirms the diagnosis.
Varicella (cont.)
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Treatment
In most cases, it is enough to keep children comfortable while their
own bodies fight the illness.
Oatmeal baths in lukewarm water provide a crusty, comforting
coating on the skin.
An oral antihistamine can help to ease the itching, as can topical
lotions. Trim the fingernails short to reduce secondary infections and
scarring.
Until all chickenpox sores have crusted over or dried out, avoid
playing with other children, going back to school, or returning to
work.
Erythema Infectiosum (Fifth Disease)
Refer to Table 14-1 pgs. 454-463
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Agent: human parvovirus
Rash in three stages:
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“Slapped face” appearance
disappears between 1 and 4
days
Maculopapular rash on
extremities; lasts 7 days or
more
Rash subsides but reappears
if skin irritated or traumatized
by heat, cold, friction, etc.
Roseola (Sixth
disease)
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Agent: human herpes
virus type 6
Incubation: 5-15 days
Persistent high fever for 3-4 days; otherwise
appears well
After fever subsides, rash appears
Rash first on trunk, then face and extremities
Mumps
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Agent: paramyxovirus
Transmitted via droplet or direct contact
Incubation period: 14-21 days
Fever, headache, malaise, followed by
parotitis
May cause orchitis and meningoencephalitis
Rubeola (Measles)
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Agent: virus
Source: secretions; droplet
transmission
Incubation period: 10-20 days;
communicability from 4 days before
to 5 days after appearance of rash
Koplik spots: white spots in mouth
appear 2 days before rash
The three Cs—cough, coryza
(runny nose) and conjunctivitis (red
eyes and photophobia)
Complications of Measles
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Complications of measles infection may
include:
Bronchitis
Encephalitis (about 1 out of 1,000 measles
cases)
Ear infection (otitis media)
Pneumonia
Rubella (German Measles)
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Agent: rubella virus
Transmission: direct contact or indirect
contact with article freshly contaminated with
nasopharyngeal secretions, blood, stool, or
urine
Incubation period: 14-21 days
Complications: rare; greatest danger is
teratogenic effect on fetus
Poliomyelitis
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Cause by highly infectious
poliovirus
Spread fecal-to-oral or oral-to-oral
route
Most common in young children,
also called infantile paralysis
Rare in USA due to polio
vaccinations
S&S: fever, fatigue, headache,
vomiting, stiff neck, limb pain.
Progress to tremors of extremities
and possible paralysis. Severe
may involve respiratory muscles
Treatment: PREVENT by vaccine;
supportive care since no cure
Zoonotic Infections
Rabies
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Preventable viral infection
Transmitted to humans by contact with saliva of
infected animal
Rare in USA due to routine vaccination of domestic
animal. May catch from wild animals
Teach children to avoid wild, aggressive animals
Treatment: Regimen of immune globulin as soon
after exposure as possible. Once S&S appear poor
survival rate
Cat Scratch Disease
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Fairly common; caused by Bartonella
henselae in saliva of cats
S&S: appear 7-12 days after infected.
Include: headache, fever, anorexia,
fatigue, papule or pustule at site of
scratch or bite. Lymphadenopathy may
develop
Management:
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Antibiotics as ordered
Wound care
Teach prevention and caution with cats
Vector-Borne Infections
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Lyme Disease
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Most common in USA, caused by
spirochete Borrelia burgdoreri
Most common in Northeast between April and October.
Incidence highest in children 5-10 years
Assess child for tick bites
S&S: fever, malaise, mild neck stiffness, headache, fatigue,
myalgia, and arthalgia of joints, often with swelling
 Early sign ring-like or bullet rash
 2 step test to find antibodies by blood or joint fluid
Treatment: Antibiotics for prescribed time. Educate
child and family about prevention: repellent, cover
skin, check for ticks daily
Rocky Mountain Spotted Fever
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Most severe rickettsial illness in USA
Carried by ticks, fleas and lice
S&S: noncardiogenic pulmonary edema.
Cerebral edema, neurologic involvement,
rash
Treatment: Tetracyclines, chloramphenicol in
children less than 9 years due to risk of teeth
staining
West Nile Virus and
Eastern Equine Encephalitis(EEE)
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West Nile Virus: fever, meningitis, encephalitis, flaccid paralysis
EEE:
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TREATMENT:
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abrupt onset and is characterized by chills, fever, malaise, arthralgia, and
myalgia.
lasts 1 to 2 weeks, and recovery is complete when there is no central nervous
system involvement.
In infants, the encephalitic form is characterized by abrupt onset; in older
children and adults, encephalitis is manifested after a few days of systemic
illness.
Signs and symptoms in encephalitic patients are fever, headache, irritability,
restlessness, drowsiness, anorexia, vomiting, diarrhea, cyanosis, convulsions,
and coma.
Supportive, manage symptoms
No vaccine available
Approximately a third of all people with EEE die from the disease.
Parasitic and Helminthic
Infections
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Children at risk for both due to poor hygiene
practices
Parasites
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Organisms larger than yeast or bacteria
Live in or on a host
Receive nourishment from host without benefiting or killing
the host
Example include scabies and head lice
Helminth
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A parasitic intestinal worm
Include pinworms, roundworms and hookworms
Intestinal Parasitic Diseases
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Ascariasis (common roundworm)
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Tranferred to mouth from contaminated food, fingers or
toys
Prevalent in warm climates
Infections light-heavy-severe: S&S include anorexia,
irritability, weight loss, enlarged abdomen, fever. May lead
to intestinal obstruction, appendicitis, perforation,
obstructive jaundice, pneumonitis
Diagnosis will need to be made by a doctor with the
assistance of a pathology laboratory. The laboratory will be
able to discover characteristic roundworm eggs in a stool
sample. Adult roundworms, which can grow as big as 40cm
long, may occasionally be passed in a stool or be present in
vomit.
Treatment
A roundworm infestation can be treated with Vermox or
Combantrin-1, which contain mebendazole, or Combantrin,
which has pyrantel embonate as its active ingredient.
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Hookworm
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Transmitted by eggs in soil, picked up by skin contact. Child
should wear shoes
S&S vary with severity: anemia, malnutrition, erythema and
papular eruptions with itching and burning
Enterobiasis (Pinworms)
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Caused by nematode Enterobius vermicularis – most common helminthic
infection in USA
Present in temperate climate zones
Found in crowded conditions: classrooms, daycare centers. May infect 30% of
children at one time
Spread when eggs ingested or inhaled (eggs float in air)
Diagnosis: Tape test
S&S: *Intense perianal itching > irritability, restlessness, poor sleep, bedwetting; perianal dermatitis and excoriation; vulvovaginitis; urethral infection
Therapeutic/Medical Management
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Drugs include: *mebendazole (Vermox), pyrantel pamoate (Pin-Rid,
Antiminth) and albendazole

All members of household treated

Repeat in two weeks to prevent reinfection
Nursing Management
Perform or teach “Tape test”: tongue depressor with sticky tape placed near
rectum in early morning as soon as child awakens and before first BM.
Done 3 or > days; depressors placed in bag or jar for microscopic exam
Administer and Teach parents proper drug administration and dosing
- Teach parents ways to prevent reinfection by washing clothes, bedding;
vacuum home
Cycle for Pinworm Infection
Giardiasis (Traveler’s diarrhea): caused by protozoan Giardia
lamblia
Most common intestinal parasite in USA
It's estimated that between 1% and 20% of the U.S.
population has giardiasis, and this figure may be 20% or
higher in developing countries, where giardiasis is a
major cause of epidemic childhood diarrhea.

Children three times more likely to have giardiasis than
adults, Found in child care centers, long-term care
facilities, someone who recently travelled to endemic
area

Potential for transmission GREAT – Cysts (nonmotile
state of protozoa) can last for months

Chief mode of transmission: *person to person (in
children)by feces; contaminated water, food and animals
(especially puppies)

S&S: diarrhea, vomitting, anorexia, growth failure,
abdominal cramps; malodorus watery, pale and
greasy stools
Therapeutic Management
- Diagnose by microscopic exam of stool or duodinal
fluid
- Medications: 5 – 7 day course
-metroniazole (Flagyl), nitazoxanide (Alinia),
tinidazole (Tindamax)
Nursing Care Management
- Educate parents to PREVENT infection
- Meticulous hygiene and disposal of diapers, separate
care of soiled clothing
- Manage vomitting; hydration and nutrition during
treatment
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Zion National Park, UT
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Beautiful to look at
but Don’t Drink the
Water!
Signs posted
warning about
Giardiasis
Scabies
http://www.cdc.gov/search.do?queryText=scabies&action=search&searchButton.x=28&searchButton
.y=8
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Infestation of the skin by the human itch mite
(Sarcoptes scabiei var. hominis).
Scabies is a common condition found worldwide;
affects people of all races and social classes. Scabies
can spread easily under crowded conditions, like child
care centers
Treating infants and young children:

Scabicide lotion or cream also should be applied
to their entire head and neck as well as the rest of
their body.

Lotion or cream should be applied to a clean body
and left on for the recommended time before
washing it off. Clean clothing should be worn after
treatment.

Bedding, clothing, and towels used by infested
persons or their household, should be
decontaminated by washing in hot water and
drying in a hot dryer, by dry-cleaning, or by
sealing in a plastic bag for at least 72 hours.

Scabies mites generally do not survive more than
2 to 3 days away from human skin.
Sexually Transmitted Infections
(STI’s or STD’s)
Read Tables 15.8 & 16.9 on pgs. 486-492 in Kyle text
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Major health concern in adolescents
25% of high school students will get an STI
Risky behaviors
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Frequently have unprotected sex
Biologically more susceptible to infection
Engage in shorter relationships
Have difficulty accessing health care systems
Also warning sign for potential sexual abuse
in infants and children
Nursing Care
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Assess sexual behavior, often not done!
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All states allow adolescents to give consent to
confidential STI testing and treatment
Build trusting relationship with adolescent
Management
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Teach to complete antibiotic prescription
Counsel with ways to PREVENT STI’s
Teach abstinence, safe sex
Sexuality Education
and Guidance
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Media influences
Knowledge often acquired
from peers, TV, movies,
magazines
Knowledge often inaccurate
Need for factual information,
presentation based on
developmental maturity
STI’s Effects on Fetus or
Newborn (see page 486 in Kyle)

Chlamydia
Gonorrhea
Herpes type II (genital herpes)
Syphillis
Trichomoniasis
Venereal warts
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You don’t have to Memorize for Exam
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STI’s Common in Adolescents
Refer to pages 487-492 in Kyle & Carman
* You don’t have to Memorize for Exam
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Chlamydia
Gonorrhea
Herpes type II
Syphilis
Trichomoniasis
Venereal warts
End of Presentation