Transcript infcomdiseaseimmunizations

INFECTIOUS AND
COMMUNICABLE DISEASES
PYRAMID POINTS
• Clinical manifestations of the various infectious
and communicable diseases
• Infectious periods of the various infectious and
communicable diseases
• Methods of transmission of the various infectious
and communicable diseases
• Teaching related to measures to prevent
transmission of infectious and communicable
diseases
• Immunization schedules
• Contraindications to immunizations
RUBEOLA (MEASLES)
• AGENT
– Virus
• INCUBATION PERIOD
– 10 to 20 days
• COMMUNICABLE PERIOD
– From 4 days before to 5 days after the rash
appears; mainly during prodromal (catarrhal)
stage
RUBEOLA (MEASLES)
• SOURCE
– Respiratory tract secretions, blood, and urine
of infected person
• TRANSMISSION
– Airborne or direct contact with infectious
droplets
RUBEOLA (MEASLES)
• ASSESSMENT
– Fever
– Malaise
– Coryza and cough
– Rash appears as red, discrete maculopapules
that blanch easily with pressure and gradually
turn a brownish color (lasts 6 to 7 days); rash
begins behind the ears and spreads downward
to the feet
– Koplik’s spots: small, red spots with a bluishwhite center and a red base located on the
mucosa that last 3 days
RUBEOLA (MEASLES)
From Seidel HM et al (1995): Mosby’s guide to physical examination, (3rd ed.), St. Louis: Mosby.
RUBEOLA (MEASLES)
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.
KOPLIK SPOTS
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.
RUBEOLA (MEASLES)
• IMPLEMENTATION
– Respiratory precautions if hospitalized
– Restrict to quiet activities and bed rest
– Use a cool mist vaporizer for cough and coryza
– Dim lights if photophobia is present
– Administer antipyretics for fever
ROSEOLA (EXANTHEMA SUBITUM)
• AGENT
– Human herpesvirus type 6 (HHV-6)
• INCUBATION PERIOD
– 5 to 15 days
• COMMUNICABLE PERIOD
– Unknown but thought to extend from the
febrile stage to the time the rash first appears
• SOURCE
– Unknown
• TRANSMISSION
– Unknown
ROSEOLA (EXANTHEMA SUBITUM)
From Habif TP: Clinical dermatology: a color guide to diagnosis and therapy, ed. 3, St. Louis, 1996, Mosby.
ROSEOLA (EXANTHEMA SUBITUM)
• ASSESSMENT
– Fever for 3 to 5 days followed by a rash (rosepink macules that blanch with pressure)
– The rash appears 2 to 3 days after the onset of
fever and lasts 1 to 2 days
• IMPLEMENTATION
– Supportive
RUBELLA (GERMAN MEASLES)
• AGENT
– Rubella virus
• INCUBATION PERIOD
– 14 to 21 days
• COMMUNICABLE PERIOD
– 7 days before to approximately 5 days after the
rash appears
• SOURCE
– Nasopharyngeal secretions; virus is also
present in blood, stool, and urine
RUBELLA (GERMAN MEASLES)
• TRANSMISSION
– Airborne or direct contact with infectious
droplets
– Indirectly via articles freshly contaminated
with nasopharyngeal secretions, feces, or
urine
– Transplacental
RUBELLA (GERMAN MEASLES)
From Habif TP: Clinical dermatology: a color guide to diagnosis and therapy, ed. 3, St. Louis, 1996, Mosby.
RUBELLA (GERMAN MEASLES) RASH
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.
RUBELLA (GERMAN MEASLES)
• ASSESSMENT
– Low-grade fever
– Malaise
– Pinkish-red maculopapular rash that begins on
the face and spreads to the entire body
– Petechiae may occur on the soft palate
• IMPLEMENTATION
– Supportive treatment
– Isolate the infected child from pregnant women
MUMPS
• AGENT
– Paramyxovirus
• INCUBATION PERIOD
– 14 to 21 days
• COMMUNICABLE PERIOD
– Immediately before and after the swelling
begins
• SOURCE
– Saliva of infected person and possibly urine
MUMPS
• TRANSMISSION
– Direct contact with infected person
– Droplet spread from infected person
• ASSESSMENT
– Fever
– Headache and malaise
– Anorexia
– Earache aggravated by chewing, followed by
parotid glandular swelling
MUMPS
• IMPLEMENTATION
– Respiratory precautions
– Bed rest until the parotid glandular swelling
subsides
– Avoid foods that require chewing
– Apply hot or cold compresses as prescribed to
the neck
– To relieve orchitis, apply warmth and local
support with tight-fitting underpants
CHICKENPOX (VARICELLA)
• AGENT
– Varicella zoster virus (VZV)
• INCUBATION PERIOD
– 13 to 17 days
• COMMUNICABLE PERIOD
– 1 day before eruption of lesions (prodromal) to
6 days after the first crop of vesicles, when
crusts have formed
CHICKENPOX (VARICELLA)
• SOURCE
– Respiratory tract secretions of infected
person; skin lesions
• TRANSMISSION
– Direct contact, droplet (airborne) spread, and
contaminated objects
CHICKENPOX (VARICELLA)
• ASSESSMENT
– Slight fever, malaise, and anorexia followed by
a macular rash that first appears on the trunk
and scalp and moves to the extremities
– Lesions become pustules, begin to dry, and
develop a crust
– Lesions may appear on the mucous
membranes of the mouth, the genital area, and
the rectal area
STAGES OF LESIONS IN CHICKENPOX
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.
CHICKENPOX (VARICELLA) RASH
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.
CHICKENPOX (VARICELLA)
From Habif TP: Clinical dermatology: a color guide to diagnosis and therapy, ed. 3, St. Louis, 1996, Mosby.
CHICKENPOX (VARICELLA)
• IMPLEMENTATION
– In the hospital setting, strict isolation
– In the home setting, isolate the infected child
until the vesicles have dried
– Isolate high-risk children from the infected
child
PERTUSSIS (WHOOPING COUGH)
• AGENT
– Bordetella pertussis
• INCUBATION PERIOD
– 5 to 21 days (usually 10 days)
• COMMUNICABLE PERIOD
– Greatest during the catarrhal stage
• SOURCE
– Discharge from the respiratory tract of the
infected person
PERTUSSIS (WHOOPING COUGH)
• TRANSMISSION
– Direct contact or droplet spread from infected
person; indirect contact with freshly
contaminated articles
• ASSESSMENT
– Symptoms of respiratory infection followed by
increased severity of cough
PERTUSSIS (WHOOPING COUGH)
• IMPLEMENTATION
– Isolation during the catarrhal stage; if
hospitalized, institute respiratory precautions
– Administer antimicrobial therapy as prescribed
– Administer pertussis-immune globulin as
prescribed
PERTUSSIS (WHOOPING COUGH)
• IMPLEMENTATION
– Reduce environmental factors that promote
paroxysms of cough such as dust, smoke, and
sudden changes in temperature
– Encourage fluid intake
– Provide high humidity with the use of a
humidifier or tent
DIPHTHERIA
• AGENT
– Corynebacterium diphtheriae
• INCUBATION PERIOD
– 2 to 5 days
• COMMUNICABLE PERIOD
– Variable; until virulent bacilli are no longer
present (three negative cultures), usually 2
weeks but as long as 4 weeks
DIPHTHERIA
• SOURCE
– Discharge from the mucous membrane of the
nose and nasopharynx, skin, and other lesions
of the infected person
• TRANSMISSION
– Direct contact with infected person, carrier, or
contaminated articles
DIPHTHERIA
• ASSESSMENT
– Low-grade fever, malaise, sore throat
– Foul-smelling, mucopurulent nasal discharge
– Gray membrane on the tonsils and pharynx
– Lymphadenitis (neck edema)
DIPHTHERIA
• IMPLEMENTATION
– Strict isolation of the hospitalized child
– Administer antitoxin as prescribed (preceded
by a skin or conjunctival test to rule out
sensitivity to horse serum)
– Bed rest
– Administer antibiotics as prescribed
POLIOMYELITIS
• AGENT
– Enteroviruses
• INCUBATION PERIOD
– 7 to 14 days
• COMMUNICABLE PERIOD
– Not exactly known; the virus is present in the
throat and feces shortly after infection and
persists for approximately 1 week in the throat
and 4 to 6 weeks in the feces
POLIOMYELITIS
• SOURCE
– Oropharyngeal secretions and feces of the
infected person
• TRANSMISSION
– Direct contact with infected person; fecal-oral
and oropharyngeal routes
POLIOMYELITIS
• ASSESSMENT
– Fever, malaise, anorexia, nausea, headache,
sore throat
– Abdominal pain followed by soreness and
stiffness of the trunk, neck, and limbs that
progresses to flaccid paralysis
POLIOMYELITIS
• IMPLEMENTATION
– Enteric precautions
– Supportive treatment
– Bed rest
– Monitor for respiratory paralysis
– Physical therapy
SCARLET FEVER
• AGENT
– Group A, beta-hemolytic streptococci
• INCUBATION PERIOD
– 1 to 7 days
• COMMUNICABLE PERIOD
– During the incubation period and clinical
illness, approximately 10 days; during the first
2 weeks of the carrier stage, although may
persist for months
SCARLET FEVER
• SOURCE
– Nasopharyngeal secretions of infected person
and carriers
• TRANSMISSION
– Direct contact with infected person or droplet
spread; indirectly by contact with
contaminated articles, ingestion of
contaminated milk, or other foods
SCARLET FEVER
• ASSESSMENT
– Abrupt high fever, vomiting, headache,
malaise, abdominal pain
– A red, fine papular rash in the axilla, groin, and
neck that spreads to cover the entire body
– The rash blanches with pressure except in
areas of deep creases and folds of the joints
(Pastia’s sign)
SCARLET FEVER RASH
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.
SCARLET FEVER
• ASSESSMENT
– The tongue is coated and papillae become red
and swollen (white strawberry tongue); by the
fourth to fifth day the white coat sloughs off
leaving prominent papillae (red strawberry
tongue)
– Tonsils are edematous and covered with a
gray-white exudate
– Pharynx is edematous and beefy-red in color
WHITE STRAWBERRY TONGUE AND
RED STRAWBERRY TONGUE
From Wong, D. (1999). Whaley and Wong’s nursing care of infants and children, ed 6, St Louis: Mosby.
SCARLET FEVER
• IMPLEMENTATION
– Respiratory precautions until 24 hours after
the initiation of treatment
– Supportive therapy
– Bed rest
– Encourage fluid intake
– Administer antibiotics as prescribed
ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
• AGENT
– Human parvovirus B19 (HPV)
• INCUBATION PERIOD
– 4 to 14 days, may be as long as 20 days
• COMMUNICABLE PERIOD
– Uncertain but before the onset of symptoms in
most children
ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
• SOURCE
– Infected person
• TRANSMISSION
– Unknown; possibly respiratory secretions and
blood
ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
• ASSESSMENT
– Fever
– Myalgia
– Lethargy
– Nausea
– Vomiting
– Abdominal pain
ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
• STAGES OF THE RASH
– Erythema of the face (slapped face
appearance) chiefly on the cheeks; disappears
by 1 to 4 days
– Approximately 1 day after the rash appears on
the face, maculopapular red spots appear,
symmetrically distributed in the extremities;
rash progresses from proximal to distal
surfaces and may last a week or more
– Rash subsides but may reappear if the skin
becomes irritated or traumatized by such
factors as the sun, heat, cold, or friction
ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
From Habif TP: Clinical dermatology: a color guide to diagnosis and therapy, ed. 3, St. Louis, 1996, Mosby.
ERYTHEMA INFECTIOSUM (FIFTH DISEASE)
• IMPLEMENTATION
– Respiratory isolation in the hospitalized child
– Pregnant women should not be in contact with
or care for the infected person
– Supportive
– Administer antipyretics, analgesics, and
antiinflammatory medications as prescribed
INFECTIOUS MONONUCLEOSIS
• AGENT
– Epstein Barr (EB) virus
• INCUBATION PERIOD
– 4 to 6 weeks
• COMMUNICABLE PERIOD
– Unknown, the virus is shed before the onset of
the disease until 6 months or longer after
recovery
INFECTIOUS MONONUCLEOSIS
• SOURCE
– Oral secretions
• TRANSMISSION
– Direct intimate contact, infected blood
INFECTIOUS MONONUCLEOSIS
• ASSESSMENT
– Fever, sore throat, malaise, headache, fatigue,
nausea, abdominal pain
– Lymphadenopathy and hepatosplenomegaly
INFECTIOUS MONONUCLEOSIS
• IMPLEMENTATION
– Supportive
– Monitor for signs of splenic rupture, which
includes abdominal pain, left upper quadrant
pain, or left shoulder pain
ROCKY MOUNTAIN SPOTTED FEVER
• AGENT
– Rickettsia rickettsii
• INCUBATION PERIOD
– 2 to 14 days
• SOURCE
– Tick; mammal source: wild rodents, dogs
• TRANSMISSION
– Bite of infected tick
HARD TICK: SOURCE OF
ROCKY MOUNTAIN SPOTTED FEVER
From Leahy, J. & Kizilay, P. (1998). Foundations of nursing practice, Philadelphia: W.B. Saunders.
Courtesy of the Centers for Disease Control and Prevention.
ROCKY MOUNTAIN SPOTTED FEVER
• ASSESSMENT
– Fever, malaise, anorexia, vomiting, headache,
myalgia
– Maculopapular or petechial rash primarily on
the extremities (ankles and wrists) but may
spread to other areas, characteristically on the
palms and soles
ROCKY MOUNTAIN SPOTTED FEVER
• IMPLEMENTATION
– Vigorous supportive care
– Administer antibiotics as prescribed
– Teaching regarding protection from tick bites
ENTEROBIASIS (PINWORM)
• AGENT
– Enterobius vermicularis
• SOURCE
– Universally present in temperate climatic
zones
– Eggs are ingested or inhaled (eggs float in the
air), hatch in the upper intestine, mature in 2 to
8 weeks, and migrate to the cecal area;
females then mate, migrate out the anus, and
lay eggs
ENTEROBIASIS (PINWORM)
• TRANSMISSION
– Favored in crowded conditions
– Ingestion or inhalation of eggs
– Hand-to-mouth or fecal-oral route
– Contaminated items (pinworm eggs persist in
the environment for 2 to 3 weeks)
ENTEROBIASIS (PINWORM)
• ASSESSMENT
– Intense perianal itching, irritability,
restlessness, poor sleep, bed-wetting,
distractibility, short attention span
– In females, the worm may migrate to the
vagina and urethra and cause infection
ENTEROBIASIS (PINWORM)
•
IMPLEMENTATION
– Identify the worms
– Use of a flashlight to inspect the anal area 2 to
3 hours after the child is asleep
– Tape test: Transparent, sticky tape is used to
obtain a specimen from the child’s perianal
area; specimen is collected in the morning as
soon as the child awakens and before a bowel
movement or a bath
ENTEROBIASIS (PINWORM)
• IMPLEMENTATION
– Enteric precautions
– Anthelmintic medications (all household
members are treated); course of medication is
repeated in 2 weeks following the first course
to prevent reinfection
– Teach home care measures to prevent
reinfection
IMMUNIZATIONS
• GENERAL CONTRAINDICATIONS
– Severe febrile illness
– Live virus vaccines are generally not
administered to anyone with an altered
immune system
– Allergic reaction to a previously administered
vaccine or a substance in the vaccine
HEPATITIS B VACCINE (Hep B)
• Protects against hepatitis B
• All infants should receive the first dose of
hepatitis B vaccine soon after birth and before
hospital discharge
• The first dose of hepatitis B vaccine may also be
given by age 2 months if the infant’s mother is
HBsAg-negative
• Only monovalent hepatitis B vaccine can be used
for the birth dose
HEPATITIS B VACCINE (Hep B)
• Monovalent or combination vaccine containing
Hep B may be used to complete the series; four
doses of the vaccine may be given if combination
vaccine is used
• The second dose should be given at least 4
weeks after the first dose, except for Hibcontaining vaccine which cannot be administered
before age 6 weeks
• The third dose should be given at least 16 weeks
after the first dose and at least 8 weeks after the
second dose
HEPATITIS B VACCINE (Hep B)
• The last dose in the series (third or fourth dose)
should not be administered before age 6 months
• Infants born to HBsAg-positive mothers should
receive hepatitis B vaccine and 0.5 ml hepatitis B
immune globulin (HBIG) within 12 hours of birth
at separate sites; the second dose is
recommended at age 1 to 2 months and the
vaccination series should be completed (third or
fourth dose) at age 6 months
HEPATITIS B VACCINE (Hep B)
• Infants born to mothers whose HBsAg status is
unknown should receive the first dose of the
hepatitis B vaccine series within 12 hours of
birth; maternal blood should be drawn at the time
of delivery to determine the mother’s HBsAg
status and if the test is positive, the infant should
receive HBIG as soon as possible (no later than
age 1 week)
• Contraindication: Anaphylactic reaction to
common baker’s yeast
DTaP (DIPHTHERIA, TETANUS TOXOIDS,
ACELLULAR PERTUSSIS)
• Protects against diphtheria, tetanus, and
pertussis
• DTaP is administered at 2 months, 4 months, 6
months, between 15 to 18 months of age, and
between 4 to 6 years of age
• The fourth dose of DTaP can be given as early as
12 months of age, provided 6 months have
elapsed since the third dose and the child is
unlikely to return at age 15 to 18 months of age
DTaP (DIPHTHERIA, TETANUS TOXOIDS,
ACELLULAR PERTUSSIS)
• Tetanus and diphtheria toxoids (Td) is
recommended at 11 to 12 years of age if at least 5
years have passed since the last dose of tetanus
and diphtheria toxoid-containing vaccine
• Subsequent routine Td boosters are
recommended every 10 years
• Contraindication: Encephalopathy within 7 days
of administration of previous dose
HAEMOPHILUS INFLUENZAE TYPE b
CONJUGATE (Hib) VACCINE
• Protects against Haemophilus influenzae type b
• Hib is administered at 2 months, 4 months, 6
months, and between 12 to 15 months of age
• Depending on the brand of Hib vaccine used for
the first and second doses, a dose at 6 months of
age may not be needed
• DTaP/Hib combination products should not be
used for primary immunization in infants at age 2,
4, or 6 months, but can be used as boosters
following any Hib vaccine
INACTIVATED POLIOVIRUS VACCINE (IPV)
• Protects against polio
• An all-IPV schedule is recommended for routine
childhood poliovirus vaccination in the United
States
• IPV is administered at 2 months, 4 months,
between 6 and 18 months, and between 4 to 6
years of age
• Cautions: Anaphylactic reaction to neomycin or
streptomycin
MEASLES, MUMPS, RUBELLA (MMR)
• Protects against measles, mumps, and rubella
(German measles)
• The first dose of MMR is administered between 12
to 15 months of age; the second dose is
administered at 4 to 6 years of age
• The second dose may be administered during any
health care visit, provided at least 4 weeks have
elapsed since the first dose and that both doses
are administered beginning at or after age 12
months
MEASLES, MUMPS, RUBELLA (MMR)
• Those who have not previously received the
second dose should complete the schedule by
the visit at 11 to 12 years
• MMR contains minute amounts of neomycin;
measles and mumps vaccine, which are grown on
chick embryo tissue cultures, are not believed to
contain significant amounts of egg cross-reacting
proteins
MEASLES, MUMPS, RUBELLA (MMR)
• CONTRAINDICATIONS
– Pregnancy
– Known altered immunodeficiency
– Allergic to contents of immunization (prior to
the administration of MMR vaccine, assess for
a known history of allergy to neomycin or
related antibiotics)
MEASLES, MUMPS, RUBELLA (MMR)
• CONTRAINDICATIONS
– Presence of recently acquired passive
immunity through blood transfusions,
immunoglobulin, or maternal antibodies (MMR
should be postponed for a minimum of 3
months after passive immunization with
immunoglobulins and blood transfusions,
except washed blood cells, which do not
interfere with the immune response)
VARICELLA VACCINE
• Protects against chickenpox
• Varicella zoster vaccine is administered between
12 and 18 months of age
• Susceptible children 13 years of age and older
(who have not had chickenpox or have not been
previously vaccinated) need 2 doses, given at
least 4 weeks apart
VARICELLA VACCINE
• CONTRAINDICATIONS
– Pregnancy
– Immunocompromised individuals
– Children receiving corticosteroids
PNEUMOCOCCAL VACCINE (PCV)
• The heptavalent pneumococcal conjugate
vaccine (PCV) is recommended for all children
aged 2 to 23 months and for certain children aged
24 to 59 months
• Pneumococcal polysaccharide vaccine (PPV) is
recommended in addition to PCV for certain highrisk groups
HEPATITIS A VACCINE
• Recommended for use in selected geographical
areas and for certain high-risk groups
INFLUENZA VACCINE
• Recommended annually for children who are at
least 6 months of age with certain risk factors
(including, but not limited to, asthma, cardiac
disease, sickle cell disease, HIV, and diabetes
mellitus) and can be administered to all others
wishing to obtain immunity