childhood communicable diseases & immunizations
what med needs to be on standby for diphtheria? why?
epinephrine; anaphylaxis precautions toward equine serum
treatment & prevention of diphtheria
equine antitoxin (IV), antibiotics (penicillin or erythromycin), bedrest, tracheostomy for airway obstruction; equine & antibiotics not interchangeable
child assessment data
exposure, prodromal s/s, immunization hx, hx of previous diseases, nutritional & developmental status, physical s/s, diagnostic studies, assess fam members w special conditions/needs
source & transmission of poliomyelitis
feces & oropharyngeal secretions; direct contact, spread via fecal-oral route (contact precautions)
pertussis vaccine
first 3 immunizations usually given at 2, 4, & 6 months with DTaP; recommended for all children 6wks tp 6years (up to 7th bday)
nursing responsibilities
first contact, so thorough assessment; identify s/s of disease & prevention
measles vaccine
given at 12-15months (6-11months if outbreak); 2nd immunization recommended at 4-6years (school entry); MMRV is live (not for immune deficient children)
scarlet fever
group A hemolytic streptococci; abrupt high fever w tachycardia disproportionate to fever, vomiting, HA, chills, abdominal pain, halitosis, enlarged tonsils w exudate, beefy red pharynx, strawberry tongue (swollen & papillae), rash appears w/in 12hr of 1st symptoms (red pinhead lesions, everywhere but face, more in folds of body)
exanthema subitum (roseola/6th disease)
human herpesvirus type 6; high fever 3-7days in well-appearing child, drop in fever w rash appearance, bulging fontanel, discrete rose-pink macules on trunk then neck/face/extremities for 1-2days, lymphadenopathy (cervical or postauricular swelling)
erythema infectiosum (5th disease)
human parvovirus B19; erythema on face/cheeks (slapped) (1), maculopapular red spots symmetrically on extremities (2), rash subsides but returns w irritated skin (sun, heat, cold, friction) (3)
source & transmission of erythema infectiosum (5th disease)
infected persons (school-aged); resp secretions, blood, & blood productions
what is a unique characteristic of rubeola (measles)?
koplik spots
varicella vaccination
live-attenuated vaccine, subq 0.5mL; recommended for child who lacks proof of vaccination, has unreliable hx of infection (titer drawn), children 12-15months (1st dose) & 4-6years (2nd dose)
MMRV vaccine
measles, mumps, rubella, varicella
thimerosal
mercury-containing compound used as a preservative in vaccines
who needs to be immunized for whooping cough?
mom either before leaving or during hospital after birth as well as anyone coming in contact w newborn (fam, friends, etc.)
source & transmission of influenza
more likely to spread in winter months; direct contact (large-droplet), nasopharyngeal secretions
why are childhood vaccines 85-90% effective, so why are they not 100% effective?
most people who get a vaccine preventable disease are either not full immunized or have never been immunized
what vaccination is recommended to all individuals born after 1957 who may be susceptible?
mumps vaccination
how are immunizations documented by nurses?
name of disease vaccinating for, number of shots, date given, dosage, age of child when administered, reactions
source & transmission of scarlet fever
nasopharyngeal secretions; direct contact w infected or droplet spread (standard & droplet precautions until 24hr after tx started)
haemophilus influenza B vaccine
not influenza (virus v bacteria); protects child against infections caused by H. influenza type B (bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, & sepsis); all admin by IM using separate syringe & site from concurrent vacs
if any child is vaccinated with the measles vaccine before 12 months, what needs to happen?
they should receive 2 additional doses beginning at 12 months & separated by 4 wks
influenza (flu)
three orthomyxoviruses (a & b → epidemic; c → milder disease); dry throat/nasal mucosa, dry cough, hoarseness, flushed face, photophobia, myalgia, lack of energy, sudden onset of fever & chills
period of communicability
time during which an infectious agent may be transferred directly or indirectly from an infected person to another person, from an infected animal to humans, or from an infected person to animals; "infectious period"
treatment & prevention of poliomyelitis
use footboard or orthoses, promote ambulation w assistive devices (contractures/skin breakdown); high-protein diet & bowel management (constipation d/t immobility); observe for resp paralysis
National Childhood Vaccine Injury Act 1988
vaccination information sheet required by CDC to give before every vaccine & have to have informed consent to make people aware of risk
herpes zoster (shingles)
varicella-zoster virus; crops of vesicles appear following dermatome; neuralgic pain, hyperesthesias, itching
chickenpox (varicella)
varicella-zoster virus; fever, malaise, pruritic rash begins on trunk & spreads to proximal extremities; macule → papule → vesicles (small blisters)
what are some complications that can happen from influenza?
viral pneumonia, ear infections, or sinusitis commonly contracted
rubeola (measles)
virus; fever & malaise followed in 24hrs by coryza, cough, conjunctivitis, Koplik spots; rash appears 3-4days after onset, begins as erythematous maculopapular on face & spreads downward, after 3-4days assumes brownish appearance
what is the treatment for rubeola (measles)?
vit A for children w acute illness; bedrest, antipyretics; antibiotics to prevent secondary bacterial infection for high-risk children; immunization
oral poliomyelitis vaccine
was used but had small risk of VAPP; since 2000 (start of IPV), no new indigenously acquired cases of VAPP have occurred
when infected w a communicable disease, when do prevention measures begin (primary nursing focus)?
with the identification of the infectious agent
what is the flu vaccine doses for children 6-35months?
0.25mL
what is the flu vaccine doses for children 3yo & older?
0.5mL
dose schedule for MMR (measles, mumps, & rubella) and VAR (varicella) for infants (birth-15months)
12-15mon: 1st dose
what are the US vaccine laws?
1988 National Childhood Vaccine Injury Act & 1995 Vaccines For Children
dose schedule for Hib (haemophilus influenzae type b) for infants (birth-15months)
2mon: 1st dose 4mon: 2nd dose 6-15mon: 3rd/4th
dose schedule for DTaP <7years (diphtheria, tetanus, & acellular pertussis) for infants (birth-15months)
2mon: 1st dose 4mon: 2nd dose 6mon: 3rd dose 15mon: 4th dose
what ages is DTaP given?
2months, 4months, 6months, & younger than 7
prodromal
early symptom that a disease is developing or that an attach is about to occur; any symptom, sensation or change in bodily function that is experienced by pt & associated w particular disease
what is a rare complication than can occur from measles (rubeola)?
encephalitis and death
poliomyelitis
enteroviruses; paralysis followed by recovery, then CNS paralysis; can be abortive or inapparent, nonparalytic, & paralytic
source & transmission of rubella (german measles/3-day measles)
primarily nasopharyngeal secretions; virus also present in blood, feces, & urine; droplet precaution
source & transmission of chickenpox (varicella)
primary secretions of resp tract, lesser degree skin lesions; droplet (airborne), direct/indirect contact (once crusted, no longer contagious)
what are some complications caused by rubella (german/3-day measles)?
rare, affects on a fetus (titers on preg adolescents, avoid preg people if have rubella)
what does a nurse assess for regarding communicable diseases?
recent exposure, prodromal symptoms, immunization hx, prior hx of the disease
influenza vaccine
recommended annually in fall for children starting at 6months (inactivated); if 1st time recipient <9yo, 2 doses given 4wks apart; assess for egg allergy (risk v benefits discussion); LAIV alt to IM no longer recommended
mumps vaccine
recommended for 12-15months, usually given w measles & rubella (MMR); should not be given to infants younger than 12months (persisting maternal antigens can affect the vaccine)
rubella vaccinate
recommended for all children 12-15months & at age of school entry (4-6years), combined w measles & mumps (MMR), live attenuated virus that may cross placenta, don't become preg for 28days after injection
source & transmission of rubeola (measles)
resp tract secretions, blood, urine of infected person; direct contact w droplets (primarily winter), airborne precaution until day 5 of rash
what vaccine can preg and immunocompromised people not have but others around them should?
rubella vaccination
rubella (german measles/3-day measles)
rubella virus; low-grade fever, HA, malaise, anorexia, conjunctivitis, coryza, sore throat, cough, lymphadenopathy (last 1-5 days); rash first appearing on face & rapidly spreads downward to neck, arms, trunk, & legs - disappears in same order (usually gone by 3rd day)
source & transmission of exanthem subitum (roseola/6th disease)
saliva (even from health adult); virtually limited to children under 3 but peak b/t 6-15months; most cases no reported contact
source & transmission of mumps
saliva of infected person; direct contact w or droplet spread (most contagious immediately before & after swelling)
what are some secondary complications that can arise from chickenpox (varicella)?
secondary bacterial infections, encephalitis, varicella pneumonia (rare in children), hemorrhagic varicella
what complications can arise with exanthem subitum (roseola/6th disease)?
seizures d/t latent fever
what are some complications from common childhood diseases?
seizures, encephalitis, myocarditis, mitral & aortic valve insufficiency, death
what are absolute contraindications for vaccines?
severe febrile illness or allergies
poliomyelitis vaccine
should receive 4 doses of IPV at 2months, 4months, 6-18months, & 4-6 years; all IPV recommended for children
education regarding inactivated agents in vaccines
side effects usually occur w/in few hrs & usually limited to local tenderness, erythema, & swelling at the site; low-grade fever; & behavioral changes (fussiness)
management & prevention of herpes zoster (shingles)
symptomatic tx, analgesics for pain, antiviral meds; preventative vaccine available for >50 years; isolation, airborne & contact precautions until crusted over
treatment & prevention of influenza
symptomatic tx, antiviral drugs (Tamiflu, Relenza), vaccination
treatment of rubella (german measles/3-day measles)
symptomatic; analgesics & antipyretics
what is recommended in regard to the first 3 immunizations of the pertussis vaccination?
that they are given from the same manufacturer; 4th may be from a different manufacturer
diphtheria
corynebacterium diphtheriae; nasal symptoms (like cold), tonsillar-pharyngeal (sore throat, white/gray mem, lymphadenitis, fever, malaise), laryngeal (cough, hoarseness, apprehensive, dyspneic retractions, cyanosis)
management & prevention of chickenpox (varicella)
daily bathing & linen changes, short finger nails, oatmeal baths, keep cool; no immunity via breastfeeding
complications that can occur with pertussis (whooping cough)
decreased oxygenation/apnea in younger infants (<6months), pulmonary hemorrhage, coughing may continue until mucus plug expelled (vomiting can occur)
what medications can be used for chickenpox (varicella)?
diphenhydramine or calamine cream (itching), antiviral (Acyclovir-Zovirax)
source & transmission of diphtheria
discharge from mucous mems of nose & skin; direct contact (standard & droplet precautions until 2 neg cultures)
source & transmission of pertussis (whooping cough)
discharge from resp tract; direct contact or droplet, indirect contact w freshly contaminated articles
VAERS
Vaccine Adverse Events Reporting System; any side effects (should expect mild but not severe) reported using this form; vac manufacturers required to report all side effects, nurses report some
when can post-polio syndrome occur?
about 15-40 years after original polio dx
MenHibrix doses (Hib vac)
admin in a 4-dose series at 2, 4, 6, & 12-15 months; only one dose given to kids 15months or older who haven't been previously vac
diphtheria vaccine
admin variety of ways; combo w tetanus & pertussis (DTaP) for kids <7, combo w Hib vaccine, combo w tetanus (DT) for kids <7 w contraindication for pertussis vac, combo w tetanus & acellular pertussis (Tdap) for kids 11 & older, single antigen when combo antigen prep aren't indicated
treatment & management of mumps
analgesics & antipyretics; IV fluids for child refusing drink d/t vomiting; decrease activity until swelling declines, can apply hot/cold compress
what is now recommended at 11-12 years for children who have completed the DTaP/DTP series?
Tdap
what are some complications of erythema infectiosum (5th disease)?
anemia, arthritis, myocarditis (rare), & very dangerous for preg women in 2nd trimester (anemia, hydrops fetalis, fetal death)
treatment and prevention of pertussis (whooping cough)
antimicrobial (-mycin), hospitalization sometimes required for infants/children who are dehydrated, oxygen & humidity, fluid admin; immunizations
treatment & management of roseola/6th disease (exanthem subitum)
antipyretics for fever, adequate oral fluid intake
what medications can be used for erythema infectiosum (5th disease)?
antipyretics, analgesics, anti-inflammatory drugs
Relenza (zanamivir)
antiviral, disc inhaler, children 7 & older, start w/in 48hrs of s/s onset, best for influenza types a & c
Tamiflu (oseltamivir)
antiviral, number one recommended for influenza type a & b, oral for 5 days to decrease flu-like s/s, infants/children of any age, best results start 2 days w/in onset of symptoms
what are some complications that mumps can cause?
arthritis, sterility in adult males, pancreatitis, sometimes meningitis
signed consent for vaccinations
becomes part of permanent record & includes name/address/title of person admin, date of admin, & vaccine manufacturer & lot number
pertussis (whooping cough)
bordetella pertussis; URI symptoms (sneezing, coryza, lacrimation, cough, low-grade fever), advances to cough at night (short & rapid followed by sudden high-pitched crowing); young infants may have apnea instead of cough; can last up to 10wks
source & transmission of herpes zoster (shingles)
can be both airborne & contact but mostly contact; must have varicella before
mumps
paramyxovirus; fever, HA, malaise, anorexia for 24hrs followed by earache aggravated by chewing, parotitis by day 3 (uni or bilateral) accompanied by pain/tenderness (reach max size by day 1-3)
treatment & prevention of scarlet fever
penicillin (erythromycin for PCN-sensitive), rest during febrile phase. analgesics for sore throat, antihistamines for pruritis; throw toothbrush away, no sharing drinks/utensils/food, avoid irritating foods/liquids
incubation period
period b/t infection of an individual by a pathogen & the manifestation of illness/disease it causes
what are some complications that can occur with poliomyelitis?
post-polio syndrome (slow, irreversible exacerbation of weakness most likely occurring in same muscle groups affected originally), paralysis
who do nurses NEVER give live virus vaccines to?
pregnant women, immunodeficient, & immunocompromised