NUR243 Chapter 15

What is the rationale for Antipyretics will not help change the course of the infection.

Rationale: Antipyretics provide symptomatic relief but do not change the course of the infection. The major benefits of decreasing fever are increasing comfort in the child and decreasing fluid requirements, which helps to prevent dehydration.

Prevention for tick-borne illnesses

Wear appropriate protective clothing when entering tick-infested areas. Clothing should fit tightly around wrists, waists, and ankles. Tuck pants into socks if possible. After leaving the area, do a full body check for ticks and remove them promptly. Examine gear, clothes, and pets for ticks. Tumble dry clothes and appropriate gear on high heat for an hour. Insect repellent may provide temporary relief but may produce toxicity, especially in children, if used frequently or in large doses.

Active immunity

the immunity that results from the production of antibodies by the immune system in response to the presence of an antigen. (vaccines)

Passive immunity

the short-term immunity that results from the introduction of antibodies from another person or animal. (mother to infant).

Prodrome phase

time from appearance of non-specific symptoms (fatigue, malaise) to more specific symptoms of the disease. flu like s/s fatigue malaise to rash

Incubation period

time from entrance of pathogen to the first symptom, pathogen actively multiplying

Common treatments and medications for infectious disorders

•Treatments-Hydration(helps with many things)-Fever reduction(decreased 104/105) •Medications-Antibiotics-Antivirals-Antipyretics-Antipruritics

Assessment made during a physical examination- Palpation

-Palpate skin: temperature, texture, turgor, moisture. -Palpate rash.(feel, ex...sandpaper and salmon color as seen in scarlet fever) -Palpate lymph nodes.(how big are they, tender)

Assessment made during a physical examination- Inspection and observation

-Skin(rash, coloration, mites, ticks), mouth(strawberry tongue), throat(white patches, red), and hair(missing hair, lice, nits) for lesions or wounds. -Hydration status(what do they drink) and vital signs.

TRANSMISSION-BASED PRECAUTIONS (TIER TWO)

-These precautions are used in addition to standard precautions for clients with known or suspected infections that are spread in one of three ways: by airborne or droplet transmission, or by contact.

T/F-Neonates may not present with fever; some may be hypothermic.

True

Boosters are needed until about ____

4 years old

Ibuprofen

4-10 mg/kg/dose Only children older than 6 months of age No more than four doses in a 24-hour period

Common laboratory tests for Infectious Diseases

Complete blood count (CBC)-white count Erythrocyte sedimentation rate (ESR)-what kind of toxin C-reactive protein (CRP) Blood culture and sensitivity Stool culture Urine culture Wound culture Throat culture

National Notifiable Diseases

physicians are required to report occurrence Anthrax, Arboviral diseases, California serogroup virus diseases, Eastern equine encephalitis virus disease Powassan virus disease, St. Louis encephalitis virus disease, West Nile virus disease, Western equine encephalitis virus disease, Babesiosis, Botulism, Brucellosis, Chancroid, Chlamydia trachomatis infection, Cholera, Coccidioidomycosis, Cryptosporidiosis, Cyclosporiasis, Dengue virus infections, Dengue shock syndrome, Diphtheria, Ehrlichiosis and anaplasmosis Anaplasma phagocytophilum infection, Ehrlichia chaffeensis infection, Ehrlichia ewingii infection Undetermined human ehrlichiosis/anaplasmosis, Giardiasis, Gonorrhea, Haemophilus influenzae, invasive disease, Hansen's disease, Hantavirus pulmonary syndrome, Hemolytic uremic syndrome, post-diarrheal, Hepatitis A, Hepatitis B, Hepatitis C, HIV infection, Influenza-associated pediatric mortality, Invasive pneumococcal disease, Legionellosis, Listeriosis, Lyme disease, Malaria, Measles, Meningococcal disease, Mumps, Novel influenza A virus infections, Pertussis, Plague, Poliomyelitis, paralytic, Poliovirus infection, nonparalytic, Psittacosis, Q fever, Rabies, animal, Rabies, human, Rubella, congenital syndrome, Salmonellosis, Severe acute respiratory syndrome-associated coronavirus disease, Shiga toxin-producing Escherichia coli, Shigellosis, Smallpox, Spotted fever rickettsiosis, Streptococcal toxic shock syndrome, Syphilis, Tetanus, Toxic shock syndrome (other than streptococcal), Trichinellosis, Tuberculosis, Tularemia, Typhoid fever, Vancomycin-intermediate Staphylococcus aureus and Vancomycin-resistant, Staphylococcus aureus, Varicella, Varicella deaths, Vibriosis, Viral hemorrhagic fever, Crimean-Congo hemorrhagic fever virus, Ebola virus, Lassa virus, Lujo virus, Marburg virus, Yellow fever

Illness phase

signs and symptoms of disease are clearly evident. Red eyes, rash, fever, etc....specific to the disease

Information obtained in health history about Infection in children

•Past medical history, including birth history, family history, immunization status, previous illness, or surgery. •History of current illness (onset, duration, signs and symptoms, any treatments given). •Any signs or symptoms present: fever, sore throat, lethargy, malaise, vomiting , diarrhea, cough, rash. •Any changes in usual behaviors: poor feeding, decreased appetite, increased irritability. •Any known exposure (ill household or school contacts).

Reservoir -defined and nursing implications

A place where the pathogen can thrive and reproduce; examples: human body, animals, insects, food, water, inanimate objects (e.g., stethoscopes) • Control or eliminate reservoirs. • Control sources of body fluids, drainage, or solutions that may harbor pathogens. • Follow institutional guidelines for disposing of infectious wastes. • Provide proper wound care; change dressings or bandages when soiled. • Assist children to carry out appropriate skin and oral care. • Keep linens clean and dry.

Pinworm

Helminthic infections; Some people are asymptomatic. May cause anal itching (pruritus ani), especially at night, some may experience restlessness and teeth grinding at night, weight loss, and enuresis. Transmission is Fecal-oral route directly, indirectly, or inadvertently by contaminated hands or shared toys, bedding, clothing, toilet seats. Incubation period is 1-2 months or longer. Diagnosis: when adult worms are visualized in the perianal region; they are best viewed when the child is sleeping. Very few ova are present in stool, so examination of stool is not recommended. Transparent tape pressed to perianal area and then viewed under a microscope may reveal eggs. Three consecutive specimens should be obtained when the child first awakens in the morning. Treatment of choice is mebendazole, pyrantel pamoate, and albendazole, usually single doses and repeated in 2 weeks. Standard precautions. Good hand hygiene is the most effective preventive measure. All family members should be treated since transmission from person to person is very easy. Infected people should bathe, preferably in a shower, in the morning, which will remove a large portion of the eggs. Frequent changing of underclothes and bedding.

Antipruritics (usually antihistamines)-Actions/Indications Nursing Implications

Given orally or topically to block the histamine reaction Used to relieve discomfort associated with itching • When applying topically, wear gloves. • Do not apply to open wounds. • Oral antihistamines may cause drowsiness.

convalescence phase

acute symptoms begin to disappear. Rash going away

Stages of infectious diseases

1. incubation period 2. prodromal period 3. illness 4. decline 5. convalescence

Acetaminophen

10-15 mg/kg/dose No more than every 4 hours No more than five doses in a 24-hour period

A parent of a young child preparing for an immunization is concerned that the immunization may cause the disease in the child. What is the nurse's best response to the parent's concerns? 1)It's required by law that your child is immunized. 2)Immunizations are developed from an inactive form of the bacteria or virus causing the disease. 3)It's no big deal. 4)This immunization may cause autism.

2). Immunizations are developed from an inactive form of the bacteria or virus causing the disease. Rationale: Immunizations are required for school entry but not required by law—parents may opt out for religious or other reasons. Dismissing the parent's concern does not foster confidence in the healthcare provider. There is no definitive evidence to date linking immunizations with the subsequent diagnosis of autism.

Portal of entry -defined and nursing implications

A way for the pathogen to enter the host; examples: skin and mucous membranes, respiratory tract, urinary tract, gastrointestinal tract, reproductive tract • Use proper sterile technique during invasive procedures. • Provide appropriate wound care. • Dispose of needles and sharps in puncture-resistant containers. • Provide all children with their own personal care items.

Portal of exit -defined and nursing implications

A way for the pathogen to exit the reservoir; examples: skin and mucous membranes, respiratory tract, urinary tract, gastrointestinal tract, reproductive tract • Control portals of exit and educate children and families. • Cover mouth and nose when sneezing or coughing. • Avoid talking, coughing, or sneezing over open wounds or sterile fields. • Use personal protective equipment.

Infectious agent -defined and nursing implications

Any agent capable of causing infection; examples: bacteria, viruses, rickettsiae, protozoa, and fungi Control or eliminate infectious agents through: • Handwashing • Wearing gloves • Cleaning, disinfecting, or sterilizing equipment

Susceptible host -defined and nursing implications

Any person who cannot resist the pathogen • Protect susceptible host by promoting normal body defenses against infection. • Maintain integrity of the child's skin and mucous membranes. • Protect normal defenses by regular bathing and oral care, adequate fluid intake and nutrition, and proper immunization.

T/F- The nurse explains to parents of a child with a fever that antipyretics will help change the course of the infection.

False

Roseola Infantum (Exanthem Subitum or sixth disease)

Caused by human herpes virus 6 (HHV-6); less frequently human herpes virus 7 (HHV-7); Transmission: little is known but suspected to be from saliva of infected person and enters the host through the oral, nasal, or conjunctival mucosa; Peak incidence: age 7-13 months; Incubation period: 5-15 days, average of 10 days; Communicability is unknown, but most likely contagious before symptoms appear Exanthem subitum (roseola infantum). Prodromal phase: usually asymptomatic but may include upper respiratory signs; Clinical illness: high fever ranging from 37.9° to 40°C (101-106°F) for 3-5 days; resolves abruptly; rash appears 12-24 hours later, lasting about 1-3 days. Rash is pinkish red, flat or raised spots that blanch when touched; Course is generally benign. In children who are uncomfortable or irritable or have a history of febrile seizures, antipyretics may be warranted. Complications: HSV-6 may be responsible for some febrile seizures, encephalitis, and meningoencephalitis (rare).

Parvovirus B19 (slapped cheek or fifth disease)

Caused by human parvovirus B19; Transmitted by large droplet spread from nasopharyngeal viral shedding or percutaneous exposure to blood and blood products. Also transmitted from mother to fetus; Peak incidence late winter and early spring; Incubation period: 4-28 days, average 16-17 days; Communicability is uncertain. Prodromal phase: mild symptoms, low-grade fever, headache, mild upper respiratory infection. Characteristic rash occurs in three stages: Begins with erythematous flushing often described as "slapped-cheek" appearance, often with circumoral pallor, Spreads to trunk, Moves peripherally, appearing as a maculopapular, lace-like appearance; often pruritic; Palms and soles are usually spared. Rash fluctuates in intensity and will disappear and reappear with environmental changes such as exposure to sunlight. Resolves spontaneously over 1-3 weeks; Pain or swelling in joints may be present; Children with pre-existing anemias may develop aplastic crisis (will have fever, malaise, myalgia, but usually no rash). Usually benign and self-limited; supportive treatment is all that is needed. Blood transfusion may be necessary in children with aplastic crisis. Complications: arthritis and arthralgia. May result in fetal loss, hydrops fetalis in pregnant woman.

Varicella Zoster (chicken pox)

Caused by varicella zoster virus, human herpes virus 3; Incubation period: 10-21 days, usually 14-16 days, communicable 1-2 days before the onset of rash until all vesicles have crusted over (about 3-7 days after the onset of rash), Prodromal symptoms (fever, malaise, anorexia, headache, mild abdominal pain) may be present 24-48 hours before the onset of the rash. In children, rash is often the first sign of disease. Lesions often appear first on scalp, face, trunk, then extremities; initially intensely pruritic erythematous macules that evolve to papules and then form clear, fluid-filled vesicles. Vesicles eventually erupt, and then lesions scab and crust. More severe in adolescents and adults than in young children. Usually self-limiting; treatment is mainly supportive: fever reduction, antipruritic, and skin care to prevent infection of lesions. Antiviral therapy and varicella zoster immune globulin may be used in those considered to be at high risk (immunocompromised, pregnant women, and newborns exposed to maternal varicella). Routine antiviral therapy is not recommended for the treatment of uncomplicated varicella infection in otherwise healthy children. Complications: bacterial superinfection of skin lesions, thrombocytopenia, arthritis, hepatitis, cerebellar ataxia, encephalitis, meningitis, pneumonia, glomerulonephritis, congenital infection, and life-threatening perinatal infection. Lifelong latent infection occurs; reactivation results in herpes zoster (shingles), uncommon in childhood.

Antipyretics (acetaminophen, ibuprofen)-Actions/Indications Nursing Implications

Decrease the temperature set point (only in a child with a raised temperature) by inhibiting the production of prostaglandins, leading to heat loss (through vasodilation and sweating) and resulting in a reduction in fever Used to decrease temperature in the febrile child who is uncomfortable or who can't keep up with the increased metabolic demands associated with fever • Ensure proper dosing, concentration, and dosing interval. • Avoid aspirin use in children and adolescents. • Avoid ibuprofen use in children with a bleeding disorder. • Assess fever and any related symptoms such as tachycardia, shivering, or diaphoresis. • Properly educate caregivers on appropriate dosing, concentration, dosing interval, and use of accurate measuring device.

air borne precautions techniques

Designed to reduce the risk of infectious agents transmitted by air-borne droplet nuclei or dust particles that may contain the infectious agent. Examples of such illnesses include measles, varicella, and tuberculosis. Techniques include standard precautions as well as: Room with negative air pressure ventilation, with air externally exhausted or high-efficiency particulate air filtered if recirculated; if unavailable, mask the child and place in private room with the door closed. Wear a mask or respirator depending on specific recommendations based on disease, such as if infectious pulmonary tuberculosis is suspected or proven, wear a respiratory protective device, such as an N95 respirator, while in the child's room. Susceptible healthcare personnel should not enter the room of children with measles or varicella zoster infections. Those with proven immunity to these viruses need not wear a mask.

Mode of transmission- defined and nursing implications

Direct transmission: body-to-body contact Indirect transmission: transferred by fomite or vector; spread by droplet or air-borne transmission • Wash hands before and after child contact, invasive procedures, or touching open wounds. • Use personal protective equipment when necessary. • Urge children and family to wash hands frequently, especially before eating or handling food, after eliminating, and after touching infectious material.

Droplet precautions techniques

Intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions. Designed to reduce the risk of infectious agents transmitted by contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large-particle droplets containing pathogens generated from a person (generally through coughing, sneezing, talking, or procedures such as suctioning) who has a clinical disease or who is a carrier of the disease. Examples of such illnesses include diphtheria, pertussis, streptococcal group A, influenza, mumps, rubella, and scarlet fever. Techniques include standard precautions as well as: Private room (if unavailable, consider cohorting children with the same disease. If this is not possible, separation of at least 3 ft between other children and visitors should be maintained.) Wear a mask if within 3 ft of the child.

Antibiotics -Actions/Indications Nursing Implications

Kill and prevent the growth of bacteria Used for treatment of bacterial infections such as sepsis • Check for antibiotic allergies. • Give as prescribed for the length of time prescribed.

Antivirals (e.g., acyclovir)-Actions/Indications Nursing Implications

Kill and prevent the growth of viruses Used for treatment of viral infections such as herpes simplex type 2 • Observe infusion site for signs of tissue damage. • If administering topically, clean and dry area before application and wear gloves. • Give as prescribed for the length of time prescribed.

Pediculosis pubis (pubic lice)

Parasitic infection; Transmission usually occurs through sexual contact, or contact with infected items (ex.. towels). Teenagers and young adults most commonly affected. Pruritus of anogenital area; other hairy areas of the body, including eyelashes, eyebrows, axilla, legs, and beard, can be affected. Diagnosis by identification of eggs, nymph, and lice with the naked eye is possible; adult lice are rarely seen. Same as treatment with pediculicides to treat head lice Retreat 9-10 days later To treat eyelashes and eyebrows: if only a few nits are present remove these with fingernails or a nit comb. Standard precautions. All sexual contacts should be treated simultaneously. Bedding and clothing should be machine washed and dry at a high temperature or bagged for 2 weeks. If found on children, may be a sign of sexual exposure or abuse

Contact precautions techniques

Most important and most common route of transmission of healthcare-associated infections Designed to reduce the risk of infectious agents transmitted by direct or indirect contact. Direct-contact transmission involves skin-to-skin contact and physical transfer of pathogens between a susceptible host and an infected or colonized person. Examples include patient care activities that involve physical contact such as turning and bathing. Direct-contact transmission also can occur between two children, where one serves as the source of infectious pathogen and the other as a susceptible host. Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, in the child's environment. Examples of such illnesses include diphtheria, a pediculosis, scabies, and multidrug-resistant bacteria. Techniques include standard precautions as well as: Private room (if unavailable, consultation with infection control personnel is recommended. Consider cohorting children with the same disease. If this is not possible, separation of at least 3 ft between other children and visitors should be maintained.) Gloves (clean or sterile) should be used at all times. Proper hand hygiene after glove removal Use gloves and gowns for all interactions that involve contact with the child or potentially contaminated areas. Don before entering and remove before leaving the child's room.

Fever based on measurement route.....

Oral: >37.8°C (100°F) Rectal: >38°C (100.4°F) Axillary: >37.2°C (99°F) Tympanic: >38°C (100.4°F) Temporal: >38°C (100.4°F)

Pediculosis capitis (head lice)

Parasitic infection; contact with hair of infested people, Incubation period from laying of eggs to hatching of nymph is 6-10 days; adult lice will appear 2-3 weeks later, Extreme pruritus is the most common symptom, Adult eggs (nits) or lice may be seen, especially behind the ears and at the nape of the neck; Treatment: washing hair with a pediculicide such as permethrin, pyrethrins, lindane, malathion; Retreatment is usually recommended 9 days after first treatment; Contact precautions; Bedmates should be treated prophylactically; Head lice do not survive long once they have fallen off. Washing and drying on hot cycle can prevent reinfection. Or place in a plastic bag for 10 days. Combs and brushes in hot water. Lice infestation is not a sign of poor hygiene; all socioeconomic groups are affected.

passive immunity vs active immunity

Passive: An individual does not produce his or her own antibodies, but rather receives them directly from another source, such as mother to infant through breast milk Active: An individual receives a vaccine that stimulates an actual infection by a pathogen, stimulating the body to produce antibodies for future protection

Rabies

Preventable viral infection of the central nervous system. Zoonotic infection. Transmitted to other animals and humans through close contact with the saliva of a rabid animal, usually by a bite. Rare due to vaccination of domestic animals. Most cases in these areas are due to wild animals such as raccoons, skunks, bats, mongooses, and foxes. Most cases of rabies occur in children younger than 15 years of age, and most human deaths occur in Asia and Africa. The incubation period for rabies is extremely variable. Typically it is 1 to 3 months but can range from days to years. The incubation period tends to be shorter in children. Once symptoms of rabies have developed, the prognosis is poor. Death usually occurs within days of the onset of symptoms. Prevention is of paramount importance, and eliminating infection in animal vectors is essential. Rabies immune globulin and the first dose of rabies vaccine should be given as soon as possible after exposure, ideally within 24 hours. Additional doses of rabies vaccine should be given on days 3, 7, and 14 after the first vaccination. Administered intramuscularly into the anterolateral thigh or deltoid, depending on the age and size of the child. Administration into the gluteus muscle should be avoided, since this site has been associated with vaccine failure. Few people survive once symptomatic rabies infection develops. Intensive supportive care is required, but recovery is extremely rare. Therefore, it is vital to educate children and families about the importance of seeking medical care after any animal bite to prevent death from rabies infection.

Rubella (German Measles)

Rash starts from head goes to foot(disappears same order), low grade fever, malaise, upper respiratory symptoms, mild pruritus, Usually mild and self-limiting, Treatment is mainly supportive. Complications: encephalitis and thrombocytopenia (rare) Maternal rubella during pregnancy can result in miscarriage, fetal death, or congenital malformations. Transmission: by direct or indirect contact with droplets, primarily by nasopharyngeal secretions, but also in blood, stool, and urine. Also transmitted from mother to fetus, Peak incidence: late winter and early spring, Incubation period: 12-23 days (usually 14), Communicable: 7 days before to 7 days after onset of rash

Lyme disease

The most common reported vector-borne disease in the United States, is caused by the spirochete Borrelia burgdorferi. Transmitted to humans via the bite of an infected black-legged (deer) tick. Lyme disease can affect any age group, but the incidence is highest among children between 5 and 9 years of age. The prognosis for recovery in children who are treated is excellent. In most cases Lyme disease can be cured by antibiotics, especially if they are started early in the illness. Doxycycline is the drug of choice for children older than 8 years. Because of the risk that it can cause permanent discoloration of the teeth, children younger than 8 years should be treated with amoxicillin. For children allergic to penicillin, cefuroxime axetil can be used. Duration of treatment is usually 14 to 28 days, depending on the stage of disease. The clinical signs of Lyme disease are divided into three stages—early localized, early disseminated, and late disease. Observe for a rash. A ring-like rash at the site of the tick bite (erythema migrans) characterizes early local disease. If untreated, the rash gradually expands and will remain for 1 to 2 weeks. Immunoglobulin-specific antibody tests may not be positive in the early stage of the disease but may be useful in the later stages. The CDC recommends a two-step test—a sensitive enzyme immunoassay (EIA) or immunofluorescent assay (IFA), if positive, followed by a Western immunoblot. Prompt removal of ticks is essential to the prevention of Lyme disease.

Erythema Migrans

a ring-like rash at the site of the tick bite, occurs in Lyme disease.

Infants younger than 3 months of age with a rectal temperature greater than 38°C should be seen by a physician or nurse practitioner. What are they at risk for....

They are considered at risk for sepsis until proven otherwise due to their immature immune system and inability to localize or handle infection very well

STANDARD PRECAUTIONS (TIER ONE)

This tier of standard precautions applies to all body fluids (except sweat), non intact skin, and mucous membranes. A nurse should implement for all clients

T/F - Sexually transmitted diseases confirmed in a child must be reported as a form of child abuse.

True

T/F- Never give aspirin to children to reduce fever, due to the risk of Reye syndrome.

True

T/F- Pepto and Alka-Seltzer contains aspirin.

True

T/F- The young infant will benefit from the use of oral sucrose and nonnutritive sucking before and during the capillary puncture.

True

Tick removal technique

Use fine-tipped tweezers. Protect fingers with a tissue, paper towel, or latex gloves. Grasp tick as close to the skin as possible and pull upward with steady, even pressure. Do not twist or jerk the tick. Once the tick is removed, clean site with soap and water, rubbing alcohol, or iodine scrub and wash your hands. Save the tick for identification in case the child becomes sick. Place in a sealable plastic bag and put it in your freezer. Write date of bite on the bag.

The nurse is caring for a toddler who is 2 years old and 28 lb. The order reads Ibuprofen 100 mg po every 6 hours as needed for temperature greater than 38°C. Is this a safe and effective dose?

Yes

The nurse is assisting with lab testing to measure the type of protein produced in the liver that is present during episodes of acute inflammation. Which of the following tests is the nurse performing? a. complete blood count b. erythrocyte sedimentation rate c. C-reactive protein d. blood culture and sensitivity

c. C-reactive protein. C-reactive protein measures the type of protein produced in the liver that is present during episodes of any acute inflammation. Rationale: Complete blood count evaluates white blood cell count. Erythrocyte sedimentation rate determines the presence of inflammation or infection. Blood culture and sensitivity detects the presence of bacteria or yeast and what antibiotics they are sensitive to.

Key teaching points for a child with an infectious disease

•Assess child's and family's willingness to learn. •Provide family with time to adjust to diagnosis. •Repeat information. •Teach in short sessions. •Gear teaching to level of understanding of the child. •Provide reinforcement and rewards. •Use multiple modes of learning involving many senses.

Nursing interventions to promote comfort for a child with an Infectious Disease

•Assess pain and response to interventions frequently. •Administer analgesics and antipruritic as ordered. •Apply cool compresses or baths to areas of pruritus. •Provide fluids frequently. •Provide cool mist humidification. •Dress the child in light clothing if febrile. •Use diversional activities and distraction.

Managing fever in a child with an infectious disease

•Assess temperature at least every 4 to 6 hours, 30 to 60 minutes after antipyretic is given and with any change in condition. •Use same site and device for temperature measurement. •Administer antipyretics per physician order when the child is experiencing discomfort or cannot keep up with the metabolic demands of the fever. •Notify physician of temperature per institution or specific order guidelines. •Assess fluid intake and encourage oral intake or administer intravenous fluids per physician order. •Keep linens and clothing clean and dry.

Types of infectious diseases

•Bacterial infections (e.g., sepsis) •Viral infections (e.g., viral exanthems and rabies) •Zoonotic infections (e.g., rabies) •Vector-borne infections (e.g., Lyme disease) •Parasitic and helminthic infections (e.g., pediculosis capitis [head lice] and roundworm, respectively ) •Sexually transmitted infections (e.g., chlamydia, HIV)

Laboratory and diagnostic tests ordered for Sepsis

•Complete blood count: WBC levels will usually be elevated. •C-reactive protein: elevated. •Blood culture: positive in septicemia. •Urine culture: may be positive. •Cerebrospinal fluid analysis: may reveal increased WBCs and protein and low glucose. •Stool culture: may be positive for bacteria or other infectious organisms. •Culture of tubes, catheters, or shunts suspected to be infected. •Chest radiograph: may reveal signs of pneumonia.

Pediatric Physiology and Immune System with infection in children

•Due to the immature responses of the immune system, infants and young children are more susceptible to infection. •The newborn displays a decreased inflammatory response to invading organisms, contributing to an increased risk for infection. •Cellular immunity is generally functional at birth, and humoral immunity occurs when the body encounters and then develops immunity to new diseases. •Since the infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies, the risk of infection is higher. •Disease protection from immunization is incomplete.

Methods of Preventing Infection Disease

•Hand washing •Adequate immunization •Proper handling and preparation of food •Judicious antibiotic use(should not be given for viruses)

Chain of infection

•Infectious agent •Reservoir •Portal of exit •Mode of transmission (contact) •Portal of entry (how someone else will get infection) •Susceptible host

Role of immunizations in preventing Childhood Infections

•Many childhood diseases (both viral and bacterial) can be prevented with adequate immunization. •Many vaccinations require multiple doses. •Immunizations can prevent:-diphtheria, pertussis, tetanus (DTP) -mumps, measles, rubella (MMR)-varicella-poliomyelitis-others

Nursing interventions to promote skin integrity.

•Monitor skin for color changes, temperature, redness, swelling, warmth, pain or signs of infection, changes in rash lesions, distribution, or size. •Encourage fluid intake and proper nutrition. •Keep child's fingernails short. •Encourage child to press on rather than scratch the area of pruritus. •Use antipruritics and topical ointments or creams as ordered.