The Child with an Infectious Disease
*Describe the Catarrhal, Paroxysmal, and Convalescent stages of Pertussis?
-Catarrhal: duration: 1-weeks symptoms: upper respiratory tract infection (rhinorrhea, lacrimation, mild cough, low grade fever) -Paroxysmal: -duration: 2-4 weeks or longer -symptoms: increased severity of cough, repetitive series of coughs during single expiration, followed by massive inspiration with a whoop (may not be seen in older children), cyanosis, protrusion of tongue, salivation, distention of neck veins. Coughing spells may be triggered by yawning, sneezing, eating, or drinking. Coughing may induce vomiting -Convalescent: -duration: 1-2 weeks -symptoms: episode of couching, whooping, and vomiting that decreases in frequency and severity. Cough may last for several months
*Presence of Koplik spots are found in which disease? Describe Koplik spots?
-Rubeola (Measles) -spots found on buccal mucosa (under bottom lip) -*begins behind ears, at hairline, and on upper neck and spreads downward toward feet -red, maculopapular rash that gradually turns brownish -duration 6-7 days (begins around face, then spreads toward feet)
Explain shingles?
-Shingles: reactivation of varicella zoster virus including burning, tingling, itching, sharp knifelike prickling, or deep pain. May also be enlargement of lymph nodes. Risk factors are hx of chicken pox, 50 yrs old, weakened immune system, stress trauma, and being treated for cancer
*Explain Rickettsial (Rocky Mountain Spotted Fever)?
-are transmitted from person to person -reservoir: wild rodents or dogs -transmitted via bite of infected tick (vector) -season: April though October -no vaccine -onset marked by nonspecific signs and symptoms such as headache, fever, anorexia, ad restlessness -maculopapular or petechial rash appears on third day -rah begins on extremities such as wrists, palms, ankles, and soles and spreads to rest of body -hemorrhagic and necrotic lesions appear as rash progresses -Treatment: -early detection and treatment within 5 days of beginning of illness -Doxycycline is recommended treatment with a fluoroquinolone as alternative -treatment lasts 7-10 days -use Doxycycline with caution in children younger than 8 due to staining of teeth -if vascular damage has occurred drugs may not work -Nursing Care: -obtain hx if skin eruptions, exposures, medications, and recent hiking -assess body temperature and other vital signs -use straws to flush tetracycline because of risk of staining of teeth -give full course of antibiotics
*Explain Neonatal Sepsis?
-cause includes strep, E. coli, and Staph -transmitted via placental, perinatal, postnatal fro other or environment -serious bacterial illness found in infants-3 months old -occurs when endotoxins gain excess to bloodstream causing systemic signs and symptoms -evaluation of sepsis is difficult because of the frequent nonspecific subtle signs and symptoms of the infant -infants beyond newborn period expression serious illness -primary sign of serious bacterial illness is fever -*infants younger than 3 months with temp equal to or higher than 100.4 should be seen -approach to evaluate infant for sepsis is called sepsis or septic workup including sings, hx, and lab findings -diagnostic tests such as CBC, WBC, CRP, and lumbar puncture should be obtained in the symptomatic neonate -Nursing Care: infants who appear well, no signs of infection, normal lab tests may be treated on outpatient basis with long acting antibiotic such as ceftriazone (make sure to follow up within 24 hrs) -High risk febrile infant need hospitalization for IV antibiotics
*Explain Scarlet Fever?
-cause: group A strep -transmitted via airborne (inhalation or ingestion), direct contact -immunity: none -season: late fall, winter, and spring -symptoms: abrupt fever, vomiting, headache, abdominal pain, pharyngitis, and chills characterize onset -fever reaches peak by second day and returns to normal within 5 to 6 days -within 24 hrs a fine red papular rash appears in the axillae, groin, and neck which feels like sandpaper -rash then spreads peripherally to cover entire body -*rash will blanch except in areas of deep creases (Pastia's sign) -Desquamation (peeling) may begin on face at end of first week, and flaking proceeds down the trunk and may continue for up to 6 weeks -tongue may have white, furry covering with red projecting papillae (white strawberry tongue_ -by fourth day the papillae slough off leaving red swollen tongue (strawberry tongue) -tonsils are edematous and may be covered with a gray-white exudate which may spread to the pharynx -petechial hemorrhages cover soft palate Complications: sinusitits, otitis media, mastoiditits, peritonsillar abscess, bronchopneumonia, meningitis, osteomyelitis, rheumatic fever, and glomerulonephritis -Treatment: -rapid streptococcal screening with lab throat culture confirmation if rapid screen is negative for all children with sore throats to rule out viral sore throat -preferred treatment is for strep infection is penicillin -children allergic to penicillin give erythromycin -children with strep throat may return to school 24 hrs after beginning antibiotics -*droplet precautions should take place until child has been on antibiotics for 24 hrs -Nursing Care: -assess child's throat, tongue, rash, nutritional and fluid intake, vital signs, and level of general wellness. Note allergies to penicillin -children with scarlet fever are cared for a t home with fluids (cool nonacidic liquids), and administering antipyretics for fever -analgesics given for discomfort and antipruritic, teach to complete full dose of antibiotics, and stay on be rest and quiet activities
*Explain Methicillin-resistant staph aureus (MRSA)?
-cause: staph gram positive -transmitted via contact -common in ICU settings -HA-MRSA is often cause of medical device related infections, pneumonia,, and catheter related bloodstream infections -CA-MRSA is often caused by skin and soft tissue infections (furuncles, carbuncles, and abscesses) and less commonly UTIs, pneumonia, and bacteremia -risk factors for MRSA include chronic illness, immunocompromised status, participating in close contact sports, and daycare centers -Treatment: -HA-MRSA: includes after incision and drainage of lesions or abscess give IV vancomycin or linezolid. For severe infections, IV vancomycin is used -CA-MRSA: for skin and tissue infections acquired in the community, culture and sensitivity is recommended. Antibiotics should not be given unless severe disease is present, infection progresses rapidly, or wound does not respond to incision and drainage alone -if necessary treat CA-MRSA with a 5 to 10 day course of oral clindamycin, sulfamethoxazole trimethoprim, tetracycline, or linezolid -patients who are colonized should disinfect their body using chlorhexidine gluconate and nasal mupirocin -Nurse Care: -educate to use proper hand hygiene -athletes should avoid sharing personal equipment and choices must ensure that all equipment is cleaned -early identification of cases are vital to prevent spread in hospital setting
*Describe Roseola Infantum (Exanthem Subitum)?
-caused by human herpesvirus 6 (HHV-6) -transmitted via contact with secretions (saliva, CSF) -occurs in children 6-18 months -child has sudden high fever (103F-106F), malaise, and irritability but may remain active and alert -child may also have mild cough, runny nose, abdominal pain, headache, vomiting and diarrhea -intermittent or constant fever may persist for 3-5 days. After fever rash appears -rash appears rose-pink with maculopapular or macules that blanch -rash occur around neck and trunk and surrounded with whitish ring -complications uncommon -febrile seizures may occur -Treatment: fever control, antipyretic meds, decreased clothing, cooler temp, and increased fluid intake -make sure family knows how to use thermometer -*avoid any form of aspirin (risk for reye's syndrome) -teach about seizure precautions
*Explain Borrelia Infections?
-diseases caused by Borrelia are relapsing fever and Lyme disease -transmitted by a spiral bacteria from an arthropod
*Describe Immunity?
-either active or passive -active immunity: occurs as a result of immune system stimulation from exposure to antigens wither naturally or through vaccines -passive immunity: form of infection protection acquired though administration of serum containing antibodies
Describe infection and host defenses?
-first stage of infection begins with colonization of the host by the pathogen -first line of defense in the innate immune system are the skin and mucous membranes
*What should the nurse teach the family in regards to how to care for the child with an Infection?
-signs and symptoms of hyperthermia and complications that should be reported such as visual disturbances, headache, nausea, vomiting, muscle flaccidity, absence of sweating, delirium, and coma -teach to use acetaminophen r ibuprofen for fever control -avoid aspirin to avoid developing reye's syndrome -max dose of acetaminophen a child 2 to 3 yrs old should be 160 mg
*Explain patient teaching for how to care for the child with a Viral Exanthem?
-for elevated temperature, restrict child activities to quiet activities and bed rest -control fever with acetaminophen or ibuprofen, sponge baths, decreased clothing, decreases temperature, and increased fluid intake. Change linens frequently -lukewarm baths should help relieve itching -avoid use of topical corticosteroid unless prescribed -avoid wool and scratchy materials that are irritating -coughing can be managed with cool humidification of the room and antitussives -for arthralgia give anti-inflammatory meds -keep room dimly lite due to photophobia -increase fluid intake and give soft bland foods if mucous membranes are involved
*How to care for the child with Scarlet Fever?
-give entire course of antibiotics -cool drinks and ice pops and milkshakes are soothing and help with hydration -acetaminophen, ibuprofen, throat lozenges, antiseptic throat spray, and cool mist relieve discomfort -encourage quiet activities -avoid acidic preparations and give saline to rinse moth -soft, bland diet should be offered -call doctor if child develops drooling or has trouble swallowing -after 48 hrs fever child should not have fever 0after 24 hrs of antibiotic therapy, child should not longer by contagious. The rash is not contagious
*Explain Clostridium difficile?
-gram positive bacteria -transmitted via contact fecal-oral route -common cause of diarrhea in infants and children -children 1-4 most affected -some children may be asymptomatic, others may have watery diarrhea, abdominal cramps, fever, and systemic toxicity -C-diff associated with antibiotic administration in young children and its growth is from reduction in normal bowel flora -symptoms begin while child receiving antibiotics and after course is complete -complication occur in immunosuppressed pts causing inflammatory bowel disease and intestinal perforation and toxic megacolon -Treatment: -Dx through identifying toxin in stool -infants younger than 12 months have C-diff in their gastrointestinal tract and are asymptomatic. Infants this age are not tested for C-diff -initial treatment is cessation of antibiotic -almost all antibiotics can cause C-diff diases (CDAD), clindamycin, third generation cephalosporins, and penicillin's are most common -antibiotics used to treat C-Diff are oral metronidazole for mild to moderate cases and vancomycin for severe disease -Nursing Care: -place on contact precautions -*use proper hand hygiene (using soap and water) not alcohol based hand sanitizer -parents should be taught to use bleach based products if necessary
*Describe Bacterial infections?
-gram positive can cause chronic inflammation of dermal tissue, fever and shock -gram negative bacteria have thinner cell wall -exotoxins are highly poisonous -endotoxins can cause fever, shock, and DIC
*Explain Varicella-zoster (chickenpox, Shingles) Infection?
-infectious 1-2 days before rah until lesions have dried up (5-7 days) -transmitted via direct contact, droplet, airborne -immune via natural disease or varicella vaccine -can get in late winter through early spring -primary infection with varicella-zoster virus causes chickenpox -shingles common in elderly, adolescents and young children -during 24-48 hrs before lesion, symptoms include slight elevated temperature, malaise and anorexia -rash first appears on trunk and scalp followed by appearance of lesions which become teardrop vesicles with an erythematous base. Vesicles then become pustular then becoming dry and crusty -lesions appear in crops for 3-4 days -children with secondary cases have more extensive rashes than children with primary cases -lesions may appear on the mucous membranes in the mouth, genitals, and rectum -second attacks are rare and occur in immunocompromised children -Complications: most common is secondary bacterial infection of skin lesions. Staph and group A strep are common causes. Other include CNS, encephalitis with ataxia, tremor, seizures, and nystagmus in first week. Reye's syndrome has been known to occur after varicella infection. *Avoid any form of aspirin (immunocompromised children who contract varicella may have large hemorrhagic lesions. Primary varicella pneumonia is a frequent complications) -Treatment: -frequent bathing in oatmeal bath and use of antihistamines (relieve itching) -use acetaminophen to control fever rather than aspirin -use acyclovir for severe cases -start antiviral drugs early in the illness -in hospital place child in private room with strict isolation (airborne and contact precautions) -varicella vaccine should be given to healthy nonimmune child 1 yrs of age or older immediately after exposure and before 3-5 days (will reduce severity of disease) -*primary prevention includes screening and administering the vaccine at routine well child visits -vaccine should be given at any visit on or after first birthday without hx of disease ir immunization -in the hospital all contaminated items should be bagged and labeled before processing -wash hands before and after contact with child -hospitalized children should be kept on strict isolation for 8-21 days after onset of rash -neonates born to mothers with active varicella should be placed on strict isolation
*Describe Fifth Disease (Erythema Infectiosum)?
-infectious for 5-12 days before rash appears -transmitted via airborne, droplets, blood, blood products, transplacental transmission -immunity via natural disease -seasonal: winter and spring -common in children 5-14 yrs -child infectious before symptoms appear and may have headache, runny nose, malaise, and mild fever -symptoms are mild and child may appear well but has a rash appearing on the cheeks resembling a slapped cheek -lacy rash on the trunk, arms, and legs appear 1 to 4 days after facial rash appears -rash fades resulting in lacy appearance -characteristics are preceded by a low grade fever lasting 5-7 days -no treatment necessary -once rash occurs children are no longer contagious -contact provider if, rash becomes itchy, child develops fever over 101, your child is getting worse, have other concerns -lasts 2-39 days and can reappear by environmental factors like heat, exercise, warm baths, rubbing of skin, and stress -Complications: not usually reported because disease is mild -pregnant women with 5 disease should seek care -Treatment: disease is benign and self limiting. Treatment is symptomatic and supportive
*Describe Viral Exanthems?
-virus either containing DNA or RNA -can be triggered by stress such as herpes resulting in cold sores -exanthema is an eruption or rash on the skin -children with typical uncomplicated viral exanthems are usually cared for at home -hospitalization occurs when the exanthema is associated with a severe disease or complications occur -nurses who care for hospitalized children with infectious diseases should not care for other immunosuppressed children Ex: Rubeola (measles), Rubella (German measles), Fifth disease (parvovirus B19), Roeola infantum, Enterovirus infection (Coxsackievirus), Varicella-zoster (chickenpox), and Herpes zoster
Preventive measures to avoid insect and tick bites?
-wear long sleeves -use repellents that contain diethyltoluamide (DEET) -use in caution with infants because of risk of encephalopathy
*Describe Rabies?
-infectious period 10 days in infected animal -transmitted via bites from contaminated saliva, scratches fro claws, airborne, and transplantation of corneas -immunity: via vaccine -commonly found in skunks, bats, raccoons, foxes, squirrels, and woodchucks -slowly developing infection -bites on the lower extremities like the feet have longer incubation periods -incubation periods are short in children -there is vague signs and symptoms such as child not feeling well, or having sore throat, headache, fever, discomfort at site of bite, hyperactivity, anxiety, muscle spasms, or convulsions -decreased ability to swallow leading to drooling or aspiration (hydrophobia) -once symptoms appear the disease lasts 5-6 days progressing to death -Treatment: preventative -bite wound should be cleaned with copious amounts of soap and water and human rabies immune globulin HRIG is given. One half of dose is infiltrated locally around wound and other is given IM -vaccine should be given as early as possible after exposure within 24 hrs. Additional amounts of the vaccine are given into the deltoid muscle on days 3, 7, 14, and 28 days after first vaccine -rabies vaccine is only vaccine that can be given after exposure -Nursing Care: complete hx obtained including type of animal and examine wounds -for child who needs to receive several vaccinations help them practice on doll prior to giving to relieve anxiety -primary prevention: teaching children to avoid touching unknown animals -for child who develops rabies: support child and family through the dying process. Child is placed on strict isolation and standard precautions.
*Describe Rubeola (Measles)
-infectious period ranges from 3-5 days before appearance of rash to 4 days after appearance of rash -transmitted by direct contact with droplets or airborne -immune by natural disease or live attenuated vaccine -seasonal late winter and spring -respiratory symptoms appear after 10 days -children have prodrome period with fever with three C's (coryza; profuse runny nose, cough, and conjunctivitis) that lasts 1-4 days -Koplik spots appear 2 days before appearance of rash -Koplik spots are small, blue white spots with a red base that cluster near the molars on the buccal mucosa -Koplik spots last 3 days -when prodromal symptoms reach peak, exanthema appears and looks like a deep red, macular rash that begins on the face and neck and spreads down the trunk and extremities to the feet -rash blanches and turns a brown color and lasts 6-7 days -partially immune child such as 9 month old who has passive immunity may contract modified measles -Complications: respiratory involvements, secondary infections such as otitis media, bronchopneumonia, laryngotracheobronchitis (croup), premature birth, and miscarriage in pregnant women -Treatment: symptomatic. If hospitalized, child is placed on airborne precautions. During febrile period, child should be restricted to quiet activities and bed rest. Fluids are encouraged, and humidification and antitussives are used to relieve cough. *Vitamin A supplementation is recommended in certain more severe cases of measles. Children should receive two doses of measles, mumps, and rubella (MMR) vaccine to be fully protected. First MMR receive at 1 yr of age, second at 4-6 yrs -these is slight risk of fever and febrile seizures 7-10 days after vaccination in children 12-24 months old when taking MMR combined
*Describe Rubella (German Measles, 3-Day Measles)?
-infectious period ranges from 7 days before onset of symptoms t 14 days after appearance pf rash -transmitted via airborne or direct contact with droplets, transplacental transmission -immunity via natural disease or live vaccine -seasonal: late winter and early spring -mild disease for children and adults -rash is produced after 14 to 16 days of infectious period -young children or asymptomatic until appearance of rash -older children may report profuse nasal drainage, diarrhea, malaise, sore throat, headache, low grade fever, polyarthritis, eye pain, aches, chills, anorexia, and nausea -children get impressive posterior cervical, posterior auricular, and occipital lymphadenopathy -rash looks like a pinkish rose maculopapular exanthema that begins on the face, scalp, and neck -rash spreads downward to include entire body within 1-3 days -when rash spreads to trunk rash on the face fades -Petechiae spots such as red or purple color and pinpot size may appear on the soft palate known as Forchheimer's sign -Complications: arthritis and arthralgia occurring most often in women. Mild thrombocytopenia may occur and encephalitis as well -consequences are severe when it reaches the fetus during maternal infection -most devastating form of rubella is congenital rubella (occurring first 12 weeks of pregnancy) -most common manifestation of congenital rubella is intrauterine growth retardation in which infant weighs less than 2500 g and have failure to thrive during infancy -common causes of death include pneumonia, heart defects, encephalitis, and immune deficiency -Treatment: -exclude affected children from school or child care for 7 days after rash begins -infants with congenital rubella are contagious until 1 yrs old or cultures of the rubella viruses are negative -primary prevention includes the rubella vaccine with MMR
*Explain how to care for the child with infectious mononucleosis?
-prolonged rest during acute stage -acetaminophen for fever and large tonsils -activity restriction (due to enlarged spleen) -prepare for gradual recovery (fatigue common) -encourage hydration -give soothing liquid, bland foods, and milkshakes for sore throat -anxiety common die to missed school work. Arrange for homebound school programs -prepare parents for a lengthy recovery (baby sitting arrangements, and decrease in lost income and job security)
*Explain Roseola Infantum Rash Distribution?
-rash appear several hours to 2 days after fever subsides -erythematous maculopapular or macular rash surrounded by whitish ring -blanches with pressure -predominantly on neck and trunk -usually persist for 24-48 hours
*Explain Scarlet Fever Rash distribution?
-red, fine, popular rash appears within 24 hrs of fever -in dark skin rash is seen as punctate popular elevations -begins in axillae, groin, and neck and spreads to cover entire body -desquamation begins on face at end of first week and flaking proceeds down trunk (may last up to 6 weeks) -tongue: initially white, furry coat with red, projecting papillae (white strawberry tongue) by fourth day white sloughs off leaving red, swollen tongue (strawberry tongue)
*Explain Enterovirus infection (Coxsackievirus)?
-spread via fecal-oral and possibly oral (respiratory) route -infection most common in summer and fall -symptoms found in infants and children include respiratory, gastrointestinal, cardiac, neurologic, skin, oral, and eyes symptoms -common pattern in young children is hand-foot-and-mouth disease caused by coxsackievirus A16 -*inflammation and lesions in the mouth, on the palms of hands, and soles of feet, along with mild fever, and small lesions on buttocks are common -lesions become vesicular over several day and resolve in a week -if lesions appear in the oropharynx child may refuse to eat or drink -risk for dehydration in very young children -complications include young infants with hx of prematurity are at high risk from complications like myocarditis, hepatitis, and encephalitis -mortality higher for coxsackievirus B virus and lower for coxsackievirus A -enteric contact precautions should be used for infected infant and children -emphasize importance of hand hygiene after going to the bathroom -parent can provide comfort with acetaminophen and cool liquids -milk based ice cream is palatable -extensive orophryngeal lesions that prevent oral intake can be treated with salt and water mouth rinse or lidocaine gel, diphenhydramine liquid, and a liquid antacid -treatment of enterovirus can be challenging because of the wide variety of signs and symptoms
*Describe Gonorrhea?
-transmitted 3 ways: -perinatally: (during birth from mother, by premature rupture of membranes, aspiration of vaginal secretions leading to sepsis, through direct contact through the conjunctiva, or through direct contact of a fetal scalp electrode) -sexual abuse: child with positive culture and without voluntary sexual hx should be considered potential abuse victim -voluntary sexual activity: primary route among adolescents -symptoms: ophthalmia neonatorum : most common type of gonorrheal infection in the infant occurring 1-4 days after birth -thick purulent discharge from eyes which can progress to corneal ulceration, rupture, and blindness -ophthalmia neonatorum treated through prophylactic treatment with ophthalmic antibiotic given immediately after birth -in older children ophthalmic infection can be result of self inoculation from the genital site -girls with gonorrhea have purulent vulvo vaginitis whereas boys have urethritis -hx of purulent discharge with burning on urination is often elicited -serious complication is pelvic inflammatory disease PID infection of female upper genital tract -PID can lead to ectopic pregnancy and infertile, and chronic pelvic pain -Treatment: -testing should be done for hepatitis B, HIV, syphilis, and Chlamydia infection as well -cefixime, ceftriaxone, and cefotaxime for newborns are recommended -pts would be treated with azithromycin or doxycycline for chlamydia infection
*Explain Lyme Disease?
-transmitted bite of infected tick -season: April and October -lyme disease affects the skin, musculoskeletal, cardiovascular, and nervous systems -s/s 3 stages: - early localized stage: -skin lesions prominent. There are vague, flulike symptoms, headache, chills, fatigue, and vague muscle aches and pains -erythematous macule or papule forms at site bite within 3-30 days -bulls eye rash that itches, prickles or burns lasting 3-4 weeks -early disseminated stage: -cardiac and neurologic findings are prominent -occurs 1-4 months after bite -CNS symptoms include severe headaches with myelitis, nausea, vomiting, facial nerve paralysis (Bell's palsy), forgetfulness or decreased concentration, cerebral ataxia, general lymphadenopathy and joint muscle pain -Lyme arthritis affects large joints with knee being most involved -children can get carditis -signs and symptoms resolve over few days but many pts have recurrences -lesions may recur but are smaller than initial ones -late disseminated: arthritis is main symptom -occurring months to years after bite -occurs intermittently and include chronic arthritis, proud fatigue, ad chronic neurologic symptoms -debilitating effect affect child's ability to participate in normal activities because of extreme fatigue or cardiac complications -Treatment: -early identification and treatment with antibiotics -course of doxycycline, amoxicillin, or cefuroxime is common oral treatment -treatment is usually 14-21 days -IV ceftriaxone or penicillin used for neurologic or cardiac symptoms -if identified early and treated, does not progress -the bull's eye rash and other symptoms leads to dx except when child has atypical manifestation (one septic joint, usually the knee) -Nursing Care: Because ticks must be attached or longer than 24 hrs to transmit disease, parents should be vigilant in inspecting the skin after exposure to wooded area -fever, headache, and arthralgia treat with antipyretics and analgesics
*Describe Herpes Simplex Virus?
-transmitted by direct sexual contact -type 2 is the main cause of genital herpes -lesions are painful and may bring about discharge occur on the vulva, perineum, perianal area or the in the vagina and on the cervix where they cannot be seen -vesicles erupt, rupture, and then ulcerate over 1-7 days -virus is shed for 2-3weeks -flu like symptoms such as fever, malaise and enlarged lymph nodes occasionally accompany vesicle eruption -virus can reappear to stressful triggers -Treatment: -viral culture can confirm dx -acyclovir (Zovirax) can diminish symptoms and reduce shedding -infected infants are treated with parental acyclovir (Zovirax) and those with ocular involvement receive a topical ophthalmic drug -adolescents treated for 7-10 days with oral acyclovir, valavyclovir, or famciclovir -pts should refrain from sex for several weeks until all lesions are healed
*Describe the Human Papillomavirus?
-transmitted by sexual contact and perinatal contact during delivery -warts -children with anogenital warts should be investigated for sexual abuse -can get through aitoinoculation fro mother body sites. -all it takes is a break in the skin -anogenital warts begin s small papules that grow into soft clustered lesions -found in moist areas like the labia minora, vagina, cervix, anus, rectum, and penis glans -HOV types such as HPV-6 and HPV-11 are associated with genital warts and do not cause cancer -common warts like the ones you get on your fingers or soles of feet resolve in a few years for children -adolescents clear low risk types in 4-5 months and high risk types in 8-10 months -Treatment: gels or creams (imiquimod, cryotherapy, electrocautery) and laser treatment or surgical removal -transmission decreased with condoms -screening for cervical cancer with Pap smears can detect cervical cancer in early form and prevent progression to cervical cancer -females ages 11-12 should be immunized with either the quadrivalent or bivalent vaccine -males should receive the quadrivalent vaccine (both given in a 3 dose series)
*Explain Fungal infections?
-transmitted through inhalation or penetration of tissue -fungi grow slowly -they are aerobic and are resistant to most antibiotics -exit in 2 forms: molds and yeast -they are: -opportunistic: defect in host -systemic: involving deep tissues or organs -subcutaneous: limited to deep tissue -superficial: limited to kin, hair, and nails ex: tinea captitis, tinea pedis and candidal infections
*Describe Bacterial Vaginosis?
-transmitted through sexual contact because it is uncommon in females who are not sexually active -bacterial vaginosis can occur with infections that come from vaginal discharge (trichomoniasis) -common diagnosis in adolescent girls who are sexually active -characterized by a profuse, white, malodorous (fish smell_ vaginal discharge that sticks to vaginal walls -may be asymptomatic and is not associated with pain, rashes, itching or painful urination -sexually active adolescents with bacterial vaginosis should be tested for other STDs since it usually doesn't occur alone -Bacterial vaginosis is a risk factor for PID (pelvic inflammatory disease) -in a perpubertal girl: bacterial vaginosis is caused by poor hygiene, vaginal foreign body, or other infections -Treatment: -responds well to oral metronidazole or to vaginal gels and creams (5-7days administration) -clindamycin cream may alter effectiveness of condoms for 72 hrs due to it having oil in it -*male partners do not need to be treated, but pts should be aware of the risk of recurrence
What are roundworms?
-transmitted via ingestion of eggs from soil or food transfer to mouth from fingers, toys, or other vectors -causes abdominal pain, distention, abdominal obstruction, vomiting with bile staining, pneumonitis
What are pinworms?
-transmitted via ingestion or inhalation of eggs, transfer from hands to mouth -causes nocturnal anal itching, sleeplessness
*Explain Mumps?
-transmitted via airborne droplets, saliva, and possibly urine -immune via natural disease or live attenuated vaccine -season: late winter and spring -prodromal s/s: fever, myalgia, headache, ,and malaise -clinical sign of a parotid glandular swelling (parotitis) follows prodromal s/s. Some pts have no swelling -parotid swelling may be accompanied by a fever -complications: mumps affect salivary glands or organs. Most common complication is aseptic meningitis in CSF (CNS involvement) -Signs of CNS symptoms: nuchal rigidity, lethargy, and vomiting (children with these s/s usually completely recover) -less common complication is meningoencephalomyelitis -*most serious complication is orchitis (inflammation of the testis) seen in adolescent boys (sterility is uncommon) -although rare, mumps can cause ovarian or breast inflammation in postpubertal girls or sensorineural hearing impairment -Treatment: -*droplet precautions until 9 days after onset of parotid swelling -*avoid aspirin -orchitis requires bed rest, intermittent application of ice packs, emotional support -CNS complication require neurologic evaluations and vital sign measurement -Nursing care: obtain hx of onset of symptoms, examine child's ear and throat, and perform neurologic assessment -vitals signs, unusual state of health, and characteristics of the lymph nodes in the neck should be documented -exam of testes should be done in boys -teach meticulous hand hygiene and place in isolation on droplet precautions -primary prevention: administration of mumps vaccine in combination with leasles and rubella vaccine MMR
*Describe Chlamydial Infection?
-transmitted via birth or sex -most common STD -screen all females younger than 26 -responsible for eye infections in neonates and interstitial pneumonia -sometimes no s/s and can go undiagnosed until complications develop -neonatal conjunctivitis: -develops anywhere from few day after to several weeks after birth -there is a watery discharge that becomes purulent, eyelids are edematous and conjunctiva may become inflamed -mucoid rhinorrhea common -infants with conjunctivitis will develop infection of the nasopharynx which can progress to pneumonia. These infants may have hx of cough and congestion. Can result in chronic respiratory problems -*urethritis with dysuria, urinary frequency, or mucopurulent discharge may indicate chlamydial infection (if theses s/s are seen in young children could indicate possible abuse) -Treatment: -infants with conjunctivitis or pneumonia: give 14 day course of antibiotics or oral erythromycin -uncomplicated genital tract infection for children and adolescents: give single dose of azithromycin and a 7 day course of doxycycline may also be used for older children >8yrs old and teenagers -follow up with repeat culture -treat all sexual partners contacted within last 60 days and remain free from sex for7 days and until all symptoms are gone
Explain Sexually Transmitted Disease?
-transmitted via body fluids and mucous membranes -condoms can reduce not eliminate your changes of acquiring an STD -s/s: unseal discharge, swelling, pain, sores, rash, unusual nonmenstrual bleeding, pain when you urinate, sore throat for several weeks. Contact provider
*Describe Diphtheria?
-transmitted via contact with pt with disease or by droplets -symptoms include nasal s/s initially resembling the common cold, then gradually begin to include discharge of foul smelling mucopurulent material -low grade fever is common -*Hallmark sign: thin, gray membrane on the tonsils and pharynx, causing "bull neck," or neck edema -Complications: -respiratory compromise due to a narrowing of the upper airway -myocarditits -peripheral neuropathies -Treatment: -IV diphtheria antitoxin and antibiotics (erythromycin or penicillin G) within 3 days of the onset of symptoms -prevention through routine immunization and boosters
*Explain Pertussis (Whooping Cough)?
-transmitted via direct contact or coughing (droplets) - immunity: bacteria or vaccine -3 stages which are catarrhal (lasting 1-2 weeks until 4th week), paroxysmal, and convalescent -diagnosis though positive nasopharyngeal culture -Complication: -most frequently seen complication of pertussis is pneumonia. Others include atelectasis, emphysema, pneumothorax. Hypoxemia can lead to CNS involvements -malnutrition and dehydration can result from extensive vomiting and be dangerous in infants -other complications are otitis media, ulcers f the frenulum of the tongue, epistaxis, hernia, and rectal prolapse -*infants younger than 6 months old are at greatest risk for complications and are more likely to acquire pertussis -Treatment: primary prevention include pertussis vaccine in combination with tetanus and diphtheria (DTaP) -booster recommended called Tdap for children 11-12 -Erythromycin, azithromycin, or clarithromycin is given during catarrhal stage to eliminate organism from nasopharynx within few days to reduce communicability -exposed infants and children should continue routine vaccines -Erythromycin, azithromycin, or clarithromycin should also be given to close contacts (children older than 13 yrs old) because childhood immunization declines by early adolescence -*hospitalization, monitoring airway patency, respiratory status with cardiopulmonary monitor and pulse ox, as well as droplet precautions should be given for the infant. -explain any monitoring devices to child and parents to decrease anxiety -have suction and oxygen equipment available and provide supplemental oxygen if o2 sat drops or during paroxysmal spells -older children usually cared for at home -Nursing Care: -often pertussis goes unrecognized in adolescents and adult so obtain complete immunization hx and any recent exposure's -vital for infants to be immunized against pertussis -assessment of child's respiratory, fluid, nutrition, output ,and neurologic status should be done -During paroxysmal spells have suctioning equipment nearby and ready. Maintain calm, reassuring environment that is quiet -monitor nutritional status and give small, frequent feedings if feeding is exhausting for infant -give gavage or parenteral nutrition to help prevent dehydration or weight loss -give frequent oral care if child vomits when coughing -cluster nursing care to allow child and parent to rest
*Explain Variola virus?
-transmitted via droplets via direct and face to face contact. Can also be less commonly transmitted by contaminated objects -most contagious when lesions rupture -prodome of fever, malaise, headache, muscle pain, prostration, and nausea, vomiting, and backache -lesions appear as red spots in the mouth and on the tongue, that develop into sores and break -after few days generalized vesicular rash appears -lesions progress into pustules then into scabs -complete scabbing of pustules by end of second week (can be a fatal disease) -Treatment: isolate exposed pts as soon as fever appears -place in negative air pressure room with airborne and contact precautions -wear N95 respiratory mask -vaccinate all exposed contacts and health care workers that come into contact with infected pt
*Explain Poliomyelitis?
-transmitted via fecal oral, or oral respiratory route -symptoms include fever, malaise, anorexia, nausea, headache, sore throat, and generalized abdominal pain, which begins as mild symptoms then become more intense -flaccid paralysis especially of lower extremities can occur -Complications: -cervical involvements (bulbar polio), affects the respiratory and vasomotor centers resulting in damage to respiratory centers and inability to breathe -Treatment: -no specific treatment -respiratory paralysis is treated with mechanical ventilation -physical therapy helps maintain muscle integrity and prevent contractures -prevention through routine immunization -risk for postpolio syndrome
What are tapeworms?
-transmitted via ingestion from handling or eating infected beef or pork -asymptomatic, part of worm seen in stool, abdominal pain, nausea, anorexia, weight loss, insomnia
*Describe Syphilis?
-transmitted via intimate contact, transplacentally, or sexually -can be transmitted by infected mother at any time during pregnancy or birth (transplacentally) -acquired syphilis is contacted via sexual contact -children diagnosed with syphilis during neonatal period almost always is linked to sexual abuse -if untreated during pregnancy can cause stillbirth and neonatal death -infants with congenital syphilis may be asymptomatic or exhibit symptoms within first 3 months of life -classic signs are rhinitis, maculopapular rash, and hepatosplenomagaly -radiographs may show osteochondritis or metaphyseal changes in the femur and humerus -late signs are from scarring from the systemic disease process -bones, teeth, eyes, and eighth cranial nerve are involved -teeth are notched (Hutchinson's teeth) and hearing loss can occur suddenly at 8-10 years of age -divided into 3 stages: -primary stage: one or more painless ulcer which heal spontaneously -second stage: occurs 1-2 months later and there is a generalized rash that includes the palms and soles -final stage: latent syphilis in which there are no clinical manifestations -Treatment: -syphilis responds well to single dose of benzathine penicillin G IM (preferred treatment for children and adults) -Aqueous crystalline penicillin G or procaine penicillin is effective with congenital syphilis -Acquired syphilis can be treated with benzathine penicillin G -Tetracycline and doxycycline for 14 days are options for children older than 8 but should not be used in younger children (risk of tooth staining) -When follow up cannot be guaranteed for penicillin allergic children under 8, skin testing for a penicillin allergy is recommended -education about long term effects from syphilis should be considered and resources to make sure the disease is completely eradicated due to treatment should take place
*Describe Trichomoniasis?
-transmitted via perintal contact during delivery and sexual activity -trichomonas is often is asymptomatic (only 50% females will exhibit symptoms) -most males are asymptomatic as well -when symptoms do occur they include dysuria, vaginal itching and burning (in females), and frothy, yellowish green, foul smelling discharge -infected mothers can transmit the disease to their newborn infants during birth -children with positive culture for trichomonas should be investigated for possible sexual abuse -Treatment: single dose of metronidazole (Flagyl, Protostat) or tinidazole is the treatment of choice for adolecents -for prepubertal girls: metronidazole is given in 2 or 3 divided doses -sexual partners should also be treated and pts should avoid sex until they and their partners or asymptomatic -Nursing care: -prevention, early identification, and treatment are goals for nursing care
*Explain Epstein-Barr virus (mononucleosis)?
-transmitted via saliva, intimate contact, blood -immunity: natural disease -primary sites of infection are epithelial cells and B lymphocytes -occurs in healthy individuals most commonly older children and young adults -signs include fever, exudative pharyngitis, lymphadenopathy, and hepatosplenomegaly -some children develop maculopapular rash -children may report malaise, headache, fatigue, nausea, and abdominal pain -acute illness usually lasts 2-4 weeks with gradual recovery -EBV can remain dormant and recur during times of suppressed immunity -Complications: rare and include exanthems and hepatitis. Risk of splenic rupture occurs most frequently during first to third week of illness. Pts with palpable spleen higher risk of rupture. Swelling of pharynx and tonsils can be severe enough to compromise respiration -Treatment: -illness I self limiting so treatment is supportive -antivirals have little effect -use of steroid to treat tonsil swelling is controversial -avoid strenuous physical activity and sports during acute illness and when spleen is enlarged -Nursing Care: -perform physical exam of the pharynx and document redness or swelling -note rashes and description of their appearance, look for large spleen and liver, and record body temp and nutrition and hydration status -most children are cared for at home -hospitalization with standard precautions for hydration if child unable to swallow -*care in both setting involves bed rest, hydration, and relief of discomfort
*Explain Cytomegalovirus (CMV)?
-transmitted via saliva, urine, blood, semen, cervical secretions, breast milk, and organ transplants -immunity: none -common cause of congenital infection in infants and leading cause of hearing loss and intellectual disability -child may become infected during prenatal, perinatal, or postnatal period -only infection sin utero cause permanent infection -asymptomatic infants with no symptoms at birth have better prognosis -*most common disability is hearing loss and leading cause of deafness -symptoms: jaundice, lethargy, seizures, enlarged spleen and liver, petechial rash, respiratory distress, microcephaly, and intracerebral calcifications. Child can shed virus up to 5 yrs -virus can be transmitted via breast milk of infected mother or by blood transfusions children can also get it during toddler years or during sexual activity in teen years -affected adolescents may be asymptomatic but have mono like syndrome with fever, hepatosplenomegaly, mild hepatitis, and absence of heterophil antibody -Treatment: early detection, hearing aids, cholear implants, and speech therapy to treat hearing loss -assessments to detect learning disabilities and early interventions with physical, speech, and cognitive therapy are important -CMV negative donors for transfusions may reduce risk via blood transfusions -*education about CMV and good hygiene is best source of prevention -Nursing Care: obtain hx of symptoms, and care should be coordinated towards developmental deficit. Nurse play key role in referrals and other resources in community
What are hook worms?
-transmitted via skin penetration from direct contact with contaminated soil -causes dermatitis, anemia, pneumonitis, blood loss, and malnutrition
*Explain Relapsing Fever?
-type of Borrelia infection -spread from person to person by live or ticks -bacteria introduced into bite when the bite is rubbed -infection is spread when people fail to wash thoroughly and do not change clothes -symptoms: abrupt onset of fever up to 106.7F, shaking chills, sweats, headache, muscle and joint pain, and progressive weakness -symptoms resolve within a week, reoccur 1 to 2 weeks later, and continue to reoccur at intervals until treated -as fever resolves two phases occur: -chill phase: extreme high fever and confusion -flush phase: fever decreases rapidly causing child to sweat profusely -Treatment: -antibiotics including penicillin, tetracycline, erythromycin, and chloramphenicol for children older than 8 -penicillin or erythromycin for younger children -Nursing Care: -hx of rash, meds, and living environment including washing and bathing -fever, headache, and arthralgia should be treated with antipyretics and analgesics -educate on use of repellents, eradication, an hygiene
*Disease that primarily affects sexually active adolescent girls, is asymptomatic, usually occurring with an STD, and can lead to pelvic inflammatory disease?
Bacterial Vaginosis
*Which disease is known for it's thin, gray membrane on the tonsils and pharynx, causing "bull neck," or neck edema?
Diphtheria (can cause upper airway obstruction)
*Risk of splenic rupture in which disease?
Epstein-Barr virus (mononucleosis). Children should avoid contact sports
*Orchitits is seen in which disease?
Mumps
*Paroxysmal spells are common in which disease?
Pertussis (have suctioning equipment available) incase of coughing spell -triggered by noises and frightening experiences so make sure child has quiet environment and maintain a calm, reassuring approach -monitor for any drop in saturation
*Which disease can result in respiratory paralysis?
Poliomyelitis
*Chill phase and flush phase is characterized by which disease?
Relapsing fever
*Petechiae spots or Forchheimer's sign is seen in which disease?
Rubella (German Males, 3-Day Measles)
*A fine red papular rash appearing in the axillae, groin, and neck which feels like sandpaper occurs in which disease?
Scarlet Fever
*White strawberry tongue progressing to strawberry tongue is seen in which disease?
Scarlet Fever as well as desquamation (peeling of the skin)
*Disease causing Hutchinson's teeth and sudden hearing loss at 8-10 years of age is known as what?
Syphilis
*Disease that is asymptomatic in both females and males and when symptoms do occur include dysuria, vaginal itching and burning and a frothy yellowish green, foul smelling discharge?
Trichomonas
*What is an atypical manifestation of Lyme disease?
one septic joint, usually the knee
What is prodrome
any signs or symptoms of developing disease (prodrome)
*Avoid using what in the child with chickenpox and mumps?
aspirin
What is direct inoculation?
contaminated needles
Use standard precautions when?
during contact with blood, mucous membranes, nonintact skin, or any body substance except sweat
*Most common disability in Cytomegalovirus (CMV) is what?
hearing loss
*There is a lengthy recovery in which disease?
infectious mononucleosis
*What is the Coxasckievirus known for?
it's mouth lesions
*STDs transmitted after the neonatal period should always be evaluated for what?
possible sexual abuse
*Decreased ability to swallow leading to drooling or aspiration (hydrophobia) is seen in which disease?
rabies
What should be suspected in children who acquire STD after neonatal period?
sexual abuse
*Describe Helminths?
tapeworms, flukes, and roundworms -children are commonly infected due to hand to moth activity and oral fecal ingestion -Treatment: -oral med to entire family -teach basic enteric isolation procedures to family -Nursing Care: -obtain info about exposure, hygiene, running water, bathing and laundry facilities, along with nutritional intake -have family brings in stool specimen give clear instructions as well as container and proper storage -plastic wrap can be placed over toilet bowel or collecting from diaper with tongue blade can be done to obtain urine free specimens -mark container with name and date and place in refrigerator
When should the child with chickenpox return to school or daycare?
until the sixth day after onset of rash or sooner if all lesions have dried and crusted
*Which signs and symptoms of chlamydial infection could indicate possible abuse in young children?
urethritis with dysuria, urinary frequency or mucopurulent discharge
