The Child With an Infectious Disease Chapter 41

A mother calls the pediatrician's office to find out how to provide comfort for her son who is itching from chickenpox. Information from the nurse is correct if which information is shared with the mother? "Encourage frequent warm baths." "Give acetaminophen (Tylenol)." "Give diphenhydramine (Benadryl)." "Apply a thick coat of Caladryl lotion over open lesions."

"Give diphenhydramine (Benadryl)." Antipruritic medicines such as diphenhydramine (Benadryl) are useful for severe itching, which interferes with sleep and may contribute to secondary infection. Caladryl lotion (contains Benadryl) should be applied sparingly over open lesions to minimize absorption. Cool baths are recommended for relief of itching. Acetaminophen (Tylenol) has no anti-itching effects.

The mother of a child with sickle cell disease calls the pediatrician's office because she thinks her son may have fifth disease. What information should the nurse give the mother? "Keep your child comfortable at home, but if you notice a major change in his activity level or behavior, call us immediately." "Use cool baths with oatmeal to decrease itching first thing in the morning and before going to bed at night." "Keep your child away from all of the other members of the household for the next three days." "Increase your son's intake of protein and fluids to help replace the liquid he is losing through his skin."

"Keep your child comfortable at home, but if you notice a major change in his activity level or behavior, call us immediately." Because the disease is mild, complications are not usually reported, especially in children. Patients with sickle cell disease or beta-thalassemia are at risk for anemia and aplastic crisis. A change in activity or energy could indicate anemia. Cool baths with oatmeal are not indicated for this illness. The child needs to be kept away from other family members for longer than 3 days. Increasing protein and fluids is not indicated for this child.

Rubeola (Measles) Interventions

1. Teach the family and child (if old enough) the symptoms of secondary bacterial infections and complications of infectious diseases that should be promptly reported to their primary medical caregiver (e.g., redness, warmth, swelling, tenderness or pain, new onset of drainage or change in drainage from wound, increase in body temperature, malaise, abdominal pain, vomiting or diarrhea, enlarged glands, changes in skin lesions including sores or wounds that do not heal). Teach the family the signs and symptoms of hyperthermia and the complications that should be promptly reported to their primary medical caregiver (e.g., visual disturbances, headache, nausea, vomiting, muscle flaccidity, absence of sweating, delirium, coma). Provide the phone number(s) to call if complications occur.

Lyme Disease Therapeutic Management

A course of doxycycline, amoxicillin, or cefuroxime is commonly used for oral treatment. The length of treatment is usually 14 to 21 days, although a shorter 10-day course may be as effective. If the patient has neurologic or cardiac symptoms, IV ceftriaxone for 2 to 3 weeks is recommended

The camp nurse is telling a group of campers and their counselors how to avoid insect and tick bites. What information should the nurse include? Select all that apply. Dark, long-sleeved shirts should be worn. A hat is helpful when in wooded and grassy areas. Try to stay on paths rather than walking through dense areas. Apply insect repellent lightly on the hands. Ticks should be scraped off the skin. Shirts should be tucked into the pants.

A hat is helpful when in wooded and grassy areas. Try to stay on paths rather than walking through dense areas. Shirts should be tucked into the pants. A hat is very helpful to protect the head from insects getting in the hair when in wooded and grassy areas. Trying to stay on paths rather than walking through dense areas is true. Shirts should be tucked into the pants to prevent insects and ticks getting to the skin. Light, long sleeved shirts should be worn because of being able to see insects and ticks. Insect repellent should not be applied on the hands because the hands often touch the eyes and mouth. Ticks should be removed with tweezers. The tick should be removed as close to the skin as possible using steady upward pressure. Ensure that all mouthparts are removed from the skin.

Varicella Rash

A rash generally first appears on the trunk and scalp, followed by the appearance of lesions, which quickly become teardrop vesicles with an erythematous base. The vesicles then become pustular, after which they begin to dry and develop a crust. The lesions appear in crops over the course of usually 3 to 4 days and can be seen to be in different stages of development. Children in the household with secondary cases generally have rashes that are more extensive than that of the child with the primary case. The lesions can appear on the mucous membranes in the mouth, genital area, and rectum. Second attacks are rare and are more common in immunocompromised children. Breakthrough attacks in immunized children are also rare, and the disease presentation is mild, with few lesions

Scarlet Fever Manifestations

Abrupt fever, vomiting, headache, abdominal pain, pharyngitis, and chills characterize the onset of scarlet fever The fever reaches a peak by the second day and returns to normal within 5 to 6 days.

Active v Passive Immunity

Active immunity occurs as a result of immune system stimulation from exposure to antigens, either naturally or through vaccine administration. Passive immunity is a form of infection protection acquired through the administration of serum containing antibodies.

Roseola Infantum (Exanthem Subitum, 3-day fever) Rash

After 3 to 5 days, the fever subsides, and within several hours to 2 days, a rash appears. The rash consists of rose-pink maculopapules or macules that blanch with pressure The rash occurs predominantly on the neck and trunk and may be surrounded by a whitish ring. It normally persists for 24 to 48 hours before fading.

Lyme Disease Rash

An erythematous macule or papule forms at the site of the tick bite within 1 to 31 days This rash can enlarge to 16 to 68 cm in diameter, with a clearing in the center (erythema migrans, or "bull's eye" rash). It may itch, prickle, or burn. The rash generally lasts for 3 to 4 weeks, during which time it gradually fades.

Exanthem Infection

An exanthem is an eruption or rash on the skin Perform a general physical assessment to look for associated signs of inflammation, which may include abnormal enlargement or tenderness of the spleen, liver, or lymph nodes. Nurses who care for hospitalized children with an infectious disease should not also care for high-risk (immunosuppressed) children to prevent any possible cross transmission by the nurse. Generally, fever can be controlled with acetaminophen or ibuprofen (no aspirin products because of the risk of developing Reye's syndrome)

Roseola Infantum (Exanthem Subitum, 3-day fever) Therapeutic Management

Antipyretic medications, lightweight clothing, cooler environmental temperatures, and increased fluid intake all assist with fever control. parents should be given information regarding the absolute avoidance of any form of aspirin (including over-the-counter medications containing salicylates) because of the potential risk of developing Reye's syndrome Anticipatory guidance should include alerting the parent to the possibility of febrile seizures and teaching about seizure precautions (especially if the child has a history of previous febrile seizures).

Epstein-Barr Virus (Infectious Mononucleosis) Therapeutic Management

Antivirals have little effect on the illness

Gonorrhea Therapeutic Management

Because hepatitis B, HIV, syphilis, and Chlamydia infection are also often present in individuals with gonorrhea, testing should take place for those diseases. Both penicillin and fluoroquinolones are no longer used as a treatment because of an increased incidence of resistance in the United States. Currently, ceftriaxone is recommended for children and adolescents with cefotaxime as an alternative in infants Patients should also be treated with azithromycin or doxycycline for presumed Chlamydia infection. Adolescents coinfected with syphilis are treated appropriately as well. Sexual partners should be treated.

Rubeola (Measles) Complications

Because of respiratory involvement, secondary infections such as otitis media, bronchopneumonia, and laryngotracheobronchitis (croup) can occur, especially in infants and younger children, as well as cardiac manifestations such as myocarditis and pericarditis. The most common cause of death from measles is pneumonia Measles can cause premature birth and miscarriage in pregnant women, but, unlike Rubella, it does not cause birth defects

Erythema Infectiosum (Fifth Disease, Parvovirus B19) Complications

Because the disease is mild, complications are not usually reported, especially in children. Patients with sickle cell disease or beta-thalassemia are at risk for anemia and aplastic crisis. Patients with a poor immune system are also at risk for anemia

A child who has measles and a compromised immune system needs to be watched for secondary infections or complications. Symptoms of which conditions should the nurse teach the parents to report immediately? Select all that apply. Bronchopneumonia Epiglottitis Laryngotracheobronchitis (croup) Otitis media Rheumatic fever Myocarditis

Bronchopneumonia Laryngotracheobronchitis (croup) Otitis media Myocarditis Bronchopneumonia, otitis media and laryngotracheobronchitis (croup), and myocarditis can occur as complications of measles. Epiglottitis and rheumatic fever are not from measles.

Cytomegalovirus (CMV)

CMV is a common cause of congenital infection in infants and is a leading cause of hearing loss and intellectual disability in the United States. A child can become infected with the virus during the prenatal, perinatal, or postnatal period. Only infections in utero cause permanent infection.

Stages of Pertussis Manifestations

Catarrhal • Duration: 1 to 2 weeks • Symptoms: Symptoms of upper respiratory tract infection (rhinorrhea, lacrimation, mild cough, low-grade fever). Paroxysmal • Duration: 2 to 6 weeks • Symptoms: Increased severity of cough. Repetitive series of coughs during a single expiration, followed by massive inspiration with a whoop (older children may not manifest this). 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 to 2 weeks • Symptoms: Episodes of coughing, whooping, and vomiting that decrease in frequency and severity. Cough may persist for several months.

Pertussis (Whooping Cough)

Causative agent: Bordetella pertussis (a gram-negative bacillus)Incubation period6 to 20 days Infectious period: Catarrhal stage (1 to 2 weeks) until the fourth week Transmission: Direct contact or respiratory droplets from coughing Immunity: Bacteria or vaccine, both of which provide varying degrees and duration of immunity against pertussis

Epstein-Barr Virus (Infectious Mononucleosis)

Causative agent: Epstein-Barr virus (EBV, a herpes-like virus); double-stranded DNA Incubation period: 4 to 7 weeks Infectious period: Unknown; the virus is commonly shed before clinical onset of disease until 6 months, then intermittently for life; asymptomatic carriers are common Transmission: Saliva, intimate contact, bloodImmunityNatural disease

Scarlet Fever

Causative agent: Group A beta-hemolytic streptococci Incubation period: 1 to 7 days (average of 3 days) Infectious period: Acute stage until 24 hours after antimicrobial therapy has begun TransmissionAirborne: (inhalation or ingestion), direct contact

Cytomegalovirus (CMV)

Causative agent: Human cytomegalovirus (CMV), double-stranded DNA virus Incubation period: Unknown, except for 3 to 12 weeks after blood transfusions and 4 weeks to 4 months after organ (tissue) transplantation Transmission: Saliva, urine, blood, semen, cervical secretions, breast milk, organ transplants Immunity: None, although CMV immune globulin, used only in seronegative transplant patients, has had moderate effectiveness

Roseola Infantum (Exanthem Subitum, 3-day fever)

Causative agent: Human herpesvirus 6 (HHV-6) Incubation period: 5 to 15 days Infectious period: Unknown but thought to extend from the febrile stage to the time the rash first appears Transmission: Most likely by contact with secretions (saliva, cerebrospinal fluid [CSF]) of asymptomatic close contacts

Mumps

Causative agent: Paramyxovirus, single-stranded RNA Incubation period: Usually 16 to 18 days but can be 12 to 25 days Infectious period: From 7 days before swelling (parotitis) to 9 days after onset Transmission: Airborne droplets, salivary secretions, possibly urine Immunity: Natural disease or live attenuated vaccine

Erythema Infectiosum (Fifth Disease, Parvovirus B19)

Causative agent: Parvovirus B19 Incubation period: 4 to 17 days but can be up to 28 days Infectious period: Shedding of virus occurs between days 5 and 12 of the infection; usually from the prodromal period until the rash appears Transmission: Airborne particles, respiratory droplets, blood, blood products, transplacental transmissionImmunity Natural disease is thought to provide antibodies for immunity

Rubella (German Measles, 3-Day Measles)

Causative agent: RNA virus Incubation period: 14 to 21 days Infectious period: Ranges from 7 days before onset of symptoms to 14 days after appearance of the rash Transmission: Airborne particles or direct contact with infectious droplets, transplacental transmission; small number of infants with congenital rubella continue to shed the virus for months after birth Immunity: Natural disease or live attenuated vaccine

Rubeola (Measles)

Causative agent: RNA virus Incubation period: 8 to 12 days from exposure to onset of symptoms Infectious period: Ranges from 3 to 5 days before the appearance of the rash to 4 to 6 days after appearance of the rash Transmission: Transmitted between individuals by direct contact with infectious droplets or less frequently by airborne spread Immunity: Natural disease or live attenuated vaccineSeasonWinter and spring **airborne isolation precautions

Varicella-Zoster Infections (Chickenpox, Shingles)

Causative agent: Varicella-zoster virus, Double-stranded DNA virus Incubation period: 10 to 21 days Infectious period: 1 to 2 days before the onset of rash until all lesions are dried (crusted over), usually 5 to 7 days Transmission: Direct contact, droplet, airborne particles Immunity: Natural disease of varicella; same virus causes zoster, and child may contract zoster at a later time; varicella vaccine

Enterovirus (Nonpolio) Infections (Coxsackieviruses, Group A and Group B), Echoviruses, and Enteroviruses

Causative agents: RNA viruses including 23 group A coxsackieviruses (types A1 to A24, except type A23), six group B coxsackieviruses (types B1 to B6), 31 echoviruses (types 1 to 33, except types 10 and 28), and four enteroviruses (types 68 to 71) Incubation period: Usually 3 to 6 days Infectious period: Unknown, but fecal viral excretion and transmission can continue for 7 to11 weeks after the onset of infection Transmission: Spread by fecal-oral and possibly by oral-oral (respiratory) routes. Contact precautions are implemented for infants and young children.

Enterovirus (Nonpolio) Infections (Coxsackieviruses, Group A and Group B), Echoviruses, and Enteroviruses Manifestations

Common presentations in both infants and children include nonspecific febrile illnesses with a wide variety of respiratory, gastrointestinal, cardiac, neurologic, skin, oral, and eye signs and symptoms. A frequently seen pattern of illness in young children is hand-foot-and-mouth disease, caused by coxsackievirus A16 or other enteroviruses. Inflammation and lesions in the mouth, on the palms of the hands, and on the soles of the feet are the hallmarks of this syndrome, along with mild fever; some children experience small lesions on the buttocks. Lesions become vesicular over the course of several days and usually resolve by 1 week If lesions are particularly widespread in the oropharynx, the child may refuse to eat or drink; the potential for dehydration is present in very young children.

Scarlet Fever Complications

Complications generally result from extension of the streptococcal infection. They include sinusitis, otitis media, mastoiditis, peritonsillar abscess, bronchopneumonia, meningitis, osteomyelitis, rheumatic fever, and glomerulonephritis.

A child with a depressed immune system due to chemotherapy for cancer has been admitted to the pediatric unit because of possible measles. What would the nurse expect to assess if the child is in the prodrome period of the disease? Confusion, chorea, and conjunctivitis Coryza, cough, and conjunctivitis Coordination problems, clubbing, and contractures Croup, congestion, and crying

Coryza, cough, and conjunctivitis Typically, children have a prodrome period with fever that rises gradually and the "three Cs" ([coryza or profuse runny nose], cough, and conjunctivitis) that lasts between 1 and 4 days. There are no coordination problems, clubbing of the digits, or contractures. Croup is a collection of problems and is not seen with measles. Crying is very vague, but there is some congestion. Confusion doesn't occur unless the fever is very high. There are no uncoordinated movements, but conjunctivitis is present.

Enterovirus (Nonpolio) Infections (Coxsackieviruses, Group A and Group B), Echoviruses, and Enteroviruses Therapeutic Management

Currently, no specific therapy is available for enteroviral infections Parents and caregivers should be given educational information regarding the importance of hand hygiene and personal hygiene, especially after diaper changes and trips to the bathroom.

Rocky Mountain Spotted Fever Therapeutic Management

Doxycycline is the recommended treatment with a fluoroquinolone as an alternative. Treatment usually lasts 7 to 10 days. Doxycycline is used with caution in children younger than 8 years because of staining of the teeth Straws should be used, and the mouth should be flushed if tetracycline is administered because it can stain the teeth

Varicella Manifestations

During the 24 to 48 hours before the appearance of lesions, symptoms may include a slightly elevated body temperature, malaise, headache, and anorexia.

A mother calls the pediatrician's office and states that her 4-year-old son looks like "someone slapped his cheeks" and he's running a fever. What would the nurse suspect the child has based on the mother's description? Fifth disease Rubella Scarlet fever Roseola infantum

Fifth disease Fifth disease is a relatively mild systemic disease. Typically the child may appear well but has an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance or a history of a rash that "comes and goes." Before the appearance of the rash, many children are asymptomatic or have nonspecific symptoms such as headache runny nose, malaise, and mild fever. Rubella often has the following signs and symptoms: Older children may report profuse nasal drainage, diarrhea, malaise, sore throat, headache, low-grade fever, polyarthritis, eye pain, aches, chills, anorexia, and nausea. Scarlet fever is known for the "strawberry tongue" and a fine red papular rash in the axillae, groin, and neck, which feels like sandpaper to the touch. Roseola infantum causes a sudden high fever (103 to 106° F [39.4 to 41.1° C]), malaise, and irritability, a mild cough, runny nose, abdominal pain, headache, vomiting, and diarrhea, and then several days later when the fever subsides a rash appears. The rash consists of rose-pink maculopapules or macules that blanch with pressure.

The office nurse is taking a history on a child's illness from the parents. The nurse notes that the parents treated their 7-year-old child appropriately for a fever when they report that they provided what care? Gave baby aspirin (ASA) Bathed the child in cold water Gave fluids at frequent intervals Gave alternating dosages of acetaminophen (Tylenol) and ibuprofen (Motrin)

Gave fluids at frequent intervals Providing fluids at frequent intervals helps to meet the body's need for fluids during a febrile illness. Alternating acetaminophen (Tylenol) and ibuprofen (Motrin) might result in an overdose and has no real benefit. Aspirin is associated with Reye's syndrome and should not be given to children with a fever. The cold bath will chill the child and cause shivering, which is a response that will increase the body temperature.

Rocky Mountain Spotted Fever Rash

Generally, on the third day a characteristic maculopapular or petechial rash appears. This rash begins on the extremities (usually the wrists, palms, ankles, and soles) and spreads to the rest of the body. As the rash progresses, hemorrhagic and necrotic lesions can appear.

The nurse is using Standard Precautions while caring for her patients. Nursing care is correct if which procedures are used to promote infection control? Gloves are worn any time a patient is touched. Needles are capped immediately after use and disposed of in a special container. Gloves are worn to change diapers when there are loose or explosive stools. Masks are used only when caring for patients with airborne infections.

Gloves are worn to change diapers when there are loose or explosive stools. Changing a diaper with loose or explosive stools has the greatest risk for exposure to body substances. Masks are a component of Transmission-Based Precautions and not Standard Precautions. Gloves are not indicated unless there is potential for contact with body substances. Used needles should never be capped. They should be immediately disposed of in a rigid puncture-proof container.

Varicella and the Immunocompromised Child Safety Alert

Immunocompromised children who contract varicella may have large hemorrhagic lesions. Primary varicella pneumonia is a frequent complication. Some children develop an acute form of varicella with disseminated intravascular coagulation (DIC) that is fatal, often before antiviral therapy can be started.

Chlamydial Infection Therapeutic Management

In infants with conjunctivitis or pneumonia, a 14-day course of oral erythromycin is recommended; for incomplete eradication, a subsequent course of erythromycin may be necessary.

Varicella-Zoster Infections (Chickenpox, Shingles) Therapeutic Management

In the hospital setting, children with varicella or zoster infections should be placed in a private room with strict isolation (Airborne and Contact Transmission Precautions). The nurse assigned should not simultaneously care for immunocompromised patients to decrease the risk of varicella transmission.

Rubeola (Measles) Rash

Koplik spots appear approximately 1 to 4 days before the appearance of the rash Koplik spots are small, blue-white spots with a red base that cluster near the molars on the buccal mucosa. These spots increase in number before disappearing at approximately 3 days, after which they slough off. As prodromal symptoms reach a peak, the exanthem appears and is characterized by a deep-red, macular rash that usually begins on the face and neck and spreads down the trunk and extremities to the feet. The rash blanches easily with pressure and will gradually turn a brownish color. The duration of the rash is approximately 6 to 7 days.

Chlamydial Infection Manifestations

Many people with a chlamydial infection have few or no symptoms, but chlamydia can cause urethritis and pelvic inflammatory disease Neonatal conjunctivitis develops anywhere from a few days to several weeks after birth and manifests with a watery discharge that becomes purulent. Eyelids are edematous, and the conjunctiva may become inflamed. Mucoid rhinorrhea may be associated with the infection. Many infants with conjunctivitis will develop infection of the nasopharynx, which can progress to pneumonia. These infants may have a history of a cough and congestion. Long-term abnormalities of pulmonary function may result in chronic respiratory problems. Urethritis with dysuria, urinary frequency, or mucopurulent discharge may indicate chlamydial infection. Any identification of this organism in young children indicates possible sexual abuse.

Roseola Infantum (Exanthem Subitum, 3-day fever) Manifestations

Most clinical cases of roseola occur in children 6 to 18 months old. The child has a sudden high fever (103° F to 106° F [39.4° C to 41.1° C]), malaise, and irritability but may remain active and alert. An intermittent or constant fever may persist for 3 to 5 days. The child may also have a mild cough, runny nose, abdominal pain, headache, vomiting, and diarrhea

Gonorrhea Manifestations

Ophthalmia neonatorum is the most common type of gonorrheal infection in the infant, manifesting 2 to 5 days after birth. A thick, purulent discharge from the eyes may be present and, if not treated promptly, will progress to corneal ulceration, rupture, and blindness. Ophthalmia neonatorum has been controlled through prophylactic treatment with an ophthalmic antibiotic given immediately after birth. In older children, ophthalmic infection can be the result of self-inoculation from the genital site. Girls with gonorrheal infection may have a purulent vulvovaginitis, whereas boys often have urethritis. A history of purulent discharge with burning during urination is often elicited. Adolescent girls may exhibit cervicitis, urethritis, perihepatitis, and salpingitis. One serious complication of gonorrhea is pelvic inflammatory disease (PID), which is an infection of the female upper genital tract. PID can lead to ectopic pregnancy, infertility, and chronic pelvic pain

A school-age child is recovering from infectious mononucleosis. What information should the nurse give the mother about activities when he returns to school? The child should eat away from the other children in the lunchroom. Participation in his physical education class should be limited to non-contact sports. Allow the child to rest until he returns to school without worrying about homework. He will be able to return to school full-time when he has his medical release.

Participation in his physical education class should be limited to non-contact sports. Participation in his physical education class should be limited to non-contact sports and quiet activities to protect the child's enlarged spleen from rupture. Allowing the child to postpone homework until he returns to school could put the child behind and cause additional stress. He might need to return to school part-time when he has his medical release. There is no reason he needs to eat away from the other children in the lunchroom. However, he should not share any of his lunch or anything saliva has touched.

Rubella (German Measles, 3-Day Measles) Complications

Rubella has relatively few complications. The most common are arthritis and arthralgia, which occur more often in adult women than in children or adolescents. Mild thrombocytopenia may also occur but is usually self-limiting and of short duration. A rare complication is encephalitis, which is usually less severe than measles-related encephalitis.

Pertussis (Whooping Cough) Therapeutic Management

Primary prevention of pertussis can be accomplished through administration of five doses of the pertussis vaccine in combination with tetanus and diphtheria (DTaP) booster, called Tdap, for children age 11 to 12 who completed a primary series of DTaP Erythromycin, azithromycin, or clarithromycin (depending on age), if given during the catarrhal stage, will eliminate the organism from the nasopharynx within 5 days, thereby reducing communicability. Infants and young children who are exposed to pertussis should continue their routine schedule of immunization.

Mumps Manifestations

Prodromal manifestations include fever, myalgia, headache, and malaise. The classic clinical sign of parotid glandular swelling (parotitis) often follows these, although a substantial number of individuals have no such swelling. When parotid swelling occurs, it can be accompanied by fever.

Cytomegalovirus (CMV) Manifestations

Signs and symptoms in the infant include jaundice, lethargy, seizures, enlarged spleen and liver, petechial rash, respiratory distress, microcephaly, and intracerebral calcifications. The child can continue to shed the virus for up to 5 years.

Varicella Vaccine

The CDC recommends that varicella vaccine can be given to healthy, nonimmune children (1 year of age or older) immediately after exposure and before 3 to 5 days; in some cases this will reduce the severity of the disease. Varicella vaccine is recommended at any visit on or after the first birthday for healthy susceptible children without a reliable history of actual disease or immunization and without contraindications to receiving the vaccine. A booster dose is given between 4 and 6 years of age.

Mumps Complications

The most common complication is aseptic meningitis, with the virus identified in the CSF. Signs of CNS involvement include nuchal rigidity, lethargy, and vomiting. Children with these manifestations usually completely recover. A less common CNS complication is meningoencephalomyelitis manifested by fever, headache, nausea, vomiting, nuchal rigidity, and changes in sensorium. These complications are treated symptomatically and generally have an uneventful recovery period. The potential complication of most concern to parents is orchitis (inflammation of a testis).

Pertussis (Whooping Cough) Complications

The most frequently seen complication of pertussis is pneumonia. Other respiratory complications occur to varying degrees, ranging from atelectasis to interstitial or subcutaneous emphysema to pneumothorax. Malnutrition and dehydration can result from extensive vomiting and can be quite dangerous, especially for infants

The nurse is explaining the time interval between early manifestations of disease and the overt clinical syndrome to a parent calling about her sick child. Which word would the nurse use? The incubation period The prodromal period The desquamation period The period of communicability

The prodromal period The definition of prodromal period is the interval between early manifestations of the disease and the appearance of overt clinical symptoms. The "desquamation period" refers to the shedding of skin. The period of communicability is the time when the child is infectious. The incubation period is the time from exposure to appearance of first symptom.

Rubella (German Measles, 3-Day Measles) Rash

The rash manifests as a pinkish rose maculopapular exanthem that begins on the face, scalp, and neck and is often pruritic It spreads downward to include the entire body within 1 to 3 days. As the rash spreads to the trunk, the rash on the face begins to fade. Petechiae (spots), which are red or purple color and pinpoint in size, may occur on the soft palate. Their appearance is sometimes referred to as Forchheimer's sign.

Congenital Rubella Syndrome Safety Alert

The rubella virus can cross the placenta and infect the fetus, causing fetal death or abnormalities.

Pertussis (Whooping Cough) Manifestations

The three stages of pertussis are catarrhal, paroxysmal, and convalescent, lasting a total of 6 to 12 weeks The classic stages are not commonly seen in infants younger than 3 months Diagnosis is through positive nasopharyngeal culture.

Infection and Host Defenses

The two components of the immune response are the innate, nonspecific immune response and the adaptive, specific immune response: cell mediated and humoral The first lines of defense in the innate immune system are the skin and intact mucous membranes. Large numbers of pathogens or their toxins can inhibit phagocytosis. Under such conditions, the adaptive immune system is activated. This system "recognizes" and responds to pathogens by destroying them. The adaptive immune system "imprints" on these pathogens so that if the body encounters them again, the response will be rapid and specific.

Rubella (German Measles, 3-Day Measles) Therapeutic Management

Treatment is generally supportive and symptomatic, with the disease being self-limiting with resolution within 5 days. Recommendation for exclusion of affected children from school or child care is 7 days after the rash begins. Infants with CRS are presumed contagious until age 1 year or nasopharyngeal and urine cultures for the rubella virus are repeatedly negative.

MMR Vaccine

Two doses of measles, mumps, and rubella (MMR) vaccine are required for full protection. The first MMR is recommended routinely at 1 year of age. The second dose of MMR is recommended at 4 to 6 years but can be administered during any visit if at least 4 weeks has elapsed since the first dose and both doses are administered beginning at or after 1 year of age. Children who have not previously received their second MMR dose should complete the schedule on or before 6 years of age

Rubeola (Measles) Manifestations

Typically, children have a prodrome period with fever that rises gradually and the "three Cs" (coryza [profuse runny nose], cough, and conjunctivitis) that lasts between 2 and 4 days. Children are most contagious during this time

Erythema Infectiosum (Fifth Disease, Parvovirus B19) Rash

Typically, the child appears well but has an intense, fiery red, edematous rash on the cheeks, which gives a "slapped cheek" appearance, or a history of a rash that "comes and goes." Before the appearance of the rash, many children are asymptomatic or have nonspecific symptoms such as headache, runny nose, malaise, and mild fever. Approximately 1 to 4 days after the facial rash appears, an erythematous, maculopapular rash appears on the trunk and extremities. The rash fades with a central clearing area, resulting in a lacy appearance. The rash lasts 2 to 39 days and can reappear when aggravated by environmental factors such as heat, exercise, warm baths, rubbing of the skin, and stress.

Mumps Therapeutic Management

Uncomplicated mumps may require only symptomatic care and encouragement of adequate hydration. Avoidance of acidic foods such as orange juice is helpful. Droplet Precautions are indicated until 9 days after the onset of the parotid swelling.

Scarlet Fever Rash

Within 24 hours, a fine red papular rash appears in the axillae, groin, and neck, which feels like sandpaper to the touch. The rash then spreads peripherally to cover the entire body The rash will blanch on pressure except in areas of deep creases (Pastia's sign). Desquamation, peeling of the skin, may begin on the face at the end of the first week, and flaking proceeds down the trunk. This process may continue for up to 6 weeks. The tongue is initially coated with a white, furry covering with red projecting papillae (so-called white strawberry tongue). By the fourth day the papillae slough off, leaving a red, swollen tongue (so-called strawberry tongue). The tonsils are edematous and may be covered with a gray-white exudate, which can spread to the pharynx. Petechial hemorrhages cover the soft palate.

Rubella (German Measles, 3-Day Measles) Manifestations

Young children are often asymptomatic until the appearance of the 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 of all ages usually have impressive posterior cervical, posterior auricular, and occipital lymphadenopathy.

Enterovirus (Nonpolio) Infections (Coxsackieviruses, Group A and Group B), Echoviruses, and Enteroviruses Complications

Young infants with a history of prematurity are at higher risks for complications and death. Serious complications such as myocarditis, hepatitis, and encephalitis are often the cause

Herpes zoster (shingles) Manifestations

Zoster manifests with tenderness along the involved nerve and surrounding skin for approximately 2 weeks before the appearance of the lesions. If pain is present, its intensity can range from an unpleasant, abnormal sensitivity to touch to burning, tingling, itching, sharp knife-like prickling, or even deep pain. Unilateral crops of lesions appear along a single dermatome of one or more sensory nerves. These lesions progress through the same stages as varicella. There may be enlargement and tenderness of the lymph nodes in the same region.

Herpes Simplex Virus

an infected mother can transmit it to her newborn during vaginal delivery, causing multisystem disease. The highest risk for transmission is during the first infection with active lesions Viral culture from vesicular fluid can confirm the diagnosis. There is no cure for HSV 2, but administration of acyclovir (Zovirax) can diminish symptoms and reduce shedding time.

Lyme Disease Manifestations

divided into three stages (early localized, early disseminated, and late disseminated). In the first stage (early localized), the skin lesions are most prominent; in the second stage (early disseminated), cardiac and neurologic findings are prominent; and in the third stage (late disseminated), arthritis is the main manifestation vague, flu-like symptoms (headache, chills, fatigue, and vague muscle aches and pains)

Epstein-Barr Virus (Infectious Mononucleosis) Manifestations

fever, exudative pharyngitis, lymphadenopathy (cervical, axillary and inguinal), and hepatosplenomegaly malaise, headache, fatigue, nausea, and abdominal pain. The acute illness usually lasts 2 to 4 weeks and is followed by a gradual recovery

Chlamydial Infection

most prevalent STDs in the United States Infants are infected during the birthing process. Half of all infants born vaginally to infected mothers will develop the disease. Chlamydial infection can cause morbidity in the infant and is responsible for neonatal eye infections and interstitial pneumonia.

Rocky Mountain Spotted Fever Manifestations

nonspecific signs and symptoms such as headache, fever, anorexia, and restlessness

Epstein-Barr Virus (Infectious Mononucleosis) Complications

rare, include exanthems and hepatitis

Varicella-Zoster Infections (Chickenpox, Shingles) Complications

secondary bacterial infection of the skin lesions Encephalitis with ataxia, tremor, and nystagmus can occur in the first week. The prognosis is generally positive unless CNS involvement is severe—usually manifested by convulsions and coma. Children with these complications may have future CNS difficulties, including seizures, intellectual disability, or behavior disorders. Varicella pneumonia, a common complication in adults, rarely occurs in children.

Preventive Measures to Avoid Insect and Tick Bites

• Children should wear tightly woven clothing consisting of long pants, long-sleeved shirts, long socks, and a hat when in wooded and grassy areas. Pants should be tucked into socks. Clothing should also be light-colored so ticks are easily visible. • Paths should be followed and dense areas avoided if possible. Avoid known tick-infested areas. • Insect repellents that contain diethyltoluamide (DEET) and permethrin should be used; apply before any possible exposure and every 1 to 2 hours sparingly according to manufacturer's directions. Care should be taken to avoid contact of repellent with the child's eyes or mouth. The repellent should not be applied to the hands to avoid contact with the eyes and mouth. Wash hands and skin after the child goes indoors. • Repellents should be used with caution in infants because of the risk of encephalopathy. • Insect repellent should not be applied to wounds or irritated skin. • The body (especially exposed hairy regions) should be inspected periodically for ticks, which may resemble small moles or blood blisters. Early removal can prevent transmission of disease from an infected tick. • Ticks should be removed with tweezers. The tick should be removed as close to the skin as possible using steady upward pressure. Ensure that all mouthparts are removed from the skin. • Care should be taken to avoid handling the tick with bare hands or crushing the tick's body. • Ticks may be preserved in alcohol for later identification. • Pets should be kept free of ticks by dipping and spraying during tick season. • Yards should be kept free of brush and undergrowth.

How to Prevent Parasitic Infections

• Handwashing (including under the fingernails) with soap and water should be done before eating or handling of food and after using the toilet. • Placing hands in the mouth and nail biting should be discouraged. • Toilets or other appropriate bathroom facilities should be used for elimination. • Toilets or bathroom facilities should be cleaned with agents containing bleach. • Scratching the anal area with bare hands should be discouraged. • Dogs and cats should be kept at a distance from play areas and sandboxes, and the latter need to be covered when not in use. • Shoes should be worn when outside. • All fruits and vegetables should be washed before being eaten. • Diapers should be changed frequently and disposed of properly (out of children's reach). • Swimming facilities that allow diapered children should be avoided. • Only bottled water should be used during camping outings.

Key Concepts

• Infectious diseases can be transmitted by direct contact with another infected person, by contact with animal or insect carriers, by ingestion of contaminated food or water containing the pathogens, and by contact with a contaminated object. • Vaccines can be live or attenuated, killed or inactivated toxoids, human immune globulin, or animal serums or antitoxins. • Assessment of the child with an infectious disease includes a thorough history (recent exposure, other family members or friends exhibiting signs or symptoms, environmental causes) and documentation of the type, configuration, and distribution of any lesions; the child's temperature; and any associated signs and symptoms. • Children with infectious diseases usually can and should be cared for at home. • STDs can be transmitted to neonates from exposure to organisms during delivery, but children who acquire an STD after the neonatal period should always be evaluated for possible sexual abuse. • Abstinence is the only 100% effective way to prevent both pregnancy and STD transmission. Sexually active individuals should use barrier protection to prevent STDs.

Mononucleosis Patient-Centered Teaching

• Prolonged rest is indicated during the acute stage of the illness. • Acetaminophen may be useful in controlling discomfort caused by fever and enlarged tonsils. • Activity restrictions include no contact sports of any type, including roughhousing at home with siblings or friends, to protect the child's enlarged spleen from rupture. With improvement in clinical signs, the child should be allowed to gradually resume normal activities as tolerated. • The parents and child need to be prepared for a slow and gradual recovery. Fatigue may continue, necessitating a gradual return to school activities. • Hydration should be monitored and encouraged. • In children with a sore throat, soothing liquids, bland foods, and milkshakes may be better tolerated than a regular diet. • Anxiety related to missed schoolwork should be anticipated. Homebound school programs should be arranged if the child will be absent from school for a prolonged period. • The parents should have an understanding of the disease and the usual course of recovery. They may need support in exploring options for caring for their child during a lengthy recovery period, including referrals for alternative child-care arrangements, to decrease lost income and maintain job security.

Scarlet Fever Patient-Centered Teaching

• The entire course of antibiotic therapy (usually 10 to 14 days) must be taken to destroy all the bacteria and decrease the risk of complications. If a partial course of antibiotics is given (antibiotic stopped by parent when child is feeling better), the bacteria can become resistant and fail to be eradicated with subsequent attempts. • Cool drinks and liquid refreshments (ice pops, milkshakes) may be soothing and help maintain hydration. • Acetaminophen, ibuprofen, throat lozenges, antiseptic throat spray (e.g., Chloraseptic), and cool mist may be used to relieve discomfort. • Encouraging quiet activities will help prevent fatigue. • In providing oral care, acidic preparations should be avoided. Saline rinses can provide comfort and promote hygiene. • A soft, bland diet should be offered. • Call your primary healthcare provider if your child develops drooling or great difficulty swallowing or acts very sick. After 48 hours of antibiotic therapy, your child should not have a fever. • Your child is no longer contagious after 24 hours of antibiotic therapy. The rash is not contagious.