Ch. 37 Child with a Communicable Disease
A school-age child is brought for emergency care because of sudden paralysis after having mild cold symptoms and a low-grade fever. For which health problem would the nurse anticipate providing care? 1. Polio 2. Spinal cord tumor 3. Guillain-Barré syndrome 4. Duchenne's muscular dystrophy
Answer: 1.
An adolescent patient receives a foot wound after stepping on a rusty nail during a hike. Which information would the nurse obtain from the parents as part of this patient's care? 1. Date of the last tetanus booster 2. Type of nail the patient stepped on 3. List of medications the patient takes 4. Length of time since the injury occurred
Answer: 1.
The nurse is caring for a pediatric patient who has body and joint aches, sore throat, and a faint maculopapular rash on the forehead. Which health condition would the nurse suspect the patient is experiencing? 1. Rubella 2. Measeles 3. Roseola 4. Chickenpox
Answer: 1.
The nurse is caring for a preschool-age child who is diagnosed with the flu. Which recommendation would the nurse make in addition to providing the child with antipyretics? 1. Encourage fluids. 2. Isolate for a week to 10 days. 3. Maintain current activity schedule. 4. Provide the child with another flu vaccine.
Answer: 1.
The nurse suspects that a pediatric patient is experiencing an adverse effect from a vaccine. Which action would the nurse take first? 1. Call for help. 2. Measure vital signs. 3. Provide emotional support. 4. Ensure respiratory support.
Answer: 1.
The parent of a 24-month-old patient is concerned because the child has a red mark along one cheek. For which infection would the nurse anticipate planning care for this patient? 1. Fifth disease 2. Mononucleosis 3. Nasopharyngitis 4. Respiratory syncytial virus
Answer: 1.
The nurse is concerned because a toddler is demonstrating signs of an ear infection and has a deep productive cough. For which infection would the nurse anticipate providing care? 1. Influenza 2. Epiglottitis 3. Otitis media 4. Pneumococcus
Answer: 4.
The nurse is reviewing the health history of a preadolescent patient. Which nonseasonal vaccine would the nurse recommend to the parent that the child receive? 1. Influenza 2. Rotavirus 3. Hepatitis A 4. Human papillomavirus (HPV)
Answer: 4.
The nurse learns that a pediatric patient has a Clostridium difficile infection. Which precaution would the nurse anticipate when caring for this patient? 1. Protective isolation 2. Airborne precautions 3. Standard precautions 4. Expanded contact precautions
Answer: 4.
The standard flu vaccine or "flu shot" is an ______ influenza vaccine that contains only killed viruses, so it cannot give someone the flu.
Inactivated
Members of high-risk populations such as pregnant women or children with immune dysfunction diseases may require IV immunoglobulins (antibodies) to prevent serious complications from ______.
Measles
Once a person contracts ______ and recovers, he or she is considered to have lifelong immunity.
Measles
Once contracted, the ______ cause fever, a generalized red rash, red eyes (conjunctivitis), runny nose, cough, and general malaise. The development of bluish spots on the buccal mucosa (Koplik's spots) is unique to this disease
Measles
______ is a very contagious respiratory illness caused by the rubeola virus and is spread by infected airborne droplets that are expelled when someone coughs or sneezes.
Measles
Which vaccines are live (attenuated)?
Measles, mumps, rubella (MMR); varicella; rotavirus; oral polio; and the nasal flu vaccines.
Inflammation of the testicles (epididymitis) in males who have reached puberty is the most common complication of ______.
Mumps
______ typically starts with a few days of fever, headache, muscle aches, tiredness, and loss of appetite and is followed by swelling of salivary glands.
Mumps
______, also known as viral parotitis, is a virus that only affects humans and causes illness that can last from several days to several weeks.
Mumps
For H1N1 (very serious) strains of the flu, a _______ is required.
N95 mask
Exposure to rubella, particularly during the first ______ weeks of pregnancy, can cause serious birth defects such as heart problems, hearing and vision loss, brain damage, and liver or spleen damage.
12
The usual incubation period for mumps is ____ to ____ days; it is contagious from 7 days before to 5 days after salivary gland swelling begins.
16-18
This medication Tamiflu can be administered to children as young as ______.
2 years old
Howl long is the incubation period of influenza?
24-72 hours.
A parent of a 3-year-old pediatric patient reports being tested for tuberculosis (TB) and asks if there is any way that the child could have the disease. Which response by the nurse would be appropriate? 1. "Your child should be tested." 2. "There is no treatment for children with TB." 3. "A test is not needed because there are no symptoms of the disease." 4. "Your child's immune systems can combat the TB infection better than yours."
Answer: 1.
Tamiflu should be started within _____ hours after symptoms occur.
48 hours
Flu vaccines are recommended for anyone older than _________.
6 months
Define antigen.
A foreign substance such as bacteria, viruses, toxins, and foreign proteins that stimulates the formation of antibodies and therefore provides immunity.
The nurse is reinforcing teaching previously provided by the RN to the parent of a pediatric patient with otitis media. Which statements would indicate that teaching has been effective? Select all that apply. 1. "I will not smoke around my child." 2. "I will wash my hands before picking up my child." 3. "I will position my child on the side of the affected ear." 4. "I will give the antibiotics until the symptoms subside." 5. "I will not give my child a sippy cup when being put in the crib for a nap."
Answer: 1, 2, 5.
Which minimum personal protective actions would be required for expanded contact precautions? Select all that apply. 1. Apply gloves. 2. Apply a gown. 3. Wear a mask. 4. Use a face shield. 5. Wash hands with soap and water.
Answer: 1, 2, 5.
The parent of a 15-month-old patient asks which vaccines contain the live virus. The nurse would list which vaccines? Select all that apply. 1. Varicella 2. Hepatitis B 3. Pneumococcal 4. Measles, mumps, rubella (MMR) 5. Diphtheria, tetanus, acellular pertussis (DTaP)
Answer: 1, 3, 4.
The nurse is reviewing prior teaching by the RN about infection control with a new parent. Which information would the nurse emphasize as the most important aspects? Select all that apply. 1. Hand washing 2. Clean water supply 3. Environmental pollution 4. Early refrigeration of food 5. Personal protective equipment
Answer: 1, 5.
Transmission of influenza is ______, requiring _______ precautions
Aerosol, airborne
Define protective precautions.
Also called reverse precautions or neutropenic precautions; the pt is protected from communicable diseases by a positive-pressure room. Here as the door opens, air is pushed out toward the hallway to prevent airborne or droplet-transmitted microbes form entering the child's room.
The nurse is concerned that a pediatric patient has influenza. Which observations would support this clinical determination? Select all that apply. 1. Fever and chills 2. Sore throat and cough 3. Vomiting and diarrhea 4. Headache and dizziness 5. Dilated pupils and confusion
Answer: 1, 2, 3, 4.
A 2-year-old pediatric patient is diagnosed with respiratory syncytial virus (RSV). Which personal protective equipment would the nurse don to prevent spreading this virus to other patients and staff? Select all that apply. 1. Mask 2. Gown 3. Gloves 4. Goggles 5. Face shield
Answer: 1, 2, 3.
The nurse is caring for a pediatric patient with varicella. Which personal protective equipment would the nurse don before entering the patient's room? Select all that apply. 1. Mask 2. Gown 3. Gloves 4. Goggles 5. Face shield
Answer: 1, 2, 3.
The nurse is assisting in the creation of a teaching tool to prevent infections from tick bites. Which information would the nurse recommend be included in this tool? Select all that apply. 1. Wear long pants. 2. Tuck pants inside socks. 3. Allow tick to detach on its own. 4. Apply insect repellent containing DEET. 5. Wear long-sleeved shirt tucked inside pants.
Answer: 1, 2, 4, 5.
The nurse suspects that an adolescent patient is experiencing symptoms of hepatitis A. Which signs and symptoms would the nurse observe in the patient to make this clinical determination? Select all that apply. 1. Vomiting 2. Diarrhea 3. Itchy skin 4. Dry mucous membranes 5. Report of abdominal pain
Answer: 1, 2, 4, 5.
The parent of a preschool-age patient says that someone in the child's class at school has the measles. Even though the child had the illness a few months ago, the parent does not want the child to contract it again. Which response would be appropriate for the nurse to offer to the parent? 1. "Because your child had the illness already, they have lifelong immunity." 2. "There is no way to prevent your child from contracting measles." 3. "Your child is already contagious and will remain so until 4 days after the rash appears." 4. "The incubation period is 8 to 12 days, so it is likely that your child has already been exposed."
Answer: 1.
A parent of a preschool-age patient asks how the child could have the flu, since the child has been in the house for 2 days, and no one else is sick. Which response by the nurse would be appropriate to offer the parent? 1. "Someone else in your home is a carrier of the flu virus." 2. "Your child became infected before staying home and showing symptoms." 3. "Your child isn't washing their hands as frequently as they should." 4. "The virus is dormant on objects such as doorknobs and sink faucet handles."
Answer: 2.
A pediatric patient is diagnosed with a communicable disease. Which condition would the nurse anticipate being reported to the local public health department? 1. Influenza 2. Chickenpox 3. Pneumonia 4. Otitis media
Answer: 2.
A pediatric patient is diagnosed with southern tick-associated rash illness (STARI). The nurse understands that the treatment program for STARI is similar to the treatment program for which condition? 1. Fifth disease 2. Lyme disease 3. Mononucleosis 4. Rocky Mountain spotted fever (RMSF)
Answer: 2.
The nurse is caring for a pediatric patient diagnosed with Lyme disease. Which medication class would the nurse anticipate being prescribed for this patient? 1. Steroids 2. Antibiotics 3. Decongestants 4. Antihistamines
Answer: 2.
The nurse is collecting data on a 24-month-old patient. Which observation would indicate to the nurse that the patient has otitis media? 1. Rash along the cheeks 2. Tugging on the ear 3. Slight respiratory wheeze 4. Redness of the conjunctiva
Answer: 2.
The parent of a school-age patient regrets not permitting the child to be vaccinated and fears that the child will have many illnesses in the future. Which response by the nurse would be appropriate? 1. "Keep your child away from anyone who appears sick." 2. "There is a catch-up schedule that can be started right away." 3. "Give your child extra vitamins to reduce the symptoms if an illness occurs." 4. "There is nothing that can be done now except to follow good hygienic practices."
Answer: 2.
The nurse is concerned that a school-age child has strep throat. Which findings would the nurse use to make this clinical determination? Select all that apply. 1. Muscle aches 2. Low-grade fever 3. Pain with swallowing 4. Swollen neck lymph nodes 5. Red raw throat with white spots
Answer: 3, 4, 5.
The nurse is collecting data on an adolescent patient who was diagnosed with mononucleosis 2 months ago. Which clinical manifestation would the nurse expect to see in this patient? 1. Fever 2. Anorexia 3. Ongoing fatigue 4. Lymphadenopathy
Answer: 3.
The nurse notes that a 3-month-old patient has a dry cough. For which sign would the nurse recommend that the parent monitor the baby when at home? 1. Diarrhea 2. Infrequent urination 3. Violent coughing fits 4. Elevated temperature
Answer: 3.
The school nurse is asked how 10 students can have hepatitis A at the same time. Which response by the nurse would be appropriate to provide? 1. "They must have ingested infected water at the same location." 2. "They all must have eaten the same food in the cafeteria." 3. "The infection is most contagious 1 week before symptoms begin." 4. "The students with the infection use poor hand washing technique."
Answer: 3.
A pediatric patient is diagnosed with Rocky Mountain spotted fever (RMSF). For which reason would the nurse expect this patient to be transferred to the intensive care unit? 1. Prevent nutritional deficiencies. 2. Provide high-dose antibiotic therapy. 3. Support a developing seizure disorder. 4. Treat disseminated intravascular coagulation (DIC).
Answer: 4.
A pediatric patient receiving high-dose steroid therapy for asthma is showing signs of a weakened immune system. Which treatment would the nurse anticipate being prescribed to prevent the child from developing a cytomegalovirus (CMV) infection? 1. Diuretics 2. Antibiotics 3. Vasodilators 4. Immunoglobulins
Answer: 4.
A pregnant patient infected with HIV is concerned that the newborn will have the infection. Which response by the nurse would be appropriate? 1. "There is no treatment unless symptoms occur." 2. "The virus is not transmitted during pregnancy." 3. "There is no way of knowing if the baby has the virus." 4. "Testing cannot be done until the baby is 18 months old."
Answer: 4.
A preschool-age patient is being treated for hepatitis B. Which prior teaching by the RN would the nurse reinforce with the parents once the child recovers? 1. Enforce strict hand washing in the home. 2. Have the child vaccinated for the hepatitis B virus. 3. Seek medical attention for any change in the child's appetite. 4. Monitor the child for signs of chronic hepatitis B infection.
Answer: 4.
The nurse administers the first does of the measles, mumps, and rubella (MMR) vaccine to a 13-month-old patient. At which time would the parent be reminded to have the second dose of the vaccine provided? 1. At age 18 months 2. At age 10 years 3. Between 2 to 4 years of age 4. Between 4 to 6 years of age
Answer: 4.
The nurse is caring for a 2-month-old patient who was just given the rotavirus vaccine. Which prior teaching from the RN would the nurse emphasize with the patient's parents? 1. "Your child's urine will be darker than usual." 2. "Expect your child to sleep more for a few days." 3. "Seek medical attention if your child develops diarrhea." 4. "Perform careful hand washing after changing your child's diapers."
Answer: 4.
The nurse is caring for a pediatric patient who is immunocompromised. Which vaccine would the nurse question before providing it to this patient? 1. Whooping cough 2. Haemophilus influenzae 3. Pneumococcal pneumonia 4. Measles, mumps, rubella (MMR)
Answer: 4.
The parent of a pediatric patient does not want the child to receive the seasonal influenza vaccine because the child had the flu immediately after receiving the vaccine the previous year. Which response by the nurse would be appropriate to make? 1. "It's not necessary for your child to receive the vaccine." 2. "Keep your child away from others who have symptoms of the flu." 3. "That sounds like an allergic reaction, and the vaccine should not be given." 4. "Body aches, fever, fatigue, and headache are common side effects of the vaccine, which can be confused as the flu."
Answer: 4.
What vaccines are whole (inactivate)?
Anthrax, cholera, whooping-cough, rabies, inactivated polio, and typhoid.
What is a major complication associated with influenza?
Dehydration
After vaccination, the body produces antibodies that will inactivate the bacterial toxin in the case of future exposure. This is the type of immunization used for ______ and ______.
Diphtheria and tetanus.
If a person has an allergy to _______, that allergy might cause a reaction because most flu vaccines are produced in an ______ product.
Egg
Serious cases of measles are rare but can involve complications in the brain tissue called ______ or ______.
Encephalitis or Encephalopathy
Young children are at risk for _______ _______ because the flu can cause rapid increases in body temperature.
Febrile seizures
Define expanded contact precautions.
Hand washing only, no alcohol-based hand gels; gown and gloves.
Define standard precautions.
Hand washing, gloves, gowns, masks, eye protection, and facial shields as needed.
Define contact precautions.
Hand washing, gown, and gloves; may also be called enteric contact precautions when the microbe is present in the stool.
The only medication that is currently approved for treating influenza is ______.
Oseltamivir phosphate (Tamiflu)
What are some examples of recombinant vaccines?
Pneumonia and Haemophilus influenzae.
Define droplet precautions.
Private room or room with pt with same organism, hand washing, mask if within 3ft of pt, gown, gloves, and eye shielding as needed.
Define airborne precautions.
Private room with door closed, hand washing, masks, gowns, gloves, eye protection, and face shields as needed.
The primary risk of rubella, and therefore the primary reason for vaccination, is ______.
Protecting women who are pregnant.
Common influenza symptoms are:
Rapid onset of fever, chills, conjunctivitis, headache, malaise, muscle pain (myalgia), and sudden onset of rigor, inflammation of the larynx and trachea, cough, sore throat, nasal congestion, and retrosternal pain are associated with the flu. Children often develop croup, pneumonia, and bronchitis as secondary conditions. Vomiting, diarrhea, and dehydration can also occur. Headaches and dizziness are also common.
Define immunity.
Refers to the body's ability to develop antibodies against specific bacteria, viruses, and toxins that can prevent future illness from exposure to the same antigen.
______ isolation precautions should be implemented when a child has been diagnosed with mumps.
Respiratory
Mumps is spread by ______, frequently through the coughing and sneezing of an infected person.
Respiratory droplets
______, also known as exanthem subitum or human herpesvirus type 6b (HHV-6b), is a viral infection caused by the HHV-6 pathogen.
Roseola
A child may have body and joint aches, but ______ does not usually cause severe illness in a child who is otherwise healthy.
Rubella
Children can be infectious up to 10 days before the appearance of the ______ rash.
Rubella
Children with ______ will present with a 1- to 2-day history of not feeling well, mild fevers, and a sore throat. The child may present with a maculopapular rash that typically begins on the child's forehead or face and progresses downward to the rest of the body.
Rubella
______ is an airborne virus spread by coughing and sneezing or by contact with nasopharyngeal secretions, urine, blood, or stool of those infected.
Rubella
The characteristic symptom of mumps is ______ (also known as parotitis), causes swelling of the glands, cheeks, and jaw. The swelling can be unilateral or bilateral.
Salivary gland inflammation
What age range of children have the highest flu infection rate in the population and may be hospitalized because of the complications of this virus.
School-aged
Define toxoids.
Substances that are chemically modified to retain their antigen properties bt are no longer considered poisonous.
What is the risk that comes with a whole (inactive) virus vaccine?
The possibility of an allergic reaction.
What is the main benefit of a live (attenuated) virus vaccine?
The strength of the immunity it produces. It is often effective with just one dose.
What are some interventions or treatments for the measles?
There are no interventions or treatments.
Toxoids operate somewhat differently than other vaccines. How is this so?
They produce antibodies against toxoids secreted by the organism.
Define acquired immunity.
This is obtained by either exposure to a bacterium, virus, or toxin sufficient to stimulate an immune response by the body, or stimulating the body's immune response through vaccination or immunization.
Define passive immunity.
This is the temporary immunity acquired by transfusing immune globulins or antitoxins either artificially from another human or from an animal that has been actively immunized against an antigen, or naturally from the mother to the fetus via the placenta.
Define active immunity.
This results from the development of antibodies or sensitized T lymphocytes after being exposed to an invading organism.
Define whole (inactivated) virus vaccine.
This type of vaccine contains the whole, killed organism, which retains the surface and internal structures that are strong stimulants to the immune system. The virus is killed, or inactivated, by heat, phenol, formalin, or thimerosal.
Define live (attenuated) virus vaccine.
This type of vaccine uses the whole virus, which has been manipulated in the laboratory in a number of ways to produce a weakened strain. These viruses mimic the natural virus so closely that the body can produce antibodies to provide immunity to the actual disease.
Define polysaccharide conjugate vaccine.
Uses sugars from the bacteria and bonds them to portions of another germ. This type of vaccine does not contain live viruses and does not contain the whole microbe, so it will not cause the infection or disease.
In such children who have contracted the measles, two doses of 200,000 IU of ______ during the toddler developmental period were found to reduce mortality by 83%.
Vitamin A
What type of vaccine requires multiple doses (boosters) to be given over time?
Whole (inactive) virus
Define endemic.
a disease that occurs continuously or in expected cycles in a population with a certain number of cases expected for a given period.
Define epidemic.
an infectious disease or condition that attacks many people at the same time in the same geographical area
Define influenza.
is a yearly occurring viral infection that occurs in the winter and has significant mortality and morbidity worldwide, particularly in the very young, the elderly, and immunocompromised patients.
Define incubation period.
the time interval between exposure to a communicable disease or infection and the presentation of the first symptoms.
Define recombinant vaccine.
this vaccine produces a genetically altered organism. It contains some manufactured proteins that match the germ's proteins closely, which stimulate the immune response in the body. These vaccines do not contain any part of the original germ, so they do not have the risk of causing the disease.
