Chpt 37 Nursing Care of the Child With an Infectious or Communicable Disorder

Pediculosis capitis (head lice) Dx/Tx

*Diagnosis* by identification of eggs, nymph, and lice with the naked eye is possible; adult lice are rarely seen *Treatment:* washing hair with a pediculicide such as permethrin, pyrethrins, lindane, malathion

Scabies Dx/Tx

*Diagnosis:* - can be made by a history of itching (especially at night), classic rash, and reports of itching in household or sexual contacts. - Mites can be seen on microscopic examination of skin scrapings to confirm diagnosis. *Treatment:* - A scabicide, such as permethrin or lindane, should be applied to the entire body below the head. - Treatment of infants and young children should include the head, neck, and body. - Retreatment 1-2 weeks later may be needed - Itching may not subside for several weeks, even after successful treatment.

Roseola infantum management and nursing implications

*Management:* • Course is generally benign. • In children who are uncomfortable or irritable or have a history of febrile seizures, antipyretics may be warranted. *Nursing implications:* • Comfort measures, such as antipyretics, antipruritics • Standard precautions are sufficient in the hospitalized child.

Fifth disease (parvovirus B19) management and nursing implications

*Management:* • Usually benign and self-limited; supportive treatment is all that is needed *Nursing implications:* • Comfort measures, such as antipyretics, antipruritics • Inform pregnant women of the potential risks to the fetus and preventive measures to ↓ these risks • *Droplet precautions* are required in the hospitalized child.

Enterovirus infection (Coxsackievirus) management and nursing implications

*Management:* • Usually mild and self-limiting, resolving within 1 week • Treatment is mainly supportive. *Nursing implications:* • Encourage oral fluids of preference, such as popsicles. • Provide analgesics as needed. • Mouthwash or sprays to numb the mouth may be needed. • Standard precautions and good hand hygiene are necessary.

Tetanus medical and nursing management

*Medical:* • supporting respiratory and cardiovascular function, stopping toxin production, neutralizing unbound toxins, and controlling muscle spasms. • Tetanus immunoglobulin and vaccine may be given • Removal of the offending organism, by debridement of the wound • IV antibiotics *Nursing:* • observing for signs of respiratory distress • Provide a quiet environment with reduced external stimuli to ↓ the incidence of spasms. • Pain management • Administer sedatives and muscle relaxants as ordered to ↓ the pain r/t muscle spasms and to prevent seizures. • reduce the child's anxiety • not contagious from person to person; standard precautions • Tetanus booster every 10 years

Rubeola (measles) Therapeutic and Nursing Management

*Therapeutic Management:* • Treatment is mainly supportive, including antipyretics, bed rest, and adequate fluid intake. • Post exposure vaccination of unimmunized child within 72 hours of exposure may prevent or reduce illness severity and duration. • Immune serum globulin given within 6 days of exposure may prevent or make symptoms less severe. *Nursing Management:* • Comfort measures, such as antipyretics and antipruritics • Clean eyes with warm, moist cloth to remove secretions. • Cool mist humidification to alleviate coryza and cough • Airborne precautions until 4 days after the onset of rash

Rubella (German measles) Therapeutic Management/Complications

*Therapeutic Management:* • Usually mild and self-limiting • Treatment is mainly supportive. *Complications:* • encephalitis and thrombocytopenia (rare) • Maternal rubella during pregnancy can result in miscarriage, fetal death, or congenital malformations

Varicella Zoster (chickenpox) Therapeutic and Nursing Management and complications

*Therapeutic Management:* • Usually self-limiting; treatment is mainly supportive: fever reduction, antipruritics, and skin care to prevent infection of lesions • Antiviral therapy and varicella zoster immune globulin may be used in those considered to be at high risk *Nursing Management:* • Comfort measures, such as antipyretics and antipruritics • Children may return to school or child care once lesions have crusted. • Air-borne and contact precautions in the hospitalized child *Complications:* • Lifelong latent infection occurs; reactivation results in herpes zoster (shingles), uncommon in childhood

Scarlet fever nursing assessment: S/S, diagnosis

- *S/S occur abruptly:* • fever greater than 101°F, chills, body aches, loss of appetite, N/V • pharynx is usually very red and swollen • tonsils may have yellow or white specks of pus • *erythematous rash begins on axillae, groin, and neck and proceeds to cover whole body* → rash looks like a sunburn but feels like sandpaper → rash lasts approximately 5 days and is followed by desquamation (peeling skin) • tongue develops a thick coat with a strawberry appearance → The tongue will later lose the coating and become bright red - *Dx:* identification of group A streptococcus on throat cultureh

Tetanus nursing assessment: S/S, and diagnosis

- *S/S:* • First trismus (masseter muscle spasm or lockjaw) and stiff neck (most profoundly affected muscles are those of the neck and back.) • S/S progresses in a descending fashion to other skeletal muscles and cause intermittent intense, painful muscular spasms of the neck, arms, legs, and stomach; seizures may result • fever • elevated BP • tachycardia - *Dx:* • Based on the clinical findings of the history and physical examination. • NO laboratory test to confirm tetanus.

Pertussis nursing assessment: S/S

- *S/S:* • Usually starts with 7 to 10 days of cold symptoms → paroxysmal coughing spells then begin and can last 1 to 4 weeks. • During the paroxysms, the child might cough 10 to 30 times in a row, followed by a whooping sound. • Between the paroxysmal episodes, the child might rest well and appear relatively unaffected.

Sepsis: Therapeutic management

- Aggressive IV antibiotic treatment started after a C&S is obtained - If final culture reports are negative and symptoms have subsided, antibiotics may be discontinued - If sepsis progresses to septic shock → ICU

Rocky Mountain Spotted Fever (RMSF)

- American dog tick and Rocky Mountain wood tick are the primary vectors - can be fatal without prompt and appropriate treatment - Complications of RMSF include pulmonary edema, cerebral edema, and multiorgan damage - Long-term neurologic involvement, such as partial paralysis of the lower extremities, hearing loss, loss of bladder and bowel control, movement disorders, and language disorders

Diphtheria nursing assessment and management

- Assess for sore throat, fever, and pseudomembrane - CLOSE observation of respiratory status → The pseudomembrane causes difficulty swallowing, airway obstruction and suffocation - Administration of antibiotics and the antitoxin is CRITICAL to encourage sloughing of the membrane. - Bed rest - *Droplet precautions*

Nursing Interventions to Promote Comfort for a Child With an Infectious Disease

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

CAMRSA nursing management and education

- Care of the child with CAMRSA will typically occur at home. - Antibiotics with microbial susceptibility will often be prescribed. - Comprehensive wound care, which may include I&D, may occur. - Follow-up for reassessment is key. - Education: • Taking the antibiotics as directed and finishing tx • proper hand hygiene and handwashing. • Discourage family members from sharing personal items. • Explain the risk factors involved in transmission. • Explain the importance of keeping cuts and scrapes cleaned and covered.

Pediculosis capitis (head lice) Isolation/Control Measures/Concerns

- Contact precautions - After treatment check hair and comb nits and lice from hair shafts every 2-3 days to prevent reinfestation. - Control measures: •Household and other close contacts should be examined and if infested treated. •disinfection of clothing, headgear, pillowcases, towels, and other items used by the individual within the past 2 days by washing in hot water and drying on the hot cycle may be helpful. • Dry-cleaning nonwashable items or simply sealing them in a plastic bag for 10 days is effective.

Scabies Isolation/Control Measures/Concerns

- Contact precautions - Prophylactic therapy for household members and sexual contacts - Wash bedding and clothing used by infested person or household, sexual, or close contacts within 4 days before treatment mites do not survive more than 3-4 days without skin contact). - Avoid direct skin-to-skin contact with person or items used by those infested. - Clean room used by an infected person

Hookworm Dx/Tx

- Diagnosis: through microscopic examination of feces that reveals hookworm eggs - Treatment: albendazole (preferred), mebendazole, and pyrantel pamoate Iron supplementation and possible blood transfusion in severe cases

Pediculosis capitis (head lice) clinical manifestations

- Extreme pruritus is the most common symptom. - Adult eggs (nits) or lice may be seen, especially behind the ears and at the nape of the neck

Rabies Nursing Management

- Few people survive once symptomatic rabies infection develops → seek medical care after any animal bite - Postexposure prophylaxis (PEP): • Wound management; virucidal agent, soap and water • regimen of 1 dose of immune globulin and 4 doses of human rabies vaccine.

Airborne precautions PPE and diseases

- Goggles, Respirator • Rubeola (measles) • Varicella • Mumps

Droplet precautions PPE and diseases

- Goggles, mask • streptococcal group A • mumps • rubella (German measles) • scarlet fever • Fifth disease (parvovirus B19) • diphtheria • pertussis *Stupid MR. Sam Forgot Droplet Precautions*

Contact precautions PPE and diseases

- Gown, gloves • Varicella • Diphtheria • Mumps • Scabies • CMRSA • Pediculosis capitis Very Dumb Men Skip Contact Precautions

Scabies clinical manifestations

- Intense pruritus (especially at night) with the presence of erythematous, papular rash with excoriations. • lesions are generally distributed but often are concentrated on the hands and feet and in body folds. • May be found on head and neck - In infants and young children the rash is often heavy on palms, soles and fingers, and it may include vesicles, pustules, or bullous lesions.

Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA): risk factors, transmission, and protection

- MRSA acquired NOT in the hospital - These infections range from minor skin rashes to abscesses to serious, complicated, life-threatening infections. - *Risk factors:* frequent skin-to-skin contact; openings in the skin/skin trauma; contact with potentially contaminated personal items, equipment and surfaces; poor hygiene; limited access to health care; frequent exposure to antimicrobial agents and crowded living conditions - *Transmission:* direct person-to-person contact, respiratory droplets, blood, or sharing personal items, and touching surfaces or items contaminated with MRSA. - *Protection:* Intact skin and mucous membranes, and proper hand hygiene, are the best barriers to MRSA.

Hookworm Clinical manifestations

- Most often people are asymptomatic until significant worms are established. - May see pruritic erythematous papular rash at entry site or pulmonary symptoms as the larvae migrate - One of the greatest concerns in chronic infection is anemia (microcytic hypochromic anemia) secondary to blood loss as the worms suck blood and juices from the intestines.

Cytomegalovirus (CMV)

- Most people have it unknowingly as CMV is typically asymptomatic - transmitted via body fluid - Nurse must educate mother that if acquired by pregnant mom can be harmful to child

Managing Fever in a Child With an Infectious Disease

- No Aspirin if fever is unknown in origin → Reyes - Assess temperature at least every 4 to 6 hours, 30 to 60 minutes after antipyretic is given and with any change in condition. - Administer antipyretics per physician order when the child is experiencing discomfort or cannot keep up with the metabolic demands of the fever - Assess fluid intake and encourage oral intake or administer intravenous fluids per physician order.

Sepsis physical examination: inspection and observation

- Observe the child's general appearance, color, level of arousal, and hydration status. • Parent may report child is not acting right - The child with sepsis may appear lethargic and pale and show signs of dehydration - Inspect the skin for petechiae or other skin lesions. - Observe respiratory effort and rate - Assess VS, noting abnormalities • Hypotension indicates worsening condition

Rubella (German measles) clinical manifestations

- Rash usually first sign. • Begins on face and spreads DOWNWARD to entire body → Rash disappears in same order it spread (fades on face as it spreads to trunk) • Mild pruritus • Polyarthralgia (multiple joint pain) and polyarthritis

Lyme disease nursing assessment: S/S and nursing management

- S/S: • Ring like rash at the site of the tick bite (erythema migrans) characterizes early local disease • Rash typically does not occur until a few days after tick removal - Management: • For infection to occur, typically the tick must be attached for 36 to 48 hours → prompt removal of ticks is essential to prevention • Antibiotics if infected

Rocky Mountain Spotted Fever (RMSF) nursing assessment: S/S and treatment

- S/S: • sudden onset of fever, HA, malaise, N/V, muscle pain, and anorexia • Rash • abdominal pain, joint pain, and diarrhea - Tx: Prompt antibiotics (Doxycycline)

Pinworm Clinical manifestations

- Some people are asymptomatic. - May cause anal itching (pruritus ani), especially at night - Other clinical findings may include restlessness and teeth grinding at night, weight loss, and enuresis.

Scarlet Fever: Nursing Management

- Usually cared for at home - ANTIOBIOTIC TX - Encourage fluid intake to maintain adequate hydration due to fever - A cool mist humidifier can soothe the child's sore throat. - Soft foods, warm liquids like soup, or cold foods like popsicles may help - *If the child is hospitalized, droplet precautions are necessary*

Mumps

- Viral infection characterized by fever and parotitis (inflammation and swelling of the parotid gland). - Mumps is spread via airborne droplets or contact with infected droplets.

Bacterial infections occurring in Children: Sepsis

- a systemic overresponse to infection resulting from bacteria and viruses, which are the most common, fungi, viruses, rickettsia, or parasites. - can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure.

Epstein-Barr virus (EBV)

- acute infection which causes sore throat, fever, EXTREME fatigue, and enlarged lymph nodes; also called mononucleosis (MONO) - Transmitted through saliva

Pertussis definition, transmission, and incubation period

- acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. - highest incidence and the greatest risk for severe disease and death are seen in children < 1 y/o - *Transmission:* Droplet - *Incubation period:* 6 to 21 days

Tetanus

- acute, often fatal neurologic disease caused by the toxins produced by Clostridium tetani - Spores commonly found in soil, dust, and feces from humans or animals - The spores can enter the body through a wound that is contaminated, through a burn, or by injecting contaminated street drugs. - Characterized by ↑ muscle tone and spasm - Recovery can be long and difficult, and children with tetanus may have to spend several weeks in the hospital in an intensive care setting

Pertussis Nursing Management

- administering ANTIBIOTICS to eradicate the bacterial infection and providing respiratory support - providing a high-humidity environment and frequent suctioning to mobilize secretions. - Observe for signs of airway obstruction. - Encourage fluids to keep secretions thin and maintain adequate hydration. - *Droplet precautions*

Scarlet fever and transmission, incubation period, communicability, and complications

- an infection resulting from group A streptococci; typically from a group A streptococci throat infection - *Transmission:* through droplets and follows contact with respiratory tract secretions - *Incubation period:* 2-5 days - *Communicability:* highest during acute infection, child is no longer contagious 24 hours after initiation of appropriate antimicrobial therapy - *Complications:* rheumatic fever, glomerulonephritis, skin infections, abscesses of the throat, pneumonia, and arthritis

Diphtheria and S/S and TX

- bacterial infection and may affect the nose, larynx, tonsils, or pharynx. - *S/S:* • pseudomembrane forms over the pharynx, uvula, tonsils, and soft palate • neck becomes edematous and lymphadenopathy develops. - *TX:* • Immunization can prevent • Management involves administration of antibiotics and airway management

Rabies nursing assessment: S/S

- early symptoms of rabies infection, which are nonspecific and flu-like, such as fever, headache, and general malaise. - child may complain of pain, pruritus, and paresthesia at the bite site. - As the virus spreads to the CNS, encephalitis develops. - The disease will have progressive neurologic manifestations: insomnia, confusion, anxiety, changes in behavior, agitation or excitation, hallucinations, hypersalivation, dysphagia, and hydrophobia, and periods of lucidity

Mumps nursing assessment: S/S

- low-grade fever and onset and progression of parotid swelling (swelling of the neck either bilaterally or unilaterally) - most common complication in postpubertal boys is orchitis (inflammation of the testicle) → atrophy and sterility - Some children with mumps will have nonspecific or mild respiratory symptoms or no symptoms at all

Lyme disease therapeutic management

- most cases Lyme disease can be cured by antibiotics, especially if they are started early in the illness. - Doxycycline is the drug of choice for children older than 8 years - Because of the risk that it can cause permanent discoloration of the teeth when given for greater than 2 weeks, children younger than 8 years should be treated with amoxicillin

Mumps nursing management

- primarily supportive - Acetaminophen or ibuprofen is used for fever management and pain management - Oral fluids are encouraged to prevent dehydration - If orchitis is present, ice packs to the testicles and gentle testicular support may be helpful - airborne and contact precautions

CAMRSA nursing assessment: S/S, Assessments, and diagnosis

- skin and tissue infections are common infections caused by CAMRSA - *S/S:* • a bump or skin area that is red, swollen, painful, and warm to touch. • fever, fluctuance, and purulent drainage • the lesion may have appeared suddenly and be red and raised • Abscesses - *Assessments:* past medical history to determine history of recurrent skin infections with or without complete resolution along with assessment for risk factors - *Dx:* C&S determiens diagosis

Rabies

- viral infection of the CNS - It is transmitted to other animals and humans through close contact with the saliva of a rabid animal, usually by a bite - Once symptoms of rabies have developed, the prognosis is poor → Death usually occurs within days

Antipyretics actions/indications and nursing implications

Actions/indications: • Used to ↓ temperature Nursing implications: • Never give aspirin or aspirin-containing products to a child younger than 19 years with a fever due to the risk of Reye syndrome. • Ensure proper dosing, concentration, and dosing interval. • Avoid ibuprofen use in children with a bleeding disorder. • Assess fever and any related symptoms such as tachycardia, shivering, or diaphoresis.

Pinworm Dx/Tx

Diagnosis: - when adult worms are visualized in the perianal region; they are best viewed when the child is sleeping. - Tape test - Very few ova are present in stool, so examination of stool is not recommended. - Treatment of choice is mebendazole, pyrantel pamoate, and albendazole, usually single doses and repeated in 2 weeks.

Tick removal guidelines

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

Zoonotic and vector-borne infections

diseases caused by infectious agents that are transmitted directly or indirectly from animals or vectors, such as ticks, mosquitos, or other insect vectors to humans.

incubation periods: Scarlet fever, Pertussis, Rubella, Rubeola, Varicella zoster, Roseola infantum, Fifths disease (Parvovirus B19) and Enterovirus infection (Coxsackievirus)

the period between exposure to an infection and the appearance of the first symptoms Scarlet: 2-5 days Coxsackievirus (Enterovirus infection): 3-6 days Fifths disease (Parvovirus B19): 4-28 days Roseola Infantum: 5-15 days Pertussis 6-21 days Rubeola 10-12 days Varicella zoster: 10-21 Rubella: 12-23 days *S*cary *C*ops *F*ound *R*olled *P*ipes by the *RVR*

Enterovirus infection (Coxsackievirus): transmission, incubation period, and communicable

• *Transmission:* direct contact with infected fecal, oral secretions; spread mostly through saliva • *Incubation period:* 3-6 days • *Communicable* from time of infection until fever resolves; virus is shed for several weeks after the infection begins

Roseola infantum: transmission, incubation period, and peak incidence ages

• Caused by human herpes virus • *Transmission:* suspected to be from saliva of infected person and enters the host through the oral, nasal, or conjunctival mucosa • *Peak incidence:* ages 7-13 months • *Incubation period:* 5-15 days

Fifth disease (parvovirus B19): transmission and incubation period

• Caused by human parvovirus B19 • *Transmission:* large droplet spread from nasopharyngeal viral shedding or percutaneous exposure to blood and blood products. Also transmitted from mother to fetus • *Incubation period:* 4-28 days

Rubeola (measles): transmission, incubation period, and communicability

• Caused by measles virus • *Transmission:* direct or indirect contact with droplets, primarily by nasopharyngeal secretions, but also blood and urine. Highly contagious • *Incubation period:* 10-12 days • *Communicable* 1-2 days before the onset of symptoms until 4-6 days after rash has appeared

Rubella (German measles): transmission, incubation period, and communicability

• Caused by rubella virus • *Transmission:* by direct or indirect contact with droplets, primarily by nasopharyngeal secretions, but also in blood, stool, and urine. Also transmitted from mother to fetus • *Incubation period:* 12-23 days • *Communicable:* 7 days before to 7 days after onset of rash

Varicella Zoster (chickenpox): transmission, incubation period, and communicable

• Caused by varicella zoster virus • *Transmission:* Highly contagious; direct contact with infected persons' nasopharyngeal secretions or via air-borne spread. Also transmitted from mother to fetus • *Incubation period:* 10-21 days • *Communicable* 1-2 days before the onset of rash until all vesicles have crusted over (about 3-7 days after the onset of rash)

Rubella (German measles) nursing implications

• Comfort measures such as antipyretics, antipruritics, and analgesics for joint pain • *Droplet precautions* until 7 days after onset of rash • Rubella vaccine may be given to mother after birth before leaving hospital (rubella vaccine are live); should not be given during birth

Enterovirus infection (Coxsackievirus) clinical manifestations

• High fever usually occurs first. • Vesicles on tongue and oral mucosa erode to shallow ulcers → Extensive mouth lesions may lead to anorexia, dehydration, and drooling. • vesicles on hands and feet are football shaped, with erythematous rims.

Nursing Interventions to Promote Skin Integrity

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

Rubeola (measles) clinical manifestations

• Prodromal phase: 2-4 days, consisting of fever, cough, nasal membrane inflammations, conjunctivitis • FOLLOWED BY: → Koplik spots on buccal mucosa (bright red spots with blue white centers on mucous membranes) → Erythematous rash that gradually proceeds from head downward and outward.

Fifth disease (parvovirus B19) clinical manifestations

• Prodromal phase: mild symptoms, low-grade fever, headache, mild upper respiratory infection • Characteristic rash occurs in 3 stages: 1. Begins with erythematous flushing often described as "slapped-cheek" appearance 2. Rash spreads to trunk 3. Rash moves peripherally • Rash fluctuates in intensity and will disappear and reappear with environmental changes such as exposure to sunlight. • Resolves spontaneously over 1-3 weeks

Roseola infantum clinical manifestations

• Prodromal phase: usually asymptomatic but may include upper respiratory signs • Clinical illness: high fever ranging from 37.9° to 40°C (101-106°F) for 3-5 days • Fever resolves abruptly; THEN rash appears 12-24 hours later, lasting about 1-3 days. • Rash is predominately on NECK AND TRUNK • pinkish red, flat or raised spots that blanch when touched

Varicella Zoster (chickenpox) clinical manifestations

• Prodromal symptoms (fever, malaise, anorexia, headache, mild abdominal pain) may be present 24-48 hours BEFORE the onset of the rash. • Rash is often the first sign of disease. • Lesions often appear FIRST on scalp, face, trunk, THEN extremities • Lesions are initially intensely pruritic erythematous macules that evolve to papules and then form clear, fluid-filled vesicles. • Vesicles eventually erupt, and then lesions scab and crust.