1. Family Health Lecture March 18, 2015
University of Texas at Tyler
Nurs 5329
Angela Preston, BSN, RN

2. Communicable Diseases
“Children are the hands by which we take hold of heaven”
-Henry Beecher
Communicable Diseases
Nurses play a key role in preventing infections in the pediatric population by confidently recognizing subtle signs and symptoms of infectious diseases in the community, initiating appropriate interventions, and providing education concerning availability and access of services. Any child who presents with a rash or fever needs a more thorough assessment
Chapter 22

3. Lecture Objectives-taken from Syllabus
COMMUNICABLE DISEASES
Expected Learning Outcomes:
Identify common communicable diseases, collaborative management and prevention for pediatric population.
Use the nursing process to describe the nursing care of a child with an infectious disease.
Pre-class Assignments: Pediatric Chapter 22 pp

4. Immunizations for Children
Measles, mumps, rubella- MMR
Varicella- V
Hepatitis A
Influenza- FLU
Meningococcal*
Human Papilloma Virus- HPV*
Hepatitis B
Diphtheria*, tetanus*, pertussis-DTaP
Polio- IPV*
Haemophilus influenzae Type B –Hib*
Pneumococcal- PCV*
Rotavirus- RV*
There is a schedule put out by CDC delineating at which age which vaccine needs to be given- important parents keeps up with well child appointments because it is here they would administer vaccines- if not up to date, will have to be given prior to entry to school (exemptions- Religious, Medical, Conscientious)
Hep B – given to newborns, if mother HbsAg+ HBIG also given; 3 doses given before age 2
DTaP – 4 doses given for infants & toddlers (2, 4, 6mos, 15-18mos), final dose 4-6y; may cause irritability, loss of appetitie, localized swelling & tenderness to site; seizures rare side effect r/t pertussis component, much safer now since only acellular components used
IPV – replaced live, OPV which could cause paralysis in immunodeficient children- not given in US since 2000; 4 4, 6-18mos, 4-6y; often in combo vaccine with DTaP
Hib – bacterium that causes infection in various parts of time was leading cause of meningitis in young children, 4 doses 4, 6, 15-18mos; not given after age 5
Pneumococcal – recommended for children<5y; protects from meningitis, otitis media, & other infections; high-risk condition: cochlear implants, sickle cell, congenital heart disease, asplenia
Rotavirus – prevents severe diarrhea & dehydration, avoid if hx intussuseption or other GI disorder, oral
MMR – live vaccine, don’t given before 1st b-day, 2nd dose 4-6y; may experience maculopapular rash, fever, swollen cheeks, mild joint pain; contraindication: allergy to neomycin or gelatin
Varicella – don’t given before 1st b-day, 2nd dose 4-6y; side effects: erythema & rarely varicella-type contraindication: allergy to neomycin or gelatin; don’t give if pregnant or immunocomprised
Hep A – not given before 12mos, 2 doses given 6mos apart for high-risk or travel
Influenza – annual, 6m-18y should receive annually, children under 8 receiving 1st immunization need 2 doses 4wks apart; >2y can rec live, attenuated influenza virus (LAIV) thru nasal spray (contraindicated w/asthma, immunodeficient) which may cause mild flu symptoms since manufactured from weakened form of live virus. CDC only recommends healthy* 2-8 yo children receive nasal spray; if nasal spray not available, just give flu shot. Flu virus may morph/change so that can alter effectiveness of vaccine.
Meningococcal – 2 doses 8wks apart aged 2-10 risk r/t asplenia, HIV+, or immunodeficiency, booster q5y; travel to countries where meningococcal is endemic need 1 dose; avoid if latex allergy or hx Guillian-Barre

5. General Considerations of Immunizations
Private Insurance or State Funded
Educate on possible side effects- including mild fever/cold symptoms or soreness/redness at injection site
Teach appropriate doses of acetaminophen or ibuprofen for relief
Provide Vaccine Information Statement (VIS) and obtain parental consent
Document lot #, site, manufacturer
Report all adverse effects of immunizations
Location of administration
Warm site
Mild s/s of cold can still get immunizations, but hold if fever
VIS sheet – purpose, side effects, care of child, contraindications & allergies; should sign consent form
Report adverse effects – provider may file Vaccine Adverse Event Report (VAER) w/CDC
Documentation – lot#, route & site, date
Administer in anterolateral thigh NB-2yo, deltoid muscle 3-19yo

6. Types of Immunity Active immunity Passive immunity
Natural active immunity
Vaccine-induced immunity
Passive immunity
Natural passive immunity
Passive immunity through immunoglobulins
What is an example of each type??
Good review – see critical component: types of immunity p. 502
Active- permanent/long lasting immunity- person exposed to disease
Natural- has infection- have a cold, get immunity to that specific virus
Vaccine-exposed to weakened form of infection-
Passive-temporary/lasts a few weeks or months
Natural- passed from mother to fetus or nursing mother to breastfed baby i.e. cold viruses, etc
IG- Immune globulins given to provide immediate protection against disease or infection i.e. exposure of infant to HBsAg + mother (mom is + for Hep B antigen) Hep B Immunoglobulin would be given

7. Types of Vaccines Inactivated or killed organism
Live attenuated or weakened virus- can cause mild symptoms
Acellular vaccine
Toxoids
Subunit of virus
See critical component: types of vaccines p. 502
Inactivated- example- IPV- cannot replicate, but enough of original to stimulate immune response
Weakened virus- example- MMR and Varicella
Acellular- example- Pertussis, Hib- fragments of cells (does not contain whole cell) that stimulate immune response
Toxoids- example- Tetanus, Diptheria- toxins produced by the bacteria are inactivated so cannot cause harm, but stimulate immune response
Subunit-example- HepB- small fragments of viral protein are used
Review clinical pearl: routes of vaccines p. 502
Nasal- flu for healthy* children 2-8yo if available
Oral- RV
SC- MMRV
IM- DTAP, HepB, HepA, HPV, Flu, Hib, MCV, PCV, IPV

8. Critical Components of History
Exposure to the disease
Incubation period of the disease and the onset of symptoms
Communicable diseases in the past
Child’s immunization history
Physical assessment, including prodromal and general signs and symptoms
To assess child who may have communicable disease, hx essential
Has child been around other children w/disease? Have family members been exposed to a communicable disease?
Consider incubation period & length of time it takes for s/s to appear after exposure
Has child had any communicable diseases in past?
Is child up to date w/immunizations*
Physical assessment – includes prodromal s/s (runny nose, cough, fever, malaise) that appear before rash or main illness appears, often assoc w/increased communicability; general s/s w/communicable disease: changes in behavior (lethargy, irritability); skin rashes that may itch, may be macules, papules, pustules, vesicles; enlarged lymph nodes, fever, n/v/d, pain
See table 22-1: Summary of common communicable diseases p

9. Universal and Standard Precautions
Universal precautions: Prevent the transmission of bloodborne pathogens; provide guidelines for using protective barriers
Standard precautions: more comprehensive, applying to patients in all settings
Isolation guidelines: contact, droplet, and airborne precautions
Promoting safety p. 503
Universal- gloves, gown, masks, eyewear
Contact- gloves, gown – stool incontinence, rashes
Droplet-gloves, gown, surgical mask, goggles (if expect resp fluid to spray) -flu, pertussis
Airborne- gloves, gown, N-95, goggles(if expect resp fluid to spray) – special room with different venting- measles, chickenpox

10. Situations Requiring Emergency Services
Difficulty breathing
Blue, gray, or purple tinge to lips or skin
Fever with headache or stiff neck
Vomiting blood, or blood in stool
Behavior changes: lethargy, acting withdrawn, unresponsiveness
Seizure activity
Purple or red rash
Dehydration
Critical component: caregiver education p. 503

11. 15 Viral and Bacterial Communicable Diseases seen commonly in the Pediatric population
Erythema Infectiosum (Fifth’s Disease)
Hand-Foot-and-Mouth Disease
Respiratory Syncytial Virus Bronchiolitis
Roseola (Exanthum subitum) HHV 6
Hepatitis A
Hepatitis B
Influenza
Mononucleosis
Mumps (Parotitis)
Rubella (German measles)
Rubeola (Measles)
Varicella zoster (Chickenpox)
Bordetella pertussis (Whooping cough)
Group A Strep throat/Scarlet fever
Conjunctivitis (Pink eye)

12. Distribution of Content for the NCLEX-RN® Test Plan
Blueprint
Include:
1. Incidence in US & globally
2. If it is a vaccine-preventable disease; if so, what age vaccine is given along with information r/t vaccine
3. Physiological effect- how does virus or bacteria manifest itself in the body (include incubation period, prodromal phase and communicability)
4. Nursing management including:
Assessment- expected signs and symptoms
Comfort
Treatment &/or medication- how disease is usually diagnosed, i.e. lab tests, is it viral or bacterial?
Education
5. Special considerations/Higher risk population/Emergent care
Distribution of Content for the NCLEX-RN® Test Plan
Physiological Adaptation 14%
Reduction of Risk Potential 12%
Pharmacological and Parenteral Therapies 15%
Safety and Infection Control
12%
Health Promotion and Maintenance 9%
Basic Care and Comfort 9%
Psychosocial Integrity 9%
Management of Care 20%

13. Resources www.ncsbn.org https://www.dshs.state.tx.us www.cdc.gov
Textbook
Powerpoint posted online for Mod 9 Communicable Diseases

14. Team based Active Learning
1. Gather information and answer questions
2. Present information to class through skit, short powerpoint,
Take notes on other groups

15. Viral Diseases— Erythema Infectiosum (Fifth Disease)
Human parvovirus B19
Transmission by contact with respiratory secretions
4- to 21-day incubation period
Contagious until rash appears
“Slapped cheek” appearance
Prodromal – fever, aches, HA
Rash distribution – erythema of cheeks “slapped cheek” appearance; rash appears after cheek erythema characterized by lacy pattern on truck, may disappear & reappear if child becomes hot
Systemic s/s – none after rash appears
Diagnosis – blood test for presence of immunoglobulin M antibody indicates immunity
Nursing interventions- can trigger crisis in those with sickle cell; can trigger aplastic crisis in immunodeficient children (should by placed on resp isolation, may not have typical rash but c/o fever, n/v, abd pain, malaise, lethargy)
Home care – acetaminophen/ibuprofen for fever/pain, adequate hydration
Can pass from pregnant woman to fetus*- if mother has had it in past, already has immunity, if unsure of exposure prior to pregnancy need to practice careful hand hygiene- possible complications: anemia, miscarriage (1st half of pregnancy)
Once fever gone, can return to school.

16. Viral Diseases— (2) Hand-Foot-and-Mouth Diseases
Agent: Coxsackie virus or enterovirus
Transmitted by direct contact, respiratory, fecal-oral route
3- to 6-day incubation period
May be shed for several weeks
Small vesicles in mouth and on hands and feet
s/s – cold symptoms, runny nose, fever, sore throat; sm vesicles appear in mouth & on palms of hand & soles of feet, may also appear on genitalia & buttocks
Diagnosis – stool samples & throat swabs can be tested for presence of virus, but usually diagnosed clinically
Caregiver education – careful hand hygiene & disposal of tissues; clean surfaces & toys w/soap & water & disinfect w/bleach solution (1tbsp bleach to 4cups water); bland food & drinks since mouth may be sore, ensure adequate hydration; acetaminophen/ibuprofen for fever/pain, OTC sprays & mouthwashes w/local anesthetic to relieve mouth pain
Common in daycares

17. Viral Diseases — (3) Roseola (Exanthum Subitum), HHV-6
Respiratory Syncytial Virus Bronchiolitis
Roseola (Exanthum Subitum), HHV-6
Agent: human herpes virus 6
Transmitted by saliva of persons who have the disease or are carrying the virus
9- to 10-day incubation period
Communicability is unknown
Pink or red papular rash appears on the day the fever returns to normal
Agent: respiratory syncytial virus
Transmitted by contact with saliva and nasal secretions; can live on surfaces for several hours; readily transmitted by hands
4- to 6-day incubation period
Viral shedding may last 6 weeks
Premature babies high risk of hospitalization if acquire RSV
Clinical presentation for Respiratory Syncytial Virus Bronchiolitis- very common!
s/s cold in older children: cough, congestion, fever
As disease progresses in infants there may be resp distress w/tachypnea, wheezing, retractions, severe coughing, poor air exchange
Diagnosis – RSV screening
Nursing interventions
Emergency care – virus may cause resp distress in infants & toddlers, emergency tx may be needed, prematurity or medical problems such as congenital heart defects esp vulnerable
Acute hosp care – hospitalization needed for infants w/bronchiolitis & pneumonia in resp distress; contact isolation; freq assess resp status; sched activities to allow time for rest; cool humidified air; admin O2 as needed; hydration w/IVF if needed; bronchodilator nebs, inhaler tx
Home care
Careful hand hygiene & disposal of tissues
Cool mist humifier, hydration
Don’t administer OTC cough/cold products to children<4
Teach s/s resp distress in infant & when to seek medical care
Immunizations to (see Medication: Administration of Synagis p.510)- if Synagis given, must be given MONTHLY in premature babies- hospital will refer if baby needs it- expensive if self pay
Texas DSHS designates RSV season by regions across state- generally end of October to end of March.
Roseola (Exanthum Subitum), HHV-6
75% adults carry virus in saliva w/o symptoms, most people have had it by 4y
Clinical presentation
Prodromal – fever>103 x3-7d
Rash distribution – papular pink or red rash that appears day fever returns to normal
Diagnosis – typically based on rash, blood test may look for antibodies
Nursing interventions – fever management at home
Home care – fever mgmt: tepid bath, acetaminophen/ibuprofen

18. Viral Diseases — (4) Hepatitis A Hepatitis B Agent: hepatitis A virus
Transmitted by contaminated food, fecal- oral route
Incubation period approximately 30 days
Most contagious for 2 weeks before onset of symptoms and for 1 week after onset of jaundice
Agent: hepatitis B virus
Transmitted by blood or blood products, sexual contact
Incubation period on average is 90 days
Can be spread as long as the virus is in the blood of an individual; some people are chronic carriers and carry the disease for life
*What is given to newborns whose mothers are HbsAg+?*
Hepatitis A
Clinical presentation – fever, malaise, poor appetite, nausea, jaundice, abd pain, dark urine; <6y may be asymptomatic or mild symptoms, may play role in transmission
Diagnosis – blood test for presence of anti-HAV IgM; other abn labs: presence of bilirubin in urine, elevated serum bilirubin, elevated liver enzymes (AST, ALT)
Nursing interventions –
Contact isolation if incontinent feces
Immune globulin can be given after exposure to prevent or reduce severity
Report incidence to health dept
Home care
Strict hand hygiene & sanitization of surfaces
Appropriate rest & activity
Nutritious, well-balanced diet
In 2012, incidence was 0.5 cases per 100k (<5000)
Hepatitis B
Clinical presentation
Aching, malaise, joint pain, jaundice, dark urine, loss of appetite, mild RUQ pain
Children w/chronic may be asymptomatic & for developing hepatocellular carcinoma later in life
Newborns may acquire perinatally, 40% infants who don’t rec post-exposure prophylaxis will develop chronic HBV – important to admin HBIG in addition to HBV if mom HbsAg+- admin in separate thighs, must admin HBIG within 12 hours of life
High-risk groups among children & adolescents include those living in institutions, involved in IV drug use, infected by sexual partners, travel to Africa or Asia
Hosp care – blood-borne precautions (see universal precautions)
Don’t share toothbrushes or razors
Importance of tx (see Medication: treatment for HBV p. 507) & f/u
In 2012, new acute hep b cases (since vaccine created in 1991, 82% decr). 240 mil chronic hep b carriers globally- 786k deaths worldwide each year

19. Viral Diseases — (5) Influenza Mononucleosis
Agent: influenza viruses Type A (H1N1), Type A (H3N2), or Type B
Transmitted by contact with contaminated objects, coughing and sneezing
1- to 4-day incubation period
Can be spread 1 day before until 7 days after symptoms
Agent: Epstein-Barr virus
Transmitted by person-to- person contact, sharing of personal objects
30- to 50-day incubation period
Virus may be excreted for months following infection
May develop splenomegaly or hepatomegaly
Influenza
Type A most prevalent
Clinical presentation – fever, chills, HA, sneezing, cough, malaise, conjunctivitis, myalgia (aching)
Diagnosis – rapid screening for flu virus antigens in nasal secretions
Nursing interventions
Emergency care – may trigger croup in infants
Acute hosp care – pneumonia is complication that may require hospitalization, other complications: ear infections, sinus infections, dehydration, increased severity of medical conditions such as diabetes, asthma; isolation – droplet
Home care
Acetaminophen/ibuprofen for fever (no aspirin r/t risk of Reye syndrome)
Careful hand washing & disposal of tissues
Encourage increased fluid intake
Admin of meds w/in 48h of s/s (see Medication: Treating Influenza p. 508)
Importance of annual flu vaccine
CAM tx – traditional Chinese medicinal herbs may be used to treat flu- share article – Chen et al 2008
Mononucleosis
Clinical presentation
Fever, sore throat, malaise, pharyngitis, enlarged posterior cervical lymph nodes w/symptoms lasting 1-4wks
May develop splenomegaly or hepatomegaly
Diseases primarily affect adolescents or young adults, children often have very mild symptoms
Diagnosis - +mono spot test, +Paul-Bunnell heterophile antibody test, elevated lymphocytes, >10% atypical lymphocytes; EBV antibody titers
Acute hosp care – hospitalization may be needed if child develops resp distress, abd pain w/splenomegaly, dehydration (Spleen can hold platelets)
Prevent injury to spleen – no contact sports (football, basketball, soccer, rugby, baseball, boxing, hockey, rodeo, wrestling, martial arts, lacrosse, water polo) for 6-8wks
Rest w/appropriate quiet activities & play
Fever mgmt w/acetaminophen or ibuprofen
Hydration & nutrition
Counseling & emotional support for adolescents on BR

20. Scenario
12 month old infant in good health up to date on vaccinations presents to clinic with sudden onset of moderate fever (103 degrees) lasting for four days with otherwise non-specific complaints. Mother calls clinic because fever has returned to normal, but mild, pink, papules 1-5mm in diameter have appeared all over body. What is an appropriate nursing diagnosis?
Use critical components of history:
Up to date
4 days high fever
Fever returned to normal then rash appeared
Nonspecific complaints
75% of adults carry virus in saliva- most have disease by age 4
Roseola- fever management, fever has already gone away, rash usually lasts 2 days. Communicability is unknown.
Would need to call doctor if: febrile seizure, fever hasn’t gone away after seven days, rash hasn’t gone away after 3 days
Nursing care: fever mngmnt, bed rest, fluids
Risk of impaired skin integrity
Imbalanced body temperature

21. Viral Diseases — (6) Mumps or Parotitis
Agent: paramyxovirus
Transmitted by contact with oral and nasal secretions
16- to 18-day incubation period
Can be spread 2 to 3 days before swelling of salivary glands up to 5 days after swelling starts
Clinical presentation
Swelling of salivary gland in front of ear, below ear, under jaw
Boys may have painful swelling of testicles, girls may have ovarian involvement w/abd pain & breast inflammation
Diagnosis – virus can be isolated from saliva
Nursing interventions
Emergency care – complications: meningitis, encephalitis, glomerulonephritis, permanent deafness, sterility, myocarditis, joint inflammation; infection during preg may result in fetal death; seek medical help for complications
Acute hospital care – resp isolation
Home care
Acetaminophen/tylenol for fever/pain
Bland, soft foods; bland liquids, avoid citrus juices, keep well hydrated
Ice packs or warm compresses to neck for comfort

22. Viral Diseases — (7) Rubeola (Measles) Rubella (German Measles)
Agent: measles virus
Airborne through respiratory droplets or direct contact with secretions
8- to 12-day incubation period
Can be spread 1 to 2 days before prodromal symptoms, 3 to 5 days before rash, and 4 days after rash appears
Presence of Koplik spots in the mouth
Agent: rubella virus
Airborne through respiratory droplets or direct contact with secretions; also found in blood, urine, and stool
16- to 18-day incubation period
Can be spread from 7 days before until 14 days after rash; starts at hairline and works down
Rubella (German Measles)
Most children contagious 3-4d before rash to 7d after rash
Clinical presentation
Prodromal – not present in children; adolescents may have mild fever, malaise, sore throat, HA
Rash distribution – fine red or pink rash that appears on face 1st then spreads downward, lasts approx 3d & disappear in same order appear
Systemic s/s – fever, aching, posterior cervical lymph nodes tender & swollen
Home care
Fever mgmt
Importance of MMR vaccine before childbearing yrs- Rubella infection in pregnancy can cause congenital defects
Rubeola (Measles)
Prodromal – congestion, cough, conjuntivitis, fever, malaise, sm red spots in mouth w/bluish white center (Koplik spots)
Rash distribution – brownish red macular rash & spreads downward over body
Systemic s/s – fever, cough, red watery eyes, congestion
Diagnosis – blood test to detect antibodies
Nursing interventions
Emergency care – complications: ear infections, diarrhea, encephalitis, pneumonia, seizures, deafness, mental retardation, death; seek medical care
Acute hosp care – resp isolation
Chronic hosp care – long-term care, including vent care, may be needed for child w/brain damage from measles encephalitis
Keep child isolated for 5d after rash
Dim lights if photophobia present, use warm compresses to remove crusting from eyes as needed
Soft, bland foods; keep well hydrated w/plenty of fluids
Cool mist humidifier

23. Viral Diseases — (8) Varicella- Zoster (Chicken Pox)
Agent: Varicella zoster virus
Transmitted by fluid from vesicles, secretions from nose, mouth and eyes, and airborne from coughing and sneezing
10- to 21-day incubation period
Can be spread 1 day before rash appears until all vesicles have crusted over
Same virus causes Shingles(Herpes Zoster virus) later in life
Special considerations
Possible to get 2nd time, usually more mild
15-20% vaccinated get virus, usually more mild
Clinical presentation
Prodromal – fever, malaise, congestion
Rash distribution – 1st appears on trunk & face, spreads to other parts of body; goes thru stages of macule, papule, vesicle, & scab (crust) all time, severe itching
Systemic s/s – fever, HA, dehydration
Diagnosis – visualizing rash
Nursing interventions
Emergency care – complications: bacterial infections of skin, pneumonia, septicemia, bleeding probs; urgent medical care needed
Acute hosp care – may need hospitalization if immunocompromised or w/complications, IV acyclovir may be given; strict isolation – contact & resp
Home care
Avoid aspirin, use acetaminophen for fever, ibuprofen 6+mos
Keep isolated until vesicles have crusted over
Keep well hydrated
Prevent itching – keep cool, dress in light cotton, distraction w/play activities, apply gloves or mittens if needed & keep fingernails clean & short
Aveeno (oatmeal powder) or baking soda baths
Calamine or cetaphil lotion to lesions
Shingles- unvaccinated child cannot get shingles from someone with shingles or shingles from someone with chickenpox, but child may get chickenpox from adult with shingles if contact with lesion

24. What should the nurse say?
A mother comes into the clinic concerned because her 6- year old daughter was just diagnosed with varicella zoster. The blisters have begun to scab over. There is a 3 year old and another 4 month old infant in the home. What does the nurse recommend regarding prevention of the disease?
3 year old should get the Varicella vaccine. If already caught will not prevent but may lessen symptoms. 4 month old infant is too young for varicella vaccine but educate on strict handwashing and not picking scabs, Keep 6 year old isolated- incubation period is 10 to 21 days but child is contagious 1 days before rash appears until all vesicles have completely crusted over. Keep 6 year old well hydrated to prevent complications and offer solutions to itching to improve healing time (oatmeal baths, calamine lotion, clear, short fingernails)

25. Bacterial Diseases — Pertussis (Whooping Cough)
Agent: Bordetella pertussis
Transmitted through oral and nasal secretions
6- to 21-day incubation period
Contagious from the onset of symptoms and for about 2 weeks; infants not immunized may be contagious for at least 6 weeks
DTaP- 2 month shots
Cough ends with crowing (whooping), coughing “fits”
Classic pertussis is characterized by 3 phases of illness:
Catarrhal – lasts 1-2wks; cold symptoms including congestion, mild cough, fever
Paroxysmal – lasts 1-6wks or longer; cough ends w/crowing (whooping) & may be severe enough to cause vomiting & cyanosis
Recovery – cough gradually becomes less severe
Some children & adolescents, may present as chronic cough that lasts for wks, whooping may or may not be present – immunity from childhood vaccine fades after 5-10yrs, most don’t know they have the disease and expose others; Tdap Booster vaccine became available in 2005 for adolescents
Diagnosis – polymerase chain reaction (PCR) test identifies genetic material of bacteria of nasal secretions
Nursing interventions
Acute hosp care – infants may require hospitalization to manage resp distress & dehydration
Complications that can occur during the course of pertussis include hypoxia, pneumonia, weight loss, seizures, encephalopathy, death
Caregiver education
Give sm amt fluid freq to keep hydrated, esp during bouts of vomitting
Teach s/s resp distress & dehydration & urge to seek medical care as needed (see critical components: signs of respiratory distress & signs of dehydration p.516)
Provide for rest & quiet activities & avoid stimuli that trigger coughing
Cool mist humidifier
Educate adults to get PERTUSSIS booster if coming into contact with newborns!!!!

26. Bacterial Diseases — (2) Strep Throat/Scarlet Fever
Agent: Group A beta-hemolytic streptococcus
Transmitted by respiratory droplets, direct contact with secretions
2- to 5-day incubation period
Can be spread for 10 days without treatment; not contagious after 24 hours on antibiotics
Scarlet fever is strep throat with a rash in “creases of body”, possibly strawberry-like tongue
Swollen tonsils, may or may not have white pus pockets, may be associated with stomach ache
Complications of GAS – rheumatic fever & poststreptococcal glomerulonephritis
Clinical presentation
Sore throat, fever, HA, enlarged & tender anterior cervical & tonsillar lymph nodes, abd pain, decreased appetite
Cough & congestion aren’t major signs of strep throat, so if these are present likely caused by another organism
<3y may have infection w/o complaining of sore throat, s/s include fever, irritability, nasal d/c
Scarlet fever – strep throat w/fine red rash w/sandpaper texture; rash more pronounced in armpits & groin, creases of elbows, behind knees; after rash fades skin of fingers & toes may peel, may be pallor around mouth & white tongue w/swollen red papillae (strawberry tongue)
Diagnosis – rapid strep test, throat culture
Nursing interventions
Emergency care – complications of untreated strep throat include glomerulonephritis & rheumatic fever
Home care
Administration of pcn as ordered
Keep hydrated with extra fluids – soups, popsicles, milkshakes
Cool mist humidifier
Acetaminophen/ibuprofen for pain/fever
Replace toothbrush
Throat lozenges
CAM tx – saltwater gargles

27. Conjunctivitis (Pinkeye)
Agent: virus (adenovirus-cold) or bacteria
Transmitted through contact with discharge from an infected eye, either directly or by touching contaminated surfaces
Communicability varies depending on the organism
Bacterial- classic pink eye, pink/red, swelling, purulent discharge, eyes “crusted” shut in AM, abx begin resolving in 24 hours
Viral- pink, excessive tearing, may be slight crusting from tears, eyes might feel “dry”, no treatment available
Both contagious- educate to change pillows nightly, not to share hand towels, meticulous hand washing, do not touch eyes, requires doctor appointment to diagnose and prescribe antibiotic eye drops (if bacterial), warm compress may help alleviate pain
May cause re-infection if not cared for carefully, easily spread to both eyes and among family members, schools.
Upon presentation to clinic, ask history
Clinical presentation
Viral – pink or red conjunctiva, edema, watery d/c; may be unilateral
Bacteria – pink or red conjunctiva, edema, purulent d/c, crusted eyelids in am, c/o itching or pain
Nursing interventions
Teach administration of eyedrops as ordered for bacterial infections **clarify with parents saline drops won’t work
If 2 or more children in same setting (home or school) develop conjunctivitis cause may be viral & lead to epidemic in school/group setting
Home care – avoid touching eyes, careful handwashing after touching eyes, sanitize objects touched by eyes or hands, discard tissues used to wash eyes, admin eyedrops as ordered (see medication: administering eyedrops p. 514)
- Student needs doctor note or resolution of symptoms to return to school

28. Question – 3
A mother is caring for her 9-month-old baby, who has respiratory syncytial virus, and is calling the pediatrician’s office for advice. She reports that the baby is fussy and doesn’t want to take her bottle. She just noticed she has only changed one wet diaper that day and when the baby cries she’s not seeing tears. Which of the following would be the appropriate recommendation by the nurse?
“The baby will need to be seen by the doctor today. Let’s get you set up for an appointment .”
“Suction the nose prior to feedings and provide them more frequently in small amounts. Offer pain relief as needed.”
“The baby is in respiratory distress and needs to be taken to the emergency room immediately.”
“Administer over-the-counter cough/cold medicine to help alleviate the symptoms.”
Answer: B

29. Answer-3
The nurse knows the child is at risk for dehydration when the mother says she has had a notable decrease in wet diapers in 24 hours and is crying without tears. By suctioning prior to feedings, making them frequent and small, and comforting the infant through holding or giving pain relief if needed, the mother will be setting her child up for a successful feed. The nurse can recommend a visit to the pediatrician or ER if this does not increase diapers following this regime within a 12 hour period or if the child begins projectile vomiting or becomes lethargic.

30. Question – 4
A 4-year-old boy is brought into the pediatrician’s office for evaluation of fever, headache, and new-onset rash noted in his armpits and groin and behind his knees. The nurse assesses the boy’s mouth and throat and notices his tongue has a strawberry-like appearance. She inquires if the boy has been exposed to any sick children. The mother replies that several children in his daycare have had a sore throat. The nurse suspects which of the following communicable diseases?
Exanthem subitum
Hand-Foot-and-Mouth
Scarlet fever
Erythema infectiosum
Answer: C

31. Answer – 4
Scarlet fever
Scarlet fever is strep throat with a rash. A fine, red rash with the texture of sandpaper is more pronounced in the armpits and groin, in the creases of the elbows, and behind the knees. A strawberry tongue may also be noted. The child may also complain of stomach pain.

32. Minute Paper & Muddy Points: You may use bullets.
1. Starting now- write down in bullets what you learned today, starting with the most important and working down to less important points.
2. What was “muddy” or unclear that you want to know more about?
Include your name because I will go review these and send out an to clarify significant questions.