Standard Precautions
Barrier protection from blood and body fluids
Respiratory hygiene/cough etiquette
Safe injection practices
Hand hygiene
Airborne
Small particle or evaporated droplets or dust
Negative pressure isolation room -MTV
Droplet
Large-particle droplets (sneeze, cough, speech, cry)
Contact
Exercise judgment with gloves, gowns, masks
Immunizations
Vaccines have dramatically impacted the health and well-being of infants and children.
Schedule begins at birth and continues throughout childhood
Immunizations: Nurse's Role
Be familiar with the schedule (annually updated)
Be prepared for adverse reactions
Be aware of contraindications and precautions
Ensure parental consent prior to administration
Provide safe administration
Provide vaccine information and anticipatory
guida
Communicable Diseases
Incidence has declined with vaccine use
Nurse's role:
Familiarity with infectious agents
Recognize potential disease during history and exam
Institute appropriate preventive and supportive measures (isolation)
Diphtheria
Agent: Corynebacterium diphtheriae
Transmission: Direct contact
Clinical manifestations: URI-like symptoms which progress.
"Bull's neck"
White or gray mucous membranes, fever, cough
Treatment: Antibiotics, bed rest, and support
Precautions: Droplet
Chicken Pox (Varicella)
Agent: varicella-zoster virus
Transmission: Direct contact and respiratory secretions
Clinical manifestations:
Prodromal stage�slight fever, malaise.
Pruritic rash begins a macule vesicle then erupts
Rash is typically centripetal extremities, face
Treatme
Erythema Infectiosum (Fifth Disease)
Agent: Human herpesvirus type 6
Transmission: probably droplet or direct contact
Clinical manifestations:
Persistent fever for 3-7 days in child who is otherwise well appearing
"Slapped Cheek" appearance
Mild URI symptoms, cough
Treatment: Supportive care
Measles (Rubeola)
Agent: Viral
Transmission: Direct contact from respiratory system
Clinical manifestations:
Prodromal state: fever, malaise coryza, cough, conjunctivitis
"Koplick Spots" on mucosa
Rash appears on day 3-4 of illness
Treatment: Antibiotics, bed rest, and sup
Pertussis (Whooping Cough)
Agent: Bordetella pertussis
Transmission: Direct contact from droplets
Clinical manifestations:
Catarrhal stage: URI symptoms 1-2 weeks
Paroxysmal stage: short, rapid cough bought followed by high-pitched crowing, "whoop" or gasp 4-6 weeks cyanosis may oc
Rubella (German Measles)
Agent: Rubella virus
Transmission: Direct contact from droplets
Clinical manifestations: Low-grade fever, headache, malaise, sore throat, RASH
Treatment: Supportive care
Precautions: Droplet
Scarlet Fever
Agent: Group A Beta-hemolytic streptococci
Transmission: Direct contact from droplets
Clinical manifestations:
Prodromal stage: abrupt high fever, halitosis
Enanthema: tonsils large, edematous, covered with exudate
"Strawberry tongue"
Exanthema: sandpaper
Influenza (Flu)
Agent: Influenza Virus (varies from year to year)
Transmission: Direct contact
Clinical manifestations:
Abrupt Fever
URI-like symptoms which progress
Malaise, anorexia
Treatment: PREVENTION, antiviral treatment if detected early, supportive care
Precautio
Pneumococcal Disease
Agent: Streptococcal pneumococci
Transmission: Direct contact affecting children under 2 years most commonly
Clinical manifestations:
Pneumonia, otitis media, sinusitis, localized infections.
Treatment: PREVENTION, Antibiotics, supportive care
Precautions
Nonvaccine Communicable Diseases
Nursing Management:
Contact precautions
Keep eye clean and dry
Administer ophthalmic medications
Comfort and supportive care
Educate caregivers
Prevent spread of infection
Stomatitis
Nursing Management
Two types:
Aphthous ulcers
Herpetic gingivostomatitis
Goal is to relieve pain
NSAIDs
Topical anesthetics
Prevent spread of illness
Oral transmission
Meticulous handwashing
Intestinal Parasites
Most frequent infections worldwide
Young children at highest risk
Most common in the United States:
Giardiasis
Pinworms
Nursing Management:
Assist with identification, treatment, and prevention
Fecal smears are diagnostic
Treat family members
Provide educ
Giardiasis
Agent: protozoan Giardia intestinalis
Transmission: Direct contact with contaminated water or food
Treatment: Flagyl or Tindamax and prevention of reoccurrence
Enterobiasis (Pinworms)
Agent: nematode Enterobius vermicularis
Transmission: Inhalation or ingestion of eggs from contaminated hands
DX: Tape Test
Treatment:
Pyrantel Pamoate or Albendazole x 1, then again in 2 weeks.
Treat family members
Prevention of reoccurrence
Skin Infections
Bacterial Agents: staphylococci and streptococci
MRSA on the rise
Transmission: Invasion and toxicity in susceptible skin (self-inoculation is common)
Treatment:
Topical or systemic ABX
Hand-washing and hygiene
Dilute bleach baths
May require hospitalizat
Skin Infections Viral
Viral Agents: viruses
Transmission: Invasion and toxicity in susceptible skin or oropharyngeal mucosa following contact with droplets
Treatment:
Antiviral medications for HSV
Hand-washing and hygiene to prevent spread
Destruction of warts
Disorders includ
Skin Infections Fungal
Fungal Agents: typically dermatophystoses; tinea or candidia
Transmission: Invasion in susceptible skin, corneum, hair, or nails
May be transmitted from infected animals
DX: Microscopic exam
Treatment:
Topical or systemic antifungal
Disorders include:
Tin
Skin Infestations Scabies
Infestation agent: Sarcoptes scabiei
Transmission: Prolonged close personal contact where the mite burrows into the epidermis and deposits eggs.
Clinical manifestations:
Intense pruritus
Excoriation and burrows
Discrete inflammation between finger webs, n
Pediculosis Capitis (head lice)
Infestation agent: Pediculus humanus capitis
Transmission: Prolonged close contact when a female louse is able to obtain blood meal at scalp and deposit eggs on hair shaft at night.
Clinical manifestations:
Intense pruritus of scalp (behind ears or nape o
Bedbugs
Infestation agent: Cimex lectularius
Transmission: Contact/sleep in infested mattress mite burrows into the epidermis to feed on blood.
Clinical manifestations:
Intense pruritus, inflammation/rash
May progress to folliculitis/cellulitis
May trigger asthm
Rickettsial Infection
Disorders transmitted to humans via arthropods
Ticks, infected fleas, mites
More common in temperate and tropical climates
Bite or exposure may occur without knowledge to family and child
Illness ranges from self-limiting to fatal
Lyme Disease
Agent: Spirochete Borrelia burgdorferi
Transmission: Infected deer tick bite
Clinical manifestations:
Stage 1: "Bull's Eye"
Fever, HA, malaise
Stage 2: rash on hands and feet 3-10 weeks after inoculation
Fever, fatigue, lymphadenopathy, cough
Stage 3: Sys
Rocky Mountain Spotted Fever
Agent: spirochete Rickettsia rickettsii
Transmission: Infected tick bite, rodent or dog
Clinical manifestations:
Gradual or abrupt onset of fever, malaise, HA
Rash on palms, soles of feet
Treatment:
Tetracycline
Supportive therapy
Nursing implications:
Pr
Cat Scratch Disease
Agent: bacteria Bartonella henselae
Transmission: scratch from kitten or cat
Clinical manifestations:
Painless nonpruritic papule
Regional lymphadenitis
Treatment: Usually supportive without need for ABX
Nursing implications:
Support child and family with