Chapter 16

1. Chapter 16 The Child With an Infectious Disease

2. Immune Functions • Nonspecific immunity • Functional at birth • First line of defense • Reacts similarly to all invaders • Includes phagocytosis of foreign material by white blood cells

3. Immune Functions • Specific immune response • Second line of defense • Not functional at birth, must be learned by the body • Not fully functional until a child is 6 years old • Humoral immunity depends on the antibody-producing abilities of B-cells

4. Vaccines • Live (attenuated viruses) • Killed (inactivated viruses) • Toxoids • Human immune globulin

5. Immunity • Active immunity involves the body’s formation of antibodies in response to exposure to an antigen • Passive immunity is temporary immunity achieved by the administration of antibodies produced by another individual

6. Infectious Disease Terminology Incubation period describes the time between exposure to the disease and disease outbreak; during this time the child may be contagious Period of communicability is the period when the organism can move from the host to another individual Prodromal period is the time between the initial symptoms and the presence of the full-blown disease

7. Commonalities in Viral Infections • Many have a rash (exanthem) • Most are accompanied by a fever • Most are accompanied by cold or flulike symptoms • Most are transmitted by direct contact with droplets or airborne particles • Most can be prevented by immunization • All require that the child be isolated from others to prevent spread • Treatment is mostly symptomatic • Encephalitis is rare but can occur as a complication of most childhood viral infections

8. Rubeola vs. Rubella Red maculopapular rash that gradually turns brownish Begins behind ears at hairline and spreads downward toward feet Koplick’s spots on buccal mucosa Pinkish maculopapular rash Begins on face, neck, and scalp and spreads downward to feet over a 3-day period As rash develops on a new area, rash over previous area fades Forschheimer’s sign Measles Rubella (3-day measles)

9. Rubeola Incubation period: 8 to 12 days Infectious period: 3 to 5 days before rash appearance to 4 days after rash appearance Transmission: direct contact with droplets or airborne particles (lesser degree) Rubella Incubation period: 14 to 21 days Infectious period: 7 days before onset of symptoms to 14 days after rash appearance Transmission: direct contact with droplets or airborne particles, transplacental transmission Rubeola vs. Rubella

10. Rubeola Most common complication in children: secondary bacterial infections such as otitis media, croup, or bronchopneumonia Therapeutic management: treatment is symptomatic and supportive in the normal, healthy child Research supports the use of vitamin A in some cases of childhood measles Rubella Most common complication in children: thrombocytopenia Therapeutic management: treatment is symptomatic and supportive in the normal, healthy child Rubeola vs. Rubella

11. Rubeola vs. Rubella Nursing considerations (for all viral infections): • Take immediate steps to reduce exposure of other children to the possibly infected child • Monitor temperature and use temperature control measures to reduce hyperthermia • Provide skin care to prevent breakdown • Recommend bed rest during prodromal and/or febrile phase of the infectious disease • Teach good handwashing to prevent infection spread

12. Rubeola vs. Rubella Child and family education: • Educate parents regarding MMR vaccine • Family needs to be educated regarding the length of time the child is contagious • No school until period of contagion has passed • Child should not be around pregnant women • Teach good handwashing to prevent infection spread

13. Varicella Zoster Infections Varicella (chickenpox) Varicella Zoster (Shingles) Lesions begin as macular; appear in crops, progress to papules, then vesicles to pustules Lesions are unilateral macular/papular and follow a dermatome root • Incubation period: 10 to 21 days • Infectious period: 1 to 2 days before onset of rash until all lesions are crusted over • Transmission: direct contact with droplets, airborne particles • Most common complications in children: secondary infections of skin lesions caused by staphylococcus and group A beta-hemolytic streptococcus

14. Chickenpox

15. Varicella Zoster Infections Child and family education: • Reye syndrome has been known to occur after varicella infections: do not administer aspirin or aspirin-containing products during illnessbecause of the potential risks of developing Reye syndrome • Child is contagious until all lesions are crusted over • Educate parents regarding varicella zoster immune globulin (VZIG) vaccine at well checkups • Prevent child from scratching lesions to avoid secondary bacterial infection from developing

16. Erythema Infectiosum (Fifth Disease) Maculopapular, lacy rash on trunk and extremities Fiery red, edematous rash on cheeks “slapped cheek” sign • Incubation period: 4 to 14 days • Infectious period: thought to extend from the prodromal period until the rash appears • Transmission: direct contact with droplets, airborne particles, blood/blood products, transplacental transmission • Most common complications in children:none reported

17. Erythema Infectiosum (Fifth Disease) Therapeutic management and nursing considerations: see rubeolla and rubella Family and child education: • As with rubella, children should not be around pregnant women • Do not administer aspirin or aspirin-containing products during illness because of the potential risks of developing Reye syndrome • Teach good handwashing to prevent infection spread

18. Roseola Infantum (Sixth Disease) • Incubation period: estimated at 9 to 10 days • Infectious period: thought to extend from febrile stage until the rash appears • Transmission: Most likely through secretions of asymptomatic contacts • Most common complications in children: none reported Erythematous maculopapular rash

19. Roseola Infantum (Sixth Disease) Family and child education: • Family needs to be taught principles of fever management • Do not administer aspirin or aspirin-containing products during illness because of the potential risks of developing Reye syndrome • Knowledge regarding seizure precautions in the event of a febrile seizure • Teach good handwashing to prevent infection spread

20. Mumps • Incubation period: 16 to 18 days • Infectious period: 7 days before swelling to 9 days after onset • Transmission: Airborne droplets, salivary secretions • Most common complication in children:aseptic meningitis; orchitis is a common complication for the adolescent

21. Mumps Family and child education: • Do not administer aspirin or aspirin-containing products during illness because of the potential risks of developing Reye syndrome • Teach good handwashing to prevent infection spread • Educate parents regarding importance of immunizations at well-child visits

22. Epstein-Barr (Mononucleosis) • Incubation period: 4 to 7 weeks • Infectious period: Unknown; virus is shed before clinical onset of disease until 6 months or longer after recovery • Transmission: Saliva, intimate contact, blood • Complications in children:Risk for splenic rupture; swelling of pharynx and tonsils severe enough to compromise respiration

23. Epstein-Barr (Mononucleosis) • Therapeutic management: supportive unless swelling of pharynx and tonsils is severe enough to compromise respiration • Nursing considerations: management of viral illness

24. Epstein-Barr (Mononucleosis) Family and child education: • Avoid contact sports until the primary care provider approves • Do not share food, drink, or utensils • Keep well hydrated • Teach good handwashing to prevent infection spread • Discuss the importance of rest and possible lengthy convalescence

25. Rabies • Incubation period: 5 days to more than 1 year • Infectious period: 10 days • Transmission: bites with contaminated saliva • Disease is fatal once virus has established itself

26. Rabies Therapeutic management: prevention through education If determination is made to treat, vaccines are as follows: • Human rabies immune globulin (HRIG): half of the dose is infiltrated locally around the wound, the rest is administered intramuscularly • Human diploid cell vaccine (HDCV): best if administered 48 hours after bite, then on days 3, 7, 14, and 28

27. Rabies Nursing considerations: • Obtain complete history of event • Examine and document a description of the wound • Distraction techniques and therapeutic play for child who must undergo rabies treatment series • For the child who develops rabies: strict isolation per hospital policy and support of parents through the grieving process • Family education is the key to prevention

28. Pertussis (Whooping Cough) • Incubation period: 6 to 20 days • Infectious period: catarrhal stage (1 to 2 weeks) until the fourth week • Transmission: direct contact or respiratory droplets from coughing • Most common complication in children:pneumonia

29. Pertussis (Whooping Cough) Therapeutic management: erythromycin to infected child and all nonimmune close contacts Nursing considerations: • Documentation of immunization history • Physical assessment: respiratory status, neurologic status, fluid, nutrition, intake and output • Monitor oxygen saturation levels • Monitor nutritional status • Cluster activities to promote rest • Emotion support for parents

30. Rocky Mountain Spotted Fever • Incubation period: 2 to 14 days • Transmission: wood tick or dog tick bite • Complications in children: gangrene of the distal parts of the body can result from thrombosis Therapeutic management: • Doxycycline is the drug of choice • Positive resolution of illness is best if used within 5 days of onset

31. Rocky Mountain Spotted Fever Nursing considerations: • Obtain thorough history • Physical examination and documentation of any rashes or lesions • Vital signs • Educate parents to give full course of antibiotics • If hospitalized: supportive care for presenting symptoms

32. Lyme Disease • Incubation period: 3 to 32 days • Transmission: infected deer tick bite • Symptoms in children:directly related to when Lyme disease is diagnosed • Therapeutic management for early localized disease: doxycycline for children aged 9 years and older; amoxicillin for children younger than 9 years Where Lyme disease is found in the United States

33. Lyme Disease Nursing considerations: • Obtain thorough history • Physical examination and documentation of any rashes or lesions • Vital signs • Educate parents to give full course of antibiotics • Important to teach preventive strategies