Nursing Care of a Family when a Child has Infectious Disorder

infectious diseases

remain a leading cause of morbidity in children.

vaccination programs

have been the most effective in reducing infectious diseases in children

Pathogens

any organism that causes disease

viruses, bacteria, rickettsia, helminths and fungi.

5 types of microorganism pathogens

Incubation period

Prodromal period

Illness

Convalescent period

Stages of infectious disease

Incubation period

the time between the invasion of an organism and the onset of symptoms of infection. During this time, microorganisms grow and multiply the time between the invasion of an organism and the onset of symptoms of infection.

the virulence of the microorganism, the mechanism of spread, and the host

Incubation period vary widely depending on

Prodromal period

time between the beginning of nonspecific symptoms such as malaise, low-grade fever, fatigue, and arthralgia to the onset of disease specific symptoms like rash, diarrhea, and vomiting. Infectious diseases spread readily through communities from a person with the disease to any susceptible individual. This stage is generally short, ranging from hours to a few days.

Illness

stage during which specific symptoms occur

Exanthem

refers to a widespread rash, usually in children

Enanthem

rash on mucous membranes arising from a disease

Convalescent period

Interval between when symptoms first begin to fade and when the child returns to a healthy baseline. The return to baseline will vary from child to child depending on the host, other underlying illnesses and the type and severity of infection.

Chain of Infection

the method in which organisms are spread and enter a new individual to cause disease

Reservoir

container or place in which an organism grows and reproduces

Fomites

are inanimate objects that can also transmit infections from one person to another without direct contact with a human vector

Portal of exit

the route by which an organism leaves an infected child's body to be spread to others. Organism can be carried out of the body by upper respiratory excretions, feces, vomitus, saliva, urine, vaginal secretions, blood or lesion secretions.

Mode of transmission

refers to whether the infection is spread by direct or indirect contact and vectors.

Direct contact

spread by mucous membrane to mucous membrane

Indirect contact

spreads indirectly by fomites- inanimate objects. The most common means is the spread of mouth and nose secretion (droplet).

Droplet

Occurs when a person is in close contact (within 1 m) with someone who has respiratory symptoms. It may also occur through fomites in the immediate environment around the infected person.

Airborne

refers to the presence of microbes within droplet nuclei, which are generally considered to be particles <5ʯm in diameter, can remain in the air for long periods of time and be transmitted to others over distances greater than 1m

Vectors

insects, rats or other vermin- who may not be ill but are carriers of a human disease

Portal of entry

refers to the opening through which a pathogen can enter a child's body such as by inhalation, ingestion, or breaks in the skin from bites, abrasions, or burns.

Age

Gender

Virulence

Body Defenses

Certain characteristics make some individuals more prone to infection than others

Macules, Papules, Plaques, Vesicles, Bullae, Pustules, Urticaria, Scales, Crusts, Erosions, Ulcers, Petechiae, Purpura, Nodules, Atrophy, Scars, Telangiectases

Types of Lesions

Macules

•flat, nonpalpable lesions usually < 10 mm in diameter. represent a change in color and are not raised or depressed compared to the skin surface.

patch

large macule greater than 1 cm in diameter

Papules

elevated lesions usually < 10 mm in diameter that can be felt or palpated.

Plaques

palpable lesions > 10 mm in diameter that are elevated or depressed compared to the skin surface. may be flat topped or rounded. Lesions of psoriasis and granuloma annulare commonly form this.

Vesicles

small, fluid-filled blisters < 10 mm in diameter. Are characteristic of herpes infections, acute allergic contact dermatitis, and some autoimmune blistering disorders

Bullae

Fluid-filled blisters > 10 mm in diameter. These may be caused by burns, bites, irritant contact dermatitis or allergic contact dermatitis, and drug reactions.

Pustules

vesicles that contain pus. They are elevated, usually yellow-topped lesions that contain pus

Urticaria (wheals or hives)

characterized by elevated lesions caused by localized edema. are pruritic and erythematous. are a common manifestation of hypersensitivity to medications, stings or bites, autoimmunity, and, less commonly, physical stimuli including temperature, pressure, and sunlight. Typically lasts < 24 hours.

Scales

heaped-up accumulations of horny epithelium. is a characteristic feature of many dermatophytoses, including tinea capitis, resulting in the large bald patches.

Crusts (scabs)

consist of dried serum, blood, or pus. Can occur in inflammatory or infectious skin diseases

Erosions

are open areas of skin that result from loss of part or all of the epidermis. can be traumatic or can occur with various inflammatory or infectious skin diseases

excoriation

a linear erosion caused by scratching, rubbing, or picking.

Petechiae

non-blanchable punctate foci of hemorrhage. Causes include platelet abnormalities (eg, thrombocytopenia, platelet dysfunction), vasculitis, and infections

Purpura

larger area of hemorrhage that may be palpable. does not blanch. may indicate a coagulopathy. Large areas may be called ecchymoses or, colloquially, bruises

Leukocytoclastic vasculitis

Palpable purpura is considered the hallmark of

Nodules

are firm papules or lesions that extend into the dermis or subcutaneous tissue

Atrophy

thinning of the skin, which may appear dry and wrinkled, resembling cigarette paper. may be caused by chronic sun exposure, aging, and some inflammatory and neoplastic skin diseases. also may result from long-term use of potent topical corticosteroids

Scars

are areas of fibrosis that replace normal skin after injury. Some scars become hypertrophic or thickened and raised

Keloids

are hypertrophic scars that extend beyond the original wound margin.

telangiectases (vascular lesions)

Foci of small, permanently dilated blood vessels that may occur in areas of sun damage. Are small, dilated blood vessels; they are most often idiopathic.

Causative agent: Human herpesvirus 6 (HHV-6)

Incubation period: 9 to 10 days

Period of communicability: during febrile period

Mode of transmission: unknown

Immunity: contracting the disease offers lasting natural immunity; no vaccine is available

Details of Exanthem Subitum (Roseola Infantum)

•First symptoms is fever 101-105 degree Fahrenheit or 38.3-40.6 degree Celsius

•Rash of discrete, rose-pink macules approximately 2 to 3 mm in size

Hallmark appearance of a rash appearing immediately after the sharp decline in fever

•Lesions occur mostly prominently on the trunk, fade on pressing and last 1-2 days

•Coryza (upper respiratory symptoms), conjunctivitis, or cough

Assessment of Exanthem Subitum (Roseola Infantum)

10% to 15% of children.

Roseola is a cause of febrile seizure in up to

encephalitis, encephalopathy and bulging fontanels

Complications of Exanthem Subitum

Acetaminophen (Tynenol) or ibuprofen (Motrin) if the child is over 6 months - fever. Follow standard infection precautions.

Therapeutic management of Exanthem Subitum

•Causative agent: rubella virus

•Incubation period: generally 14 days within a range of 12-23 days

•Period of communicability: 7 days before to approximately 7 days after the rash appears

•Mode of transmission: direct and indirect contact with droplets

•Immunity: contacting the disease offers lasting natural immunity

•Active artificial immunity: attenuated live virus vaccine (MMR)

•Passive artificial immunity: Immune serum globulin is considered for pregnant women exposed to the virus

Details of German Measles

German Measles

Tigdas Hangin (Tagalog), Dupang (Cebuano) was first described in 1691 by a German physician Daniel Sennert calling it röteln, or rubella, for the red-coloured rash that accompanies the illness

isolated in 1962, and a vaccine was made available in 1969

When was the rubella first isolated and then a vaccine made available

Norman McAlister Gregg

Australian ophthalmologist that discovered that prenatal infection with the virus was responsible for congenital malformations in children in 1941

togavirus, genus Rubivirus

Rubella virus is classified as a

group A arboviruses, such as eastern and western equine encephalitis viruses

Rubella virus is most closely related to

lipid solvents, trypsin, formalin, ultraviolet light, low pH, heat, and amantadine.

Rubella virus is relatively unstable and is inactivated by

• Rubella

• Rosy disease

• Three-day measles

• Rotein

names for German Measles

Pathognomonic Sign

a sign whose presence means that a particular disease is present beyond any doubt

Forscheimer's spots

fleeting enanthem seen as small, red spots (petechiae) on the soft palate and may precede or accompany the skin rash of rubella (German measles)

•A mild maculo papular rash (pink) (non itchy) that starts on the face and spreads to the neck, the chest, and the rest of the body.

•Swollen glands (lymph nodes), especially behind the ear and at the back of the head.

•Adults, especially women, also may have joint pain. Older children and teens also may have eye pain, a sore throat, and body aches. Young children may have only a rash.

Illness stage of Rubella (1-2 days of illness)

•Disappearance of the rash

•Enlargement of lymph nodes subsides

Convalescence of Rubella (3rd day of illness)

congenital rubella syndrome

Defects of the eye, heart, brain and large arteries are most common

cataract, deafness and cardiac abnormalities

Classical Triad of Rubella

Deafness

the most common and often the sole manifestation of congenital rubella infection, especially after the fourth month of gestation

cataracts, glaucoma, retinopathy, and microphthalmia may occur

Eye defects in Rubella

patent ductus arteriosus, ventricular septal defect, pulmonic stenosis, and coarctation of the aorta are possible

Cardiac defects in Rubella

microcephaly and mental retardation

Neurologic abnormalities in Rubella

bone lesions, splenomegaly, hepatitis, and thrombocytopenia with purpura may occur.

Other abnormalities in Rubella

fetal death, spontaneous abortion, or preterm delivery

Most severe effects of Rubella in utero

early gestation. As many as 85% of infants infected in the first trimester of pregnancy will be found to be affected if followed after birth

Infection with rubella virus is most severe in

2 to 4 years

Manifestations of CRS may be delayed from

Diabetes mellitus appearing in later childhood. Progressive encephalopathy resembling subacute sclerosing panencephalitis. Have a higher than expected incidence of autism.

Complications of CRS in later life

20th week of gestation. The overall risk of defects during the third trimester is probably no greater than that associated with uncomplicated pregnancies.

defects are rare when infection occurs after what week of gestation

•Vaccine (MMR or Measles Mumps Rubella) should be given on or after the child's first birthday; the recommended age range is from 12-15 months. The 2nd dose is usually given when the child is 4-6 years old, or before he or she enters kindergarten or first grade.

•Gammaglobulin (after exposure for 72 hours if pregnant)

Treatment/ Prevention of Rubella

Measles

Tigdas (Tagalog), Tipdas (Cebuano) is a highly contagious respiratory infection that's caused by a virus. It causes a total-body skin rash and flu-like symptoms, including a fever, cough, and runny nose. It is caused by a single-stranded, enveloped RNA virus with 1 serotype

Morbillivirus in the Paramyxoviridae family.

Measles is classified as a member of the genus

Humans

are the only natural hosts of measles virus and mumps virus.

•Rubeola

•Morbilli

•Hard Measles

•10-day measles

•Red measles

•Little red disease

Other names for measles

•Fever

•Dry cough

•Runny nose

•Sore throat

•Inflamed eyes (conjunctivitis)

•A skin rash made up of large, flat blotches that often flow into one another

•Koplik's spots

Signs and symptoms of measles typically include:

infected droplets spray into the air (airborne), where other people can inhale them

Mode of transmission of Measles

•High grade fever (40-41 degree Celsius)

•3 C's- cough, colds/coryza, conjunctivitis

Prodromal stage of Measles (3-4 days)

Koplik's spot

Pathognomonic sign of measles

•Appearance of maculopapular rashes (non-itchy)

•Reddish blotchy

•Behind the ears, eyes, entire face, neck and entire torso (head to toe)

Illness stage of measles (2-3 days)

•Disappearance of rashes (fine branny desquamation)

•On the road to recovery

Convalescence stage of measles

Ear infection (otitis media)

Bronchitis, laryngitis or croup

Pneumonia

Encephalitis

Pregnancy problems

Low platelet count (thrombocytopenia)

Complications of measles

Vaccination

the most cost-effective protection against measles.

first dose given when a child is 9 months old and the second dose given when a child is 12-months old.

When is the measles vaccine given

Post-exposure vaccination

Non-immunized people, including infants, may be given the measles vaccination within 72 hours of exposure to the measles virus to provide protection against the disease. If measles still develops, the illness usually has milder symptoms and lasts for a shorter time.

immune serum globulin

Pregnant women, infants and people with weakened immune systems who are exposed to the virus may receive an injection of what within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe.

Chickenpox

Bulutong tubig (Tagalog), Hangga (Cebuano), also known as Varicella, is a highly contagious disease. an airborne disease which spreads easily from one person to the next through the coughs and sneezes (nasopharyngeal secretions) of an infected person. It may be spread from one to two days before the rash appears until all lesions have crusted over. It may also spread through contact with the blisters.

varicella zoster virus

Causative agent of Chickenpox

14 to 16 days

incubation period of chicken pox

about 1 or 2 days after the first symptoms start.

itchy chickenpox rash usually appears

Most people recover in about 2 weeks.

Recovery period of chickenpox

•Presence/ absence of high-grade fever

•Malaise

•Muscle pain

•Headache

Prodromal stage of Chickenpox

•Rashes appear (itchy) distribution: center to peripheries

•Abundantly found (covered areas such as scalp)

•Macule, papule, vesicle, pustule

Illness stage of chickenpox

•Crusting of rashes: falls off (peel off), dry

•On the road to recovery

Convalescence stage of chickenpox

first six months

During pregnancy the dangers to the fetus associated with a primary VZV infection are greater in

congenital varicella syndrome

If infection occurs during the first 28 weeks of gestation. Effects on the fetus can range in severity from underdeveloped toes and fingers to severe anal and bladder malformation. Possible problems include: