Peds: Communicable & Infectious Diseases of Childhood

___________ are the most common acute illnesses in kids

Infections

Why are infants and young kids at risk for infections?

Developmental

Hygiene

Immature immune system

Vaccination series incomplete

Why are teens and young adults at risk for infections?

STIs

College/close living quarters

Vaccination booster non-compliance

active immunity :

1

2

Natural; exposure to illness

Vaccine-induced

Passive immunity:

1

2

Natural; breast milk

Artificial; antibodies to fight of pathogen

_________ immunity:

1 Natural → exposure to illness

2 Vaccine-induced

active

___________ immunity:

1 Natural → breast milk

2 Artificial → antibodies to fight of pathogen

passive

Measles, varicella, TB are spread via ______________ transmission

airborne

Meningitis, pneumonia, epiglottitis, and sepsis are spread via ______________ transmission

droplet

GI, resp, skin, or wound infections or colonizations with multidrug-resistant bacteria (MRSA) are spread via ______________ transmission

contact

Enteric infections are spread via ______________ transmission

contact

Skin infections that are highly contagious or that may occur on dry skin are spread via ______________ transmission

contact

Viral or hemorrhagic conjunctivitis are spread via ______________ transmission

contact

Viral hemorrhagic infections (Ebola, Lass, Marburg) are spread via ______________ transmission

contact

_________________ are protected from resp infections due to protective function of maternal antibodies

Full term infants younger than 3 months

even though infants <3 months have protective function of maternal antibodies, they are more susceptible to ________________ which is why __________________ are so important

pertussis, vaccination booster for mother and close family

When a nurse suspects a communicable disease:

Obtain careful history

Provide comfort & support, document findings

Primary prevention » immunizations

Prevent complications

What falls under obtaining a careful history?

Type of exposure (known or community)

Prodromal symptoms

Immunization

Hx of having disease/co-morbidity/risk factors

Primary prevention techniques for communicable diseases:

Handwashing, reduce transmission

Infection rate increases from __________ months:

Maternal antibodies disappear and the infant begins to produce their own antibodies

3-6

Viral rate is high during ______________ years

toddler and preschool

By age 5, viral URIs are ___________ common, but, mycoplasma pneumoniae (walking pneumonia) and GABHS infections _____________

less, increase

Kids should NOT receive aspirin because its possible link w ________________

reye syndrome

Reye syndrome: rare but serious condition that causes swelling of the ________________, typically in kids recovering from a viral infection

brain and liver damage

Upper Respiratory Infection Therapeutic Management (URI):

-Antipyretics (NOT aspirin)

-Fluids and rest

-Saline nasal spray/drops

-Little evidence that decongestants show efficacy in kids (safe for kids over 12)

-Cough suppressants are NOT routinely recommended

Flu can be more dangerous than the _____________ for kids (especially kids <2 years of age or those with chronic illness)

common cold

Highest risk for complications and severe illness from influenza:

kids aged __________, especially kids aged ________

kids with any ______________

<5, <2, chronic illnesses

Parents can help kids fight flu by ....

getting themselves and their kids vaccinated each year

Influenza therapeutic management:

Antipyretics

Maintain hydration

Antivirals (oseltamivir/tamiflu)

pertussis aka ____________

whooping cough

pertussis transmission:

direct contact from droplets

In US, pertussis occurs most often in .....

kids who have not been vaccinated

_____________: Agent: bordetella pertussis

Highly contagious and life threatening in young infants

pertussis/whooping cough

Clinical manifestations of pertussis/whooping cough:

Infants __________ old may not present w typical cough

APNEA is the presenting symptom

<6 months

Clinical manifestations of pertussis/whooping cough:

Infants <6 months old may not present w typical cough----___________ is the presenting symptoms in young infants

APNEA

pertussis (whooping cough) can be prevented by ________________

vaccination of household members as easily as it is transmitted

Tx of pertussis/whooping cough:

-prevention :_______________

-Supportive care during hospitalization w ______________

-____________: in early stage, can cause milder form of infection, but also limits spread to others)

vaccines,

suctions, humidity, careful oral feeding, and hydration,

Oral antibiotics

________________:

Responsible for a number of infections in kids <2 yr

May cause serious morbidity and mortality

Pneumococcal disease

Pneumococcal disease is particularly problematic in kinds who ______________

attend daycare facilities- 2-3x higher incidence vs those not attending daycare

mode of transmission for Pneumococcal disease is ______________

direct contact

Pneumococcal disease most commonly affects kids aged ___________

<2

pneumococcal disease can be prevented via a ________ dose vaccine starting at _________

4, 2 months

_____________ Clinical manifestations:

1. Generalized infections (septicemia + meningitis)

2. Localized infections (otitis media, sinusitis & pneumonia)

pneumococcal disease

pneumococcal disease is spread by __________ and causes serious disease in pts with _____________

direct contact, underlying conditions

Croup aka ________________

laryngotracheobronchitis

croup impacts ....

Impacts upper airway- larynx, trachea, bronchi

croup is characterized by ....

characterized by hoarseness, "barking cough, inspiratory stridor, + varying degrees of resp distress

croup Therapeutic mgt:

1 ______________ (dexamethasone, prednisone) → reduce airway inflam

2 Nebulized ______________ to open airways

3 Severe illness → _____________ (reduces airflow turbulence in narrowed airways)

Corticosteroid, epinephrine, Heliox

______________:

Serious obstructive inflam process

*** potentially life-threatening

Epiglottitis

3 clinical observations that predictive of epiglottitis:

1

2

3

Absence of spontaneous cough

Presence of drooling

Agitation

croup Therapeutic mgt:

-Potential for _____________

-______________

-______________ (for intubated pts)

-_______________ for reducing edema may be used in early hr of tx

complete resp obstruction, IV antibiotics, Blood culture & epiglottic culture, Corticosteroid

prevention of croup =

HIB vaccine

hib vaccine helps prevent ....

croup

croup Nursing care mgt:

Position for comfort,

Decrease anxiety,

No tongue blade,

Keep suction at bedside,

Keep emergency resp, equipment at bedside,

Throat inspection should only be performed when immediate endotracheal intubation or emergency tracheotomy is needed

Kids w ___________ usually SOUND worse than they look

croup

Kids w ____________ usually LOOK worse than they sound

epiglottis

Generally, __________ occurs in very young kids vs ____________ is more common in older kids

croup, epiglottitis

Generally, croup occurs in ___________ kids vs epiglottitis is more common in ____________ kids

very young, older

pneumonia can be classified as either ___________ or _________

viral, bacterial

pneumonia is usually introduced via

to lungs thru inhalation or from bloodstream

______________ is a localized acute inflam of the lung w/o toxemia a/w lobar pneumonia

Pneumonitis

kids with pneumonia usually present with _____________

cough, increased WOB, tachypnea

pnuemonia Nursing care mgt:

1 Admin of _____________

2. Frequent assessments:

_____________

3. ______________ during acute phase

supplemental O2 (PRN) and antibiotics

RR and resp status, O2, general disposition, & level of activity

hydration/fluids are frequently administered IV

acute gastroenteritis etiology and pathophysiology:

____________→ most common cause in kids <5 yr

Viral (rotavirus)

acute gastroenteritis etiology and pathophysiology:

Viral (rotavirus) → most common cause in kids aged ___________

<5 yr

acute gastroenteritis leads to _______________

dehydration

acute gastroenteritis Clinical manifestations:

Non-bloody & non-bilious emesis

Diarrhea

Fever

Anorexia

Mild abdominal pain

acute gastroenteritis Complications & need for hospitalization:

DEHYDRATION

Malabsorption

Fluid & electrolyte disturbances

ORSs enhance & promote the reabsorption of ____________

Na & water

____________ Greatly reduces vomiting, duration of illness, & need for IV

Oral rehydration therapy (ORT) --> oral rehydration solutions (ORSs)

vomiting _____________ (IS/ IS NOT) a contraindication for Oral rehydration therapy (ORT) --> oral rehydration solutions (ORSs)

is not

oral rehydration can be trialed in kids, giving small amounts of ______________ frequently

electrolyte solns (pedialyte)

IV fluids are used when ________________ is not successful

oral rehydration/hydration

Skins infections are common in children

most common Bacterial agents: ______________

staph. + strepto.

skin infection transmission: ________________

invasion & toxicity in susceptible skin (self-inoculation is common)

_______________ Clinical manifestations:

-Areas of skin redness, swelling, & warmth

-Can include fever, chills, malaise, & headache

cellulitis

Cellulitis tx

1 _______________

2 IF, at risk for MRSA → ________________

Oral or IV antibiotics;

Typically 1st & 2nd gen cephalosporin, Clindamycin

cellulitis Nursing care mgt:

Pain mgt

Antibiotic admin

Antipyretic PRN

Assessment of worsening condition + continued fever

_____________ Clinical manifestations:

-Collection of pus within the dermis or subcut space

-Painful, fluctuant, red nodule

-W or w/o surrounding cellulitis

abscesses

abscesses are often a/w ____________

pain

abscess tx:

Incision & drainage

May receive US 1dt

Oral or iv antibiotics after drainage

abscess nursing mgt:

Collection of wound culture

Pain mgt

Antibiotic admin

Antipyretics PRN

Wound care

_______________: Bacterial toxin-mediated skin disorder that primarily affects young kids but can also occur in older kids + adults

Staff Scalded Skin Syndrome

Staff Scalded Skin Syndrome tx:

Admission to hospital for IV antibiotics

Transition to oral antibiotics once clinical improvement is made

Staff Scalded Skin Syndrome nursing mgt:

Prevention of dehydration

Gentle skin care

Wound care for open skin

Admin of antibiotics

Family education

_______________: Clinical illness characterized by rapid onset of fever, rash, hypotension, & multiorgan system involvement

*** may cause critical illness

Staphylococcal toxic shock syndrome

Staphylococcal toxic shock syndrome is characterized by rapid onset of .... (4)

fever, rash, hypotension, & multiorgan system involvement

Staphylococcal toxic shock syndrome tx:

Tx of shock

Surgical debridement (if needed)

Removal of infected foreign bodies

Antibiotic therapy

nursing care mgt of Staphylococcal toxic shock syndrome:

Recognition

IV fluids & antibiotics, vasopressors

O2 therapy PRN

Continuous mon of BP, HR, SpO2

** close hemodynamic mgt

Bacterial meningitis is most common in kids aged ____________

<1 year

bacterial meningitis' Most common route of infection is __________________

vascular dissemination from a focus of infection elsewhere

bacterial meningitis complications:

lifelong impairments including _____________, _____________, ______________, & ______________

mod-sev dev. Delay, blindness, deafness, epilepsy

Prevention

Vaccines prevent some types of meningitis

Bacterial meningitis nursing care mgt:

Early recognition of symp

Antibiotic admin

Cerebral edema prevented

Exposure prevented by early isolation

Side effects managed

Neuro sequelae prevented

_____________, _______________, _____________ are nursing priorities in pts with bacterial meningitis

isolation/PPE, rapid recognition of neuro changes, & antibiotic admin

____________: Inflam around brain tissue itself

Inflam around brain tissue itself

Encephalitis is often caused by ______________

virus

Encephalitis is often caused by viruses:

______________ is most common, but can also occur with ______________

Enteroviruses, flu + measles

encephalitis requires ______________

isolation/PPE

encephalitis therapeutic mgt:

Unless theres a specific antiviral, tx is primarily supportive

Conscientious nursing care

Control cerebral manifestations

Adequate nutrition & hydration

Observations & mgt as for other cerebral disorders