Communicable Diseases

Measles (Rubeola)

•Highly contagious, spread through droplet contagion and secretion contact

Fever, URI symptoms, sore throat, Koplik spots

•Complications – Pneumonia, encephalitis

•Prevention: MMR vaccine – 2 doses

•Treatment: symptomatic, antibiotics if pneumonia occurs

•Reportable to departments of health

Rubella

•Viral – Most contagious during the 7 days before rash appears

•Patients should avoid any pregnant women

•Mild rash, fever and swollen lymph nodes

•Headache, URI, Sore throat

•Complications: miscarriage if exposed during pregnancy

•Can cause temporary and extreme joint pain

•Rare: brain infection

Roseola (6th disease)

•Viral  - Human herpesvirus 6 or 7  -  Most contagious 6 mo. – 2 yr.

•Onset 5-15 days after

•High fever x 3-7 days

•Rash after fever subsides, irritability, anorexia, URI symptoms

•Dx. From symptoms

•Self-limited, symptomatic care

•Complications are rare – febrile seizures

Chickenpox (varicella)

•Highly contagious – Varicella Zoster – Vaccine prevention

    Immune following clinical case of chickenpox

•URI symptoms – Contagious from 2 days before rash through scabbing

•Fever, fatigue, headache, anorexia, itchy rash

•Rash – eraser size/color rash - smooth

•Complications – Bacterial pneumonia, encephalitis, Reye’s syndrome risk

•Treatment – Antivirals, Calamine/Benadryl for itch, OTC pain relief

   Oatmeal bath, Short nails (cover hands of babies), Symptomatic care

Pertussis (Whooping Cough)

•Highly contagious – Vaccine prevention (DTaP)

•Bacterial infection (Bordetella pertussis) – Most contagious under 5 yoa

•Multi-week illness

•Early stage 1-2 weeks, mild URI symptoms

•Paroxysmal stage 2-5 weeks, Severe, unrelenting cough. High-pitched sound of cough. “Whoops” with no break in the cough. Can fracture ribs.

•Convalescent stage (Many weeks) will ultimately fade and resolve

•Complications – Pneumonia, Pregnancy complications, Brain damage, Death.

•Treatment – Azythromycin, fluids and oxygen

Mumps - parotitis

•Viral

•Starts with fever, headache, muscle aches, fatigue & anorexia

•Puffy cheeks and swollen jaw

•Onset 2-4 weeks following exposure

•2 week recovery

•Symptomatic Care

•“Locker Room” contagion

•Severe complications rare (can be fatal)

– inflammation of testes, ovaries, brain and pancreas, Loss of hearing

Strep Throat

•Bacterial – Group A Strep

•Settles in the tonsils and throat

•Treatment – Antibiotics – Complete entire regimen and retest

•Complications – Cardiac damage if not cleared – Rheumatic Heart Disease (damages heart valves – Common between ages 5 & 15)

•Symptoms

• Severe sore throat, Fever, Swollen lymph nodes of neck/jaw, White or yellow patches in the throat – foul odor, Headache, Nausea and vomiting, Rash – Feels like sandpaper

Otitis

•Primary cause – obstruction of eustachian tube/s (infection, swelling, fluid build-up

•Young immune systems predispose children to this

•Enlarged adenoids

•Antibiotics, pain medications, positional support, surgery

Otitis Media

Middle Ear (Reddened inflamed membrane)

Otitis Externa

Outer Ear (Swimmers Ear)

Otitis Externa (swimmers ear)

•Prescription antibiotic and steroid drops x 10-14 days

•Pain relievers

•Prevent from exposure to water

•Cool hair dryer to dehydrate ear

•Don’t insert anything into the ear

•Lasts 7-10 days with careful treatment

•Hydrogen peroxide to manage ear wax build up and prevent

Gastroenteritis (rotavirus)

•Drug of choice

• Amoxicillin, Augmentin, Rocephin

HIV - AIDS management

•Maternal - Prevention – exposure can be from sexual activity or assault, STI’s

•Prenatal testing on all mothers during prenatal period

•Treatment of mother – antiretrovirals during pregnancy and after (suppresses the virus)

•No breast feeding – primary route of transmission to child.

•Treatment of infants and children – antiretrovirals

•Counseling, on-going support and group support

Neonatal Abstinence Syndrome (NAS)

•Known or unknown maternal substance use/exposure

•Symptoms: Continual/excessive high-pitched cry

•Tremors or shaking

•Lack of interest in being held

•Uncoordinated suck/feed

•High pitched cry – not soothed by touch

•Trouble sleeping

•Rapid breathing, sneezing, stuffy nose

Neonatal Abstinence Syndrome (NAS) Interventions

•Treat with small amounts of drug similar to exposure drug

•Titrate downward

•Co-room with mother if possible

•Quiet darkened room

•Swaddle

•Gentle rocking – minimal touch

•Frequent small feedings with high calorie formula

•Post-discharge support of family

Phenylketonuria (PKU)

•Inability to breakdown amino acid phenylalanine

•Low PHE diet

•Inherited disorder – 1 in every 10,000-15,000 births

•Commonly found in foods

•If not identified/treated children will show no interest in their surroundings, developmental delays occur, pale skin tone, weak.

•Identified via newborn screening

Phenylketonuria (PKU) foods to avoid

Animal protein, Dairy, Legumes, Wheat, oats, barley and Aspartame (artificial sweetener).

Phenylketonuria (PKU) Foods to eat 

Fruits, vegetables, butter, margarine, olive oil herbs for flavor and low-protein foods

Hyperbilirubinemia definition

•Presents as newborn jaundice, hemolytic anemia, liver disease

•The immature liver cannot process bilirubin effectively

•More common in preemie babies and breastfed babies

Hyperbilirubinemia nursing

•Treatment: Phototherapy, Exchange transfusion and medications

•Goal – Eat and stool to clear the bilirubin

•TCBM used to screen – Blood draws to validate

•Continual evaluation until WNL

Plagiocephaly

•Flat head on one side, Occurs due to uneven rotation of head, and Pressure on the developing skull causes the misshaping

•Can be positional or congenital

•Treatment Positional: 

• Increase position on opposite side of head and use pillows or wedges to position

• Avoid prolonged sitting in car seat/swing

Congenital:

• Surgery to re-form skull or helmet fitting

Meningocele, myelomeningocele

•Neural tube defect that occurs at week 3-4 of development

•Incomplete closure/containment of spinal canal

•Presents at birth  - Causes sensory/neuromuscular dysfunction

•Causative factors – Illicit drug exposure, malnutrition of pregnancy lack of Folic Acid during pregnancy

•Radiation/chemical exposure during birth

•Pre-pregnancy obesity, DM, hyperthermia exposure, low B12

Meningocele, myelomeningocele definition

•Neural tube defect that occurs at week 3-4 of development

Trisomy

•3 copies of a usual chromosome rather than 2

•Down Syndrome

•Trisomy 13

•Trisomy 18

Monosomy

•Missing 1 chromosome from a pair (Monosomy X/Turner Syndrome

Trisomy and Monosomy manifestations

•Developmental delays or learning problems

•Heart, kidney or organic defects

•Facial differences, Cleft lip and palate

•Neurologic differences - Seizures

Trisomy and monosomy management

• prenatal care

• screening before and during pregnancy

• early intervention - school districts

• home care - G&D surveillance, OT, PT, group supports

Neonatal Sepsis

•Life-threatening blood infection in babies within the first 90 days of life (can be bacterial, viral or fungal – Early onset w/I 7 days of birth

Neonatal Sepsis risk factors

•Premature birth, low birth weight, poor prenatal care, prolonged ROM

Neonatal Sepsis symptoms

• fever or low body temperature, lethargy or irritability, difficulty breathing, poor feeding, vomiting and diarrhea, seizures, rashes.

Neonatal Sepsis diagnostics

•blood culture, urine culture, CSF culture (LP) and physical examinations

Neonatal Sepsis treatment

•IV antibiotics, antivirals and/or antifungals

Failure to thrive definition

•Insufficient growth and development in babies and children (can occur in adults)

Failure to thrive symptoms

•Faltering growth, insufficient weight

•Irritability

•Easily fatigued

•Excessive sleep

•Does not vocalize

•Lack of interest in life/family

Failure to thrive cause

•insufficient nutrition, medical conditions, Environment

Failure to thrive Intervention

•Often easily reversed with aggressive attention to quality diet, stimulation and therapeutic movement/stimulation

•Evaluate underlying causes and treat them:

•Illness, Neglect, Abuse, Malnutrition, Malabsorption, Lack of resources, Lack of knowledge

Measles (Rubeola) hallmark signs

•Fever, URI symptoms, sore throat, Koplik spots

Congenital rubella syndrome

transmitted to mother, born with birth defects; hearing loss, blindness, heart defects and developmental delays.

Rubella hallmark signs

•Mild rash, fever and swollen lymph nodes

•Headache, URI, Sore throat

Roseola (6th disease)

High fever x 3-7 days

•Rash after fever subsides, irritability, anorexia, URI symptoms

Chickenpox (varicella) hallmark signs

•URI symptoms – Contagious from 2 days before rash through scabbing

•Fever, fatigue, headache, anorexia, itchy rash

•Rash – eraser size/color rash - smooth

Pertussis (Whooping Cough) early stage

1-2 weeks, mild URI symptoms

Pertussis (Whooping Cough) paroxysmal stage

2-5 weeks, Severe, unrelenting cough. High-pitched sound of cough. “Whoops” with no break in the cough. Can fracture ribs.

Pertussis (whooping cough) convalescent stage

Many weeks - will ultimately fade and resolve

Mumps - Parotitis hallmark signs

•Starts with fever, headache, muscle aches, fatigue & anorexia

•Puffy cheeks and swollen jaw

•Onset 2-4 weeks following exposure

Strep Throat hallmark signs

•Severe sore throat, Fever, Swollen lymph nodes of neck/jaw, White or yellow patches in the throat – foul odor, Headache, Nausea and vomiting, Rash – Feels like sandpaper

MMR vaccine

measles prevention

Varicella Zoster vaccine

chickenpox prevention

DTaP vaccine

Pertussis (whooping cough) prevention

Rubeola rash

Kopliks Spots

Roseola rash

Varicella rash

Mumps

strep

Otitis Externa