NUR 203 Child Health Week 3 Part I (1)
NUR 203 CHILD HEALTH
West Virginia Junior College
Week 3 Part I
Learning Objectives
Utilize the nursing process to develop and implement a patient-centered care plan based on evidence-based practice for children with infections or communicable illnesses.
Discuss effective evidence-based strategies for reducing fever in pediatric patients.
Create a collaborative evidence-based plan of care for pediatric patients with sepsis or scarlet fever, incorporating input from the patient, family, and health care team.
Provide nursing care for children with viral infections, integrating knowledge of pathophysiology, pharmacotherapy, and consideration for family values and needs.
Identify common types of conjunctivitis in pediatric patients.
Discuss the most commonly diagnosed refractive errors in children.
Incorporate cultural considerations in patient care and education for children with acute otitis media.
Design a nursing care plan emphasizing communication and educational strategies that align with patient and family preferences after tube placement for pressure equalization in the ear.
Analyze current health trends and protocols supporting health promotion and maintenance for diabetic pediatric patients.
Develop an educational plan for parents focusing on essential nutrition for therapeutic outcomes.
Chapter 37: Nursing Care of the Child with an Infection
Role of Immunizations in Preventing Childhood Infections
Importance of immunization in preventing viral and bacterial diseases.
Required for multiple doses for effectiveness.
Preventable diseases include:
Diphtheria, pertussis, tetanus (DPT)
Mumps, measles, rubella (MMR)
Varicella
Poliomyelitis
Other infections.
Types of Infectious Diseases
Bacterial Infections: sepsis, community-acquired infections, etc.
Viral Infections: viral exanthems, mumps.
Zoonotic and Vector-borne Infections: rabies, Lyme disease.
Parasitic Infections: pediculosis capitis (head lice), roundworm.
Sexually Transmitted Infections (STIs): chlamydia, HIV.
Inflammatory Response
Triggered by tissue injury, resulting in:
Capillary widening and increased permeability.
Increased blood flow, fluid release leading to symptoms like heat, redness, swelling.
Attraction of leukocytes and systemic responses such as fever and pain.
Function of White Blood Cells by Leukocyte Type
Granulocytes: First line of defense; includes neutrophils, eosinophils, and basophils.
Lymphocytes: Maintain immune responses; includes B cells, T cells, and natural killer cells.
Monocytes: Second line of defense responding to severe infections.
Fever
Infection stimulates endogenous pyrogens releasing signals to hypothalamus.
Results in increased body temperature through mechanisms like shivering and vasoconstriction.
Managing Fever in a Child with an Infectious Disease
Keep linens clean and dry.
Assess fluid intake; encourage oral or IV fluids as per orders.
Notify physician about temperature as per guidelines.
Administer antipyretics as ordered for discomfort.
Use a consistent site for temperature measurements; reassess every 4 to 6 hours.
Stages of Infectious Diseases
Incubation: Pathogen entry until the first symptom appears.
Prodrome: Nonspecific symptoms (fatigue, malaise) before specific disease symptoms.
Illness: Disease symptoms become evident.
Convalescence: Acute symptoms begin to fade.
Chain of Infection
Components include:
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host.
Methods of Preventing Infectious Diseases
Hand washing.
Adequate immunization.
Proper food handling and preparation.
Judicious antibiotic use.
Limiting the Spread of Infections
Standard precautions (Tier 1).
Transmission-based precautions (Tier 2):
Airborne, droplet, contact precautions.
Pediatric Physiology and Immune System
Infants and young children have immature immune responses, making them more susceptible to infections.
Newborns show decreased inflammatory response, increasing infection risk.
Cellular immunity is functional at birth; humoral immunity develops over time as the infant encounters new pathogens.
Common Treatments and Medications for Infectious Disorders
Hydration: Essential for recovery.
Fever Reduction: Important to manage symptoms.
Medications: Include antibiotics, antivirals, antipyretics, and antipruritics.
Information Obtained in Health History
Review past medical history (birth history, family history, immunization status).
Current illness history: onset, duration, symptoms, prior treatments.
Observe any change in usual behavior (feeding, irritability).
Note exposure to ill contacts.
Assessments Made During Physical Examination
Examine skin, mouth, throat, and hair for lesions or wounds.
Assess hydration, vital signs, and perform palpation of skin and lymph nodes.
Common Laboratory Tests for Infectious Diseases
Complete blood count (CBC).
Erythrocyte sedimentation rate (ESR).
C-reactive protein (CRP).
Cultures: blood, stool, urine, throat, nasal swabs.
Nursing Interventions to Promote Comfort for a Child with an Infectious Disease
Use diversional activities and distraction.
Dress child lightly if febrile.
Provide cool mist humidification and fluids.
Administer prescribed analgesics and antipruritics, monitoring effectiveness.
Nursing Interventions to Promote Skin Integrity
Monitor skin for signs of infection and changes in lesions.
Encourage fluid intake and nutrition.
Keep fingernails short to reduce skin irritation.
Use prescribed antipruritics and topical ointments.
Key Teaching Points for a Child with an Infectious Disease
Assess family's willingness to learn and provide adequate adjustment time.
Repeat information and deliver in short sessions.
Tailor teaching methods to the child's understanding level, involving multiple senses for effectiveness.
Laboratory and Diagnostic Tests Ordered for Sepsis
CBC: typically shows elevated WBC levels.
C-reactive protein: elevated in infections.
Positive blood cultures indicate septicemia.
Urine culture, cerebrospinal fluid analysis, can show signs of infection.
Bacterial Infections
High-risk conditions include community-acquired methicillin-resistant Staphylococcus aureus, scarlet fever, and diphtheria.
Viral Infections Occurring in Children
Characteristic rashes in viral illnesses include:
Rubella (German measles).
Rubeola (measles characterized by Koplik spots).
Varicella zoster (chickenpox).
Parvovirus B19 (fifth disease - slapped cheek).
Roseola infantum (sixth disease).
Zoonotic and Vector-Borne Infections
Transmitted from animals or vectors; includes rabies, cat-scratch fever, Lyme disease, and Rocky Mountain spotted fever.
Parasitic and Helminthic Infections
Parasitic: pediculosis (head and pubic lice), scabies.
Helminthic: includes pinworm, hookworm, ascaris.
Sexually Transmitted Infections (STIs)
Transmitted through sexual contact; some may pass to newborns in utero or during childbirth.
High rates of STIs found in adolescents; detection in children can indicate abuse.