Pediatric Communicable Diseases and Immunizations

P E D I A T R I C C O M M U N I C A B L E D I S E A S E S A N D I M M U N I Z A T I O N S

O B J E C T I V E S

• Discuss the role of the nurse in infection control in the pediatric population.

• Discuss etiology, pathophysiology, prevention, care, and treatment of childhood communicable diseases.

• Examine immunotherapy concepts, provision of atraumatic care related to immunizations, and administration of vaccines across the lifespan.

• Discuss etiology, pathophysiology, prevention, care, and treatment of transmissible diseases, infections, and infestations.

• Apply the nursing process using clinical judgment functions while providing care to pediatric clients with a communicable or transmissible disease.

P E D I A T R I C P H Y S I O L O G Y A N D I M M U N E S Y S T E M

• Immature Immune Response: Infants and young children exhibit immature immune responses, making them particularly vulnerable to infections.

• Inflammatory Response: Newborns typically show a decreased inflammatory response to invading organisms, resulting in a heightened risk of infection.

• Immunity Types:
    - Cellular Immunity: Generally functional at birth.
    - Humoral Immunity: Develops as the body encounters and builds immunity against new diseases.

• Passive Immunity: Infants lose passive immunity acquired through maternal antibodies over time, increasing their susceptibility to infections.

• Immunization Effectiveness: Immunization may not provide complete protection against diseases.

M A N A G I N G F E V E R

• Temperature Assessment: Check temperature every 4 to 6 hours, 30 to 60 minutes post-antipyretic administration, and during any change in condition.

• Consistent Measurement: Use the same site and device for temperature measurements.

• Antipyretic Administration: Give antipyretics as per physician's orders in cases where the child is experiencing discomfort or is unable to manage metabolic demands due to the fever.

• Notify Physicians: Report temperature elevations as per institutional or specific order guidelines.

• Fluid Intake Assessment: Monitor fluid intake; encourage oral fluids or administer intravenous fluids according to medical orders.

• Linen Care: Maintain cleanliness and dryness of linens and clothing.

CASE STUDY ON FEVER

• Scenario: A 2-year-old toddler weighing 28 lb has a physician's order for ibuprofen 100 mg administered orally every 6 hours as needed for temperatures exceeding 38°C.

• Dosage Calculation: Confirm if this dosage is safe and effective based on recommended dosage ranges of 4-10 mg/kg/dose.
    - Weight of Toddler: 28 lb translates to approximately 12.7 kg (1 lb = 0.453592 kg).
    - Dosage Range: Calculate the safe dose range:
      - Minimum dose: $4 imes 12.7 = 50.8 ext{ mg}$
      - Maximum dose: $10 imes 12.7 = 127 ext{ mg}$
    - Conclusion: The order for 100 mg is within the safe dose range (50.8 mg to 127 mg).

I N F E C T I O N C O N T R O L

• Infection Prevention: Employ proper personal protective equipment (PPE).

• Patient and Family Education:
    - Teach hygiene practices.
    - Emphasize the importance of immunizations.

• Isolation Precautions:
    - Contact Precautions: To prevent disease transmission.
    - Airborne Precautions: Required for certain infections that can be transmitted through the air.
    - Droplet Precautions: For diseases that spread via respiratory droplets.

C O M M U N I C A B L E D I S E A S E S

C H I C K E N P O X (V A R I C E L L A)

• Clinical Presentation:
    - Rash: Starts on the chest, back, and face; progresses to other body parts, manifesting as small, itchy blisters that eventually scab over.
    - Symptoms: Accompanied by fever, fatigue, sore throat, and headache.

• Treatment:
    - Focus on symptom relief using acetaminophen.
    - Avoid administering aspirin (risk of Reye’s Syndrome).
    - Relieve pruritus with calamine lotion, soothing oatmeal baths, and antihistamines.
    - Ensure hydration is maintained.

D I P H T H E R I A

• Pathophysiology:
    - Caused by a nonencapsulated, gram-positive bacillus affecting the respiratory system, producing exotoxins responsible for clinical manifestations.

• Clinical Presentation:
    - Symptoms resemble flu: sore throat, malaise, headache, and swollen cervical lymph nodes.
    - Characteristic gray-colored pseudomembrane covers the throat and tonsils.

M E A S L E S (R U B E O L A)

• Pathophysiology:
    - Affects nasopharyngeal or conjunctival mucosa; spreads to regional lymph nodes, and disseminates to the liver, spleen, and bone marrow.

• Clinical Presentation:
    - Initial phase includes fever, cough, rhinorrhea, and conjunctivitis.
    - Followed by small red spots with white centers known as Koplik spots appearing in the mouth.
    - Rash typically starts at the hairline and spreads downward across the body.

M O N O N U C L E O S I S

• Pathophysiology:
    - Caused by Epstein-Barr virus (EBV), leading to inflammation of lymph nodes, liver, and spleen.

• Clinical Presentation:
    - Key symptoms include fever, pharyngitis, fatigue, enlarged lymph nodes, headache, malaise, and potentially enlarged tonsils with exudate, as well as possible liver or spleen enlargement.

• Nursing Interventions:
    - Focus on prevention and management of manifestations through supportive care.
    - Advise good hygiene practices, such as avoiding sharing drinking cups and utensils, and practicing proper hand hygiene.

C O M M U N I C A B L E D I S E A S E S (C O N T.)

• Roseola:
    - Characterized by a sudden onset of fever (104°F or 40°C) lasting 3 to 5 days.
    - Symptoms may include irritability, periorbital edema, ear pain (otalgia), anorexia, cough, rhinorrhea, and cervical lymphadenopathy.
    - Classic rash is small, rose-pink, maculopapular, occurring on the trunk and may spread.

• Fifth Disease:
    - Presents with flu-like symptoms: fever, malaise, headache, myalgia, nausea, vomiting, and diarrhea.
    - Notable for the