Nursing therapeutics specifically for children and adolescents with

Infectious Diseases

November 10, 20098:00-11:00 am

13:00-15:00 pm

Diphtheria

an upper respiratory tract illness characterized by sore throat,

low fever, and an adherent membrane (a pseudomembrane) on the tonsils, pharynx, and/or

nasal cavity

causes the progressive deterioration of myelin sheaths in the central

and peripheral nervous system leading to degenerating motor control and

loss of sensation.

a contagious disease spread by direct physical contact or breathing the aerosolized secretions of infected

individuals

Schick test

• test used to determine whether or not a person is susceptible to diphtheria

• named after its inventor, Béla Schick (1877–1967), a Hungarian-born American pediatrician

A diphtheria skin lesion on

the leg

Nursing Diagnosis

• Risk for infection

• Knowledge deficit

• Altered body temperature

• Altered comfort:pain (sore throat)

• Risk for altered breathing pattern

• Risk impaired gas exchange

Nursing Interventions

• Encourage the patient and significant others to avoid contact with infected individuals

• Educate the public

• Encourage compliance to treatment regimen

Treatment

in more severe cases lymph nodes in the neck may swell, and breathing and swallowing will be more difficult. People in this

stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. Abnormal

cardiac rhythms and can occur early in the course of the illness or weeks later, and can lead to heart failure. Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles.

Patients with severe cases will be put in a hospital intensive care unit (ICU) and be given a diphtheria anti-toxin.

Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration is associated with an

increase in mortality risk. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should

not await laboratory confirmation.

•

Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or

Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and

600,000 U/d for those weighing >10 kg). Patients with allergies to penicillin G or erythromycin can use

rifampin or clindamycin

Pertussis

bacterial infection of the respiratory tract. It is also called "whooping cough.“

Pertussis is a very contagious disease of the

mucous membranes that line the air passages

spread easily from person to person. People get Pertussis by breathing in

airborne droplets expelled from the nose or throat of an infected person.

Despite an effective vaccine, Pertussis continues to cause serious illness and

death. Young children are most at risk for

Pertussis, but the disease is increasing in adolescents and adults.

caused by Bordetella Pertussis, a bacterium

s/sx: Cold, including sneezing, runny nose, low-grade fever, and a mild cough. Within 2 weeks, the

cough becomes much worse. Children with pertussis often have episodes of rapid, spasmodic

coughing followed by a characteristic intake of breath that sounds like a "whoop." The violent

coughing spells are worse at night and can last for as long as 1 to 2 months

The spells can make it hard for a child to eat, drink, or even breathe. Infants under age 6 months, adolescents, and adults generally have milder

symptoms without the typical whoop.

Nursing Diagnosis

• Risk for infection

• Knowledge deficit

• Altered body temperature

• Altered comfort:pain (sore throat)

• Risk for altered breathing pattern

• Risk impaired gas exchange

Nursing Interventions

• Encourage the patient and significant others to avoid contact with infected individuals

• Educate the public

• Encourage compliance to treatment regimen

Treatment

Treated with antibiotics. Infected persons can still spread the disease until 5 days after treatment begins

The most important way to prevent pertussis is through complete

immunization.

caused by bacteria named Clostridium tetani

Tetanus in Children

Signs & Symptoms

painful spasms of the muscles.  The first sign is often "lockjaw", caused by a spasm of the masseter muscle.

Other early signs are headache, difficulty swallowing, neck stiffness,

irritability, and restlessness

Nursing Diagnosis

• Altered comfort:pain (jaw, muscles)

• Knowledge deficit

• Risk for infection

• Risk for altered breathing pattern

• Risk for injury

Nursing Interventions

• Stay with the patient especially during seizure episodes

• Always ready the intubation set at the bedside

• Encourage the patient to cooperate in the treatment regimen

• Avoid environmental stimuli e.g., lighting & excessive noise

Poliomyelitis

acute viral infectious disease spread from person to person, primarily via

the fecal-oral route

genus Enterovirus known as poliovirus

Pathophysiology

A blockage of the lumbar anterior spinal cord artery due to polio

(PV3)

Nursing Diagnosis

• Knowledge deficit

• Risk for infection

• Fatigue

• Altered comfort: pain

Prognosis

Patients with abortive polio infections recover completely

Treatment

A modern negative pressure ventilator (iron lung)

used to artificially maintain respiration during an acute polio infection until a person could breathe independently

(generally about one to two weeks

Continuation..

• There is no cure for polio. The focus of modern treatment has been on providing relief of symptoms, speeding recovery and preventing complications. Supportive measures include antibiotics to prevent infections in weakened muscles, analgesics for pain, moderate exercise and a nutritious diet. Treatment of polio often requires long-term rehabilitation, including physical therapy, braces, corrective shoes and, in some cases, orthopedic surgery.

Prevention

Mumps

viral disease, and its distinctive characteristic is a swelling of the

parotid salivary glands

Signs & Symptoms

* Fever

* Headache

* Body ache

* An unwell feeling

Facts

The swelling progresses for 1-3 days, and then subsides over the next 3-7

days.

Complications of Mumps

The most important is perhaps the brain (encephalitis), which is fatal in 2% of

cases. Infection of the testes (orchitis) in boys can lead to sterility. The

pancreas, kidneys, joints, thyroid, heart, ears, and eyes are also affected

sometimes.

Nursing Diagnosis

• Altered body temperature

• Altered comfort:pain

• Fatigue

• Knowledge deficit

• Risk for infection

Prevention of Mumps

can be prevented by the MMR vaccine. Apart from mumps, it

protects the child from measles and rubella

Kawasaki

The cause is still not known according to scientists

Researchers said that virus of “Fifth Disease” can also be the cause

Nursing Diagnosis

• Knowledge deficit

• Risk for infection

• Risk for injury

Nursing Interventions

• Educate the patient and significant others regarding the condition based on their understanding

• Encourage cooperation in treatment regimen

Rubella ( German measles)

usually a mild illness

However it can cause serious harm to an unborn baby if a woman gets it

during early pregnancy

How does rubella spread?

Rubella spreads by droplets from an infected person when

that person coughs or sneezes.

How long does it takes to develop?

takes between 14 to 21 days (usually 16 to 18 days) to develop after

contact with it

How long is it infectious?

A person with rubella is most infectious when the rash is appearing, but can also be

infectious for about 5 days before and for 5 to 6 days after the rash

appears. 

Signs and symptoms

rash and swollen glands in the neck, behind the ears and in the scalp at the back of the head, without being unwell.

Nursing Diagnosis

1. Altered comfort: pain (throat)

2. Self-esteem disturbance (rashes)

3. Knowledge deficit

4. Risk for infection

5. Altered body temperature

Nursing Responsibilities

• There is no specific treatment for rubella.

• Paracetamol or ibuprofen may help if there is headache and fever.

• The topic 'Feeling sick' has suggestions for caring for a sick child.

Preventing the spread of rubella

• Keep the child away from any pregnant women even if that woman has been immunized.

• Keep a child away from school, preschool or child care until well or for at least 4 days after the rash appears.

Rubeola (Measles)

also called 10-day measles, red measles, or measles, is a viral

illness that results in a viral exanthem

What causes the measles?

the cause of measles, is classified as a Morbillivirus. It is mostly seen in the winter and spring. Rubeola

is preventable by proper immunization with the measles

vaccine.

Symptoms

It may take between eight to 12 days for a child to develop

symptoms of rubeola after being exposed to the disease

Continuation..

• hacking cough • redness and irritation of the eyes • fever • small red spots with white centers appear on the inside

of the cheek (usually occur two days before the rash on the skin appears)

• rash - deep, red, flat rash that starts on the face and spreads down to the trunk, arms, and legs. The rash starts as small distinct lesions, which then combines as one big rash. After three to four days, the rash will begin to clear leaving a brownish discoloration and skin peeling.

Most serious complications

• ear infections

• pneumonia

• croup

• inflammation of the brain

Nursing Diagnosis

• Altered comfort:pain

• Risk for infection

• Knowledge deficit

• Self-esteem disturbance (rash)

• Risk for altered breathing pattern

• Risk for impaired gas exchange

Treatment

• Children should not attend school or daycare for four days after the rash appears.

• Assure all of your child's contacts have been properly immunized

• increased fluid intake • your child's age, overall health, and medical history • extent of the disease • your child's tolerance for specific medications,

procedures or therapies • expectations for the course of the disease • your opinion or preference

Reminders

Do not give aspirin to a child without first

contacting the child's physician

Chicken Pox

• contagious illness that should become much less a part of childhood as more children are given the Varivax vaccine

• caused by the varicella zoster virus and occurs most commonly in late winter or early spring

Symptoms

begin with a low grade fever, loss of appetite and decreased activity. About two days later,

your child will develop an itchy rash consisting of small red bumps that start on the scalp, face and trunk and then spread to the arms and legs (but may also occur in the

mouth and genitalia). The bumps then become blisters with clear and then cloudy

fluid, and then become open sores and finally crust over within about twenty four

hours, but your child will continue to get new bumps for about four more days

Nursing Diagnosis

• Altered body temperature

• Fatigue

• Risk for infection

• Self-esteem disturbance

• Altered nutrition: less than body requirements

• Knowledge deficit

Treatment

ACYCLOVIR, an antiviral medication that can help to decrease the symptoms of chickenpox, should be considered for children at risk of developing a severe

case of chickenpox. This includes children with pulmonary disorders, on steroid medications, or with immune

system problems

FACTS

he does not need to stay home from school if you can keep the

rash completely covered

Herpes Zoster

Herpes zoster (shingles) on the back

Shingles

Herpes zoster (shingles) - close-up of lesion

Herpes zoster (shingles) on the arm

Herpes zoster (shingles) on the chest

Herpes zoster (shingles) on the hand and fingers

Herpes zoster (shingles) on the neck and cheek

Herpes zoster (shingles) on the hand

Herpes zoster (shingles), disseminate

Herpes zoster (shingles) on the back

Symptoms

• Abdominal pain • Chills • Difficulty moving some of the muscles in

the face • Drooping eyelid (ptosis) • Fever • General ill-feeling • Genital lesions

Continuation..

• Headache

• Hearing loss

• Joint pain

• Loss of eye motion (ophthalmoplegia)

• Swollen glands (lymph nodes)

• Taste problems

• Vision problems

Nursing Diagnosis

• Altered comfort pain: headache, joint pains, abdominal pain

• Risk for auditory impairment: hearing loss

• Altered nutrition: less than body requirements r/t decreased appetite

• Risk for visual impairment

Pharmacology

• Antihistamines to reduce itching (taken by mouth or applied to the skin)

• Pain medicines

• Zostrix, a cream containing capsaicin (an extract of pepper) to prevent post-herpetic neuralgia

Nursing Responsibilities

• Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion, may help to relieve itching and discomfort.

• Resting in bed until the fever goes down is recommended.

• The skin should be kept clean, and contaminated items should not be reused. Nondisposable items should be washed in boiling water or otherwise disinfected before reuse. The person may need to be isolated while lesions are oozing to prevent infection of others -- especially pregnant women.

Outlook (Prognosis)   

usually clears in 2 to 3 weeks and rarely recurs. If the virus affects the nerves that control movement (the motor nerves),

you may have temporary or permanent weakness or

paralysis

Prevention   

• Avoid touching the rash and blisters of persons with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine.

• The chickenpox vaccine may be recommended for teenagers or adults who have never had chickenpox. Medical evidence has shown that older adults who receive the vaccine are less likely to have complications from shingles. Adults older than 60 should receive the vaccine as part of routine medical care.

Dengue Hemorrhagic Fever (DHF)

KEY FACTS

• Dengue is a mosquito-borne infection that causes a severe flu-like illness, and sometimes a potentially lethal complication called dengue hemorrhagic fever.

• Global incidence of dengue has grown dramatically in recent decades.

• About two fifths of the world's population are now at risk.

• Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas.

Continuation..

• Dengue hemorrhagic fever is a leading cause of serious illness and death among children in some Asian countries.

• There is no specific treatment for dengue, but appropriate medical care frequently saves the lives of patients with the more serious dengue hemorrhagic fever.

• The only way to prevent dengue virus transmission is to combat the disease-carrying mosquitoes.

Transmission

Continuation..

Dengue viruses are transmitted to humans through the bites of infective

female Aedes mosquitoes

Nursing Diagnosis

• Risk for infection

• Knowledge deficit

• Risk for altered peripheral tissue perfusion

• Risk for altered body temperature

• Risk for fluid volume deficit

• Altered comfort: abdominal pain r/t gastrointestinal irritation

Prevention and control

Continuation..

• Vector control is implemented using environmental management and chemical methods. Proper solid waste disposal and improved water storage practices, including covering containers to prevent access by egg-laying female mosquitoes are among methods that are encouraged through community-based programmes.

• The application of appropriate insecticides to larval habitats, particularly those that are useful in households, e.g. water storage vessels, prevents mosquito breeding for several weeks but must be re-applied periodically. Small, mosquito-eating fish and copepods (tiny crustaceans) have also been used with some success.

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Any questions?