Disease
What virus causes chicken pox? How is it transmitted and what is the period of communicability?
Agents—Varicella-zoster virus (VZV)
Transmissions—Direct contact, droplet (airborne) spread, and contaminated objects
Period of communicability—Probably 1 day before eruption of lesions (prodromal period) to 6 days after first crop of vesicles when crusts have formed
Prodromal stage of chickenpox?
Slight fever, malaise, and anorexia for first 24 hr; rash highly pruritic
Tx for scarlet fever?
Full course of penicillin (since caused by Group A β-hemolytic streptococci)
Supportive— analgesics; antipruritics
How can you provide eye care for a patient with measles?
Dim lights if photophobia ; clean eyelids to remove secretions or crusts
Complications of Rubella (german measles)
Complications—greatest danger is teratogenic effect on fetus
What is the source of diphtheria? How is it transmitted and what is the period of communicability?
Source—Discharges from mucous membranes of nose and nasopharynx, skin, and other lesions of infected person
Transmission—Direct contact with infected person, a carrier, or contaminated articles
Period of communicability—until virulent bacilli are no longer present (identified by three negative cultures); usually 2 wk but as long as 4 wk
S/S of diptheria?
Nasal—Resembles common cold, mucopurulent nasal discharge Tonsillar-pharyngeal—Malaise; anorexia; sore throat; low-grade fever; pulse increased above expected for temperature within 24 hr; lymphadenitis possibly pronounced (“bull's neck”); in severe cases, toxemia, septic shock, and death within 6-10 days Laryngeal—Fever, hoarseness, cough; potential airway obstruction; dyspneic retractions; cyanosis |
What is the tx of chicken pox, what age would the child get the immunization?
Specific—Antiviral agent acyclovir (Zovirax);
Supportive treatment
Preventive—Childhood immunization @ 12 months
Nursing interventions for a child with chickenpox, what kind of care should you provide? What kind of precautions should you keep in mind?
Maintain Airborne and Contact Precautions if hospitalized until all lesions are crusted
Administer skin care: give bath and change clothes and linens daily; topical calamine lotion; keep child's fingernails short and clean
Keep child cool
What are complications of chickenpox?
Complications—Secondary bacterial infections
What causes erythema infectiosum aka fifth disease? How is it transmitted?
Agent—Human parvovirus B19
Transmission—Respiratory secretions and blood, blood products
I—Erythema on face - cheeks (**“slapped face” appearance); disappears by 1-4 days
II—About 1 day after rash appears on face, maculopapular red spots appear, symmetrically distributed on upper and lower extremities; rash progresses from proximal to distal surfaces and may last ≥1 wk
III—Rash subsides but reappears if skin is irritated or traumatized (sun, heat, cold, friction)
What is the tx for fifth disease, is there a vaccine?
Symptomatic and supportive—Antipyretics, analgesics, anti-inflammatory drugs
If patient has respiratory complications with diphtheria, what are some examples of nursing interventions for this patient?
Use suctioning as needed; Observe for signs of airway obstruction; Administer humidified oxygen as prescribed. |
Complications of diphtheria?
Complications—Toxic cardiomyopathy (2nd-3rd week)
Toxic neuropathy
How is measles (rubeola) transmitted? What are the sources of infection?
Transmission—direct contact
Source—Respiratory tract secretions, blood, and urine of infected person
Describe the first stage of measles?
When does the rash appear and where does it start?
Other S/S?
Prodromal (catarrhal) stage— Most contagious stage: Fever and malaise, followed in 24 hr by coryza, cough, conjunctivitis, Koplik spots (small, irregular red spots with a minute, bluish-white center first seen on buccal mucosa opposite molars 2 days before rash); symptoms gradually increasing in severity until second day after rash appears, when they begin to subside
Rash—Appears 3-4 days after onset of prodromal stage; begins as erythematous maculopapular eruption on face and gradually spreads downward; more severe in earlier sites (appears confluent) and less intense in later sites (appears discrete); after 3-4 days assumes brownish appearance, and fine desquamation occurs over area of extensive involvement
Constitutional signs and symptoms—Anorexia, abdominal pain, malaise, generalized lymphadenopathy
Preventive—Childhood immunization. Supportive—antipyretics Antibiotics to prevent secondary bacterial infection in high-risk children Treatment–Vitamin A supplementation for children with acute illness |
Tx of diphtheria?
Equine antitoxin (usually intravenously) - preceded by skin test to rule out sensitivity
Antibiotics in addition to equine antitoxin
Complete bed rest (prevention of myocarditis)
Complications of fifth disease?
What is the most serious complication?
Complications—Self-limited arthritis and arthralgia
May result in serious complications (anemia, hydrops) or fetal death if mother infected during pregnancy (primarily second trimester)
Pertussis (Whooping Cough) is transmitted by? What are the sources of infection?
Transmission—Direct contact or droplet spread
Source—Discharge from respiratory tract of infected persons
Describe the catarrhal and paroxysmal stage of pertussis?
How does an infant vs adolescent vs adult present s/s of pertussis?
Catarrhal stage—Greatest stage of transmission. Begins with symptoms of upper respiratory tract infection,; symptoms continue for 1-2 wk, when dry, hacking cough becomes more severe Paroxysmal stage—Cough most common at night, consists of short, rapid coughs followed by sudden inspiration associated with a high-pitched crowing sound or “whoop”; during paroxysms, cheeks become flushed or cyanotic, eyes bulge, and tongue protrudes; paroxysm may continue until thick mucus plug is dislodged; vomiting frequently follows attack; stage generally lasts 4-6 wk, Infants <6 mo may not have characteristic whoop cough, but have difficulty maintaining adequate oxygenation with amount of secretions, frequent vomiting of mucus and formula or breast milk Pertussis may occur in adolescents and adults – cough and whoop may be absent, however, as many as 50% of adolescents may have a cough for up to 10 wk |
Can you prevent pertussis?
What is tx for pertussis?
What kind of care and specific tx is needed for infants <6 months old?
Preventive—Immunization; Tdap pertussis booster is recommended for persons who come in close contact with infant including the mother – “cocooning” theory
Antimicrobial therapy
Supportive—Hospitalization sometimes required for infants & children who are dehydrated
Intensive care and mechanical ventilation if needed for infants <6 mo
True or false: Fifth disease: isolation of child is not necessary, except hospitalized child.
True
Isolation of child is not necessary, except hospitalized child (Droplet Precautions and Standard Precautions).
Complication of pertussis
Complications—Pneumonia (usual cause of death in younger children)