Communicable Diseases: ​

3 ps of communicable diseases: ​
•Prevent Spread
•Prevent Complications
•Promote Comfort

Functions of white blood cells by leukocyte type:

•Granulocytes: the first line of defense, phagocytic cells,
•Neutrophils – first responders to an infectious agent
-​ Immature -bands
-​ Mature - legs
-​ Eosinophils – a big player in asthma
-​ Basophils – allergic response
•Monocytes: the second line of defense, responds to larger and more severe infections
•Lymphocytes: produce and maintain immune response
-​ B cell, T cell, and natural killer types

Break the chain of infection:

•Infectious agent
•Reservoir (sitting water, stethoscope, bandage)
•Portal of exit
•Mode of transmission
•Portal of entry Susceptible host

Role of immunizations in preventing childhood infections: (Know when we see clusters

of certain vaccinations)
•Many childhood diseases (both viral and bacterial) can be prevented with adequate
immunization.
•vaccine visual
•Many vaccinations require multiple doses.
•Immunizations can prevent:
–diphtheria, pertussis, tetanus (DTP)
–mumps, measles, rubella (MMR)
–varicella
–poliomyelitis
–Others
–Pertussis
–Pertussis

Fever:
•Infection stimulates the release of endogenous pyrogens.
•Pyrogens act on the hypothalamus and trigger prostaglandin production, which increases the
body’s set temperature.
•This triggers the cold response (shivering, vasoconstriction, decrease in peripheral perfusion).
This decreases heat loss and resets body temperature.
•Fever occurs as a result.

Managing fever in a child with an infectious disease:

•Assess temperature at least every 4 to 6 hours, 30 to 60 minutes after antipyretic is given and
with any change in condition.
•Use the same site and device for temperature measurement.
•Administer antipyretics per physician's order when the child is experiencing discomfort or
cannot keep up with the metabolic demands of the fever.
•Notify the physician of temperature per institution or specific order guidelines.
•Assess fluid intake and encourage oral intake or administer intravenous fluids per physician's
order.
•Keep linens and clothing clean and dry.

Measles:
•Virus: Morbillivirus
•Transmission: Respiratory Droplets, blood and urine
•Incubation period: 10-20 days
•Communicability: 4 days prior and 5 days after onset of rash
•Prodrome: fever (>40 degrees C), coryza, cough, and conjunctivitis, Koplik spots (hallmark
sign)
•Exanthem: erythematous maculopapular rash beginning on face, behind ears, then goes to
trunk and extremities
•Treatment: hydration, vitamin A supplementation, antipyretics
•Complications: otitis media, pneumonia
•Prevention: MMR vaccination (live attenuated) at 12-15 months and 4-6 years

Varicella:
•Virus: Varicella Zoster Virus (VZV)
•Risk Factors: steroid therapy, cancer, immunocompromised state, pregnancy
•Transmission: respiratory secretions, direct contact with lesions, airborne
•Incubation: 14-21 days
•Communicability: 24 hours prior to onset of rash and until all lesions are crusted
•Prodrome: fever, malaise, intense itching
•Exanthem: begin as macult à papule à superficial vesicular lesions (resemble dewdrops), a red
base develops à lesions crust over
•Treatment: Antipruritic lotions, antipyretics, acyclovir, and antihistamines
•Complications: viral pneumonia, secondary bacterial infections, fetal growth retardation, herpes
zoster
•Prevention: Varicella Vaccination (live attenuated) given at 12-15 months and 4-6 years

Conjunctivitis:
Bacterial:
•Purulent drainage
•Crusting of eyelids
•Inflamed conjunctiva
•Swollen lids

Foreign Body:
•Tearing
•Pain
•Inflamed Conjunctiva
•Usually unilateral

Viral:
•Usually comorbid with URI
•Serous (watery) drainage
•Inflamed conjunctiva
•Swollen lids

Allergic:
•Itching
•Watery to thick, stringy discharge
•Inflamed conjunctiva
•Swollen lids

Parasitic and helminthic infections:

•Parasitic infection:
–Scabies
•Pediculosis
•Helminthic infections:
–Pinworm
–Hookworm
–Ascariasis

Lice (pediculosis)
•Prescription (contain benzyl alcohol, ivermectin (applied to skin) and malathion (insecticide
shampoo)
•Over the counter pediculicides (contain pyrethrins (Rid – lacks residual activity) and permethrin
5% shampoo (Nix – has residual activity) scalp
•Long hair may need 2 bottles for treatment
•To rid hair of lice; manual extraction of nits and lice
•Wet hair and remove with a fine-toothed comb
•Careful removal of egg sacs is necessary to prevent reinfestation
•Treatment 1) Kill the active lice 2) remove nits 3) prevent spread or recurrence by managing
the environment **
•Educate caregivers on washing of clothing, linens, towels, washable toys in hot water (130
degrees F.) and then placed in hot dryer (103 degrees F.) for at least 5 minutes
•All stuffed animals – un-washable items bagged for a minimum of 2 weeks
•Brushes and combs soaked in hot water 130 degrees F.
•Furniture, floors, upholstery vacuumed
Fumigants should not be used in the home: toxicity/ carcinogens

Scabies:
•Impregnated female burrows into stratum corneum of epidermis (not into living tissue) and lays
eggs and discards her feces
•Transmitted by prolonged close personal contact
•May take 30 to 60 days after infestation to have symptoms
•Inflammatory response causes intense pruritis – can cause excoriation
•Often shows up in webs or fingers, antecubital fossa, popliteal fold, but can be almost
anywhere.
•Mite appears as a black/grey dot under skin with a thread-like burrow usually visible.
•Treated with permethrin 5% cream or oral ivermectin
•Treatment must be repeated in 1 to 2 weeks to be effective
•Rash & itch will not go away for 2 to 3 weeks – Must wait for stratum corneum to be replaced
•Moisturizer, ointments, topical corticosteroids and antihistamines can be used for symptoms
•Treat all family members
•How do we get rid of scabies?

Nursing Interventions to Promote Comfort for a Child With an Infectious Disease

•Assess pain and response to interventions frequently.
•Administer analgesics, antipyretics, and antipruritics as ordered.
•Apply cool compresses or baths to areas of pruritus.
•Assess intake and output and Provide fluids frequently.
•Provide cool mist humidification.
•Dress the child in light clothing if febrile.
•Use diversional activities and distraction.
•Keep nails short

Vaccine contraindications:
•Severe febrile illness
•May give for exposure to illness
•Recently acquired passive immunity (blood transfusion, immunoglobulin, or maternal)
•Known allergic response

Precautions with vaccines:

•Immunocompromised child or household member
•Known allergic response
•Parental fears, misinformation, and questions
•Religious beliefs
VAERS/VIS
•Vaccine Adverse Event Reporting System
•Report any adverse reactions after administration of any vaccine: [Link]
•Vaccine Information Statements (VIS)
•Information statements that must be given to parents before administration of vaccines
•Provide updated information for the parent or guardian of a child being vaccinated

SKIN:
Impetigo:
•Most common skin infection in children - often a secondary infection from another lesion or
upper respiratory infections
–Very Contagious bacterial infection
–Most often Streptococcus and/or Staphylococcus
–Incubation: 7-10 days. Begins as a red macule then becomes a vesicle that ruptures with an
overlay of honey colored crusted lesions.
–May spread to other parts of the child’s skin or to others who touch the child; poor hygiene
–Treatment
•Topical antibiotic: Mupirocin (Bactroban)
•Systemic if more advanced disease
Caring for the child:
•The child can spread impetigo by touching another part of the skin after scratching infected
areas
•Keep the child’s fingernails short and wash the child’s hands frequently with antibacterial soap
•Emphasize good hand washing and careful hygiene for the entire household. Discourage
family members from sharing towels, combs, or eating utensils with the infected child
•Child can return to school 24 hours after beginning treatment

Contact Dermatitis:
•Localized rash or irritation of the skin caused by direct contact to an inducing substance
•Most commonly seen is diaper rash
•Causes
–Products used for skin care, perfumes, lotions or soap, dyes in beauty products
–Urine or stool
–Detergents, cleaning products
–Chemicals or metals (nickel), latex, poison ivy/ oak
•Assessment of Diaper Rash
–Bright red macular-papular rash with weeping lesions on the perineum
–Begins with mild redness, progresses to swelling, blisters, scaling, crusting, oozing of fluid
–May have satellite lesions
–Bacterial overgrowth can occur; if so treatment may require oral antibiotics
Treatment of Diaper Rash:
•Cleanse skin immediately after child urinates or stools
•Allow open air diaper time, no plastic diaper coverings
•Gently clean with soft cotton cloths – not baby wipes
•Clean all skin well – pat dry. Apply thick layer of Vitamin A, Vitamin D and/or Zinc Oxide
protective cream
•Creams left on except for twice daily complete cleansing
•Reduce stool pH; increased veggies in diet
•Aveeno baths, Burrow’s solution or calamine lotion
•If severe itching occurs can use oral antihistamines/ Atarax

Candidiasis (yeast)
•Superficial fungal infection – inflamed area with white exudate
•Types
–Thrush: oral; overgrowth of candida albicans
–Candida dermatitis: causes diaper rash from candida albicans passing through the GI system
into warm, moist environment
•Causes
–can occur in infants, immunosupression, antibiotic therapy, diabetes, exposure to mother’s
breast infection or unclean bottles or pacifiers
•Oral: white, curdlike plaques on the tongue, gums, buccal mucosa
•Diaper: Lesions fiery red, scaling
•Treatment
–Oral: Nystatin oral suspension swabbed onto the mucous membranes
–Diaper: topical antifungal cream (ketoconazole or Nystatin) and oral Nystatin
–Both: eliminate sugar
–Complete treatment even after symptoms gone

Acne Treatment:
Education and Self-Care:
•Debunk myths
•Adherence to prescribed POC
•Written & verbal instructions
•Gentle cleansing 1-2 times daily
•No popping, picking, squeezing
-​ Infection & cellulitis, scarring
•Support and encouragement
Treatments:
•Tretinoin- interrupts abnormal keratinization> desquamation
•Benzyl peroxide-antibacterial inhibits P. acnes
•Topical & oral antibiotics-use can dry, burning, redness of skin
•Isotretinoin-restricted provider only. Many side effects including suicidal ideation (?). Monitor
LFTs, cholesterol & triglycerides. Teratogenic
–Oral contraception (females)
–Pregnancy prevention for client who is sexually active. At least 2 forms of birth control used
concurrently pre-during & post-tretinoin usage

Cancer:
Childhood cancers compared to adult cancers:

Factor Child Adult

Tissue types affected Tissues Organs

Most common sites Blood, lymph, brain, bone, Breast, lung, prostate, bowel,
kidney, muscle bladder

Environmental factors Minimal Strongly influences

Detection Usually accidental or Very early detection possible

incidental

Response to treatment Very responsive Less Responsive

Cardinal Signs and Symptoms of Cancer in Children

(Pain, Fatigue, Fever)
Overt signs:
-​ A palpable mass
-​ Purpura; unusual bruising
-​ Pallor
-​ Weight loss; unexplained
-​ Whitish reflex in the eye; unusual squint
-​ Vomiting in early morning; increased ICP
-​ Recurrent or persistent fever; low WBC
Covert Signs:
-​ Bone pain; growing pain vs. disease
-​ Headache; anemia, bone tumor
-​ Persistent lymphadenopathy
-​ Change in balance, gait, or personality
-​ Fatigue, malaise

Pediatric Leukemia:
-​ Most common form of cancer < 15 yrs
Etiology: proliferation of immature WBC’s, disease of the bone marrow, often infiltrates the
spleen and lymph glands.
Believe increased environmental exposure increases risk: pesticides, electromagnetic
fields, parental smoking, occupational chemical exposures
ALL Lymphocytic: 80%, AML Myelocytic: 20%, CML Chronic Myelocytic: rare
Diagnostic: History, clinical presentations, initial CBC, microscopic examination of a Bone
marrow aspiration, lumbar puncture to determine if CNS involvement
 -​ Varicella is deadly in immunocompromised child

Clinical Manifestations: (persistence of symptoms is key!)

-​ Fever & inability to fight infection = â or ↑ WBCs
-​ epistaxis, bruising and petechiae, pallor = â platelets, profound anemia and
thrombocytopenia
-​ Refusal to walk = bone pain
-​ Fatigue
-​ Hepatosplenomegaly = cells are destroyed in the spleen
-​ Difficult to differentiate symptoms - infection?

Pediatric Brain Tumors:

-​ Most common solid tumor; second most common malignancy after leukemia
-​ Cause is unknown
-​ Increased incidence with neurofibromatosis
-​ 2200 children annually diagnosed
-​ >50% develop in the posterior fossa, lower part of the brain cerebellum and brainstem
-​ Hallmark sign: headache and morning vomiting prior to even getting out of bed.
Increased ICP
Clinical Manifestations:
May occur rapidly or slowly
Most common:
-​ H/A (most common), N/V, abnormal gait, dizziness, change in vision/ hearing, fatigue
-​ Mental status change:
-​ Educational or behavioral problems
Brainstem tumors:
-​ May present with weight deficits/FTT in infancy or childhood

Wilms’ Tumor: Nephroblastoma

-​ Intrarenal abdominal tumor
-​ Occurs before age 5 yrs
-​ Associated congenital anomalies/genetic mutations
-​ Rapid growth, doubles every 11-13 days
Clinical Manifestations:
•Asymptomatic, firm, lobulated mass on one side of midline in abdomen (Do not palpate!)
•Hypertension, anemia, weight loss
•Some with hematuria, abd. pain, fever
•Bilateral in 5-10% cases
Nursing Care:
-​ Wilm’s Tumor: DO NOT PALPATE THE ABDOMEN!!!!!!
Teach what to expect after Chemo or radiation:
-​ Mouth ulcers, N&V, alopecia, diarrhea or constipation, easy bruising or bleeding, risk for
infection, neuropathy, hemorrhagic cystitis, FATIQUE.
-​ Possible sterilization
Treatment:
•Surgery to remove kidney and look for metastasis
•Chemo and/or radiation may be used before surgery to reduce size of tumor
•Radiation may follow surgery w/i 10 days to treat tumor spill

***Goal is curative, remission, or supportive

Mucositis/Stomatitis:
•Provide frequent oral care
•Use soft-bristled brush for oral care
•Lubricate lips frequently
•Offer bland foods
•Assist child with salt water/baking soda mouth wash
•Apply local anesthetics as ordered
•Use mouthwashes or lozenges that are anti-fungal or anti-bacterial
•Avoid viscous lidocaine (depressed gag reflex), Hydrogen peroxide (delays healing), Milk of
Magnesia (dries mucous membranes), Lemon glycerin swabs (causes tooth decay and erosion
of tissue, alcohol-based mouthwash.

Sepsis Care:
Rule out sepsis
-​ Manage temp
-​ Obtain cultures
-​ Administer antibiotics
-​ Rest
After identification of severe sepsis or septic shock (Weiss & Pomerantz, 2018):
-​ Obtain vascular access (IV or intraosseous [IO]) within 5 minutes
-​ Start appropriate fluid resuscitation within 30 minutes
-​ Begin broad-spectrum antibiotics within 60 minutes
-​ For patients with fluid-refractory shock, initiate peripheral or central inotropic infusion
within 60 minutes
Normal Hemogran Values:
Typical range is 5.0-21.0

Neutropenia: making sure the pt does not get any infections from the hospital
•Reverse Isolation
•Neutropenic Diet
•Monitor fevers
•Masks
•Regular cultures
•Limit antipyretics
•Limit visitors
•Prophylactic ABX
•Neupogen, etc.

Calculating ANC (Absolute Neutrophil Count)

ANC = (Bands% + Segs%) x Total WBCs
Bands 5%, Segs 15%, WBCs 2,500
5% + 15% = 20% (0.20) = total neutrophils
2,500 x 0.20 = 500
ANC = 500*
ANC <1500 may indicate immunosuppression (neutropenia)

Hematopoietic Stem Cell Transplantation (HSCT)

-​ Transplantation of blood stem cells
-​ Medical procedure commonly seen in oncology/hematology
-​ Most often used for people with disease of blood, bone marrow, and certain types of CA
-​ Risky procedure with many possible complications
Allogenic transplantation
•The donor, usually a sibling, has a compatible human leukocyte antigen (HLA)
Isogenic
•Marrow taken from genetically identical twin
Autologous
•Child’s own marrow taken, treated, stored and reinfused after child has received chemotherapy

Psychosocial Conditions:
Failure to thrive (FTT)
•Inadequate caloric intake*
•Inadequate absorption
•Increased metabolism
•Defective utilization
•Infant/child falls below 5th% for weight or drops 2 growth curve percentiles
•Weight affected before length/height and can have all growth parameters decreased (chronic
malnutrition)
Risk factors
•Premmie with very low birth weight or IUGR w/I 1st 2 years
•Lack of adequate parental care
•Family stress/poverty/health-childrearing beliefs
•Feeding resistance/ improper latch/uncoordinated suck/swallow
•Reciprocal interaction issues
•Parent does not offer enough food, or is not responsive to infant’s hunger cues
•Infant is irritable, not soothed, and does not give clear cues about hunger
Clinical Manifestations:
•Nurses play a critical role is observing abnormal behaviors & child-parent or social interactions.
•Undernutrition-growth failure-- Look malnourished, dehydration
•Developmental delays
•Apathy, withdrawn, avoids eye contact, minimal smiling
•Feeding or eating disorders: vomiting, anorexia, pica, rumination, refusal
•No fear of strangers at age when stranger anxiety is normal
•Stiff & unyielding posture or flaccid & unresponsive
•Radar gaze (scanning) and wide blank vacant gaze
Management:
Goals are to:
-​ Correct nutritional deficiencies,
-​ Achieve ideal weight for height by providing sufficient calories for “catch up” growth
-​ Restore optimal body composition
-​ Educate caregiver re: nutrition & feeding methods
•Interdisciplinary team-dietician, OT, Child life, social work, mental health specialist
•Hospitalized if abuse/neglect, moderate-severe dehydration, caretaker substance abuse/mental
health, if outpatient management fails.
•Assign consistent caregivers (primary core) and provide structure environment to reduce
frustration & dissatisfaction between parent & child.
-​ Teach the parent-infant’s hunger cues, formula prep, calm patience when food refused
-​ Routines & rituals for eating, nurturing, developmental stimulation
-​ High calorie formulas, and milk supplements (Ensure), multivitamins

Autism Spectrum Disorder (ASD)

•Autism spectrum disorders (ASDs) are complex neurodevelopmental disorders of brain function
•Autistic disorder
•Asperger syndrome
•Pervasive developmental disorder not otherwise specified
Three behavior domains affected (DSM-5-TR)
-​ Social-emotional reciprocity
-​ Nonverbal communication behaviors used in social interactions
-​ Developing, maintaining, and understanding relationships
The cause of ASD is unknown
Theories:
-​ A link between hereditary, genetic, and medical problems
-​ Immune and environmental factors may increase the incidence
 -​ High risk of recurrence in families
-​ No supportive evidence that ASD is caused by the measles–mumps–rubella (MMR)
vaccine or vaccines containing thimerosa
CM:
Failure of social interaction & communication
-​ Abnormal eye contact, decrease response to own name, lack of cuddling, decreased
imitation, verbal & motor delay, lack of response to social cues
Stereotypy: rigid, repetitive, and machine-like movement with obsessive behavior (head
banging, spinning in circles, flapping hands and arms, biting themselves). Can be
self-stimulating or self-destructive.
-​ Abnormal responses to sensory stimuli: extreme aversion to touch, loud noises, bright
lights, smells, taste
-​ Emotional lability
-​ Some degree of cognitive impairment (moderate to severe)
•Savants excel in a particular area (music, art, math, memory)
Absence or delayed speech; often 1st symptoms leading to Dx
-​ No babbling by 12 mo; single words by 16 mo; 2-word phrases by 24 mo
-​ Autism regression is a RED flag; child seemed to develop normally then regresses
suddenly esp. expressive language
•GI symptoms (constipation), pica (30%), alternative diets and supplements need to be
monitored to provide good nutrition
A variety of conditions:
Abnormal EEG, seizures 1 in 3, delayed development of hand dominance, persistent primitive
reflexes, head & brain enlargement, sleep disturbances, Fragile X
Diagnostics:
•Ages & Stages Questionnaire & Modified Checklist for Autism in Toddlers (M-CHAT R/F)
•Applied Behavior Analysis, emotional & social responses, visual picture cards
Nursing Considerations for ASD:
•Wide variation in the individual client response to treatment efforts
•No cure for ASD, but many therapies are used
•Most promising results seem to be obtained with the use of highly structured routines and
intensive behavior modification programs
•When a child is seen in clinic or hospitalized:
•Ask parent about child’s routine, rituals, likes/dislikes and
•Ways to promote interaction and cooperation
•Special toys or objects important to child
•Eating patterns & food restrictions
•Use of complementary or alternative medical treatments
•Orient to new environment & avoid overstimulation with noise lights, activity in room
•Use short, direct sentences and visual cues
•Close supervision to avoid injury

Nurse Survival During Hospitalization:

•Short, clear explanations, repeat more than once, verbal, written, photos, book
•Set clear limits & be consistent
•Reward/withdrawal privilege program for +/- behaviors
•Safe environment (reduce injury risk)
•Channel energy with play
•Emotional support for child/family