MB4 peds infectious dz Sellers

• 1. fever
• 2. malaise
• 3. aches
• 4. sore throat
• 5. anorexia
• 6. nausea
• 7. rash

• 1. cool,dark atmosphere
• 2. rest
• 3. encourage fluids
• 4. acet/ibup
• 5. minimal clothing
• 6. oatmeal baths
• 7. baking soda baths (1/2 c)
• 8. shorten nails
• 9. cool humidifier for cough
• 10. soft, bland foods

may have photophobia

may have fever

need non-stimulating env

FEVER

fever and may be itchy with rash

grind in a blender and put in bath

baking soda

cool humidifier

universal precautions

use for everyone

1. wash hands before and after pt contact, blood or body fluid contact, contact with objects in pt area, & after gloving

2. gloves gowns, goggles as app.

3. treat all pt as if infectious

• 1. contact
• 2. droplet
• 3. airborne

• 1. gloves and gown for any entry into room
• 2. Remove before leaving room
• 3. Use disposable or pt-dedicated equipment and disinfect before returning to general pt use
• 4. Limited pt-transfer with assurance that infected areas are covered
• 5. Remove PPE and wash hands prior to transfer and reapply at destination

C diff

• 1. gown, glove, & mask prior to entry to pt room
• 2. private room or 3' seperation
• 3. limited pt-transfer with pt wearing mask

influenza

droplets can only travel up to 3 ft.  airborne can float through the air

• 1. negative pressure room with door closed. (check daily with flutter strips)
• 2. out of room pt must wear surgical mask
• 3. staff don NIOSH N95 mask before entering (have to be fit-tested for the mask)
• 4. gloves and gown also

TB, varicella, rubeola

diptheria, scarlatina/scarlet fever, pertussis, tetanus

• 1. excessive nasal drainage - mucupurulent and foul smelling
• 2. thin, grey membrane on the pharynx (can be with strep or others also

bacterial

Tdap

ABX

IV diphtheria antitoxin that contains preformed antibodies from animal serum

• 1. sepsis
• 2. peripheral nerve paralysis
• 3. multiorgan involvement

whooping cough

infants do not receive maternal immunity to pertussis

it is highly contagious and has high infant mortality rate

Tdap?

• 1. pneumonia
• 2. malnutrition - burning calories when cough
• 3. dehydration- can't eat/drink b/c severe coughing
• 4. rectal prolapse - cough so hard

• 1. droplet precautions
• 2. closely monitor resp and cardiac status
• 3. monitor O2 sat during coughing episodes
• 4. closely monitor fluid status
• 5. provide small, frequent feedings - may need tube feedings
• 6. frequent oral care
• 7. quiet environment
• 8. medical Tx - ABX

• 1. daily weights
• 2. I&O
• 3. MM, skin turgor

oxygenation due to coughing

group A beta-hemolytic strep

scarlet fever

• 1. fine, raised, red rash that feels rough - will eventually peel off
• 2. desquamation that begins on face and spreads - may take up to 6 weeks to complete
• 3. edematous tonsils with grayish exudate (strep)
• 4. strawberry tongue - white furry coating with red papillae that will slough off by 4th day leaving red, swollen tongue

• 1.pneumonia
• 2. meningitis
• 3. glomerulonephritis
• 4. rheumatic heart disease

• 1. ABX
• 2. fever reduction with acet
• 3. encourage fluids
• 4. soft, bland oral intake
• 5. pt teaching

when they have been on ABX for 24 hours

can go back to school

clostridium tetanii through a wound (may not be aware of the wound or remember how it occurred)

3 days to 3 weeks

immunization

may affect person in older age if not treated in childhood

finish the ABX or can cause glomerulonephritis

• 1. painful muscular rigidity of masseter and neck muscles - locked jaw
• 2. sardonic grin
• 3. facial spasms
• 4. dysphagia
• 5. severe pain
• 6. laryngospasm
• 7. muscular rigidity of trunk and extremeities
• 8. back becomes arched/ opisthotonos

prevention - has very high mortality rate

assess resp b/c can affect breathing muscles

back arched r/t muscle rigidity

• 1. ICU
• 2. ventalatory and resp support
• 3. quiet, stimulation free environment
• 4. admin of tetanus immune globulin
• 5. passive antibodies to eradicate organism
• 6. parenteral penicillin G or erythromycin
• 7. admin of a sedative and muscle relaxant

time care so can do together and give plenty of time alone

MUSCLE RIGIDITY

AKA measles (true measles)

airborne precautions

infectious 3 to 5 days prior to exanthem

• 1. fever >100
• 2. coryz
• 3. cough
• 4. conjunctivitis
• 5. Koplik's spots - bluish white spot on MM of mouth (ind to rubeola)
• 6. red, macular rash on face spreading to trunk, limbs, and feet
• 7. rash will fade to brown before resolving and lasts about a week

Koplik spots

small red spots with blue-white center on oral mucosa or buccal area

appear before rash

slough off after 3 days

• 1. bronchopneumonia
• 2. laryngotraceobronchitis/croup
• 3. acute encephalitis
• 4. otitis media
• 5. acute encephalitis

virus

symptomatic:  fever, itching, and fatigue

oral or parenteral vitamin A supplement

6th disease

• 1. high fever - 103-106 with malaise for 3 to 5 days then fever breaks and exanthem appears
• 2. exanthem mainly on neck and trunk, pink, macular/flat, maculopapular/flat & raised mix
• 3. cough
• 4. coryza
• 5. NV
• 6. HA occurring with fever

febrile seizures

• higher fever in roseola
• lighter rash with roseola
• major risks with rubeola

german measles

droplet precautions

teratogenic

crosses uteroplacental barrier

7 days prior to exanthem through 7 days afterward

• 1. pink maculopapular rash to face spreading to trunk, limbs - will fade from upper as it spreads lower
• 2. polyarthritis
• 3. eye pain
• 4. forschheimer's sign - petechiae to soft palate

petechiae to soft palate

• 1. arthritis and arthralgia
• 2. fetal death if pregnant
• 3. encephalitis

more common in adult women than CH

• 1. 1 year of age
• 2. nasopharyngeal & urine cultures are repeatedly negative

• 1. growth retardation
• 2. cataracts
• 3. retinopathy
• 4. cardiac anomalies
• 5. encephalopathy
• 6. sensorineural deafness
• 7. learning disabilities
• 8. diabetes mellitus
• 9. thyroid disorder

sensorineural deafness

caused by parvovirus B19

AKA 5th disease

• 1. slapped face appearance then a maculopapular rash to trunk and limbs
• 2. rash fades by clearing the center of the lesions first - leaves a lacy design
• 3. may have mild fever, malaise, HA

• 1. can cause fetal death in pregnant females but is not ass. with anomalies in baby
• 2. can cause crisis in sickle cell pt

no longer infectious upon appearance of rash

erythema infectiosum

form of coxsackie virus

fecal excretion

contact

vesicular lesions to palms, soles, and mouth that are painful

• 1. dehydration
• 2. hemorrhagic conjunctivitis
• 3. encephalitis
• 4. myopericarditis

refusal to eat or drink due to pain

• 1. 1 tsp salt to quart of water
• 2. mixture rinse ordered by MD containing lidocaine, benadryl, and maalox

inflammation of pericardium & cardiac muscular wall

chicken pox

1 to 2 days before rash onset until all lesions are dried or crusted over

• 1. low grade fever
• 2. malaise
• 3. anorexia
• 4. rash

teach pt not to scratch - can push on the area

prevent scarring

• 1. macule- unraised red rash
• 2. papule
• 3. fluid-filled vesicle
• 4. crusting

when all are crusting no longer contagious

• 1. secondary infection - cellulitis
• 2. encephalitis
• 3. reye syndrome
• 4. corneal involvement
• 5. deadly for the immuno-compromised

acyclovir IV (zovirax)

• 1. limited window of opportunity
• 2. must start a soon as s/s appear
• 3. prevention is much better- immunize!!

prevent secondary infection and scarring by stopping itching

yes, but it is much less severe

• 1. cover hands
• 2. trim nails

dark, quiet room

keep it cool to decrease itching

no aspirin- both can cause Reye's syndrome

SE- crystalluria

increase fluids to 2000 - 3000 ml/day

acyclovir

airborne isolation

small pox

• 1. droplets via direct and prolonged face-toface contact with infected person
• 2. contact with contaminated objects

airborne isolation b/c of high mortality rate

from appearance of mouth lesions until ALL lesions scabbed over and dried and fallen off

• will have abrupt onset/no warning
• fever 38.3/101
• prostration - absolute exhaustion (cannot function because so sick)

red spots in mouth an on tongue (first) -> dev into sores and break open

macules on face esp forehead - "herald spots"

generalized vesicular rash then pustules -> scabs

vaccination will have some protection against disease and mortaility even if it occurs after exposure to the illness

anybody exposed should imm. be vaccinated ASAP

warning that a viral infection is on board and coming

7 days before swelling to 9 days after onset of parotid swelling (saliva glands)

saliva glands

droplet isolation

• earache
• swollen & tender parotid glands (parotitis)

swollen parotid glands

• 1. meningitis
• 2. orchitis
• 3. sensorineural hearing impairment (rare)

meningitis

yes, but it is uncommon

mono

contact with blood and body fluids

mostly through saliva - kissing disease

droplets

• 1. malaise
• 2. HA
• 3. fatigue
• 4. nausea
• 5. abd pain
• 6. exudative pharyngitis
• 7. lymphadenopathy

fatigue

child just keeps feeling bad with sore throat and fatigue and doesn't get better

hepatosplenomegaly

• No specific Tx
• 1. activity as tolerated - may need prolonged rest
• 2. NO CONTACT SPORTS until spleen back to normal size

Don't do anything that could rupture the spleen

during second week of illness

NO DEEP ABD PALPATION

6 months after onset of disease

may become asymptomatic carriers

polio

• 1. same as most viruses in prodromal then progresses:
• 2. soreness and stiffness of trunk, neck, and limbs
• 3. paralysis
• 4. flaccid paralysis - esp lower extremeities and large muscle groups
• respiratory paralysis

• 1. permenant paralysis
• 2. resp arrest

post-polio syndrome

• 1. not infectious
• 2. occurs 10-40 years after illness
• 3. new muscle weakness in arms & legs
• 4. exhaustin after any normal activity
• 5. muscle and joint pain
• 6. breathing or swallowing probs
• 7. sleep apnea
• 8. sensitivity to cold temps

process of elimination

fatigue and muscle weakness

• 1. difficulty talking
• 2. ineffective cough
• 3. inability to hold breath
• 4. shallow and rapid resp

Tell someone immediately!!!

• 1. supportive care - resp managment
• 2. complete bedrest during acute phase
• 3. physical therapy for muscles following acute phase

no= depends on amnt of nerve damage

almost always death

• 1. round
• 2. tape
• 3. hook
• 4. pin

• 1. abd pain
• 2. anemia
• 3. wt loss
• 4. rectal irritation/itching

fecal smears and/or tape test

worms may feed on blood in GI tract

may be r/t upset stomach or fullness of stomach due to presence of worm mass

mother worm lays eggs and her moving can cause rectal itching/burning sensation

larvae or ova

put tape around anus will have tiny white threads when pulled off

• 1. intestinal obstruction
• 2. nutritional malabsorption
• 3. lung infection with resp distress
• 4. brain involvement

worms can move to lungs and brain

anti-helminth:  mebendazole

depends on type of infection

families must be treated together

oral/fecal

teaching!!!

• 1. no barefoot outside- can enter through soles
• 2. handwashing
• 3. avoid oral contact with pets
• 4. no hands in mouth/nail biting
• 5. use toilets/bathroom for elimination
• 6. no scratching you anus!
• 7. keep dogs/cats out of sandbox or play area and/or cover when not using
• 8. wash fruits/veg
• 9. change diapers frequently and dispose properly
• 10. swimming facilites that allow diapered CH should be avoided
• 11. only bottled water during camping

annually

• read package insert carefully:
• 1. handling
• 2. storage
• 3. admin site
• 4. dosage
• 5. route

rubella/german measles

• 1. use separate syringe for each vaccination
• 2. use diff sites - document which one went where so can see which causes reaction
• 3. give DTaP in separate leg from others b/c has highest possibiliy of a reaction
• 4. record lot number & manufacturer & exp date for each vaccine
• 5. aspirate

if < 18 mo anterolateral thigh

if 18 mo or older deltoid muscle

pick up where left off - give next dose and go from there

admin only missed doses

must give VIS to CG that tells about the vaccine (from CDC)

• 1. fever
• 2. local irritation
• 3. rash
• 4. feel bad for a few days

• 1. acet - first 24 h
• 2. cold first 24 h then warm (mus soreness) or cold prn

can cause anaphylactic reactions and need to track it

b/c maternal antibodies are passed onto infant & will neutrolzie the antibodies resulting from the vaccination

passive

live flue virus - possibility of getting flue

• 1. MMR
• 2. varicella
• 3. nasal flu

if a child/person is immunocompromised they SHOULD NOT get live vaccines

must get 2 doses about one month apart if it is the first year they are getting the vaccine

only the first year - they only need one thereafter even if they are under 9

children under the age of 6 months

recommended for all babies over 6 months

children <2years old and ppl with asthma due to risk of developing the flu from the live virus