Communicable Illnesses and Immunizations in Pediatric

• Communicable diseases are prevented and treated with vaccinations, antibiotics, antiviral drugs and antitoxins
• EARLY IDENTIFICATION is KEY to prevent spread

• National, reportable/notiable diseases:
• measels, mumps, rubella, menigococous, pertussis, polio, rabies, diptheria, tetanus, hep a & B, tb, STI, gonorrhea, syphillis and others, chamid. 

prevention methods: wash hands, vaccination, educations, judious antibiotic use bacteria- precautions, virus, immunization to prevent

• Increase immunization
• decrease preventable disease
• Immunize at every chance u get sick v well visit

• Infection occurs when organism enters the body and multiples
•  inflammation- protect self
•  increase fluid, blood, and nutrients area

• Vascular and cellular reactions occur
• Vascular
•  - vasocontriction (wall off invaders) then vasodilation ( so all the different fluids that can help can get into that area)

• Cellular response
• - wbc (army of protectors body;s defense_
• - different types- neutrophils, lymphocytes, basophils, eosinphils, monocytes

• Phagocytosis- engulf foreign cells (pathogens). eat up invaders
• - produce pus- if there is a cut in skin u will see pus- control invasion
• - should the bacteria escape destruction 
•     - sepsis or septicemia= serious condition (infection in blood)

• Infection and inflammation
• 100.4 is consider a fever
• triggers release of endogenous pyrogens which then triggers prostagladin production - which triggers fever (not testing us)

• PO > 99.5 (core)
• Rectal > 100.4 (core)
• Axillary > 99.1 
• Tympanic > 100.4 (cores

• Antipyretics 
• - control fever and increase comfort (motrin/tylenol)

• kids/people are contagious 
• 1. Incubation period- time between invasion of an organism and onset of infection
• 2. Prodomal period- time between beginning of non specific symptoms and disease specific ones (contagious) 
• 3. Illness- pt demonstrates disease specific s/s (contagious) 
• 4. convlescent period- symptoms begin to fade and child returns to wellness

• Chain of infection (break that chain of infection)
• 1. Infections agent- bacteria/virus/fungal
• 2. reservoir- where the organism grows and multiple (could be in the human, animal, soil, food)
• 3. Portal of exit- where it leaves and spreads to causing disease (URI- cough mouth portal of exit)
• 4. modes of transmission- direct/indirect contact
• 5. portal of entry- cut on body, mucous membranes/orfices in body
• 5. susecptible host- immune system compromise, young, old, pt on antibiotics > 72 hr, hospital pt

hand washing...

• Health promotion and teaching 
• Teach good nutrition practices (increase protein)
• offer immunization at well and sick
• hand washing most important act to prevent spread

• Importance of preventing the spread of infection
• - Noscomial infection acquired in the hospital
• Increased risk for severe illness
• - < 2 years old
• - nutritional deficiences
• - immunosuppressed
• - indwelling vascular lines or catheters
• - on antibiotics
• - in hospital > 72 hours
• - elders

• disinfect the toys
• use strict aspectic technique- sterile gloves and field (to keep bacteria out)
• frequent hand washing and infection control practices- first line of defense. 
• Nurses must protect themselves following standard precautions with patient- wearing gloves

• Isolation precautions
• - tier 1= standard precautions
• - tier 2= transmission based precautions- contact, droplet, airborne p. 1262 table box

• Normal immune function- protective response 
• Some people of more susceptible due to:
•  - immature immune response 
•  - newborns display decreased inflammatory response - increase risk for infection
• - cellular immunity functional at birth (because of mom IgG)
• - humoral immunity occurs as child exposed to new diseases and develops immunity 
•   - infant limited exposure to the disease
•   - young children protection from immunization not complete

• Hydration- promotes fluid balance
•  PO fluids
•  IV fluids (really sick)
•  maintain strict I/O

• Fever reduction technique
• - antipyretics- acetaminophen or ibuprofen
• - no ASA for under 12 bc reyes disease
• - non pharm
•  light clothing, remove blankets, fan, tepid bath, cooling blankets

assess temp q 4-6 hour and 30-60 after antipyretics

• Medications:
• antibiotics - treat bacteria 
• antiviral- treat virus
• antipyretics- decrease temp (aceto/ibuprofen)
• antipruritics - given PO or topically to relieve itching (hydrocodazone and antihistamine)

• Assessment
• health hx- when did it start, what relieves it, anyone in the family, s/s, what have u been experiencing, N/V/D, rash, travel, what makes it worst, meds, how long have u been  going thru this, use of any new products

• perform physical examination0 systemic and rashes
• Monitor labs/dx testing- recognize when labs come back and report any abnormalities, get this info to the md
• nx diagnosis, pain, impaired skin integrity, risk for infection, fever, impaired comfort

Planning- family centered care (involve the whole fam), coping, prevention

implementation- nurse responsible ie monitor I/O, hydation, vital signs, meds etc

Evaluation- getting better or worst

• Inspect
•  - assess lesions, wounds,, rashes (exanthems- viral in nature)
•  note color,, shape, distribution
•  exudate
•  scratching, restlessness, guarding

• Observe
•  affect (bouncy playing, listless), energy level, interactions with the world
•  note lethergy
•  nasal discharge, cough, respiratory problem (respiratory usually goes first on a child not heart)
• check hydration
•  mucosa, eyes, tears

vital signs- T,P, R,BP, O2

• Palate
• temperature
• moisture
• turgor and texture
• fontanels
• rash
• lymph nodes- anterior cervical, swollen hard and firm if they have an infection

• CBC- wbc most often- usually high with infection
• erythrocytes sedimentation rate- inflammatory marker (could be high)
• c-reactive protein
• blood culture/sensitive- figure out bacteria and which antibiotic can kill it
• stool culture/ O&P (ovum and parasite)
• urine culture
• wound culture
• throat culture 

• sepsis or septicemia- presence of pathogenic organisms in the blood and tissues
•  develops when bacteria avoid destruction and enter systemic circulation and lymphatics which transport the pathogens to other parts of the body

• systemic inflammatory response syndrome (emergency)
• can lead to septic shock (medical emergency)
• prognosis variable and depends on age of child mortality rate 9-35%

• most common in neonates and small infants because of their immature immune system. 
• the don't have inflammatory response and not all have their vaccines yet. 

• Common cause
• neonate- e. coli, group b strep, herpes virus, enterovirus

older children- neisseira, menigtudis, strep, salmonella, staph

• s/s fever, chills, fatigue, malaise, nausea, vomiting, difficulty breathing, anxiety or confusion-
• neonates maybe hypothermic- may not have a fever- low temp

Therapeutic management- agressive med treatment ie IV and antibiotic

nursing management- monitor closely, adminster meds as ordered

infection prevention- hand washing, aseptic tech, cleaning equipment

education- early recognition, fever < 3 months old, lethargy, poor response, lack of facial expression