1. Nursing Care of the Child With an Infectious or Communicable Disorder

2. anatomic and physiologic differences in children versus adults in relation to the infectious process
Children are particularly vulnerable to infectious diseases because their immune systems are still developing and their curiosity has them putting foreign objects in their mouths (especially infants and toddlers).

3. Variations in Pediatric Anatomy and Physiology
Due to the immature responses of the immune system, infants and young children are more susceptible to infection.
The newborn displays a decreased inflammatory response to invading organisms, contributing to an increased risk for infection.
Cellular immunity is generally functional at birth, and humoral immunity occurs when the body encounters and then develops immunity to new diseases.

4. Variations in Pediatric Anatomy and Physiology
Since the infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies, the risk of infection is higher.
Also, disease protection from immunization is incomplete.

5. Types of Infectious Diseases
Bacterial infections (e.g., sepsis)
Viral infections (e.g., viral exanthems and rabies)
Zoonotic infections
Vector-borne infections
Parasitic and helminthic infections (e.g., roundworm and pediculosis capitis [head lice])
Sexually transmitted infections

6. Nationally Notifiable Diseases
Look at CDC website if you wish...
For complete list

7. Methods of Preventing Infectious Diseases
Hand washing
Adequate immunization
Proper handling and preparation of food
Judicious antibiotic use

8. The infectious process, the function of each type of white blood cell, and the process of Phagocytosis.
Adapted from Fischbach, F. T., & Dunning III, M. B. (2009). A manual of laboratory and diagnostic tests (8th ed., pp. 74–85). Philadelphia: Lippincott Williams & Wilkins; and Gaspard, K. J. (2009). Blood cells and the hematopoietic system. In C. M. Porth & G. Matfi n (Eds.), Pathophysiology: Concepts of altered health states (8th ed., pp. 254–261). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

9. Stages of Infectious Disease

10. Chain of Infection behaviors of infants and young children increase their risk for infection by promoting the chain of infection.
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host

11. 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.

12. Dose Recommendations for Acetaminophen and Ibuprofen
10 to 15mg/kg/dose
No more than every 4 hours
No more than 5 doses / 24 hours
Ibuprofen
5 to 10mg/kg/dose
Only children older than 6 months of age
No more than four doses / 24 hours

13. Hospital Infection Control Practices Advisory Committee (HICPAC)
Standard Precautions and Isolation Precautions
Has presented guidelines for hospitalized children that include two tiers:
tier 1 is standard precautions, which are designed for the care of all children in the hospital regardless of their diagnosis
tier 2 is transmission-based precautions, designed for children who are known, or suspected, to be infected with epidemiologically important pathogens.
Note that these pathogens can be spread by airborne, droplet, or contact transmission.

14. Common Laboratory Tests for Infectious Diseases
Complete blood count (CBC)
Erythrocyte sedimentation rate (ESR)
C-reactive protein (CRP)
Blood culture and sensitivity
Stool culture
Urine culture
Wound culture
Throat culture

15. Information Obtained in Health History
Any known exposure to infectious or communicable disease
History of immunization and childhood communicable diseases
Fever, sore throat
Lethargy, malaise
Poor feeding or decreased appetite
Vomiting, diarrhea, cough, rash

16. Assessments Made During Physical Examination
Inspection and observation
Skin, mouth, throat, and hair for lesions or wounds
Hydration status and vital signs
Palpation
Palpate skin: temperature, texture, turgor, moisture.
Palpate rash.
Palpate lymph nodes.

17. Common Treatments and Medications for Infectious Disorders
Hydration
Fever reduction
Medications
Antibiotics
Antivirals
Antipyretics
Antipruritics

18. Sepsis
Systemic over-response to infection resulting from bacteria (most common), fungi, viruses, or parasites.
Can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure. Brainstorm with the class for examples of signs and symptoms of sepsis seen in children.

19. Laboratory and Diagnostic Tests Ordered for Sepsis
Complete blood count: WBC levels will usually be elevated
C-reactive protein: elevated
Blood culture: positive in septicemia
Urine culture: may be positive
Cerebrospinal fluid analysis: may reveal increased WBCs and protein and low glucose
Stool culture: may be positive for bacteria or other infectious organisms
Culture of tubes, catheters, or shunts suspected to be infected
Chest radiograph: may reveal signs of pneumonia

20. Bacterial Infections Occurring in Children
Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA)
Scarlet fever
Diphtheria
Pertussis
Tetanus

21. Viral Infections Occurring in Children
Viral exanthems
Mumps
Zoonotic infections
Cat scratch fever
Rabies
Erythema Migrans

27. Vector-Borne Infections
Children are at particular risk for contracting vector-borne diseases, which are diseases transmitted by ticks, mosquitoes, or other insect vectors.
Definition
Diseases transmitted by ticks, mosquitoes, or other insect vectors
Types
Lyme disease
Rocky Mountain spotted fever
Erythema Migrans

28. sexually transmitted infections (STIs)
Commonly called sexually transmitted diseases
Infectious diseases transmitted through sexual contact
oral, vaginal, and anal intercourse
Estimated that one in four adolescent women in the United States have an STI

29. 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 same site and device for temperature measurement.
Administer antipyretics per physician order when the child is experiencing discomfort or cannot keep up with the metabolic demands of the fever.
Notify physician of temperature per institution or specific order guidelines.
Assess fluid intake and encourage oral intake or administer intravenous fluids per physician order.
Keep linens and clothing clean and dry.

30. Nursing Interventions to Promote Comfort for a Child With an Infectious Disease
Assess pain and response to interventions frequently.
Administer analgesics and Antipruritics as ordered.
Apply cool compresses or baths to areas of pruritus.
Provide fluids frequently.
Provide cool mist humidification.
Dress the child in light clothing.
Use diversional activities and distraction.

31. Nursing Interventions to Promote Skin Integrity
Monitor skin for color changes, temperature, redness, swelling, warmth, pain or signs of infection, changes in rash lesions, distribution, or size.
Encourage fluid intake and proper nutrition.
Keep child’s fingernails short.
Encourage child to press on rather than scratch the area of pruritus.
Use antipruritics and topical ointments or creams as ordered.

32. Managing Skin Rashes
Accompany many infections or communicable diseases
Could be very uncomfortable
Management is to stay at home
Antipyretics
Topical creams or ointments
Prevent scratching (scarring)
Cool compresses

33. Key Teaching Points for a Child With an Infectious Disease
Assess child’s and family’s willingness to learn.
Provide family with time to adjust to diagnosis.
Repeat information.
Teach in short sessions.
Gear teaching to level of understanding of the child.
Provide reinforcement and rewards.
Use multiple modes of learning involving many senses.

34. Parasites
Frequently seen in children: scabies and head lice. Note that a helminth is a parasitic intestinal worm seen in children (pinworms, roundworms and hookworms).

35. Teaching Guidelines for Tick Removal
Use fine-tipped tweezers.
Protect fingers with a tissue, paper towel, or latex gloves.
Grasp tick as close to the skin as possible and pull upward with steady, even pressure.
Do not twist or jerk the tick.
Once the tick is removed, clean site with soap and water and wash your hands.
Save the tick for identification in case the child becomes sick.

36. Question??
The nurse is assisting with lab testing to measure the type of protein produced in the liver that is present during episodes of acute inflammation. Which of the following tests is the nurse performing?
a. complete blood count
b. erythrocyte sedimentation rate
c. C-reactive protein
d. blood culture and sensitivity

37. Answer
c. C-reactive protein. C-reactive protein measures the type of protein produced in the liver that is present during episodes of acute inflammation.
Rationale: Complete blood count evaluates white blood cell count. Erythrocyte sedimentation rate determines the presence of inflammation or infection. Blood culture and sensitivity detects the presence of bacteria or yeast and what antibiotics they are sensitive to.

38. Question?? Is the following statement true or false?
The nurse accurately explains to parents of a child with a fever that antipyretics will help change the course of the infection.

39. Answer
False. Antipyretics will not help change the course of the infection.
Rationale: Antipyretics provide symptomatic relief but do not change the course of the infection. The major benefits of decreasing fever are increasing comfort in the child and decreasing fluid requirements, which helps to prevent dehydration.

40. Question??
The nurse caring for a 4-year-old child documents headache, spasms, clamping of the jaw, difficulty swallowing, and stiff neck. Which of the following infections should the nurse suspect?
a. tetanus
b. pertussis
c. diphtheria
d. scarlet fever

41. Answer
a. tetanus. Tetanus manifests as headache, spasms, crankiness, and cramping of the jaw (lockjaw), followed by difficulty swallowing and a stiff neck.
Rationale: Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. Diphtheria causes infections in the nose, larynx, tonsils, or pharynx. Scarlet fever manifests as a fever greater than 101°F, chills, body aches, loss of appetite, nausea, and vomiting.

42. The End....