Bb Childhood Diseases Fall12(1)

8/22/2019 Bb Childhood Diseases Fall12(1)

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ChildhoodDiseases

Kimberly Ambruso, RN, MS


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Fever Why does it happen/what

does it mean?

What is considered febrile Oral Rectal

Axilla or tympanic

Consequences of fever?

Brain damage >105

Febrile seizures 9 months-5 years


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Otitis Media S. pneumoniae, H.

influenzae

RSV, rhinovirus,

influenza virus ,

adenovirus May include effusion

Prevention

Second Hand smoke

Breastfeeding

Upright feeding

immunizations

Symptoms

Pain

Irritability

Pulling on ear

Fever

Difficulty with

balance, hearing

Treatment

Antipyretics

Analgesics

Antibiotics (if bacterial)


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Perforated eardrum (tympanicmembrane) Caused from pressure/fluid accumulationbehind the membrane

After rupture, pain decreases/subsides

Ringing/buzzing

Drainage

Decreased Hearing/loss


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Stages of Infectious diseases

Incubation period

Prodromal period

Illness phase

Convalescent period


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Communicable Diseases

Classifications andSymptoms

Infectious in nature

Bacterial vs. Viral vs. fungal Fever

red, swollen throat

Rash

nasal congestion

Oral lesions

crusty lesions

malaise

Management

Varies with causative

agent

Antibiotics

Antivirals

Supportive care

Immune Globulins

Prevention

Immunizations
http://healtheillinois.files.wordpress.com/2008/05/immune.gif


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Immunizations

Purpose

Types

Attenuated

Toxoid

Active vs.PassiveImmunity

Gammaglobulin/Immuno-globulin

Who gets them?

Controversy Religion

Autism

Personalpreferences/Philo-sophicalexemptions
http://healtheillinois.files.wordpress.com/2008/05/immune.gifhttp://healtheillinois.files.wordpress.com/2008/05/immune.gif


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Scheduling of Immunizations

Transplacental

immunity

Ability to make

antibodies

Ages 0-6 yrs:

Ages 7-18

Catch-up schedule

http://www.cdc.go

v/vaccines/schedul

es/downloads/chil

d/0-18yrs-11x17-fold-pr.pdf
http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdf


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Acute Streptococcal Pharyngitis

Group A -hemolytic

streptococci

With or without

tonsillitis

Untreated/mis-

managed:

Acute rheumatic fever Acute glomerulonephritis

Occurrence

Peak 4-7 years

Winter months

Crowded livingconditions

Diagnosis of pathogens

Throat culture

rapid strep test

viral

Mosby items and derived items 2007, 2003 by Mosby, Inc., an affiliate of

Elsevier Inc.

Slide 9


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Mosby items and derived items 2007,2003 by Mosby, Inc., an affiliate of Elsevier

Inc.Slide 10


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Pharyngitis/Tonsillitis

Clinical manifestations

Kissing tonsils

Mouth

Therapeuticmanagement

Symptommanagement

Antipyretics

Analgesics

Warm saline gargle

Pharmacologicalmanagement

Penicillin

Erythromycin

Non-infectious after 24hrs on Abx

Surgical Mangement

Tonsillectomy and/oradenoidectomy

.

10


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Bacterial Meningitis

Description

Acute inflammation of

the CNS

Decreased incidencefollowing use of Hib

vaccine

caused by:

meningococcus

pneumococcus

Group streptococci

Transmission

Droplet infection fromnasopharyngealsecretions

Appears as extension ofother bacterial infectionthrough vasculardissemination

Organisms then spreadthrough CSF

Increased ICP /Hydrocephalus / cerebraledema

Slide 12


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Bacterial Meningitis

Diagnostics:

Lumbar Puncture

CBC

Blood cultures

Manifestations:

Fever

Extreme irritability

Poor feeding

Vomiting

Nuchal rigidity

Opisthotonus

Therapeuticmanagement

Antibiotics

Isolation

Supportive care

Corticosteroids

Fluid replacement

Monitoring neurological

status Hearing loss

ADD

Learning disabilities

Slide 13


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Meningitis Signs

Kernigs Sign:

http://youtu.be/rJ-5AFuP3YA

Brudzinskis Sign:

http://youtu.be/jO9PAPi-yus
http://youtu.be/rJ-5AFuP3YAhttp://youtu.be/rJ-5AFuP3YAhttp://youtu.be/jO9PAPi-yushttp://youtu.be/jO9PAPi-yushttp://youtu.be/jO9PAPi-yushttp://youtu.be/jO9PAPi-yushttp://youtu.be/jO9PAPi-yushttp://youtu.be/jO9PAPi-yushttp://youtu.be/rJ-5AFuP3YAhttp://youtu.be/rJ-5AFuP3YAhttp://youtu.be/rJ-5AFuP3YA


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Nonbacterial Meningitis

(Aseptic Meningitis)

Causative agents are principally viruses

Frequently associated with other diseases Measles, mumps, herpes, leukemia

Onset abrupt or gradual

Manifestations: headache, fever, malaise Diagnosis and treatment

Mosby items and derived items 2007,

2003 by Mosby, Inc., an affiliate of

Elsevier Inc.

Slide 16


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Fifth Disease

Parvovirus

Peak age: 5-14 yrs

No vaccination

Headache, fever,malaise

Rash:

After 1 week (face) extremities

trunk
http://www.mdconsult.com/das/patient/body/0/0/10041/19074_en.jpg


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Fifth Disease: transmission issues

http://www.cdc.gov/ncidod/dvrd/revb

/respiratory/b19&p

reg.htm

Nursing

Management

Standard and

droplet precautions

Antipyretics

Antipruritcs

Avoid exposure tosunlight

Can go to school

with rash
http://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htm


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H. Influenza

Spring and summer months

More common in daycare center population

Droplet-based transmission URI symptomsmeningitis, otitis,

epiglottitis, pneumonia, septic arthritis,

cellulitis


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Hib Vaccine

Haemophilus influenzae type b

Inactivated NOT the flu shot!

Schedule

2, 4 and 6 months

Or 2,4 and 12-15 months


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Measles (Rubeola)

Unimmunizedpersons

Peak age: youngadults/adults

Winter and springmonths

Spread via droplet

Symptoms

High fever andmalaise

Lymphadenopathy

Kopliks spots

Respiratorysymptoms

Conjunctivitis

Photophobia


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Measles

Rash appears day 4

Head trunk Red brown Very pruritic!!

Management

Supportive Care

Dark environment/

sunglasses

pneumonia,encephalitis

Airborne precautions
http://wpcontent.answers.com/wikipedia/commons/thumb/e/e0/Measles_enanthema.jpg/180px-Measles_enanthema.jpghttp://www.southstaffordshirepct.nhs.uk/images/yourHealth/vacs/mumps.jpg


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Mumps

Adolescents

Classic symptom isparotitis

Fever, malaise,

headache No rash

Diet Droplet precautions

Symptommanagement
http://www.aurorahealthcare.org/healthgate/images/si55551288.jpghttp://www.southstaffordshirepct.nhs.uk/images/yourHealth/vacs/mumps.jpg


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Rubella (German Measles)

Peak age: pre-teen,

adolescent

Winter and Spring

months

Inhalation or

nasopharyngealsecretions

Symptoms

Low grade fever

Mild cough Sore throat

Lymphadenopathy

Arthritic pain

Rash: face trunkextremities


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Rubella Management Relieve joint pain

Control fever

Tylenol / Motrin

Standard and Droplet

precautions

birth defects
http://www.wales.nhs.uk/sites3/gallery/457/rubella_rash.jpghttp://www.wales.nhs.uk/sites3/gallery/457/rubella_rash.jpg


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Measles, Mumps, Rubella (MMR)

Vaccine

Live, attentuated

1st

dose: 12-15 months 2nd dose: 4-6 yrs

s/e rash fever (5-12 days after) Autism controversy

May be combined with varicella (MMRV)


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Varicella

Varicella-Zostervirus

Peak age: older

children youngadults

Incubation: 10-21days

When is itcontagious?

Symptoms

Low grade fever,

malaise

Rash appears 24

hours afterprodromal

symptoms

Stages: macule,

papule, vesicle, crust

Appear mostly on

trunk


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Varicella Vaccine

Only childhood disease epidemic that stillexists

After 1st birthday (12-15 months)

Attenuated live virus s/e fever, rash Chicken pox pneumonia, encephalitis

Cannot give to immunocompromisedchild or family member
http://www.geocities.com/wela/ChickenPoxBabyCartoon.jpg


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Other Immunizations

Diphtheria, Tetanus, Pertussis IPV (Inactivated Polio)

Rotavirus

Hepatitis A,B Pneumococcal

HPV (Human Papilloma Virus)

Meningococcal (MCV4) Seasonal Flu (includes H1N1)

Shingles


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Nursing care for Immunizations

Indications for holdingvaccine

seriously ill

Pregnancy (liveviruses)

Corticosteroids

Chemotherapy

Radiation

Record all vaccineinformation

Lot #, manufacturer, name

of providerSide effects Fever, rash, malaise

Give acetaminophen (Tylenol)

anaphylaxisEducate on importance ofkeeping on schedule andcontinuing sequence


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Nursing management

Scabs will not scar if

you let them be!

Antihistamines antipyretics

Analgesics

NO ASPIRIN!!!REYES SYNDROME!!


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Patient education

Skin care for rashes

Light cotton clothing

Avoid perspiration

Avoid wool clothing

Increase fluids

Keep fingernails shortand clean (mittens)

Press or rub on itchyareas

Cold cloths

Lukewarm baths withbaking soda

Dipenhydramine

(Benadryl) Avoiding transmission of

disease

Avoid sick contacts

Handwashing

Keeping on schedule

Documents

Bb Childhood Diseases Fall12(1)