Ch 41 The Child with Infectious Disease Continued

Ch 41 The Child with Infectious Disease Continued


The Child With Infectious Disease Continued
Chapter 41 The incubation period for Pertussis is 6 to
20 days with the infectious period being 1-4 weeks. It is transmitted by contact or respiratory
droplets from coughing. There is a vaccine for it. Can occur at any season but usually in the
summer and fall. There are 3 stages and they are catarrhal,
paroxysmal and convalescent and last a total of 6-12 weeks. See Box 41.1 for details of each. Diagnosis is make through a positive nasopharyngeal
culture. The most common complication is pneumonia. Other respiratory complications can occur
as well. Malnutrition and dehydration can occur and
be dangerous. Primary prevention of pertussis is the best
therapeutic management. Erythromycin, azithromycin or clarithromycin
if given during the catarrhal stage will eliminate the organism form the nasopharynx within 5
days. Hospitalization and supportive care for the
infant may be needed especially for infants younger than 6 months. Nursing considerations is a thorough history
including immunizations and exposure to the illness. Also get a good description of any respiratory
events prior to admission and the symptoms they experienced. The child’s respiratory status needs to
be carefully monitored. Suction and oxygen should be available and
used as needed. Monitor the child’s nutritional status and
encourage small frequent feedings/meals. IV fluids may be needed if the child is at
risk for dehydration. Resting is important so clustering care to
allow for this is important. Incubation period for scarlet fever is 1-7
days with the average of 3 days. Infectious period is the acute stage until
24 hours after microbial therapy has begun. Transmission is via airborne or direct contact. There is not a vaccine for this. More common in later fall, winter and spring. Manifestations include abrupt fever, vomiting,
headache, abdominal pain, pharyngitis and chills. The fever reaches its peak by the second day
but returns back to normal within 5-6 days. Within 24 hours , a fine red popular rash
appears in the axillae, groin, and neck which feels like sandpaper to the touch. Desquamation may begin on the face at the
end of the first week and flaking will proceed down the trunk. The tongue is initially covered in a white
furry covering with red projecting papillae. By the fourth day the papillae slough off,
leaving a red, swollen tongue. The tonsils are edematous as well. Complications result from the extension of
the streptococcal infection which can include otitis media, peritonsillar abscess, meningitis,
rheumatic fever and glomerulonephritis. A rapid streptococcal screening and/or a throat
culture to confirm. The preferred treatment is penicillin and
if allergic, erythromycin. May return to school or day care 24 hours
after beginning antibiotics. Droplet precautions should be used until 24
hours after the start of antibiotics. The nurse needs to get a complete history
including symptoms and when exposed. Assess the child’s tongue, rash, vitals. Comfort measures include encouraging fluids
and administering antipyretics. Analgesics may be given for discomfort. Bed rest and quiet activities during the acute
phase. Lyme disease incubation period is 1-31 days. Transmission is by the bite of infected tick
and peak season is April to October. It is a multisystem disease. It is divided into 3 stages, early localized,
early disseminated and late disseminated. The skin lesions are most prominent in the
first stage. During the second stage, cardiac and neurologic
findings are prominent and in the third stage, arthritis is the main symptom. In the early stage they will also experience
flu like symptoms and an erythematous macule or papule forms at the site of the tick bite
within 1-31 days. The rash can look like a bull’s eye appearance
and will last about 3-4 weeks. About 1-4 months after the bite and during
the second stage, the neurologic signs can appear. This includes headache, nausea, vomiting,
Bell’s palsy, or forgetfulness are a few of the common symptoms. Joint pain can occur and it is typically the
larger joints that are affected and will last a few days but can reoccur. During the third phase, which can be months
or years after the initial bite the symptoms can be intermittently include chronic arthritis,
fatigue and chronic neurologic manifestations. Prevention is the key to therapeutic management
which includes anticipatory guidance on avoidance of the tick bites. Early identification and treatment is needed
as well. Antibiotic treatment is commonly used with
doxycycline, amoxicillin or cefuroxime are the main medications used. If the disease is caught early and antibiotic
treatment is followed, the disease may not progress into the others stages. Nursing consideration is a complete history
and physical, when the exposure occurred , onset of symptoms. The ticks have to be attached for more than
36 hours to transmit the disease so education to parents on checking children frequently
can decrease the risk. Instruct on using appropriate insect repellant
and outdoor wear to help prevent. Helminths are worms that live as parasites. Common types include roundworm, pinworm, tapeworm
and hookworm. The roundworm is transmitted by ingestion
of eggs from contaminated soil or food and is transferred to mouth from fingers, toys
or other vectors. Symptoms include abdominal pain or distention,
vomiting with bile staining and is diagnosed by a fecal smear. Pinworm is transmitted by ingestion or inhalation
or eggs, transfer from hand to mouth. Symptoms include nocturnal anal itching and
sleeplessness and diagnosed by tape test and microscopic examination. Tapeworm is transmitted from ingestion from
handling or eating infected beef or pork. They can be asymptomatic but segments of worms
seen in stool, they could have abdominal pain, nausea, anorexia, weight loss and insomnia. Diagnosed by a fecal smear or microscopic
examination. Hookworm is transmitted by skin penetration
from direct contact with contaminated soil. Symptoms include dermatitis, blood loos leading
to anemia, and malnutrition. Diagnosed by fecal smear or microscopic exam. Treatment includes administration of oral
medications that is for the specific helminth. Treatment is for the whole family. Anticipatory guidance on the prevention of
the spread of disease, personal hygiene and sanitary practices. Nursing considerations is to obtain a thorough
history, incuding hygiene habits and the availability of running water and bathing. What do they have for laundry facilities and
also their nutritional intake. Clear instructions on how to collect a stool
sample if needed. Education to the parents and caregivers regarding
proper medication administration and compliance. Teaching on primary prevention measures. Chlamydial infection has an incubation period
of 7 to 21 days. It is transmitted via birth if mother is infected,
also through sexual activity. It is the most prevalent STI. Many people have no or just a few symptoms
but it can cause urethritis and pelvic inflammatory disease (PID) and can go undiagnosed until
these complications occur. Neonatal conjunctivitis develops anywhere
from a few days to several weeks after birth and manifests with a watery discharge that
becomes purulent. Eyelids will be edematous. Urethritis, urinary frequency, or mucopurulent
discharge may indicate a chlamydial infection. If this is found in a younger child, then
there could be possible sexual abuse. Therapeutic management includes 14 day or
oral erythromycin for infants with conjunctivitis and pneumonia. Nurse will educate on the importance of treating
all sexual partners and avoid intercourse for 7 days and until symptoms have resolved
Gonorrhea has an incubation period of 2-7 days and is transmitted via intimate contact. It can be transmitted via prenatally, sexual
abuse or voluntary sexual activity. Ophthalmia neonatorum is the most common type
of gonorrheal infections for infants. It starts developing in about 2-5 days after
birth. The eyes will have a thick, purulent discharge
and if not treated will lead to blindness. Girls with a gonorrheal infection have a purulent
vulvovaginitis, and boys often have urethritis. Many times burning with urination will be
present. A serious complication includes PID. Hep B, HIV, syphilis and chlamydial infections
are also present in people who have gonorrhea so checking for those is part of the therapeutic
treatment. Sexual partners should be treated as well. The incubation period for herpes simplex virus
is 2 to 14 days and is transmitted via direct sexual contact with an infected person. Herpes simplex virus 2 is the predominant
cause of genital herpes. It is one of the most frequent STI’s. If it is transmitted to a newborn via vaginal
delivery, it can cause multisystem problems. At the initial infection, lesions occur in
the genital area mainly on the vulva, perineum or perianal area. They can also occur in the vagina and on the
cervix and not seen. Pain and tenderness in the affected area is
common when the lesion erupt. Sometimes flu like symptoms can happen with
eruption. After the initial acute phase, the virus can
remain dormant where it can reappear with triggers of stress. There is no cure for the virus but administration
of acyclovir can diminish symptoms and shedding time. Infected neonates are treated with parenteral
acyclovir and if they are experiencing ocular involvement, they will also receive a topical
ophthalmic. Adolescents are treated for 10 days with Acyclovir. Infected individuals need to refrain from
all sexual contact until the lesions are healed. Incubation period for HPV is 3 weeks to many
months and is transmitted via sexual contact or perianal contact through delivery. It is responsible for the common wart and
for genital warts. The anogenital warts begin as small papules
that grow into soft clustered lesions. Typically found in the labia minora, vagina,
cervix, anus, rectum and glans penis. In many cases genital warts will resolve spontaneously
within 1-2 years. Treatment becomes difficult due to location
but topical gels or creams can be used. Also cryotherapy or laser treatment may be
used. Transmission can be decreased with use of
a condom. There is a vaccine for HPV

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