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NURISNG CONSIDERATIONS Maintain strict isolation in the hospital Isolate child in home until vesicles have dried (usually 1 week after onset of the disease), and isolate high –risk children from infected children Administer skin care: give bath and change linens daily; administer topical application of calamine lotion; keep child’s fingernails short and clean; apply mittens if child scratches Keep child cool (may decrease number of lesions) Lessen pruritus; keep child occupied Remove loose crusts that rub and irritate skin Teach child to apply pressure to pruritic area rather than scratching it I older child, reason with child regarding danger of scar formation from
1. CHICKENPOX Varicella Zoster Primary secretions of respiratory tract of infected persons; to a lesser degree lesions (scabs not infectious) Transmission: 2 – 3 weeks, usually 13 – 17 days
1 day before eruption of lesions (prodromal pd) to 6 days after 1st crop of vesicle when crust have formed
PRODROMAL: Slight fever, malaise, and anorexia for the 1st 24 hours Rash highly pruritic as macule, rapidly progresses to papule and then vesicle (surrounded by erythematous base, becomes umbilicated and cloudy, breaks easily and forms crusts) Centripetal (spreadin to face and proximal extremities but sparse on distal limbs) Elevated temp from lymphadenopathy, Irritability from pruritus
SPECIFIC: Antiviral agent: Acyclover (Zovirax) Varicella-Zoster Immune Globulin (VZIG) after exposure in high risk children SUPPORTIVE: Antihistamine: Diphenhydramine hydrochloride for itching Skin care to prevent secondary bacterial infection
Secondary infections (abscesses, cellulitis, pneumonia, sepsis) Encephalitis Varicella pneumonia Hemorrhagic varicella: tiny hemorrhages in vesicles and numerous petechiae in skin Chronic aand transient thrombocytopenia
toxemia. analgesics. septic shock. use of acetaminophen controversial (may delay scabbing) 2. observe for signs of sensitivity to penicillin administer complete care to maintain bedrest use suctioning as needed regulate humidity for liquefaction of secretions observe respirations for signs of obstruction 3. hoarseness. apprehensive. smooth. sore throat.scratching Avoid use of aspirin. may Transmission: be as long unknown. most children. usually 2 weeks but as long as 4 weeks Nasal: resembles common cold. precede by skin or conjunctival test to rule out sensitivity to horse serum antibiotics (penicillin or erythromycin) complete bedrest ( prevention of myocarditis) tracheostomy for airway obstruction treatment of infected contacts and carriers Mycocarditis (2nd week) Neuritis maintain strict isolation in the hospital participate in sensitivity testing. skin. white or gray membrane. as 20 possibly days respiratory secretions and uncertain but rash appears in 3 stages: before onset of Stage I: erythema on face. but no evidence of necessary. may be frank epistaxis Tonsillar/pharyngeal: malaise. dypsneic retractions. and death within 6 to 10 days laryngeal: fever. except hospitalized child (immunsuppressed or with aplastic crises) suspected of HPV infection is placed on . symptoms of chiefly on cheeks. until virulent bacilli are no longer present (identified by 3 negative cultures). adherent. possibly longer variable. have epinephrine available administer antibiotics. cyanosis antitoxin (usually intravenously). a carrier. in severe cases. disappears by week after onset 1 to 4 days of symptoms in Stage II: about 1 day after Antipyretics. Self-limited arthritis Isolation of child is not anti-inflammatory drugs Possible blood and arthralgia May result in fetal transfusion for transient aplastic anemia death if mother is infected during pregnancy. and other lesions of infected persons Transmission: direct contact with infected person. lymphadenitis possibly pronounced (bull’s neck). or contaminated articles usually 2 to 5 days. sero-sanguineous mucopurulent nasal discharge without constitutional symptoms. “slapped face” also for about 1 appearance. ERYTHEMA INFECTIOSUM (FIFTH DISEASE) Human parvovirus infected persons 4 to 14 days. low-grade fever. DIPHTERIA Corynebacterium diphtheria discharges from mucous membranes of nose or nasopharynx. pulse increased above expected for temperature within 24 hours. potential airway obstruction. cough. anorexia.
MEASLES (RUBEOLA) . nonpruritic. EXANTHEMA SUBITUM (ROSEOLA) Human Herpes unknown Unknown Virus type 6 Transmission: unknown (virtually limited to children between 6 months to 2 years of age) Unknown Antipyretic (fever) Febrile seizure teach parents to 4 days in child who appears well precipitous drop in fever to normal with appearance of rash rash: discrete rose-pink macules or macupapules appearing first on trunk. maculopapular red spots appear. coryza measures for lowering temperature if child is prone to seizure. cold friction) In children with aplastic crisis. cough. symmetrically distributed on upper and lower extremities. last 1 to 2 days Associated s/s: cervical/ postauricular lymphadenopathy. heat. discuss appropriate precautions reassure parents regarding benign nature of illness 5. vomiting. lethargy. face. then spreading to neck. injected pharynx.blood children with aplastic crisis rash appears on face. should not care for patients with aplastic crises. myalgia. explain low risk of fetal death to those in contact with affected children 4. nausea. and abdominal pain persistent high fever for 3 congenital anomalies Aplastic crisis in children with hemolytic disease or immune deficiency Myocarditis (rare) respiratory isolation and universal precautions Pregnant women: need not be excluded in workplace where HPV infection. rash is usually absent and prodromal illness includes fever. fades on pressure. and extremities. rash progresses fromproximal to distal surfaces and may last a week or more Stage III: rash subsides but reappears if skin is irritated or traumatized (sun.
cough. encourage fluids and soft bland foods Skin care: keep skin clean. if hospitalized. use tepid baths as necessary 6. symptoms gradually increase in severity until 2nd day After rash appears. institute respiratory precautions Maintain bed rest during prodromal stage. clean eyelids with warm saline solution to remove secretions or crusts. begins as erythematous maculopapular eruption on face and gradually spreads downward. and urine of infected person 10 – 20 days from 4 days before to 5 days after rash appears but mainly during prodromal stage Prodromal (catarrhal) stage: Fever and malaise. provide quiet activity For fever: instruct parents to administer antipyretics.respiratory tract secretions. generalized lymphadenopathy during febrile period. keep child from rubbing eyes. more severe in earlier sites ( appears confluent ) and less intense in later sites. ezmine cornea for signs of ulcerations Coryza/cough: use cool mist vaporizer. when they begin to subside Rash: appears 3 to 4 days after onset of prodromal stage. if child is prone to seizures. bluish white centerfirst seen on buccal mucosa opposite molars 2 days before rash). blood. antibiotics to prevent secondary bacterial infection in high-risk children Otitis media Pneumonia Bronchiolitis Obstructive laryngitis and laryngotracheitis Encephalitis Isolation until 5th day of rash. institute appropriate precautions (fever spikes to 40 degrees Celsius between 4th and 5th day Eye care: dim lights if photophobia is present. irregular red spots with a minute. protect skin around nares with layer of petrolatum. Analgesics for pain Sensorineural Isolation during . after 3 to 4 days assumes brownish appearance. avoid chilling. followed Vitamin A supplementation Supportive: bed rest in 24 hours by coryza. conjunctivitis Koplik spots (small. antipyretics. and fine desquamation occurs over areas of extensive involvement Constitutional S/S: anorexia. malaise. MUMPS paramyovirus saliva of infected 14 – 21 most Prodromal stage: fever.
and meningoencephalitis Antipyretics for fever Intravenous fluid may be necessary for child who refuses to drink or vomits because of meningoencephalitis deafness Postinfectious encephalitis Myocarditis Arthritis Hepatitis Epididymo-orchitis Sterility ( extremely rare in adult males period of communicability. if child is unwilling to chew medications. orchitis. if hospitalized.persons Transmission: direct contact with or droplet spread from an infected person days communicable immediately before and after swelling begins headache. children who are dehydrated. followed by “earache” that is aggravated by chewing Parotitis: by 3rd day. or those who have complications Bed rest cause of death) Atelectasis Otitis media Convulsions Hemorrhage (subarachnoid. symptoms continue from 1 to 2 weeks. cough and lowgrade fever. erythromycin) Administraion of pertussis-immune globulin Supportive treatment: Hospitalization required for infants. sneezing. subconjunctival. institute respiratory precautions Maintain bed rest as long as fever is present Keep child occupied during the day ( interest in play . when dry hacking cough becomes more severe Paroxysmal stage: cough (e.. lacrimation. bland foods. provide warmth and local support with tight-fitting underpants 7. PERTTUSSIS (WHOOPING COUGH) Bordetella pertussis discharge from respiratory tract of infected persons Transmission: direct contact or droplet spread from infected person. avoid foods requiring chewing Apply hot or cold compresses to neck whichever is more comforting To relieve orchitis. accompanied by pain and tenderness Other manifestations: submaxillary and sublingual infection. malaise and anorexia for 24 hours. usually 10 days greatest during catarrhal stage before onset of paroxysms and may extend to 4th week after onset of paroxysms Catarrhal stage: begins with Antimicrobial therapy Pneumonia (usually Isolation during symptoms of upper respiratory tract infection.g. parotid glands (either unilateral or bilateral) enlarges and reaches maximum size in 1 to 3 days. use elixir form Encourage fluids and soft . indirect contact with 5 – 21 days. institute respiratory precautions during hospitalization Maintain bed rest during prodromal phase until swelling subsides Give analgesics for pain. epistaxis) Weight loss and dehydration catarrhal stage. such as coryza.
retractions. POLIOMYELITIS Enteroviruses.freshly contaminated articles most often occurs at night and consists of short. chilling. activity. offer small amount of fluids frequently. apprehension. cyanosis) Involve public health nurse if child is cared at home 8. keep room well ventilated Encourage fluids. smoke. 3 feces and types: oropharyngeal secretions of Type 1: most Usually 7 – 14 days. stage generally lasts 4 to 6 weeks. with not exactly known. rapid coughs by sudden inspiration associated with high-pitched crowing sound or “whoop”. sudden change in temperature. excitement). eyes bulge. and tongue protrudes. paroxysms may continuew until thick mucous plug is dislodged. reefed child after vomiting Provide high humidity ( humidifier or tent). cheeks become flushed or cyanotic. followed by convalescent stage Increased oxygen intake and humidity Adequate fluids Intubation possibly Hernia Prolapsed rectum necessary associated with fewer paroxysms) Reassure parents during frightening episodes of whooping cough Provide restful environment and reduce factors that promote paroxysms ( dust. vomiting frequently follows attack. virus is present in may be manifest in 3 different forms: Abortive or inapparent: No specific treatment. diring paroxysms. Permanent Maintain complete including antimicrobials or gamma globulin paralysis Respiratory arrest bed rest Administer mild . suction gently but often to prevent choking on secretions Observe for signs of airway obstruction (increased restlessness.
shallow and rapid respirations). spread is via fecal-oral and pharyngealoropharyngeal routes range of 5 – 35 days throat and feces shortly after infection and persists for about 1 week in throat and 4 to 6 weeks in feces fever. anorexia. most benign of all childhood communicable diseases. with pain and stiffness in neck. uneasiness. especially young children Transmission: direct contact with persons with apparent or inapparent active infection. headache. encephalitis or purpura). vomiting.frequent cause of paralysis. headache. present in adults and in adolescents. greatest Reassure parents of benign nature of illness in affected child Employ comfort measures as necessary Isolate child from . ineffective cough. mild No treatment necessary other than antipyretics for low-grade fever and analgesics for discomfort Rare (arthritis. administer analgesics for maximum comfort during physical activity Observe for respiratory paralysis (difficulty in talking. sore throat. report such S/S to practitioner. both epidemic and endemic Type 2: least frequently associated with paralysis Type 3: 2nd most frequently associated with paralysis infected persons. use footboard Encourage child to move. lasts a few hours to a few days Nonparalytic: same manifestations as abortive but morew sever. followed by recovery and then signs of central nervous system paralysis Complete bed rest during acute phase Assisted respiratory Hypertension Kidney stones from ventilation in case of respiratory paralysis Physical therapy for muscles following acute stage demineralization of bone during prolonged immob sedatives as necessary to relieve anxiety and promote rest Participarte in physiotherapy procedures ( use of moist hot packs and range-of-motion exercises Position child to maintain body alignment and prevent contractures or decubiti. RUBELLA (GERMAN MEASLES) Rubella virus primarily nasopharyngeal secretions of persons with apparent or inapparent 14 – 21 days 7 days before to about 5 days after appearance of rash Prodromal Stage: absent in children. abdominal pain. malaise. consists of low-grade fever. back and legs Paralytic: initial course similar to non-paralytic type. inability to hold breath. anorexia. have tracheostomy tray at bedside 9.
edematous. by 4th or 5th day white coat sloughs off. with range of 1 – 7 days during incubation period and clinical illness approximately 10 days. coryza. body is covered with w discrete. disappears in same order as it began and is usually gone by 3rd day Constitutional S/S: occasional low-grade fever. indirectly via articles freshly contaminated with nasopharyngeal secretions. sore throat. cough and lymphadenopathy. pulse increased out of proportions to fever. in severe cases appearance resembles membrane seen in diphtheria. stool. trunk and legs. virus is also present in blood. tongue is coated and papillae become red and swollen (white strawberry tongue). provide quiet activity during convalescent period Relieve discomfort of sore throat with . lasts for 1 to 5 days. analgesics for sore throat Otitis media Peritonsillar abscess Sinusitis Glomerulonephritis Carditis. subsides 1 day after appearance of rash Rash: 1st appears in face and rapidly spreads downward to neck. headache . arms. during 1st 2 weeks of carrier phase. and urine Transmission: direct contact and spread via infected person. headache. malaise and abdominal pain Enanthema: tonsils enlarged. vomiting. although may persist for months Prodromal Stage: abrupt Treatment of choice is a high fever. leaving full course of penicillin ( or erythromycin in penicillin-sensitive children). during 1 to 2 days. ingestion of contaminated milk or other food 2–4 days. malaise and lymphadenopathy danger is teratogenic effect on fetus pregnant women 10. by end of 1st day. chills. indirectly in contact with contaminated articles. pharynx is edematous and beefy red. pinkish red maculopapular exanthema. and covered with patches of exudates.infection. SCARLET FEVER GABHS usually from nasopharyngeal secretions of infected persons and carriers Transmission: direct contact with infected persons or droplet spread. reddened. fever should subside 24 hours after beginning therapy Antibiotic therapy for newly diagnosed carriers (nose and throat cultures are positive for streptococci Supportive measures: bed rest during febrile phase. polyarthritis (uncommon) Institute respiratory precautions until 24 hours after initiation of treatment Ensure compliance with oral antibiotic therapy (intramuscular benzathine penicillin G [Bicillin] may be given if parent’s reliability in giving oral drugs is questionable) Maintain bed rest during febrile phase. feces and urine conjunctivitis.
palate is covered with erythematous punctuate lesions Exanthema: rash appears within 12 hours after prodromal signs. CONJUNCTIVITIS Acute conjunctivitis. sandpaper-like on torso. Warm.sized punctuate lesions rapidly become generalized but are absent on face. by end of 1st week desquamation begins (fine. begin with soft diet Advise parents to consult practitioner if fever persists after beginning therapy Discuss procedures for preventing spread of infection 11. avoid irritating liquids (citrus juices) or rough foods. gargles. lozenges. Bacterial conjunctivitis is usually treated with topical antibacterial agents. such as clean washcloth wrung out with hot tap water. Accumulated secretions are always removed by wiping from the inner canthus downward and outward. inflammation of the conjunctiva occurs in a variety of causes that typically agerelated Newborn conjunctivitis can occur from infection during birth. red pinhead. antiseptic throat sprays (Chloraseptic). moist compresses. rash is more intense in folds of joints. which may be complete by 3 weeks or longer analgesics. . sheet-like sloughing on palms and soles). and inhalation of cool mist Encourage fluids during febrile phase. Drops may be used during the day and an ointment at bedtime because the ointment preparation remains in the eye longer. They are not used during the day Nursing goals include keeping the eye clean and properly administering ophthalmic medication. esp on awakening Inflamed conjunctiva Swollen lids Usually both eyes are affected Viral conjunctivitis Usually occurs with URTI Serous (watery) drainage Inflamed conjunctiva Viral conjunctivitis is selflimiting and treatment is limited to removal of the accumulated secretions. when child is able to eat. which becomes flushed with striking circumoral pallor.prominent papillae (red strawberry tongue). away from the opposite eye. most often from Bacterial conjunctivitis (“Pink Eye”) Purulent drainage Crusting of eyelids.
Tissues are discarded. STOMATITIS Stomatitis is the inflammation of the oral mucosa. stringy discharge Inflamed conjunctiva Swollen lids Usually both eyes affected Conjunctivitis caused by foreign body Tearing Pain Inflamed conjunctiva Usually only 1 eye affected because they blur vision. Diagnosis: made primarily from the clinical manifestations although cultures of purulent drainage may be needed to identify the specific cause. The washcloth and towel are kept separate from those used by the others. Bacterial infection accounts for most instances of acute conjunctivitis in children. allergic or rewlated to a foreign body. APHTHOUS STOMATITIS (APHTHOUS ULCER. palate and floor of the mouth. Prevention of infection to other family members is an important consideration with bacterial conjunctivitis. Compresses are not kept on the eye because an occlusive covering promotes bacterial growth. The child should refrain from rubbing the eye and is instructed to good handwashing. a. bacterial. CANKER SORE) . Medications are instilled immediately after the eyes have been cleaned. which may include the buccal (cheek) and labial (lip) mucosa. tongue. It may be infectious or noninfectious and may be due to local or systemic factors. 12. are helpful in removing the crusts. Swollen lids Usually both eyes infected Allergic conjunctivitis Itching Watery to thick.Chlamydia trachomatis (inclusion conjunctivitis) Infants recurrent conjunctivitis may be a sign of nasolacrimal duct obstruction In children. gingival. the usual causes are viral.
the use of soft bristle toothbrush or disposable foamtipped toothbrush provides gentle cleaning near ulcerated areas. Anbesol and Kanka or prescription formulas such as viscous xylocaine. absence of vesicles. and no systemic illness. Topical anesthetics are helpful and include over.It is a benign but painful condition whose cause is unknown. Careful handwashing is essential when caring for children with HGS. but with more severe HGS. Ulcers persist for 4 to 12 days and heal uneventfully types of stomatitis is aimed at relief of symptoms. small. Distinguished from other types of stomatitis by healthy adjacent tissues. contaminated hands also can also infect other body . especially before meals to encourage food and fluid intake. primarily pain. Analgesics and topical anesthetics are used as needed to provide relief. Since the infection is autoinoculable. Mouth care is encouraged. for children with stomatitis are relief of pain and prevention of spread of the herpes virus. Onset is usually associated with mild traumatic injury (biting the cheek. Treatment for both The chief nursing goals whitish ulcerations surrounded by a red border. Lesions are painful. hitting the mucosa with a toothbrush. and emotional stress. Acetaminophen is usually sufficient for mild cases. children should keep their fingers out of the mouth. An oral dressing (Orahesive) that adheres to the mucosa can provide a barrier over the lesions. Drinking bland fluids through a straw is helpful in avoiding the painful lesions. stronger analgesics such as codeine may be needed. Specific treatment for children with severe cases of HGS is the use of acyclovir (Zovirax). or a mouth appliance rubbing on the mucosa). allergy.thecounter preparations such as Orabase.
most often type 1. Newborns and individuals with immunosuppression should not be exposed to infected children. When examining herpetic lesions. and may occur as primary infection or recur in a less severe form known as recurrent herpes labialis Primary infections usually See stomatitis a See stomatitis a begin with a fever. the type not associated with sexual activity. All articles placed in the mouth are cleaned thoroughly. b.parts. Very young children may need elbow restraints to ensure compliance. HERPETIC GINGIVOSTOMATITIS (HGS) herpes simplex virus (HSV). the nurse should wear gloves. the nurse should explain to parents and older children that HGS is usually caused by type 1 HSV. Because herpes infection is often associated with sexual transmission. The virus easily enters breaks in the skin and can cause herpetic whitlow of the fingers. Cervical lymphadenitis . and vesicles erupt on the mucosa. the pharynx becomes edematous and erythematous. causing severe pain.
(commonly called “cold sores” or “fever blisters”). Lasts 5 to 14 days with varying degrees of severity . often occurs and the breath has a distinctly foul odor.
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