Nursing Care of the

Child With An
Infectious Disorder
 Nursing Process Overview
For a Child with an Infectious Disorder

• Assessment
1. Health history
a. Onset, Duration, Location and
Precipitation.

Cardinal signs and symptoms include:

- fever
- general malaise
- vomiting and diarrhea
b. Explore prenatal, personal and family history
for risk factors for respiratory disorders.

- Prenatal: a maternal infectious disease history

- Personal: an immunization history, a history of
recurrent or chronic illness and etc.
- Family: early infant mortality,
immunodeficiency, autoimmune disease or
malignancy
2. Physical examination

a. Vital signs.
b. Inspection
- Inspect the skin and mucous
membranes for jaundice and
rashes.
- Observe the eyes for conjunctival
redness and discharge.
- Inspect tympanic membranes for
redness and etc.
- Assess the tongue, tonsils, buccal
mucosa and pharynx.
c. Palpation
- Palpate the lymph nodes for
adenopathy.
- Assess the abdomen for
hepatosplenomegaly.

d. Auscultation
- Auscultate the heart for
tachycardia .
- Auscultate the lungs for
abnormal breath sounds .
3. LABORATORY STUDIES AND
DIAGNOSTIC TESTS

a. Culture and sensitivity tests

b. Enzyme-linked immunosorbent assay
c. Direct fluorescent antibody tests
d. A complete blood count with differential
e. The erythrocyte sedimentation rate
f. A lumbar puncture (spinal tap).
• Nursing Diagnosis
Pain related to pruritus from skin lesions
Impaired skin integrity related to rash,
pruritus, and scratching
Risk for infection related to presence of
infective organism in sibling
• Outcome Identification and Planning
 Include those that help parents deal with
the current infection and also prevent
another infection.

• Implementation
 Counseling parents about techniques to
relieve the irritation of rashes.
 Administering antibiotics and being alert
for potential adverse effects.
• Outcome Evaluation
Child states pain from pruritus and skin
lesions .
Sibling remains free of signs and
symptoms of infectious disorder.
Parent names activities he has planned.
 Infectious Process
and the
Chain of Infection
1. A causative organism
can be any microorganism.
• Five types of microorganisms:
Viruses
Bacteria
Rickettsiae
Helminths
Fungi
2. Reservoir is the term used for any human,
animal, plant or substance that provides the
causative organism with both nourishment and a
mode for dispersal.
3. The causative organism
requires a means of exit from
the reservoir.
• The method to be spread to
others.
Respiratory excretions
Feces
Vomitus
Saliva
Urine
Vaginal secretions
Blood
Lesion secretions
4. A Route of Transmission is needed to
connect the organism to its new host.
It includes direct skin-to-skin, close contact or
exposure; sexual or parenteral fluids.
.
• The most common means of indirect contact is
the spread of mouth and nose secretions.
Talking
Sneezing
Coughing
Breathing
Kissing
5. The host must be susceptible for
infection to occur. Young age, organism
virulence and impaired body defenses
increase susceptibility to infection.
6. The organism must gain
entry to the susceptible
host through a portal
of entry such as the
respiratory tract.

• The portal of entries:

Inhalation
Ingestion
Breaks in the skin such as
bites, abrasions and
burns
Stages of Infectious Diseases

1. The COMMUNICABILITY PERIOD is

the stage when the disease is transmissible to
others.

2. The INCUBATION PERIOD is the time

between the invasion of the organism and the
onset of infection.
3. The PRODROMAL PERIOD is the time
between the beginning of nonspecific signs and
symptoms such as lethargy and fever and
disease-specific symptoms

4. The ILLNESS STAGE is the period when

disease-specific symptoms are manifested.
5. The CONVALESCENT PERIOD is the
interval between the time when the symptoms
begin to disappear and the complete return to
wellness.
 Immunizations
1. Types of Immunity
2. Types of Immunization
a. Live attenuated
- Pathogen is treated with
chemicals or heat
- Examples of live
attenuated immunizations
include the measles,
mumps, rubella (MMR)
vaccine and etc.
b. Inactivated
- A toxoid (e.g. tetanus, diptheria) is a bacterial
exotoxin that has been treated with formalin or
heat which yields a nontoxic.
- Inactivated viral vaccines (e.g. inactivated
poliovirus [IPV;Salk], pertussis, Haemophilus
influenzae type B [Hib], hepatitis B virus [HBV]
use killed viral organisms
c. Immunoglobulins
- Immune globulin or IV immune globulin is a
solution that contains antibodies from large
pools of human blood plasma.
3. Recommended routine immunizations

a. Diptheria and tetanus toxoid and acellular

pertussis (Dtap)
- Younger than 7 years old
- Mild or common adverse effects include
redness, pain, swelling or a nodule at injection
site; a fever of up to 101 F and mild anorexia.
Severe adverse effects include anaphylaxis,
shock or collapse, a fever greater than 102 F.
b. Diphtheria-tetanus (DT, dT)
- DT administered to children younger than 7
years.
c. Inactivated polio vaccine (Salk)
d. Measles, mumps and rubella
- MMR should be administered after 12 months
of age .
e. Haemophilus influenzae type B
- Hib conjugate vaccine protects against a
number of serious diseases caused by Hib,
f. Hepatitis B
- Recommended for universal immunization
starting at birth as follows:

- infants who are born to mothers who test

negative should receive a second dose of HBV
vaccine at least 1 month after the first.

- infants who are born to HBsAg-positive

mothers should receive hepatitis vaccine and 0.5
ml of hepatitis B immune globulin (HBIG) within
12 hours of birth
g. Pneumococcal vaccine (PCV)
- Children 2 to 23 months of age

h. Varicella-zoster vaccine
- Varicella-zoster vaccine is a live vaccine given
after age 12 months.
4. Nonmandatory immunizations

a. Influenza virus vaccine

- The vaccine provides protection against strains
of influenza

b. Meningococcal vaccine
- The vaccine provides protection against
Neisseria meningitides.

c. Hepatitis A vaccine
 Health Promotion and Risk
Management

• Prevention of infectious disease begins

with being certain all children are in
general good health.
• Be certain all parents are aware of the
need for their children to be immunized.
 Preventing the Spread of
Infections

• Nosocomial or health care-associated infections

(HAI)
• Nurses provide a line of defense against infection
by adhering to strict aseptic techniques
Communicable Diseases With Rashes

A. Rubeola (Measles)

1. The infectious agent is a virus.

2. The mode of transmission is usually through
direct contact with droplets.
3. The incubation period is 10 to 20 days.
4. The period of communicability is from 4
days before to 5 days after the rash appears.
5. Clinical manifestations
a. The prodromal stage consists of fever and
malaise, followed by coryza, cough and
conjunctivitis and photophobia in 24 hours.
Koplik is also evident.
b. The rash appears 3 to 4 days after the onset
of the prodromal stage. It begins as an
erythematous (reddened) maculopapular rash
on the face and gradually spreads downward.
6. Complications
a. Otitis media
b. Pneumonia
c. Encephalitis

7. Nursing implications
a. Show parents how to provide supportive
management for fever and discomfort.
b. Use a dimly lit room or sunglasses for
photophobia

8. Prevention is through vaccine (MMR).

B. Rubella (German measles)

1. The infectious agent is the rubella virus.

2. The mode of transmission is through direct
and indirect contact.
3. The incubation period is from 14 to 21 days.
4. The period of communicability is from 7
days before to about 5 days after the rash
appears.
5. Clinical manifestations
a. There is no prodromal stage in children.

b. The rash starts on face and rapidly spreads

downward.

c. General signs and symptoms include low-

grade fever, headache, malaise and
lymphadenopathy
6. Complications include possible teratogenic
effects on a fetus.

7. Nursing implications. Provide supportive

care.

8. Prevention is through vaccine (MMR).

C. Varicella (chickenpox)

1. The infectious agent is the

varicella-zoster virus.
2. Modes of transmission are
through direct contact and
contact with contaminated
objects.
3. The incubation period is from 2
to 3 weeks.
4. The period of
communicability is from 1 to
2 days before the rash develops
until all lesions are crusted.
5. Clinical manifestations
a. Low-grade fever, malaise and anorexia
characterize the prodromal stage.

b. A multilesion rash includes maculas, papules,

vesicles, pustules and crusts. It is centripetal
c. General signs and symptoms include
fever, lymphadenopathy and irritability from
pruritus.
6. Complications
a. Secondary infections, encephalitis and pneumonia
b. Hemorrhagic varicella.

7. Nursing implications
a. Maintain strict isolation in the hospital setting:
isolate children at home until all vesicles dry.
b. Provide skin care; provide cool baths and loose
clothing.
c. Administer an antipyretic and an antihistamine.

8. Prevention is through vaccine

D. Erythema infectiosum (fifth disease)

1. The infectious agent is the human parvovirus

B19 (HPV).
2. Modes of transmission are unknown;
probably via the respiratory tract and blood.
3. The incubation period is 4 to 14 days, may be
as long as 20 days.
4. The period of communicability is uncertain,
but usually before the onset of symptoms
5. Clinical manifestations
a. Three-stage rash
- The first stage begins with erythema on the
face that gives the cheeks a “slapped face”
appearance..
- The second stage begins about 1 day after the
facial rash appears. It is a symmetrical, red
maculopapular rash that appears on upper and
lower extremities.
-During the third stage, the rash subsides but it
can resurface if skin is irritated or traumatized.
6. Complications
a. Self-limited arthritis and arthralgia
b. Myocarditis
c. Encephalitis
d. Fetal death (if the mother is infected during
pregnancy)

7. Nursing implications
a. Administer an antipyretic and an anlagesic.

8. Prevention. No vaccine is available.

E. Exanthema subitum (roseola)

1. The infectious agent is human herpex

simplex virus type 6 (HHV-6).
2. Modes of transmission are unknown.
3. The incubation period is usually 5 ton 15
days.
4. The period of communicability is unknown.
5. Clinical manifestations
a. A general sign is a high fever (temperature
102 F [38.9 C]) that persists for 3 to 4 days in a
child who appears well.
b. The rash is a discrete, nonpruritic pink
macular or maculopapular rash, first appearing
on trunk, then face, neck and extremities.
c. Associated signs and symptoms include
coryza and cough.
6. Complications
a. Recurrent febrile seizures
b. Encephalitis (rare)

7. Nursing implications
a. Teach parents temperature regulation
measures.
b. Discuss seizure precautions if the child is
seizure prone.

8. Prevention. No vaccine is available.

F. Scarlet fever

1. The infectious agent is group A beta-

hemolytic streptocci.
2. Modes of transmission are direct contact,
droplet spread and indirect contact.
3. The incubation period is from 2 to 4 days but
can range from 1 to 7 days.
4. The period of communicability is during the
incubation phase and clinical illness and during
first 2 weeks of the carrier phase.
5. Clinical
manifestations
a. The prodromal stage consists of a sudden
high fever, pulse increased out of proportion to
fever.

b. The rash appears within 12 hours after the

prodromal stage. Red pinpoint punctate lesions
rapidly become generalized except for face.
The rash is more intense in joint folds and the face
is usually flushed with significant circumoral
pallor.
c. General signs. The tonsils are enlarged, red
and covered with exudate. The pharynx is beefy
red and the palate is covered with erythematous
punctate lesions. The tongue is coated and
papillae are red and swollen (white strawberry
tongue).
6. Complications
a. Otitis media
b. Peritonsillar abscess
c. Sinusitis

7. Nursing implications
a. Administer the full course of antibiotic (usually
penicillin or erythromycin if child is allergic to
penicillin) , an analgesic and an antipyretic.
b. Encourage the child to drink plenty of fluid.

8. Prevention. No vaccine is available.

Thank you!