CHAPTER 43:

Nursing Care of a Family When a Child Has an Infectious

Disorder

Cindy Mae G. De la Torre BSN – II

March 11, 2020
 Streptococcal Diseases
FACTS
 Streptococci, which are gram-positive organisms, are found
normally
. in the respiratory, alimentary and female genital
tracts.
 There are more than 120 serotypes or genotypes of
group A BETA-hemolytic streptococci or
Streptococcus pyogenes.
 S. pyogenes is responsible for sore throat and scarlet
fever while a BETA-hemolytic, group b streptococcal
infection can be contracted from vaginal secretions at
birth.
Impetigo
 Causative Agent: BETA-hemolytic streptococcus, group A or S.
aureus including MRSA
 Incubation Period: 1-7 days for impetigo.
 Period of Communicability: from outbreak of lesions until lesions
are healed.
 Mode or Transmission: direct contact with lesions
 Immunity: none
 It is common see several children in a family with identical
impetigo lesions because it is spread by direct contact.
 An underlying scabies infections can cause impetigo due to
infection from scratching with nails.
Assessment:
 Impetigo involves the top layer or epidermal layer of the skin and
is generally characterized by honey-colored crusts with local
erythema.
 The lesions are found most commonly on the face and
extremities. They are often seen as secondary infections of insect
bites or in children who have body piercing.
 If the impetigo is extensive, children may have local lymph node
enlargement.
Management:
 Localized disease is treated with mupirocin ointment for 7-10
days or with retapamulin for children 9 mo. BID for 5 days.
 The use of oral antibiotic that cover both staphylococcus and
streptococcus is reserved for extensive for extensive impetigo.
 Although rare, complications of rheumatic fever or acute
glomerulonephritis may occur as sequelae to impetigo.
Scarlet Fever
 Causative Agent: Beta-hemolytic streptococci, group A
 Incubation Period: 2-5 days for streptococcal pharyngitis.
 Period of Communicability: greatest during acute phase of
respiratory illness 1-7 days.
 Mode or Transmission: direct contact from a person with
the disease and large droplets, not fomites or household
pets.
 Immunity: 1 episode of disease gives lasting immunity to
scarlet fever toxin. No vaccination is available.
Assessment:
 Symptoms of streptococcal pharyngitis begin abruptly and
include fever, sore throat, headache, chills, a rapid of pulse
and malaise.
 The skin rash typically is red with pinpoint lesions that
blanch on pressure and feel as rough as sandpaper.
 The tonsils appear inflamed and enlarged and are usually
covered with white exudate.
 The tongue, during the first 2 days of the illness, is white
and appears furry.
 By day 3, papillae and protrude through the white coat,
giving the tongue a “white strawberry” appearance.
 By day 4 or 5, the white coat disappears and the prominent
papillae of the tongue give it a “red strawberry”
appearance.
Management:
 Children with scarlet fever usually recover without sequel
once penicillin is administered.
 Penicillin V is the drug of choice, but AHA & PIDS
guidelines all endorse orally administered once a day
amoxicillin at 50 mg up to 1,200 mg as daily dose for 10
days.
 IM penicillin G benzathine an alternative therapy if there is
a history of noncompliance.
 Children may need an analgesic and antipyretic, such as
acetaminophen or children’s ibuprofen for pain & fever.
 They need a soft or liquid diet until the apin from
pharyngitis improves.
 Comfort measures are important for the rash.
 Caution parents to give the full amount prescribed for the
full course to prevent the complications of BETA-
hemolytic, group A streptococcal infections.
 Cat-Scratch Disease
 Causative Agent: Bartonella Henselae Bacteria which is slow growing
 Incubation Period: usually 1-2 weeks with a range of 7 to 60 days
 Period of Communicability: unknown
 Mode or Transmission: bite or scratch from more commonly a kitten rather than a cat
 Immunity: one episode of disease gives lasting immunity; no passive artificial immunity
 It is commonly in preschool children because children at that age paly roughly with cats or pick them up and so
receive scratches.
 The first symptom is a single skin papule or pustule at the site of inoculation which precedes the lymphadenopathy by
1 to 2 weeks.
 A Bartonella-infected lymph node will usually resolve over a period of 4 to 6 weeks without treatment.
 Other forms of this disease includes Parinaud oculoglandular syndrome, which presents clinically with preauricular
lymphandnitis and a follicular conjunctivitis as well as 1 to 2 weeks of fever with nonspecific symptoms.
 The diagnostic test is an indirect immunofluorescent for antibody detection to serum antigens of the Bartonella
species.
 Treatment is symptomatic, although azithromycin may be prescribed to decrease the lymph node size.
 With more antimicrobials for several weeks will be initiated.
 Children may need analgesic to relieve pain from swollen lymph node.
 Parents may if the cat should be destroyed.

Staphylococcal Infections Furunculosis/Carbunculosis

Facts Facts

 Gram-positive S. aureus is the most common
infecting organism for pyogenic infections of
the skin as well as soft tissue.
 Staphylococci are normally found on the skin
surface; therefore, they are commonly the
organism involved in skin infectons.
 The organism grow rapidly in cream foods
that are not well refrigerated, such as potato
salad, or cream pies, they are also often the
organisms involve in summer food poisoning
episodes.
 A furuncle is a staphylococcal infection of a single hair follicle
and a carbuncle has multiple hair follicle with openings.
 A single or multiple yellow pustule forms at the site.
 There is localized redness, pain and edema of the surrounding
skin.
 As these enlarge, they may need an incision and drainage to drain
the pus.
 The nurse should educate the family and child to never press an
abscess to rupture the lesions.
 The treatment is a systemic antibiotic that will cover both
staphylococci and streptococci.

Cellulitis Scalded Skin Disease

 Cellulitis is staphylococcal inflammation and  Staphylococcal scalded skin syndrome (is a

subcutaneous layers of the skin.
 It can occur anywhere on the body and there
will be warmth, tenderness, and erythema at
the area of cellulitis.
 The treatment is a systemic antibiotic that
will cover both staphylococci and
streptococci.
staphylococcal infection seen in infants.
 Newborns develop rough-textured skin & general
erythema, especially on areas that encounter friction.
 Large bullae (vesicles) filled with clear fluid form.
 The epidermis seperates in large sheets & desquamates,
leaving a raw, red, glistening and scalded-looking
surface. This is called Nikolsky sign.
 Methicillin-Resistant Staphylococcus Aureus

 MRSA is a strain of staphylococcus that cause skin infections and has become resistant to common broad-
spectrum antibiotics.
 When an infection occurs in a healthcare setting, it is a referred to as health care-associated MRSA or HA-
MRSA.
 Children with weakened immune system are the greatest risk for contracting the infection.
 Vancomycin is the drug of choice for treatment of hospital-based lesions.
 Clindamycin or trimethropin-sulfamethoxazole is commonly used with community infections.
 Prevention centered on nasal, skin, and household decolonization is important.
 Good hand washing and reporting skin wounds can become infected can help prevent these infections.

Other Bacterial Infections Diphtheria

 Other bacteria are also responsible for
infections in pediatric patients.
 Although vaccines are available to protect
against Haemophilus influenza, Streptococcus
pneumonia, Clostridium tetani and
diphtheria.
 Children can still get infections with other
serotypes due to lack of vaccination, warning
immunity, or tobe infected with a serotype
that vaccines do not protect against.
 Causative Agent: Corynebacterium diphtheriae
 Incubation Period: 2-5days with a range of 1 to 10
days.
 Period of Communicability: In untreated persons, the
organism is contagious from nares, throat, skin and
eyes for 2 to 6 weeks ff. infection; 48 hrs. after
initiation of antibiotics in treated children & adults.
 Mode or Transmission: direct contact or indirect
contact droplets.
 Active Artificial Immunity: contracting the disease
give lasting as part of diphtheria, tetanus, and
pertussis vaccine.
 Passive Artificial Immunity: Diphtheria antitoxin

Assessment:
Whooping Cough (Pertussis)
 Causative Agent: Bondetella Pertussis
 Incubation: 5-21 days
 Mode of Transmission: highly contagious by direct or
indirect contact.
 Period of Communicability: greatest in catarrhal stage;
but continues for wks. in the untreated pt.
 Immunity: contracting the disease often lasting natural
Management:
immunity.
 Active Artificial Immunity: pertussis vaccine given as
part of DTaP vaccine.
 Passive Artificial Immunity: Pertussis immune serum
globulin.
Assessment:
 History of typical signs and symptoms
 Physical examination
 Laboratory test which involves taking a sample of
mucus (with a swab or syringe filled with saline) from
the back of the throat through the nose
 Blood test
 Diphtheria bacilli invades and grow in the
nasopharynx of children & produce an exotoxin that
causes massive cell necrosis and inflammation.
 If untreated, myocarditis with heart failure and
conduction disturbances may occur.
 Diphtheria can also form lesions aside from the usual
presentation of respiratory infections.
 Treatment involves a single dose of equine antitoxin
based on clinical suspicion and this can be obtained
through the CDC.
 Children are given penicillin or erythromycin IV.
 Complete bed rest is crucial during the acute stage of
the illness.
 Children need careful observation at all times to
prevent airway obstruction.
 Whooping Cough (Pertussis) Continued
Management:
 Healthcare providers generally treat pertussis with
antibiotics and early treatment is very important.
 Treatment can also help prevent spreading the
disease to close contacts (people who have spent a
lot of time around the infected person).
 Treatment after three weeks of illness is unlikely to
help. The bacteria are gone from the body by then,
even though its usually will still have symptoms.
 There are several antibiotics (medications that can
help treat diseases caused by bacteria) available to
treat pertussis.
Tetanus (Lockjaw)
 Causative Agent: C. tetani
 Incubation: 3 days to 3 weeks
 Mode of transmission: direct to indirect contamination of
a closed wound
 Immunity: development of the disease gives lasting
natural immunity
 Active Artificial Immunity: tetanus toxoid contained in
DTaP vaccine.
 Passive Artificial Immunity: TIG
 Tetanus occurs worldwide causing an acute, spastic
paralytic illness caused by neurontoxins produced by
Clostridium.
 If the wound is deep, such as stab wound, where the
distal end of the wound is shut off from an oxygen
source, bacilli begin to reproduce.
Assessment:
 A common first sign suggestive of tetanus in older
children and adults is abdominal rigidity, although
rigidity is sometimes confined to the region of injury.
 Generalized spasms occur, frequently induced by sensory
stimuli. History of an injury or apparent portal of entry
may be lacking.
 Characteristic symptoms of tetanus are painful muscular
contractions, primarily of the masseter and neck muscles
and secondarily of trunk muscles.
Management:
 Immediate treatment with human tetanus immune
globulin (TIG)
 Agents to control muscle spasm
 Aggressive wound care
 Antibiotics
 A tetanus toxoid booster
 Assess the type of wound and provide appropriate wound
care.
 Evaluate the immunization status of the patient.
Anthrax
 Causative Agent: Bacillus Anthracis, a bacteria
 Incubation: 1-7 days (inhalational), 1-12 days (cutaneous),
1-7 days (gastrointestinal)
 Mode of Transmission: originally contracted from contact
with the feces of infected cows or sheep; bot transmissible
from person to person.
 Types of Immunity: Unstudied
 Active Artificial Immunity: At present, the anthrax
vaccine is not used in children.
 Passive Artificial Immunity: N/A
 Anthrax is an acute infectious disease that is contracted
from exposure to the anthrax bacteria or its spores.
 As the organism grows inside the human body, a toxin is
produced that causes the bulk of the symptoms.
Assessment:
 If inhalation anthrax is suspected, chest X-rays or CT
scans can confirm if the patient has mediastinal widening
or pleural effusion, which are X-ray findings typically
seen in patients with inhalation anthrax.
 The only ways to confirm an Anthrax diagnosis are:
 To measure antibodies or toxin in blood
 To test directly for Bacillus anthracis in a sample
 blood
 skin lesion swab
 spinal fluid
 respiratory secretions
Management:
 The standard treatment for anthrax is a 60-day course of
an antibiotic, such as ciprofloxacin (Cipro) or doxycycline
(Monodox, Vibramycin, others).
 Although some cases of anthrax respond to antibiotics,
advanced inhalation anthrax may not. By the later stages
of the disease, the bacteria have often produced more
toxins than drugs can eliminate.
Lyme disease
 Causative Agent: Borrelia Burgdorferi, a spirochete
 Incubation: 3-30 days
 Period of communicability: not communicable from one
person another
 Mode of transmission: Deer tick
 Active Artificial Immunity: N/A, Lyme vaccine
discontinued
 Passive Artificial Immunity: immune globulin
 Lyme disease (Continued)
 Lyme disease is caused by a spirochete, B. Burgdorgeri, which is transmitted by a tick frequently carried on
deer.
 This disease is the most frequently reported vector-bone infection in US, occurring most often in the
summer and early fall &on the east coast.
Assessment:
 Lab tests to identify antibodies to the bacteria can help confirm or rule out the diagnosis.
 Enzyme-linked immunosorbent assay (ELISA) test.
 Western blot test. If the ELISA test is positive, this test is usually done to confirm the diagnosis. In this two-
step approach, the Western blot detects antibodies to several proteins of B. burgdorferi.
Management:
 Oral antibiotics. These are the standard treatment for early-stage Lyme disease. These usually include
doxycycline for adults and children older than 8.
 Intravenous antibiotics. Intravenous antibiotics can cause various side effects, including a lower white blood
cell count, mild to severe diarrhea, or colonization or infection with other antibiotic-resistant organisms
unrelated to Lyme