Nursing therapeutics specifically

for children and adolescents with

Infectious Diseases
November 10, 2009
8:00-11:00 am
13:00-15:00 pm

Diphtheria

an upper respiratory tract illness characterized by

sore throat,
low fever, and an adherent membrane (a
pseudomembrane) on the tonsils, pharynx, and/or
nasal cavity

causes the progressive deterioration

of myelin sheaths in the central
and peripheral nervous system
leading to degenerating motor
control and loss of sensation.

a contagious disease spread by direct

physical contact or breathing the
aerosolized secretions of infected
individuals

Schick test

test used to determine whether or not a

person is susceptible to diphtheria

named after its inventor, Bla Schick (1877

1967), a Hungarian-born American
pediatrician

A diphtheria
skin lesion on
the leg

Nursing Diagnosis

Risk for infection

Knowledge deficit
Altered body temperature
Altered comfort:pain (sore throat)
Risk for altered breathing pattern
Risk impaired gas exchange

Nursing Interventions
Encourage the patient and significant
others to avoid contact with infected
individuals
Educate the public
Encourage compliance to treatment
regimen

Treatment

in more severe cases lymph nodes in the neck may swell, and
breathing and swallowing will be more difficult. People in this
stage should seek immediate medical attention, as obstruction
in the throat may require intubation or a tracheotomy.
Abnormal cardiac rhythms and can occur early in the course of
the illness or weeks later, and can lead to heart failure.
Diphtheria can also cause paralysis in the eye, neck, throat, or
respiratory muscles. Patients with severe cases will be put in a
hospital intensive care unit (ICU) and be given a diphtheria antitoxin. Since antitoxin does not neutralize toxin that is already
bound to tissues, delaying its administration is associated with
an increase in mortality risk. Therefore, the decision to
administer diphtheria antitoxin is based on clinical diagnosis,
and should not await laboratory confirmation.


Erythromycin (orally or by injection) for 14 days (40
mg/kg per day with a maximum of 2 g/d), or

Procaine penicillin G given intramuscularly for 14

days (300,000 U/d for patients weighing <10 kg and
600,000 U/d for those weighing >10 kg). Patients with
allergies to penicillin G or erythromycin can use
rifampin or clindamycin

Pertussis

bacterial infection of the

respiratory tract. It is also
called "whooping cough.
Pertussis is a very contagious
disease of the
mucous membranes that line the air
passages

spread easily from person to person.

People get Pertussis by breathing in
airborne droplets expelled from the nose
or throat of an infected person.
Despite an effective vaccine, Pertussis
continues to cause serious illness and
death.
Young children are most at risk for
Pertussis, but the disease is increasing
in adolescents and adults.

caused by Bordetella Pertussis, a

bacterium

s/sx: Cold, including sneezing, runny nose, lowgrade fever, and a mild cough. Within 2 weeks, the
cough becomes much worse. Children with
pertussis often have episodes of rapid, spasmodic
coughing followed by a characteristic intake of
breath that sounds like a "whoop." The violent
coughing spells are worse at night and can last for
as long as 1 to 2 months
The spells can make it hard for a child to eat, drink,
or even breathe. Infants under age 6 months,
adolescents, and adults generally have milder
symptoms without the typical whoop.

Nursing Diagnosis

Risk for infection

Knowledge deficit
Altered body temperature
Altered comfort:pain (sore throat)
Risk for altered breathing pattern
Risk impaired gas exchange

Nursing Interventions
Encourage the patient and significant
others to avoid contact with infected
individuals
Educate the public
Encourage compliance to treatment
regimen

Treatment
Treated with antibiotics. Infected
persons can still spread the disease
until 5 days after treatment begins
The most important way to prevent
pertussis is through complete
immunization.

Tetanus in Children

caused by bacteria named

Clostridium tetani

Signs & Symptoms

painful spasms of the muscles. The
first sign is often "lockjaw", caused
by a spasm of the masseter muscle.
Other early signs are headache,
difficulty swallowing, neck stiffness,
irritability, and restlessness

Nursing Diagnosis

Altered comfort:pain (jaw, muscles)

Knowledge deficit
Risk for infection
Risk for altered breathing pattern
Risk for injury

Nursing Interventions
Stay with the patient especially during
seizure episodes
Always ready the intubation set at the
bedside
Encourage the patient to cooperate in
the treatment regimen
Avoid environmental stimuli e.g.,
lighting & excessive noise

Poliomyelitis
acute viral infectious disease spread
from person to person, primarily via
the fecal-oral route
genus Enterovirus known as
poliovirus

Pathophysiology

A blockage of the lumbar

anterior spinal cord artery due
to polio (PV3)

Nursing Diagnosis

Knowledge deficit
Risk for infection
Fatigue
Altered comfort: pain

Prognosis

Patients with abortive polio infections

recover completely

Treatment

A modern negative pressure

ventilator (iron lung)

used to artificially maintain respiration during an acute polio

infection until a person could breathe independently
(generally about one to two weeks

Continuation..
There is no cure for polio. The focus of
modern treatment has been on providing
relief of symptoms, speeding recovery and
preventing complications. Supportive
measures include antibiotics to prevent
infections in weakened muscles, analgesics
for pain, moderate exercise and a nutritious
diet. Treatment of polio often requires longterm rehabilitation, including physical
therapy, braces, corrective shoes and, in
some cases, orthopedic surgery.

Prevention

Mumps
viral disease, and its distinctive
characteristic is a swelling of the
parotid salivary glands

Signs & Symptoms

* Fever
* Headache
* Body ache
* An unwell feeling

Facts

The swelling progresses for 1-3 days,

and then subsides over the next 3-7
days.

Complications of Mumps
The most important is perhaps the brain
(encephalitis), which is fatal in 2% of
cases. Infection of the testes (orchitis)
in boys can lead to sterility. The
pancreas, kidneys, joints, thyroid,
heart, ears, and eyes are also affected
sometimes.

Nursing Diagnosis

Altered body temperature

Altered comfort:pain
Fatigue
Knowledge deficit
Risk for infection

Prevention of Mumps

can be prevented by the MMR

vaccine. Apart from mumps, it
protects the child from measles
and rubella

Kawasaki

The cause is still not known according to

scientists
Researchers said that virus of Fifth
Disease can also be the cause

Nursing Diagnosis
Knowledge deficit
Risk for infection
Risk for injury

Nursing Interventions
Educate the patient and significant
others regarding the condition based
on their understanding
Encourage cooperation in treatment
regimen

Rubella ( German measles)

usually a mild illness

However it can cause serious harm

to an unborn baby if a woman gets it
during early pregnancy

How does rubella spread?

Rubella spreads by droplets

from an infected person when
that person coughs or sneezes.

How long does it takes to develop?

takes between 14 to 21 days (usually

16 to 18 days) to develop after
contact with it

How long is it infectious?

A person with rubella is most
infectious when the rash is
appearing, but can also be
infectious for about 5 days before
and for 5 to 6 days after the rash
appears.

Signs and symptoms

rash and swollen glands in the

neck, behind the ears and in
the scalp at the back of the
head, without being unwell.

Nursing Diagnosis
1.
2.
3.
4.
5.

Altered comfort: pain (throat)

Self-esteem disturbance (rashes)
Knowledge deficit
Risk for infection
Altered body temperature

Nursing Responsibilities
There is no specific treatment for
rubella.
Paracetamol or ibuprofen may help
if there is headache and fever.
The topic 'Feeling sick' has
suggestions for caring for a sick
child.

Preventing the spread of rubella

Keep the child away from any
pregnant women even if that
woman has been immunized.
Keep a child away from school,
preschool or child care until well or
for at least 4 days after the rash
appears.

Rubeola (Measles)
also called 10-day measles, red
measles, or measles, is a viral
illness that results in a viral
exanthem

What causes the measles?

the cause of measles, is classified
as a Morbillivirus. It is mostly seen
in the winter and spring. Rubeola
is preventable by proper
immunization with the measles
vaccine.

Symptoms
It may take between eight to 12
days for a child to develop
symptoms of rubeola after being
exposed to the disease

Continuation..

hacking cough
redness and irritation of the eyes
fever
small red spots with white centers appear on the inside
of the cheek (usually occur two days before the rash on
the skin appears)
rash - deep, red, flat rash that starts on the face and
spreads down to the trunk, arms, and legs. The rash
starts as small distinct lesions, which then combines as
one big rash. After three to four days, the rash will begin
to clear leaving a brownish discoloration and skin
peeling.

Most serious complications

ear infections
pneumonia
croup
inflammation of the brain

Nursing Diagnosis

Altered comfort:pain
Risk for infection
Knowledge deficit
Self-esteem disturbance (rash)
Risk for altered breathing pattern
Risk for impaired gas exchange

Treatment
Children should not attend school or daycare for
four days after the rash appears.
Assure all of your child's contacts have been
properly immunized
increased fluid intake
your child's age, overall health, and medical history
extent of the disease
your child's tolerance for specific medications,
procedures or therapies
expectations for the course of the disease
your opinion or preference

Reminders
Do not give aspirin to a
child without first
contacting the child's
physician

Chicken Pox
contagious illness that should become
much less a part of childhood as more
children are given the Varivax vaccine
caused by the varicella zoster virus and
occurs most commonly in late winter or
early spring

Symptoms
begin with a low grade fever, loss of appetite
and decreased activity. About two days later,
your child will develop an itchy rash
consisting of small red bumps that start on
the scalp, face and trunk and then spread to
the arms and legs (but may also occur in the
mouth and genitalia). The bumps then
become blisters with clear and then cloudy
fluid, and then become open sores and
finally crust over within about twenty four
hours, but your child will continue to get new
bumps for about four more days

Nursing Diagnosis

Altered body temperature

Fatigue
Risk for infection
Self-esteem disturbance
Altered nutrition: less than body
requirements
Knowledge deficit

Treatment
ACYCLOVIR, an antiviral medication that
can help to decrease the symptoms of
chickenpox, should be considered for
children at risk of developing a severe
case of chickenpox. This includes
children with pulmonary disorders, on
steroid medications, or with immune
system problems

FACTS
he does not need to stay home
from school if you can keep the
rash completely covered

Herpes Zoster

Herpes zoster (shingles) on the

back

Shingles

Herpes zoster (shingles) - close-up

of lesion

Herpes zoster (shingles) on the

arm

Herpes zoster (shingles) on the

chest

Herpes zoster (shingles) on the

hand and fingers

Herpes zoster (shingles) on the

neck and cheek

Herpes zoster (shingles) on the

hand

Herpes zoster (shingles),

disseminate

Herpes zoster (shingles) on the

back

Symptoms
Abdominal pain
Chills
Difficulty moving some of the muscles in
the face
Drooping eyelid (ptosis)
Fever
General ill-feeling
Genital lesions

Continuation..

Headache
Hearing loss
Joint pain
Loss of eye motion (ophthalmoplegia)
Swollen glands (lymph nodes)
Taste problems
Vision problems

Nursing Diagnosis
Altered comfort pain: headache, joint
pains, abdominal pain
Risk for auditory impairment: hearing
loss
Altered nutrition: less than body
requirements r/t decreased appetite
Risk for visual impairment

Pharmacology
Antihistamines to reduce itching (taken
by mouth or applied to the skin)
Pain medicines
Zostrix, a cream containing capsaicin
(an extract of pepper) to prevent postherpetic neuralgia

Nursing Responsibilities
Cool wet compresses can be used to reduce pain.
Soothing baths and lotions, such as colloidal
oatmeal bath, starch baths, or calamine lotion, may
help to relieve itching and discomfort.
Resting in bed until the fever goes down is
recommended.
The skin should be kept clean, and contaminated
items should not be reused. Nondisposable items
should be washed in boiling water or otherwise
disinfected before reuse. The person may need to be
isolated while lesions are oozing to prevent infection
of others -- especially pregnant women.

Outlook (Prognosis)
usually clears in 2 to 3 weeks
and rarely recurs. If the virus
affects the nerves that control
movement (the motor nerves),
you may have temporary or
permanent weakness or
paralysis

Prevention
Avoid touching the rash and blisters of
persons with shingles or chickenpox if you
have never had chickenpox or the
chickenpox vaccine.
The chickenpox vaccine may be
recommended for teenagers or adults who
have never had chickenpox. Medical
evidence has shown that older adults who
receive the vaccine are less likely to have
complications from shingles. Adults older
than 60 should receive the vaccine as part of
routine medical care.

Dengue Hemorrhagic Fever

(DHF)

KEY FACTS
Dengue is a mosquito-borne infection that
causes a severe flu-like illness, and
sometimes a potentially lethal complication
called dengue hemorrhagic fever.
Global incidence of dengue has grown
dramatically in recent decades.
About two fifths of the world's population are
now at risk.
Dengue is found in tropical and sub-tropical
climates worldwide, mostly in urban and
semi-urban areas.

Continuation..
Dengue hemorrhagic fever is a leading cause
of serious illness and death among children
in some Asian countries.
There is no specific treatment for dengue,
but appropriate medical care frequently
saves the lives of patients with the more
serious dengue hemorrhagic fever.
The only way to prevent dengue virus
transmission is to combat the diseasecarrying mosquitoes.

Transmission

Continuation..

Dengue viruses are transmitted to

humans through the bites of infective
female Aedes mosquitoes

Nursing Diagnosis
Risk for infection
Knowledge deficit
Risk for altered peripheral tissue
perfusion
Risk for altered body temperature
Risk for fluid volume deficit
Altered comfort: abdominal pain r/t
gastrointestinal irritation

Prevention and control

Continuation..
Vector control is implemented using environmental
management and chemical methods. Proper solid
waste disposal and improved water storage
practices, including covering containers to prevent
access by egg-laying female mosquitoes are among
methods that are encouraged through communitybased programmes.
The application of appropriate insecticides to larval
habitats, particularly those that are useful in
households, e.g. water storage vessels, prevents
mosquito breeding for several weeks but must be reapplied periodically. Small, mosquito-eating fish and
copepods (tiny crustaceans) have also been used
with some success.

??

Any
questions?