Childhood Diseases

Kimberly Ambruso, RN, MS

Fever
Why does it happen/what does it mean? What is considered febrile
Oral Rectal Axilla or tympanic

Consequences of fever?
Brain damage
>105

Febrile seizures
9 months-5 years

Otitis Media
S. pneumoniae, H. influenzae RSV, rhinovirus, influenza virus , adenovirus May include effusion

Prevention
Second Hand smoke Breastfeeding Upright feeding immunizations

Symptoms Pain Irritability Pulling on ear Fever Difficulty with balance, hearing Treatment
Antipyretics Analgesics Antibiotics (if bacterial)

Perforated eardrum (tympanic Caused from pressure/fluid accumulation membrane)

behind the membrane After rupture, pain
decreases/subsides
Ringing/buzzing Drainage Decreased Hearing/loss

Stages of Infectious diseases

Incubation period Prodromal period Illness phase Convalescent period

Communicable Diseases
Classifications and Symptoms Infectious in nature Bacterial vs. Viral vs. fungal
Fever red, swollen throat Rash nasal congestion Oral lesions crusty lesions malaise

Management Varies with causative agent Antibiotics Antivirals Supportive care Immune Globulins Prevention
Immunizations

Immunizations
Purpose Types Attenuated Toxoid Active vs. Passive Immunity Gamma globulin/Immun o-globulin Who gets them? Controversy Religion Autism Personal preferences/Philosophical exemptions

Scheduling of Immunizations
Transplacental immunity Ability to make antibodies Ages 0-6 yrs: Ages 7-18 Catch-up schedule http://www.cdc.go v/vaccines/schedul es/downloads/chil d/0-18yrs-11x17fold-pr.pdf

Acute Streptococcal Pharyngitis

Group A -hemolytic streptococci With or without tonsillitis Untreated/mismanaged:
Acute rheumatic fever Acute glomerulonephritis

Occurrence
Peak 4-7 years Winter months Crowded living conditions

Diagnosis of pathogens
Throat culture rapid strep test viral

Mosby items and derived items 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

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Mosby items and derived items 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

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Pharyngitis/Tonsillitis
Clinical manifestations
Kissing tonsils Mouth

Pharmacological management
Penicillin Erythromycin Non-infectious after 24 hrs on Abx

Therapeutic management
Symptom management Antipyretics Analgesics Warm saline gargle

Surgical Mangement
Tonsillectomy and/or adenoidectomy

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Bacterial Meningitis
Description Transmission Droplet infection from nasopharyngeal secretions Appears as extension of other bacterial infection through vascular dissemination Organisms then spread through CSF Increased ICP / Hydrocephalus / cerebral edema
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Acute inflammation of the CNS Decreased incidence following use of Hib vaccine caused by:
meningococcus pneumococcus Group streptococci

Bacterial Meningitis
Diagnostics:
Lumbar Puncture CBC Blood cultures

Therapeutic management
Antibiotics Isolation

Manifestations:
Fever Extreme irritability Poor feeding Vomiting Nuchal rigidity Opisthotonus

Supportive care
Corticosteroids Fluid replacement Monitoring neurological status
Hearing loss ADD Learning disabilities

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Meningitis Signs
Kernigs Sign: http://youtu.be/rJ5AFuP3YA Brudzinskis Sign: http://youtu.be/jO 9PAPi-yus

Nonbacterial Meningitis (Aseptic Meningitis)

Causative agents are principally viruses Frequently associated with other diseases
Measles, mumps, herpes, leukemia

Onset abrupt or gradual Manifestations: headache, fever, malaise Diagnosis and treatment
Mosby items and derived items 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
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Fifth Disease
Parvovirus Peak age: 5-14 yrs No vaccination Headache, fever, malaise Rash:
After 1 week (face) extremities trunk

Fifth Disease: transmission issues

Nursing Management http://www.cdc.go v/ncidod/dvrd/revb /respiratory/b19&p reg.htm
Standard and droplet precautions Antipyretics Antipruritcs Avoid exposure to sunlight Can go to school with rash

H. Influenza
Spring and summer months More common in daycare center population Droplet-based transmission URI symptoms meningitis, otitis, epiglottitis, pneumonia, septic arthritis, cellulitis

Hib Vaccine
Haemophilus influenzae type b Inactivated NOT the flu shot! Schedule
2, 4 and 6 months Or 2,4 and 12-15 months

Measles (Rubeola)
Unimmunized persons Peak age: young adults/adults Winter and spring months Spread via droplet Symptoms High fever and malaise Lymphadenopathy Kopliks spots Respiratory symptoms Conjunctivitis Photophobia

Measles
Rash appears day 4
Head trunk

Management

Red brown Very pruritic!!

Supportive Care Dark environment/ sunglasses pneumonia, encephalitis Airborne precautions

Mumps
Adolescents Classic symptom is parotitis Fever, malaise, headache No rash

Diet Droplet precautions Symptom management

Rubella (German Measles)

Peak age: pre-teen, adolescent Winter and Spring months Inhalation or nasopharyngeal secretions

Symptoms Low grade fever Mild cough Sore throat Lymphadenopathy Arthritic pain Rash: face trunk extremities

Rubella Management
Relieve joint pain Control fever Tylenol / Motrin Standard and precautions birth defects

Droplet

Measles, Mumps, Rubella (MMR) Vaccine

Live, attentuated 1st dose: 12-15 months 2nd dose: 4-6 yrs s/e rash fever (5-12 days after) Autism controversy

May be combined with varicella (MMRV)

Varicella
Varicella-Zoster virus Peak age: older children young adults Incubation: 10-21 days When is it contagious?
Symptoms Low grade fever, malaise Rash appears 24 hours after prodromal symptoms
Stages: macule, papule, vesicle, crust Appear mostly on trunk

Varicella Vaccine
Only childhood disease epidemic that still exists After 1st birthday (12-15 months) Attenuated live virus s/e fever, rash Chicken pox pneumonia, encephalitis Cannot give to immunocompromised child or family member

Other Immunizations
Diphtheria, Tetanus, Pertussis IPV (Inactivated Polio) Rotavirus Hepatitis A,B Pneumococcal HPV (Human Papilloma Virus) Meningococcal (MCV4) Seasonal Flu (includes H1N1) Shingles

Nursing care for Immunizations

Indications for holding vaccine seriously ill Pregnancy (live viruses) Corticosteroids Chemotherapy Radiation
Record all vaccine information Lot #, manufacturer, name of provider Side effects
Fever, rash, malaise Give acetaminophen (Tylenol) anaphylaxis

Educate on importance of keeping on schedule and continuing sequence

Nursing management
Scabs will not scar if you let them be! Antihistamines antipyretics Analgesics NO ASPIRIN!!! REYES SYNDROME!!

Patient education
Skin care for rashes
Light cotton clothing Avoid perspiration Avoid wool clothing Increase fluids Keep fingernails short and clean (mittens) Press or rub on itchy areas Cold cloths Lukewarm baths with baking soda Dipenhydramine (Benadryl) Avoiding transmission of disease
Avoid sick contacts Handwashing Keeping on schedule