bb childhood diseases fall12(1)
TRANSCRIPT
-
8/22/2019 Bb Childhood Diseases Fall12(1)
1/32
ChildhoodDiseases
Kimberly Ambruso, RN, MS
-
8/22/2019 Bb Childhood Diseases Fall12(1)
2/32
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
-
8/22/2019 Bb Childhood Diseases Fall12(1)
3/32
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)
-
8/22/2019 Bb Childhood Diseases Fall12(1)
4/32
Perforated eardrum (tympanicmembrane) Caused from pressure/fluid accumulationbehind the membrane
After rupture, pain decreases/subsides
Ringing/buzzing
Drainage
Decreased Hearing/loss
-
8/22/2019 Bb Childhood Diseases Fall12(1)
5/32
Stages of Infectious diseases
Incubation period
Prodromal period
Illness phase
Convalescent period
-
8/22/2019 Bb Childhood Diseases Fall12(1)
6/32
Communicable Diseases
Classifications andSymptoms
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
http://healtheillinois.files.wordpress.com/2008/05/immune.gif -
8/22/2019 Bb Childhood Diseases Fall12(1)
7/32
Immunizations
Purpose
Types
Attenuated
Toxoid
Active vs.PassiveImmunity
Gammaglobulin/Immuno-globulin
Who gets them?
Controversy Religion
Autism
Personalpreferences/Philo-sophicalexemptions
http://healtheillinois.files.wordpress.com/2008/05/immune.gifhttp://healtheillinois.files.wordpress.com/2008/05/immune.gif -
8/22/2019 Bb Childhood Diseases Fall12(1)
8/32
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-11x17-fold-pr.pdf
http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdfhttp://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-11x17-fold-pr.pdf -
8/22/2019 Bb Childhood Diseases Fall12(1)
9/32
Acute Streptococcal Pharyngitis
Group A -hemolytic
streptococci
With or without
tonsillitis
Untreated/mis-
managed:
Acute rheumatic fever Acute glomerulonephritis
Occurrence
Peak 4-7 years
Winter months
Crowded livingconditions
Diagnosis of pathogens
Throat culture
rapid strep test
viral
Mosby items and derived items 2007, 2003 by Mosby, Inc., an affiliate of
Elsevier Inc.
Slide 9
-
8/22/2019 Bb Childhood Diseases Fall12(1)
10/32
Mosby items and derived items 2007,2003 by Mosby, Inc., an affiliate of Elsevier
Inc.Slide 10
-
8/22/2019 Bb Childhood Diseases Fall12(1)
11/32
Pharyngitis/Tonsillitis
Clinical manifestations
Kissing tonsils
Mouth
Therapeuticmanagement
Symptommanagement
Antipyretics
Analgesics
Warm saline gargle
Pharmacologicalmanagement
Penicillin
Erythromycin
Non-infectious after 24hrs on Abx
Surgical Mangement
Tonsillectomy and/oradenoidectomy
.
10
-
8/22/2019 Bb Childhood Diseases Fall12(1)
12/32
Bacterial Meningitis
Description
Acute inflammation of
the CNS
Decreased incidencefollowing use of Hib
vaccine
caused by:
meningococcus
pneumococcus
Group streptococci
Transmission
Droplet infection fromnasopharyngealsecretions
Appears as extension ofother bacterial infectionthrough vasculardissemination
Organisms then spreadthrough CSF
Increased ICP /Hydrocephalus / cerebraledema
Slide 12
-
8/22/2019 Bb Childhood Diseases Fall12(1)
13/32
Bacterial Meningitis
Diagnostics:
Lumbar Puncture
CBC
Blood cultures
Manifestations:
Fever
Extreme irritability
Poor feeding
Vomiting
Nuchal rigidity
Opisthotonus
Therapeuticmanagement
Antibiotics
Isolation
Supportive care
Corticosteroids
Fluid replacement
Monitoring neurological
status Hearing loss
ADD
Learning disabilities
Slide 13
-
8/22/2019 Bb Childhood Diseases Fall12(1)
14/32
-
8/22/2019 Bb Childhood Diseases Fall12(1)
15/32
Meningitis Signs
Kernigs Sign:
http://youtu.be/rJ-5AFuP3YA
Brudzinskis Sign:
http://youtu.be/jO9PAPi-yus
http://youtu.be/rJ-5AFuP3YAhttp://youtu.be/rJ-5AFuP3YAhttp://youtu.be/jO9PAPi-yushttp://youtu.be/jO9PAPi-yushttp://youtu.be/jO9PAPi-yushttp://youtu.be/jO9PAPi-yushttp://youtu.be/jO9PAPi-yushttp://youtu.be/jO9PAPi-yushttp://youtu.be/rJ-5AFuP3YAhttp://youtu.be/rJ-5AFuP3YAhttp://youtu.be/rJ-5AFuP3YA -
8/22/2019 Bb Childhood Diseases Fall12(1)
16/32
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.
Slide 16
-
8/22/2019 Bb Childhood Diseases Fall12(1)
17/32
Fifth Disease
Parvovirus
Peak age: 5-14 yrs
No vaccination
Headache, fever,malaise
Rash:
After 1 week (face) extremities
trunk
http://www.mdconsult.com/das/patient/body/0/0/10041/19074_en.jpg -
8/22/2019 Bb Childhood Diseases Fall12(1)
18/32
Fifth Disease: transmission issues
http://www.cdc.gov/ncidod/dvrd/revb
/respiratory/b19&p
reg.htm
Nursing
Management
Standard and
droplet precautions
Antipyretics
Antipruritcs
Avoid exposure tosunlight
Can go to school
with rash
http://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/b19&preg.htm -
8/22/2019 Bb Childhood Diseases Fall12(1)
19/32
H. Influenza
Spring and summer months
More common in daycare center population
Droplet-based transmission URI symptomsmeningitis, otitis,
epiglottitis, pneumonia, septic arthritis,
cellulitis
-
8/22/2019 Bb Childhood Diseases Fall12(1)
20/32
Hib Vaccine
Haemophilus influenzae type b
Inactivated NOT the flu shot!
Schedule
2, 4 and 6 months
Or 2,4 and 12-15 months
-
8/22/2019 Bb Childhood Diseases Fall12(1)
21/32
Measles (Rubeola)
Unimmunizedpersons
Peak age: youngadults/adults
Winter and springmonths
Spread via droplet
Symptoms
High fever andmalaise
Lymphadenopathy
Kopliks spots
Respiratorysymptoms
Conjunctivitis
Photophobia
-
8/22/2019 Bb Childhood Diseases Fall12(1)
22/32
Measles
Rash appears day 4
Head trunk Red brown Very pruritic!!
Management
Supportive Care
Dark environment/
sunglasses
pneumonia,encephalitis
Airborne precautions
http://wpcontent.answers.com/wikipedia/commons/thumb/e/e0/Measles_enanthema.jpg/180px-Measles_enanthema.jpghttp://www.southstaffordshirepct.nhs.uk/images/yourHealth/vacs/mumps.jpg -
8/22/2019 Bb Childhood Diseases Fall12(1)
23/32
Mumps
Adolescents
Classic symptom isparotitis
Fever, malaise,
headache No rash
Diet Droplet precautions
Symptommanagement
http://www.aurorahealthcare.org/healthgate/images/si55551288.jpghttp://www.southstaffordshirepct.nhs.uk/images/yourHealth/vacs/mumps.jpg -
8/22/2019 Bb Childhood Diseases Fall12(1)
24/32
Rubella (German Measles)
Peak age: pre-teen,
adolescent
Winter and Spring
months
Inhalation or
nasopharyngealsecretions
Symptoms
Low grade fever
Mild cough Sore throat
Lymphadenopathy
Arthritic pain
Rash: face trunkextremities
-
8/22/2019 Bb Childhood Diseases Fall12(1)
25/32
Rubella Management Relieve joint pain
Control fever
Tylenol / Motrin
Standard and Droplet
precautions
birth defects
http://www.wales.nhs.uk/sites3/gallery/457/rubella_rash.jpghttp://www.wales.nhs.uk/sites3/gallery/457/rubella_rash.jpg -
8/22/2019 Bb Childhood Diseases Fall12(1)
26/32
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)
-
8/22/2019 Bb Childhood Diseases Fall12(1)
27/32
Varicella
Varicella-Zostervirus
Peak age: older
children youngadults
Incubation: 10-21days
When is itcontagious?
Symptoms
Low grade fever,
malaise
Rash appears 24
hours afterprodromal
symptoms
Stages: macule,
papule, vesicle, crust
Appear mostly on
trunk
-
8/22/2019 Bb Childhood Diseases Fall12(1)
28/32
Varicella Vaccine
Only childhood disease epidemic that stillexists
After 1st birthday (12-15 months)
Attenuated live virus s/e fever, rash Chicken pox pneumonia, encephalitis
Cannot give to immunocompromisedchild or family member
http://www.geocities.com/wela/ChickenPoxBabyCartoon.jpg -
8/22/2019 Bb Childhood Diseases Fall12(1)
29/32
Other Immunizations
Diphtheria, Tetanus, Pertussis IPV (Inactivated Polio)
Rotavirus
Hepatitis A,B Pneumococcal
HPV (Human Papilloma Virus)
Meningococcal (MCV4) Seasonal Flu (includes H1N1)
Shingles
-
8/22/2019 Bb Childhood Diseases Fall12(1)
30/32
Nursing care for Immunizations
Indications for holdingvaccine
seriously ill
Pregnancy (liveviruses)
Corticosteroids
Chemotherapy
Radiation
Record all vaccineinformation
Lot #, manufacturer, name
of providerSide effects Fever, rash, malaise
Give acetaminophen (Tylenol)
anaphylaxisEducate on importance ofkeeping on schedule andcontinuing sequence
-
8/22/2019 Bb Childhood Diseases Fall12(1)
31/32
Nursing management
Scabs will not scar if
you let them be!
Antihistamines antipyretics
Analgesics
NO ASPIRIN!!!REYES SYNDROME!!
-
8/22/2019 Bb Childhood Diseases Fall12(1)
32/32
Patient education
Skin care for rashes
Light cotton clothing
Avoid perspiration
Avoid wool clothing
Increase fluids
Keep fingernails shortand clean (mittens)
Press or rub on itchyareas
Cold cloths
Lukewarm baths withbaking soda
Dipenhydramine
(Benadryl) Avoiding transmission of
disease
Avoid sick contacts
Handwashing
Keeping on schedule