Pediatric nursing ch 22 Flashcards

Question

Subunit of virus (example: hepatitis B):

Answer 1

Subunit of virus (example: hepatitis B): Small fragments of viral protein are used.

Answer 2

Concern regarding vaccine safety has been highly publicized in the media, leading to an anti-vaccine movement and lower vaccination rates. One of the largest controversies is the MMR vaccine’s reported link to autism. Despite this report, multiple studies have shown no link to autism related to vaccines or their components. In a systematic review by Maglione et al. (2014), they found strong evidence after review of the literature including more than 66 studies that MMR is not associated with autism. Further, Jain et al. (2015) did a study to identify those with and without older siblings with autism and their rates of autism in association to MMR vaccinations. After searching almost 100,000 charts, they found no association between increased risk for autism with the MMR vaccine even if the older sibling had autism. To promote adequate vaccination rates, it is important to educate parents and the public regarding the magnitude of evidence of no link between autism and MMR vaccination.

Answer 3

Communicable diseases can affect most body systems and have distinct patterns of presentation. The diagnosis and management of the disease will be based on the subjective and objective findings present in the patient. Nurses should complete a thorough history and physical examination to understand the diagnosis and extent of disease process.

Answer 4

``` Intramuscular vaccines Diphtheria, tetanus, pertussis (DTaP, DT, Tdap, Td) Hib Hepatitis A Hepatitis B HPV Influenza, trivalent inactivated Meningococcal—conjugate PCV Intramuscular or subcutaneous PPSV IPV Subcutaneous MMR Varicella Meningococcal—polysaccharide Oral Rotavirus ```

Answer 5

Vaccines and needlestick procedures are a source of significant distress for children and families. It is important for clinicians to understand ways to manage vaccine anxiety. Discuss previous vaccine experiences and educate patients and families on what to expect from the vaccinations. Parental coaching on supportive, honest cues assists in managing their child’s anxiety. Based on the child’s developmental stage, different comfort measures are more effective: Infant comfort measures: swaddling, being held by parents with legs exposed, pacifier, feeding, the use of sugary substances to suck on, and distraction objects in older infants Toddler comfort measures: simple explanations of what to expect, comfort holds by parents or assistant, distraction measures, managing parental anxiety, positive instructions, and positive rewards School-age comfort measures: more complex preparatory discussions; use of distractions like deep breathing, guided imagery, interactive toys, coaching activities such as counting to the end of procedure, and talking about other things like pets.

Answer 6

History is essential to assessment of the child who may be experiencing a communicable disease. It is important to ask about the following issues: Exposure to the disease: Has the child been around other children who have the communicable disease? Is the child in close contact with other children at daycare or schools? Have family members been exposed to a communicable disease? Consider the incubation period of a disease and the length of time it takes for symptoms to appear from the time the child was exposed. Has the child had any communicable diseases in the past? What immunizations has the child had? Are immunizations up to date with recommended schedule? Any child 2 months or younger with a fever of 101°F or higher should be seen by a health-care professional to evaluate for subtle signs of sepsis or other concerning infections. The very young infant does not yet have a fully functioning immune status, and presentations of communicable diseases may be subtle.

Answer 7

Physical assessment of a child with communicable disease includes assessing prodromal signs and symptoms that may appear before a rash or the main illness appears. The prodromal period is often associated with increased communicability of the disease. Prodromal signs and symptoms may include: ``` Coryza (runny nose) Cough Fever Malaise General signs and symptoms experienced by a child with communicable disease include: ``` Changes in behavior—lethargy or irritability Skin rashes that may itch and may include macules, papules, pustules, and vesicles Enlarged lymph nodes that may vary in location based on the disease but are predominately located in the anterior cervical, posterior cervical, and tonsillar areas Fever Vomiting and diarrhea Pain in any part of the body, including headache, abdominal pain, throat pain, or muscle aches

Answer 8

Viral communicable diseases are some of the most common diseases acquired by humans. Thousands of viruses can result in minor illnesses such as the common cold, as well as more significant diseases such as meningitis. This section highlights common and serious viral diseases in childhood.Table 22-1 page 522

Answer 9

Universal precautions prevent the transmission of HIV, hepatitis B and C, and other blood-borne pathogens. Universal precautions apply to blood, any body fluids that contain blood, semen, and vaginal discharge. Universal precautions provide guidelines for using protective barriers such as gloves, gowns, masks, and eyewear as needed to protect the health-care worker. Guidelines also prevent injuries from needlesticks and other sharp instruments

Answer 10

Standard precautions are more comprehensive than universal precautions and apply to all patients in any setting. Major components of standard precautions include careful hand hygiene, safe injection practices, safe handling of contaminated equipment, and appropriate isolation techniques based on possible exposure to pathogens. Isolation techniques may involve gloves only or may call for gowns, masks (droplet precaution), or eye protection (invasive procedures). Standard precautions also protect the patient by preventing spread of pathogens from health-care providers or equipment to the patient

Answer 11

Situations with an ill child that require emergency medical services include the following (Randolph & McCulloh, 2014): Difficulty breathing Refusal to lie down Blue, gray, or purple tinge on lips or skin Fever associated with difficulty breathing or abnormal skin color (pallor, bluish tinge, exceptionally pink) Fever with headache or stiff neck Behavior changes such as lethargy, acting withdrawn, or becoming more unresponsive Seizure activity in a child not known to have seizures and without a plan for managing seizures Purple or red rash that is spreading quickly, rash that does not blanch (petechiae) Dehydration accompanied by lethargy, sunken eyes, no tears in an infant older than 2 months, decreased urine output Vomiting blood, or blood in the stool

Answer 12

Erythema infectiosum commonly affects school-age children 5 to 15 years of age. This rash is a self-limited viral infection but can have persistent lacy rash for several weeks after initial infection. Disease process Agent: human parvovirus B19 (HPV) Transmission: contact with respiratory secretions Incubation period: 4 to 21 days Communicability: contagious until the rash appears Precautions: droplet

Answer 13

Prodromal: fever, upper respiratory symptoms, headache Rash distribution: erythema of the cheeks, giving the appearance of “slapped cheeks.” The rash appears after the red cheeks appear and is characterized by a lacy pattern on the trunk and extremities. The rash may disappear and then reappear if the child becomes hot for weeks after the infection (Fig. 22–2). Systemic signs and symptoms: no signs or symptoms after the rash has appeared. In adults, there may be pain and swelling of joints (American Academy of Pediatrics Blood testing will reveal the presence of immunoglobulin M (IgM) antibody that indicates immunity to parvovirus B19. Nursing interventions for patients with fifth disease include emergency care and acute hospital care. Emergency Care Sickle cell crisis may occur with HPV in susceptible persons. Acute Hospital Care Fifth disease may be severe in individuals with immune deficiency disorders. A child with HPV who is hospitalized with aplastic crisis or because of immunodeficiency must be placed on droplet precautions. A child in aplastic crisis may not have the typical rash, but complain of fever, nausea and vomiting, abdominal pain, malaise, and lethargy. The disease may trigger a crisis in persons with sickle cell disease. It may also trigger aplastic crisis in children who are immunodeficient. Home Care Acetaminophen or ibuprofen for fever or discomfort; adequate hydration

Answer 14

Erythema infectiosum (fifth disease) in pregnant women may be passed on to the fetus and cause severe anemia in the fetus or possible complications such as miscarriage. Approximately 50% of pregnant women have had fifth disease in the past and are already immune to parvovirus B19. These women and their fetuses are not affected if exposed. However, all pregnant women should consult their health-care provider if exposure to fifth disease is suspected. Less than 5% of pregnant women who are exposed to parvovirus B19 may experience complications, and these usually occur during the first half of the pregnancy. To prevent complications from Fifth disease, pregnant women who are in contact with children should practice careful hand hygiene. Women of childbearing age can have a blood test to determine whether they have had fifth disease and are therefore immune to this disease

Answer 15

Hand, foot, and mouth disease (HFMD) is common among infants and children younger than 10 years. HFMD is a self-limited condition and usually resolves within 10 days without complications. However, the child may have significant difficulty with eating and playing because of the painful lesions to the hands, feet, and mouth. Because multiple strains cause HFMD, children can contract this virus more than onc Disease Process Agent: Coxsackie virus or enterovirus Transmission: direct contact, droplet, fecal–oral Incubation period: 3 to 6 days Communicability: the virus may be shed for several weeks Clinical Presentation Signs and symptoms: cold symptoms, coryza, fever, sore throat Small vesicles appear in the mouth and on the palms of the hands and soles of the feet, and may also appear on the genitalia and buttocks Stool samples and throat swabs can be tested for presence of a virus, but the disease is usually diagnosed clinically.

Answer 16

Careful hand hygiene and disposal of tissues Clean surfaces and toys with soap and water, and disinfect with a solution of 1 tablespoon of bleach to 4 cups of water Give bland foods and drinks because the mouth may be sore; make sure the child is well hydrated Acetaminophen or ibuprofen for pain and fever Over-the-counter sprays and mouthwashes that contain local anesthetic to relieve pain in the mouth

Answer 17

Hepatitis A virus (HAV) is a disease process that causes inflammation and decreased liver function. The most common source of HAV is contaminated food or water. Most patients have a mild illness and recover without permanent liver damage within 2 weeks. Longer and more severe disease processes are more common in older children and adults or those with underlying liver issues. Disease Process Agent: HAV viral infection Transmission: fecal–oral route, contaminated food Incubation period: approximately 30 days Communicability: most contagious for 2 weeks before onset of symptoms and for 1 week after onset of jaundice Clinical Presentation Fever, malaise, poor appetite, nausea, jaundice, abdominal pain, dark urine Children younger than 6 years may have mild or no symptoms; therefore, they may play a significant role in the transmission of HAV Diagnostic testing Blood test for presence of anti-HAV IgM in the serum Other abnormal laboratory work: presence of bilirubin in urine, elevated serum bilirubin, elevated liver enzymes (aspartate transaminase and alanine transaminase)

Answer 18

Contact isolation if the child is incontinent with feces Immune globulin can be given after exposure to prevent or reduce the severity of the disease Report incidence to the local health department Strict hand hygiene and sanitizing of surfaces Appropriate rest and activity Nutritious, well-balanced diet (

Answer 19

Hepatitis B virus (HBV) is a virus that can cause short-term and long-term liver dysfunction. HBV is commonly transmitted through blood or body fluids. Some children younger than 5 years will show no symptoms of HBV; however, 50% of individuals older than 5 will experience signs and symptoms of liver dysfunction and inflammation including jaundice, vomiting, and abdominal pain. The disease process can last from weeks to months; at longer than 6 months, HBV is considered chronic and puts the individual at long-term risk for cirrhosis and liver cancer Disease Process Agent: HBV viral infection Transmission: blood or blood products, sexual contact Incubation period: average of 90 days Communicability: can be spread as long as the virus is in the blood of an individual; some people are chronic carriers and carry the disease for life

Answer 20

Symptoms include aching, malaise, joint pain, jaundice, dark urine, loss of appetite, and mild right upper quadrant abdominal pain. Children with chronic hepatitis B may be asymptomatic. Children with chronic hepatitis B are at risk for development of hepatocellular carcinoma later in life. Newborns may acquire HBV perinatally. The CDC (2017f) reports that 40% of infants who do not receive postexposure prophylaxis will experience development of chronic hepatitis B. It is important to administer HBIG in addition to the hepatitis B vaccine if the mother is HBsAg positive. High-risk groups among children and adolescents include those living in institutions, those involved in IV drug use, those infected by sexual partners, and children who are hemophiliacs or receive frequent blood transfusions. Individuals who have traveled to Africa or Asia are also at higher risk. Diagnostic Testing Blood tests reveal the HBsAg and the IgM anti-HBc core antibody. In chronic hepatitis B, the positive HBsAg persists. Chronic carriers are those who have a positive HBsAg for more than 6 months. HBV DNA markers will also be present. Nursing Interventions Blood-borne precautions (universal precautions) Caregiver Education Teach family members not to share toothbrushes or razors. Lifestyle counseling is necessary if risky behaviors such as drug use or sexual activity are present. Teach importance of treatment and follow-up.

Answer 21

Two medications may be used for children with chronic HBV: Interferon-alpha reduces replication of the HBV virus. It may be given as subcutaneous injection at 6 months. Side effects include fever, aching, joint pain, anorexia, and weight loss. Lamivudine inhibits replication of the HBV virus. This drug is given orally, and treatment may last for 1 year. There are fewer side effects than with interferon, but lamivudine may develop resistance

Answer 22

HBV remains a significant health problem, especially in countries such as Asia and Africa. Approximately 257 million people around the world have HBV. Therefore, nurses and families must be aware that immigrant children and international children who are adopted into families in the United States may have been exposed to this disease. The health history is very important because children may be asymptomatic

Answer 23

Influenza, commonly called the flu, is a very contagious disease process that occurs worldwide annually and is often epidemic. The influenza virus constantly mutates, resulting in new strains annually. The most common months for influenza in the United States are October through May. Most patients have a self-limited disease with common symptoms such as cough, fever, and body aches. However, infants, very young children, those with chronic diseases, and older adults are at increased risk for complications related to the flu, such as pneumonia, encephalitis, myocarditis, pericarditis, and many others. It is important to prevent influenza in all patients, especially individuals in high-risk categories.

Answer 24

Disease Process Agent: influenza viruses; influenza may be type A or type B, with type A being much more prevalent Transmission: coughing and sneezing; contact with objects contaminated with oral or nasal secretions Incubation period: 1 to 4 days Communicability: 1 day before symptoms until approximately 7 days after child becomes ill Clinical Presentation Fever, chills, headache, sneezing, cough, malaise, conjunctivitis, and myalgia (aching) Diagnostic Testing Rapid screening for flu virus antigens in nasal secretions Nursing Interventions Nursing interventions for influenza among pediatric patients include emergency care and acute hospital care measures. Emergency Care Influenza may trigger croup in infants. Acute Hospital Care Pneumonia is a complication of influenza and may require hospitalization. Other complications include ear infections, sinus infections, dehydration, myocarditis, pericarditis, and increased severity of existing medical conditions such as diabetes and asthma. Droplet isolation is necessary. Caregiver Education Tylenol or ibuprofen for fever (no aspirin because of risk for Reye syndrome) Careful hand washing and disposal of tissues Encourage fluids Administration of medications within 48 hours of symptoms (see Safe and Effective Nursing Care: Treating Influenza feature) Importance of annual influenza immunizations Complementary and Alternative Therapies Multiple herbs, minerals, vitamins, and other treatments may be effective in reducing replication, reducing inflammation, and decreasing length of symptoms for those affected by influenza and other upper respiratory infections. Additional research is needed to identify the safety and efficacy of these therapies

Answer 25

Medications for influenza must be given within 48 hours of the onset of symptoms. Two antiviral medications for influenza approved by the U.S. Food and Drug Administration were recommended for the 2016 to 2017 influenza season: oseltamivir (Tamiflu) and zanamivir (Relenza). These medications are effective for both influenza type A and type B. Oseltamivir (Tamiflu) may be given to children older than 1 year and should be given on weight-based dosing. Zanamivir (Relenza) is recommended for children older than 7 years. It is administered as a 10-mg once-daily inhalation medication and is not recommended for children with airway disease such as asthma

Answer 26

Mononucleosis is sometimes called mono or the “kissing disease” because it is commonly transmitted through saliva. Mononucleosis is a viral infection caused by the Epstein-Barr virus (EBV); it is most common among adolescent patients but can affect individuals of all ages. This infection results in an increase in white blood cells with a single nucleus, called monocytes or mononuclear lymphocytes. Most patients have a self-limited disease that lasts a few weeks, but rare cases will lead to long-term chronic fatigue syndrome

Answer 27

Disease Process Agent: EBV Transmission: person-to-person contact, sharing personal objects such as cups or toothbrushes, through saliva Incubation period: 30 to 50 days Communicability: virus may be excreted for months after infection Clinical Presentation Fever, sore throat, malaise, pharyngitis, enlarged posterior cervical lymph nodes, with symptoms lasting 1 to 4 weeks (Fig. 22–4) May develop splenomegaly or hepatomegaly Disease primarily affects adolescents and young adults; children often have very mild symptoms, and adults are usually immune due to previous exposure Diagnostic Testing Positive mono spot test, positive Paul-Bunnell heterophile antibody test, increased lymphocytes, greater than 10% atypical lymphocytes EBV antibody titers Nursing Interventions Hospitalization may be needed if the child experiences respiratory distress, abdominal pain with splenomegaly, or dehydration due to inability to swallow adequate fluids. Caregiver Education To prevent injury to spleen, no contact sports for 6 to 8 weeks if spleen is enlarged. Examples of contact sports include basketball, football, soccer, rugby, baseball, boxing, ice hockey, rodeo, wrestling, martial arts, lacrosse, and water polo Rest, with appropriate quiet activities and play Fever management with acetaminophen or ibuprofen Hydration and nutrition Counseling and emotional support for adolescents who must be on bedrest

Answer 28

It may be difficult to distinguish mononucleosis from streptococcal sore throat or pharyngitis. However, health-care providers need to distinguish between the two infections. If ampicillin or amoxicillin is given to an individual with mononucleosis, a maculopapular rash will result.

Answer 29

Mumps is a virus that causes a disease resulting in inflammation primarily of the salivary glands below and in front of the ears. This inflammation can also affect other areas of the body, leading to complications such as sterility in males from orchiditis, hearing loss, encephalitis, and pancreatitis. While the incidence of mumps has significantly declined with immunization, outbreaks continue worldwide, including a significant one in the United States in 2016. Mumps can have systemic symptoms but most commonly present with significant parotid swelling.

Answer 30

Disease Process Agent: paramyxovirus Transmission: Contact with oral and nasal secretions (droplet spread) Incubation period: 16 to 18 days Communicability: 2 to 3 days before swelling of salivary glands to 5 days after swelling starts Clinical Presentation Location: Swelling of parotid salivary glands in front of the ear, below the ear, under jaw (Fig. 22–5) Boys may have painful swelling of the testicles (orchitis) Girls may have ovarian involvement with abdominal pain (oophoritis) and breast inflammation (mastitis) Systemic signs and symptoms: headache, fever, earache, muscle aches, malaise, loss of appetite Diagnostic Testing IgM enzyme immunoassay is used to detect the mumps virus.

Answer 31

Nursing Interventions Nursing interventions for patients with the mumps virus include emergency care and acute hospital care. Emergency Care Complications may include meningitis, encephalitis, glomerulonephritis, permanent deafness, sterility, myocarditis, and joint inflammation. Infection during pregnancy may result in fetal death. Seek medical care immediately for complications. Acute Hospital Care Droplet spread isolation is required. Caregiver Education Acetaminophen or ibuprofen for fever and pain Bland, soft foods Bland liquids; avoid citrus juices; keep well hydrated. Ice packs or warm compresses to neck for comfort and pain relief Snug-fitting underwear and warmth may provide comfort and pain relief for orchitis

Answer 32

Respiratory syncytial virus (RSV) is a viral respiratory infection that can affect all ages. RSV is usually well tolerated with symptoms of the common cold in older children, but is the most common cause of bronchiolitis and pneumonia in infants and toddlers. In infants, toddlers, those born prematurely, and those with chronic lung or heart disease, RSV can result in a life-threatening illness. In these individuals, significant respiratory distress, wheezing, and in some cases, respiratory failure can result from RSV. The usual disease process is self-limited to approximately 1 week, with the worst symptoms occurring on days three through five. However, cough and wheezing can persist for up to 3 to 6 weeks after the illness.

Answer 33

Disease Process Agent: RSV Transmission: contact with saliva and nasal secretions. The virus can live on surfaces for several hours and is readily transmitted by hands. Incubation period: This period is usually 4 to 6 days Communicability: Viral shedding may last as long as 3 to 4 weeks in infants. In older persons, it is shed for 3 to 8 days. Clinical Presentation Symptoms of a cold in older children: cough, coryza (nasal congestion), fever As the disease progresses in infants and young children, there may be respiratory distress with tachypnea, wheezing, retractions, severe coughing, and poor air exchange Refer to Chapter 11 for additional information on bronchiolitis. Diagnostic Testing RSV screening

Answer 34

Nursing Interventions Nursing interventions for RSV include the following measures. Emergency Care The virus may cause respiratory distress in infants and toddlers. Emergency treatment may be needed. Infants who were born prematurely or who have medical problems such as congenital heart defects are especially vulnerable to the effects of RSV. Acute Hospital Care Hospitalization may be needed for infants with bronchiolitis and pneumonia. Contact isolation with gowns and gloves; mask if close to the infant’s face Frequent assessments of respiratory status Schedule activities to allow rest time for infant Cool humidified air at bedside Administer oxygen as needed Hydration with IV fluids if needed Careful hand hygiene and disposal of tissues Cool mist humidifier, hydration Do not administer over-the-counter cough/cold products to children younger than 4 years Teach parents signs of respiratory distress in an infant and when to seek medical care Immunization: infants who are at risk and more vulnerable to RSV due to medical problems may require the palivizumab (Synagis) vaccine to prevent RSV

Answer 35

The palivizumab (Synagis) vaccine has significantly reduced the incidence of RSV bronchiolitis in infants. This immunization is needed for preterm infants who were born at less than 29 weeks’ gestation without chronic lung disease, preterm infants born at 32 weeks’ gestation who have chronic lung disease, or children with hemodynamically significant congenital heart disease. The AAP (2015) has given specific guidelines based on gestational ages of infants and risk factors. The dose is given intramuscularly and repeated monthly (every 28 to 30 days) for three to five doses during RSV season. Specific RSV season varies from state to state, but it generally starts in the fall and ends in the spring

Answer 36

Teach parents the signs of respiratory distress for seeking medical care: Restlessness, anxiety Respiratory rate over 60 in an infant, over 40 in a toddler Retractions Wheezing Distress that increases when lying down Breathlessness, gasping, continuous coughing Nasal flaring Color changes—duskiness around mouth, pallor Crowing sound when taking a breath Hoarse cry or barking cough

Answer 37

Roseola is defined as a rose-colored rash and is also called roseola infantum because it is most common among infants and toddlers. Many patients are asymptomatic when they have the virus, but classic presentation of this disease is a high fever that resolves after about 3 to 7 days, after which the rose-colored rash emerges throughout the body. The disease process is usually benign and self-limited, but rarely causes febrile seizures in infants with very high fevers.

Answer 38

``` Disease Process Agent: human herpes virus 6 Transmission: saliva of persons who have the disease or are carrying the virus; 75% of adults carry the virus in their saliva without symptoms; most people have had roseola by age 4 years Incubation period: 9 or 10 days Communicability: unknown ``` Clinical Presentation Prodromal: high (potentially as high as 103°F or greater) for 3 to 7 days; the high fever may trigger febrile seizures Rash distribution: papular pink or red rash that appears on the day that the fever returns to normal (Fig. 22–6) Diagnostic Testing Typically diagnosed based on the rash. A blood test may look for antibodies. Nursing Interventions Emergency care may be needed for febrile seizures. Caregiver Education Home care includes fever management, sponging with tepid water, and administration of acetaminophen or ibuprofen

Answer 39

Rubella, sometimes called German measles or 3-day measles, is a contagious viral infection resulting in no symptoms or a mild febrile illness with a rash that lasts approximately 3 days. Rubella infection in infants and children rarely causes significant complications. However, if a pregnant woman is affected, her unborn fetus can develop multiple congenital anomalies such as hearing and vision loss, heart defects, and mental retardation, referred to as congenital rubella syndrome. Given the devastating lifelong consequences to the unborn fetus, it is important that we prevent rubella through adequate immunization.

Answer 40

Disease Process Agent: Rubella virus Transmission: respiratory droplets or direct contact with respiratory secretions; virus is also found in blood, urine, and stool Incubation period: 16 to 18 days Communicability: 7 days before rash until 14 days after rash; most children are contagious 3 to 4 days before rash to 7 days after rash Clinical Presentation Prodromal: Children do not have prodromal symptoms. Adolescents may experience mild fever, malaise, sore throat, and headache. Rash distribution: Fine red or pink rash that appears on the face first and then spreads downward. The rash lasts approximately 3 days and disappears in the same order that it appeared. Systemic signs and symptoms include fever, aching, and posterior cervical lymph nodes tender and swollen (Fig. 22–7). Caregiver Education Home care includes fever management as needed. Teach the importance of getting the MMR vaccine before the childbearing years.

Answer 41

Rubella infection during pregnancy may result in an infant born with congenital rubella syndrome. Problems associated with congenital rubella syndrome are congenital heart defects, congenital cataracts, deafness, mental retardation, miscarriage, and fetal death. These infants may shed the virus and be contagious for 1 year.

Answer 42

Rubeola is a viral syndrome resulting in a rash for 7 days, often referred to as measles. The disease process is usually a self-limiting moderate illness in most children, presenting with the rash and fever. However, complications such as encephalitis, pneumonia, and death can occur in children younger than 5 years and adults. Prior to immunizations, many children and adults died of complications related to rubeola. Rubeola is still present worldwide and has intermittent outbreaks, most recently in multiple states in the United States in 2017. It is essential to prevent this disease through adequate immunizations to avoid the complications associated with rubeola.

Answer 43

Disease Process Agent: measles virus Transmission: airborne through respiratory droplets or direct contact with respiratory secretions Incubation period: 8 to 12 days Communicability: 1 or 2 days before prodromal symptoms, 3 to 5 days before rash, 4 days after rash appears Clinical Presentation Prodromal: coryza, cough, conjunctivitis, fever, malaise; small red spots in the mouth with a bluish white center (Koplik spots; Fig. 22–8) Rash distribution: brownish-red macular rash starts at hairline and spreads downward over body Systemic signs and symptoms: fever, cough, red, watery eyes, coryza (Fig. 22–9) Diagnostic Testing Blood test to detect antibodies Nursing Interventions Nursing interventions for measles include the following measures. Emergency Care Complications include ear infections, diarrhea, encephalitis, pneumonia, seizures, deafness, mental retardation, and death. Seek medical care immediately for complications. Acute Hospital Care Airborne isolation is required. Chronic Home Care Long-term care, including ventilator care, may be needed for children with brain damage resulting from measles encephalitis. Caregiver Education Manage fever with acetaminophen or ibuprofen. Keep child isolated for 5 days after rash appears. Dim lights if photophobia exists. Use warm compresses to remove crusting from eyes as needed. Give soft, bland foods. Keep child well hydrated with plenty of fluids. Use cool mist humidifier.

Answer 44

Measles is one of the leading causes of death among young children worldwide with an estimated 135,000 people dying of measles in 2015, and it is estimated that measles vaccination prevented 20 million deaths from 2000 to 2015 (WHO, 2017b). Outbreaks of measles in the United States occur in regions with under-vaccination and when travelers or immigrants who have not been immunized in their home countries enter the United States (CDC, 2017e). In recent years, multiple outbreaks have occurred in the United States, the largest occurring in 2014 with 667 cases of measles in multiple states linked to an amusement park in California (CDC, 2017e). It is always important to check immunization records and promote adequate immunization domestically and worldwide.

Answer 45

Immune globulin may prevent measles or lessen the severity of the case in unimmunized individuals if given within 6 days of exposure. This is especially helpful for infants younger than 6 months, pregnant women, and those who are immunocompromised

Answer 46

The World Health Organization has recommended two doses of vitamin A to reduce complications and death from measles in areas of the world where vitamin A deficiency may be present. The recommended dose is 100,000 IU daily for 2 days in infants and 200,000 IU daily for 2 days in older children. A systematic review and meta-analysis by the Cochrane Database of Systematic Reviews found that vitamin A therapy reduced the risk for complications, pneumonia, and death in children younger than 2 years.

Answer 47

Varicella zoster virus (VZV) most commonly causes chickenpox in children and rarely may cause shingles. VZV infection most commonly presents in children with the classic rash of maculopapular lesions that begins on the head or trunk, progressing quickly to vesicles with eventual crusting and resolution. The key finding in VZV infection is lesions in all different stages of formation and healing. The most distressing symptom for patients is often the severe pruritus, which can result in scarring or secondary bacterial infections. After initial infection with VZV, the virus lays dormant in the nervous system, often for years. But in some cases, during periods of weakened immune system such as stress, the VZV will result in a secondary infection of shingles in older children and adults. Given the burden of the disease and potential complications, it is essential to prevent this disease process through adequate immunization.

Answer 48

Disease Process Agent: VZV Transmission: fluid from vesicles of an infected person; secretions from nose, mouth, and eyes; airborne from coughing and sneezing Incubation period: 10 to 21 days Communicability: 1 day before rash appears, while rash is spreading, and until all vesicles have crusted over Clinical Presentation Prodromal: fever, malaise, coryza Rash distribution: The rash first appears on the trunk and face, then spreads to other parts of the body. The rash goes through the stages of macule, papule, vesicle, and scab (crust). All stages are present at the same time. Severe itching may be present (Fig. 22–10). Systemic signs and symptoms: fever, headache, dehydration Diagnostic Testing Typically diagnosed by visualizing rash Nursing Interventions Nursing interventions for chickenpox include emergency care and acute hospital care. Emergency Care Complications may include bacterial infections of the skin, pneumonia, septicemia, encephalitis, and bleeding problems. Urgent medical care is needed for any complications. Acute Hospital Care Children with chickenpox are not generally hospitalized unless the child is immunocompromised or experiencing complications; IV acyclovir may be given to children in these situations Strict isolation for the hospitalized child, including contact and airborne isolation

Answer 49

It is possible to get chickenpox twice. The second case is usually mild, with less fever and few vesicles. Care is the same as for the first case of chickenpox. A small percentage of people who receive the chickenpox vaccine get chickenpox, but the disease is mild with fewer lesions. Risk of breakthrough is higher if varicella vaccine is given less than 30 days after the MMR vaccine. Varicella vaccination should be given simultaneously with MMR or longer than 30 days from MMR. It is possible to have a mild rash with a few vesicles around the injection site after varicella immunization. These vesicles must be covered with clothing or a nonporous bandage to prevent spread to others. Isolation may be needed if the rash is more widespread.

Answer 50

Use acetaminophen to relieve fever. Aspirin or any medication that contains salicylates should never be used because of the risk for Reye syndrome. The caregiver should receive education on the signs and symptoms of this syndrome. Keep child isolated until all vesicles have crusted over. Keep the child well hydrated. Offer cool, bland liquids because the inside of the mouth may be affected. To help prevent itching, keep child cool, dressed in light cotton, and distracted with play activities. Apply gloves or mittens if necessary; keep fingernails clean and cut short. Aveeno (oatmeal powder) or baking soda baths may bring relief. Apply calamine or Cetaphil lotion to lesions. Complementary and Alternative Therapies Capsaicin may be used to relieve the pain of shingles

Answer 51

Reye syndrome is a life-threatening disease that primarily affects the brain and liver. It typically follows a viral infection such as chickenpox, influenza, or an upper respiratory infection. The ingestion of aspirin or other medication that contains salicylates during a viral illness greatly increases the probability of development of Reye syndrome. It is important to teach caregivers not to give aspirin or salicylate products to any child or adolescent during a febrile illness.

Answer 52

Ibuprofen should never be given to infants younger than 6 months secondary to immature renal function that takes 6 to 12 months to reach adult activity. Use of ibuprofen can cause reduction of kidney function

Answer 53

Shingles (herpes zoster) occurs when the VZV that causes chickenpox becomes reactivated in the nervous system, causing a painful, blistering rash in the portion of skin supplied by a particular nerve fiber (dermatome). The person has already completely recovered from chickenpox and the virus that was inactive (latent) becomes active, often years after having chickenpox. Educate caregivers that a child cannot get shingles from someone with chickenpox. However, a child may contract chickenpox from an individual with shingles if there is direct contact with uncovered lesions. Shingles lesions must be covered to prevent spread. It is contagious until all lesions are crusted over

Answer 54

The key to preventing the spread of communicable disease is careful hand hygiene. Hands must always be washed before and after caring for infants and children. Caregivers and children must be taught to wash hands before eating and handling food, after using the bathroom or changing diapers, after handling animals, after playing in water or in the sand, and after using tissues to wipe eyes or noses.

Answer 55

Bacterial communicable diseases are highly contagious, resulting in outbreaks throughout the year, especially in schools, day-care centers, and crowded living conditions. These diseases can often be treated with antibiotics, good hygiene practices, and symptomatic care. Many of these diseases are common in the community but must be treated appropriately to prevent complications in children and adolescents.

Answer 56

The AAP urges health-care providers and caregivers to use caution in administering over-the-counter cough and cold medications to young children. Serious side effects have been observed, and studies indicate that cold medications are not effective for children younger than 6 years. In addition, use of these medications may delay important care needed by children. The AAP recommends the use of home remedies such as cool mist humidifiers, saline nose drops, and suctioning bulbs to clear the nares

Answer 57

Conjunctivitis is a disease process that results in erythema and edema of the conjunctiva of the eye, as well as thick, purulent drainage in the case of bacterial infection. Multiple bacteria can result in conjunctivitis, but the most common causes in children are respiratory and skin bacteria such as staphylococcal and streptococcal bacteria. In neonates, sexually transmitted diseases such as herpes simplex virus, gonorrhea, or chlamydia can result in conjunctivitis, which can lead to more serious infections. Most conjunctivitis infections resolve with appropriate treatment. Complications such as vision loss, eye infection, and periorbital cellulitis are rare but significant. It is important for nurses to educate families on conjunctivitis prevention and prompt treatment of eye symptoms.

Answer 58

Disease Process Agent: virus or bacteria Transmission: contact with discharge from an infected eye, either direct contact or by touching contaminated surfaces Communicability: varies depending on organism Clinical Presentation Viral infection: pink or red conjunctiva, edema, watery discharge (Fig. 22–11); may affect only one eye Bacterial infection: pink or red conjunctiva, edema, purulent discharge, crusted eyelids in the morning, complaints of itching or pain Nursing Interventions Teach administration of eyedrops as ordered for bacterial infections. If conjunctivitis develops in two or more children in the same setting (home or school), the cause may be adenovirus. This may cause epidemics in school or group settings. Caregiver Education Avoid touching eyes, wash hands carefully after touching eyes, sanitize objects that have been touched by eyes or hands, discard tissues that are used to wipe eyes, and administer eyedrops as ordered.

Answer 59

Perform hand hygiene. Draw the correct amount of medication into the dropper. Do not touch the dropper to the eye or any other surface. The dropper must remain sterile. Tilt the child’s head back and pull down the lower eyelid. The child can be instructed to look up at the ceiling. Squeeze the correct number of medication drops into the pouch formed by pulling down the lower eyelid. Allow the child to close the eye. Gently press the tear duct situated in the inner corner of the eye. Gently wipe off excess solution with a clean cotton ball or gauze pad. Perform hand hygiene.

Answer 60

Pertussis is also known as whooping cough because it causes a characteristic “whoop” sound after paroxysmal coughing fits. In older children and adults, pertussis is usually well tolerated. In infants and very young children, however, this virus often results in a severe respiratory illness that can cause respiratory failure and death. This disease mainly affects babies or children who are not immunized or not fully immunized. Pertussis begins with similar symptoms to a common upper respiratory infection, followed by an increase in symptoms that include the classic paroxysmal coughing fits with posttussive inspiratory whoop and vomiting. Pertussis can cause persistent symptoms for several weeks. Given the consequences to the very young, recent recommendations from the CDC promote a vaccine net of protection around these at-risk infants.

Answer 61

Disease Process Agent: Bordetella pertussis Transmission: oral and nasal secretions Incubation period: 6 to 21 days Communicability: contagious from the onset of symptoms and for about 2 weeks; infants who have not been immunized may be contagious for at least 6 weeks The disease is most dangerous to young infants Clinical Presentation Catarrhal phase that lasts 1 to 2 weeks: cold symptoms, including coryza, mild cough, and fever Paroxysmal phase that lasts 1 to 6 weeks or longer: cough ends with crowing (whooping) and may be severe enough to cause vomiting and cyanosis; the classic whoop may not occur in an infant; respiratory distress may be severe Recovery phase when cough gradually becomes less severe In some children, adolescents, and adults, pertussis may present as a chronic cough that lasts for weeks; the crowing or whooping may not always be present Pertussis is becoming more common among adolescents and adults

Answer 62

Diagnostic Testing The polymerase chain reaction test identifies genetic material of the B. pertussis bacteria in nasal secretions. Nursing Interventions Infants have more severe cases of pertussis and may require hospitalization to manage respiratory distress and dehydration. Caregiver Education Give small amounts of fluid frequently to keep the child hydrated, especially during bouts of vomiting. Refeed or give small amounts of fluid after episodes of coughing and vomiting. Teach signs of respiratory distress and dehydration, and urge parents to seek medical care as needed. Provide for rest and quiet activities, and avoid stimuli that trigger coughing. Use a cool mist humidifier.

Answer 63

Signs of Dehydration Teach parents the signs of dehydration for seeking medical care: Lethargy No tears when crying if older than 2 months For young infant, less than five or six wet diapers in 24 hours Eyes sunken Skin not elastic (poor skin turgor) Fontanel sunken

Answer 64

Pertussis must be treated with azithromycin (Zithromax), erythromycin, or clarithromycin. Treatment should be started before 21 days into the illness.

Answer 65

In recent years, there has been a significant increase in pertussis incidence in infants, adolescents, and adults. It is now recommended that adolescents 11 to 18 years of age who have completed the recommended DTaP series and adults who have close contact with children receive a single dose of Tdap vaccine. In addition, it is now recommended that pregnant women receive a single dose of Tdap between 27 and 36 weeks’ gestation to maximize passive antibody transfer to the infant

Answer 66

Strep throat, also known as strep pharyngitis, group A beta-hemolytic streptococcus, or Scarlet fever, is a bacterial infection resulting from group A beta-hemolytic streptococcus. The disease affects all ages but is more common in children older than 2 years, especially school-age children. Strep throat has an abrupt onset of symptoms including a severe sore throat, headache, stomachache, and possible rash called a sandpaper rash (fine, maculopapular, rough rash that occurs especially in the groin, axilla, and neck folds). In some children, the symptoms of strep are subtle, so a good history and physical examination are essential for these children. Prevention and treatment are essential to prevent complications such as rheumatic fever.

Answer 67

Agent: group A beta-hemolytic streptococcus; causes Group A Streptococcus (GAS) pharyngitis (Fig. 22–12) and may also cause impetigo Complications of group A beta-hemolytic streptococcus include rheumatic fever and poststreptococcal glomerulonephritis; please refer to Chapters 12 and 16 for additional information on these diseases Transmission: droplet spread, direct contact with secretions Incubation period: 2 to 5 days Communicability: approximately 10 days without treatment; no longer contagious after 24 hours on antibiotics

Answer 68

Presentation includes sore throat, fever, headache, enlarged and tender anterior cervical and tonsillar lymph nodes, abdominal pain, and decreased appetite. Cough and coryza are not major signs of strep throat. If a child has nasal congestion, the sore throat is likely caused by another organism. Children younger than 3 years may have a streptococcal infection without complaining of a sore throat. Symptoms may include fever, irritability, and nasal discharge. Scarlet fever is strep throat with a fine, red rash (Fig. 22–13) that has the texture of sandpaper. The rash is more pronounced in the armpits and groin, in the creases of the elbows, and behind the knees. After the rash fades, the skin of the fingers and toes may peel. There may be pallor around the mouth and a white tongue with swollen, red papillae.

Answer 69

Diagnostic Testing Rapid strep test, throat culture Nursing Interventions Complications of untreated strep throat include glomerulonephritis and rheumatic fever. Caregiver Education Administration of penicillin or amoxicillin as ordered Fluids to keep the child hydrated—soups, popsicles, milkshakes Cool mist humidifier Acetaminophen or ibuprofen for pain and fever Replace toothbrush Throat lozenges Complementary and Alternative Therapies Saltwater gargles (Bochner, Gangar, & Belamarich, 2017) See Table 22–1 or refer to Chapter 21 for information on communicable diseases of the skin, refer to Chapter 11 for additional information on bronchiolitis and TB, and refer to Chapter 18 for information on sexually transmitted infections.

Pediatric nursing ch 22 Flashcards

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