Manifestations - Prodromal period - sudden high fever 103-106, malaise, irritability, child remains active and alert - fever persists for 3-5 days - Mild cough, runny nose, abdominal pain, headache, V/D - After fever subsides within several hours to 2 days - rash appears - Rose-pink maculopapules or macules, blanche with pressure, whitish ring

Therapeutic management - Symptomatic - Antipyretics - Lightweight clothing - Cooler environmental temperatures - Increase fluid intake

The Child with an Infectious Disease Flashcards by Kaylie Krauzyk

Disease Process

Time interval between initial infection and 1st appearance of signs and symptoms

Incubation period

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Early, mild symptoms of disease

Prodromal period

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Period of Illness

* Overt signs and symptoms of disease

* WBC may increase or decrease

* Death may result if immune system or treatment fails

Period of Decline

* Signs and symptoms subside

* Vulnerable to secondary infections

Period of convalescence

* Regains strength and body returns to pre-disease state

* Recovery has occurred

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Chain of Infection

* For a pathogen to maintain an infectious state it needs to be transmitted to another host

* To spread the infection, the pathogen must follow the chain of infection

Agent > Reservoir > Portal of exit > Transmission mode > Portal of entry > Host susceptibility >

Characteristics of the Organism (Pathogen)

Type (viruses, bacteria, fungi, parasites)
Ability to invade host
Virulence
Degree to which it causes disease

Portal of Entry

Eyes
Mucus membranes
Respiratory tract
Placenta
Breaks in host barriers

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Reservoir

Humans
Animals
Environmental surfaces

Portal of exit

Respiratory tract
Genitourinary tract
Gastrointestinal tract
Skin/mucosal surfaces
Placenta
Blood

Mode of Transmission

Direct contact
Droplets
Vectors
Airborne

Characteristics of the Host

Lack of effective resistance
Changes in host defenses
Tissue destruction

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Viral Infections

Viruses

* Small parasitic organisms

* One type of DNA or RNA

* Lack reproductive ability - need host

* Infected host can respond to that viral invasion

Lysis
Continue functioning (asymptomatic)

* May remain dormant until triggered

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* Rubeola (“ordinary” measles, 7-day)

* Rubella (German measles, 3-day)

* Erythema infectiosum (“Fifth Disease”, Parvovirus B19)

* Roseola Infantum (Exanthem Subitum, 3-day fever)

* Coxsackievirus A (hand-foot-mouth)

* Varicella zoster infections (chickenpox, shingles)

* Mumps

* Cytomegalovirus (CMV)

* Infectious mononucleosis (EBV)

* Rabies

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Viral Exanthemas (Rashes)

Rubeola (Measles) - “7-day Measles”

* Causative agent: RNA virus

* Incubation: 8-12 days from exposure to onset of symptoms

* Infectious Period: 3-5 days prior to rash through 4-6 days after onset of rash

* Transmission: Direct contact with droplets and airborne (less frequent)

* Manifestations:
- Prodromal period: 10 days of high fever, 3 C’s = __, __, and __

__ spots
Exanthem (rash) - deep red macular rash, blanches with pressure and gradually turns brownish

coryza, cough, conjunctivitis

Koplik

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Therapeutic management

* Treating symptoms
* Airborne precautions
* Antipyretics
* Quiet activities and bed rest
* Fluids and humidification
* Antitussives

Prevention ⇒ immunization
> 2 doses of MMR

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? (German Measles, 3-day Measles)

Causative agent: RNA virus

Incubation period: 14-21 days

Infectious period: 7 days before onset of symptoms to 14 days after appearance of the rash

Transmission: airborne particles or direct contact with droplets and transplacental transmission (congenital)

Rubella

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Manifestations

* Mild disease - rash 14-21 days after exposure

* Young children - asymptomatic until the rash appears

* Older children - profuse nasal drainage, diarrhea, malaise, sore throat, headache, low grade fever, polyarthritis, eye pain, aches, chills, anorexia, and nausea

* Posterior cervical, posterior auricular, and occipital lymphadenopathy

* Pinkish rose maculopapular exanthem - on the face, scalp, and neck - pruritic

* Petechiae (spots) red or purple color or pinpoint on the soft palate - __ __

Forchheimer’s sign

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Congenital rubella syndrome (CRS) - after maternal infection

Intrauterine growth retardation, weight less than 2500 g, failure to thrive in infancy
Pregnant females should avoid contact
Presumed contagious until one year or after repeated negative nasopharyngeal and urine cultures

Therapeutic management

Supportive and symptomatic
Exclusion from school and should be on droplet precautions for 7 days after onset of rash
Primary prevention for rubella - MMR vaccine

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? (“Fifth Disease” Parvovirus B19)

* Causative agent: parvovirus B19

* Incubation period: 4-17 days up to 28 days

* Infectious period: shedding - 5 and 12 days - from the prodromal period until onset of rash

* Transmission: airborne respiratory droplets, blood, blood products, transplacental transmission

Erythema Infectiosum

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Manifestations

* Common in children ages 5-15

* Mild systemic disease

* Prodromal period: headache, runny nose, malaise, and mild fever

* Rash:
> Intense, fiery red edematous rash on face (maculopapular rash) - “slapped cheek” appearance

> 1-4 days after facial rash appears - erythematous, maculopapular rash appears on trunk and extremities - lacy appearance

* Rash can last from 2 to 39 days; can reappear with environmental factors

Therapeutic management

Symptomatic and supportive
Antipyretics
Antihistamines

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? (Exanthem Subitum, 3-day fever)

* Causative agent: human herpesvirus 6 (HHV-6)

* Incubation period: 5-15 days

* Infectious period: unknown most likely from febrile stage to onset of rash

* Transmission: contact with secretions such as saliva, CSF

Roseola Infantum

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Manifestations

Prodromal period - sudden high fever 103-106, malaise, irritability, child remains active and alert - fever persists for 3-5 days
Mild cough, runny nose, abdominal pain, headache, V/D
After fever subsides within several hours to 2 days - rash appears
Rose-pink maculopapules or macules, blanche with pressure, whitish ring

Therapeutic management

Symptomatic
Antipyretics
Lightweight clothing
Cooler environmental temperatures
Increase fluid intake

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Enteroviruses - ___ (hand, foot and mouth)

Causative agents: RNA viruses

Incubation period: 3-6 days

Infectious period: unknown

Transmission: fecal-oral and oral-oral: contact precautions

Manifestations

Prodromal period: fever
Vesicles in mouth, on palms of hands, soles of feet, and sometimes on buttocks

Coxsackievirus A

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Therapeutic management

Symptomatic
Special attention to dehydration
Hand hygiene/personal hygiene/diaper changes/bathroom use
Analgesics (acetaminophen)
Soft or cool liquid diet - milk-based ice cream
For oropharyngeal lesions
> Rinse mouth with salt and water or
> “Magic mouthwash”
* Equal parts of lidocaine gel, diphenhydramine liquid, and liquid antacid

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Varicella zoster infections (chicken pox and shingles)

* Causative agent: varicella zoster virus

* Incubation period: 10-21 days

* Infectious period: 1-2 days before onset of rash and until all lesions are dried and crusted over

* Transmission: direct contact (open vesicles), droplet, airborne particles

* Immunity: either by natural disease of varicella or varicella vaccine

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Manifestations: Varicella

* Prodromal period: 24-48 hours before onset of lesions
> Low-grade fever, malaise, headache, and anorexia

* On trunk and scalp
> teardrop vesicles with an edematous base > pustular vesicles > crust

Herpes zoster (shingles)

* Primary infection with varicella - lays dormant

* Activation causes herpes zoster - shingles

> Must have had chickenpox previously to get herpes zoster

* Tenderness along the involved nerve and surrounding skin for approximately 2 weeks before lesions

* Rash is unilateral - along a single dermatome of one or more sensory nerves

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Therapeutic management (chickenpox and shingles)

* Symptomatic and supportive
* Oatmeal baths
* Antipyretics (acetaminophen and NEVER ASA)
* Antihistamines
* Avoid scratching the lesions to prevent scars and infection
* Airborne and contact precautions until lesions scabbed
* Prevention through vaccination (1st dose on or before 1st birthday and booster between ages 4-6)

* For herpes zoster
> analgesics; acyclovir; airborne and contact precautions (strict isolation)

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* Causative agent: paramyxovirus

* Incubation period: 16-18 days can go up to 25 days

* Infectious: 7 days prior to swelling (parotitis) and up to 9 days after onset

* Transmission: airborne droplets, salivary secretions, and possibly urine

Manifestations

Prodromal: fever, myalgias, headaches, and malaise
Pain with chewing, earache, pain in the jaw line in front of the ear
Male complication - inflammation of the testes (___ ?)

Mumps

orchitis

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Therapeutic management

* Symptomatic care and adequate hydration
* Soft or liquid diet
* Avoid acidic foods such as orange juice
* Droplet precautions until 5 days after onset
* Antipyretic
* For orchitis - bedrest, intermittent application of ice packs, pain management, emotional support and diversional activities

* Prevention - vaccination with the MMR vaccine

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* Causative agent: human cytomegalovirus

* Incubation period: unknown

* Transmission: saliva, urine, blood, semen, cervical secretions, breast milk, organ transplants

* Leading cause of hearing loss and intellectual disability in infants in the US

Therapeutic management
> Early detection of disabilities
> Hearing aids, cochlear implants, speech therapy
> Detect learning disabilities and early interventions with physical speech and cognitive therapy

Cytomegalovirus (CMV)

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? (Epstein-Barr Virus [EBV]) \* Incubation period: 4-7 weeks \* Infectious period: unknown \* Transmission: direct contact through saliva, intimate contact or blood

Infectious Mononucleosis

Manifestations \* *Prodromal period*: fever, exudative pharyngitis, lymphadenopathy (cervical, axillary, and inguinal) \* **_Enlarged lymph nodes_**, sore throat, high fever, pain with swallowing, petechiae on palate, enlarged tonsils with white exudate, and firm, tender, cervical lymph nodes \* May develop to abdominal pain with liver and spleen enlargement - hepatosplenomegaly

Therapeutic management \* Supportive \* Steroids PRN for acute tonsillar swelling \* Rest; avoid physical activity and contact sports to minimize the risk of rupturing the spleen \* Antipyretics \* Hydration \* Soft or liquid diet and foods; milkshakes

? \* Causative agent: rhabdovirus \* Incubation period: 5 days to more than 1 year \* Infectious period: 10 days \* Transmission: bites with contaminated saliva, scratches from claws of infected animals, airborne from bat infested caves Manifestations \> Slowly developing infection \> Prodromal period: sore throat, headache, fever, anxiety \> Discomfort at the site of the bite, hyperactivity, muscle spasms (involuntary twitching) or convulsions \> Decreased ability to swallow (contractions of the mouth) resulting in drooling or aspiration \> Coma, death

Rabies

Therapeutic management - Prevention is important - Cleanse bite wound with large amounts of soap and water - Administer human rabies immune globulin (HRIG) - Rabies vaccination

Bacterial Infections

\* Organisms that contain both DNA and RNA \* Complex cell wall \* Classified as gram-positive or gram-negative bacteria \* Bacteria secrete toxins (exotoxins, endotoxins)

\* Whooping cough \* Scarlet fever \* Cellulitis \* Methicillin Resistant Staphylococcus Aureus (MRSA) \* Clostridium difficile (C. diff) \* Impetigo

Rare Viral & Bacterial Infections \* Poliomyelitis infantile paralysis \* Diphtheria

? Portion of a gram-negative cell and cause fever, shock, and DIC

Endotoxins

? May cause cell damage by cell lysis, inhibition of protein synthesis, or interference with passage of nerve impulses

Exotoxins

? \* Causative agent: *Bordetella pertussis* (gram-negative bacteria) \* Incubation period: 5-21 days \* Infectious period: catarrhal stage 1-2 weeks up until the 4th week \* Transmission: direct contact or respiratory droplets from coughing Manifestations \> 3 stages of

Whooping cough

? stage Episodes of coughing and vomiting

Convalescent

? stage Rhinorrhea, lacrimation, mild cough, and low-grade fever

Catarrhal

? stage Increased severity of cough; repetitive series of coughs with a whoop; cyanosis Thick, tenacious mucous; protrusion of the tongue; salivation; distention of neck veins Coughing spells may be triggered by yawning, sneezing, eating or drinking; coughing may induce vomiting

Paroxysmal

Treatment regimen - Push fluids - Monitor respiratory status (with cardiopulmonary monitor), pulse oximeter and vital signs - Keep oxygen and suction equipment available - Quiet and calm environment - Monitor nutritional status - small frequent to avoid exhaustion - Erythromycin, azithromycin, or clarithromycin may be given during catarrhal stage - Droplet precautions - Prevention with vaccination administration of 5 doses of the pertussis vaccine in combination with tetanus and diphtheria (DTaP)

? \* Causative agent: Group A beta-hemolytic streptococci \* Incubation period: 1-7 days \* Infectious period: acute stage until 24 hours after antibiotic therapy has begun \* Transmission: direct contact and airborne (inhalation or ingestion)

Scarlet fever

Manifestations \* Prodromal period: fever, vomiting, headache, pain, pharyngitis, and chills \* Within 24 hours - rash fine red papules - axillae, groin, and neck (feels like sandpaper) \* Rash blanches on pressure (\_\_ \_\_) \* Desquamation (peeling of the skin) \> flaking \* Tongue is coated - a white furry covering with red projecting papillae (called __ \_\_ \_\_) \> slough off leaving a red swollen tongue (called __ \_\_) \* Tonsils edematous and covered with grey-white exudate that can spread to the pharynx \* Petechial hemorrhages cover the soft palate

**Pastia's sign** * *white strawberry tongue** * *strawberry tongue**

Therapeutic management \* Diagnostic is done with rapid streptococcal screening in the office setting \* Penicillin - complete full course - 10 days \* Supportive care for symptoms like antipyretics and analgesics, antipruritics, throat lozenges, antiseptic spray (chloroseptic) \* Droplet precautions until the child has been on antibiotic for 24 hours

\* Hydration - soft or liquid diet - avoid acidic foods or fluids - encourage ice-pops or milkshakes \* Bedrest and quiet activities - prevent fatigue \* Oral care - avoid acidic mouthwash preparations - may do saline rinses \* Complications - rheumatic fever and acute post-streptococcal glomerulonephritis

? \* Bacterial infection of the subcutaneous tissue and dermis \* Causative agents: *Haemophilus influenzae* type B, Group A streptococci, and *Staphylococcus aureus* * Manifestations* - Affected area red, hot, tender, and indurated - If *Haemophilus influenzae* - affected area may have purplish tinge - With periorbital cellulitis - edema and purple discoloration of the eyelids and decreased eye movement \> ___ - red streaking of surrounding area and enlarged regional lymph nodes (lymphadenitis) - Fever, malaise, and headache

Cellulitis Lymphangitis

Therapeutic management \* Initial dose of IM or IV antibiotic - ceftriaxone \* Extremity - oral antibiotics such as cephalosporin, cloxacillin, or dicloxacin \* Joint or face - IV antibiotics; incision and drainage \* Rest with elevated extremity \* Warm moist soaks \* Analgesics and antipyretics \* Frequent hand washing

Methicillin Resistant Staphylococcus Aureus (MRSA) \* Causative agent: *Staphylococcus aureus* (a gram-positive cocci) \* May cause cellulitis \* Transmission: contact \> Can be hospital-acquired or community-acquired \> Source of most skin and soft tissue infections Manifestations - _HA-MRSA_: are medical device-related infections, pneumonia (VAP), and catheter related bloodstream infections - _CA-MRSA_: are infections of skin and soft tissue

Therapeutic regimen \* Warm soaks \* Severe cases - incision and drainage and IV vancomycin or linezolid \* Blood cultures \* Most cases - treated with a 5-10 day course of oral vancomycin, clindamycin, sulphamethoxazole-trimethoprim or linezolid \* Handwashing important for prevention \* Contact precautions

Clostridium difficile (C. diff) \* Causative agent: Clostridium difficile (gram-positive anaerobic bacterium) \* Transmission: contact (fecal-oral) \* Incubation period: unknown \* Manifestations \> May be asymptomatic \> May have watery diarrhea, abdominal cramps, fever, and possible systemic toxicity \> Associated with antibiotic therapy

Diagnosis - identification of toxins in stool Treatment regimen: - Initial treatment would be cessation of antibiotic - C. difficile associated diarrhea (CDAD) \> Includes a 7-10 day course of oral metronidazole for mild-to-moderate disease \> or vancomycin for more severe diseases \* **Contact precautions (requires meticulous hand hygiene)** \* ***C. difficile* spores are not killed by alcohol-based hand sanitizers**

? \* Highly contagious \* Incubation period: 7-10 days \* Transmission: direct contact or indirect contact \* Causative agent: *Staphylococcus aureus*, group A beta hemolytic streptococci or both

Impetigo

Manifestations \* __ \_\_ - small vesicles - progress to bullae - lesions filled with serous fluid and later become pustular - rupture - a shiny lacquered-appearing lesion surrounded by a scaly rim \* __ \_\_ - vesicle or pustule - ruptures - honey-colored crust erosions that bleed easily when crusts are removed \* May be pruritic \* Located around the mouth and nose \* Usually resolve within 12-14 days with treatment

Bullous impetigo Crusted impetigo

Therapeutic regimen - Topical and oral antibiotics - Gently wash 3x/day with warm soapy washcloth, crust soaked, and carefully removed \* Topical ointment - muciprocin (Bactroban) or bacitracin (Baciguent) x7-10 days \* Good hand washing and careful hygiene \* NOT attend school or daycare for 24 hours after beginning treatment

\* Child should sleep alone and bathe alone daily \* Caregiver should wear gloves when caring for the child \* Complete full course of topical or systemic antibiotics as prescribed \* Keep fingernails short and wash child's hands frequently with antibacterial soap \* Do not share towels, combs or eating utensils with the infected child

Poliomyelitis Infantile Paralysis \* Causative agent: polio virus \* Incubation period: 7-10 days \* Infectious period: just before and after onset of symptoms 1-6 weeks \* Transmission: fecal-oral or oral-oral: direct and indirect contact Manifestations - Prodromal period: fever, headache, nausea, vomiting, abdominal pain, mild neck, back, and leg stiffness - Intense pain, tremors of extremities, and paralysis due to CNS involvement - Difficulty swallowing and respiratory paralysis

Treatment regimen - Mechanical ventilation - Physical therapy - Analgesics - Contact precautions Prevention - routine immunization (polio)

Diphtheria \* Causative agent: Corynebacterium diphtheriae (gram-positive non-motile bacillus) \* Incubation period: 2-6 days \* Infectious period: 2-4 weeks untreated or 1-2 days treated \* Transmission: direct contact with respiratory secretions Manifestations - Prodromal period: resemble common cold - Gradually progresses to nasal discharge of foul-smelling mucopurulent material and brassy cough - Low-grade fever - Hallmark sign - **"bullneck"** or neck edema - May lead to myocarditis, HF, paralysis, and airway obstruction

Treatment regimen \* IV diphtheria antitoxin \* IV antibiotics - erythromycin or penicillin G within 3 days of symptom onset \* Bed rest \* Droplet precautions \* Prevention - with vaccination (DTaP)

Fungal Infections

\* Normal human flora (mouth, intestine, vagina, skin) \* Transmitted through inhalation or penetration of tissue \* Slow growth \* Resistant to temperatures and most antibiotics \* Pathogenic fungi: molds and yeasts \* Infections caused by fungi are classified as: - Opportunistic - Systemic - Subcutaneous - Superficial (skin and nails)

? Ringworm of the scalp Interventions: oral griseofulvin for at least 6 weeks

Tinea capitis

? Jock itch \* Not contagious - results from poor hygiene, friction from tight clothing, and obesity \* Interventions: clotrimazole cream or lotion

Tinea cruris

? Athlete's foot Interventions: clotrimazole (Lotrimin) cream, lotion or spray; Miconazole (Monistat) or oxiconazole (Oxistat) 2x/day until lesions have cleared for 1 week

Tinea pedis

? Ringworm of the body Interventions: Clotrimazole (Lotrimin) cream or lotion or Miconazole (Monistat) 2x/day for 4 weeks \* Keep dry and avoid contact, handwashing Tinea infections are transmitted from person to person, animal contact, or by contact with contaminated fomites (combs, hats, headrests, pillows)

Tinea corporis

Candidal Infections - Candidiasis Oral = ? \> Superficial fungal infection of oral mucous membranes resulting from an overgrowth of *C. albicans* Manifestations - white curd-like plaques on tongue and buccal mucosa Diaper area - Lesions caused by passage of *C. albicans* through the intestine - Manifestations: bright red and coalesced lesions may spread to the child's abdomen and thighs

thrush

Therapeutic Management \* Nystatin oral suspension (100,000 units per mL) every 6 hours until 3-4 days after the symptoms have resolved \> Applied to mucous membranes of the mouth (gums, tongue, and buccal mucosa); applied after feedings \* Pacifiers, nipples, and bottles should be cleaned thoroughly \* Teach hand hygiene technique \* If breastfeeding - breast should also be treated with Nystatin

\* Encourage small frequent feedings and for older children - cool liquids \* Oral fluconazole may be given as an alternative \* Candidal diaper dermatitis treated with topical antifungal agent - Nystatin or clotrimazole (Lotrimin) \> Leave diaper area exposed to air to reduce moisture

Rickettsia Infections ? \* Rickettsiae - small, parasitic bacteria Causative agent: *Rickettsia rickettsii* Reservoir: Wild rodents and dogs Vector: ticks (wood, dog, or Lone Star) Incubation period: 2-14 days Transmission period: bite of infected tick

Rocky Mountain Spotted Fever

Manifestations - Headache, fever, and anorexia, restlessness - Maculopapular rash (wrists, palms, ankles, and soles) - Hemorrhagic and necrotic lesions may appear

Therapeutic managment - Doxycycline (may stain teeth - use straws and flush mouth after adminstration) - Fluoroquinolone as an alternative - Treatment lasts 7-10 days

Borrelia Infections Lyme Disease \* Causative agent: Borrelia burgdorferi (spirochete) \* Vector: Tick \* Incubation period: 3-33 days \* Infectious period: not communicable from one person to another \* Transmission: bite of infected deer tick

Manifestations - Early localized stage - Early disseminated stage - Late disseminated

\_\_ __ stage - Intermittent, chronic arthritis, profound fatigue, chronic neurological manifestations

Late disseminated

\_\_ __ stage - Severe headaches with myelitis, N/V, facial nerve paralysis (Bell's palsy), forgetfulness or decreased concentration, and cerebral ataxia - General lymphadenopathy and joint and muscle pain

Early disseminated

\_\_ __ stage - Local reactions - erythematous papule at bite site - erythema migrans or "**_bullseye rash_**" and flu-like symptoms (headaches, chills, fatigue, muscle aches, and pains)

Early localized

\* Primary prevention - anticipatory guidance and measures to prevent and avoid insect bites - Protective, light-colored clothing - Inspect skin thoroughly after exposure to heavily wooded area - Proper use of insect repellents (DEET - not over 30%) \* Oral antibiotic therapy - doxycycline, amoxicillin, or cefuroxime - 14-21 days \* If neurologic or cardiac symptoms - IV ceftriaxone 2-3 weeks \* Analgesics and antipyretics (fever, arthralgias, headaches)

Helminthic Infections - Tapeworms - Roundworms - Pinworms - Hookworms *Education focus on medication administration, primary prevention (personal hygiene and health habits), and identifying resources for basic living needs (running water)*

? Handling or eating infected beef or pork Manifestations \> Asymptomatic, abdominal pain, nausea, anorexia, weight loss, insomnia Treatment \> Praziquantel, niclosamide

Tapeworms

? Ingestion or inhalation of eggs, transfer from hands to mouth Manifestations: nocturnal anal itching, sleeplessness Treatment: Pyrantel pamoate, mebendazole, albendazole

Pinworms

? Ingestion of eggs from contaminated soil or food, transfer to mouth from fingers, toys, or other vectors Manifestations: abdominal pain or distention, abdominal obstruction, vomiting with bile staining, pneumonitis Treatment: Mebendazole, albendazole, ivermectin

Roundworms

? Skin penetration from direct contact with contaminated soil Manifestations: dermatitis, blood loss - anemia, pneumonitis, malnutrition Treatment: Mebendazole, albendazole, pyrantel pamoate

Hookworms

Sexually Transmitted Diseases (STDs) \* Chlamydia (chlamydial infection) \* Gonorrhea \* Human Papillomavirus (HPV) \* Herpes simplex virus \* Syphilis \* Trichomoniasis

Chlamydial Infection \* Most prevalent \* Transmission: during birth with infected mother or through sexual activity \* Manifestations \> __ \_\_ - watery discharge - purulent; eyelids edematous and conjunctiva inflamed; mucoid rhinorrhea; may progress to infection of nasopharynx with progression to pneumonia \> Adolescents - urethritis with dysuria; urinary frequency; mucopurulent vaginal discharge

**Neonatal conjunctivitis** Therapeutic management \* Conjunctivitis and pneumonia: 14-day course of erythryomycin \* Genital tract infection - single dose of azithromycin or 7-day course of doxycycline \* Treat all sexual partners

Gonorrhea \* Transmission: intimate contact (perinatally - during birth, sexual abuse, sexual intercourse) \* Manifestations \> __ \_\_: 1-4 days after birth - thick purulent discharge from eyes may progress to corneal ulceration, rupture, and blindness - Prophylactic treatment with ophthalmic antibiotic ointment immediately after birth \> Females - purulent vulvovaginitis \> Males - urethritis

**Ophthalmia neonatorum** Therapeutic management - Ceftriaxone for children and adolescents - Cefotaxime for infants - Sexual partners should also be treated

Human Papillomavirus (HPV) \* Responsible for common wart and genital warts (condylomata acuminata) \* Transmission: direct sexual contact; multiple sexual partners; or perinatal contact during birth \> ***Children with anogenital warts should be investigated for sexual abuse*** \* Manifestations: anal genital warts; found in moist areas (labia minora, vagina, cervix, anus, rectum, and glans of the penis)

Therapeutic management: most resolve spontaneously; - Topical gels, creams, cryotherapy, electrocautery laser treatment or surgical removal - Screening for cervical cancer - Papanicolau (Pap) test - Vaccinations \> HPV 6/11/16/18 vaccine (Gardasil) females and males ages 9-26 \> Recommendation is for females ages 11-12 to be immunized with one of the HPV vaccines \> Males can receive the HPV 9 or HPV 4 vaccine

Herpes Simplex Virus \* Most frequent STD in US \* Causative agent: Herpes Simplex Virus type 2 (genital herpes) \* Incubation period: 2-14 days \* Transmission: Direct sexual contact with infected person - Infected mother can transmit to newborn with vaginal delivery - Women with active HSV advised to have C-section delivery

Manifestations - Vesicles on the vulva, perineum, perianal area - Pain and tenderness in the affected area - Flu-like symptoms (fever, malaise, dysuria, and enlarged lymph nodes) - Virus remains dormant in the nerve ganglia and reappear with stressful trigger Therapeutic management - Culture from the secular fluid confirms diagnosis - No cure for HSV 2 - Acyclovir (Zovirax) - reduce symptoms and shedding time - Infected neonates - treated with parenteral acyclovir - Adolescents treated for 10 days with oral acyclovir, valacyclovir, or famciclovir

Syphilis \* Transmission: intimate contact; transplacentally or sexually \* __ syphilis transmitted through placenta or during birth \> Symptoms within the first 3 months of life \* __ syphilis transmitted through sexual contact Manifestations - Rhinitis, maculopapular rash, hepatosplenomegaly - Bones, teeth, eyes, and eighth cranial nerve involved - teeth notched (Hutchinson's teeth) and hearing loss may occur around age of 8-10 Treatment: penicillin and tetracycline

Congenital Acquired

Trichomoniasis \* Transmission: perinatal contact during delivery, sexual activity Manifestations - Mostly asymptomatic in males - Females - dysuria, vaginal itching, burning, frothy yellowish green foul-smelling discharge - Classic - ***strawberry cervix*** Therapeutic management - One dose of metronidazole (Flagyl, Protostat) or tinidazole - Sexual partners should also be treated ***Prevention is major nursing goal***

Nursing Considerations \* *Prevention, early identification, and treatment are major goals of nursing care related to any STD* - Nurse plays key role in educating - Being non-judgmental - Reassuring confidentiality - Build trust and rapport with adolescents \> School nurses - healthcare professional with whom adolescents establish trusting relationships To prevent STDs - encourage abstinence for adolescents who are not sexually active and condoms for those who are sexually active

Nursing Diagnosis Associated with Infectious Process - Acute Pain - Impaired comfort - Impaired skin integrity - Risk for infection - Risk for imbalanced body temperature - Ineffective thermoregulation - Deficient fluid volume - Impaired swallowing - Fatigue - Deficient knowledge - Social isolation - Deficient diversional activity

The Child with an Infectious Disease Flashcards

(75 cards)