* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Nursing Care - rivier.instructure.com.
Survey
Document related concepts
Child protection wikipedia , lookup
Diseases of poverty wikipedia , lookup
Child migration wikipedia , lookup
Transnational child protection wikipedia , lookup
Child Protective Services wikipedia , lookup
Focal infection theory wikipedia , lookup
Public health genomics wikipedia , lookup
Unaccompanied minor wikipedia , lookup
Eradication of infectious diseases wikipedia , lookup
Canine parvovirus wikipedia , lookup
Canine distemper wikipedia , lookup
Compartmental models in epidemiology wikipedia , lookup
Marburg virus disease wikipedia , lookup
Hygiene hypothesis wikipedia , lookup
Transcript
Essentials of Pediatric Nursing Chapter 15: Nursing Care of the Child With an Infectious or Communicable Disorder Infectious Process Preventing the spread of infection Read pages 446 – 449 in Kyle & Carman to review this information Also review Box 15.3 page 450 in Kyle & Carman on Standard and Isolation Precautions(AirbornDroplet-Contact) which are commonly used caring for children with infectious diseases. Nurses are responsible for following these precautions and teaching children and families about these standards Many children hospitalized will be put on isolation – ALWAYS follow requirements for PPE. Variations in Pediatric A&P Immature immune systems of infants and children make them more susceptible to infections Newborns display a decreased inflamatory response to invading organisms Once infected, more difficult for child to fight infection Immunizations in young children not complete Infants and toddlers are curious and handle/put into mouth objects that may be contaminated Nursing Process Overview of Child with Communicable Disorder Assessment Nursing Diagnoses Goals Interventions Evaluation GENERAL CONCEPTS WHEN PROVIDING CARE Managing Fever (read page 451-52 Boxes 15.1 in Kyle & Carman) Fever is a sign of illness, not a disease, and is body’s weapon to fight infections Teach parents about fever and how to manage them Infants < 3 months with rectal temp >38 degrees Centigrade or 100 degrees F should contact PCP Infants > 3 months temp >39 degrees C or 102 F contact PCP Plan ahead and give parents directions/doses BEFORE event Managing Fever (cont.) Home management if child uncomfortable: Hydrate, dress lightly, tepid bath if child tolerates, cooling blanket Antipyretics: acetaminophen: Recommended dose 1015 mg/kg/dose every 4 hours. Don’t exceed 5 doses/24 hours Ibuprofen: Recommended dose 5-10 mg/kg/dose in children more than 6 months. Maximum 4 doses daily NEVER give Aspirin to reduce fever in children < 19 y.o. – risk of Reye syndrome Managing Skin Rashes http://www.medicinenet.com/skin_pictures_child_pictures_slideshow/article.htm Teach parents ways to manage discomfort and maintain skin integrity Management includes: Antipyretics/antihistamines like Benadryl, oral and topical. Consult PCP before giving for dose Diphenhydramine (Benadryl)Give 0.5 mg per pound every 4-6 hours. (See dosing chart) The package doesn't give a dose for under 2 years of age; not recommend for children under the age of one. Cool compresses, running cool water or baths with soothing additives like oatmeal Topical: aloe vera, Caladryl, Calamine lotion Managing Rashes (cont.) Discourage scratching Keep nails short Cover infants/young child’s hands with mittens or gloves Sepsis Systemic overresponse to infection resulting from various organisms Can lead to septic shock, a medical emergency that may lead to organ failure and death May affect any age group but more common in neonates and young infants due to immature immune system Treated in NICU or PICU with antibiotics, symptom management, support vital signs Prognosis variable so AIM is to PREVENT! Mortality rate range 40-60% Managing Infections Thorough Nursing Assessment History: especially exposure to someone with contagious or infectious disease VS, skin, respiratory or GI signs and symptoms Laboratory and Diagnostic Tests Blood tests: complete count. WBC elevated (low in severe cases) Elevated C-reactive protein Positive blood culture with septicemia Tests (cont.) Urine Cultures: positive if bacteria present Remember how to obtain specimens in infants/children Cerebral Spinal Fluid: increased WBC’s and protein, low glucose Stool Cultures: positive for bacteria or other organisms, including worms Cultures of wounds, tube sites, nares, sputum X-rays or Scans: lung infections Infectious Disorders Communicable diseases: Incidence has declined with increase of immunizations Further decreased with use of antibiotics and antitoxins Nursing Assessment in Identification of Infection Recent exposure to infectious agents Prodromal symptoms: symptoms that occur between early manifestations of the disease and its overt clinical syndrome Immunization history History of having the disease Caution for Compromised Children Children with immunodeficiency: Receiving steroid therapy Other immunosuppressive therapies Generalized malignancies Immunologic disorder Chronic diseases like sickle-cell Prevent Spread of Disease Primary prevention of the disease: Immunization Control spread of disease to others: Reduce risk of cross-transmission of organisms Infection control policies Hand washing Nursing Process and Care Plan The following slides include guidelines to care for children with communicable diseases Individualize the plan of care based on Child’s age and developmental needs Type of infection, mode of transmission Signs and symptoms of disease Nursing Management of Child with Communicable Disease ASSESSMENT: Identify S&S of disease. Nurses in schools, ambulatory care settings and child care centers often first to observe. Diagnoses (Problems): Risk for infection r/t susceptable host and infectious agent Pain/discomfort r/t skin lesions, malaise Impaired social interactions r/t isolation Risk for Impaired skin integrity r/t scratching from pruritis/itching Interrupted Family Processes r/t sick child Planning: Expected patient outcomes. Child will: Not spread infection to others Not experience complications Have minimum discomfort With family, receive adequate emotional support Implementation (Refer to pgs. 469-473 & 482-85 for each disease) Maintain and teach proper precautions with hospitalized child based on disease: standard, airborne, droplet, contact Keep children at home away from susceptible individuals: high risk children and elderly, pregnant women Obtain any cultures if ordered Encourage rest and decreased activity. Children with poliomyelitis will need physiotherapy, positioning and added skin care Manage symptoms to provide comfort: Fever: antipyretic like acetaminophen, NSAIDS like ibuprophen. Avoid aspirin with children > Reyes syndrome (toxic encephalopathy with cerebral edema and fatty liver changes). Teach parent correct dosage for child’s weight and age. Keep child cool but not cold enough to shiver Added precautions if child prone to seizures Implementation (cont.) Pain Itching/Skin Care Analgesics like acetaminophen, ibuprophen (NO ASA). Children usually prefer liquid form Apply hot or cold compresses to affected area (neck with mumps) Keep skin clean, change clothes and linens daily Apply topical calamine lotion Keep child’s nails short (mittens if child scratches). Teach child to press not scratch itchy lesions > may lead to secondary infections Eye Care Dim lights if photophobia present Clean eyes with warm saline solution to remove secretions or crusts Keep child from rubbing eyes More Interventions Cough/Airway/Breathing Observe for signs of airway obstruction or paralysis (pertussis & poliomyelitis) Ensure adequate oxygenation. During spasms keep infant/child on side to minimize chances of aspiration with vomitting Provide humidified oxygen if needed and ordered to maintain O2 sats. Oral suctioning to prevent choking on secretions Relieve sore throat with analgesic gargles, lozenges, throat sprays and inhaled cool mist. Consider child’s age when selecting method Nutrition and Fluids Encourage fluids, small amounts at a time. Avoid irritating liquids Soft diet, offer foods child likes Other Therapies Additional Medications Antibiotics (oral or IM) for children with scarlet fever, diptheria and pertussis to prevent complications Varicella-Zoster immune globulin (VariZIG) or immune globulin intravenous (IGIV) for immunocompromised children who may be exposed to varicella Antivirals:Acyclovir (Zovirax) for at risk newborns, children, pregnant women - Vitamin A suppliments with measles to reduce morbidity and mortality - Mild sedatives as needed to relieve anxiety and promote rest Bacterial Infections One-celled organisms that exist everywhere Children at risk for developing bacterial infections Sanitation, avoidance and immunizations ways to PREVENT INFECTIONS Community-Acquired MethicillinResistant Staphylococcus Aureus (CAMRSA) Increasing in incidence in USA Before 1990’s mainly hospital acquired Varies from mild( skin rash, abscesses) to serious (sepsis, pneumonia, osteomyelitis) Transmission by direct contact with person, blood, sputum or sharing personal items Clusters seen in day care centers and athletic teams CAMRSA Dx. And Management S&S: Skin: Bump (resembles insect bite); or red, swollen, painful or warm area Lesion or abscess, purulent drainage Fever Cellulitis Diagnosis Culture: may need to incise and drain area Antimicrobial susceptibility essential to test Nursing Management Home or Inpatient – depends on severity Antibiotics with microbial susceptibility Comprehensive wound care Oral: teach to complete prescription IV: hospitalize or IV home therapy Warm soaks to abscess/bump/pimple May require I&D – incision and drainage Child and family education Medications; wound care; hand washing; risk factors; S&S of MRSA Communicable Diseases Scarlet Fever FIG. 14-6 Scarlet fever. Scarlet Fever Agent: group A β-hemolytic streptococci Transmission: droplet or direct contact Incubation period: 1-7 days Complications: carditis, peritonsillar abscess, glomerulonephritis Pertussis (Whooping Cough) Agent: Bordetella pertussis Transmission: droplet or direct contact Incubation period: 6-20 days Short rapid coughs followed by crowing or “whoop” sound Complications: pneumonia (usual cause of death) 2010 - Pertussis Outbreak in California http://www.youtube.com/watch?v=0GKiB YuzpL0 Diphtheria Caused by Corynebacterium diphtheriae May affect nose, larynx, tonsils or pharynx Occurs in unimmunized children under 15 years S&S: Sore throat, fever,edematous neck and lymphadenopathy, pseudomembrane may cause airway obstruction and suffocation Treatment: antibiotics and antitoxin, airway management, strict droplet precautions, bedrest Tetanus Acute, often fatal caused by toxins produced by Clostridium tetani Rare in USA due to immunization 4 Types: Neonatal most common worldwide Spores found in soil, dust feces and enters body through wound S&S: Affects muscles of back and neck. Complications include: breathing problems, fractures, elevated BP, dysrhymias, blood clotting and coma Treatment: support breathing an cardiovascular function, tetanus immunoglobulin, debride wound, antibiotics. Severe may need mechanical ventilation Nursing Care: Teaching about prevention and immunization Viral Infections Microscopic organisms that cannot multipy on their own and require a living host Children highly sensitive to viruses due to their immune system Best to PREVENT by immunizing children Treatment includes symptom management Common Viral Exanthems (rash or skin eruption) of Childhood Refer to pages 440-444 in Kyle Usually cared for at home Hospitalized if child very ill Use appropriate transmission-based precautions Management and plan of care focuses on fever management and relief of symptoms Varicella zoster (Chicken Pox) The virus that causes chickenpox is varicella-zoster, a member of the herpes virus family. The same virus also causes herpes zoster (shingles) in adults. An airborne disease spread easily through coughing or sneezing of ill individuals or through direct contact with secretions from the rash. A person with chickenpox is infectious one to two days before the rash appears.[2] The contagious period continues for 4 to 5 days after the appearance of the rash, or until all lesions have crusted over. A child with chickenpox should be kept out of school until all blisters have dried, usually about 1 week. A varicella vaccine was first developed by Michiaki Takahashi in 1974 derived from the Oka strain. It has been available in the U.S. since 1995. Varicella zoster (Chicken Pox) Symptoms Most children with chickenpox act sick, with symptoms such as a fever, headache, tummy ache, or loss of appetite for a day or two before breaking out in the classic pox rash. These symptoms last 2 to 4 days after breaking out. The average child develops 250 to 500 small, itchy, fluid-filled blisters over red spots on the skin. The blisters often appear first on the face, trunk, or scalp and spread from there. Appearance of the small blisters on the scalp usually confirms the diagnosis. Varicella (cont.) Treatment In most cases, it is enough to keep children comfortable while their own bodies fight the illness. Oatmeal baths in lukewarm water provide a crusty, comforting coating on the skin. An oral antihistamine can help to ease the itching, as can topical lotions. Trim the fingernails short to reduce secondary infections and scarring. Until all chickenpox sores have crusted over or dried out, avoid playing with other children, going back to school, or returning to work. Erythema Infectiosum (Fifth Disease) Refer to Table 14-1 pgs. 454-463 Agent: human parvovirus Rash in three stages: “Slapped face” appearance disappears between 1 and 4 days Maculopapular rash on extremities; lasts 7 days or more Rash subsides but reappears if skin irritated or traumatized by heat, cold, friction, etc. Roseola (Sixth disease) Agent: human herpes virus type 6 Incubation: 5-15 days Persistent high fever for 3-4 days; otherwise appears well After fever subsides, rash appears Rash first on trunk, then face and extremities Mumps Agent: paramyxovirus Transmitted via droplet or direct contact Incubation period: 14-21 days Fever, headache, malaise, followed by parotitis May cause orchitis and meningoencephalitis Rubeola (Measles) Agent: virus Source: secretions; droplet transmission Incubation period: 10-20 days; communicability from 4 days before to 5 days after appearance of rash Koplik spots: white spots in mouth appear 2 days before rash The three Cs—cough, coryza (runny nose) and conjunctivitis (red eyes and photophobia) Complications of Measles Complications of measles infection may include: Bronchitis Encephalitis (about 1 out of 1,000 measles cases) Ear infection (otitis media) Pneumonia Rubella (German Measles) Agent: rubella virus Transmission: direct contact or indirect contact with article freshly contaminated with nasopharyngeal secretions, blood, stool, or urine Incubation period: 14-21 days Complications: rare; greatest danger is teratogenic effect on fetus Poliomyelitis Cause by highly infectious poliovirus Spread fecal-to-oral or oral-to-oral route Most common in young children, also called infantile paralysis Rare in USA due to polio vaccinations S&S: fever, fatigue, headache, vomiting, stiff neck, limb pain. Progress to tremors of extremities and possible paralysis. Severe may involve respiratory muscles Treatment: PREVENT by vaccine; supportive care since no cure Zoonotic Infections Rabies Preventable viral infection Transmitted to humans by contact with saliva of infected animal Rare in USA due to routine vaccination of domestic animal. May catch from wild animals Teach children to avoid wild, aggressive animals Treatment: Regimen of immune globulin as soon after exposure as possible. Once S&S appear poor survival rate Cat Scratch Disease Fairly common; caused by Bartonella henselae in saliva of cats S&S: appear 7-12 days after infected. Include: headache, fever, anorexia, fatigue, papule or pustule at site of scratch or bite. Lymphadenopathy may develop Management: Antibiotics as ordered Wound care Teach prevention and caution with cats Vector-Borne Infections Lyme Disease Most common in USA, caused by spirochete Borrelia burgdoreri Most common in Northeast between April and October. Incidence highest in children 5-10 years Assess child for tick bites S&S: fever, malaise, mild neck stiffness, headache, fatigue, myalgia, and arthalgia of joints, often with swelling Early sign ring-like or bullet rash 2 step test to find antibodies by blood or joint fluid Treatment: Antibiotics for prescribed time. Educate child and family about prevention: repellent, cover skin, check for ticks daily Rocky Mountain Spotted Fever Most severe rickettsial illness in USA Carried by ticks, fleas and lice S&S: noncardiogenic pulmonary edema. Cerebral edema, neurologic involvement, rash Treatment: Tetracyclines, chloramphenicol in children less than 9 years due to risk of teeth staining West Nile Virus and Eastern Equine Encephalitis(EEE) West Nile Virus: fever, meningitis, encephalitis, flaccid paralysis EEE: TREATMENT: abrupt onset and is characterized by chills, fever, malaise, arthralgia, and myalgia. lasts 1 to 2 weeks, and recovery is complete when there is no central nervous system involvement. In infants, the encephalitic form is characterized by abrupt onset; in older children and adults, encephalitis is manifested after a few days of systemic illness. Signs and symptoms in encephalitic patients are fever, headache, irritability, restlessness, drowsiness, anorexia, vomiting, diarrhea, cyanosis, convulsions, and coma. Supportive, manage symptoms No vaccine available Approximately a third of all people with EEE die from the disease. Parasitic and Helminthic Infections Children at risk for both due to poor hygiene practices Parasites Organisms larger than yeast or bacteria Live in or on a host Receive nourishment from host without benefiting or killing the host Example include scabies and head lice Helminth A parasitic intestinal worm Include pinworms, roundworms and hookworms Intestinal Parasitic Diseases Ascariasis (common roundworm) Tranferred to mouth from contaminated food, fingers or toys Prevalent in warm climates Infections light-heavy-severe: S&S include anorexia, irritability, weight loss, enlarged abdomen, fever. May lead to intestinal obstruction, appendicitis, perforation, obstructive jaundice, pneumonitis Diagnosis will need to be made by a doctor with the assistance of a pathology laboratory. The laboratory will be able to discover characteristic roundworm eggs in a stool sample. Adult roundworms, which can grow as big as 40cm long, may occasionally be passed in a stool or be present in vomit. Treatment A roundworm infestation can be treated with Vermox or Combantrin-1, which contain mebendazole, or Combantrin, which has pyrantel embonate as its active ingredient. Hookworm Transmitted by eggs in soil, picked up by skin contact. Child should wear shoes S&S vary with severity: anemia, malnutrition, erythema and papular eruptions with itching and burning Enterobiasis (Pinworms) Caused by nematode Enterobius vermicularis – most common helminthic infection in USA Present in temperate climate zones Found in crowded conditions: classrooms, daycare centers. May infect 30% of children at one time Spread when eggs ingested or inhaled (eggs float in air) Diagnosis: Tape test S&S: *Intense perianal itching > irritability, restlessness, poor sleep, bedwetting; perianal dermatitis and excoriation; vulvovaginitis; urethral infection Therapeutic/Medical Management Drugs include: *mebendazole (Vermox), pyrantel pamoate (Pin-Rid, Antiminth) and albendazole All members of household treated Repeat in two weeks to prevent reinfection Nursing Management Perform or teach “Tape test”: tongue depressor with sticky tape placed near rectum in early morning as soon as child awakens and before first BM. Done 3 or > days; depressors placed in bag or jar for microscopic exam Administer and Teach parents proper drug administration and dosing - Teach parents ways to prevent reinfection by washing clothes, bedding; vacuum home Cycle for Pinworm Infection Giardiasis (Traveler’s diarrhea): caused by protozoan Giardia lamblia Most common intestinal parasite in USA It's estimated that between 1% and 20% of the U.S. population has giardiasis, and this figure may be 20% or higher in developing countries, where giardiasis is a major cause of epidemic childhood diarrhea. Children three times more likely to have giardiasis than adults, Found in child care centers, long-term care facilities, someone who recently travelled to endemic area Potential for transmission GREAT – Cysts (nonmotile state of protozoa) can last for months Chief mode of transmission: *person to person (in children)by feces; contaminated water, food and animals (especially puppies) S&S: diarrhea, vomitting, anorexia, growth failure, abdominal cramps; malodorus watery, pale and greasy stools Therapeutic Management - Diagnose by microscopic exam of stool or duodinal fluid - Medications: 5 – 7 day course -metroniazole (Flagyl), nitazoxanide (Alinia), tinidazole (Tindamax) Nursing Care Management - Educate parents to PREVENT infection - Meticulous hygiene and disposal of diapers, separate care of soiled clothing - Manage vomitting; hydration and nutrition during treatment Zion National Park, UT Beautiful to look at but Don’t Drink the Water! Signs posted warning about Giardiasis Scabies http://www.cdc.gov/search.do?queryText=scabies&action=search&searchButton.x=28&searchButton .y=8 Infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). Scabies is a common condition found worldwide; affects people of all races and social classes. Scabies can spread easily under crowded conditions, like child care centers Treating infants and young children: Scabicide lotion or cream also should be applied to their entire head and neck as well as the rest of their body. Lotion or cream should be applied to a clean body and left on for the recommended time before washing it off. Clean clothing should be worn after treatment. Bedding, clothing, and towels used by infested persons or their household, should be decontaminated by washing in hot water and drying in a hot dryer, by dry-cleaning, or by sealing in a plastic bag for at least 72 hours. Scabies mites generally do not survive more than 2 to 3 days away from human skin. Sexually Transmitted Infections (STI’s or STD’s) Read Tables 15.8 & 16.9 on pgs. 486-492 in Kyle text Major health concern in adolescents 25% of high school students will get an STI Risky behaviors Frequently have unprotected sex Biologically more susceptible to infection Engage in shorter relationships Have difficulty accessing health care systems Also warning sign for potential sexual abuse in infants and children Nursing Care Assess sexual behavior, often not done! All states allow adolescents to give consent to confidential STI testing and treatment Build trusting relationship with adolescent Management Teach to complete antibiotic prescription Counsel with ways to PREVENT STI’s Teach abstinence, safe sex Sexuality Education and Guidance Media influences Knowledge often acquired from peers, TV, movies, magazines Knowledge often inaccurate Need for factual information, presentation based on developmental maturity STI’s Effects on Fetus or Newborn (see page 486 in Kyle) Chlamydia Gonorrhea Herpes type II (genital herpes) Syphillis Trichomoniasis Venereal warts You don’t have to Memorize for Exam STI’s Common in Adolescents Refer to pages 487-492 in Kyle & Carman * You don’t have to Memorize for Exam Chlamydia Gonorrhea Herpes type II Syphilis Trichomoniasis Venereal warts End of Presentation