Chapter 43: Nursing Care of a Family When a Child has an Infectious

Disorder
Nursing Process Overview
Assessment
 Fever, malaise, myalgia and arthralgia are common associations with infectious
diseases
Nursing Diagnosis
 Pain related to pruritus from skin lesions
 Impaired skin integrity related to rash, pruritus, and scratching
 Risk for infection related to presence of infective organism in sibling
 Altered body temperature, fever, related to systemic infection
 Fluid volume deficit related to insensible fluid loss from increased body temperature
 Social isolation related to precautions required to prevent infection transmission
 Deficient diversional activity related to activity restriction and precautions to prevent
disease transmission
Outcome Identification and Planning
 Preventing through immunization, treating current infection, and preventing further
spread by practicing good infection control measures
Implementation
 Patient education
Outcome Evaluation
 Child indicates relief from pruritus and pain
 All family members remain free of signs and symptoms of the infectious disorder
 Parent identifies appropriate diversional activities for distracting the child
 Parent verbalizes how to prevent transmission of infectious disease to other family
members and understands the importance of proper hand washing

A. The Infectious Process

 Pathogens: any organism that causes disease and can be classified into 5 types of
microorganisms:
1. Virus
2. Bacteria
3. Rickettsia
4. Helminths
5. Fungi

1. Stages of Infectious Disease

a. Incubation period
- Time between the invasion of an organism and the onset of symptoms of
infection
b. Prodromal period
- Time between the beginning of nonspecific symptoms such as malaise,
low-grade fever, fatigue and arthralgia to the onset of disease-specific
symptoms such as rash, diarrhea and vomiting
- Generally short, ranging from hours to few days
- Illness: stage during which specific symptoms occur
c. Convalescent period
- Interval between when symptoms first begin to fade and when the child
returns to a healthy baseline

2. Chain of Infection
 Is the method by which organisms are spread and enter a new individual
to cause disease
a. Reservoir
-The container or place in which an organism grows and reproduce
-Fomites: inanimate objects that can also transmit infections from one person
to another without direct contact with a human vector
 b. Portal of exit
-Route by which an organism leaves an infected child’s body to be spread to
others
c. Portal of entry
-Refers to the opening though which a pathogen can enter a child’s body such
as by inalation, ingestion or breaks in the skin from bites, abrasions or burn
d. Modes of Transmission
-Refers to whether the infection is spread by direct or indirect contact

e. Susceptible host
-Susceptible to the infection
-Characteristics depend on: age, gender, virulence and body defenses

3. Body’s Immune Response to Organisms

a. Innate immunity (nonspecific response)
 Neutrophils: first line of defense and active;
 WBC: a monocyte to become macrophage
 Macrophage: clean cellular debris andkill infecting organism
 Complement and cytokines: signal specific cellular and humeral
immunity to add in host defenses
b. Adaptive immunity (specific response)
T lymphocytes differentiates into:
 TH1: promotes cellular immunity by activating microphages,
enhancing cytotoxic T cell unction, producing cytokines, and
recognizing infecting agent.
 TH2: release cytokines, which enhance antibody formation by B cells
and mediating eosinophil recruitment and activation
Note: Blood infection: pathogenic microorganism in bloodstream
B. Health Promotion and Risk Management
1. Preventing the Spread of Infection
 Nosocomial/ health care-associated infections (HAIs)
- Are infections that are contracted while in a hospital or other healtcare
setting
- 3 approach:
1. Prevention with surgery or catheter placement
2. Prevent spread of infection between patients
3. Appropriate antibiotic use
- 6 antibiotic resistant bacteria that are identified by the CDC
1. Carbapenem-resistant Enterobacteriaceae (CRE)
2. Methicillin-resistant Staphylococcus aureus (MRSA)
3. Extended-spectrum Beta-lactamases (ESBL)-producing
Enterobacteriaceae
4. Vancomycin-resistant enterococci (VRE)
5. Multidrug-resistant pseudomonas
6. Multidrug-resistant Acinetobacter
 C. Viral Infections
 Smallest infectious agents known
 Are small that they cannot be seen through an ordinary microscope
 Are not true cells, therefore cannot replicate

1. Viral Exanthems (skin rashes)

Microorganis Causative Incubation Symptoms Period of Mode of Treatment

m agents Period Communicabili Transmission
ty
Exanthem Human 9 to 10 days  Fever During febrile unknown Acetaminoph
Subitum herpesvirus 6 (101 to period en or
(Roseola (HHV-6) 105 F) ibuprofen to
Infantum)  Cranky reduce fever
 Distinctiv
e rash of
discrete,
rose-pink
macule
approx. 2
to 3 mm
Rubella Rubella virus Gen. 14 days  Rash by 7 days before Direct and Acetaminoph
( German within range discrete approx. 7 days indirect en or
Measles) of 12 to 23 pink-red after rash contact with ibuprofen for
days maculopa appears droplets fever
pular rash Comfort
 Low- measure for
grade rash
fever MMR
 Headache vaccine
 Malaise before
 Anorexia pregnancy
 Mild
conjunctiv
itis
 Upper
respirator
y
symptoms
 Lymph
adenopath
y
Measles Measles 8 to 12 days  Cough, 4 days before Direct contact Comfort
(Rubeola) virus with range of  Coryza approx. 4 days with droplets measure for
7 to 21 days  Conjuncti after rash or airborne rash
vitis appears spread Antipyretic
 Confluent for fever
maculopa Lubricating
pular, jel to prevent
erythemat excoriation
ous rash Buckwheat
 Koplik honey
spots Draw
 curtains and
wear glass
Chickenpox Varicella- 10 t0 21 days  Rash 1 day before Highly Topical
(Varicella) zoster virus most  Low- the rash to 5 to contagious oatmeal-
(VZV) common grade 6 days after its Spread by based cream
fever initial direct or and
 Malaise appearance indirect antihistamine
 Macule contact of to reduce
 Papule saliva or open pruritus
 Vesicle vesicles Acetaminoph
en for fever
 Crust
Herpes Zoster  Paresthesi Analgesia for
-reactivation a pain and
of the VZV  Pain reduce
 Groups of pruritus
vesicular Acyclovir
lesions that inhibits
viral DNA
synthesis
Smallpox Smallpox 7 to 17 days  Febrile Child Airborne Antibiotic to
( Variola) virus with a mean prodone contagious for transmission prevent
of 12 days  Pustular 24 hours before secondary
lesions the onset of rah infection
and remain and Oxygen
dried up to 4
weeks
Erythema Parvovirus 4 to 14 days  Relative uncertain Respiratory Antipyretics
Infectiosum B19 common aplasia of tract secretion and
( Fifth red cell Blood analgesics
Disease) line for 7 transfusion and comfort
to 10 days Vertical measures for
 Patient transmission rash
with from mother
hemolytic to baby
anemia
will lead
to cardiac
failure
 Fever
 Headache
 Malaise
 “slapped
check”

2. Nonpolio Enteroviruses
Causative agent: member of the enteroviral family
Incubation period: 3 to 6 days common
Period of communicability: uncertain
Mode of transmission:
 Respiratory tract secretion
 Fecal-oral
 Vertical transmission from mother to baby at the time of birth
 Breastfeeding

Microorganis Causative Incubation Symptoms Period of Mode of Treatment

m agents Period Communicabili Transmission
ty
Numbered Antipyretic
Enterovirus for fever
and Echovirus Comfort
Infections measures for
-responsible rash
for aseptic
meningitis,
diarrhea, acute
respiratory
illness and
maculopapular
rashes
Coxsackieviru Coxsackievir  Hand- Bland, soft
s infections us A6 and foot- diet in mouth
A16 mouth lesions
Herpangina disease Analgesia
with with
distinctive acetaminoph
erythemat en at
ous 10mg/kg/dos
papules e to 15
 High mg/kg/dose
fever every 4 to 6
 Anorexia hours but no
more than 5
 Anorexia dose
 Fever
 Difficulty
swallowin
g
 Sore
throat
 Headache
 Abdomina
l pain
 vomiting
Poliovirus Poliovirus Nonparalytic Paralytic: 1 to 2 weeks in Respiratory Nonparalytic:
Infections: : 3 to 6 days  fever the throat secretions and bed rest with
Poliomyelitis Paralytic: 7  headache 3 to 6 weeks in feces antipyretics
(Infantile to 21 days  nausea feces
Paralysis) with a range  vomiting
of 3 to 35  abdominal
days pain
 constipati
on
 malaise
3. Viral Infections of the Integumentary System
Microorganis Causative Incubation Symptoms Period of Mode of Treatment
m agents Period Communicabili Transmission
ty
Herpesvirus HSV 1 and 2 days to 2 HSV 1 Greatest early Direct contact
Infections HSV 2 weeks  Oral in course of with persons
(HSV) region infection with active
HSV2 lesions or
 Genital persons
region shedding the
virus
asymptomatic
ally
Acute 5 to 14 days  Sudden Antipyretic
Herpetic onset of to reduce
Gingivostomat pain fever
itis  Drooling Soft
 Anorexia nonirritating,
 Signicant acid free
fever in foods to
high a reduce
s105 F irritation
(40.6 C) Popsicles, ice
 Gumline milk and Jell
is O for
swollen, soothing
reddened Oral
and acyclovir to
bleads shorten
easily course of
illness
Herpes Recurrent  Painful, Topical
Simplex form of HSV grouped acyclovir
(Herpes vesicles
Labialis) surrounde
Known as cold d by
sore or fever erythemat
blister ous base
on the
border of
lips
 Tingling,
burning,
itching,
pain for 6
to 48
hours
Acute HSV 2 Sexual contact
Herpetic
Vulvovaginitis
(Genital
Herpes)
Warts Papillomavir 3 to 8 months  Skin Salicylic acid
(verrucae) uses (HPV) manifestat solution
ion Carbon
 Genital dioxide snow
and oral Liquid
malignanc nitrogen
ies Electrodessic
 Flesh- ation
colored, Laser
dirty- Cryotherapy
appearing Gardasil 9
papules vaccine

4. Viruses Causing Central Nervous System Disease

Microorganis Causative Incubation Symptoms Period of Mode of Treatment
m agents Period Communicabili Transmission
ty
Rabies RABV 1 to 3 months  Malaise 3 to 5 days Bite of rapid Immunity
 Fever animal status of the
 Anorexia Saliva enter animal
 Nausea open wound Postexposure
 Sore prophylaxis
 throat (bat)
 Drowsine RIG
ss administered
 Irritability
 Restlessne
ss
 Water-
fear

5. Other Infections Transmitted by Animal Vectors

Microorganis Causative Incubation Symptoms Period of Mode of Treatment
m agents Period Communicabili Transmission
ty
Hantavirus Member of Hantavirus HPS: Rodent Prevention is
Pulmonary arbovirus pulmonary  Fever key
Syndrome group syndrome  Chills
Infection (HPS): 1 to 6
 Cough
weeks  Myalgia
 Gastrointe
Hemorrhagic stinal
fever with symptoms
renal of
syndrome diarrhea,
(HFRS): 10 vomit and
days to 6 headache
weeks HRFS:
 Febrile
phase
 Hypotensi
on
 Oliguria
 Polyuria
 Convalesc
ence

Zika Virus Aedes Less than 1  Fever Yellow fever Screen

Disease aegypti and week  Arthralgia mosquito potential
Aedes  Conjuncti blood donors
albopictus vitis Advise use of
 Eye pain condoms
 Myalgia Insect
 Rash repellant
 Headache
West Nile Arthropods,  Fever Infected IgM
Virus Disease usually small  Anthralgi mosquito or antibodies
mammal or a ticks
birds  Myalgia Brood
transfusion

6. Other Viral Infections

Microorganis Causative Incubation Symptoms Period of Mode of Treatment
m agents Period Communicabili Transmission
ty
Mumps Mump virus 16 to 18 days  Fever 5 days Direct contact Supportive
(Epidemic  Headache with care
Parotitis)  Anorexia respiratory Acetaminoph
 Malaise droplets en
Soft bland
  Parotid diet
gland
enlargeme
nt
Epstein-Barr Epstein-barr 30 to 50 days  Anorexia Occurs at direct Direct contact Acetaminoph
Infectious virus (EBV)  Chills contact and through en for pain
Mononuclueos  Malaise blood and fever
is with fever transfusion Stress fluid
in 90% intake with
 Enlargem cool,
ent of nonacidic
cervical fluids and
nodes and soft,
tonsils nonirritating
foods

D. Bacterial Infections
 Independent, living organisms with nucleus that contains DNA and RNA
 3 shapes: spheres (cocci), rods (bacilli), spirals (spirochetes)
 Gram-positive: violet stain
 Gram-negative: pink-stained

1. Streptococcal Diseases
Microorganis Causative Incubation Symptoms Period of Mode of Treatment
m agents Period Communicabili Transmission
ty
Scarlet Fever Beta- 2 to 5 days  Fever 1 to 7 days Direct contact Penicillin V
hemolytic  Sore from a person IM penicillin
streptococci, throat with the G benzathine
group A  Head ache disease and Analgesic
 Chills largest and
 Rapid droplets, not antipyretic
pulse fomites or Soft or liquid
 Malaise household diet
pets
 Skin rash
Impetigo Beta- 7 to 10 days  Honey From outbreak Direct contact Mupirocin
hemolytic colored of lesions with lesions ointment for
streptococcu crust with 7 to 10 days
s, group A or erythema Retapamulin
S. Aureus  Face and twice a day
including extremitie for over 9
MRSA s found months
Oral
antibiotic
Cat- Scratch Bartonella 1 to 2 weeks  Single unknown Bite or scratch Azithromyci
Disease henselae skin from kitten n to decrease
papule lymph node
 Lymph size
node
infected

2. Staphylococcal Infections
Microorganism Definition Treatment
Furunculosis/Ca Staphylococcal infection of a single hair follicle and a carbuncle has multiple Educate not
rbunculosis hair follicles with openings to press
(Abscesses or
Boils)
Cellulitis Staphylococcal inflammation of dermal and subcutaneous layers of skin Systemic
antibiotic

Methicillin- Strain of staphylococcus that causes skin infections and has become resistant Vancomycin
Resistant to common broad-spectrum antibiotics Clindamycin
Staphylococcus
aureus
Scalded Skin Nilkolsky sign, large bullae with clear fluid form
Diseases (Ritter
disease)

3. Other Bacterial Infections

Microorganis Causative Incubation Symptoms Period of Mode of Treatment
m agents Period Communicabili Transmission
ty
Diphtheria Corynebacte 2 to 5 days  Brassy 2 to 6 weeks Direct or Single dose
rium range of 1 to cough indirect of equine
diptheriae 10 days  Skin contact antitoxin
(Kleb- lesions droplets Penicillin or
Loffler erythromycin
bacillus) intravenously
Complete
bed rest
Whooping Bordetella 5 to 21 days  Rhinitis 5 to 7 days Highly Nutritional
Cough pertussis with mild contagious by intake
(Pertussis) cough direct or Oxygen
indirect therapy
contact Full 10 day
of
erythromycin
Anthrax Bacillus 1 to 7 days  Inhalation Originally Prophylaxis
anthracis al contracted with
 Cutaneous from contact Ciprofloxaci
 Gastrointe with the feces n
stinal of infected
cows or sheep
Tetanus C. tetani 3 days to 3  Stiffness none Direct and Quiet,
(Lockjaw) weeks of muscle indirect stimulation-
contamination free room
of close with total
wound parenteral
nutrition,
sedation and
muscle
relaxation
TIG with
parenteral
penicillin G
or orals or
intravenous
metronidazol
e
Immunizatio
n
Lyme Disease Borrelia 3 to 30 days  Erythemat Not Deer tick Amoxicillin
burgdorferi ous communicable Inspect skin
papule of children
 Cardiac
involveme
nt
 Neurologi
 c
involveme
nt
 Musculos
keletal
involveme
nt

E. Other Infectious Pathogens

1. Rickettsial Diseases
- Are organism that resemble virus both in size and their inability to
reproduce except inside the cells of host organism
- Include fever and trigger immune response
Microorganis Causative Incubation Symptoms Period of Mode of Treatment
m agents Period Communicabili Transmission
ty
Rocky Rickettsia 3 to 12 days  Malai Not Wood, dog, doxycycline
Mountain rickettsii se communicable rabbit tick
Spotted Fever  Nause
a
 Vomi
ting
 Myal
gia
 Blanc
hing
pink
macul
ar
rash

2. Psittacosis
Microorganis Causative Incubation Symptoms Period of Mode of Treatment
m agents Period Communicabili Transmission
ty
Psittacosis Chlamydoph 3 to 4 weeks Cough Inhalation of Tetracycline
ila psittaci Fever respiratory or
Pharyngitis secretions doxycycline
Malaise or from the eyes
diarrhea of beaks of
infected bird

3. Parasitic Infections
Microorganis Causative Incubation Symptoms Period of Mode of Treatment
m agents Period Communicabili Transmission
ty

4. Helminthic Infection
- Are pathogenic or parasitic worm
Microorganis Definition Treatment
m

Roundworms Asymptomatic infections but when there is an extensive parasite load, Single dose
(Ascariasis) malnutrition and gastrointestinal symptoms of
 8 weeks albendazole
 with food
Nitazoxanide
twice a day
for 3 days
Single dose
of ivermectin

Hookworms Tend to be asymptomatic and are more common in children living in tropical Albendazole
climates with poor sanitation Mebendazole
 4 to 6 weeks Pyrantel
pamoate
Enterobiasis Small , white, threadlike worms that live in cecum Single dose
(Pinworms) of
mebendazole
or pyrantel
pamoate

5. Protozoan Infections
- Unicellular organism
- Absorb fluid through their cell membrane
- Can move from place to place by pseudopod, flagella or cilia

Microorganis Causative Incubation Symptoms Period of Mode of Treatment

m agents Period Communicabili Transmission
ty
Giardiasis Giardia Diarrhea Fecal oral Metronidazol
lamblia Weight loss route e
Abdominal Person to Nitazoxanide
cramps person Tinidazole
Bloating Animal to
Wight loss person

6. Fungal Infections
- Larger than bacteria
- Some unicellular but generally multicellular
- Deep mycoses: invade internal organs
- Subcutaneous mycoses: subcutaneous tissue
- Superficial mycoses: hair, skin or nails

a. Superficial Fungal Infections

Microorganis Definition Incubation Treatment
m Period

Tinea Cruris A brownish 1 to 3 weeks Antifungal agent for 4 to 6 weeks

(jock itch) to
erythematou
s, well
demarcated
patch on the
groin, inner
thighs and
scrotum
Tinea Pedis Dermatophyt Antifungal agent such as clotrimazole
ic fungal
 infection of
scalp that
present in 4
ways
Tinea Capitis Superficial, 1 to 3 weeks Oral antifungal and topical shampoo
well-
demarcated,
mildly
erythematou
s, ring-like
infection of
epidermal
layer of the
skin
Tinea Corporis Antifungal treatment

b. Candidiasis
Microorganis Causative Agents Definition Treatment
m

candidiasis Candida Albicans A yeast that reproduce budding and in well infants cause Antifungal
oral and skin monilial or candida infection drugs