Johnson J., Keogh J. Pediatric Nursing Demystified: A Self-Teaching Guide

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Treatment

No treatment. The infection is self-limiting.

Nursing Intervention

䊋 Administer antipyretics (acetaminophen) to relieve fever.

䊋 Soothing baths to relieve itching.

䊋 Antipruritics to relieve itching.

䊋 Explain the disorder and treatment to the family.

Nursing alert There is no need to isolate the patient because the infection is

no longer contagious when the rash appears.

MUMPS

What Went Wrong?

Mumps, also known as parotitis, is a viral infection of the parotid glands

and at times the sublingual or submaxillary glands caused by the paramyx-

ovirus. The infection causes swollen glands and is spread by airborne droplets

or contact with infected saliva. The infection can become systemic or can

resolve without treatment or with treatment of symptoms alone. The disease

is highly communicable, particularly immediately before and after swelling.

The incubation period is between 12 and 25 days before the symptoms

appears.

Signs and Symptoms

䊋 Early signs:

• Prodromal phase (early manifestation of disease to period of overt

symptoms), initial 24 hours:

䊊

Fever

䊊

Headache

䊊

Malaise

䊊

Anorexia

䊊

Neck pain

䊊

Fever

• Pain in jaw or ear increased with chewing

• Dehydration may result if child refuses to drink

䊋 Late signs:

• Bilateral or unilateral enlargement of the parotid gland(s)

• Painful parotid glands

• Complications from infection may include

䊊

Deafness (sensorineural)

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䊊

Encephalitis

䊊

Myocarditis

䊊

Meningitis

䊊

Hepatitis

䊊

Arthritis

䊊

Epididymoorchitis

䊊

Sterility

Test Results

䊋 Serum: Elevated amylase due to enlarged parotid glands

䊋 Complete blood count: Elevated white blood count (leukocytosis) and

elevated lymphocytes (lymphocytosis)

䊋 Culture to confirm involved organism

䊋 Mumps titer may be performed to determine immunity

Treatment

䊋 Prevention:

• Encourage immunization—measles, mumps, and rubella (MMR)

vaccine:

䊊

Initial immunization is given after 12 months of age.

䊊

Immunization is recommended for individuals born after 1957 who

have not had the mumps or been immunized, or do not have titers

showing immunity.

䊋 Treatment:

• Administer corticosteroids to reduce inflammation.

• Administer NSAIDs to reduce inflammation.

• Administer acetaminophen (Tylenol), ibuprofen (Advil), or naproxen

sodium (Aleve) to relieve pain.

• Maintain bed rest during the prodromal stage and while swelling

present.

• Isolate child and contaminated items from other children or adults,

including used cups, plates, and utensils to prevent exposure to con-

taminated saliva.

• Apply warm or cold compresses to neck, based on comfort and

preference.

• Provide support in the event of orchitis:

䊊

Warmth.

䊊

Local support with tight-fitting clothes.

• Push fluids to prevent dehydration.

• Hydration therapy, including intravenous fluid, if child dehydrates.

Nursing Intervention

䊋 Droplet isolation, if hospitalized.

䊋 Bed rest: Provide age-appropriate diversion activities.

CHAPTER 14 / Infectious and Communicable Conditions

313

䊋 Soft diet with bland foods requiring minimal chewing.

䊋 Warm or cool compresses on the swollen neck.

䊋 Monitor for swollen testicles, which indicates complications of the disorder.

䊋 Monitor for Kernig sign (unable to straighten legs at knees), which indi-

cates complications of the disorder.

䊋 Monitor for Brudzinski sign (flexion of the hips and knees when neck

is flexed), which indicates complications of the disorder.

䊋 Report the diagnoses to local health officials according to policy.

䊋 Explain the disorder and treatment to the family.

Nursing alert Emphasize to the parents that anyone can be infected, adult or

child, and sterility can result from infection.

Nursing alert The patient is contagious beginning 7 days before the swelling

of the parotid gland and until 9 days after the swelling subsides.

POLIOMYELITIS

What Went Wrong?

Poliomyelitis is a viral infection by the polioviruses that is transmitted by con-

tact with infected oropharyngeal secretions or infected stools resulting in a

brief illness to paralysis. The incubation period is between 7 and 10 days

before the symptoms appear. Children should be vaccinated (inactivated

poliovirus vaccine [IPV]) beginning at 2 months of age.

There are three types of poliovirus:

䊋 Type 1: Brunhilde

䊋 Type 2: Lansing

䊋 Type 3: Leon

Signs and Symptoms

䊋 No symptoms

䊋 Fever

䊋 Headache

䊋 Vomiting

䊋 Nausea

䊋 Pharyngitis

䊋 Lethargy

䊋 Muscle weakness

䊋 Constipation

䊋 Urine retention

䊋 Paresthesia

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Nursing alert The patient may have no symptoms or a range of symptoms.

Test Results

䊋 Stool sample: Presence of the virus

䊋 Serum: Elevated antibodies

Nursing alert Diagnosis is based on symptoms and history and by ruling out

other disorders.

Treatment

䊋 No treatment except for symptomatic treatment

Nursing Intervention

䊋 Place the child on droplet and contact isolation.

䊋 Only those who have received the IPV vaccination are permitted to con-

tact the patient.

䊋 Monitor for skin breakdown.

䊋 Monitor for demineralization.

䊋 Monitor for pneumonia.

䊋 Apply high-top sneakers to the patient to prevent contractures.

䊋 Perform range-of-motion exercise.

䊋 Report the diagnoses to local health officials according to policy.

䊋 Explain the disorder and treatment to the family.

ROSEOLA INFANTUM

What Went Wrong?

Roseola infantum is a viral infection caused by the human herpes virus 6

and is suspected of being transmitted via oral viral shedding. Oral viral

shedding is the process by which the virus can travel along the patient’s

nerves to the skin surface where the virus is transferred by contact with the

skin. The incubation period is between 5 and 15 days before the symptoms

appear.

Signs and Symptoms

䊋 Rash beginning on the trunk and spreading to the extremities and face

that resolves by the third day.

䊋 Sudden fever between 103°F and 106°F that resolves within 4 days.

Test Results

䊋 No tests

CHAPTER 14 / Infectious and Communicable Conditions

315

Treatment

䊋 Roseola infantum is self-limiting.

䊋 Administer acetaminophen (Tylenol) for fever.

䊋 Administer intravenous (IV) fluids and electrolytes as ordered.

Nursing Intervention

䊋 Monitor vital signs.

䊋 Explain the disorder and treatment to the family.

Nursing alert Monitor for febrile seizures.

RUBELLA

What Went Wrong?

Rubella is a viral infection commonly called German measles and is

caused by the rubella virus that is transmitted by airborne droplets, contact

with contaminated items, or direct contact with an infected person. The incu-

bation period is between 14 and 21 days.

Nursing alert Only the nonpregnant should come in contact with the patient.

Assume that a woman who is of childbearing age is pregnant because a woman

in very early pregnancy may not know she is pregnant. Women of childbearing

age should receive the rubella vaccine.

Signs and Symptoms

䊋 Early signs (first 5 days):

• Headache

• Fever

• Sore throat

• Pus containing (purulent) nasal drainage

• Malaise

• Swollen lymph nodes

䊋 Late signs:

• Rash appears first on the face and then spreads to the trunk and legs.

• Forescheimer spots (small red flat spot on the soft palate).

Test Results

䊋 Serum: Positive for rubella antibodies

Nursing alert Diagnoses is usually made based on signs and symptoms.

Treatment

䊋 Rubella is self-limiting.

䊋 Administer acetaminophen (Tylenol) for fever.

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Nursing Intervention

䊋 Place the child on droplet isolation if hospitalized.

䊋 Report the diagnoses to local health officials according to policy.

䊋 Explain the disorder and treatment to the family.

Nursing alert The patient is contagious beginning 1 week before a rash appears

and until 4 days after the rash appears.

RUBEOLA

What Went Wrong?

Rubeola, commonly called the measles, is a viral infection caused by the rube-

ola virus and is transmitted by airborne droplets or direct contact with contam-

inated items. The incubation period is from 8 to 12 days before the symptoms

appear. The children should be vaccinated for rubeola (MMR) at 12 months

of age.

Signs and Symptoms

䊋 Early stage:

• Malaise

• Fever

• Cough

• Lethargy

• Conjunctivitis

• Koplik spots (gray specks with red halos in the buccal mucosa): 2 days

before the rash appears on the body

• Periorbital edema

䊋 Later stage:

• Red flat rash on the face and spreads to the trunk and extremities

that disappears in 7 days

• Severe cough

• Swollen glands

• Watery nose (rhinorrhea)

Test Results

䊋 No tests

Nursing alert Diagnoses is usually made based on signs and symptoms.

Treatment

䊋 Rubeola is self-limiting.

䊋 Administer acetaminophen (Tylenol) for fever.

䊋 Administer antipruritic medication for itching.

CHAPTER 14 / Infectious and Communicable Conditions

317

Nursing Intervention

䊋 Monitor vital signs.

䊋 Increase fluids to reduce secretion viscosity.

䊋 Provide cool mist from a vaporizer for inflamed mucous membranes.

䊋 Place the child on droplet isolation if hospitalized.

䊋 Report the diagnoses to local health officials according to policy.

䊋 Explain the disorder and treatment to the family.

Nursing alert The patient is contagious beginning several days before a

rash appears and until 5 days after the rash disappears.

VARICELLA

What Went Wrong?

Varicella, commonly called chickenpox, is a viral infection caused by the vari-

cella zoster virus (VZV) that is transmitted by airborne droplets and by contact

with lesions. The VZV is latent in the dorsal root ganglia and can become reac-

tivated later in life as a herpes zoster infection, commonly called shingles. The

incubation period is between 10 and 21 days before the symptoms appear. Chil-

dren should receive the varicella vaccination beginning at 12 months of age.

Nursing alert Only the nonpregnant should come in contact with the

patient. Assume that a female who is of childbearing age is pregnant because

a woman in very early pregnancy may not know she is pregnant. Women of child-

bearing age should receive the rubella vaccine.

Signs and Symptoms

䊋 Early signs:

• Malaise

• Fever

• Anorexia

䊋 Late signs:

• Itchy rash of red macules begins on the face, scalp, or trunk.

• Macules transform into small solid (not pus containing) elevation of

the skin (papules).

• Papules develop into clear sacs (vesicles) with a red base.

• Vesicles break and scabs form a lesion.

• Lesions are crusted over.

Test Results

䊋 VZV antibody test: Positive

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Nursing alert Diagnoses is usually made based on signs and symptoms.

Treatment

䊋 Varicella is self-limiting.

䊋 Administer acetaminophen (Tylenol) for fever.

䊋 Administer antipruritic medication for itching.

Nursing Intervention

䊋 Place the child on droplet and contact isolation if hospitalized.

䊋 Provide oatmeal baths to soothe itching.

䊋 Explain the disorder and treatment to the family. Tell the family not to

use over-the-counter locations that contain antihistamines. Lotions such

as calamine lotion and Aveeno are permissible to help soothe itching.

Nursing alert The patient is contagious beginning 5 days before a rash appears

and until all lesions are crusted over.

ANAPHYLAXIS

What Went Wrong?

Anaphylaxis is the dilating of capillaries and contracting of smooth muscles

in the respiratory tract caused by the release of histamines in response to an

allergen resulting in respiratory distress, hives (urticaria), and edema.

Signs and Symptoms

䊋 Shortness of breath due to swelling of the larynx

䊋 Hypotension and shock due to generalized vasodilation

䊋 Sneezing due to an allergen

䊋 Anxiety secondary to difficulty in breathing

䊋 Rales (crackles) heard in the lungs due to fluid in the lungs

䊋 Wheezing (rhonchi) due to bronchospasm

Test Results

䊋 Serum: Elevated tryptase levels from mast cells

Treatment

䊋 Administer emergency medications:

• Epinephrine to open airways and to reduce bronchospasm

• Corticosteroids to reduce symptoms

• Antihistamines to mitigate symptoms

CHAPTER 14 / Infectious and Communicable Conditions

319

䊋 Administer circulatory volume expanders to treat hypotension caused

by vasodilation:

• Saline

• Plasma

䊋 Administer vasopressors to counteract vasodilation and to increase blood

pressure:

• Norepinephrine

• Dopamine

䊋 Oxygen therapy to support breathing.

䊋 Insert endotracheal tube to maintain airways.

䊋 Allergy skin testing to identify allergen.

Nursing Intervention

䊋 Maintain airway to facilitate breathing.

䊋 Monitor for hoarseness and difficulty breathing to check for symptoms

of decreased respiration.

䊋 Explain to the family to avoid exposure to allergens to prevent future

occurrences and to seek medical help immediately if exposed to aller-

gens to prevent anaphylaxis.

MONONUCLEOSIS

What Went Wrong?

Mononucleosis is a viral infection commonly caused by the Epstein-Barr virus

but can also be caused by the cytomegalovirus and frequently secondary to a

streptococcus bacterial infection that weakened the immune system. Mononu-

cleousis is transmitted by contact.

Signs and Symptoms

䊋 Malaise

䊋 Fever

䊋 Muscle ache (myalgias)

䊋 Headache

䊋 Sore throat

Test Results

䊋 Heterophil antibody test: Positive

䊋 Mono spot test: Positive

Treatment

䊋 No treatment except for symptomatic treatment

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Nursing Intervention

䊋 Adequate rest

䊋 Increase fluids

䊋 Monitor vital signs

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321

CASE STUDY

Six-year-old Martin Rivera presented in the ED with his parents at 8 AM.

His mother reported that he has been lethargic and coughing. His mother

said he had a temperature of 102.4°F during the overnight hours and he

hasn’t been feeling well for a week or so. She and her husband became

concerned when his face began turning red.

Assessment data: Temperature 102.5°F. Periorbital edema. Conjunctivi-

tis. Red flat rash on the child’s face and faint the rash on his trunk. Severe

coughing. Watery nose. Swollen lymph nodes. The parents are unsure

about the child’s vaccinations. No Forescheimer spots.

Interpretation: The rash on the face and a faint rash on the trunk are

consistent with the rash starting on the face rather than the trunk and then

spreading to the trunk. This probably rules out roseola infantum, which

begins on the trunk. No Forescheimer spots rules out rubella, which also

causes a rash on the face. Conjunctivitis, periorbital edema, a fever,

lethargy, and coughing is consistent with rubeola. The fact that the par-

ents are unsure of the child’s vaccinations can lead to the supposition that

the child might not have received all his vaccinations.

Nursing intervention: Place the child on droplet isolation. Expect the

health-care provider to order acetaminophen for fever and antipruritic med-

ication for itching. Administer fluids to reduce secretion viscosity and pro-

vide cool mist from a vaporizer for inflamed mucous membranes. Explain

the disorder and treatment to the family and child and explain to the family

that other children at home should be vaccinated for rubeola and other com-

municable diseases. Also tell the parents that child will be contagious for

5 days after the rash disappears and that the rash should disappear in about

7 days. Report the diagnoses to local health officials according to policy.

Evaluation: Assess the child’s temperature and how well the antipruritic

medication is relieving the itching. Monitor the rash to determine if the

skin is opened from the child scratching.