Nursing Care of a Family when the Child has an infectious Disorder

1. JASON ADOYOGAN, RN
NCM 109 Lecturer
MODULE NO. 19 – Nursing Care of A
Family When the Child has an Infectious
Disorder

2. MODULE OBJECTIVES
1.Discuss the important concepts relating
to Infectious process.
2.Enumerate the most common and
significant infectious diseases.
3.Discuss how to assess the health of
children with infectious diseases.

3. MODULE OBJECTIVES CONT.
3.Formulate nursing diagnoses for
a child with an infectious disorder.
4.Establish Nursing care outcomes
and plan of care for children with
specific Infectious disorders.

4. LECTURE CONTENTS
A.Brief introduction/overview of the Infectious
process
a.Stages of Infectious Disease
b.The Chain of Infection
c.Infection Control/Prevention
i.Important Infection Control concepts
ii.Standard Precaution
iii.Transmission-Based Precautions
- Contact Precaution
- Droplet Precaution
- Airborne Precaution

5. LECTURE CONTENTS CONT.
A.Common Infectious Disorders
a.Viral Infections
i.Viral Exanthems
- Exanthem Subitum (Roseola
Infantum)
- Rubella (German Measles)
- Measles (Rubeola)
- Chickenpox (Varicella)
- Herpes Zoster
- Smallpox (Variola)

6. LECTURE CONTENTS CONT.
i. Non-Polio Enteroviruses
ii.Coxsackievirus Infections (HFMD)
iii.Poliovirus Infection (Poliomyelitis)
iv.Viral Infections of the integumentary system
- Herpesvirus Infections
v.Virus causing CNS diseases
- Rabies
vi.Virus transmitted by Animal Vectors
vii.Other Viral Infections
- Mumps
- COVID 19
- MIS-C

7. LECTURE CONTENTS CONT.
a.Bacterial Infections
i.Staphylococcal Infections
- Cellulitis
- MRSA
- Scalded Skin Disease
ii.Other Bacterial Infections
- Tetanus
b.Parasitic Infections
c.Fungal Infections

8. THE INFECTIOUS PROCESS
BRIEF OVERVIEW OF
IMPORTANT CONCEPTS IN THE
INFECTIOUS PROCESS AND
INFECTION CONTROL

9. STAGES OF THE INFECTIOUS PROCESS
1.INCUBATION PERIOD - is the time between
the invasion of an organism and the onset of
symptoms of infection. During this time,
microorganisms grow and multiply. Incubation
periods vary widely depending on the virulence
of the organism, the mechanism of spread, and
the host.

10. STAGES OF THE INFECTIOUS PROCESS
2. PRODROMAL PERIOD is the time
between the beginning of nonspecific
symptoms such as malaise, low-grade
fever, fatigue, and arthralgia to the onset of
diseases-specific symptoms such as a
rash, diarrhea, and vomiting.

11. STAGES OF THE INFECTIOUS PROCESS
3.ILLNESS is the stage during which specific
symptoms occur. It is important to keep in mind that
the body’s response to infectious agents causes a
variety of symptoms including fever, myalgia (muscle
aches), arthralgia (joint pain without swelling),
malaise, increased need for sleep, and headache,
which is usually secondary to fever. There is also a
site-specific reactions.

12. STAGES OF THE INFECTIOUS PROCESS
i.The CONVALESCENT PERIOD is the
interval between when symptoms first
begin to fade and when the child returns to
a healthy baseline. The return to baseline
will vary from child to child depending on
the host, other underlying illnesses, and the
type and severity of infection.

13. THE CHAIN OF INFECTION
The method by which
organisms are spread and enter
a new individual to cause
disease. Breaking the chain at
one of its susceptible points is
the most efficient way to prevent
infection from spreading (Chusid
& Rotar, 2016)

14. THE CHAIN OF INFECTION
RESERVOIR - the container or
place in which an organism
grows and reproduces. The
reservoir would be another
person with the disease, a
contaminated object such as a
kitchen counter, or an animal or
insect.

15. THE CHAIN OF INFECTION
• PORTAL OF EXIT - the route by
which an organism leaves an
infected child’s body to be spread
to others. Organisms can be
carried out of the body by upper
respiratory excretions, feces,
vomitus, saliva, urine, vaginal
secretions, blood, or lesion
secretions.

16. THE CHAIN OF INFECTION
• MODE OF
TRANSMISSION -
refers to whether the
infection is spread by
direct or indirect contact.

17. THE CHAIN OF INFECTION
• PORTAL OF ENTRY -
refers to the opening
through which a pathogen
can enter a child’s body
such as by inhalation,
ingestion, or breaks in the
skin from bites, abrasions,
or burns.

18. THE CHAIN OF INFECTION
• SUSCEPTIBLE HOST - For
infection to occur, one more
step must be present: The
child must be susceptible to
the infection (susceptible
host). Certain characteristics
make some individuals more
prone to infection than others.

19. THE CHAIN OF INFECTION

20. OTHER INFECTION CONTROL
CONCEPTS

21. PROPER
SEQUENCE
IN
DONNING
AND
DOFFING
PPE

22. ISOLATION VS REVERSE ISOLATION
Isolation is the separation of an
infectiously ill patient from others to
prevent the spread of an infection
whereas reverse isolation (protective) is
the protective separation of a highly
susceptible patient whose resistance is
low from acquiring an infection

23. STANDARD PRECAUTION
Standard Precautions are used for all
patient care. They’re based on a risk
assessment and make use of common
sense practices and personal protective
equipment use that protect healthcare
providers from infection and prevent the
spread of infection from patient to patient.

24. STANDARD PRECAUTION
To decrease the transmission of infectious agents in the healthcare setting:
1. Perform Hand-Hygiene. Wash hands for at least 20 seconds immediately with a non-
antimicrobial soap and water or alcohol-based hand sanitizers before and after
examining patients and after any contact with blood, body fluids, excretions, secretions,
and contaminated items despite the use of gloves (AAP, 2015). Soap and water is
always used if the hands are visibly dirty or contaminated.
2. Use Personal Protective Equipment (PPE) whenever there is an expectation of a
possible exposure to infectious materials. Wear clean, nonsterile gloves anytime
contact with blood, body fluids, mucous membranes, or broken skin is likely. Hand
hygiene should be done before and after glove use. Change gloves between tasks or
procedures on the same patient. Before going to another patient, remove gloves, wash
hands, and then put on new gloves.

25. STANDARD PRECAUTION
3.Wear a mask, protective eyewear, gowns, and face shields
during any patient care activity when splashes or sprays of
body fluids, excretions, secretions, or blood are likely.
Remove the soiled gown and wash hands as soon as
possible. Remove the gown and gloves in the room of the
patient before moving to the next patient (CDC, 2016)
4.Make sure contaminated non-disposable equipment is not
reused with another patient until it has been cleaned,
disinfected, and sterilized properly. Do not recap needles.
Dispose of nonreusable needles, syringes, and other sharp
patient care instruments in puncture-resistant containers.

26. STANDARD PRECAUTION
5.Ensure housekeeping routinely clean and disinfect
frequently touched surfaces including beds, bed rails,
examination tables, and bedside tables.
6.Do not touch linens soiled with blood or body fluids
with bare hands. Use plastic bags to transport soiled
linen.
7.Place a patient whose blood or body fluids are likely
to contaminate surfaces or other patients in an
isolation room or area.

27. STANDARD PRECAUTION
8.Minimize the use of invasive procedures to
avoid the potential for injury and accidental
exposure. Use oral rather than injectable
medications whenever possible.
9.When a specific diagnosis is made, find out
how the disease is transmitted. Use precautions
according to the transmission risk

28. TRANSMISSION-BASED PRECAUTION
Transmission-Based Precautions are the second
tier of basic infection control and are to be
used in addition to Standard Precautions for
patients who may be infected or colonized
with certain infectious agents for which
additional precautions are needed to prevent
infection transmission.

29. TRANSMISSION-BASED PRECAUTION
1. Airborne
Precaution
2. Contact
Precaution
3. Droplet Precaution

30. AIRBORNE PRECAUTION
Airborne precautions reduce the risk of small-particle
organisms being transmitted through the air as
microorganisms carried by this route can be carried
widely.
Use Airborne Precautions for patients known or
suspected to be infected with pathogens transmitted by
the airborne route (e.g., tuberculosis, measles,
chickenpox, disseminated herpes zoster)

31. AIRBORNE PRECAUTION
1. Place the patient in a single-patient isolation room that is not
air-conditioned or where air is not circulated to the rest of the
healthcare facility. Make sure the room has a door that can be
closed.
2. Wear a high-efficiency particulate air (HEPA) or other
biosafety mask when in the patient’s room.
3. Limit movement of the patient from the room to other areas.
Place a surgical mask on a patient who must be moved.

32. DROPLET PRECAUTION
Droplet precautions reduce the risk of pathogens being spread
through large-particle droplet contact by acts such as coughing,
sneezing, and talking or through procedures such as suctioning
or bronchoscopy. Large droplets do not remain suspended in the
air for long periods and generally travel only short distances, so
close proximity is required for the spread of disease. Respiratory
viruses, Bordetella pertussis, and patients within the first 24
hours of meningococcal infections or group A streptococcal
infections can be transmitted by droplets.

33. DROPLET PRECAUTION
1. Place the patient in a single-patient isolation room.
2. Wear a HEPA or other biosafety mask when caring for the
patient.
3. Limit movement of the patient from the room to other
areas. If the patient must be moved, place a surgical mask
on the patient.

34. CONTACT PRECAUTION
1. Place the patient in an isolation room and limit access.
2. Wear gloves during contact with the patient and with infectious body fluids or
contaminated items.
3. Wear a disposable gown when in the patient’s room.
4. Limit movement of the patient from the isolation room to other areas.
5. Avoid sharing equipment between patients. Designate equipment for each
patient if supplies allow. If sharing equipment is unavoidable, clean and disinfect
it before use with the next patient.

35. CONTACT PRECAUTION
Contact precautions reduce the risk of
transmission of pathogens by direct contact
such as skin-to-skin contact (shaking
hands) or indirect contact through an
intermediate object such as a comb or
soiled dressing.

36. COMMON INFECTIOUS
DISEASES

37. VIRAL EXANTHEMS
Viruses cause childhood
exanthems (skin rashes). Each
of these diseases has specific
symptoms, characteristic
lesions, and a specific
distribution or pattern to the
rash that allows it to be
identified.

38. EXANTHEM SUBITUM (ROSEOLA
INFANTUM)
• Causative agent: human
herpesvirus 6 (HHV-6)
• Incubation period: 9 to 10 days
• Period of communicability: during
febrile period
• Mode of transmission: unknown
• Immunity: Contracting the disease
offers lasting natural immunity; no
vaccine is available (American
Academy of Pediatrics [AAP],
2015).

39. ASSESSMENT
• Roseola is a disease with fever followed by a
defervescence. HHV-6 is the causative viral agent, and
nearly all humans develop this infection with 77% of
children acquiring roseola by age 2 years
• Signs/Symptoms:
o Fever (38.3-40.6C)
o Cervical adenopathy
o Distinctive rash: discreet rose-pink macules approx.
2-3mm, more prominently on the trunk and fade on
pressure. Lasts 1-2 days.
o No coryza, conjunctivitis nor cough.
• cause of febrile seizure in up to 10% to 15% of
children. Other rare complications of roseola include
encephalitis, encephalopathy, and bulging fontanels.

40. MANAGEMENT
• Treatment focuses on measures to
reduce the fever with
acetaminophen (Tylenol) or
ibuprofen (Motrin) if the child is over
6 months.
• There are no long-term effects of
roseola. If an infant should develop
this exanthem in the hospital, follow
standard infection precautions.

41. RUBELLA (GERMAN
MEASLES)
• Causative agent: rubella virus
• Incubation period: generally, 14 days within
a range of 12 to 23 days (CDC, 2015a;
CDC, 2016j)
• Period of communicability: 7 days before to
approximately 7 days after the rash appears
• Mode of transmission: direct and indirect
contact with droplets
• Immunity: Contracting the disease offers
lasting natural immunity; a high rubella
antibody titer reveals infection has occurred.

42. RUBELLA (GERMAN
MEASLES)
• Active artificial immunity: attenuated live
virus vaccine (e.g., MMR vaccine)
• Passive artificial immunity: Immune serum
globulin is considered for pregnant women
exposed to the virus.
• Rubella (often called German or 3-day
measles) is rarely seen today, but when it
does occur, it is seen most commonly
during the spring and mostly affects older
school-age and adolescent children
• May cause extensive congenital
malformation in fetus if mother is exposed.

43. ASSESSMENT
• Signs and Symptoms;
o Rash – discreet pink-red maculo-papular
rash that begins on the face and then
spreads downward to the trunk and
extremities.
o low-grade fever
o headache
o malaise
o anorexia
o mild conjunctivitis
o upper respiratory symptoms
o lymphadenopathy
▪ suboccipital
▪ Postauricular
▪ cervical chains

44. MANAGEMENT
• Comfort measures for the
rash
• Administration of antipyretics.
• Droplet precaution in addition
to the standard precaution for
7 days after the onset of rash
• MMR vaccination at 1 year
and 4 years of age.

45. MEASLES (RUBEOLA)
• Causative agent: measles virus
• Incubation period: 8 to 12 days from time of exposure to
onset of any symptoms AAP, 2015) with a range from 7 to 21
days (Goodson & Seward, 2015)
• Period of communicability: 4 days before the rash to 4 days
after the rash appears (AAP, 2015)
• Mode of transmission: direct contact with droplets or airborne
spread (AAP, 2015)
• Immunity: Contracting the disease offers lasting natural
immunity.
• Active artificial immunity: attenuated live measles vaccine
(e.g., MMR)
• Passive artificial immunity: immune serum globulin.

46. ASSESSMENT
• Signs and Symptoms:
o 3 C’s:
▪ Cough
▪ Coryza (clear nasal discharge)
▪ conjunctivitis
o Confluent maculopapular, erythematous
rash – starts behind the ear and spreads
to the feet over a course of 3 to 6 days.
This maculopapular coalescing rash
develops over the entire body and
eventually turns from red to brown
desquamation over a few days. While the
rash is red, it fades on pressure; when it
is brown, it does not fade.
o Koplik spots
o Fever as high as 40C

47. ASSESSMENT
o Prodromal Period:
▪Enlargement of lymph
nodes
•Post-auricular
•Cervical
•Occipital
▪Low-grade fever
▪Malaise
▪Photophobia
▪Cough
▪Coryza
▪Mild GI-symptoms

48. MANAGEMENT
• Comfort measures for the rash
• Antipyretic for fever.
• Applying lubricating jelly or
emollient to prevent
excoriation.
• Airborne precaution in addition
to standard precaution.

51. CHICKENPOX (VARICELLA)
• Causative agent: varicella-zoster virus
(VZV)
• Incubation period: 10 to 21 days with the
most common incidence at 14 to 16 days
following exposure (Kroger, 2015)
• Period of communicability: 1 day before
the rash to 5 to 6 days after its initial
appearance, when all the vesicles have
crusted
• Mode of transmission: highly contagious;
spread by direct or indirect contact of
saliva or open vesicles

52. CHICKENPOX (VARICELLA)
• Immunity: contracting the disease offers
lasting natural immunity to chickenpox;
however, because VZV is latent, it causes
herpes zoster (shingles) when it is
reactivated at a later time
• Active artificial immunity: attenuated live
virus vaccine
• Passive artificial immunity: children who
are immunosuppressed, such as those
with leukemia or HIV/AIDS, or those who
are being treated with corticosteroids are
offered varicella-zoster immune globulin
(VZIG) within 72 hours of exposure to help
prevent or modify disease symptoms.

53. CHICKENPOX (VARICELLA)
• Common and highly
contagious childhood
infection.
• Complications include:
oSeconary infections
of the lesions
oPneumonia
oEncephalitis

54. ASSESSMENT
• Signs and
Symptoms
oRash
oLow-grade fever
oBody malaise
oLesions
oSecondary soft-
tissue infections
can also occur.

55. ASSESSMENT
Lesions – present as macule, papule,
and vesicle all appearing at the same
time. Starting on the trunk and
progressing outward to the arms, face,
legs, and mucosal surfaces including
the genitalia. When the lesion is in the
healing stage, there is a characteristic
black crust. The hallmark is a 2- to 3-
mm vesicle on an erythematous base.
The lesions appear in crops, with each
new lesion moving through
progressive stages. Usually, all four
stages of lesions (macule, papule,
vesicle, and crust) may be present at
the same time

56. MANAGEMENT
• Comfort measures for the rash. Rash is very pruritic.
Advise to decrease scratching to reduce infection.
o Use of topical creams and antihistamine (ex.
Diphenhydramine can reduce pruritus)
• Antipyretic for fever. (ex.
Acetaminophen/Paracetamol/ibuprofen)
o Avoid aspirin. Rye syndrome – associated with
varicella/influenza illness and use of aspirin.
• Acyclovir (Zovirax), an antiviral, may be prescribed to
reduce the number of lesions and shorten the course of
the illness.
• Standard infection precaution, airborne and contact
precaution should be adhered until all lesions are
crusted.

57. HERPES ZOSTER (SHINGLES)
Herpes zoster is a reactivation
of the VZV. The herpes viral family
has viral latency, which means
that once you develop varicella,
the virus lies latent in the posterior
dorsal root ganglia (Alter et al.,
2015). The reactivation of the VZV
occurs during aging as well as
during times of
immunosuppression

58. ASSESSMENT
• Signs and
Symptoms
oParesthesia
oPain
oVesicular lesions
in different stages
of healing

59. MANAGEMENT
• Analgesics for pain
• Comfort measures for the rash.
• Antiviral medication – Acyclovir
oMay be effective at limiting the
disease but should be started within
72hours of the start of the rash
• VZIG – can be administered within
96hours for immunocompromised
children to minimize symptoms.

60. SMALLPOX (VARIOLA)
• Causative agent: smallpox virus
• Incubation period: 7 to 17 days with a mean of
12 days
• Period of communicability: The child is
contagious for 24 hours before the onset of the
rash and remains contagious until all lesions
are dried which can take up to 4 weeks.
• Mode of transmission: airborne transmission;
can also be transmitted through a direct
contact with an infected person or indirectly
with a fomite.
• Smallpox is a serious illness. Mortality rate is
greater than 30%

61. SMALLPOX (VARIOLA)
• Distinct differences between smallpox and varicella
o Febrile prodrome.
▪ Smallpox ✔
▪ Varicella ❌
o Lesion. Smallpox lesion may resemble that of
varicella however
▪ Smallpox – all lesion progress at the same
rate. Has a pustular stage. These pustular
lesions are firm and deeply embedded in the
skin dermal layer.
▪ Varicella – All stages of lesion usually is
present at the same time.
o Crusting phase of the lesion:
▪ Smallpox – contagious
▪ Varicella – not contagious

62. MANAGEMENT
• Administration of disease specific
vaccinia immune globulin (VIG)
• Administration of antibiotics to treat
and/or prevent secondary bacterial
infection of the lesions.
• O2 support whenever needed.
• Standard infection precaution, airborne
and contact precaution should be
implemented.

66. NON-POLIO ENTEROVIRUSES
• Causative agent: member of the enteroviral family
• Incubation period: most common is between 3 to 6 days,
with hemorrhagic conjunctivitis having a shorter incubation
of 24 to 72 hours (AAP, 2015)
• Period of communicability: uncertain
• Mode of transmission: respiratory tract secretion, fecal–
oral, vertical transmission from mother to baby at the time
of birth; possibly breastfeeding
• Immunity: none

67. COXSACKIEVIRUS INFECTIONS
• Responsible for a variety
of diseases.
• Coxsackievirus A6 and
A16 – associated with
Hand Foot and Mouth
Disease (HFMD)

68. ASSESSMENT
oSigns and symptoms:
▪Distinctive erythematous
papules on the hands and
feet, occasionally on the
buttocks and oral ulcers in
the pharynx.
▪Associated with fever,
anorexia, dysphagia, sore
throat, headache, abdominal
pain, and vomiting.

69. MANAGEMENT
▪Soft Diet. Give non-
irritating fluids.
▪Analgesics:
Acetaminophen/Paracetam
ol
▪Contact precaution in
addition to standard
precaution.

70. POLIOMYELITIS (INFANTILE PARALYSIS)
• Causative agent: poliovirus
• Incubation period: Nonparalytic polio—
3 to 6 days. Paralytic polio is
commonly 7 to 21 days with a range of
3 to 35 days.
• Period of communicability: greatest
shortly before and after onset of clinical
symptoms, when virus is present in the
throat (1 to 2 weeks after the onset of
illness and in feces (3 to 6 weeks);
however, the virus is contagious as
long as it is present in the feces.

71. POLIOMYELITIS (INFANTILE PARALYSIS)
• Mode of transmission: respiratory
secretions and feces (AAP, 2015)
• Immunity: Contracting the disease
causes active immunity against the one
strain of virus causing the illness.
• Active artificial immunity: inactivated
polio virus (IPV) vaccine
• Passive artificial immunity: none
• 72% of infections with the polio virus
do not produce a paralysis and is
asymptomatic.

73. ASSESSMENT
• Signs and Symptoms of Paralytic Polio:
o Fever
o Headache
o Nausea
o Vomiting
o Abdominal pain
o Constipation
o Malaise
o Followed by period of no symptoms
o 1% will go on paralysis with areflexia
and bulbar symptoms.
▪ Motor paralysis. Sensation remains
intact.

74. MANAGEMENT
• Non-paralytic poliomyelitis: Bed rest and
administration of antipyretics
• Give supportive care depending on the
symptoms.
• No known antiviral drug to treat any form
of polio.
• Long-term ventilation if respiratory
muscles are involved.
• Physical therapy to prevent contracture
and promote strength during the recovery
period.

75. VIRAL INFECTIONS OF THE INTEGUMENTARY
SYSTEM
HERPESVIRUS INFECTIONS
• Causative agent: herpes simplex, type 1 or type 2 virus
• Incubation period: 2 days to 2 weeks (AAP, 2015), average of 6 days (Simos, Flynn,
Peicuch, et al., 2009)
• Period of communicability: greatest early in the course of the infection
• Mode of transmission: direct contact with persons with active lesions or persons shedding
the virus asymptomatically
• Immunity: Herpes viruses like VZV have viral latency, so patients can have recurrent
infections. There is currently no vaccine available (Stanberry, 2016)

76. ACUTE HERPETIC GINGIVOSTOMATITIS
• Common in
children from 6
months to 5
years of age but
can also be seen
in older children.

77. ASSESSMENT
•Initially: sudden onset of pain,
drooling, anorexia, and a significant
fever as high as 105°F (40.6°C)
•Gumline is swollen, reddened, and
bleeds easily.
•White, shallow ulcers with red
borders appear on the gum, lips,
buccal mucosa, tongue, palate,
perioral skin, and, less commonly,
on the tonsillar pillars.
•The anterior cervical lymph nodes
are usually enlarged and tender.

78. MANAGEMENT
•Antipyretics for fever
•Administration of oral
Acyclovir
•Ensure adequate fluid
intake

79. HERPES SIMPLEX (HERPES LABIALIS)
o popularly known as a cold
sore or fever blister, is the
recurrent form of HSV. In the
case of herpes labialis, the
HSV remains dormant in the
ganglia of the trigeminal or
fifth cranial nerve. Herpes
simplex typically appears as
a cluster of painful, grouped
vesicles surrounded by an
erythematous base on the
border of the lips (vermillion
border)

80. ASSESSMENT
•Initially: tingling,
burning, itching, or pain
•Eruption of
erythematous papules
that rapidly progress to
grouped vesicles

82. MANAGEMENT
•Oral acyclovir
•Topical acyclovir

83. ACUTE HERPETIC VULVOVAGINITIS (GENITAL HERPES)
oGenital herpes is
caused primarily by
HSV type 2, which
remains dormant in the
ganglia of the sacral
nerves. Genital herpes
is spread primarily by
sexual contact. (Will be
discussed in GU
disorders together with
STDs)

84. VIRUS CAUSING CNS DISEASES
RABIES
Rabies causes an acute encephalitis that is fatal and
caused by Lyssavirus genus, which includes rabies
virus (RABV). RABV infections number over 59,000
people and is most common in poor countries. The
domestic dog causes most rabies worldwide due to
lack of vaccination.

85. RABIES
• Causative agent: RABV
• Incubation period: average is 1
to 3 months but can range
from days to years
• Period of communicability: 3 to
5 days before the onset of
symptoms through the course
of the disease
• Mode of transmission: the bite
of a rabid animal; rarely
through saliva from an infected
animal being transferred to an
open lesion on a child’s skin

86. RABIES
• Immunity: Contracting the
disease apparently offers
active immunity, but few
people have ever survived
the illness to verify this.
• Active artificial immunity:
human diploid cell rabies
vaccine
• Passive artificial immunity:
rabies immune globulin
(RIG)

87. ASSESSMENT
• Signs and Symptoms:
o Prodromal signs of:
▪ Malaise, fever, anorexia, nausea,
sore throat, drowsiness, irritability,
and restlessness.
o Clinical manifestations:
▪ Anxiety, radicular pain pruritus,
hydrophobia, dysautonomia, and in
some patients, paralysis
• Children become comatose as the
disease progress
• Peripheral vascular collapse and death
can follow as quickly as 5 or 6 days later

88. MANAGEMENT
• The main goal of treatment or management is prevention.
Once the disease process begins, rabies is almost invariably
fatal, so the key is prevention of the active process.
• Post-exposure prophylaxis following an animal bite or
exposure.
o Immediate administration of human rabies vaccine (HRV).
o Administration of RIG (Rabies Ig) (20IU/Kg) into the area of
bite with the remainder of the RIG administered in an IM
injection.

89. VACCINATION SCHEDULE
Day 0 HRV, RIG 1st dose
Day 3 RIG 2nd dose
Day 7 RIG 3rd dose
Day 14 RIG 4th dose

90. OTHER VIRUSES
TRANSMITTED BY ANIMAL
VECTORS

91. • HANTAVIRUS PULMONARY SYNDROME
INFECTION
oTransmitted by
Rodents
oThere are usually five
phases: (a) febrile
phase, (b)
hypotension, (c)
oliguria, (d) polyuria,
and (e) convalescence

92. ZIKA VIRUS DISEASE
o Transmitted by Mosquitoes
(Aedes aegypti/Aedes
albopictus) or by sexual
contact, blood & blood
products as well as from
mother to fetus.
o The yellow fever mosquito
is one of the world’s most
deadly animals, causing
yellow fever, Zika virus,
dengue, and chikungunya
viral infections

93. WEST NILE VIRUS DISEASE
o Transmitted via arthropods
(insects) or person-person via
organ transplant or blood
transmission.
o It is possible to be
asymptomatic. Symptomatic
manifestations – fever,
arthralgia, myalgia.
o Neuroinvasive form –
uncommon but can include
encephalitis, meningitis, and
acute flaccid paralysis.

94. OTHER VIRAL INFECTIONS

95. MUMPS (EPIDEMIC PAROTITIS)
• Causative agent: mumps virus
• Incubation period: usually 16 to
18 days with an outside range
from 12 to 25 days
• Period of communicability:
communicable for 5 days from
onset of the swollen parotid
gland
• Mode of transmission: direct
contact with respiratory
droplets

96. MUMPS (EPIDEMIC PAROTITIS)
• Immunity: Contracting the
disease gives lasting
natural immunity.
• Active artificial immunity:
attenuated live mumps
vaccine in combination
with measles and rubella
(MMR)
• Passive artificial immunity:
mumps immune globulin.

97. ASSESSMENT
• Signs and Symptoms:
oParotid gland
enlargement
oTesticular pain and
swelling (orchitis) for
boys
oFever

98. MANAGEMENT
• Supportive management.
• Fever control by
Acetaminophen/Paraceta
mol.
• Administration of NSAIDs
for pain.
• Soft bland diet

99. COVID 19
• Causative agent: SARS-CoV-2
virus.
• Incubation period: on the average 5–
6 days but can take 2-14 days (Still
insufficient data. Needs more study)
• Mode of transmission: exposure to
respiratory fluids
o Inhalation of very fine respiratory
droplets and aerosol particles
o Direct splashes and sprays with
respiratory droplets
o Touching mucous membranes
with hands that have been in
contact with virus-containing
respiratory fluids

100. ASSESSMENT
• Most common
symptoms:
• fever
• cough
• tiredness
• loss of taste or
smell.
• Less common
symptoms:
• sore throat
• headache
• aches and pains
• diarrhea
• a rash on skin, or
discoloration of fingers
or toes
• red or irritated eyes.

101. ASSESSMENT
• Serious
symptoms:
• difficulty breathing
or shortness of
breath
• loss of speech or
mobility, or
confusion
• chest pain

102. MANAGEMENT
• Standard, Airborne and Droplet
precautions.
• O2 support. For more serious cases,
high-flow nasal cannula oxygen
therapy may be used. Or in severe
cases, invasive oxygenation/ventilation
(ET-intubation) can be performed to
deliver high concentrations of oxygen.
• Hemoperfusion can also be
considered.

103. MANAGEMENT
• Usual standard medications used (may change over time since
COVID 19 is a new disease and only limited number of
researches have been conducted yet):
o Corticosteroids to control inflammation of lung tissues. Ex.
Dexamethasone.
o Vitamins supplementation.
o Antiviral medications (most drugs are still in investigational
phase but was given permit to be utilized termed by DOH as
for “compassionate-use):
▪ Favipiravir
▪ Molnupiravir
▪ Remdesivir
▪ Nirmatrelvir with ritonavir (Paxlovid)
▪ Bebtelovimab

104. MANAGEMENT
o Other Drugs used:
▪ Barcitinib
▪ Tocilizumab
o Antibiotics: Azithromycin
o Anti-thrombotic drugs.
o Other drugs could also be used depending on
the patient’s clinical manifestations.
• Supportive treatment.
• Prone position for optimal lung expansion if
tolerated.

105. MIS-C
• Multisystem inflammatory syndrome in
children (MIS-C) is a condition where
different body parts can become inflamed,
including the heart, lungs, kidneys, brain,
skin, eyes, or gastrointestinal organs. We
do not yet know what causes MIS-C.
However, we know that many children with
MIS-C had the virus that causes COVID-19,
or had been around someone with COVID-
19. MIS-C can be serious, even deadly, but
most children who were diagnosed with this
condition have gotten better with medical
care.

106. MANAGEMENT
• Supportive treatment.
• O2 therapy.
• Administration of
Intravenous
Immunoglobulin.
• Corticosteroid treatment.

107. BACTERIAL INFECTIONS

108. STAPHYLOCOCCAL INFECTIONS
Gram-positive S. aureus is the most common
infecting organism for pyogenic infections of the
skin as well as soft tissue. Staphylococci are
normally found on the skin surface; therefore,
they are commonly the organisms involved in
skin infections (pyodermas).

109. CELLULITIS
• Cellulitis is staphylococcal
inflammation of the dermal and
subcutaneous layers of skin. It can
occur anywhere on the body and
there will be warmth, tenderness,
and erythema at the area of
cellulitis. The treatment is a
systemic antibiotic that will cover
both staphylococci and
streptococci.

110. METHICILLIN-RESISTANT
STAPHYLOCOCCUS AUREUS (MRSA)
• MRSA is a strain of staphylococcus
that causes skin infections and has
become resistant to common broad-
spectrum antibiotics.
• Drug of choice:
o Vancomycin – for hospital-based
infections
Clindamycin or trimethoprim-
sulfamethoxazole for community-based
infections

111. OTHER BACTERIAL INFECTIONS
TETANUS (LOCKJAW)
• Causative agent: C. tetani
• Incubation period: 3 days to 3 weeks
• Period of communicability: none
• Mode of transmission: direct or indirect
contamination of a closed wound
• Immunity: development of the disease gives
lasting natural immunity
• Active artificial immunity: tetanus toxoid
contained in DTaP vaccine
Passive artificial immunity: TIG

112. ASSESSMENT
• Signs and Symptoms:
oStiffness of the neck and
jaw (lock jaw)
oMuscular rigidity
oArched back (opisthotonos)
o“Sardonic grin” – unusual
appearance of the face
oAny stimulation causes
painful paroxysmal spasms

113. MANAGEMENT
• Prevention is key.
o Administration of DTaP vaccine
• Therapeutic Management:
o Standard precaution.
o Administration of human tetanus
Immunoglobulin (HTIg)
o Administration of:
▪ Penicillin G (oral or IV form)
▪ Metronidazole
o O2 support. Intubation and mechanical
ventilation may be necessary to maintain
respiratory function.

114. PARASITIC INFECTIONS

115. PARASITIC INFECTIONS
•Parasites are organisms that live on
and obtain their food supply from
other organisms. Although many of
these can cause illness, ones
frequently associated with children
include head lice and scabies.

116. Pediculosis Capitis (Head lice)
•Signs and Symptoms:
Small, white flecks on
hair shaft (nits or eggs of
lice); extreme pruritus
•Treatment: Use of over-
the-counter permethrin-
based or pyrethrin-based
shampoo

117. Pediculosis (Pubic Lice)
•Signs and
Symptoms: Same as
for head lice except
on pubic hair
•Treatment: Same as
head lice

118. Scabies
•Signs and Symptoms: Black
burrow filled with mite feces 1–
2 in long, usually between
fingers and toes, on palms, or
in axilla or groin.
•Treatment: Topical permethrin
5% cream is the drug of choice
with two doses of oral
ivermectin (off-label use) 1
week apart, also being an
effective drug

119. HELMENTHIC INFECTIONS
caused by parasitic worms
(helminths)

120. Roundworms (Ascaris lumbricoides)
• Signs and Symptoms - generally
asymptomatic infections but when
there is an extensive parasite
load, malnutrition and
gastrointestinal symptoms result
• Treatment: Options: (a) a single
dose of albendazole with food, (b)
nitazoxanide twice a day for 3
days, or (c) a single dose of
ivermectin (off-label use and not
to be used in children less than 15
kg)

121. Hookworm
•Signs and Symptoms – usually
tend to be asymptomatic but
could also present with colicky-
abdominal pain, nausea,
diarrhea and marked
eosinophilia. Severe anemia
can also be seen.
•Treatment: albendazole
(Albenza), mebendazole
(Vermox), and pyrantel
pamoate (Pin X)

122. Enterobiasis (Pinworms)
•Pinworms are small,
white, threadlike worms
that live in the cecum
•Signs and Symptoms:
Itching anal area
•Treatment: Single-dose
Mebendazole or pyrantel
pamoate