2. Learning Outcomes
Describe structure and function of the immune system
Explain why children are more vulnerable than adults to
communicable diseases
Describe process of infection and modes of transmission
Summarize role of vaccines in reduction and elimination of
communicable diseases
Prepare a nursing care plan for children of all ages needing
immunizations
Differentiate common communicable diseases
Describe medical and nursing management of common
communicable diseases
2
3. Infection Definition
Invasion and multiplication of microorganisms in or
on body tissue that produce signs and symptoms as
well as an immune response
Such reproduction injures the host by causing cell
damage from microorganism-produced toxins or
intracellular multiplication or by competing with the
host metabolism
3
4. Immune System
Prevent entry of or removal of foreign substances
Body’s innate (natural) defenses
Skin, body pH, maternal antibodies, inflammatory
response, phagocytic response
Natural killer cells: attack infected cells (cell-
mediated)
Complement proteins: work with antibody activity
(humoral)
4
5. Immune Response
Normally the immune system responds to an
invasion of foreign substances, or antigens, in
numerous ways.
It produces antibodies, or proteins that work
against antigens, the foreign substances that trigger
the immune response.
The immune system also produces other types of
cells, such as T –lymphocytes and natural killer (NK)
cells
5
6. Types of Immune Protection:
Natural (Innate)
This protection, present at birth, isn’t learned and
doesn’t depend on previous contact
Natural immunity includes barriers against disease,
such as skin and mucous membranes, and
bactericidal substances of body fluids, such as
intestinal flora and gastric acid
Some species are naturally immune to some
diseases
6
7. Types of Immune Protection:
Naturally Acquired Active
Person’s immune system works to produce
antibodies
Immune system produces antibodies after exposure
to disease (requires contact with the disease)
This protection lasts for life
The risk of the child developing adverse effects is
high because he contracts the disease
7
8. Types of Immune Protection:
Artificially Acquired Active
Person’s immune system works to produce
antibodies
Medically engineered substances are injected to
stimulate the immune response against a specific
disease
All immunizations are included
8
9. Types of Immune Protection:
Naturally Acquired Passive
Fetus/baby receives mother’s antibodies
No active immune process is involved; the
antibodies are passively received
Occurs during pregnancy, in which certain
antibodies (immunoglobin G) are passed from the
maternal into the fetal bloodstream
Also occurs during breast-feeding
9
10. Types of Immune Protection:
Artificially Acquired Passive
Person is given someone else’s antibodies
Short-term immunization by the injection of antibodies, such as
gamma globulin, that are not produced by the recipient's cells
(no stimulation of immune response)
The antibodies provide immediate protection that lasts for weeks
or months
Examples: Intravenous gamma-globulin to treat Kawasaki
disease; Synagis (palivizumab) monoclonal antibody (IM) to
prevent respiratory syncytial virus (RSV) in children at high risk
of RSV disease
10
11. Acquired Immunity
Humoral
Antibodies (created by
B-lymphocytes)
Cell-Mediated
T-cells (mature in
thymus)
Assist B-lymphocytes to
make antibodies
11
12. Figure 22-1 The primary immune response encompasses a cascade of events that involve
humoral and cellular immunity.
12
13. Humoral Immunity
Responsible for destroying bacterial antigens
B Lymphocytes, produced in the bone marrow, gut,
& other lymphoid tissue, are the central factor in
humoral immunity and develop into plasma cells that
produce antibodies
Antibodies are a type of protein called
immunoglobulins (IgM, IgG, IgA, IgD, & IgE)
13
14. Immunoglobulins
IgM, IgG, & IgA act to control a number of body
infections
IgE useful in combatting parasite infections and part
of the allergic response
The role of IgD is unknown
14
16. Primary Immune Response
When a child is 1st exposed to an antigen, the B-
lymphocyte system begins to produce antibodies
that react specifically to that antigen
Takes ~ 3 days
16
18. Cell-Mediated (Cellular)
Immunity
Uses T-Lymphocytes, produced mainly in the
thymus, to provide cellular immunity and protect
against most viruses, fungi, slowly developing
bacterial infections, such as TB, and tumors
Also control timing of response in delayed
hypersensitivity reactions, such as PPD test
Also responsible for rejection of foreign grafts, such
as transplants
18
19. Types of T-Lymphocytes
Killer T cells- attack & destroy cells infected w/antigen
Suppressor T cells: balance action of helper T-cells
Helper T cells-aid in the proliferation & immunologic
function of other cells
19
20. Infant Vulnerability to
Infection
Immune system not fully developed
Maternal antibodies offer limited protection
Diminishes with time
Immunization protection incomplete
20
21. Children’s Vulnerability
to Infection
Developing immune system
Exposure to infections from
others
Close contact with adults,
other children
Poor hygiene habits
Encourage handwashing
After toileting, before eating
Use disposable tissues
Educate adult caregivers
21
22. Disease Transmission
Direct or indirect transmission
Three factors required for disease to occur
Infectious agent (pathogen)
Effective means of transmission
Susceptible host
22
23. Chain of Infection
Infectious/ Causative agents
Any microbe that can produce disease
Bacterial, viral, fungal, protozoan
Reservoir
Environment or object in or on which a microbe can survive and, in
some cases, multiply; can be an inanimate object, a human being, an
animal, or an insect
Portal of exit
Path by which an infectious agent leaves its reservoir; usually it’s the
site where the organisms grow; portals of exit associated with human
reservoirs include the respiratory, genitourinary, and GI tracts; the
skin and mucous membranes; and the placenta
Excretions, secretions
23
24. Chain of Infection Cont’d…
Mode of transmission
Means by which the infectious agent passes from the portal of exit in
the reservoir to the susceptible host; infections may be transmitted by
one of four modes:
Contact, Airborne, Enteric (Oral-Fecal), Vector-borne
Vector: animal, human, object
Portal of entry
Path by which an infectious agent invades a susceptible host
Membranes, eyes, nose, skin, blood
Susceptible host
Required for the transmission of infection to occur; an infectious
agent is more likely to invade the body of a weakened host rather
than a healthy one and launch an infectious disease
24
25. An effective chain of infection transmission requires a suitable habitat or
reservoir for the pathogen. To prevent or control the spread of infection, one of
the links in the chain must be broken, such as eliminating one or more of the
habitats or reservoirs (e.g., insecticide spraying to kill mosquitoes that carry
malaria). Isolating an infected individual interferes with disease transmission,
and killing the pathogen eliminates the causal agent.
25
28. Infection Control Measures
Prevent Systemic Infections
Hand hygiene
Sterile technique: invasive procedures
Isolation as needed
Promote Skin Integrity
Promote Nutritional Balance
Manage Medications
Emotional Support
28
29. Infectious diseases are easily transmitted in
settings such as childcare centers where
multiple children handle common objects and
then put fingers in their mouths.
29
30. Stages of Infection
Incubation
The disease may develop almost instantaneously, or this
period may last for years
During this time, the pathogen is replicating, and the
infected person is contagious and can transmit the
disease
Prodromal stage
This stage occurs after incubation
The still-contagious host complains of feeling unwell;
complaints are vague
30
31. Stages of Infection Cont’d…
Acute illness
Microbes are actively destroying host cells and
affecting specific host systems
The patient recognizes which area of the body is
affected; complaints become more specific
Convalescent stage
The body’s defense mechanisms have begun to
confine the microbes, and damaged tissue is healing
31
32. Infectious Process
Organisms in body
Multiply within body
Bacteria, fungus, protozoa
Production of toxins
Infect cells
Virus forces cells to replicate virus
32
33. Body’s Response to Infection
Neutrophils-
phagocytic cells
that defend against
bacteria
33
34. Body’s Response to Infection
Complement system proteins-component of blood
serum consisting of 11 protein compounds; activates
in response to antigen-antibody functions, resulting
in a generalized inflammatory reaction that kills
foreign cells
Also plays a role in causing some autoimmune
diseases
34
35. Body’s Response to Infection
Immune cells also secrete proteins called cytokines
that carry messages for immune system function
Lymphocytes, monocytes, & macrophages all
secrete cytokines that have a variety of effects on
the target cells
35
36. Body’s Response to Infection
Macrophages - ingest antigens and signal T-cells
that antigens are present
36
37. Body’s Response to Infection
Fever
Macrophages release endogenous pyrogens
Hypothalamus releases prostaglandins
Body temperature rises
Heat speeds immune response
37
38. Pediatric Differences
Infants & children have differing amounts of some
immunoglobulins
IgG is the only immunoglobulin that crosses the
placenta
As a result, a newborn’s levels are similar to those of
the mother
This maternal IgG disappears by 6-8 months
Infant’s IgG increases gradually til mature levels are
reached at 7-8 years
38
39. Pediatric Differences
IgM levels are low at birth, rise markedly at 1 week
of age, & continue to increase til adult levels are
reached around 1 year
IgA & IgE are not present at birth
Manufacture of those begins by 2 weeks of age
Normal levels are not achieved til around 6-7 years
39
40. Figure 22-2 Different types of immunoglobulins mature at variable times throughout childhood.
Children have high levels of some types of immunoglobulins, while others may be low at certain
periods during development.
40
42. Nursing Considerations
Isolation: physical and psychosocial effects
Types of isolation on the pediatric unit
Teach parents
Fever a symptom, not disease
Infection prevention
Home antibiotic administration:
Give all; don’t share
42
45. Types of Immunizations:
Killed Virus
Microorganism has been killed but still capable of
causing body to produce antibodies
Eg: IPV (inactivated polio virus)
45
46. Types of Immunizations:
Toxoid
Toxin has been treated with heat or chemicals to
weaken toxic effects, but retain antigens
Eg: Tetanus toxoid
46
47. Types of Immunizations:
Live Virus
Microorganism is live but attenuated or weakened
90-95% protection for 20+ years w/ single dose
Egs: MMR & Varivax
47
49. Types of Immunizations:
Conjugated
An altered organism if joined with another substance
to increase the immune response
Eg: Hib (Haemophilus influenza-H-flu)
49
50. Side Effects of
Immunizations
Common local reactions- redness, swelling, pain,&
induration @ injection site
Systemic reactions- fever, fussiness, irritability,
malaise, anorexia
Rash or arthralgia may occur with some vaccines
Highly anxious adolescents- syncope or vasovagal
reaction within 15 min. (risk for falls)
50
51. Allergic Reactions
Wheal or urticaria within minute to hours
Severe local reaction: warmth, erythema, edema,
petechiae, or ulceration 2-8 hrs after vaccination
Non-life-threatening systemic reaction: urticaria & or
petechiae within minutes
Anaphylaxis (life-threatening): hypotension, urticaria,
angioedema, laryngeal edema (rare)
51
53. Vaccine Facts
Save thousands from death and injury every year
Do not harm immune system
No links to autism, inflammatory bowel disease,
multiple sclerosis, asthma, diabetes
Reduce risk of infection
Do not eliminate risk
53
56. Nursing Care: Immunizations
Assess
Immunization record, current health
Mild illness, fever not contraindication
Potential contraindications
Previous reactions
Allergies to vaccine components
Presence of serious medical condition/ pregnancy
56
57. Nursing Care: Immunizations
Withhold the DTaP vaccine if the child has a progressive and
active CNS problem or has had a previous serious reaction
Don’t vaccinate with a live virus if the child’s immune system
is suppressed or if he has received gamma globulin within the
past 6 weeks, is allergic to the contents of the immunization,
or has been on chemotherapy
Don’t give the tuberculin purified protein derivative test (PPD)
and the measles vaccine at the same time; the measles
vaccine may make a tuberculosis (TB)-positive person appear
to be TB-negative
57
58. Nursing Care:
Immunizations
Do place a reminder in the child’s health record to
alert health professionals about child’s need for
immunizations
Do give vaccines when the child has a minor illness,
even with a low-grade fever and antibiotic treatment,
or has a recent exposure to an infectious agent
Give multiple vaccines at the same time in separate
sites
58
60. Nursing Diagnoses
Risk for Infection
Related to incomplete immunizations
Knowledge Deficit
Related to potential side effects
Acute Pain
Related to injections or anxiety
Risk for Injury
Related to vaccine reactions
60
61. Nursing Interventions
Advocacy for immunizations
Information: benefits, risks, side effects
Written and verbal
Obtain consent
Be efficient and use topical anesthetic and comfort
measures
Longer needles = fewer local reactions
61
62. Educate Parents
Local pain, redness, & swelling are common; use ice
APAP & NSAID’s for fever, joint pain, muscle aches,
& fatigue (1-2 days)
S/S of severe allergic reaction: flushed face,
swelling of face, mouth or throat, wheezing or other
difficulty breathing, shock (confusion, lack of
movement or response, or unconsciousness),
abdominal cramping: call 911
62
64. Give immunizations quickly and efficiently.
Do not prolong the wait and let fear grow.
The child will be anxious, especially if more
than one injection must be given.
64
66. Immunization Documentation
Date of immunization & time
Vaccine given
Manufacturer, lot #, expiration date
Site and route of administration
Name/title/address of nurse
Information given to parents
Immunization record, instructions for home
Adverse effects: type, response
66
72. Rubeola (Regular Measles)
(p. 352 [new], 388 [old])
General information
Acute, highly contagious infection that causes a
characteristic maculopapular rash
Can be severe or fatal in patients with impaired cell-
mediated immunity; mortality highest in children younger
than age 2 and adults
Caused by rubeola virus
Spread by direct contact or by inhalation of contaminated
airborne droplets; portal of entry in the upper respiratory
tract
72
75. Rubeola (Measles)
Assessment findings
Fever, periorbital edema, conjunctivitis
Koplik’s spots (tiny gray-white specks surrounded by
red halo) on oral mucosa opposite the molars that
may bleed
Red, blotchy rash that begins on the face and
becomes generalized
Severe cough, rhinorrhea, lymphadenopathy
75
77. Rubeola (Measles)
Nursing interventions
Institute respiratory isolation measures for 4 days
after rash onset
Encourage bed rest during the acute period
Report measles cases to local public health officials
Administer antipyretics for fever, as ordered
Keep the child well-hydrated
Dim lights
77
78. Mumps (Parotitis) (p.354[new],389[old])
General information
Acute inflammation of one or both parotid glands and
sometimes the sublingual or submaxillary glands
Caused by a paramyxovirus found in the saliva of an
infected person
Transmitted by droplets or by direct contact with the
saliva of an infected person
78
80. Mumps (Parotitis)
Assessment findings
Myalgia
Anorexia
Malaise
Headache, an earache aggravated by chewing, and pain
when drinking sour or acidic liquids
Fever
Swelling and tenderness of the parotid glands
Simultaneous or subsequent swelling of one or more
other salivary glands
80
81. Mumps (Parotitis)
Complications
Epididymoorchitis
Meningoencephalitis
Male infertility (rare)
Pancreatitis
Transient sensorineural hearing loss (typically unilateral)
Arthritis
Nephritis
Nursing interventions
Apply warm or cool compresses to the neck area to relieve pain
Report all cases of mumps to local public health officials
81
82. Rubella (German Measles)
(p. 357 [new], 392 [old])
General information
Acute, mildly contagious viral disease that causes a
distinctive maculopapular rash (resembling that of
measles or scarlet fever and lymphadenopathy)
Caused by rubella virus (a togavirus)
Virus enters the blood stream, usually through the
respiratory tract
82
85. Rubella (German Measles)
Assessment findings
Rash accompanied by a low-grade fever
Exanthematous, maculopapular, mildly pruritic rash;
typically begins on the face and spreads rapidly, covering
the trunk and extremities within hours
Small, red, petechial macules on the soft palate
(Forschheimer spots) preceding or accompanying the
rash
Suboccipital, postauricular, and postcervical lymph node
enlargement
85
87. Rubella (German Measles)
Complications
Arthritis
Postinfectious encephalitis
Thrombyocytopenia purpura
Congenital rubella
In fetal infection (rare after 20 weeks’ gestation):
intrauterine death, spontaneous abortion, congenital
malformations of major organ systems
87
88. Rubella (German Measles)
Nursing interventions
Institute isolation precautions until 5 days after the rash
disappears; keep an infant with congenital rubella in isolation
for 3 months, until three throat cultures are negative
Keep the patient’s skin clean and dry
Ensure that the patient receives care only from nonpregnant
caregivers who aren’t at risk for rubella; as ordered,
administer immune globulin to nonimmunized people who
visit the patient
Report confirmed rubella cases to local public health officials
88
89. Varicella (Chickenpox)
(p. 349 [new], 385 [old])
General information
Acute, highly contagious infection that can occur at
any age
Caused by the varicella-zoster virus, which also
causes herpes zoster (shingles)
Transmitted through direct contact (primarily with
respiratory sections, less common with skin lesions)
and indirect contact (through airwaves)
89
91. Varicella (Chickenpox)
Assessment findings
Fever
Crops of small, erythematous macules on the trunk or scalp
Macules progress to papules and then clear vesicles on an
erythematous base (so-called dewdrops on rose petals)
Vesicles become cloudy and break easy; then scabs form
Rash spreads to face and torso; less distribution of rash to extremities
Rash is a combination of red papules, vesicles, and scabs in various
stages
Ulcers on mucous membranes of the mouth, conjunctivae, and
genitalia
91
92. Varicella (Chickenpox)
Complications
With scratching due to severe pruritus: infection, scarring,
impetigo, furuncles, and cellulitis
Reye’s syndrome
Myocarditis
Bleeding disorders
Arthritis
Nephritis
Hepatitis
Pneumonia
Meningitis
92
93. Varicella (Chickenpox)
Nursing interventions
Institute strict isolation measures until all skin lesions have crusted
Observe an immunocompromised patient for manifestations of
complications, such as pneumonitis and meningitis, and report them
immediately
Provide skin care comfort measures (calamine lotion, cornstarch, oatmeal
baths, sponge baths, or showers); administer oral antihistamines (preferred
over topical itch medications)
Keep the child’s fingernails short and clean
Don’t give aspirin when a viral infection is suspected; the combination of
these may result in Reye’s syndrome, an acute encephalopathy with
cerebral cortex swelling but without inflammation, accompanied by impaired
liver function and hyperammonemia
Advise the parents that the child can’t return to day care or school until all
the lesions are crusted
93
94. Fifth Disease (Erythema
Infectiosum) (p. 351 [new], 386 [old])
General information
Contagious disease characterized by rose-colored
eruptions diffused over the skin, usually starting on
the cheeks
Caused by human parvovirus B19
Transmitted by way of the respiratory tract (droplets)
94
96. Fifth Disease (Erythema
Infectiosum)
Assessment findings
Mildly erythematous pharynx and conjunctivae
Intensely red facial rash, forming a “slapped face”
appearance 4 to 7 days after resolution of symptoms
Rash on extensor surfaces of extremities 1 day after
facial rash appears
Rash on flexor surface and trunk 1 day later and
lasting 1 or more weeks
96
98. Fifth Disease (Erythema
Infectiosum)
Treatment
Isolation isn’t necessary
Cut the child’s fingernails to avoid injury from
scratching
Provide lukewarm water baths with baking soda to
soothe itching
98
99. Head Lice (p. 921 [new], 998 [old])
Definition
Also known as pediculosis
capitis
A contagious infestation
with any of the small
wingless insect or lice
order of Anoplura
It is estimated that 6 to 10
million children per year
are infected with lice
99
100. Head Lice
Causes
Sharing of clothing and
combs
Close personal contact
with peers
100
101. Head Lice
Pathophysiology
Lice feed on human blood and lay their eggs (nits) in body hairs
After the nits hatch, the lice must feed within 24 hours or die; they
mature in about 2 to 3 weeks
When a louse bites, it injects a toxin into the skin that produces mild
irritation and a purpuric spot
Repeated bites cause sensitization to the toxin, leading to more
serious inflammation
Treatment can effectively eliminate lice
Complications
Excoriation
101
102. Head Lice
Assessment findings
Pruritus of the scalp
Visual examination of lice
eggs, which look like white
flecks, firmly attached to hair
shafts
Black specks at the base of
the hair
Diagnostic test findings
Diagnostic tests aren’t
necessary because
diagnosis is based on visual
examination
102
103. Head Lice
Medical management
Removal of lice and eggs using a fine-toothed comb
Medications
Permethrin (Nix) shampoos
Pyrethrins (RID)
Benzyl alcohol 5% (Ulesfia)
Spinosad (Natroba)
Ivermectin 5% (Sklice)
Malathion (Ovide)
Preventive drug therapy for other family members and
classmates
103
105. Head Lice
Nursing interventions
Carefully follow the manufacturer’s directions when
applying medicated shampoo
Some preparations require repeat treatment in 7 to 10
days to ensure that all eggs have been killed
Instruct the child’s parents to wash bed linens, furniture,
hats, combs, brushes, and anything else that came in
contact with the hair to prevent reinfestation
Explain the importance of refraining from exchanging
combs, brushes, headgear, or clothing with other children
Place stuffed toys in a sealed plastic bag for 2 weeks
105
107. Scabies
(p. 922 [new], 999 [old])
Definition
Transmissible skin infestation with Sarcoptes scabiei
var. hominis (itch mite)
Characterized by burrows, severe pruritus, and
excoriations
Causes
Transmissible by direct (skin to skin) contact or
contact with contaminated articles for up to 48 hrs
107
109. Scabies: Pathophysiology
Mites burrow into the skin on contact, progressing 2 to 3 mm
per day
Females live about 4 to 6 weeks and lay about 40 to 50 eggs,
which hatch in 3 to 4 days
Pruritus occurs only after sensitization to the mite develops
With initial infestation, sensitization requires several weeks
With reinfestation, sensitization develops within 24 hours
Dead mites, eggs, larvae, and their excrement trigger an
inflammatory eruption of the skin in infested areas
109
110. Scabies
Complications
Excoriations
Secondary
bacterial infection
Abscess
formation
Septicemia
Assessment findings
Intense pruritus (↑severity at
night)
Gray-brown threadlike burrows
(0.5 to 1 cm long) with tiny papule
or vesicle at one end
Flexor surfaces of wrists, elbows,
axillary folds, waistline, nipples,
genitalia; in infants, the burrows
may appear on the head and
neck, feet & palms
Papules, vesicles, crusting,
abscess formation, and cellulitis
with secondary infection
110
111. Scabies: Diagnostic Test
Findings
Examining scrapings from a burrow under the
microscope
Wound culture demonstrating secondary bacterial
infection
Mineral oil burrow-scraping reveals mites, nits, or
eggs, and feces or scybala
Resolution of infestation with therapeutic trial of a
pediculocide confirms the diagnosis
111
112. Scabies: Medical
Management
Bathing with soap and water before/ after treatment
Scabicides or pediculicide in a thin layer over the entire skin
surface; application should be repeated in 1 week to ensure
thorough treatment
Permethrin or malathion, left on for 8 to 48 hours
Applied from the neck down, covering the entire body
Crotamiton (Eurax), left on for 5 days
Oral ivermectin
Systemic antibiotics
Antipruritics (Benadryl, Atarax)
Avoid the use of topical steroids, which may potentiate the infection
112
113. Scabies: Nursing
Interventions
Prevent secondary infection and spread of scabies
Trim fingernails short
Isolate the child until treatment is completed
Use meticulous hand-washing technique
BP cuffs sterilized in autoclave
Decontaminate linens, towels, clothing, & personal
articles
Disinfect the room after discharge
113
114. Scabies: Nursing
Interventions
Administers medications as ordered
Notify a child’s school of infestation
Encourage verbalization of feelings
Observe wound and skin precautions for 24 hours
after treatment with a scabicide
Anticipate treating family members and close
contacts because parasite is transmitted by close
personal contact and through clothes and linens
114
115. Impetigo: Definition
(p. 908 [new], 984 [old])
A contagious superficial bacterial skin infection
Most commonly appears on the face and extremities
Causes
Bacterial infection from group A beta-hemolytic
streptococci; may also be due to staphylococci
Spread by autoinoculation through scratching
115
117. Impetigo: Pathophysiology
Two types:
May occur simultaneously and be clinically indistinguishable
Nonbullous impetigo
Eruption occurs when bacteria inoculate traumatized skin cells
Lesions begin as small vesicles, which rapidly erode
Honey-colored crusts surrounded by erythema are formed
Bullous impetigo
Eruption occurs in nontraumatized skin via bacterial toxin or
exotoxin
Lesions begin as thin-walled bullae and vesicles
Lesions contain clear to turbid yellow fluid; some crusting exists
117
118. Impetigo: Pathophysiology
May complicate chickenpox, eczema, and other skin disorders marked by
open lesions
Predisposing factors
Poor hygiene
Anemia
Malnutrition
Warm climate
Most outbreaks occur in the late summer and early fall
In the US, impetigo occurs most commonly in the Southern states
Highly contagious until all lesions are healed
The infection is spread by direct contact
The incubation period is 2 to 5 days after contact
Common in children ages 2 to 5
118
119. Impetigo: Complications
Acute glomerulonephritis
More likely to occur when many members of the
same family have impetigo
Ecthyma (an infection that occurs usually as a result
of untreated impetigo; may be followed by
pigmentation and scarring of the skin)
Exfoliative eruption (staphylococcal scalded-skin
syndrome) in neonates, infants, and children
younger than age 5
119
120. Impetigo: Assessment
Findings
Painless itching
Nonbullous impetigo
Small, red macule or vesicle that becomes pustular within a few hours
Lesions can occur anywhere, but usually occur on the face around the
mouth and nose
Characteristic thick, honey-colored crust formed from the exudates
Satellite lesions caused by autoinoculation
Pruritus
Burning
Regional lymphadenopathy
Infants and children develop aural impetigo or otitis externa; lesions usually
clear without treatment in 2 to 3 weeks, unless there is an underlying
disorder such as eczema
120
121. Impetigo: Assessment
Findings
Bullous impetigo
Thin-walled vesicle
Thin, clear crust formed from exudates
Lesions that appear as a central clearing
circumscribed by an outer rim
Most commonly appear on the face or other exposed
areas
121
122. Impetigo: Diagnostic Test
Findings
Gram stain of vesicular fluid showing infecting
organism
Culture and sensitivity testing of exudates or
denuded crust showing infecting organism
Elevated white blood cell count
122
123. Impetigo: Medical
Management
Removal of exudates by washing the lesions 2 to 3
times per day with soap (or antibacterial soap) and
water
Warm soaks or compresses of normal saline or a
diluted soap solution for stubborn crusts
Prevention by using benzoyl peroxide soap
123
124. Impetigo: Medications
Antibiotics for 10 days
Penicillinase-resistant penicillins such as dicloxacillin
Cephalosporins, such as cephalexin (Keflex)
Azithromycin (Zithromax)
Clarithromycin (Biaxin)
Retapamulin (Altabax)
Topical antibiotics for minor infections such as mupirocin
ointment (Bactroban)
Antihistamines
Therapy shouldn’t be delayed for laboratory results, which can
take up to 3 days
124
125. Impetigo: Nursing
Interventions
Follow standard precautions
Prevent secondary infection and the spread of
impetigo
Keep fingernails short
Cover the child’s hands if necessary
Cover the lesions
Encourage the patient not to scratch
Use meticulous hand-washing technique
125
126. Impetigo: Nursing
Interventions
Remove crusts by gently washing with bactericidal soap
and water
Soften stubborn crusts with warm compresses
Administer medications as ordered
Remember to check for penicillin allergy
Encourage verbalization of feelings about body image
Comply with local public health standards and
guidelines
Review the importance of not sharing towels,
washcloths, or bed linens with other family members
126
127. Ringworm (Dermatophytoses)
(p. 911 [new], 987 [old])
Fungal infections that affect skin, hair, or nails
Spread: person-to-person, animal-to-person, indirect
contact with clothing or linens
Diagnosis: microscopic examination of hair & scalp
scrapings (wet mount potassium hydroxide [KOH])
See “Clinical Manifestations of Tinea Infections” (p.
988) – tinea capitis; tinea corporis; tinea cruris; tinea
pedis
127
129. Ringworm: Nursing
Management
All family members should be assessed
Avoid contact with child’s hair & hair accessories
Give oral griseofulvin with fatty foods (e.g., whole
milk, peanut butter) to enhance absorption
Hair regrowth is slow and may take 6 to 12 months
129
130. Atopic Dermatitis (Eczema)
pp. 913-916 [new], 990-993 [old])
Chronic condition of the skin characterized by xerosis (dry
skin), intense pruritus (itching) and inflammation
Elevated serum IgE levels, impaired T-cell functioning
Often accompanied by food allergies, asthma
Clinical manifestations: dry skin, erythema, intense itching,
small papules and vesicles, lesions (that weep and crust),
lichenification (skin thickening in response to irritation),
excoriation (because of scratching), cracking, and scaling
Begins on cheeks and then found in creases of elbows,
wrists, and knees
130
133. Atopic Dermatitis: Therapy
Loose cotton clothing, cool environment
Tepid bath water for 10-15 minutes, mild unscented
soap (such as Ivory), then pat dry
Corticosteroid ointment over skin lesions
Emollients (Eucerin, Aveeno, Vanicream, Cetaphil,
petroleum jelly) over entire body
Resistant cases: immunomodulator ointments
(tacrolimus, pimecrolimus)
133
134. Prevention of Scratching
Secondary infection
Itching worse @ HS ( cortisol & histamine), less
distraction
Wet wrap therapy: cover bandages with dry
bandage or towel
Keep fingernails short & clean
Antibiotics
Humidifier in winter/ air-conditioning in summer
134
Notas del editor
Pali-viz’-u-mab
$7000/shot
Suppresser T-cells: mute the response once the antigen stops stimulating the immune system
This is why children under age 6 become sick so often
IgG (blue line): Adult levels @ birth; drops @ 6 months
T-cells: adult levels @ birth
Others, such as the thymus, spleen, & tonsils don’t reach full potential til puberty
Other lymphoid tissue, such as the spleen & tonsils are also comparatively large in young children
Newborns have somewhat lower numbers of natural killer (NK) cells than older children & adults, which decreases their ability to respond to certain antigens
Levels of some complement proteins are lower in newborns than in older children and adults, which also delays & hampers their response to certain infections
Induration: hardening of tissue
Allergic reactions most often associated with vaccine components such as eggs, gelatin, yeast, & neomycin
Anaphylaxis can occur with: DTaP or Tdap, MMR, pneumococcal, IPV, varivax; rare with Hib, Hep A, Hep B
Average infant born in 2016 receives vaccines for 14 childhood diseases by age 6
Infected person can on in a room and exhale; then a non-immune person can walk into the same room within 1-2 hours and contract it
Epydidymoorchitis: (ep-idid-imo-orki-tis) inflammation of epididymis & testes
Treatment: fluids & soft foods; no antibiotics
Droplet or direct contact
Iris dysplasia: pupil is obscured or absent secondary to fibrous overgrowth
Exanthematous: skin rash that accompanies an infectious disease
Thrombocytopenia purpura: bleeding disorder characterized by platelets
Droplet precautions
Airborne!
Furuncle: staph infection in gland or hair follicle
Droplet
Prevent sun exposure (makes rash worse)
Tea tree oil?
Repeated bites cause sensitization to the toxin
Scybala: hardened mass of feces
Griseofulvin: treatment of tinea infections of the skin or hair
Xerosis: likely to crack & fissure; permits allergens, irrritants, & organism
Scratching further damages the skin barrier
Altered immune response leads to more skin infections
Staph aureus is colonized on skin of 90% of affected children
Skin is hydrate by bathing, then lubricate by applying emollients within 3 minutes of leaving the water
Traps moisture and promotes flexibility without cracking
Moisturizing ointments & creams are applied 3-4 times a day
Ointments are preferred as they are occlusive
Corticosteroids reduce inflammation
7 categories of corticosteroid strength; low-strength are used for thinner areas (face, diaper area & skin folds) due to increased absorption
Tacrolimus & pimecrolimus (Black-Box warning)-rare cases of malignancy
Cortisol secretion is lowest at night; precursor to cortisone
Histamine release if lowest at night; can help neutralize allergic reactions
Kids are busier during the day
Antibiotics (topical, oral or IV)
Soaking in a tub with dilute bleach may be recommended 1-2 times per week to reduce Staph aureus on the skin
Avoid topical antihistamines
Systemic antihistamines have limited effect on itching but may provide sedative effect; short-term use only