Infectious disease in children nurs 3340


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Infectious disease in children nurs 3340

  1. 1. Infectious Disease in Children Joyce Buck, MSN, RN-C, CNE Joy A. Shepard, PhD(c), RN-C, CNE
  2. 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. 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. 4. Immune System Prevent entry of and remove foreign substances Body’s innate (natural) defenses Skin, body pH, maternal antibodies, inflammatory response, phagocytic response Natural killer cells: attack infected cells Complement proteins: work with antibody activity 4
  5. 5. 5
  6. 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 6
  7. 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. 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. 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. 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. 11. Acquired Immunity Humoral Antibodies created by B-lymphocytes Cell-Mediated T-cells mature in thymus Assist B-lymphocytes to make antibodies 11
  12. 12. Figure 22-1 The primary immune response encompasses a cascade of events that involve humoral and cellular immunity. 12
  13. 13. 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. 13
  14. 14. Table 22-1 Classes of Immunoglobulins 14
  15. 15. Infant Vulnerability to Infection Immune system not fully developed Maternal antibodies offer limited protection Diminishes with time Immunization protection incomplete 15
  16. 16. 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 16
  17. 17. Disease Transmission Direct or indirect transmission Three factors required for disease to occur Infectious agent (pathogen) Effective means of transmission Susceptible host 17
  18. 18. 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 18
  19. 19. 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 19
  20. 20. 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. 20
  21. 21. Iatrogenic (Nosocomial) Infections Acquired due to treatment Contaminated equipment Nonsterile technique Contact with other children in clinical setting 21
  22. 22. 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 22
  23. 23. Infectious diseases are easily transmitted in settings such as childcare centers where multiple children handle common objects and then put fingers in their mouths. 23
  24. 24. 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 24
  25. 25. 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 25
  26. 26. Infectious Process Organisms in body Multiply within body Bacteria, fungus, protozoa Production of toxins Infect cells Virus forces cells to replicate virus 26
  27. 27. Body’s Response to Infection Neutrophils, complement system proteins, macrophages to invaders Fever Macrophages release endogenous pyrogens Hypothalamus releases prostaglandins Body temperature rises Heat speeds immune response 27
  28. 28. Infections: Management Diagnostic tests Culture and sensitivity Radiographs Treatment Drugs: antibiotics, antifungals, antivirals Antibiotic overuse encourages resistant strains Fever management Antipyretics Isolation precautions Hydration Skin/oral mucous- membrane management Family support 28
  29. 29. 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 29
  30. 30. Immunizations 30
  31. 31. Vaccines Introduce antigen Trigger antibody creation Create active immunity Introduce antibodies Create passive immunity 31
  32. 32. Types of Immunizations: Live, Attenuated A live organism, grown under suboptimal conditions, results in a live vaccine with reduce virulence Vaccine confers 90% to 95% protection for 20+ years with a single dose Promotes full range of immunologic responses Vaccine inactivated by heat Examples: measles, mumps, and rubella (MMR) vaccine; varicella vaccine Influenza intranasal spray (LAIV) (Live) Given to children older than age 5 without a history of chronic lung disease (asthma) 32
  33. 33. Types of Immunizations: Inactivated An inactivated vaccine offers a weaker response than a live vaccine, necessitating frequent boosters A toxoid is treated with formalin or heat and rendered nontoxic but still antigenic; it provides 90% to 100% protection A killed vaccine doesn’t promote replication; it provides 40% to 70% protection The diffusible fraction of a virus is the part 33
  34. 34. Types of Immunizations: Inactivated Examples of inactivated vaccines include the diphtheria and tetanus toxoids, the Salk polio vaccine, the pertussis vaccine, the hepatitis B vaccine, the hepatitis A vaccine, and HPV Influenza IM injection (TIV) Given annually to children ages 6 to 59 months Vaccinate children age 5 or older if they are high risk (heart disease, lung disease, diabetes, renal dysfunction, immunosuppresion, long-term aspirin therapy, 34
  35. 35. 35
  36. 36. 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 36
  37. 37. 37
  38. 38. Table 16-2 Common Misconceptions About Vaccines 38
  39. 39. 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 39
  40. 40. Nursing Care: Immunizations Withhold the DTaP vaccine if the child has a progressive and active central nervous system (CNS) problem Don’t vaccinate if the child’s temperature is elevated; a vaccine’s adverse effect would be difficult to differentiate from an exacerbation of the original disease 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)- 40
  41. 41. 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 41
  42. 42. 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 42
  43. 43. 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. 43
  44. 44. Immunization Documentation Date of immunization 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 44
  45. 45. Communicable Diseases 45
  46. 46. Communicable Diseases Vaccines reduce incidence No vaccine for many other diseases Initial symptoms Fatigue, weakness, rash, fever, irritability, tachycardia, vomiting, diarrhea, respiratory difficulties Vectors Contact with human, animal, polluted water 46
  47. 47. Infectious Diseases Children susceptible to Chickenpox, diphtheria, enteroviruses, fifth disease, haemophilus influenza B, influenza, measles, meningococcus, mononucleosis, mumps, pertussis, pneumonia, poliomyelitis, roseola, rotavirus, rubella, streptococcus A, tetanus 47
  48. 48. Rubeola (Regular Measles) (p. 413) 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 48
  49. 49. Rubeola (Measles) 49
  50. 50. Koplik Spots 50
  51. 51. 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 51
  52. 52. Rubeola (Measles) Complications Secondary bacterial infection Autoimmune reaction Bronchitis, otitis media, pneumonia Encephalitis 52
  53. 53. 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 53
  54. 54. Mumps (Parotitis) (p. 415) 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 54
  55. 55. 55
  56. 56. 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 56
  57. 57. 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 57
  58. 58. Rubella (German Measles) (p. 417) 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 58
  59. 59. Rubella 59
  60. 60. Infant with Congenital Rubella Syndrome 60
  61. 61. 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 61
  62. 62. 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 62
  63. 63. 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 63
  64. 64. Varicella (Chickenpox) (p. 410) 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) 64
  65. 65. 65
  66. 66. 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 66
  67. 67. 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 67
  68. 68. 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 68
  69. 69. Fifth Disease (Erythema Infectiosum) (p. 411) 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 69
  70. 70. 70
  71. 71. 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 71
  72. 72. Fifth Disease (Erythema Infectiosum) Complications Arthritis and arthralgia Myocarditis, encephalitis (both rare) Interventions Isolation isn’t necessary Cut the child’s fingernails to avoid injury from scratching Provide lukewarm water baths with baking soda to soothe itching 72
  73. 73. Head Lice (p. 1050) 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 73
  74. 74. Head Lice Causes Sharing of clothing and combs Close personal contact with peers 74
  75. 75. 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 75
  76. 76. 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 76
  77. 77. Head Lice Medical management Removal of lice and eggs using a fine- toothed comb Medications Permethrin (Nix) shampoos Pyrethrins (RID) Ulesfia 5% benzyl alcohol lotion Lindane – in resistant cases, TOXIC Preventive drug therapy for other family members and classmates 77
  78. 78. Head Lice Nursing interventions Carefully follow the manufacturer’s directions when applying medicated shampoo (especially Lindane) to avoid neurotoxicity Repeat treatment in 7 to 12 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 78
  79. 79. Scabies (p. 1052) 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 79
  80. 80. 80
  81. 81. 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 81
  82. 82. 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 Papules, vesicles, crusting, abscess formation, and 82
  83. 83. 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 83
  84. 84. 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, left on for 8 to 12 hours Lindane cream, left on for 8 to 12 hours Shouldn’t be used if the skin is raw or inflamed Applied from the neck down, covering the entire body Crotamiton (Eurax), left on for 5 days 6% to 10% sulfur solution Systemic antibiotics Antipruritics In infants, include the head in treatment Avoid the use of topical steroids, which may potentiate the infection 84
  85. 85. 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 85
  86. 86. 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 86
  87. 87. Impetigo: Definition (p. 1038) 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 87
  88. 88. 88
  89. 89. 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 89
  90. 90. 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 90
  91. 91. 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 91
  92. 92. 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 92
  93. 93. 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 93
  94. 94. 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 94
  95. 95. 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 95
  96. 96. 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 96
  97. 97. 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 97
  98. 98. 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 98
  99. 99. Ringworm (Dermatophytoses) (p. 1041) 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: 99
  100. 100. 100
  101. 101. 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 101