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Chapter 32 Power Point

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Chapter 32 Power Point

  1. 1. Chapter 32Chapter 32 The Child with a CommunicableThe Child with a Communicable DiseaseDisease
  2. 2. ObjectivesObjectives • Define each key term listed. • Interpret the detection and prevention of common childhood communicable diseases. • Discuss the characteristics of common childhood communicable diseases. • Discuss three principles involved in standard precautions used to prevent the transmission of communicable diseases in children. 2Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  3. 3. ObjectivesObjectives (cont.)(cont.) • Discuss national and international immunization programs. • Describe the nurse’s role in the immunization of children. • Demonstrate a teaching plan for preventing sexually transmitted infections (STIs) in an adolescent. • Formulate a nursing care plan for a child with acquired immunodeficiency syndrome (AIDS). Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 3
  4. 4. Communicable DiseaseCommunicable Disease • Prevention and control are the key factors in managing infectious disease • HIV, hepatitis, TB, and STIs are infections continue to occur worldwide • The incidence of common childhood communicable disease has decreased with the use of appropriate immunizations • The nurse must know and be alert to signs and symptoms of communicable disease because air travel enables rapid transmission around the world Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 4
  5. 5. Review of TermsReview of Terms • Communicable disease—can be transmitted from one person to another • Incubation period—time between exposure to pathogen and onset of clinical symptoms • Prodromal period—time between earliest symptom and appearance of typical rash or fever • Vector—an insect or animal that carries and spreads disease Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 5
  6. 6. Review of TermsReview of Terms (cont.)(cont.) • Pandemic—a worldwide high incidence of a communicable disease; i.e., H1N1 influenza • Epidemic—sudden increase of disease in localized area • Endemic—an expected continuous incidence of disease in a localized area • Opportunistic infection—caused by organism normally present in the environment that the immune-suppressed person cannot fight • Health care–associated infection—an infection acquired after admission to a health care facility Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 6
  7. 7. Virulence of InfectionVirulence of Infection • Host resistance to disease is influenced by – Age – Sex – Genetic makeup – Nutritional status – Physical/emotional health – Phagocytes in blood to attack/destroy pathogens – Intact skin and mucous membranes – Functioning immune system 7Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  8. 8. Types of ImmunityTypes of Immunity • Natural—resistance is inborn • Acquired—not born with it; as a result of having disease or receiving vaccines or immune serum • Active immunity—when a person produces his or her own immunity • Passive immunity—provides the antibody to the person; does not last as long 8Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  9. 9. Transmission of InfectionTransmission of Infection • Direct—transmitted by contact with an infected person • Indirect—transmitted by contact with objects that have been contaminated by an infected person (fomites) 9Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  10. 10. Medical Asepsis, Standard andMedical Asepsis, Standard and Transmission-Based PrecautionsTransmission-Based Precautions 10Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  11. 11. Preventing the Spread of InfectionPreventing the Spread of Infection • Aseptic technique—used with all patients • Standard precautions—involve hand hygiene and the use of appropriate personal protective equipment (PPE) based on the tasks to be performed or known infectious disease status of the patient • Transmission-based precautions—designed according to the method of spread of a specific organism Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 11
  12. 12. Airborne Infection IsolationAirborne Infection Isolation PrecautionsPrecautions • Airborne particles <5 microns in size float in the air and contaminate anything within the room – Particles can remain airborne for several hours – Used for conditions such as TB and varicella • Use of negative pressure room and an N95 particulate respirator mask is required whenever in the room with the patient • N95 mask is removed only upon exiting the room and hand hygiene is performed Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 12
  13. 13. Contact PrecautionsContact Precautions • When contamination is likely to occur skin to skin or through contact with a contaminated fomite – Used in conditions such as RSV, MRSA, VRE, or Clostridium difficile infections • Private room or cohorting of patients with same type of infection is recommended • Fluid-resistant cover gown and disposable gloves should be donned prior to entering the patient’s room and removed upon leaving • Hand hygiene is required Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 13
  14. 14. Droplet PrecautionsDroplet Precautions • Droplets (>5 microns in size) from coughing or sneezing can contaminate surrounding environment up to 3 feet around the patient – Droplets do not stay suspended in the air, they immediately “fall” • Use of a regular mask is required. A cover gown and gloves may also be required such as when caring for a child with RSV • PPE is removed upon exiting the room and hand hygiene is performed Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 14
  15. 15. Expanded PrecautionsExpanded Precautions (Protective Isolation)(Protective Isolation) • Used for patients who are not communicable but have high susceptibility to infection, such as a neutropenic patient or bone marrow transplant recipient • Strict adherence to standard/transmission- based precautions are required at all times, this includes any visitors – NOTE: If a disease has more than one mode of transmission, then more than one precaution technique is used Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 15
  16. 16. Hand HygieneHand Hygiene • Nurse performs hand hygiene between patients and after removal of gloves – Only hospital-approved antibacterial soaps, lotions, and sanitizers are to be used – Self-contained liquid soap dispensers, no bar soap – Alcohol-based hand sanitizers • Artificial nails, tips, wraps, and nail jewelry are not to be worn as they increase the risk of infection • Caregivers with lesions on exposed body parts should not give patient care until all lesions have healed Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16
  17. 17. Safety AlertSafety Alert • Alcohol-based hand sanitizers should not be used when caring for a patient diagnosed with Clostridium difficile diarrhea – Alcohol cannot penetrate the exterior wall of the spore-forming organism, therefore it cannot kill it • Soap and warm, running water should be used after every contact with this type of patient – Running water helps rinse the spore-forming organism off of the hands 17Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  18. 18. Family Education to Prevent theFamily Education to Prevent the Spread of InfectionSpread of Infection • Should include – Hand hygiene – Necessity of immunizations – Proper food storage – Use of pasteurized milk – Proper defrosting/cooking of meat – Avoid using community towels – Control of insects – Avoid use of sandboxes in the yard 18Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  19. 19. Rashes of the SkinRashes of the Skin • Erythema—diffuse and reddened • Macule—circular reddened area • Papule—circular reddened area that is elevated • Vesicle—circular reddened area that is elevated and contains fluid • Pustule—circular reddened area that is elevated and contains pus • Scab—dried pustule that is covered with a crust • Pathognomonic—term used to describe a lesion or symptom that is characteristic of a specific illness (i.e., Koplik spots are seen in measles) Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 19
  20. 20. Worldwide Immunization ProgramsWorldwide Immunization Programs • Healthy People 2020 – The USPHS goal for 2020 is to have 95% of all children in the U.S. immunized against childhood communicable diseases • Increase education • Accessibility to health clinics • Reduce the cost of immunizations • Follow-up and track immunizations • CDC provides advice concerning vaccinations needed when traveling (www.cdc.gov) 20Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  21. 21. Types of Immunization AgentsTypes of Immunization Agents 21 Vaccine A suspension of weakened or inactivated (killed) organisms that stimulate immune bodies to form A form of active immunity Toxoid A modified toxin that stimulates the production of antitoxin A form of active immunity Immunoglobulin A solution containing antibodies extracted from human or animal blood Provides passive immunity Specific immunoglobulin s Special preparations obtained from blood donors selected for their high antibody content to a specific disease Provides passive immunity to the specific diseaseElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  22. 22. VaccinesVaccines • Multiple doses at predetermined intervals may be needed to achieve an immunity • Used to prevent disease, cannot be used to treat disease • Route of administration – Important to achieve immunization • Proper storage and handling will ensure potency – Do not store in refrigerator door – Store in center of shelves, away from vents – Store at 35-46° F (1.6° to 7.7° C) Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 22
  23. 23. Nursing TipNursing Tip • The earliest age a vaccine should be administered is the youngest age at which the infant’s body can respond by developing antibodies to that illness 23Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  24. 24. Allergies and ToxicitiesAllergies and Toxicities • Epinephrine should be available in unit where immunizations are given • Child should be observed for 20 minutes after immunization • Do not administer the following vaccines if patient is allergic to – Baker’s yeast: avoid recombinant hepatitis B vaccine – Eggs: avoid influenza vaccine, MMR – Neomycin: avoid IPV, MMR, and varicella vaccine Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 24
  25. 25. Allergies and ToxicitiesAllergies and Toxicities (cont.)(cont.) • Varicella must be given same day as MMR or no less than one month later • A tuberculin skin test should not be given within 6 weeks of MMR or varicella • Thimerosal: a mercury-containing preservative in some vaccines can cause toxicity • Some vaccines can be given on the same day but must be in different syringes and administered in different sites • Serious adverse events must be reported to the national VAERS Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 25
  26. 26. Contraindications to ImmunizationsContraindications to Immunizations • Immunocompromised state • Pregnancy (with certain vaccines) • Bacteremia or meningitis • Immunocompromised caregiver in the home – Requires individual evaluation by the health care provider • Corticosteroid therapy – Requires individual evaluation • History of high fever or other reaction after previous immunization Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 26
  27. 27. Nursing TipNursing Tip • An interrupted vaccination series can usually continue without restarting the entire series 27Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  28. 28. The Future of ImmunotherapyThe Future of Immunotherapy • Refining and combining vaccines continues • Transcutaneous immunization through intact skin • Recombinant DNA technology is developing vaccines for use with rheumatic fever and malaria • Development of RNA and DNA viruses to be used as vectors (carriers) of antigens 28Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  29. 29. The Future of ImmunotherapyThe Future of Immunotherapy (cont.)(cont.) • Development of “gene gun” to blast vaccine through intact skin • Development of immunotherapy for non- communicable diseases such as mucosal administration of myelin for multiple sclerosis • Development of tumor antigens 29Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  30. 30. Bioterrorism and the PediatricBioterrorism and the Pediatric PatientPatient • Children are more vulnerable as immune system is not fully developed • Children are closer to the ground so heavy particles from aerosol-propelled agent reaches them in higher doses than adults • Safety of new drugs developed may not yet be available for children 30Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  31. 31. Bioterrorism and theBioterrorism and the Pediatric PatientPediatric Patient (cont.)(cont.) • Routine “HazMat” decontamination procedure may not be suitable for pediatric patient who is prone to hypothermia (due to large head and body surface area; low fat content of body) • A small blood volume makes child more susceptible to fluid losses from GI toxins • Gas masks may not be available in children’s sizes • TV coverage of terrorist attacks can affect child’s feeling of safety in the home and can alter behavior Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 31
  32. 32. Triage CategoriesTriage Categories 32 Immediate Requires prompt intervention Delayed Intervention can wait for a short time Minimal Only outpatient care is required Expectant Moribund patient, not expected to survive Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  33. 33. Common Diseases Spread ThroughCommon Diseases Spread Through BioterrorismBioterrorism Biological Agent Incubation Period Anthrax 1 to 45 days Botulism 1 to 5 days, as high as 14 days Ebola virus (Filovirus) 4 to 10 days Lassa fever (Arenavirus) 7 to 16 days Plague 2 to 3 days Smallpox 12 days on average Tularemia 3 to 5 days 33Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  34. 34. Emergency PreparednessEmergency Preparedness • Family should keep several days supply of food, water, pet food, warm clothing, blankets, medicines, copies of vital documents and toiletries • Battery-powered radio, basic first aid supplies • Hold disaster drills in the home • Have out of state family contact numbers to call in case the family is separated • Children should be taught to keep personal ID with them and how to call for help when needed 34Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  35. 35. Initial Observations DuringInitial Observations During DisastersDisasters • Assess the “ABCs” and mental status • Heightened awareness by health care personnel plays critical role in facilitating early recognition of bioterror attack • Work with emergency department, Infection Control staff, and the local public health department to help coordinate actions that are needed • NOTE: It is imperative to follow your chain of reporting at your facility 35Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  36. 36. The Pediatric Patient in a DisasterThe Pediatric Patient in a Disaster SettingSetting • Has a proportionately larger body surface area, thinner skin • May have increased pulmonary problems compared to the adult • Children are closer to the ground and may be exposed to more toxins • Immature blood-brain barrier and increased CNS receptor sensitivity increases their sensitivity to nerve agents • Use of Broselow-Luten color-coded, water-resistant tapes for drug calculations decreases risk of medication errors • Can also use the Pediatric Antidotes for Chemical Warfare for dosage calculations 36Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  37. 37. Sexually Transmitted InfectionsSexually Transmitted Infections • Infections spread through sexual activity • Can be spread from pregnant mother to fetus • Can be spread through sexual abuse of child • Can be spread by use of contaminated needles or exposure to blood • Nurse required to report STIs to the local Public Health Department • Contacts of infected person will also need to be tested 37Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  38. 38. Nursing Care and ResponsibilitiesNursing Care and Responsibilities • Create environment where patient feels safe and at ease • Listen, be nonjudgmental, and provide emotional support • Provide privacy during examinations • Encourage questions • Assure confidentiality • Assess level of knowledge and understanding • Help patient formulate positive self-attitude 38Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  39. 39. Nursing TipNursing Tip • Sex education is not limited to mechanics of intercourse, but rather includes the feelings involved in sexual experience, expectations, fantasies, fulfillments, and disappointments 39Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  40. 40. HIV/AIDS in ChildrenHIV/AIDS in Children • Children usually contract HIV by – Contact with infected mother at birth – Sexual contact with infected person – Contact with infected needles or blood 40Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  41. 41. Cause of HIV/AIDS in ChildrenCause of HIV/AIDS in Children • HIV-1 attacks lymphocytes and causes imbalance in helper T-cells (CD4+) that support immune system and suppressor T- cells that shut it down 41Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  42. 42. Diagnosis of HIV/AIDS in ChildrenDiagnosis of HIV/AIDS in Children • CD4+ cell count is measure of damage to the immune system caused by HIV and guides treatment options • ELISA test and Western Blot test to diagnose HIV are not reliable in children under 15 months of age 42Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  43. 43. HIV/AIDS in ChildrenHIV/AIDS in Children (cont.)(cont.) • Manifestations – Failure to thrive – Lymphadenopathy – Chronic sinusitis – Failure to respond to treatment of infections • Thrush • Pneumocystis jiroveci (formerly, carinii) pneumonia • Herpes infection • Cytomegalovirus (CMV) 43Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  44. 44. HIV/AIDS in ChildrenHIV/AIDS in Children (cont.)(cont.) • Treatment – Supportive – No cure available for HIV/AIDS – Education regarding drug therapy compliance – Support growth and development of the child – Psychological support of child and family – Referral to available resources within the community – Update routine immunizations 44Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  45. 45. Question for ReviewQuestion for Review • What type of immunity is given to infants and children through routine vaccinations for common childhood communicable disease? 45Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  46. 46. ReviewReview • Objectives • Key Terms • Key Points • Online Resources • Review Questions 46Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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