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Course: Pediatric Nursing

Topic: Nursing Care of Child Communicable Disease I

The Nurses International Community

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Module Goals

Learners will be able to:

Describe the stages and chain of infection
Identify common communicable diseases among children
Explain causes and risk factors for communicable diseases
Describe clinical manifestations and complications of common communicable diseases among children
Identify common diagnostic tests for infectious diseases and nursing implications
Discuss the nursing management of a child with an communicable disease
Identify preventive measures for communicable diseases

Contact info: info@nursesinternational.org

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Chain of Infections

6 components that make up

the chain of infection

Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host

All the components must be

present

for a infection to occur

Winnipeg Regional Health Authority, 2008

Contact info: info@nursesinternational.org

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Communicable Diseases in Children

A communicable disease is transmitted from one individual or animal to another directly or indirectly
Examples

Common cold
Chicken Pox
Herpes Simplex
Measles
Influenza (“flu”)
Hepatitis
Intestinal parasites

Caused by prions, viruses, bacteria, fungi, protozoa, or helminths

Hostos Community College, 2022

Contact info: info@nursesinternational.org

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

What is the nurse’s primary means of breaking the chain of infection?

Educating clients about hygiene
Hand washing
Wearing a freshly laundered uniform each day
Administer prophylactic antibiotics prior to surgery

Contact info: info@nursesinternational.org

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Eye Ear Nose Throat

Cold Sore (Herpes Simplex Virus)

Spread by direct contact with sore or saliva
Sign and symptoms:

Fever
Irritability
Blister in mouth, gums or lips
Conjunctivitis

Treatment:

Avoid picking the scab or breaking blisters
Occasionally analgesics
Antiviral medicines (acyclovir and famciclovir )

Wisconsin Department of Health Science,2021

Better Health, 2017

Contact info: info@nursesinternational.org

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Eye Ear Nose Throat

Mononucleosis (Epstein Barr Virus)

Spread by individual to individual saliva
Sign and symptoms

Fever, Sore throat, Swollen lymph nodes, Fatigue

No vaccine to protect

Mumps: (Mumps virus)

Spread by inhalation of respiratory droplets, saliva

Fever, swelling and tenderness of parotid glands, headache, earache
Swollen testicles, Abdominal pain

Prevention: MMR vaccine

Wisconsin Department of Health Science,2021

Better Health, 2017

Contact info: info@nursesinternational.org

Mononucleosis:

Prevention

There is no vaccine to protect against infectious mononucleosis

Prevention by:

not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who have infectious mononucleosis.

Treatment: Help relieve symptoms of infectious mononucleosis by—

drinking fluids to stay hydrated
getting plenty of rest
taking over-the-counter medications for pain and fever

CDC. (2020). About Infectious Mononucleosis.https://www.cdc.gov/epstein-barr/about-mono.html#:~:text=Epstein%2DBarr%20virus%20(EBV),EBV%20will%20develop%20infectious%20mononucleosis.

Mumps:

Mumps is a contagious viral infection that used to be common in children before the introduction of the MMR vaccine

Serious complications are rare
But mumps can lead to viral meningitis if the virus moves into the outer layer of the brain. Other complications include swelling of the testicles or ovaries (if the affected individualhas gone through

Treatment for mumps:

There's currently no cure for mumps, but the infection should pass within 1 or 2 weeks.

Treatment is used to relieve symptoms and includes:

getting plenty of bed rest and fluids
using painkillers, such as ibuprofen and paracetamol – aspirin should not be given to children under 16
applying a warm or cool compress to the swollen glands to help relieve pain

Prevention: child should be given 1 dose when they're around 12 to 13 months and a second booster dose at 3 years and 4 months

NHS. (2021). Mumps. https://www.nhs.uk/conditions/mumps/

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Eye Ear Nose Throat

Pink Eye (Bacterial/ Viral conjunctivitis)

Spread by direct or indirect contact with eye discharge
Red/pink itchy eyes, discharge

Strep Throat

Spread by direct or indirect contact with mouth or nose secretion
Sore throat, fever, swollen lymph nodes,

Wisconsin Department of Health Science,2021

Contact info: info@nursesinternational.org

Strep throat:

Viruses are the most common cause of a sore throat. However, strep throat is an infection in the throat and tonsils caused by bacteria called group A Streptococcus (group A strep
Pain and fever without a cough are common signs and symptoms

The most common symptoms of strep throat include:

Sore throat that can start very quickly
Pain when swallowing
Fever
Red and swollen tonsils, sometimes with white patches or streaks of pus
Tiny, red spots (petechiae — pronounced pi-TEE-kee-eye) on the roof of the mouth (the soft or hard palate)
Swollen lymph nodes in the front of the neck

Other symptoms may include:

A headache, stomach pain, nausea, or vomiting — especially in children
May also have a rash; when this happens it is known as scarlet fever (scarlatina)

Treatment: Antibiotics

Prevention:

Cover mouth and nose with a tissue when coughing or sneezing.
Put used tissue in the waste basket.
Cough or sneeze into upper sleeve or elbow, not the hands, in absence of a tissue.
Wash hands often with soap and water for at least 20 seconds.
Use an alcohol-based hand rub if soap and water are not available.

CDC. (2022). Strep Throat: All You Need to Know.https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html

Viral and bacterial conjunctivitis: See detailed in Eye disorders

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Respiratory System

Influenza (Influenza virus)

Spread by inhalation of respiratory droplets
Fever, Cough, Nasal congestion, Headache, Bodyache, Fatigue

Pertussis (Bordetella Pertussis)

Also known as Whooping cough
Inhalation or direct, indirect contact with respiratory secretions
Early cold like symptoms
Coughing progressing to severe, often with “whoop” vomiting possible, minimal or absent fever

Wisconsin Department of Health Science,2021

CDC, 2021

Contact info: info@nursesinternational.org

The best way to prevent flu is to receive an influenza vaccination every year. The Centers for Disease Control and Prevention (CDC) recommends that everyone age 6 months and older get vaccinated annually. Flu vaccination is especially important this year to help protect individuals and prevent additional strain on an already overburdened US healthcare system. The best time to get vaccinated is in the early fall, before influenza viruses begin spreading in the community. However, vaccination throughout the flu season is still beneficial.

Flu Symptoms

Influenza (flu) can cause mild to severe illness, and at times can lead to death. Flu is different from a cold. Flu usually comes on suddenly.

Symptoms:

fever* or feeling feverish/chills
cough
sore throat
runny or stuffy nose
muscle or body aches
headaches
fatigue (tiredness)
some people may have vomiting and diarrhea, though this is more common in children than adults.

CDC. (2021). Key Facts About Influenza (Flu).https://www.cdc.gov/flu/about/keyfacts.htm#:~:text=Flu%20is%20a%20contagious%20respiratory,a%20flu%20vaccine%20each%20year.

Pertussis:

Also known as whooping cough, is a highly contagious respiratory disease
It is caused by the bacterium Bordetella pertussis.
Pertussis is known for uncontrollable, violent coughing which often makes it hard to breathe

Treatment:

Antibiotics can prevent and treat whooping cough
Recommended antibiotics include azithromycin, erythromycin and clarithromycin
Trimethoprim sulfamethoxazole can also be used..

Prevention:

Diphtheria, tetanus, and pertussis (DTaP) vaccines
Tetanus, diphtheria, and pertussis (Tdap) vaccines

Babies and children younger than 7 years old receive DTaP, while older children and adults receive Tdap

CDC. (2019). Pertussis (Whooping Cough). https://www.cdc.gov/pertussis/index.html#:~:text=Pertussis%2C%20also%20known%20as%20whooping,makes%20it%20hard%20to%20breathe.

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Respiratory System (Continued)

Respiratory Syncytial Virus (RSV)

Direct or indirect contact with respiratory droplets
Symptoms:

Runny nose
Sneezing
Wheezing
Fever

Most cases only comfort care is needed

Wisconsin Department of Health Science,2021

Contact info: info@nursesinternational.org

Respiratory syncytial virus (RSV) is a common respiratory virus

It affects the lungs and its bronchioles (smaller passageways that carry air to the lung)
RSV is one of the most common causes of childhood illness, infecting most children by two years of age
RSV can also infect adults.

Most healthy children and older adults who get RSV will get a mild case with cold-like symptoms

Only self-care or “comfort care” is usually needed.

Severe infection with RSV can lead to pneumonia (an infection in the lungs) and bronchiolitis (inflammation of the small airways in the lungs) and may require hospital care. People at greatest risk of severe infection are the very young (those less than six months old), those over the age of 65 and those of any age who have heart or lung conditions or a weakened immune system. RSV can also make existing heart and lung problems worse.

RSV infects almost all children at least once before they are two years old

Most of the time, this virus only causes minor cold-like symptoms. However, for some babies and certain adults, the infection can be more dangerous.

Infants at highest risk of severe or life-threatening RSV infection are:

Premature infants (because their lungs are underdeveloped).
Infants under 6 months of age.
Infants born with heart or lung disease.
Children with weakened immune systems, including those who have received an organ transplant or those undergoing chemotherapy.
Children who have difficulty swallowing or can’t clear mucous

Steps to relieve symptoms:

Manage fever and pain with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen
Never give aspirin to children
Drink enough fluids. It is important for people with RSV infection to drink enough fluids to prevent dehydration (loss of body fluids)
Talk to the healthcare provider before giving the child non prescription cold medicines
Some medicines contain ingredients that are not good for children.

Prevention:

Cover coughs and sneezes with a tissue or upper shirt sleeve, not hands
Wash hands often with soap and water for at least 20 seconds
Avoid close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with others
Clean frequently touched surfaces such as doorknobs and mobile devices

Parents of children at high risk for developing severe RSV disease should help their child, when possible, do the following

Avoid close contact with sick people
Wash their hands often with soap and water for at least 20 seconds
Avoid touching their face with unwashed hands

CDC. (2021). Symptoms and Care.https://www.cdc.gov/rsv/about/symptoms.html

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Gastrointestinal

Diarrhea of Unknown Cause

Fecal-oral route
Three or more loose stool at 24 hrs

Gastroenteritis (Campylobacter, Salmonella, Shigella)

Fecal-oral route, Food, water, Animal to individual - Shigella
Symptoms:

Mild to moderate bloody diarrhea
Abdominal cramp, nausea, vomiting , fever

Shiga producing toxin by E. Coli may cause kidney complication

Wisconsin Department of Health Science,2021

Contact info: info@nursesinternational.org

Children need to drink drink clear fluids (or breastmilk if the baby is breastfeeding).

Babies under 6 months old can become ill quickly with gastro – they need extra fluids to replace fluids lost by diarrhea and vomiting.

If bottle feeding, give clear fluids for the first 12 hours, then give the normal formula in smaller, more frequent amounts.

It is important for the fluids to be taken even if the diarrhoea seems to get worse. It will help to:

Offer babies a drink every time they vomit.
Give older children a drink (150–200ml) after every big vomit or bout of diarrhea.
Give small amounts of fluids often if child is vomiting a lot (a mouthful every 15 minutes).

For Diarrhea in detail: See Gastrointestinal disorders slide deck.

Treatment for gastroenteritis depends on the cause, but may include:

Plenty of fluids.
Oral rehydration drinks, available from the pharmacist.
Admission to hospital and intravenous fluid replacement, in severe cases.
Antibiotics, if bacteria are the cause.
Drugs to kill the parasites, if parasites are the cause.
Avoiding anti-vomiting or anti-diarrhoea drugs unless prescribed or recommended by the doctor, because these medications will keep the infection inside the body

Instructions to parents to prevent Gastroenteritis:

Make sure everyone in the family washes their hands regularly, especially after they use the toilet and before they eat.
Wash the child’s hands with warm water and soap after they use the toilet and before and after they eat.
Wash the hands before feeding and after changing the child’s nappies.
Clean kitchen tops, toys, toilet seats, nappy change tables and taps to ensure one doesn’t spread the infection to others at home.
Keep the child away from others until 48 hours after their symptoms have stopped. If symptoms persist, visit the GP.
Don't allow the child to attend child care or school until 48 hours after their symptoms have stopped.
Teach the child good hand hygiene

Remember, washing hands with soap and water is the best way to prevent gastroenteritis infection. Alcohol-based hand sanitisers while effective against some viruses (such as coronavirus), are not effective against gastroenteritis.

Better Health. (2021). Gastroenteritis. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gastroenteritis

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Gastrointestinal

Gastroenteritis (Virus) (Rota Virus)

Fecal- oral route, water, food, environmental surfaces
Symptoms:

Acute onset of watery non bloody diarrhea
Abdominal pain
Nausea,
Vomiting
Low grade fever
Malaise

Wisconsin Department of Health Science,2021

Contact info: info@nursesinternational.org

Rotavirus is a contagious virus that causes nausea and diarrhea. It is the leading cause of severe infectious diarrhea in children. Some babies and children may have diarrhea so severe that they may lose too much water (dehydration). They may need emergency care and a hospital stay. A child may be infected with rotavirus more than once. In most cases, later illnesses are milder. There is also a vaccine for rotavirus.

Rotavirus is most often spread through a fecal-oral route. This is often because a child does not wash their hands properly or often enough. It can also be caused by eating or drinking contaminated food or water.

The virus may live on surfaces such as doorknobs, toys, and other hard objects for a long time. For this reason, outbreaks can occur in households and child-care centers. To prevent spread of the virus, children who aren’t sick should not be in contact with a sick child.

Most children get the virus between the ages of 3 months and 35 months. Infections are more common in the cooler months of the year, starting in the fall and ending in the spring. Children are more at risk at these times. Any child who is around a child sick with rotavirus is at risk.

After a child comes in contact with the virus, it may take up to 2 days for symptoms to develop. Symptoms can occur a bit differently in each child. They can range from mild to severe.

The most common symptoms of rotavirus include:

Nausea and vomiting
Watery diarrhea that occurs often and may last from 3 to 8 days
Belly (abdominal) pain
Fever that goes away after 1 to 2 days

Loss of too much water from the body (dehydration) can occur quickly, especially in babies. Symptoms of dehydration can include:

Lethargy
Sleepiness
Irritability
Dry mouth
Thirst
Pale or blotchy color to the skin
Eyes that look sunken
Baby's soft spot (fontanelle) that feels sunken
Fewer or no tears when crying
Less urine or fewer wet diapers

The symptoms of rotavirus can be like other health conditions.

Treatment will depend on child’s symptoms, age, and general health. It will also depend on how severe the condition is. Antibiotics are not used to treat this illness. Medicines for diarrhea are also not recommended. Some healthcare providers may recommend probiotics. But their effectiveness is unclear.

The goal of treatment is to help reduce symptoms.

Treatment may include:

Giving child plenty of water, formula, breastmilk, or fluids with electrolytes (sugars and salts). Don't give young children soda, juice, or sports drinks.
Feeding child solid foods if they can eat. Don’t restrict food if child is able to eat. Not having food may cause the diarrhea to last longer.

If child loses too much water, they may need to be in the hospital. Treatment there may include:

IV (intravenous) fluids. A thin, flexible tube is put into the child’s vein. Fluids are given through this tube.
Blood tests. These are done to measure the levels of sugar, salt, and other chemicals (electrolytes) in the child’s

Loss of too much water from the body (dehydration) can occur quickly, especially in babies. Dehydration needs to be treated right away (see above).

they may not be able to attend daycare or school while ill. If child is in the hospital, they will be kept away from other children to prevent spread of the virus.

At home, good handwashing is important to prevent spread of the disease. To help prevent spread of the illness:

Handle and dispose of dirty diapers carefully.
Wash hands before and after caring for child. Use soap and warm water and scrub for at least 20 seconds. Rinse well and air dry or use a clean towel.
Clean hard surfaces, toys, and doorknobs with a disinfectant.
Make sure child washes their hands often, especially after using the toilet.
Make sure child-care center encourages handwashing.

Ask child’s healthcare provider about the rotavirus vaccine. Two oral rotavirus vaccines are available. They are RotaTeq and Rotarix. The CDC recommends that babies get one of these vaccines. RotaTeq oral vaccine is given at ages 2 months, 4 months, and 6 months. Rotarix oral vaccine is given at age 2 months and 4 months.

Key points about rotavirus in children

Rotavirus is a contagious virus that causes nausea and diarrhea.
Some babies and children may have diarrhea so severe that they lose too much water (dehydration). They may need emergency care and a hospital stay.
Most children get the virus between the ages of 3 months and 35 months.
The virus causes watery diarrhea that may last from 3 to 8 days. It can also cause nausea, vomiting, and fever.
Treatment includes giving plenty of water, formula, breastmilk, or fluids with electrolytes (sugars and salts).
If the child has rotavirus, they may not be able to attend daycare or school while ill.
At home, good hand washing can prevent the disease from being spread.
Ask child’s healthcare provider about the rotavirus vaccine.

CDC. (2021). Rota Virus. https://www.cdc.gov/rotavirus/index.html#:~:text=Rotavirus%20commonly%20causes%20severe%2C%20watery,your%20child%20with%20rotavirus%20vaccine.&text=The%20most%20common%20symptoms%20of,%2C%20and%2For%20abdominal%20pain.

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Skin and Rash

Impetigo:

(Staphylococcus aureus Group A) infection

Spread by direct contact with lesions or with contaminated objects
Sign and Symptoms:

Small red pimples or fluid filled blisters
Crusty yellow scabs on face or body

Wisconsin Department of Health Science,2021

Contact info: info@nursesinternational.org

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Viral Infection: Erythema Infectiosum/Fifth Disease

Known as "slapped cheek" disease
Caused by human parvovirus B19
Spread through direct contact with fluid from the nose and throat and also with infected blood
Most common in young, school-age children
Incubation period: 4 to 14 days

Children’s National, n.d

Contact info: info@nursesinternational.org

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Erythema Infectiosum/Fifth Disease: Symptoms

A rash is usually the main symptom

The rash:

Starts on the cheeks and is bright red
Spreads to the trunk, arms, and legs, and lasts 2 to 4 days
Often a "lacey" appearance
May come back when the child is exposed to sunlight, heat or cold, or injury to the skin
May continue for several days

Children’s National, n.d

Contact info: info@nursesinternational.org

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Erythema Infectiosum: Diagnosis/Treatment

Diagnosis: Based on history and physical examination

Treatment

Increase fluids
Acetaminophen or ibuprofen for fever and discomfort
Antihistamines for itching

Children’s National, n.d

Contact info: info@nursesinternational.org

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Viral Infection: Measles (Rubeola)

Caused by Measles virus
Transmitted primarily through the respiratory droplet
Airborne transmission also occurs in closed settings
Incubation period: 10 to 12 days

Government of Canada, 2012

Children’s National, n.d

Contact info: info@nursesinternational.org

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Measles (Rubeola): Signs and Symptoms

‘Runny’ nose
Hacking cough
Conjunctivitis
Fever
Deep, red, flat rash that starts on the face and spreads to the torso, arms, legs and feet
Koplik spots: Small spots with white centers on the inside of the cheek

Government of Canada, 2012

Children’s National, n.d

Contact info: info@nursesinternational.org

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Viral Infection: Measles (Rubeola)

Diagnosis:

History and physical examination
IgG and IgM

Treatment:

Encourage a child drinks more fluids
Acetaminophen for fever and discomfort

Prevention:

MMR vaccine at 12 to 15 months of age

(Government of Canada, 2012

Children’s National, n.d

Contact info: info@nursesinternational.org

Acute and convalescent Serum Immunoglobulin G (IgG) and Serum Immunoglobulin M (IgM):

Collect IgG at time of presentation and no later than 7 days from rash onset. Collect the convalescent sample 10-30 days after the initial sample. Note: The paired sera are tested simultaneously to determine if seroconversion has occurred
Collect serum IgM at time of presentation. Note: Samples collected before 3 and after 28 days from the onset of symptoms may yield false negative results.
Collect nasopharyngeal swab for measles virus culture as soon as possible and no later than 4 days from the onset of rash.
Collect nasopharyngeal swab for measles ribonucleic acid (RNA) by RT-PCR within 7 days of rash onset, as specimens collected within this timeframe yield the best results.
Collect urine for measles virus culture within 7 days of rash onset to achieve maximum sensitivity

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Skin and Rash

MRSA

(Methicillin Resistant Staphylococcus Aureus):

Spread by individual to individual or contagious objects
Sign and symptoms:

Red swollen purulent filled lesions
Bumps under the skin that are swollen or firm
Skin around a sore that is warm or hot
Bump that gets bigger quickly or doesn’t heal
Painful sore along with a fever

Wisconsin Department of Health Science,2021

Contact info: info@nursesinternational.org

MRSA stands for methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to several antibiotics

MRSA infections are more common in groups of people that spend a lot of time close together. This includes children on a sports team. MRSA may be on sports equipment and clothing, and may transfer from skin to skin during play.

A child normally has many germs on his or her skin and in nasal passages. About a third of people in the U.S. carry the MRSA bacteria. Many people with MRSA don’t know it. These germs normally don’t cause a problem. But MRSA can cause an infection if a child’s skin gets scratched or cut, or his or her immune system is weak. The infection may be a small blister, multiple blisters, or a boil of the skin, or it may spread into the bloodstream and cause widespread problems.

A child is more at risk for MRSA if he or she has any of these:

Close contact with people who have MRSA
A scrape, cut, or other skin injury
A tattoo or piercing
A previous infection with MRSA

The symptoms of a MRSA skin infection may include any of the below:

Bump that is painful, red, leaking fluid, or swollen. It may look like a spider bite, pimple, or boil.
Bumps under the skin that are swollen or firm
Skin around a sore that is warm or hot
Bump that gets bigger quickly or doesn’t heal
Painful sore along with a fever
Rash or fluid-filled blisters
Boil or sore (abscess) that leaks fluid

Signs of a systemic infection include any of the above, plus:

Fever
Chills
Severe headache
Sleepiness
Dizziness or fainting

This type of infection needs treatment right away.

The symptoms of MRSA can be like other health conditions. Make sure the child sees his or her healthcare provider for a diagnosis.

Prevention:

Maintain good hand and body hygiene. Clean hands often, and clean the body regularly, especially after exercise.
Keep cuts, scrapes, and wounds clean and covered until healed.
Avoid sharing personal items such as towels and razors.
Get care early if suspected of an infection.

CDC. (2019). Methicillin-resistant Staphylococcus aureus (MRSA). https://www.cdc.gov/mrsa/community/index.html

NHS. (2020). MRSA. https://www.nhs.uk/conditions/mrsa/

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Viral Infection: Rubella (German Measles)

Caused by Rubella virus (Rubivirus)
Transmission:

Droplet spread
Direct contact (nasopharyngeal secretions)
Transplacental transmission

Sign and symptoms:

Low-grade fever
Conjunctivitis
Macular rash (starts on face and then to trunk and the extremities)
Lymphadenopathy
Arthritis (in adolescents)

Government of Canada, 2012

Children’s National, n.d

Contact info: info@nursesinternational.org

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Viral Infection: Rubella (German Measles)

Congenital rubella:

Cataracts in the eyes
Heart problems
Mental retardation
Growth retardation
Enlarged liver and spleen
Skin lesions
Bleeding problems

Government of Canada, 2012

Children’s National, n.d

Contact info: info@nursesinternational.org

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Viral Infection: Rubella (German Measles)

Diagnosis:

Virus culture from clinical samples (e.g., throat swab, nasopharyngeal swab/aspirate, urine)
Serum rubella Immunoglobulin M (IgM) antibody
Serum rubella Immunoglobulin G (IgG) antibody

Government of Canada, 2012

Contact info: info@nursesinternational.org

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Viral Infection: Rubella (German Measles)

Treatment:

Fluid intake
Rest
Supportive treatment for symptoms
Prevent transmission

Prevention:

MMR vaccine at 12 to 15 months of age, and then again between 4 and 6 years of age

Government of Canada, 2012

Children’s National, n.d

Contact info: info@nursesinternational.org

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Viral Infection: Chickenpox (Varicella)

Caused by the varicella-zoster virus (VZV)
Most commonly occurs in children between the ages of 5 and 9
Transmission: individual-to-individual by direct contact or through the air
Incubation period: 10 -21 days

Government of Canada, 2012

Children’s National, n.d

Contact info: info@nursesinternational.org

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Viral Infection: Chickenpox (Varicella)

Sign and Symptoms:

A rash that turns into itchy, fluid-filled blisters that eventually turn into scabs
First show up on the chest, back, and face, and
Then spread over the entire body, including inside the mouth, eyelids, or genital area

Other symptoms may appear one to two days before rash:

Fever
Tiredness
Loss of appetite
Headache

CDC, 2021

Contact info: info@nursesinternational.org

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Chickenpox (Varicella): Diagnosis/Treatment

Diagnosis:

Based on a complete medical history and physical examination of the child

Treatment:

Acetaminophen for fever (No Aspirin)
Rest
Calamine lotion (to relieve itching)
Increased fluid intake (to prevent dehydration)
Antiviral drugs (for severe cases)

Children’s National, n.d

Contact info: info@nursesinternational.org

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Skin and Rash

Shingles: (Varicella zoster virus, Herpes Zoster)

Spread by direct contact with blister fluid to only those susceptible to chickenpox
Sign and Symptoms:

Red bumps and blisters (may be itchy or painful) usually in narrow area on half of body
Fever
Chills
Headache
Upset stomach

Wisconsin Department of Health Science,2021

Contact info: info@nursesinternational.org

The rash first appears on the chest, back, and face, and then spreads over the entire body, causing between 250 and 500 itchy blisters
— Shingles, also called herpes zoster, is a disease that triggers a painful skin rash. It is caused by the same virus as chickenpox, ..

The varicella-zoster virus is responsible for both chicken pox and shingles. It creates rash of blisters with a red base .

Treatment:

Several antiviral medicines—acyclovir, valacyclovir, and famciclovir—are available to treat shingles and shorten the length and severity of the illness. These medicines are most effective if started sooner after the rash appears. In case of suspected shingles, contact the healthcare provider as soon as possible to discuss treatment.

Pain medicine, either over-the-counter or a prescription from the doctor, may help relieve the pain caused by shingles. Wet compresses, calamine lotion, and colloidal oatmeal baths (a lukewarm bath mixed with ground up oatmeal) may help relieve itching

Prevention:

Cover the rash.
Avoid touching or scratching the rash.
Wash hands often.
Avoid contact with the following people until rash crusts:

pregnant women who have never had chickenpox or the chickenpox vaccine;
premature or low birth weight infants; and
people with weakened immune systems, such as people receiving immunosuppressive medications or undergoing chemotherapy, organ transplant recipients, and people with human immunodeficiency virus (HIV)

CDC. (2019). Shingles (Herpes Zoster). https://www.cdc.gov/shingles/about/index.html

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Skin and Rash

Hand Foot and Mouth Disease: (Coxsackie virus)

Spread by Contact with fecal, oral, or respiratory secretions
Sign and Symptoms:

Fever
Rash (on hands, feet, or mouth)
Conjunctivitis
Sore throat
Vomiting
Diarrhea

No specific treatment, symptomatic treatment,prevent dehydration

Wisconsin Department of Health Science,2021

CDC, 2021

Contact info: info@nursesinternational.org

Coxsackieviruses are part of the enterovirus family of viruses (which also includes polioviruses and hepatitis A virus) that live in the human digestive tract.

Hand, foot, and mouth disease is common in children under 5 years old, but anyone can get it.
The illness is usually not serious, but it is very contagious. It spreads quickly at schools and day care centers.

Transmission:

The virus can spread to others through an infected individual’s

Nose and throat secretions, such as saliva, drool, or nasal mucus
Fluid from blisters or scabs
Feces (poop)

Treatment:

There is no specific medical treatment for hand, foot, and mouth disease.
take steps to relieve symptoms and prevent dehydration

Prevention:

Always wash hands:

After changing diapers
After using the toilet
After blowing the nose, coughing, or sneezing
Before and after caring for someone who is sick

Help children wash their hands

CDC. (2021). Hand, Foot, and Mouth Disease (HFMD).https://www.cdc.gov/hand-foot-mouth/index.html

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Skin and Rash

Scabies: (mite infestation)

Spread by individual-to-individual , contaminated bedding, towels, clothing
Sign and symptoms:

Intense itching (especially at night)
Red bumps or blisters most commonly found on skin folds

Wisconsin Department of Health Science,2021

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Communicable Diseases- Risk Factors

Contaminated water
Poor sanitation and hygiene
Crowded conditions
Lack of bed nets
Forced displacement
Poor quality shelter
Poor living condition
Lack of healthcare facilities and
Lack of adequate surveillance

Hammer, Brainard, & Hunter, n.d

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

A mother calls the clinic because her 12 yr old child complains of joint pain and has a fever of 99 and a pinkish rash that started on her face and spread to her body.

Which disease does the nurse suspect?

Rubella
Chicken Pox
Rubeolla
Coxsackie VIrus

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Infectious Diseases: Diagnosis

Many infectious diseases have similar signs and symptoms
Samples of body fluids may reveal evidence of the particular microbe that causes the illness

Blood tests
Urine tests
Throat swabs
Stool sample
Spinal tap (lumbar puncture)

Mayoclinic, 2022

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Communicable Disease: Treatment

Depending on the causes of the diseases

Antibacterial
Antiviral
Antifungal
Antiparasitics

Symptomatic management: Antipyretic, Analgesics

Mayoclinic, 2022

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Communicable Diseases- Prevention

Immunization of children and adults caring for children
Hand hygiene
Prevention of exposure to blood and body fluids
Handle and prepare food safely
Clean and disinfect commonly used surfaces
Do not share personal items
Avoid touching wild animals
Stay home when sick
Frequent deliberate hand washing

Hostos Community College,2022

Population Health Division, n.d

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

What is the most cause of severe diarrhea in children?

Gastroenteritis
Rota Virus
intestinal parasites
Hand foot and mouth disease

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur
Health customs: In some cultures family members play a large role in health care decision-making
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations

AHRQ, 2020

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Cultural Considerations (con.):

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References:

Better Health. (2017). Cold Sore. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cold-sores

CDC. (2021 April 28). Chickenpox (Varicella). https://www.cdc.gov/chickenpox/about/index.htmlCleveland Clinic. (2022). Skin Conditions in Children.

https://my.clevelandclinic.org/health/diseases/6951-skin-conditions-in-children

Children’s National. (n.d). Pediatric Common Skin Disorders. https://childrensnational.org/visit/conditions-and-treatments/skin-disorders/common-skin-disorders

Government of Canada. (2012). Pediatric and Adolescent Care - Chapter 18 - Communicable Diseases.

Clinical Practice Guidelines for Nurses in Primary Care - Pediatric and Adolescent Care. https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/health-care-services/nursing/clinical-practice-guidelines-nurses-primary-care/pediatric-adolescent-care/chapter-18-communicable-diseases.html

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References:

Hammer, C. C., Brainard, J. & Hunter, P. R. (n.d). Risk factors and risk factor cascades for communicable disease outbreaks in complex humanitarian emergencies: a qualitative systematic review. BMJ 3, 4. https://gh.bmj.com/content/3/4/e000647

Hostos Community College. (2022). Common Communicable Diseases of Children. https://guides.hostos.cuny.edu/hlt111/chapter1

Mayoclinic. (2022). Infectious Diseases. https://www.mayoclinic.org/diseases-conditions/infectious-diseases/diagnosis-treatment/drc-20351179

Population Health Division. (n.d). Healthy Habits. https://www.sfcdcp.org/communicable-disease/healthy-habits/#1511206312684-a524ecbb-728f

Winnipeg Regional Health Authority. (2008). The Chain of Infections. https://professionals.wrha.mb.ca/old/extranet/ipc/files/manuals/ltc/ManualPCH_Sec03.pd

Wisconsin Department of Health Services. (2021). Childhood Communicable Diseases. https://www.dhs.wisconsin.gov/disease/childhood-communicable-diseases.htm

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