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Chapter 32
The Child with a Communicable Disease
Objectives
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.
Objectives (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).
Communicable 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
Review of Terms
Communicable disease—can be transmitted from one person to another
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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
Review of Terms (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
Virulence of Infection
Host resistance to disease is influenced by
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Age
Sex
Genetic makeup
Nutritional status
Physical/emotional health
Phagocytes in blood to attack/destroy pathogens
Intact skin and mucous membranes
Functioning immune system
Types of Immunity
Natural—resistance is inborn
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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
Transmission 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)
Medical Asepsis, Standard and
Transmission-Based Precautions
Preventing 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
Airborne Infection Isolation Precautions
Airborne particles <5 microns in size float in the air and contaminate anything within the
room
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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
Contact Precautions
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When contamination is likely to occur skin to skin or through contact with a contaminated
fomite
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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
Droplet Precautions
Droplets (>5 microns in size) from coughing or sneezing can contaminate surrounding
environment up to 3 feet around the patient
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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
Expanded Precautions
(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
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Used in conditions such as RSV, MRSA, VRE, or Clostridium difficile infections
NOTE: If a disease has more than one mode of transmission, then more than one
precaution technique is used
Hand Hygiene
Nurse performs hand hygiene between patients and after removal of gloves
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Only hospital-approved antibacterial soaps, lotions, and sanitizers are to be used
Self-contained liquid soap dispensers, no bar soap
Alcohol-based hand sanitizers
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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
Safety Alert
Alcohol-based hand sanitizers should not be used when caring for a patient diagnosed
with Clostridium difficile diarrhea
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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
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Running water helps rinse the spore-forming organism off of the hands
Family Education to Prevent the Spread of Infection
Should include
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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
Rashes of the Skin
Erythema—diffuse and reddened
Macule—circular reddened area
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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)
Worldwide Immunization Programs
Healthy People 2020
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The USPHS goal for 2020 is to have 95% of all children in the U.S. immunized
against childhood communicable diseases
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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)
Types of Immunization Agents
Vaccines
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
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Important to achieve immunization
Proper storage and handling will ensure potency
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Do not store in refrigerator door
Store in center of shelves, away from vents
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Store at 35-46° F (1.6° to 7.7° C)
Nursing 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
Allergies 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
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Baker’s yeast: avoid recombinant hepatitis B vaccine
Eggs: avoid influenza vaccine, MMR
Neomycin: avoid IPV, MMR, and varicella vaccine
Allergies and Toxicities (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
Contraindications to Immunizations
Immunocompromised state
Pregnancy (with certain vaccines)
Bacteremia or meningitis
Immunocompromised caregiver in the home
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Requires individual evaluation by the health care provider
Corticosteroid therapy
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Requires individual evaluation
History of high fever or other reaction after previous immunization
Nursing Tip
An interrupted vaccination series can usually continue without restarting the entire series
The 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
The Future of Immunotherapy (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
Bioterrorism and the Pediatric Patient
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
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Bioterrorism and the
Pediatric Patient (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
Triage Categories
Common Diseases Spread Through Bioterrorism
Emergency 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
Initial Observations During Disasters
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
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The Pediatric Patient in a Disaster Setting
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
Sexually 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
Nursing 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
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Help patient formulate positive self-attitude
Nursing Tip
Sex education is not limited to mechanics of intercourse, but rather includes the feelings
involved in sexual experience, expectations, fantasies, fulfillments, and disappointments
HIV/AIDS in Children
Children usually contract HIV by
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Contact with infected mother at birth
Sexual contact with infected person
Contact with infected needles or blood
Cause 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
Diagnosis 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
HIV/AIDS in Children (cont.)
Manifestations
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Failure to thrive
Lymphadenopathy
Chronic sinusitis
Failure to respond to treatment of infections
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Thrush
Pneumocystis jiroveci (formerly, carinii) pneumonia
Herpes infection
Cytomegalovirus (CMV)
HIV/AIDS in Children (cont.)
Treatment
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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
Question for Review
What type of immunity is given to infants and children through routine vaccinations for
common childhood communicable disease?
Review
Objectives
Key Terms
Key Points
Online Resources
Review Questions