University of Texas at Tyler
Nurs 5329
Angela Preston, BSN, RN
“Children are the hands by which we take hold of heaven”
-Henry Beecher
Chapter 22
COMMUNICABLE DISEASES
Expected Learning Outcomes:
Identify common communicable diseases, collaborative
management and prevention for pediatric population.
Use the nursing process to describe the nursing care of a child
with an infectious disease.
Pre-class Assignments:
Pediatric Chapter 22 pp. 497-518.
 Hepatitis B
 Measles, mumps,
 Diphtheria*, tetanus*,




pertussis-DTaP
Polio- IPV*
Haemophilus influenzae
Type B –Hib*
Pneumococcal- PCV*
Rotavirus- RV*





rubella- MMR
Varicella- V
Hepatitis A
Influenza- FLU
Meningococcal*
Human Papilloma
Virus- HPV*
 Private Insurance or State Funded
 Educate on possible side effects- including mild





fever/cold symptoms or soreness/redness at injection
site
Teach appropriate doses of acetaminophen or
ibuprofen for relief
Provide Vaccine Information Statement (VIS) and
obtain parental consent
Document lot #, site, manufacturer
Report all adverse effects of immunizations
Location of administration
 Active immunity
 Natural active immunity
 Vaccine-induced immunity
 Passive immunity
 Natural passive immunity
 Passive immunity through immunoglobulins
What is an example of each type??
 Inactivated or killed organism
 Live attenuated or weakened virus- can cause mild
symptoms
 Acellular vaccine
 Toxoids
 Subunit of virus
 Exposure to the disease
 Incubation period of the disease and the onset of
symptoms
 Communicable diseases in the past
 Child’s immunization history
 Physical assessment, including prodromal and general
signs and symptoms
 Universal precautions: Prevent the transmission of
bloodborne pathogens; provide guidelines for using
protective barriers
 Standard precautions: more comprehensive, applying
to patients in all settings
 Isolation guidelines: contact, droplet, and airborne
precautions
 Difficulty breathing
 Behavior changes:
 Blue, gray, or purple
lethargy, acting
withdrawn,
unresponsiveness
 Seizure activity
 Purple or red rash
 Dehydration
tinge to lips or skin
 Fever with headache or
stiff neck
 Vomiting blood, or blood
in stool
 Erythema Infectiosum (Fifth’s
Disease)
 Mononucleosis
 Mumps (Parotitis)
 Hand-Foot-and-Mouth Disease
 Rubella (German measles)
 Respiratory Syncytial Virus
 Rubeola (Measles)
Bronchiolitis
 Roseola (Exanthum subitum) HHV
6
 Hepatitis A
 Hepatitis B
 Influenza
 Varicella zoster (Chickenpox)
 Bordetella pertussis (Whooping
cough)
 Group A Strep throat/Scarlet fever
 Conjunctivitis (Pink eye)
Include:
1. Incidence in US & globally
Distribution of Content for the
NCLEX-RN® Test Plan
Physiological Adaptation 14%
Reduction of Risk Potential 12%
Pharmacological and Parenteral
Therapies 15%
Safety and Infection Control
12%
Health Promotion and
Maintenance
9%
Basic Care and Comfort 9%
Psychosocial Integrity 9%
Management of Care 20%
2. If it is a vaccine-preventable disease; if
so, what age vaccine is given along with
information r/t vaccine
3. Physiological effect- how does virus or
bacteria manifest itself in the body
(include incubation period, prodromal
phase and communicability)
4. Nursing management including:
• Assessment- expected signs and
symptoms
• Comfort
• Treatment &/or medication- how
disease is usually diagnosed, i.e. lab
tests, is it viral or bacterial?
• Education
5. Special considerations/Higher risk
population/Emergent care
 www.ncsbn.org
 https://www.dshs.state.tx.us
 www.cdc.gov
 Textbook
 Powerpoint posted online for Mod 9 Communicable
Diseases
 www.mayoclinic.org
 www.healthychildren.org
 1. Gather information
and answer questions
 2. Present information to
class through skit, short
powerpoint,
 Take notes on other
groups
 Human parvovirus B19
 Transmission by contact with respiratory secretions
 4- to 21-day incubation period
 Contagious until rash appears
 “Slapped cheek” appearance
 Agent: Coxsackie virus or enterovirus
 Transmitted by direct contact, respiratory, fecal-oral
route
 3- to 6-day incubation period
 May be shed for several weeks
 Small vesicles in mouth and on hands and feet
Respiratory Syncytial Virus
Bronchiolitis
 Agent: respiratory syncytial




virus
Transmitted by contact with
saliva and nasal secretions; can
live on surfaces for several
hours; readily transmitted by
hands
4- to 6-day incubation period
Viral shedding may last 6
weeks
Premature babies high risk of
hospitalization if acquire RSV
Roseola (Exanthum
Subitum), HHV-6
 Agent: human herpes virus 6
 Transmitted by saliva of
persons who have the disease
or are carrying the virus
 9- to 10-day incubation period
 Communicability is unknown
 Pink or red papular rash
appears on the day the fever
returns to normal
Hepatitis A
Hepatitis B
 Agent: hepatitis A virus
 Agent: hepatitis B virus
 Transmitted by blood or
 Transmitted by
contaminated food, fecaloral route
 Incubation period
approximately 30 days
 Most contagious for 2
weeks before onset of
symptoms and for 1 week
after onset of jaundice
blood products, sexual
contact
 Incubation period on average
is 90 days
 Can be spread as long as the
virus is in the blood of an
individual; some people are
chronic carriers and carry the
disease for life
 *What is given to newborns
whose mothers are HbsAg+?*
Influenza
 Agent: influenza viruses
Type A (H1N1), Type A
(H3N2), or Type B
 Transmitted by contact with
contaminated objects,
coughing and sneezing
 1- to 4-day incubation
period
 Can be spread 1 day before
until 7 days after symptoms
Mononucleosis
 Agent: Epstein-Barr virus
 Transmitted by person-to-
person contact, sharing of
personal objects
 30- to 50-day incubation
period
 Virus may be excreted for
months following infection
 May develop splenomegaly
or hepatomegaly
Scenario
12
month old infant in good
health up to date on
vaccinations presents to
clinic with sudden onset of
moderate fever (103 degrees)
lasting for four days with
otherwise non-specific
complaints. Mother calls
clinic because fever has
returned to normal, but
mild, pink, papules 1-5mm in
diameter have appeared all
over body. What is an
appropriate nursing
diagnosis?
Viral Diseases —
(6) Mumps or
Parotitis
 Agent: paramyxovirus
 Transmitted by contact with oral
and nasal secretions
 16- to 18-day incubation period
 Can be spread 2 to 3 days before
swelling of salivary glands up to 5
days after swelling starts
Rubella (German
Measles)
 Agent: rubella virus
 Airborne through respiratory
droplets or direct contact with
secretions; also found in blood,
urine, and stool
 16- to 18-day incubation period
 Can be spread from 7 days
before until 14 days after rash;
starts at hairline and works
down
Rubeola (Measles)
 Agent: measles virus
 Airborne through respiratory
droplets or direct contact with
secretions
 8- to 12-day incubation period
 Can be spread 1 to 2 days before
prodromal symptoms, 3 to 5
days before rash, and 4 days
after rash appears
 Presence of Koplik spots in the
mouth
Viral Diseases —
(8) VaricellaZoster (Chicken
Pox)

Agent: Varicella zoster virus

Transmitted by fluid from vesicles,
secretions from nose, mouth and eyes,
and airborne from coughing and
sneezing

10- to 21-day incubation period

Can be spread 1 day before rash
appears until all vesicles have crusted
over

Same virus causes Shingles(Herpes
Zoster virus) later in life
 A mother comes into the clinic concerned because her
6- year old daughter was just diagnosed with varicella
zoster. The blisters have begun to scab over. There is a
3 year old and another 4 month old infant in the
home. What does the nurse recommend regarding
prevention of the disease?
 Agent: Bordetella pertussis
 Transmitted through oral and nasal




secretions
6- to 21-day incubation period
Contagious from the onset of
symptoms and for about 2 weeks;
infants not immunized may be
contagious for at least 6 weeks
DTaP- 2 month shots
Cough ends with crowing (whooping),
coughing “fits”
 Agent: Group A beta-hemolytic streptococcus
 Transmitted by respiratory droplets, direct contact




with secretions
2- to 5-day incubation period
Can be spread for 10 days without treatment; not
contagious after 24 hours on antibiotics
Scarlet fever is strep throat with a rash in “creases of
body”, possibly strawberry-like tongue
Swollen tonsils, may or may not have white pus
pockets, may be associated with stomach ache
 Agent: virus (adenovirus-cold) or bacteria
 Transmitted through contact with discharge from an infected eye, either






directly or by touching contaminated surfaces
Communicability varies depending on the organism
Bacterial- classic pink eye, pink/red, swelling, purulent discharge, eyes
“crusted” shut in AM, abx begin resolving in 24 hours
Viral- pink, excessive tearing, may be slight crusting from tears, eyes
might feel “dry”, no treatment available
Both contagious- educate to change pillows nightly, not to share hand
towels, meticulous hand washing, do not touch eyes, requires doctor
appointment to diagnose and prescribe antibiotic eye drops (if
bacterial), warm compress may help alleviate pain
May cause re-infection if not cared for carefully, easily spread to both
eyes and among family members, schools.
Upon presentation to clinic, ask history
 A mother is caring for her 9-month-old baby, who has respiratory
a.
b.
c.
d.
syncytial virus, and is calling the pediatrician’s office for advice. She
reports that the baby is fussy and doesn’t want to take her bottle.
She just noticed she has only changed one wet diaper that day and
when the baby cries she’s not seeing tears. Which of the following
would be the appropriate recommendation by the nurse?
“The baby will need to be seen by the doctor today. Let’s get you set
up for an appointment .”
“Suction the nose prior to feedings and provide them more
frequently in small amounts. Offer pain relief as needed.”
“The baby is in respiratory distress and needs to be taken to the
emergency room immediately.”
“Administer over-the-counter cough/cold medicine to help alleviate
the symptoms.”
 The nurse knows the child is at risk for dehydration
when the mother says she has had a notable decrease
in wet diapers in 24 hours and is crying without tears.
By suctioning prior to feedings, making them frequent
and small, and comforting the infant through holding
or giving pain relief if needed, the mother will be
setting her child up for a successful feed. The nurse
can recommend a visit to the pediatrician or ER if this
does not increase diapers following this regime within
a 12 hour period or if the child begins projectile
vomiting or becomes lethargic.
 A 4-year-old boy is brought into the pediatrician’s office for
a.
b.
c.
d.
evaluation of fever, headache, and new-onset rash noted in his
armpits and groin and behind his knees. The nurse assesses the
boy’s mouth and throat and notices his tongue has a strawberry-like
appearance. She inquires if the boy has been exposed to any sick
children. The mother replies that several children in his daycare
have had a sore throat. The nurse suspects which of the following
communicable diseases?
Exanthem subitum
Hand-Foot-and-Mouth
Scarlet fever
Erythema infectiosum
a.
Scarlet fever
Scarlet fever is strep throat with a rash. A fine, red rash with the
texture of sandpaper is more pronounced in the armpits and groin,
in the creases of the elbows, and behind the knees. A strawberry
tongue may also be noted. The child may also complain of stomach
pain.
Minute Paper & Muddy Points: You may use bullets.
1. Starting now- write down in bullets what you learned
today, starting with the most important and working
down to less important points.
2. What was “muddy” or unclear that you want to know
more about?
Include your name because I will go review these and send out an
email to clarify significant questions.