Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 26
Caring for the Child with an
Immunologic or Infectious
Condition
Susan Ward
Shelton Hisley
The Immune System
 Protection offered by the immune system
is called immunity
 Innate (natural)
 Adaptive (active)
 Passive (acquired)
The Body’s Defense
 Skin (most important physical barrier)
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Protects the deeper tissues from injury
Protects the body from foreign matter invasion
Regulates temperature
Aids in water retention
Aids in synthesis of vitamin D
Initiates the sensations of touch, pain, heat, and cold
The mucous membranes provide a protective barrier
against the entry of pathogens
Barriers
 Mechanical barriers: the mechanical action of
fluids (tears, urine, vaginal secretions, and semen) that
flow out from the body and carry unwanted
intruders
 Chemical barriers (acidic secretions of stomach
and digestive enzymes) neutralize organisms
taken into the body through the mouth
Congenital
Immunodeficiency Disorders
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B-cell disorders
T-cell disorders
B-lymphocyte disorders
Combined immunodeficiency disorders
 Wiskott-Aldrich syndrome
Immunodeficiency Disorders
Human
Immunodeficiency Virus
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Signs and symptoms
 Lymphadenopathy, hepatosplenomegaly, chronic diarrhea, FTT, oral
thrush, skin infections, fevers, recurrent respiratory infections &
neurological involvement
Diagnostic testing (ELISA & PCR)
Nursing care
 Provide psychological and physiological care
 Give antiviral therapy
 Provide symptomatic care and be supportive
 Pain management
 Treating malnutrition
 Use the team approach
Transplantation
(Medically Induced Posttransplant)
 Nursing care
 Give corticosteroids
 Induction (suppress immune system)
 Maintenance (correct amount of immunosupression)
 Rejection (increased immunosupression)
 Prevent infection
 Promote good nutrition and general health
 Maintain barriers
 Identify early identification and give aggressive treatment
Autoimmune Disorders
Systemic Lupus
Erythematosus
 Signs and symptoms
 Variable, fever, malaise, chills, fatigue, weight loss, butterfly rash,
arthritis
 Nursing care
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Manage pain and inflammation
Treat symptoms
Prevent complications
Give antimalarial medications
Give corticosteriods
Give immunosuppressive agents
Give palliative care & psychosocial support
Juvenile Rheumatoid
Arthritis
 Signs and symptoms
 Involves few or multiple joints, limping, favoring a particular joint, pain,
uneven growth, swelling, loss of motion, and stiffness
 Nursing care
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Relieve pain and prevent contractures
Encourage medical appointments
Discuss drug and physical therapy (surgery if necessary)
Provide parental support
Discuss ADLS, warm compresses, good nutrition, and summer camp
Allergic Reaction
(Anaphylaxis)
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Signs and symptoms
 Wheezing, tachycardia, hypotension, cyanosis, altered LOC (see Nursing Insight:
Signs and Symptoms of Anaphylaxis)
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Nursing care
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Perform CPR
Activate the emergency system
Ensure adequate airway
Administer epinephrine (adrenaline)
Place a tourniquet proximal to the site
Keep the child lying flat, keep the child warm, and keep child’s feet elevated
Administer corticosteroids and antihistamines
Determine the cause of the attack
Infectious Diseases of
Childhood
Infection
 Epidemiological
triangle
 Host
 Environment
 Agent
 Chain of infection
model
 Pathogenic
microorganism
 Reservoir
 Means of escape
 Mode of transmission
 Means of entry
 Host susceptibility
Infection (Table 26-1)
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Chicken pox (viral)
Diphtheria (bacterial)
Infectious mononucleosis (viral)
Fifth disease (viral)
Haemophilus influenzae Type B (bacterial)
Mumps (viral)
Pertussis (bacterial)
Pneumococcal disease (bacterial)
Poliomyelitis (viral)
Roseola (viral)
Rubeola (viral)
Scarlet fever (bacterial)
Tetanus (bacterial)
Infection
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Signs and symptoms
 Each infectious condition has unique signs and symptoms
 Common signs and symptoms
 Fever, malaise, anorexia, and pruritus
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Nursing care
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Provide good skin care and nutrition
Maintain barriers and immune response
Educate families about promoting stress reduction
Perform accurate assessment
Prevent disease transmission
Treat signs and symptoms
Teach families about universal precautions
Prevent complications
Common Viral Infections
Reye Syndrome
 Clinical Alert! Reye Syndrome
Risk with Use of Aspirin
 Prolonged fever, mild hepatitis,
and fatigue
 Educate parents about Reye
Syndrome and use of aspirin-free
medications for control of fever
Cytomegalovirus Infections
 Signs and symptoms
 Prolonged fever, mild hepatitis, and fatigue
 Nursing care
 Give ganciclovir (antiviral agent)
 Teach parents about average recovery time
 Teach parents that children can resume
activity as tolerated
Herpes Zoster
 Signs and symptoms
 Cutaneous vesicular lesions
 Nursing care
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Decrease itching (calamine lotion)
Decrease pain (Acetaminophen)
Give acyclovir (antiviral medication)
Apply cool water compresses and give baths
Small Pox
 Signs and symptoms
 Lesions produce pus
 Chills, fever, headache, and vomiting
 Nursing care
 Implement isolation
 Give antibiotic to prevent secondary infection
 Give vaccinia Immune Globulin (VIG)
Infectious Mononucleosis
 Signs and symptoms
 Cervical lymph nodes become swollen, firm, and tender
 Chills, fever, headache, anorexia, and malaise
 Nursing care
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Maintain bedrest
Maintain hydration
Decrease fever
Implement isolation
Common Fungal Infections
Candida Albicans (Oral Thrush)
 Signs and symptoms
 White plaques on the surface of tongue and
buccal membranes
 Nursing care
 Maintain nutrition
 Give nystantin (administer with gloved finger
using a swab; administer after feedings)
 Educate parents about prevention
Fungal Infections
(Table 26-2)
 Tinea capitis (Ringworm)
 Tinea pedis (Athlete’s foot)
 Tinea cruris (Jock itch)
 Tinea corporis (epidermal layer of the skin)
Immunizations
 Inactivated vaccines (microbe is killed but still
capable of producing antibodies)
 Live attenuated vaccines (microbe not killed;
decreases virulence)
 Toxoids (geared toward a toxin-producing
organism)
Immunizations
 Nursing roles
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Maintain current knowledge
Assess current immunization
Be skilled in vaccine administration
Discuss immunization clinics
Ensure long-term tracking
Keep documentation
Discuss follow-up care
Contact centers for Disease Control
Educate parents about local and systemic; allergic reactions
Address unique concerns of each family
Animal-Borne
Infectious Diseases
Rabies
 Signs and symptoms
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Generalized flu symptoms (malaise, fever, sore throat)
Alternations in mental status
Seizures
Hyperexcitability
Respiratory arrest
 Nursing care
 Clean wound
 Administer Rabies Immune Globulin (HRIG)
 Administer Rabies vaccine series (HDCV)
West Nile Virus
 Signs and symptoms
 Headache, malaise, anorexia, nausea, vomiting, myalgia, eye
pain, lymphadenopathy, and maculopapular rash
 Nursing care
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Educate parents about the disease
Give symptomatic care
Respond to parental concerns
Teach about insect repellents
Avian Influenza
 Signs and symptoms
 Typical flu symptoms (cough, sore throat, fever, and myalgia)
 Severe pneumonia and acute respiratory distress
 Nursing care
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Give supportive and symptomatic care
Give aggressive treatment of complications (pneumonia)
Give antiviral medications
Teach family about preparing for a pandemic
An Emerging Issue in Infectious Disease:
Resistant Organisms
 Bacterial resistance due to misuse, overuse, and
noncompliance
 Nurses can provide
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Implement isolation measures
Ensure education for health care professionals
Increase public awareness
Provide strategies to decrease transmission
Provide family education
Give information about current practices in infection control
Antibiotic Alternatives
 Monoclonal (based on passive immunity)
 Probiotics (colonized in the intestine to
improve immune function)