Chapter 32 Childhood Communicable Diseases Bioterrorism Natural Disasters

Chapter 32 Childhood Communicable Diseases, Bioterrorism, Natural Disasters, and the Maternal-Child Patient Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Common Childhood Communicable Disease (p. 721) 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 © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 2

Review of Terms (p. 725) 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 © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 3

Review of Terms (cont. ) (p. 725) Pandemic—a worldwide high incidence of a communicable disease; i. e. , H 1 N 1 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 immunesuppressed person cannot fight Healthcare-associated infection—an infection acquired after admission to a health care facility Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 4

Virulence of Infection (p. 725) Host resistance to disease is influenced by Age Ø Sex Ø Genetic makeup Ø Nutritional status Ø Physical/emotional health Ø Phagocytes in blood to attack/destroy pathogens Ø Intact skin and mucous membranes Ø Functioning immune system Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 5

Types of Immunity (p. 726) 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 Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 6

Transmission of Infection (p. 726) Direct—transmitted by contact with an infected person Indirect—transmitted by contact with objects that have been contaminated by an infected person (fomites) Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 7

Transmission of Infection (cont. ) (p. 726) Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 8

Medical Asepsis, Standard and Transmission-Based Precautions (p. 726) Refer to Appendix A: Standard Precautions and Body Substance Precautions (p. 771). Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 9

Preventing the Spread of Infection (p. 726) 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 © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 10

Airborne Infection Isolation Precautions (p. 726) Airborne particles <5 microns in size float in the air and contaminate anything within the room Particles can remain airborne for several hours Ø Used for conditions such as TB and varicella Ø Use of negative pressure room and an N 95 particulate respirator mask is required whenever in the room with the patient N 95 mask is removed only upon exiting the room and hygiene is performed Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 11

Contact Precautions (p. 727) When contamination is likely to occur skin to skin or through contact with a contaminated fomite Ø 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 © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 12

Droplet Precautions (p. 727) Droplets (>5 microns in size) from coughing or sneezing can contaminate surrounding environment up to 3 feet around the patient Ø 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 hygiene is performed Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 13

Protective Environment Isolation (p. 727) 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/transmissionbased precautions are required at all times, this includes any visitors Ø NOTE: If a disease has more than one mode of transmission, then more than one precaution technique is used Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 14

Hand Hygiene (p. 727) Nurse performs hand hygiene between patients and after removal of gloves Only hospital-approved antibacterial soaps, lotions, and sanitizers are to be used Ø Self-contained liquid soap dispensers, no bar soap Ø Alcohol-based hand sanitizers Ø Artificial nails, tips, wraps, gels, and nail jewelry are not to be worn as they increase the risk of infection Caregivers with lesions on exposed body parts should not provide patient care until all lesions have healed Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 15

Safety Alert (p. 727) Alcohol-based hand sanitizers should not be used when caring for a patient diagnosed with Clostridium difficile diarrhea Ø Alcohol cannot penetrate the exterior wall of the spore-forming organism, therefore it cannot kill it Soap and warm running water should be used for hand hygiene after every contact with this type of patient Ø Running water helps rinse the spore-forming organism off of the hands Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16

Family Education to Prevent the Spread of Infection (p. 727) Should include Hand hygiene Ø Necessity of immunizations Ø Proper food storage Ø Use of pasteurized milk Ø Proper defrosting/cooking of meat Ø Avoid using community towels Ø Control of insects Ø Avoid use of sandboxes in the yard Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 17

Rashes of the Skin (p. 727) 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 © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 18

Worldwide Immunization Programs (p. 728) Healthy People 2020 Ø 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) Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 19

Types of Immunization Agents (p. 728) Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 20

Vaccines (p. 728) 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 Ø Important to achieve immunization Proper storage and handling will ensure potency Do not store in refrigerator or freezer door Ø Store in center of shelves, away from vents Ø Store at 35° to 46° F (1. 6° to 7. 7° C) Ø Vaccines cannot be refrozen after they have been thawed Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 21

Emergency Preparedness (p. 729) May be times where sudden and unexpected power outages may occur To minimize the potential for vaccine loss preventive steps, such as keeping several bottles of water and cold should be taken Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 22

Nursing Tip (p. 730) 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 Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 23

Allergies and Toxicities (p. 729) 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 Ø Eggs: avoid influenza vaccine, MMR Ø Neomycin: avoid IPV, MMR, and varicella vaccine Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 24

Allergies and Toxicities (cont. ) (p. 729) Varicella must be given same day as MMR or no less than one month later A tuberculin skin test (PPD) 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 © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 25

Contraindications to Immunizations (p. 731) Immunocompromised state Pregnancy (with certain vaccines) Bacteremia or meningitis Immunocompromised caregiver in the home Ø Corticosteroid therapy Ø Requires individual evaluation by the health care provider Requires individual evaluation History of high fever or other reaction after previous immunization Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 26

Nursing Tip (p. 731) An interrupted vaccination series can usually continue without restarting the entire series Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 27

The Future of Immunotherapy (p. 731) 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 Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 28

The Future of Immunotherapy (cont. ) (p. 731) Development of “gene gun” to blast vaccine through intact skin Development of immunotherapy for noncommunicable diseases such as mucosal administration of myelin for multiple sclerosis Development of tumor antigens Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 29

Bioterrorism and the Pediatric Patient (p. 731) 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 Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 30

Bioterrorism and the Pediatric Patient (cont. ) (p. 731) Routine “Haz. Mat” 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 © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 31

Common Diseases Spread Through Bioterrorism (p. ) Which biological agents have we read/heard about recently? Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 32

Emergency Preparedness (p. 738) 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 Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 33

Initial Observations During Disasters (p. 739) 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 Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 34

The Pediatric Patient in a Disaster Setting (p. 739) 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 Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 35

Sexually Transmitted Infections (p. 739) 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 Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 36

Nursing Care and Responsibilities (p. 739) 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 Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 37

Nursing Tip (p. 740) Sex education is not limited to mechanics of intercourse, but rather includes the feelings involved in sexual experience, expectations, fantasies, fulfillments, and disappointments Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 38

HIV/AIDS in Children (p. 741) Children usually contract HIV by Contact with infected mother at birth Ø Sexual contact with infected person Ø Contact with infected needles or blood Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 39

Cause of HIV/AIDS in Children (p. 741) HIV-1 attacks lymphocytes and causes imbalance in helper T-cells (CD 4+) that support immune system and suppressor Tcells that shut it down Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 40

Diagnosis of HIV/AIDS in Children (p. 741) CD 4+ 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 Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 41

HIV/AIDS in Children (cont. ) (p. 741) Manifestations Failure to thrive Ø Lymphadenopathy Ø Chronic sinusitis Ø Failure to respond to treatment of infections • Thrush • Pneumocystis jiroveci (formerly, carinii) pneumonia • Herpes infection • Cytomegalovirus (CMV) Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 42

HIV/AIDS in Children (cont. ) (p. 743) Treatment Supportive Ø No cure available for HIV/AIDS Ø Education regarding drug therapy compliance Ø Support growth and development of the child Ø Psychological support of child and family Ø Referral to available resources within the community Ø Update routine immunizations Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 43