1. Chapter 32Chapter 32
The Child with a CommunicableThe Child with a Communicable
DiseaseDisease

2. ObjectivesObjectives
• 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.
2Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

3. ObjectivesObjectives (cont.)(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).
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 3

4. Communicable DiseaseCommunicable 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
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 4

5. Review of TermsReview of Terms
• 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 © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 5

6. Review of TermsReview of Terms (cont.)(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
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 6

7. Virulence of InfectionVirulence of Infection
• Host resistance to disease is influenced by
– Age
– Sex
– Genetic makeup
– Nutritional status
– Physical/emotional health
– Phagocytes in blood to attack/destroy pathogens
– Intact skin and mucous membranes
– Functioning immune system
7Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

8. Types of ImmunityTypes of Immunity
• 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
8Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

9. Transmission of InfectionTransmission 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)
9Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

10. Medical Asepsis, Standard andMedical Asepsis, Standard and
Transmission-Based PrecautionsTransmission-Based Precautions
10Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

11. Preventing the Spread of InfectionPreventing 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
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 11

12. Airborne Infection IsolationAirborne Infection Isolation
PrecautionsPrecautions
• Airborne particles <5 microns in size float in the
air and contaminate anything within the room
– 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
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 12

13. Contact PrecautionsContact Precautions
• When contamination is likely to occur skin to
skin or through contact with a contaminated
fomite
– 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 © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 13

14. Droplet PrecautionsDroplet Precautions
• Droplets (>5 microns in size) from coughing
or sneezing can contaminate surrounding
environment up to 3 feet around the patient
– 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
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 14

15. Expanded PrecautionsExpanded Precautions
(Protective Isolation)(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
– NOTE: If a disease has more than one mode of
transmission, then more than one precaution
technique is used
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 15

16. Hand HygieneHand Hygiene
• Nurse performs hand hygiene between patients
and after removal of gloves
– Only hospital-approved antibacterial soaps, lotions,
and sanitizers are to be used
– Self-contained liquid soap dispensers, no bar soap
– Alcohol-based hand sanitizers
• 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
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16

17. Safety AlertSafety Alert
• Alcohol-based hand sanitizers should not be
used when caring for a patient diagnosed with
Clostridium difficile diarrhea
– 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
– Running water helps rinse the spore-forming organism
off of the hands
17Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

18. Family Education to Prevent theFamily Education to Prevent the
Spread of InfectionSpread of Infection
• Should include
– 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
18Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

19. Rashes of the SkinRashes of the Skin
• 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 © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 19

20. Worldwide Immunization ProgramsWorldwide Immunization Programs
• Healthy People 2020
– 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)
20Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

21. Types of Immunization AgentsTypes of Immunization Agents
21
Vaccine A suspension of weakened or inactivated
(killed) organisms that stimulate immune
bodies to form
A form of active immunity
Toxoid A modified toxin that stimulates the
production of antitoxin
A form of active immunity
Immunoglobulin A solution containing antibodies extracted
from human or animal blood
Provides passive immunity
Specific
immunoglobulin
s
Special preparations obtained from blood
donors selected for their high antibody
content to a specific disease
Provides passive immunity to the specific
diseaseElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

22. VaccinesVaccines
• 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
– Important to achieve immunization
• Proper storage and handling will ensure potency
– Do not store in refrigerator door
– Store in center of shelves, away from vents
– Store at 35-46° F (1.6° to 7.7° C)
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 22

23. Nursing TipNursing 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
23Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

24. Allergies and ToxicitiesAllergies 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
– Baker’s yeast: avoid recombinant hepatitis B
vaccine
– Eggs: avoid influenza vaccine, MMR
– Neomycin: avoid IPV, MMR, and varicella
vaccine
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 24

25. Allergies and ToxicitiesAllergies and Toxicities (cont.)(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
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 25

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

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

28. The Future of ImmunotherapyThe 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
28Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

29. The Future of ImmunotherapyThe Future of Immunotherapy
(cont.)(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
29Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

30. Bioterrorism and the PediatricBioterrorism and the Pediatric
PatientPatient
• 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
30Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

31. Bioterrorism and theBioterrorism and the
Pediatric PatientPediatric Patient (cont.)(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
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 31

32. Triage CategoriesTriage Categories
32
Immediate Requires prompt intervention
Delayed Intervention can wait for a short time
Minimal Only outpatient care is required
Expectant
Moribund patient, not expected to
survive
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

33. Common Diseases Spread ThroughCommon Diseases Spread Through
BioterrorismBioterrorism
Biological Agent Incubation Period
Anthrax 1 to 45 days
Botulism 1 to 5 days, as high as 14 days
Ebola virus (Filovirus) 4 to 10 days
Lassa fever (Arenavirus) 7 to 16 days
Plague 2 to 3 days
Smallpox 12 days on average
Tularemia 3 to 5 days
33Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

34. Emergency PreparednessEmergency 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
34Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

35. Initial Observations DuringInitial Observations During
DisastersDisasters
• 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
35Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

36. The Pediatric Patient in a DisasterThe Pediatric Patient in a Disaster
SettingSetting
• 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
36Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

37. Sexually Transmitted InfectionsSexually 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
37Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

38. Nursing Care and ResponsibilitiesNursing 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
• Help patient formulate positive self-attitude
38Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

39. Nursing TipNursing Tip
• Sex education is not limited to mechanics of
intercourse, but rather includes the feelings
involved in sexual experience, expectations,
fantasies, fulfillments, and disappointments
39Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

40. HIV/AIDS in ChildrenHIV/AIDS in Children
• Children usually contract HIV by
– Contact with infected mother at birth
– Sexual contact with infected person
– Contact with infected needles or blood
40Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

41. Cause of HIV/AIDS in ChildrenCause 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
41Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

42. Diagnosis of HIV/AIDS in ChildrenDiagnosis 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
42Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

43. HIV/AIDS in ChildrenHIV/AIDS in Children (cont.)(cont.)
• Manifestations
– Failure to thrive
– Lymphadenopathy
– Chronic sinusitis
– Failure to respond to treatment of infections
• Thrush
• Pneumocystis jiroveci (formerly, carinii) pneumonia
• Herpes infection
• Cytomegalovirus (CMV)
43Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

44. HIV/AIDS in ChildrenHIV/AIDS in Children (cont.)(cont.)
• Treatment
– 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
44Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

45. Question for ReviewQuestion for Review
• What type of immunity is given to infants and
children through routine vaccinations for
common childhood communicable disease?
45Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

46. ReviewReview
• Objectives
• Key Terms
• Key Points
• Online Resources
• Review Questions
46Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.