CHILD HEALTH NURSING
UNIT- V
NURSING MANAGEMENT IN COMMON CHILDHOOD
DISORDERS
COMMUNICABLE DISEASES IN CHILDHOOD
OBJECTIVES
At the end of the class the students will acquire knowledge
rearding communicable disease in children,etiology, clinical
manifestations,management and appropriate vaccines and
thereby gain a positive attitude in taking care of children and
family affected with communicable diseases by implementing
appropriate skills.
DIPHTHERIA
INTRODUCTION
• Bacterial infection
• Transmitted by direct contact with respiratory secretions, droplet,
contaminated objects
• Communicable 2-4 weeks =highly contagious
• CORYNEBACTERIUM DIPHTHERIAE
Aerobic gram-positive bacillus
CLINCAL MANIFESTATION
• Yellow nasal discharge.
• May have epitaxis.
• Sore throat.
• Hoarseness with cough.
• Enlarged lymph nodes.
• Low grade fever
• Increased pulse
• Malaise
INCUBATION PERIOD
Incubation period 2-5 days
(range, 1-10 days)
CLASSIFICATION
Classified based on site of infection
– anterior nasal
– pharyngeal and tonsillar
– laryngeal
– cutaneous
– ocular
– genital
Pharyngeal and Tonsillar Diphtheria
• Insidious onset
• Exudate spreads within 2-3 days and may form adherent
membrane
• Membrane may cause respiratory obstruction
• Pseudomembrane: fibrin, bacteria, and inflammatory
cells, no lipid
• Fever usually not high but patient appears toxic
Tonsillar Diphtheria
COMPLICATIONS
• Most attributable to toxin
• Severity generally related to extent of local disease
• Most common complications are myocarditis and neuritis
• Death occurs in 5%-10% for respiratory disease
EPIDEMIOLOGY
• Reservoir Human carriers
Usually asymptomatic
• Transmission Respiratory, aerosols
Skin lesions
• Temporal pattern Winter and spring
• Communicability Up to several weeks
without antibiotics
Diagnosis and Management
Diagnosed by culture of discharge
• Strict isolation
• Suctioning
DIPHTHERIA VACCINE
• Detoxified bacterial, protein toxin
• Injectable, IM administration
• Toxigenic Corynebacterium diphtheriae
• Produced in horses (old)
• First used in the U.S. in 1891
• Used only for treatment of diphtheria
TETANUS
INTRODUCTION
• First described by Hippocrates
• Etiology discovered in 1884 by Carle and Rattone
• Passive immunization used for treatment and prophylaxis
during World War I
• Tetanus toxoid first widely used during World War II
CLOSTRIDIUM TETANI
• Anaerobic gram-positive, spore-forming bacteria
• Spores found in soil, animal feces; may persist for months to
years
• Multiple toxins produced with growth of bacteria
• Tetanospasmin estimated human lethal dose = 2.5 ng/kg
TETANUS PATHOGENESIS
• Anaerobic conditions allow germination of spores and
production of toxins
• Toxin binds in central nervous system
• Interferes with neurotransmitter release to block inhibitor
impulses
• Leads to unopposed muscle contraction and spasm
INCUBATION PERIOD
• Incubation period; 8 days
(range, 3-21 days)
CLINICAL FEATURES
Generalized tetanus: descending symptoms of trismus
(lockjaw), difficulty swallowing, muscle rigidity, spasms
Spasms continue for 3-4 weeks; complete recovery may
take months
Fatality rate ~90% w/o treatment
~30% w/ treatment
NEONATAL TETANUS
Generalized tetanus in newborn infant
The first sign of tetanus in a neonate is usually
an inability to suck or breastfeed and excessive crying.
Characteristic features of tetanus are :
• Trismus (lockjaw, or inability to open the mouth)
• Risus sardonicus (forced grin and raised eyebrows)
• Opisthotonos.
Opisthotonus (backward arching of the spine).
>270,000 cases worldwide per year
COMPLICATIONS
• Laryngospasm
• Fractures
• Hypertension
• Nosocomial infections
• Pulmonary embolism
• Aspiration pneumonia
• Death
Epidemiology
• Reservoir Soil and intestine of
animals and humans
• Transmission Contaminated wounds
Tissue injury
• Temporal pattern Peak in summer or
wet season
• Communicability Not contagious
Tetanus Transmission
• Not a communicable disease
• The only vaccine-preventable infection that is not
communicable
• Disease acquired through exposure to bacterial spores in
the environment
– inoculation of bacterial spores into body by puncture or deep
cut
Tetanus Toxoid
• Formalin inactivated tetanus toxin
• Schedule Three or four doses + booster
Booster every 10 years
• Efficacy Approximately 100%
• Duration Approximately 10 years
• Should be administered with diphtheria toxoid as DTaP,
DT, Td, or Tdap
PERTUSSIS
(whooping cough)
INTRODUCTION
• Bacterial infection
• Vaccine available “P” in Dtap
• Transmitted by direct contact, droplet
• Communicable for up to 4 weeks
BORDETELLA PERTUSSIS
• Fastidious gram-negative bacteria
SYMPTOMS
• Begins with URI symptoms:
• dry, hacking cough that becomes severe, worse at night
• **short, rapid coughs followed by sudden inspiration and
whooping**
• Cheeks flush, eyes bulge, tongue protrudes
• Thick secretions, often vomits
• Sick for 4-6 weeks
INCUBATION PERIOD
• Incubation period 5-10 days (range 4-21 days)
CLINICAL FEATURES
• Insidious onset, similar to minor upper respiratory infection with
nonspecific cough
• Fever usually minimal throughout course of illness
• Catarrhal stage 1-2 weeks
• Paroxysmal cough stage 1-6 weeks
• Convalescence Weeks to months
EPIDEMIOLOGY
• Reservoir Human
Adolescents and adults
• Transmission Respiratory droplets
• Communicability Maximum in catarrhal stage
Secondary attack rate
up to 80%
• Disease often milder than in infants and children
• Infection may be asymptomatic, or may present as classic pertussis
• Persons with mild disease may transmit the infection
• Older persons often source of infection for children
DIAGNOSIS AND MANAGEMENT
• Diagnosed by classic presentation
• Treatment:
• hospitalization for infants or children who are dehydrated
• Bed rest
• Increase fluids
• Suctioning
• Humidifier
• Observe for airway obstruction (restlessness, retractions, cyanosis)
PERTUSSIS-CONTAINING VACCINES
• DTaP (pediatric)
• approved for children 6 weeks through 6 years (to age 7 years)
• contains same amount of diphtheria and tetanus toxoid as pediatric
DTdap (adolescent and adult)
DTaP Adverse Reactions
• Local reactions
(pain, redness, swelling)
• Temp of 101oF
or higher
• More severe adverse reactions
not common
• Local reactions more common following 4th and 5th doses
