★ Pertussis / Whooping Cough
○ Signs and symptoms
■ Nasal discharge fever, long whooping sounding cough, wheezy breathing, even vomiting.
Symptoms are commonly worse at night.
○ What vaccine can prevent it?
■ DTAP <7 years. TDAP >7 years
★ Rubeola (Measles)
○ Primary prevention strategies
■ It is essential to prevent this disease through adequate immunizations to avoid the complications
associated with rubeola.
■ Airborne precautions. Spreads when the infected person sneezes & coughs. Spread by breathing,
touching & placing hands near mouth & nose. Can survive outside the host for hours
★ Roseola
○ Signs and symptoms
■ High fever through 3 days. Fever drops, THEN they develop a rosy pink rash. It develops first on
the neck & chest, then spreads to the rest of the body. Spots (rash) turn white if pressed & they
may have a lighter color ring around them.
■ Discharge instructions
● Use antipyretics to reduce fever. Push fluids to avoid dehydration.
■ Home care / supportive care
● Home care includes fever management, sponging with tepid water, and administration of
acetaminophen or ibuprofen
★ Hand, Foot, and Mouth Disease
, ○ Discharge instructions
○ Education to patient/parents
■ Careful hand hygiene and disposal of tissues
■ Clean surfaces and toys with soap and water, and disinfect with a solution of 1 tablespoon of
bleach to 4 cups of water
■ Give bland foods and drinks because the mouth may be sore; make sure the child is well
hydrated
■ Acetaminophen or ibuprofen for pain and fever
■ Over-the-counter sprays and mouthwashes that contain a local anesthetic to relieve pain in the
mouth
★ Fifth Disease (Erythema infectiosum)
○ Signs and symptoms
■ Flu-like symptoms due to infection of Parvovirus B19. Characteristic “Slapped” red cheeks
appear, then the red spots spread to different body parts. The “lacy” looking rash is usually
not itchy.
○ Transmission
■ Viral
■ Contact precautions
○ Home care
■ Emergency Care
● The disease may trigger a crisis in persons with sickle cell disease. It may also trigger
aplastic crisis in children who are immunodeficient.
■ Home Care
● Acetaminophen or ibuprofen for fever or discomfort; adequate hydration
,★ Conjunctivitis
○ Difference in signs/symptoms of viral vs. bacterial
■ Viral infection: pink or red conjunctiva, edema, watery discharge (Fig. 22–11); may affect only
one eye
■ Bacterial infection: pink or red conjunctiva, edema, purulent discharge, crusted eyelids in the
morning, complaints of itching or pain
○ Treatment options
■ Antibacterial eye drops
○ Administration of eye drops
■ Do not touch the dropper to the actual eye
■ Tilt the head, pull back the lower eyelid
■ Place drops in the pouch that is created
■ Close the eye and gently press the inner corner of the eye
■ Wipe off or dab the extra solution
■ CLEAN YOUR HANDS!!!
★ Mononucleosis
○ Transmission
■ “Kissing disease” Spread through saliva, kissing, and sharing anything children put in their
mouths. May remain infectious for up to a year after an illness.
■ Spread through direct & indirect contact with the nose & throat secretions of the infected child.
Touching items contaminated with infected saliva.
○ Discharge instructions
■ To prevent injury to the spleen, no contact sports for 6 to 8 weeks if the spleen is enlarged.
Examples of contact sports include basketball, football, soccer, rugby, baseball, boxing, ice
hockey, rodeo, wrestling, martial arts, lacrosse, and water polo
■ Rest, with appropriate quiet activities and play
■ Fever management with acetaminophen or ibuprofen
■ Hydration and nutrition
■ Counseling and emotional support for adolescents who must be on bedrest
○ Long-term consequences
■ Splenic rupture, chronic fatigue, jaundice.
, ★ Varicella
○ How many vaccinations are included in the series?
■ 1 dose 12-15 months. Second dose 4-6 years
Varicella (Varivax)
Varicella is a live attenuated virus vaccine.
The minimum age for receiving this immunization is 12 months. Do not give before the first birthday.
The second dose is generally given at 4 to 6 years of age but may be given before age 4 if at least 3 months have
elapsed since the first dose.
Negative side effects include erythema and soreness at the injection site. A few people may experience a varicella-
type rash at the injection site.
Varicella vaccine is contraindicated for persons who are allergic to components of vaccines or have had previous
severe allergic reaction to the vaccines, those with severe immunodeficiency, those who are pregnant, or those
with a family history of altered immunocompetence. Caution should be used in those with recent antibody-
containing blood products or with moderate-to-severe acute illness.
The vaccine should not be given if antiviral drugs have been given in the previous 24 hours, and antiviral drugs
should be avoided 14 days after the varicella immunization (CDC, 2017b).
If a child is taking aspirin for another condition such as Kawasaki disease, then the parents/caregivers should be
educated about the signs and symptoms of Reye syndrome.
○ Signs and symptoms
■ Rash usually first appears on the body, face, & scalp. Then spreads to limbs. A slight
fever may be present before a rash develops. The rash begins as small, red, flat spots that
develop into itchy, fluid-filled blisters. After blister breaks, open sores will crust over to form dry,
brown scabs. Presents as vesicles on macules. (Dewdrops on rose petals).
■ symptoms also include a mild fever, runny nose or nasal congestion, and generalized malaise.
■ Special Considerations: It is possible to get chickenpox twice. The second case is usually mild,
with less fever and few vesicles. Care is the same as for the first case of chickenpox.
A small percentage of people who receive the chickenpox vaccine get chickenpox, but the
disease is mild with fewer lesions. Risk of breakthrough is higher if varicella vaccine is given less
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