Alterations with

Infectious,
Inflammatory, and
Immunologic Response
DIMANGADAP, DISAMBURUN, HADJI SOCOR
NSG124 - EeFf
 1. Allergy
● Allergies occur when your
immune system reacts to a foreign
substance — such as pollen, bee
venom or pet dander — or a food
that doesn't cause a reaction in
most people.
Risk Factors
You might be more likely to develop an allergy if you:

● Have a family history of asthma or allergies, such as hay

fever, hives or eczema
● Are a child
● Have asthma or another allergic condition
Signs and Symptoms
Allergy symptoms, which depend on the substance involved, can
affect your airways, sinuses and nasal passages, skin, and digestive
system. Allergic reactions can range from mild to severe. In some
severe cases, allergies can trigger a life-threatening reaction known as
anaphylaxis.

A food allergy can cause:

• Tingling in the mouth
• Swelling of the lips, tongue, face or throat
• Hives
• Anaphylaxis
Signs and Symptoms
An insect sting allergy can cause:
• A large area of swelling (edema) at the sting site
• Itching or hives all over the body
• Cough, chest tightness, wheezing or shortness of breath
• Anaphylaxis

A drug allergy can cause:

• Hives
• Itchy skin
• Rash
• Facial swelling
• Wheezing
• Anaphylaxis
Signs and Symptoms
Atopic dermatitis, an allergic skin condition also called eczema, can cause skin to:
• Itch, redden, flake or peel

Anaphylaxis
Some types of allergies, including allergies to foods and insect stings, can trigger a severe
reaction known as anaphylaxis. A life-threatening medical emergency, anaphylaxis can cause
you to go into shock. Signs and symptoms of anaphylaxis include:
• Loss of consciousness
• A drop in blood pressure
• Severe shortness of breath
• Skin rash
• Lightheadedness
• A rapid, weak pulse
• Nausea and vomiting
Diagnostic Tests
Your provider might recommend one or both of the following tests.
However, be aware that these allergy tests can be falsely positive or falsely
negative.
● Skin test. Your skin will be pricked with small amounts of the proteins
found in common allergens. If you're allergic, you'll likely develop a
raised bump (hive) at the test location on your skin.
● Blood test. Specific IgE (sIgE) blood testing, commonly called
radioallergosorbent test (RAST) or ImmunoCAP testing, measures the
amount of allergy-causing antibodies in your bloodstream, known as
immunoglobulin E (IgE) antibodies. A blood sample is sent to a medical
laboratory, where it can be tested for evidence of sensitivity to possible
allergens.
Medical Management
● Allergen avoidance.
● Medications. Depending on your allergy, medications can
help reduce your immune system reaction and ease
symptoms.
● Immunotherapy. This treatment involves a series of
injections of purified allergen extracts, usually given over a
period of a few years.
● Emergency epinephrine. If you have a severe allergy, you
might need to carry an emergency epinephrine shot at all
times.
Drug of Choice
● Antihistamines. To treat allergy symptoms.
● Decongestants. Relieve congestion.
● Combination Allergy Drugs. Some allergy drugs contain both an
antihistamine and a decongestant to relieve multiple allergy
symptoms.
● Anticholinergic Nasal Spray. Can reduce runny nose.
● Steroids. Can reduce inflammation associated with allergies.
● Mast Cell Stabilizers. Treat mild to moderate inflammation.
● Immunotherapy. May be one of the most effective forms of
treatment if you suffer from allergies more than 3 months of the
year
Nursing Interventions
● Monitor client’s airway. Assess the client for the sensation of a narrowed airway.
● Monitor the oxygenation status. Monitor oxygen saturation and arterial blood
gas values.
● Focus breathing. Instruct the client to breathe slowly and deeply.
● Positioning. Position the client upright as this position provides oxygenation by
promoting maximum chest expansion and is the position of choice during
respiratory distress.
● Activity. Encourage adequate rest and limit activities to within client’s tolerance.
● Hemodynamic parameters. Monitor the client’s central venous pressure (CVP),
pulmonary artery diastolic pressure (PADP), pulmonary capillary wedge
pressure, and cardiac output/cardiac index.
● Monitor urine output.
Priority Nursing Diagnosis
1. Risk for infection r/t altered immune response
2. Ineffective breathing patter r/t bronchospasm of
allergic response or anaphylaxis
3. Anxiety r/t continuing or uncontrolled allergic
response
 2. Allergic Rhinitis
● It is also called hay fever, is an
allergic reaction that causes
sneezing, congestion, itchy nose
and sore throat.
Risk Factors
● Genetic Predisposition
● Exposure to House Allergens
● Exposure to Smoke
● High Pollen Count
● Occupational Hazards
● Obesity/being overweight
Signs and Symptoms
Hay fever symptoms can appear throughout the year.
• Nasal stuffiness (congestion), sneezing and runny nose.
• Itchy nose, throat and eyes.
• Headaches, sinus pain and dark circles under the eyes.
• Increased mucus in the nose and throat.
• Fatigue and malaise (general feeling of discomfort).
• Sore throat from mucus dripping down the throat (postnasal
drip).
• Wheezing, coughing and trouble breathing.
Diagnostic Tests
There are 2 main allergy tests:
● Skin prick tests - The tester places the allergen on your arm and

pricks the surface of your skin with a needle. This introduces the
allergen to your immune system.
If you're allergic to the substance, a welt (small itchy spot) appears.
● Blood tests - Blood tests check for the immunoglobulin E (IgE)

antibody in your blood. Your immune system produces this

antibody in response to an allergen.
● Other tests - You may need other hospital tests to check for

complications, such as nasal polyps or sinusitis.

Diagnostic Tests
You may need a:
● Nasal endoscopy – your doctor looks inside your nose using an

endoscope (a thin tube with a light and video camera at the end)
nasal inspiratory flow test – your doctor places a small device over
your mouth and nose. They measure the airflow when you breathe in
through your nose
● CT scan – a scan that uses x-rays and a computer to create detailed

images of the inside of the body

Medical Management
The management of allergic rhinitis consists of 3 major
categories of treatment :
(1) environmental control measures and allergen avoidance,
(2) pharmacological management, and
(3) immunotherapy.
Drug of Choice
Several allergy medications can improve symptoms and
help you live with hay fever. These treatments come in
many forms, including liquids, pills, eye drops, nasal sprays
and injections.
● Antihistamines

● Decongestants

● Corticosteroid nasal sprays

● Leukotriene inhibitors

● Immunotherapy
Nursing Management
● Identification of the allergen.
● Use of nasal sprays.
● Encourage thorough cleaning of the house
● Encourage medication compliance
Priority Nursing Diagnosis
1. Ineffective airway clearance r/t obstruction or
presence of thickened secretions
2. Disturbed sleep pattern r/t obstruction of the
nose
3. Self-concept disturbance r/t the condition
 3. Dermatitis
● Dermatitis is a general term that describes a
common skin irritation. It has many causes
and forms and usually involves itchy, dry
skin or a rash. Or it might cause the skin to
blister, ooze, crust or flake off.
● Three common types of this condition are
atopic dermatitis (eczema), seborrheic
dermatitis and contact dermatitis.
Risk Factors
● Age. Dermatitis can occur at any age, but atopic dermatitis (eczema) is
more common in children than adults, and it usually begins in infancy.
● Allergies and asthma. People who have a personal or family history of
eczema, allergies, hay fever or asthma are more likely to develop atopic
dermatitis.
● Occupation. Jobs that put you in contact with certain metals, solvents or
cleaning supplies increase your risk of contact dermatitis. Being a health
care worker is linked to hand eczema.
● Health conditions. Health conditions that put you at increased risk of
seborrheic dermatitis include congestive heart failure, Parkinson's
disease and HIV/AIDS.
Signs and Symptoms
Each type of dermatitis tends to occur on a different part of your
body. Signs and symptoms may include:
● Itchiness (pruritus)

● Dry skin

● Rash on swollen skin that varies in color depending on your skin

color
● Blisters, perhaps with oozing and crusting

● Flaking skin (dandruff)

● Thickened skin

● Bumps in hair follicles

Diagnostic Tests
● Physical Examination and Medical History
● Skin biopsy
● Patch testing
Medical Management
The treatment for dermatitis varies, depending on the cause and your
symptoms. In addition to the lifestyle and home remedies recommendations
below, dermatitis treatment might include one or more of the following:
● Applying to the affected skin corticosteroid creams, gels or ointments
● Applying to the affected skin certain creams or ointments that affect your
immune system (calcineurin inhibitors)
● Exposing the affected area to controlled amounts of natural or artificial light
(phototherapy)
● Using oral corticosteroids (pills) or injectable dupilumab, for severe disease
● Using wet dressings, a medical treatment for severe atopic dermatitis that
involves applying a corticosteroid and wrapping it with wet bandages
Drug of Choice
● Moisturizing creams. Creams that hydrate and help restore the skin
barrier.
● Calcineurin inhibitors. These topical medications decrease inflammation.
● Corticosteroid creams and ointments. Corticosteroids decrease
inflammation.
● Phosphodieterase-4 inhibitors. This also helps with inflammation.
● Biologics. This injection blocks functions of the immune system that
affect dermatitis.
● Oral medications. Pills that reduce immune responses that affect
dermatitis.
● Antihistamines. These are used, sometimes, for contact dermatitis.
● Antibiotics. These can be used for people who have perioral dermatitis.
Nursing Management
● Skin care. Encourage the patient to bathe in warm water using a
mild soap, then air dry the skin and gently pat to dry.
● Apply topical lubricants immediately after bathing. Serves as a
barrier to prevent further drying of the skin through evaporation.
● Avoid contact with the irritants.
● Topical application. These drugs reduce inflammation and
promote the healing of the skin.
● Phototherapy preparation. To promote healing of the skin.
● Acknowledge the patient's feelings.
● Proper hygiene.
Priority Nursing Diagnosis
1. Impaired skin integrity r/t contact with irritants or
allergens
2. Disturbed body image r/t visible skin lesions
3. Risk for infection r/t excoriations and breaks in the skin
 4. Viral exanthems
● A viral exanthem rash is spots,
bumps or blotches on your skin that
accompany a viral infection. It may
or may not be itchy. The rash can
start anywhere on the body, often on
your face or trunk, and then spread.
It may be associated with other virus
symptoms.
Signs and Symptoms
Viral exanthem can start anywhere on your body. Your torso and face are
the most common starting points. Then the rash spreads out from there.

The symptoms of the rash itself can vary from person to person. Rash
symptoms can include:
● Red or pink spots on large portions of your body
● Itchiness — but not all viral exanthem rashes will be itchy
● Blisters
Signs and Symptoms
Your rash will likely be accompanied by all of the other symptoms that
these viruses are known to cause. This can differ from one type of infection
to another. Symptoms that are fairly common for most of the underlying
viral infections include:
● Fever
● Fatigue
● Body aches — especially headaches
● Decreased appetite
● A runny nose
● A sore throat
● For the most part, these symptoms will also last for the entirety of your
infection.
Diagnostic Tests
A healthcare provider can usually diagnose a viral
exanthem rash based on your symptoms. Occasionally,
they may order a blood test or a swab of your nose or
throat to identify the virus.
Medical Management
Treatment aims to ease symptoms of the skin rash and
other virus symptoms. For example, your healthcare
provider might recommend lotions or creams to reduce
itchiness, and acetaminophen or nonsteroidal anti-
inflammatory drugs (NSAIDs) can lower fever and relieve
body aches.

But there’s no treatment or cure for most viruses. You

usually have to wait for the virus to run its course.
Drug of Choice
● Acetaminophen for fever (DO NOT GIVE ASPIRIN)
● Antibiotics for treating bacterial infections.
● Hydrocortisone cream
● Calamine lotion (to relieve itching) Antiviral drugs (for
severe cases)
Nursing Management
● Let the patient increase the fluid intake to prevent dehydration
● Provide rest to the patient
● Cool baths with baking soda or Aveeno to relive skin itching
● Tell the patient not to scratch the blisters as this can lead to
secondary bacterial infections
● Keep the patient's fingernails short to decrease the likelihood of
scratching
● Apply cream or lotion, and administer medications as
prescribed
Priority Nursing Diagnosis
1. Risk for infection r/t presence of infective organism in sibling or
family member
2. Impaired skin integrity r/t rash, pruritus, and scratching
3. Knowledge deficit (learning) r/t disease prognosis, prevention,
and treatment
 5. Rubella
● is an illness caused by the virus RuV. It
causes a rash, low fever and other
symptoms. It’s highly contagious person-
to-person.
● Pregnant people with rubella can pass it
to the fetus, causing hearing and vision
loss, heart defects and other serious
conditions.
● Rubella is preventable by getting
vaccinated.
Signs and Symptoms
Rubella’s prominent symptom is a rash that usually starts on your face and
moves down the rest of your body. In young children, a rash is often their
first symptom. In older children and adults, the rash can appear a few days
after other symptoms start.
Up to 50% of people have no symptoms at all but can still spread rubella to
other people.

Symptoms of rubella include:

● Rash, Low fever, Cough, Sore throat, Runny nose, Headache, Pink
eye,Joint pain, Generally feeling unwell (malaise), Swollen lymph nodes.
Diagnostic Tests
● Blood tests. Your provider will take a sample of blood from your arm
with a small needle. They’ll look for antibodies to rubella, which would
show that you’re either currently sick, have had rubella before or are
vaccinated against rubella.
● Nasal or throat swabs. Your provider will use a soft-tipped stick (swab) to
get a sample from your nose or throat. A lab will test the sample for
signs of rubella.
● Urine tests. You’ll pee in a sterile cup. A lab will test your pee (urine) for
signs of rubella.
Medical Management
● There’s no specific medicine for treating rubella. It usually gets better on
its own. You can treat symptoms at home with over-the-counter
medications. Your healthcare provider may suggest quarantining away
from others to reduce the spread of rubella.
● Most of the time, you can manage the symptoms of rubella at home with
over-the-counter medicines, like acetaminophen (also known as
paracetamol or under the brand names Tylenol or Panadol) or cough
and cold medicines. Ask your healthcare provider about the best way to
treat your symptoms.
● Check with your pediatrician before giving medications to your child for
rubella.
Nursing Management
● Provide rest and quiet environment
● Maintain adequate hydration
● Administer medications as prescribed
● Isolation
Priority Nursing Diagnosis
1. Risk for infection r/t presence of infective organism in sibling or
family member
2. Altered body temperature (fever) r/t systemic infection
3. Fluid volume deficit r/t insensible fluid loss from increased body
temperature
 6. Measles
● Measles an airborne disease caused by a
virus, and it’s very contagious. Symptoms
may develop about eight to 12 days after
you’re exposed. Symptoms can last 10 to
14 days.
● Measles is also called rubeola, 10-day
measles or red measles. It’s not the same as
German measles, or rubella. Measles is
caused by an extremely contagious virus
called morbillivirus.
Risk Factors
● Being unvaccinated. If you haven't had the measles vaccine, you're
much more likely to get measles.
● Traveling internationally. If you travel to countries where measles
is more common, you're at higher risk of catching measles.
● Having a vitamin A deficiency. If you don't have enough vitamin A
in your diet, you're more likely to have more-severe symptoms and
complications of measles.
Signs and Symptoms
The most common symptoms of measles include:
● A high fever.
● Tiredness.
● A barky cough.
● Red or bloodshot eyes (Conjunctivitis)
● A runny nose.
● A red rash, which starts at the head and then spreads downward.

Other symptoms of measles may include:

● A sore throat.
● White spots in the mouth (Koplik's Spots)
● Muscle pain.
● Sensitivity to light (light makes your eyes hurt).
Diagnostic Tests
Your healthcare provider will probably be able to diagnose measles
by examining you. However, they may order laboratory tests to find
the virus in samples of:

● Blood.
● Secretions from your nose and throat.
● Urine (pee)
Medical Management
There’s no cure for measles. The virus must run its course, which
usually takes about 10 to 14 days. You can do some things that might
make you feel better, such as:

● Taking acetaminophen or ibuprofen for aches, pains or fever.

● Getting plenty of rest.
● Drinking enough fluids.
● Gargling with salt water.
● Avoiding harsh light if your eyes hurt.
Nursing Management
● Isolation. To decrease transmission within the community.
● Skin care.
● Eye care.
● Hydration. Encourage oral hydration; medical literature
encourages the use of oral rehydration solution.
● Temperature control.

Note: Be sure to remind parents not to administer aspirin due to the

risk of Reye’s syndrome.
Priority Nursing Diagnosis
1. Risk for impaired skin integrity r/t raking pruritus
2. High risk of infection r/t the host and infectious agents
3. Acute pain r/t skin lesions and irritated mucous
membranes
 7. Herpes zoster
● Herpes zoster is commonly known
as shingles. It is a viral disease caused
by reactivation of varicella-zoster
virus which remains dormant in the
sensory ganglia of the cranial nerve
or the dorsal root ganglia after a
previous varicella infection.
 Causes/Etiology
Upon reactivation, the virus replicates in neuronal cell bodies, and
●
virions shed from the cells which are carried down the nerve to the area
of skin innervated by that ganglion. In the skin, the virus causes local
inflammation and blistering. The pain caused by zoster is due to
inflammation of affected nerves with the virus.
Triggers for herpes zoster include:
• Emotional stress
• Use of medications (immuno suppressants)
• Acute or chronic illness
• Exposure to the virus
• Presence of a malignancy
Signs and Symptoms
Early symptoms of shingles may include:
• Fever.
• Chills.
• Headache.
• Feeling tired.
• Sensitivity to light.
• Stomach upset.
Other signs and symptoms that appear a few days after the early symptoms include:
• An itching, tingling or burning feeling in an area of your skin.
• Redness on your skin in the affected area.
• Raised rash in a small area of your skin.
• Fluid-filled blisters that break open then scab over.
• Mild to severe pain in the area of skin affected.
Diagnostic Tests
● Tzanck smear and electron microscope (EM
● Polymerase chain reaction (PCR), direct immunofluorescence
assay (DFA), skin biopsy, and viral culture
● PCR
● DFA
Medical Management
● Antiviral therapy
● Corticosteroids
● Isolation of patient and local management of skin
lesions
Drug of Choice

● Valacyclovir
● Acyclovir
● Valtrex
● Famciclovir
● Prednisone
● Zovirax
Nursing Management
● Assess pain level
● Apply cool moist dressings to lesions while in vesicle stage. Discontinue
once lesions begin to crust.
● Administer medications and apply topical steroids, antihistamines and
analgesics as necessary
● Assess for signs / symptoms of bacterial infections on skin and obtain
culture and sensitivity test as indicated
● Initiate contact precautions
● Wear and encourage visitors to wear appropriate PPE
● Limit visitors, especially those who may be at high risk (elderly, pregnant,
infants, anyone who has not had chickenpox or chickenpox vaccine)
● Assess for changes in vision and rash on forehead or nose
Priority Nursing Diagnosis

1. Deficient Knowledge
2. Risk for Infection
3. Risk for Disturbed Body Image
 8. Chickenpox
● Chickenpox is an infection caused by
the varicella-zoster virus. It causes an
itchy rash with small, fluid-filled
blisters. Chickenpox is highly
contagious to people who haven't
had the disease or been vaccinated
against it.
Causes/Etiology
Varicella-zoster virus (VZV) causes the chickenpox infection.
Most cases occur through contact with an infected person. The
virus is contagious to those around you for one to two days
before your blisters appear.

VZV remains contagious until all blisters have crusted over. The
virus can spread through:
• Saliva

• Coughing

• Sneezing

• Contact with fluid from the blisters

 Signs and Symptoms
● Itchy blister rash
● Fever
● Loss of appetite
● Headache
● Tiredness and a general feeling of being unwell (malaise)

Once the chickenpox rash appears, it goes through three phases:

• Raised pink or red bumps (papules), which break out over several days
• Small fluid-filled blisters (vesicles), which form in about one day and then
break and leak
• Crusts and scabs, which cover the broken blisters and take several more days
to heal
 Diagnostic Tests
● Polymerase chain reaction (PCR) testing.
● IgM testing
● Paired acute and convalescent sera
● Blood testing.
● Tzanck smear.
● Immunohistochemical staining.
● Viral Culture
 Medical Management
• Bed rest
• Drinking extra fluids (to avoid dehydration)
• Paracetamol to bring down the fever
• Lukewarm baths with baking soda or oatmeal added to the water
• Ceeams or lotions
• Avoidance of salty or citrus foods
• Wearing mittens to prevent scratching
Drug of Choice
● Acyclovir
● Loratadine
● Tecovirimat
 Nursing Management
• Educate parents about the importance and safety of the Varicella Zoster
vaccine.
• Manage pruritus in patients with varicella with cool compresses and
regular bathing; warm soaks and oatmeal or cornstarch baths may
reduce itching and provide comfort.
• Trimming the child’s fingernails and having the child wear mittens while
sleeping may reduce scratching.
• Advise parents to provide a full and unrestricted diet to the child; some
children with varicella have reduced appetite and should be encouraged
to take sufficient fluids to maintain hydration.
 Priority Nursing Diagnosis

1. Hyperthermia r/t viral infection.

2. Impaired skin integrity r/t mechanical factors (eg
stress, tear, friction).
3. Disturbed body image r/t lesions on the skin.
 9. Smallpox
● Small Poxis an acute contagious
disease caused by the variola virus, a
member of the orthopoxvirus family.
It was one of the most devastating
diseases known to humanity and
caused millions of deaths before it
was eradicated.
Causes/Etiology
● Smallpox is a member of the viral family poxvirus, genus
orthopoxvirus, and species variola virus. Poxviruses are the
largest of the human viral pathogens and have a brick-
shaped appearance on electron microscopy. Variola virus
measures approximately 300 nm to 350 nm long. The
poxviruses possess a linear, double-stranded DNA genome,
and are unique in that their genetic makeup encodes all the
proteins necessary for replication allowing them to replicate
in the host cell cytoplasm.
Signs and Symptoms
● The first symptoms of smallpox usually appear 12 to 14 days after you're
exposed to the smallpox virus. However, the virus can be in your body
from 7 to 19 days before you look or feel sick. This time is called the
incubation period.
After the incubation period, sudden flu-like symptoms occur. These include:
• Fever
• Muscle aches
• Headache
• Severe fatigue
• Severe back pain
• Vomiting, sometimes
Diagnostic Tests

● Polymerase Chain Reaction (PCR)

● Electron Microscopy
● Serologic Tests
Medical Management
● Isolation of the patient
● Monitoring and maintaining fluid and electrolyte
balance,
● Skincare
● Monitoring for and treatment of complications
Drug of Choice
● Tecovirimat (TPOXX)
● Brincidofovir (TEMBEXA)
● Cidofovir
 Nursing Management
● Place infected person immediately into strict isolation. Keep patient infected
in isolation for 17 days or until the scabs fall off. Practice strict infection control
measures while caring for the patient.
● Quarantine anyone who has come into contact with the infected person for
up to 17 days prior to the onset of that infected person’s illness.
● Provide eye care.
● Promote good oral hygiene.
● Replace fluid lost from fever and skin breakdown
● Give diet as tolerated. Maintain adequate hydration and nutrition, although
eating and drinking are difficult due to the painful pustules that sometimes form
in the mouth and oropharynx
 Nursing Management
● Keep external lesions clean and dry.
● Incinerate or decontaminate chemically all contaminated instruments,
surfaces, excretions, fluids, and other. Clothing and bedding should be
incinerated, autoclaved, or washed in hot water and hypochlorite bleach.
● Administer antibiotics as ordered for secondary skin infections.
● Severe cases may require sedatives, I.V fluid, oxygen, blood
transfusion. Intravenous fluids may be needed to prevent dehydration
and antipyretic medications can be used to control fever.
Priority Nursing Diagnosis
1. Impaired skin integrity r/ttrauma
2. Pain r/t damage to the skin / tissue
3. Risk for infection r/t skin damage protection
 10. Fifth disease
● Fifth disease is a viral illness that most kids
recover from quickly and without problems. It's
especially common in kids ages 5 to 15.
● Fifth disease is known for a rash that makes
a child’s cheeks bright red. That’s why it’s
sometimes called a "slapped cheek" rash. A few
days later, the rash spreads down to the trunk,
arms, and legs. It usually lasts 1 to 3 weeks.
Causes/Etiology

● Fifth disease is a mild rash illness caused by

parvovirus B19. It is more common in children
than adults. A person usually gets sick with fifth
disease within 14 days after getting infected with
parvovirus B19.
Signs and Symptoms

● Fever
● Runny nose
● Headache
● Rash
● painful or swollen joints
● rashes on your face and body
Diagnostic Tests

● Blood test
 Medical Management
● There is no treatment for fifth disease. The virus will clear up on its own in a
couple of weeks. If your child has joint pain or an itchy rash, talk with your child's
provider about ways to ease symptoms. Acetaminophen (such as Tylenol) for
children can help relieve joint pain.
● If the rash itches, an antihistamine can be used. For those with joint pain,
especially in adults, anti-inflammatory pain relievers such as ibuprofen can be
helpful.
● Your child’s healthcare provider may recommend over-the-counter (OTC)
pain relievers that can treat fever, headaches and joint pain. These medicines
include: Acetaminophen. Nonsteroidal anti-inflammatory drugs (NSAIDs), such
as ibuprofen or naproxen.
Drug of Choice

● Acetaminophen
● Ibuprofen
● Naproxen
 Nursing Management
• Ensure adequate fluid intake and encourage rest.
• Encourage frequent hand washing.
• Administer Acetaminophen (Tylenol) to decrease body temperature.
Aspirin (acetylsalicylic acid) is not recommended as it is related to
the occurrence of Reye’ syndrome.
• Droplet precautions should be implemented if the child is
hospitalized. (wearing mask,gloves, eyewear, spacing client in single
room)
• Intravenous immunoglobulin therapy may be required for chronic
anemia in patients who are immunocompromised.
 Nursing Management
• For an acute aplastic crisis, supplemental oxygen and blood
transfusions may be necessary.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may be given to
relieve fever, malaise, headache, and arthralgia, along with topical
antipruritics and antihistamines (which also relieve pruritus) as
ordered.
• Avoid contact to pregnant women. Parvovirus B19 is teratogenic. It
causes severe anemia with congestive heart failure to the fetus.
• Inform parents that child may resume school as soon as the rash
appears. (the disease is no longer contagious at this time
 11. Polio Infection
● Polio is a disabling and life
threatening disease caused by the
poliovirus. The virus spreads
from person to person and can
infect a person's spinal cord,
causing paralysis (can't move
parts of the body).
 Causes/Etiology
● Polio is caused by 1 of 3 types of the poliovirus. It often spreads due
to contact with infected feces. This often happens from poor
handwashing. It can also happen from eating or drinking
contaminated food or water. It can also be spread when an infected
person coughs or sneezes infected droplets into the air. Those with
the virus can excrete the virus in their stool for several weeks. People
are most contagious right before symptoms start and soon after they
appear.
 Signs and Symptoms
● Non-paralytic polio - can last one to 10 days.
- Fever; sore throat; headache; vomiting; fatigue; meningitis

● Paralytic polio
- Loss of reflexes, severe spasms and muscle pain; loose and
floppy limbs, sometimes on just one side of the body; sudden
paralysis, temporary or permanent; deformed limbs, especially
the hips, ankles, and feet
● Post-polio syndrome
- continuing muscle and joint weakness
- muscle pain that gets worse
- becoming easily exhausted or fatigued
- muscle wasting, also called muscle atrophy
- trouble breathing and swallowing
- sleep apnea, or sleep-related breathing problems
- low tolerance of cold temperatures
- new onset of weakness in previously uninvolved muscles
- depression
- trouble with concentration and memory
 Diagnostic Tests
● Poliovirus can be detected in specimens from the throat, feces (stool),
and occasionally cerebrospinal fluid (CSF) by isolating the virus in cell
culture or by detecting the virus by polymerase chain reaction (PCR).
● CDC laboratories conduct testing for poliovirus, including:
- Culture
- Intratypic differentiation
- Genome sequencing
- Serology
● Virus Isolation and Detection
● Serologic Testing
● Cerebrospinal Fluid Analysis
 Medical Management
• You might be able to improve your symptoms
• Drinking fluids (such as water, juice and broth)
• Using heat packs to help muscle aches
• Taking pain relievers, such as ibuprofen
• Doing physical therapy and any exercise recommended by your healthcare
provider.
• Getting plenty of rest.
• Hot moist packs to control muscle pain and spasms
• Portable ventilators to help with breathing
• Physical therapy exercises to prevent bone deformity and loss of muscle
function
• Splints or other devices to encourage good position, or alignment, of the
spine and limbs
Drug of Choice
● IPV vaccine for polio IPV
● OPV vaccine for polio OPV
● Ibuprofen
 Nursing Management
● Maintain a patent airway, and keep a tracheotomy tray at the
patient’s bed side.
● Encourage a return to mild activity as soon as possible.

● Prevent fecal impaction by giving enough fluids to ensure an

adequate daily urine output of low specific gravity.

● Provide tube feedings when needed.

● Provide good skin care, reposition the patient often, and keep

bed linens dry.

● To alleviate discomforts, use foam rubber pads and sandbags or

light splints as ordered.

● Wash hands thoroughly after contact with the patient or any
of his secretions and excretions.
● Frequently check blood pressure, especially if the patient

has bulbar poliomyelitis.

● Assess bladder retention that cause muscle paralysis.

● Have the patient wear high-top sneakers or use a footboard

to prevent foot drop.

● Provide emotional support to the patient and his family.
 Priority Nursing Diagnosis
1. Imbalanced Nutrition: Less Than Body Requirements
related to anorexia, nausea and vomiting
2. Ineffective Thermoregulation related to the infection
process
3. Ineffective Airway Clearance related to muscle paralysis
 12. Mumps
● An illness caused by a virus. It
usually affects the glands on each
side of the face. These glands,
called parotid glands, make saliva.
Swollen glands may be tender or
painful.
Causes/Etiology
● Causative agent: Mumps virus (paramyxovirus)
● Incubation period: usually 16 to 18 days with an outside range
from 12 to 25 days
● Period of communicability: communicable for 5 days from onset
of the swollen parotid gland
● Mode of transmission: direct contact with respiratory droplets
● Immunity: Contracting the disease gives lasting natural immunity.
● Active artificial immunity: attenuated live mumps vaccine in
combination with measles and rubella (MMR)
● Passive artificial immunity: mumps immune globulin
Signs and Symptoms
● Fever
● Headache
● Anorexia
● Malaise
● Parotid gland enlargement
● Inability to open mouth (trismus)
● Testicular pain and swelling (orchitis)
Diagnostic Tests
● RT-PCR
● IgM serology
Medical Management
● Pain Control
● Fever Control
● Soft bland diet
● If a child is hospitalized, follow droplet precautions in
addition to standard infection precautions.
● Bed rest, scrotal support, and ice packs are
recommended.
● Applying a warm or cool compress to the swollen glands
Drug of Choice
Acetaminophen or NSAID
Surgical Management
None
Nursing Management
● Provide analgesics and apply warm or cool compresses to the neck
area to relieve pain
● Give antibiotics and tepid sponge bath for fever
● Increase fluid intake to prevent dehydration
● Provide a high calorie, nutritionally rich soft or liquid food
frequently
● Avoid spicy, sour food that stimulate salivation or require the act
of chewing
● Measure body weight daily
● Closely observe for complications
Priority Nursing Diagnosis
1. Hyperthermia r/t inflammatory process
2. Risk for deficient fluid volume r/t disease
condition such as swelling and difficulty in
swallowing
3. Acute pain r/t inflammatory process
 13. Tetanus (Lockjaw)
● A serious disease of the
nervous system caused by a
toxin-producing bacterium.
Causes/Etiology
● Causative agent: Clostridium tetani
● Incubation period: 3 days to 3 weeks
● Period of communicability: none
● Mode of transmission: direct or indirect contamination of a closed
wound
● Immunity: development of the disease gives lasting natural
immunity
● Active artificial immunity: tetanus toxoid contained in DTaP
vaccine
● Passive artificial immunity: TIG
Signs and Symptoms
● First symptoms: stiffness of neck and jaw (lockjaw)
● Within 24 to 48 hours, muscular rigidity of the trunk and
extremities develops.
● Back becomes arched (opisthotonos), stiff and board-like
abdominal muscles.
● The face assumes an unusual appearance, with wrinkling of
the forehead and distortion of the corners of the mouth (a
“sardonic grin” sign)
● Any stimulation, such as a sudden noise, a bright light, or a
touch, causes painful, paroxysmal spasms
Diagnostic Tests
There are no hospital lab tests that can confirm tetanus.
● Physical exam

● Medical and vaccination history

● Signs and symptoms of muscle spasms, muscle rigidity and

pain.
Medical Management
● A quiet, stimulation-free room with total parenteral nutrition,
sedation, and a muscle relaxant
● Debridement of wound filled with necrotic tissue
● First line of treatment: Human tetanus immune globulin
(TIG) with parenteral penicillin G or oral or intravenous
metronidazole (Flagyl) administration.
● May need to be intubated and begin mechanical ventilation
Drug of Choice
Penicillin G or Metronadizole
Surgical Management
Wound debridement
Nursing Management
● Assess the type of wound and provide appropriate wound care.
● Evaluate the immunization status of the patient.
● Assess need for administering TIG for prophylaxis.
● Clear the airway by adjusting the position of head extension.
Priority Nursing Diagnosis
1. Ineffective Airway Clearance r/t accumulation of
secretions result of damage to the muscles of swallowing
2. Ineffective Tissue Perfusion r/t damage to transport
oxygen through the alveolar and capillary membranes
3. Imbalanced Nutrition: Less Than Body Requirements
r/t decreased swallowing reflexes, less intake
 14. Diphtheria
● A serious infection caused by
strains of bacteria that make
toxin. It usually affects the
mucous membranes of the
nose and throat which can
lead to difficulty breathing,
heart rhythm problems, and
even death.
Causes/Etiology
● Causative agent: Corynebacterium diphtheriae (Klebs–Löffler bacillus)
● Incubation period: 2 to 5 days with a range of 1 to 10 days
● Period of communicability: In untreated persons, the organism is
contagious from nares, throat, skin, and eyes for 2 to 6 weeks following
infection; 48 hours after initiation of antibiotics in treated children and
adults.
● Mode of transmission: direct contact or indirect contact droplets
● Immunity: Contracting the disease gives lasting natural immunity.
● Active artificial immunity: diphtheria toxin given as part of diphtheria,
tetanus, and pertussis (DTaP) vaccine
● Passive artificial immunity: diphtheria antitoxin
Signs and Symptoms
● A thick, gray membrane covering the throat and tonsils
● Sore throat and hoarseness
● Swollen glands (enlarged lymph nodes) in the neck
● Difficulty breathing or rapid breathing
● Purulent nasal discharge
● Brassy cough
● Skin lesions
Diagnostic Tests
Swab sample from the back of your throat or from a sore
Medical Management
● Single dose of equine antitoxin
● IV Administration of Penicillin or Erythromycin
● Complete bed rest
● Droplet precautions must be followed until cultures are
negative
● Careful observation of the children
● If obstruction occurs, endotracheal intubation may be
necessary.
Drug of Choice
Antibiotics (Penicillin or Erythromycin)
Surgical Management
None
Nursing Management
● Assessment of a client with diphtheria include: history and
physical examination.
● Improve thermoregulation
● Improve caloric intake
● Improve airway clearance
Priority Nursing Diagnosis
1. Hyperthermia r/t the release of an exotoxin
2. Imbalanced nutrition: less than body requirements r/t
painful swallowing
3. Ineffective airway clearance r/t pseudomembrane
blocking the airway
 15. Pertussis (Whooping Cough)
● A serious bacterial infection
of the lungs and breathing
tubes that spreads easily.
Pertussis begins like a cold
but develops into severe
coughing and gasping for air.
Causes/Etiology
● Causative agent: Bordetella pertussis
● Incubation period: 5 to 21 days
● Mode of transmission: highly contagious by direct or indirect contact
● Period of communicability: greatest in catarrhal (respiratory illness)
stage; eliminates contagiousness within 5 to 7 days of treatment, but it
continues for weeks in the untreated patient
● Immunity: contracting the disease offers lasting natural immunity
● Active artificial immunity: pertussis vaccine given as part of DTaP
vaccine
● Passive artificial immunity: pertussis immune serum globulin
Signs and Symptoms
● Primarily manifest as a mild rhinitis with a mild cough to
persistent cough illness or to the classic pertussis disease.

Classic pertussis manifests itself in three steps: the catarrhal

stage, the paroxysmal stage, and the convalescent stage.
● CATARRHAL STAGE: Begins with upper respiratory

symptoms such as coryza, sneezing, lacrimation, cough, and a

low-grade fever, symptoms subtle enough they may at first be
mistaken for those of a common cold. This first period lasts
1 to 2 weeks.
Signs and Symptoms
● PAROXYSMAL STAGE: Cough changes from mild one to
paroxysmal, involving 5 to 10 short, rapid coughs; rapid
inspiration which causes the hallmark “whoop” or high-
pitched crowing sound of whooping cough; obvious distress
while coughing; cyanotic or red faced; thick, tenacious mucus,
vomiting after a paroxysm of coughing and exhaustion
afterwards. Lasts from 2 to 6 weeks.
● CONVALESCENT STAGE: Gradual cessation of coughing
and vomiting
Diagnostic Tests
Culture, direct fluorescent antibody (DFA) testing, polymerase
chain reactions (PCR), and serology
Medical Management
● Hospital admission for at least 48 hours for monitoring;
oxygen administration if pertussis is severe
● Keep children away from environmental factors (cigarette
smoke and dust) and avoid strenuous activities
● Frequent small meals
● A full 10-day course of erythromycin or azithromycin
● Droplet precautions
● Intercom placement
Drug of Choice
Erythromycin, Azithromycin
Surgical Management
None
Nursing Management
● Maintaining patent airway is always the first priority.
● Auscultate lungs for presence of normal or adventitious breath
sounds.
● Assess respirations, note quality, rate, pattern, depth, flaring of
nostrils, dyspnea on exertion, evidence of splinting, use of
accessory muscles, and position for breathing
● Educate about coughing and breathing
● Promote effective coughing
● Educate about proper positioning
● Encourage increase in oral fluid
● Provide chest physiotherapy
Priority Nursing Diagnosis
1. Ineffective airway clearance related to copious and
tenacious bronchial secretions
2. Impaired breathing pattern related to decreased airway
patency
 16. Parasitic Infection
● Parasites are organisms that live on
and obtain their food supply from
other organisms. Although many of
these can cause illness, ones
frequently associated with children
include head lice and scabies.
Parents are often embarrassed when
they learn their child has one of
these illnesses.
 Pediculosis Capitis
● ORGANISM: Head lice
● SYMPTOMS: Small, white flecks on hair shaft (nits
or eggs of lice); extreme pruritus
● TREATMENT:
- Wash hair with one of several approved products,
starting with an over-the-counter permethrin-based or
pyrethrin-based shampoo and comb nits from hair with
fine-toothed comb.
- Wash bed sheets and recently worn clothes; vacuum
pillows, mattresses, or other items unable to be washed.
- Teach children not to exchange combs, hair barrettes,
or other personal items.
 Pediculosis
● ORGANISM: Pubic lice
● SYMPTOMS: Small, white flecks on pubic hair
shaft (nits or eggs of lice); extreme pruritus
● TREATMENT:
- Wash hair with one of several approved products,
starting with an over-the-counter permethrin-based or
pyrethrin-based shampoo and comb nits from hair
with fine-toothed comb.
- Wash bed sheets and recently worn clothes; vacuum
pillows, mattresses, or other items unable to be
washed.
- Teach children not to exchange combs, hair
barrettes, or other personal items.
 Scabies
● ORGANISM: Female mite (Acarus scabei)
● SYMPTOMS: Black burrow filled with mite
feces 1–2 in. long, usually between fingers and
toes, on palms, or in axilla or groin
● TREATMENT:
- Caution that adolescent groin infestations might
be spread by physical intimacy.
- Topical permethrin 5% cream is the drug of
choice with two doses of oral ivermectin (off-
label use) 1 week apart, also being an effective
drug
Thank you
for listening!
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