Preventing Communicable Disorders: Immunization and Care Guide
School
Hartwick College**We aren't endorsed by this school
Course
NURS 357
Subject
Nursing
Date
Dec 11, 2024
Pages
9
Uploaded by awetselscs
Communicable Disorders Worksheet:1.review ways to prevent communicable disorders-vaccinate-hygiene with regular handwashing-safe food practices-traveling precautions-safe sex practices-avoid contact with the sick2.review immunization schedules for children (DTaP / TdaP, HIB, IPV, MMR, HAV, HBV, varicella, HPV, pneumococcal, meningococcal, influenza, rotovirus…)-see chart-3.describe 2 situations in which the nurse would hold the immunization-medical contraindication (allergy or medical condition)-illness (acute)- because they will not amount a good immune response-acute illness-lack of consent-parent is not ready- always discuss it with a parent-immunodeficiency-moderate to severe illness-regulatory restrictions- legal or institutional restrictions on administering vaccinations without proper authorization4.identify potential adverse effects of immunizations and instructions to the parents (including routine and concerning adverse effects and home treatment)routine/adverse effects:-fever- usually starting within 24 hours and lasts 1-2 days-swelling, redness, tenderness at injection site-mild pain/soreness where shot was given-fussiness/drowsiness in babies-cellulitis (infection)-slight rash 7-14 days after chickenpox or MMR vaccinesdo not want responses a couple weeks out!instructions to parents-give extra fluids-apply a cool damp cloth or ice pack wrapped in a dry cloth to injection site for 10-20 mins-gently massage injection site 3 or more times in a day?-For pain/redness- apply heating pad or warm washcloth for 10 minutes-For fevers above 102, acetaminophen (or ibuprofen depending on age)Contact HCP if:-Signs of severe allergic reaction occur-High grade fever-Seizures
-Unusual behavior changes and/or unresponsiveness5.the RN is to administer Gardasil and notices that the solution is cloudy. Is that typical?-Yes. After agitation, Gardasil should appear as a white cloudy liquid. Prior to agitation, Gardasil 9 may appear as a clear liquid with a white precipitate, after thoroughly shaking should become a cloudy white suspension.6.a 6 yo from the Dominican Republic comes to the clinic for his first immunization in several years. The aunt recalls that he previously had 1-2 tetanus shots. Describe the schedule. FOLLOW THE CDC Catchup Schedule!-administer one dose of DTaP nowoschedule next dose 4 weeks lateroplan for 3rddose 6 months after 2nddose7.review IM, sc, intradermal injection technique. Review atraumatic methods when administering immunizations. Review safety and infection control issues related to immunization administration.IM:-common sites include deltoid muscle for adults, vastus lateralis for infants and children (until 1 year of age)-shot blockers-inject at 90-degree angle-z track technique can be used for irritating medicationsSQ-common sites include upper arm, abdomen, thigh-pinch skin, inject at 45–90-degree angle-rotate injection sitesIntradermal:-common site is inner forearm-should form a small wheal/bleb under skin-do not massage site after injectionAtraumatic methods:-positioning and comfortohold infants and young children in an upright position, like parents lap in bear hug holdoavoid placing children in supine positionoallow older children to sit up or choos3e a position that’s most comfortable for them-pain managementouse topical anesthetics oconsider using the buzzy deviceofor infants, consider using sucrose solution or breastfeeding during vaccination-distractionoengage children in age-appropriate distraction techniques-injection techniqueouse appropriate size of needle and length based on patient’s age and sizeoinject quickly without aspiration
oconsider z track method for IM injections to minimize irritation-parent involvementoencourage parents to hold and comfort child during vaccinationoteach parents to use distraction methods or deep breathing-psychologicaloPrepare the child in advance by explaining the procedure in age-appropriate termsoUse neutral languageoAllow children to ask questions and address their concernsoAvoid excessive restraints-EnvironmentoCreate it calm, comfortableSafety and Infection Control Issues:-Improper storage and handling-Not rotating stock, not discarding expired vaccines-Lack of documentation-Improper administration-Improper infection control issues improper handling/disposal-Unsafe injection practices (pre-filling syringe ahead of time, combining vaccines from two or more vials to create a dose, recapping needles, not discarding needles immediately after use)-Not using aseptic technique-Not using proper vaccine amount8.the RN is caring for an adolescent who immigrated to the US and reports that she had a BCG immunization in her country. Is this significant information? What does it mean? -BCG (bacile claimant guraren) is an immunization against tb-Significant yes can lead to a positive TB test9.the school RN is doing a head lice check. a.how is this done?-Examines the hair and scalp-Huge mirror with lights-Use a fine-toothed comb to help detect lice and nits-Consider wetting hair before combing can be helpful in diagnosing-Can also use wooden stick to move/push around hairb.describe the appearance of the adult and egg-egg is oval white c.describe the common scalp locations of head lice-behind the ears-at the nape of the neck -near the scalpd.describe the CMs, & method of transmission-pruitis (severe)-hypersensitivity-method of transmission: head-to-head contact- mainly through playocrawls from one head to another
osharing hair brushes, combs, hats, towels, e.consider the effect of gender or race on risk of acquiring lice-girls, young white at more risk-African americans have less risk-More common in females, longer hair, more sharing of thingsf.what does the nurse teach parents about the treatment?-Use pediculicidal agentsoPermethrin is tx of choice- otc drug- kills adult head lice but is not ovicidal (does not kill nits)oOne treatment every 7 days-Nits should be removed from wet hair with a nit comboCaregivers should section off areas of hair and remove nits section by sectionoMust go through child’s hair nightlyg.Describe teaching about treating the home environment and care of the family pet-Machine wash clothing/bed linens and other washabale items in hot water; let them dry on high heat at least 20 minutes-Boil combs in hot water-Hot wash/hot dry clothingoFor nonwashable items (Stuffed animals)- put them in a plastic bag for 72 hours-Vacuum floors, carpets, and furniture-Soak combs/hair ties/brushes/ other hair accessories in hot water for 5-10 minutes-Teach children that pets do not carry or spread human head licedo not need to worry about their pets getting lice from them!h.What are the psychosocial considerations?-Emphasize to children that getting lice doesn’t mean someone is dirty or did anythingwrong-Nothing to be embarrassed about-Bullied-Social isolation-itchiness-Use simple languagei.What does the nurse discuss with the class about decreasing the spread?-Do not share hats/ brushes/ hair ties-Avoid head-to-head contact-Encourage kids to keep some space between their heads when playing/sitting together-Don’t share personal items-Keep belongings separate-Don’t touch or play with other people’s hair-Tell an adult if your head is itchy!-Keep long hair tied back10.what is the significance of the incubation period and period of communicability?Incubation period: the time you get the infection with onset of symptoms.
-disease surveillance- knowing incubation period helps in identifying potential infection sources and tracing contacts during an outbreak-duration of quarantine- incubation period informs the appropriate length of quarantine for exposed individuals-prognosis insights- incubation period provides clues about disease severity and expected duration of said illness-treatment strategies- can help inform potential approaches of tx-pathogen characteristics- incubation period reflects pathogen growth, replication rate,toxin excretion, which offers insight into the etiology of said diseaseperiod of communicability:-transmission control- knowing when an infected person is capable of spreading the disease is crucial for implementing effective isolation measures-contract tracing- determined timeframe for identifying contacts that could be exposedto individual-asymptomatic spread- if infectious period begins BEFORE symptom onset, it alerts health officials to the possibility of transmission from asymptomatic carriers-infection prevention in healthcare settings- informing healthcare workers dealing with infectious patients and informing them of protocol-models the spread of disease. 11. Scenario: the school nurse in a day care center. A child comes in with a lesion on her trunk. The RN suspects varicella. a.what causes varicella?-Caused by varicella-zoster virus (VZV)-Highly contagious, spreads easily from person to person-Transmitted through respiratory dropletsoWhen infected person coughs or sneezesoWeeping lesionsoNasopharyngeal secretions-Can also spread through direct contact with fluid from chickenpox blistersb.What are the clinical manifestations?-Malaise-Fever-Headache for 24-28 hours before eruption of lesions-Lesion begins as an erythematous macule and progresses to a pustule and finally a clear fluid-filled vesicle (fluid is VERY CONTAGIOUS!)-Severe pruritus c.What are the possible complications?-Shingles-REYES SYNDROME- with Tx of ASPARIN-Secondary bacterial infection of lesions with s. aureus and group a beta-hemolytic streptococcus-Cellulitis-Ammonia-sepsis-Varicella pneumonia-Meningitis
-Arthritis-Hepatitis-Cerellular ataxiad.What instructions would the RN give to the parents?-Watch for signs and symptoms of secondary infection of varicella lesions-Explain signs and symptoms of complications, when to contact HCP-Discuss prevention through immunization-Managing illness and preventing its spreadoRest and comfort- encourage PLENTY of rest for child, loose-fitting cool clothingoManage fever by monitoring temperature regularlyoUse acetaminophen for fever reductionoOffer lots of fluidsoSkin care- trim fingernails to minimize itchingApply calamine lotion, colloidal oatmeal bathsAntihistaminesoNutrition:Offer soft bland foodsoIsolate child at homeoEncourage frequent handwashingoRegularly clean and disinfect commonly touched surfaces.e.What are the concerns if an immunocompromised individual is exposed to this child?-Having the potential for antiviral resistance-Risk of reactivation as shingles later in life-Increased risk of severe infectionoImmunocompromised patients are at high risk for developing severe infections & complicationsoCan experience more prolonged/severe illness compared to immunocompetent individuals-Visceral disseminationoRisk of VZV infection spreading to internal organs, leading to pneumonia, hepatitis, encephalitis, and disseminated intravascular coagulopathy-Prolonged viral sheddingoMay shed virus for longer periods increasing risk of transmission to others-Reduced vaccine efficacy—leaving people vulnerable to infection-Higher risk of ammonia encephalitis, cellulitis, and more. Puts them at risk for OTHER OPPORTUNISTIC INFECTIONSf.Can this RN ‘catch’ varicella from the child?-Yes- transmission risk is high. Can be transmitted through blisters or respiratory droplets. Vaccine is highly effective but not 100% protective.-If RN had chicken poxlays dormant, protects them.-At risk for SHINGLES later in life. g.Many of the children in the center have had the vaccine. Parents want to know if their children can ‘catch’ this?
-There is the potential for children to catch varicella, even with having the vaccine-Not 100% protective-Researched- about 15-20% of people who have received one dose for varicella vaccine still may get chickenpox if exposedoBreakthrough cases are usually very mild, fewer than 50 spots or bumpsoBreakthrough infection rate for two-dose recipients lower than one-dose recipients. h.One of the children in the center just had her Varivax booster vaccine 4 days ago.Can she get a rash? -A vaccine associated rash will start to typically appear at least 5 days after a vaccination. Individual responses can vary, and if a rash does appear it is generally mild and self-limiting-IT CAN HAPPEN12.a college student develops sign and symptoms of rubeola (Measles)a.what are these signs and symptoms?-Mucolopapillar rash-Colic spots (whitish looking spots)-Swollen lymph nodes-Fever-malaiseb.What is the treatment?-Vitamin A-Supportive care-c.What are potential complications?-Encephalitis-Otitis-Pneumonia-Laryngitis-d.What instructions should the RN include in teaching?-No asparin-Vitamin a as needede.How could he have gotten this, since he had his 2 MMRs?-Contact droplet precautions-Can happenf.How is rubeola transmitted? And who / which populations are the likely cause ofrubeola transmission ?-Contact and droplet-Lots of spread is because of immunocompromised that have not taken shot or those that do not want the shot!13.review the following disorders (including causative organism, method of transmission, incubation, communicability, clinical manifestations, treatment and nursing care – including teaching)a.rubella-Rubella virusb.scarlet fever
-roupes strepc.pertussis-bordatella pertussisd.mumps-peramyxoviruse.diphtheria-cornium bacterium diphteriaf.erythema infectiosum (Fifth’s disease)-parvovirus-slapped check disease14.contrast the various rashes of the previously listed disorders-15.what illness / specific infection is a child protected from with the H flu vaccine? What are the complications that can occur as a result of this infection? -The H flu vaccine protects against haemophilus influenzae type b bacteriaSpecific illnesses and infections it protects from:-Pneumonia-Meningitis-Otitis media-Sepsis-Infectious arthritisComplications of infection:-Death-Permanent brain damage-Hearing loss-Seizures-Blindness-Learning disabilities-Severe breathing problems-Joint damage-Lung damage16.what illness / specific infection is a child protected from with the pneumococcal vaccine?Protects children from several serious infections caused by pneumococcal bacteria (Streptococcuspneumoniae)-meningitis-pneumonia-17.An adolescent is diagnosed with shingles. Can the RN contract it? Why? Why not? -No, 18.review which disorders are NYS reportable: -Measles-Mumps-Rubella-Covid-TB
19.review conjunctivitis: types, CM, treatments, education, prevention-10/1610/21 lkm