INTEGRATED MANAGEMENT FOR

CHILDHOOD DISEASES

After studying this topic, the learners shall be able to:

• Define the different childhood diseases.

• Describe the diet necessary to prevent malnutrition.

• Understand the interventions being discussed in every disease topic.

• Explain the value of this topic for development and good decision making.

• Identify and explain the characteristics of a child possessing a certain disease.

• Give examples of management for a child with a disease or illness that can be applied in the community.

• Formulate proper intervention on what to do during cases when the child is in dire situation.

• Select appropriate theories or findings that they find common in a certain community.

• Determine the appropriate intervention for specific types of childhood disease or illness.

• Discuss topic that could develop their knowledge and skills both in community and in the clinical area.

To avoid malnutrition!

VOMITING

• The major concerns when a child is vomiting are the risk of dehydration, the loss of fluid and electrolytes, and the development of metabolic alkalosis.

• Additional concerns include aspiration, atelectasis, and the development of pneumonia.

Assessment:• Signs of aspiration• Character of vomitus• Pain and abdominal cramping• Dehydration• Fluid and electrolyte imbalances• Metabolic alkalosis

Interventions:• Maintain patent airway.• Position the child on side to prevent aspiration.• Monitor VS.• Monitor the character, amount and frequency of

vomiting.• Assess the force of the vomiting, for projectile

vomiting indicates pyloric stenosis or inc. ICP.• Monitor I & O and for signs of dehydration.• Monitor electrolyte levels. • Provide oral rehydration therapy as tolerated and as

prescribed; start feeding slowly, with small amounts of fluid at frequent intervals.

• Assess for diarrhea or abdominal pain. • Advise the parents to inform the physician when

signs of dehydration, blood in vomitus, forceful vomiting or abdominal pain is present.

DIARRHEA

– The major concerns when a child is having diarrhea are the risk of dehydration, the loss of fluid and electrolytes, and the development of metabolic acidosis.

Assessment:• Character of stools• Pain and abdominal cramping• Dehydration • Fluid and electrolyte imbalances • Metabolic acidosis.

Interventions:• Monitor V/S• Monitor the character, amount and frequency of

diarrhea. • Monitor skin integrity.• Monitor I & O and for signs of dehydration. • Monitor electrolyte levels.• For mild to moderate dehydration, provide oral

rehydration therapy; avoid carbonated drinks and high amounts of sugar.

• For severe dehydration, maintain NPO status to place the bowel at rest and provide fluid and electrolyte replacement by IV route as prescribed; if potassium is prescribed for IV administration, ensure that the child has voided before administering.

• Reintrodu8ce a normal diet once rehydration is achieved.

• Instruct the parents in good hand washing techniques.

FEVER• Fever is an abnormal body

temperature elevation. • A child’s temperature can vary

depending on activity, emotional stress, the type of clothing the child is wearing and the temperature of the environment.

Assessment:• Temperature elevation• Flushed skin• Diaphoresis• Chills • Restlessness or lethargy

Interventions:– Monitor V/S.– Administer TSB with lukewarm water for

20-30 mins.– Administer antipyretics such as

acetaminophen (Tylenol) as prescribed. – Retake the temperature 30-60 mins.

after the antipyretic is administered. – Provide adequate fluid intake as

tolerated and as prescribed.– Monitor for dehydration and fluid and

electrolyte imbalance. – Instruct the parents in how to take the

temperature, how to medicate their child safely, and when it is necessary to call the physician.

TONSILLITIS AND ADENOIDITIS•Tonsillitis refers to inflammation and infection of the tonsils.

•Adenoiditis refers to inflammation and infection of the adenoids.

Assessment:• Persistent or recurrent sore throat• Enlarged, bright red tonsil that may be covered

with white exudates. • Difficulty in swallowing• Mouth breathing and an unpleasant mouth odor• Fever• Cough• Enlarged adenoids may cause nasal quality of

speech, mouth breathing, hearing difficulty, snoring, or obstructive sleep apnea.

Interventions:

– Assess for signs of active infection.– Assess bleeding and clotting

studies because the throat is vascular.

– Prepare the child for a sore throat postoperatively, and inform the child that he or she will need to drink liquids.

– Assess for any loose teeth to decrease the risk of aspiration during surgery.

Interventions postoperatively:– Position client prone or side lying to facilitate drainage. – Have suction equipment available, but do not suction

unless there is an airway obstruction. – Monitor for signs of hemorrhage (frequent swallowing may

indicate hemorrhage); if hemorrhage occurs, turn the child to the side and notify the physician.

– Discourage coughing or clearing throat- irritate the throat– Provide clear, cool, non citrus and noncarbonated fluids. – Avoid milk products initially because they will coat the

throat. – Avoid red liquids which will stimulate the appearance of

blood if the child vomits. – Administer Tylenol for sore throat as prescribed. – Instruct parents to notify the physician if bleeding,

persistent earache, or fever occurs. – Instruct the parents to keep the child away from crowds

until healing has occurred.

PNEUMONIA• Pneumonia is inflammation of the alveoli

caused by a virus, mycoplasmal agent, bacteria or the aspiration of foreign substances.

• Causative agent – Mycoplasma pneumoniae• Viral pneumonia occurs more frequently than

bacterial and often is associated with a viral upper respiratory infection.

• Bacterial pneumonia is often a serious infection; hospitalization is indicated when pleural effusion accompanies the disease and is mandatory for children with staphylococcal pneumonia.

• Aspiration pneumonia occurs when food, secretions, liquids or other material enter the lung and cause inflammation.

Viral pneumonia

Assessment: – Mild fever, slight cough– Malaise– Wheezes – Non productive or productive cough of small

amounts of whitish sputum

Interventions:•Administer oxygen with cool mist as

prescribed.• Increase fluid intake. •Administer antipyretics for fever as

prescribed.•Antimicrobial therapy if positive after culture. •Teach postural drainage and chest

physiotherapy.

Bacterial pneumonia

Assessment:• Acute onset, fever• Headache, chills, abdominal pain,

chest pain• Hacking, nonproductive cough• Diminished breath sounds• As the infection resolves,

crackles and wheezing are heard and the cough becomes productive with purulent sputum.

Interventions for bacterial pneumonia:

– Antimicrobial therapy is initiated.– Administer oxygen for respiratory distress as prescribed.– Place the child in a mist tent as prescribed; cool

humidification moistens the airways and assists in temperature reduction.

– Administer chest physiotherapy and postural drainage every 4 H as prescribed.

– Promote bed rest to conserve energy. – Provide fluid intake (administer cautiously to prevent

aspiration).– Administer antipyretics for fever as prescribed; monitor

temperature frequently because of the risk for febrile seizures.

– Institute isolation precautions with pneumococcal or staphylococcal pneumonia (according to agency policy).

INFLUENZA– Influenza is a viral infection that attacks

the respiratory system, including your nose, throat, bronchial tubes and lungs. Although it's commonly called the flu, influenza is not the same as the stomach viruses that cause diarrhea and vomiting.

Assessment:– Fever, Chills and sweats – Headache, Dry cough – Muscular aches and pains, especially in

your back, arms and legs – Fatigue and weakness – Nasal congestion – Loss of appetite – Diarrhea and vomiting in children

Prevention:– Get an annual flu vaccination. – Wash your hands. Thorough and frequent hand

washing is the best way to prevent many common infections.

– Eat right, sleep tight. A poor diet and poor sleep both lower your immunity and make you more vulnerable to infections.

– Exercise regularly. Regular cardiovascular exercise — walking, biking, aerobics — boosts your immune system.

– Limit air travel. – Avoid crowds during flu season. Flu spreads easily

wherever people congregate — in child care centers, schools, office buildings, auditoriums, even cruise ships. By avoiding crowds whenever possible during peak flu season, you reduce your chances of infection.

Self-care• Drink plenty of liquids. Choose water,

juice and warm soups to prevent dehydration. Drink enough so that your urine is clear or pale yellow.

• Rest up. Get more sleep to help your immune system fight infection.

• Try chicken soup. It's not just good for your soul — it really can help relieve flu symptoms by breaking up congestion.

• Consider pain relievers. Use an over-the-counter pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) cautiously, as needed.

RUBEOLA (MEASLES)– Agent: virus– Incubation period: 10-20 days– Communicable period: from 4 days before to 5

days after the rash appears; mainly during prodromal stage

– Source: respiratory tract secretions, blood or urine of infected person.

– Transmission: airborne or direct contact with infectious droplets.

Assessment:– Fever – Malaise– Cough– Koplik’s spots: small, red spots with a bluish white

center and a red base; located on the mucosa and lasts 3 days.

Interventions:

•Use respiratory precautions if the child is hospitalized

•Restrict the child to quite activities and bed rest.

•Use a cool mist vaporizer for cough and coryza.

•Dim lights if photophobia is present.

•Administer antipyretics for fever.

MUMPS• Agent: Paramyxovirus• Incubation period: 14-21 days• Communicable period: immediately

before and after the swelling begins.• Source: saliva of infected person &

possibly urine• Transmission -Direct contact with

infected person -Droplet spread from infected person

Assessment:Assess:– Fever – Headache & malaise– Anorexia– Earache aggravated by chewing,

followed by parotid glandular swelling

Interventions:•Use respiratory precautions.•Provide bed rest until the parotid glandular swelling subsides.

•Avoid foods that require chewing.•Apply hot or cold compresses as prescribed to the neck.

DIPHTERIA• Agent: Corynbacterium diphthriae• Incubation period: 2-5 days• Communicable period: variable; until

virulent bacilli are no longer present• Source: discharge from the mucous

membrane of the nose & nasopharynx, skin, and other lesions of the infected person

• Transmission; direct contact with infected person, carrier, or contaminated articles.

Assessment:•Low grade fever, malaise, sore throat

•Foul smelling, mucopurulent nasal discharge

•Gray membrane on the tonsils and pharynx

•Lymphadenitis (neck edema)Interventions:• Ensure strict isolation of the hospitalized child !• Administer antitoxin as prescribed• Proved bed rest ! • Administer antibiotics as prescribed !

CHICKENPOX (VARICELLA)

• Agent: Varicella-zoster virus• Incubation period: 13-17 days• Communicable period: 1-2 days

before the onset of the rash to 6 days after the first crop of vesicles, when crusts have formed.

• Source: respiratory tract secretions of infected person; skin lesions

• Transmission: Direct contact, droplet (airborne) spread, and contaminated objects.

Assessment:– Slight fever, malaise & anorexia are followed

by a macular rash that first appears on the trunk & scalp & moves to the extremities.

– Lesions become pustules, begin to dry, & develop a crust.

– Lesions may appear on the mucous membranes of the mouth, the genital area, and the rectal area.

Interventions:• In the hospital setting, ensure strict

isolation (contact and airborne precautions).

• In the home setting, isolate the infected child until the vesicles have dried; isolate high risk children from the infected child.

PERTUSSIS (WHOOPING COUGH)

• Agent: Bordetella pertussis• Incubation period: 5-21 days • Communicable period: greatest during the

catarrhal stage• Source: discharge from the respiratory tract

of the infected person• Transmission: direct contact or droplet

spread from infected person; indirect contact with freshly contaminated objects.

Assessment:– Symptoms of respiratory infection

followed by increased severity of cough

Interventions:•Isolate the child during the catarrhal stage; if the child is hospitalized, institute respiratory precautions.

•Administer antimicrobial therapy as prescribed.

•Administer pertussis immune globulin as prescribed.

•Reduce environmental factors that promote paroxysms of coughing, such as dust, smoke, and sudden changes in temperature.

•Encourage fluid intake. •Provide high humidity with the use of a humidifier.

POLIOMYELITIS• Agent: enterovirus• Incubation period: 7 to 14 days• Communicable period: not exactly known• Source: Oropharyngeal secretions and feces

of the infected person• Transmission: direct contact with infected

person; fecal-oral and oropharyngeal routes.Assessment:

– Fever, malaise, anorexia, nausea, headache, sore throat

– Abdominal pain, followed by soreness and stiffness of the trunk, neck and limbs that progresses to flaccid paralysis

Interventions:

•Enteric precautions•Supportive treatment•Bed rest•Monitoring for respiratory paralysis

•Physical therapy.

ENTEROBIASIS (PINWORM)• Agent: Enterobius vernicularis• Source: The nematode is universally

present in temperate climatic zones• Eggs are ingested or inhaled

(eggs float in the air), hatch in the upper intestine, mature in 2 to 8 weeks, and migrate to the cecal area; females then mate, migrate out the anus, and lay eggs.

• Transmission: Favored in crowded conditions, ingestions or inhalation of eggs, hands to mouth or fecal-oral route, contaminated items (pinworm eggs persist in the environment for 2-3 weeks)

Assessment:

•Intense perianal itching, irritability

•Restlessness, poor sleep, bed-wetting

•In females, the worm may migrate to the vagina and urethra and cause infection.

Interventions:

• Identify the worms – use a flashlight to inspect the anal area 2 to 3 hours after the child is asleep.

• Use enteric precautions• Administer antihelminthic

medications (all household members are treated) as prescribed.

• Teach home care measures to prevent reinfection.