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 childs 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 Kopliks 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

Assess: Assessment: 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, bedwetting 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.