Nursing Care of most Common Communicable Diseases of Children in Egypt

General Objective:
The student will gains knowledge and skills about the most common communicable diseases and is able to provide nursing care to children contracting these diseases.

Specific Objectives:
The student will be able to; 1. Identify the most common communicable diseases in Egypt, which are caused by viruses or bacteria. 2. Define the incubational period, communicability period and the mode of transmission of each disease. . !ssess the nursing problems and the child"s needs when he has diphtheria, pertussis, tetanus, scarlet fever, poliomyelitis, measles, #erman measles, chic$en po%, and mumps. &. 'lan for the nursing care of such cases. (. )now the 'revention of such diseases through immuni*ation.

Introduction:
+ommunicable disease is defined as an illness caused by an infectious agent or its to%ins, which can be transmitted directly or indirectly to a well person. +ommunicable diseases are caused either by bacteria or virus. ,ources of infection consist of man, animal, contaminated food or water, insects and environmental factors, such as, dust and dirt.

Incidence:
-ore common in pre.school and school.age children due to their e%posure to environmental condition unli$e those at home.

Definitions of Terms:
Incubational Period:
Time that elapses between the invasion of microorganism and the appearance of signs and symptoms of disease.

Communicability Period:
Time during which the person stric$en with the disease and can transmit it to another person directly or indirectly.

Mode of transmission:
-ethod of spread of disease to man.

Common Communicable Diseases Caused by Bacteria:

1. Diphtheria Etiology:
+orynebacterium diphtheria /Diphtheria bacillus0.

Incubational Period:
2.( days or longer.

Communicability Period:
,everal hours before onset of the disease until organism disappear from the respiratory tract.

Mode of Transmission:
Droplet from respiratory tract of an infected person or a carrier directly or indirectly.

Nursing Assessment:
! child with diphtheria usually see$s medical help for one of the following complains /sometimes they are called types0.

1. Sore t roat:
1ever. Difficulty to swallow. ,welling of the nec$. E%udates or a yellow.gray membrane on tonsils and may be the pharyn%. /-embrane varies from thin to thic$ one0. 2oarse or croupy cough and stridor. 3oisy respiration, the child may have severe respiratory distress. The membrane may cover the vocal cord /4hen e%amined with laryngoscope0. 'urulent, bloody nasal discharge. The membrane can be seen on the nasal septum. This s$in ulcer can be confused with impetigo /s$in disease0. The membrane is not always present in diphtheria.

!. Crou":

#. Nasal disc arge:

$. Infected s%in ulcer: &. 't er sings and sym"toms:

That could be present /especially in severe cases05 'urulent con6unctivitis. 7titis media. 8lcerative vulvo.vaginitis. To%ins from organisms produces fever and malaise.

Nursing Consideration:
1. Isolate the child /place him in isolating room, use medical aseptic techni9ues0. )eep the child in isolation until 2 consecutive nose and throat culture are negative /2& hours apart between the two cultures0. 2. :ed rest for about ; wee$s for all types e%cept in nasal diphtheria. . 1or respiratory distress /if present05 suction to trachea and laryn% to remove secretions and pieces of membrane, o%ygen humidifier. &. 1or fever5 chec$ vital signs, use 2. .& hours schedule; depending on the degree of fever, degree of respiratory embarrassment and change in pulse rate. +hec$ blood pressure fre9uently. (. 1or the membrane5 7ral hygiene /warm mouth wash, never use tooth brush or swabs because of danger of distracting the membrane leading to bleeding and rapid spread of to%ins into blood system. ;. 7bserve5 vital signs, secretion and the need for suction, observe signs and symptoms of paralysis. <. Tracheostomy and =or intubation trays must be ready at bedside table of the child. If tracheostomy or intubation is done, apply the proper care of tracheostomy or intubation. In intubation, the child can e%pel the tube when he coughs, so watch constantly as he can"t call for help. 1re9uent suctioning of the tube use proper restraints so that he will not remove the tube. >. If myocarditis appears as a complication, guard the child for e%haustion, beside the other nursing care.

Treatment:
:ed rest. !ntibiotics. !nti.to%ins.

Pre(ention:
1. !ctive immuni*ation5 D'T vaccine. 2. 'assive immuni*ation5 in6ection with anti.to%ins.

Com"lications)
:ronchopneumonia. )idney dysfunction. 'aralysis. -yocarditis. +ardiac failure.

2. ertussis !"hoopin# Cou#h$ Etiology:

#ram.negative bacillus.

Incubation Period:
(.1& days.

Communicability Period:
&.; wee$s from the onset of the disease.

Mode of Transmission:
Droplet /direct and indirect0.

Nursing Assessment:
Three stages5

a* Catarr al stage: +cory,a or "rodormal stageIt lasts <.1& days. -ild fever, headache, anore%ia. ,nee*ing. 'ersistent cough with tearing.

b* Paro.ysmal stage +S"asmodic or / oo"ing stage-:

?asts 1&.2> days /2.& wee$s0. 'aro%ysmal cough develops. It is characteri*ed by several sharp coughs in one e%piration, followed by one deep inspiration, which may be accompanied by a whoop. +ough is worse at night, interferes with sleep and fre9uently causes vomiting. 4ith cough, face becomes flushed and in some instances cyanosis and dyspnea might occur. !nore%ia. ?ymphocytosis occurs.

c* Con(alescent stage:
It lasts 21 days. +ough and vomiting become less.

Nursing Consideration:
1. Isolation5 Disinfection all utensils. 2. :ed rest5 $eep the child in bed in a well ventilated room. . 1or paro%ysmal stage5 'rovide; +alm atmosphere to avoid emotional swings as laugh and cry causing coughing attac$s. !void dust in the room. 7%ygen with humidity to relief cyanosis /may use o%ygen tent0. &. 1or vomiting5

(.

;. <. >. A.

@aise head and shoulders of older children to avoid aspiration of vomitus. 1or young children, place them on abdomen if no one is attending in the room. -outh care. ,mall fre9uent feeding. @efeed the child immediately after vomiting. !ccurate inta$e and output must be $ept. 1or anore%ia5 2igh caloric soft diet. Encourage the child to eat. 4eight the child daily. If ano%ia occurs during paro%ysms a tracheo.pharyngeal suction may be needed. ,o $eep the suction machine available. 'rotect the child from secondary infection, $eep him warm. 7bserve5 respiratory distress and convulsions. 7bserve signs and symptoms of airway obstruction e.g. restlessness, cyanosis, retraction.

Treatment:
,ymptomatic5 sedatives and antispasmodics are important. !ntibiotics are effective if given early /!mpicillin and Erythromycin0.

Pre(ention:
a. !ctive immuni*ation5 D'T vaccine. b. 'assive immuni*ation5 #amma #lobulin. c. In e%posed immuni*ed children, give an immediate booster dose of pertussis vaccine.

Com"lication:
7titis media. :ronchiectasis. 2emorrhage may occur. -arasmus. Encephalitis. 'neumonia.

%. &etanus !'oc( )a*$ Etiology:

+lostridium tetanti /tetanus bacillus0.

Incubational Period:
.21 days.

Communicability Period:
3ot communicable from man to man, as the organism usually live in animal"s intestinal tract.

Mode of Transmission:
Through a wound as organism is present in soil.

Nursing Assessment:
7nset of the disease is either gradual or acute. 1. +onvulsions are the first warning symptoms in children. 2. E%cessive irritability and restlessness. . Difficulty in swallowing. &. ,tiff nec$. (. 4ithin 2&.&> hours, the muscular stiffness progress5 Trismus i.e. tight 6aw, inability to open the mouth. ,tiff arm and legs, then entire stiffness of the body. ,wallowing usually becomes impossible. @esus sardonicus due to spasm of facial muscles. 7pisthotonos, i.e., bac$ward arching of the bac$ as a result of the dominance of the e%tensor muscles of the spine, head draws bac$. These ongoing tetanic spasms lasts about 1B seconds and occurs following a slightest stimuli, such as, claming the door or bumping the bed. ;. Dyspnea and cyanosis can develop. <. 1ever >.( .&BC+. >. +onstipation may develop. A. ?umbar puncture reveals increase reveals increase spinal fluid pressure.

Nursing Consideration:
1. Isolation. 2. 'rotect the child from any stimuli /auditory or tactile stimuli0, so place the child in dar$, 9uite room and minimum handling. . If dyspnea and cyanosis are present, give o%ygen. &. 1or tetanic spasm5 'rotect the child from falling.

(.

;. <. >. A.

The nurse must be alert for number, duration and fre9uency of convulsion /in relation to sedation administered0. @ecord any change in trismus or inability to swallow. 1or inability to swallow5 I.D. therapy for nutrition and fluid balance. #avage feeding may be ordered. ,o, the nurse must report if insertion of the tube causes convulsions. !ccurate inta$e and output chart is necessary. -outh care if he can open his mouth. 1or constipation, give enema. +hec$ vital signs carefully. If tracheostomy is performed; care of tracheostomy. 3aso.pharyngeal suction is done fre9uently.

Treatment:
!ntibiotics /'enicillin0. !ntito%in. Tran9uili*ers.

Pre(ention:
1. !ctive immuni*ation5 D'T vaccine. 2. 'assive immuni*ation5 In6ection of tetanus immuno.globulin or antito%in /a few hours after a wound occur0.

Com"lication:
!no%ia. !telectasis. 'neumonia.

+. Scarlet ,ever Etiology:

,treptococcus pyogeneous. /:eta hemolytic streptococcus group !0.

Incubational Period:
2.( days.

Communicability Period:
1rom onset to recover.

Mode of Transmission:
Droplet infection, direct and indirect.

Nursing Assessment:
In acute sudden onset5 /to%in from the site of infection is absorbed into blood stream0. Prodromal signs: Domiting. 2igh fever then it drops when rash appears. 2eadache. @apid pulse. Tongue5 white tongue coating des9uamates and red strawberry tongue results. Tonsils are red, enlarged, swallow, and may have a patchy whitish e%udates on their surface. Then, rash appears within the first ( days of the disease. The rash will be all over the body but not on the face. The chest and bac$ are affected first, and then the rash moves down.wards involving the legs last. The rash fades upon pressure. Distinct odor of the s$in. Des9uamation i.e., peeling of the s$in, is the typical of scarlet fever. Des9uamation could occur early at &.(.; day or later to & th wee$ of the disease. It starts at the top of the body and proceeds downwards.

Nursing Considerations:
1. 2. . &. Isolation. :ed rest for 12 days and good ventilated room. )eep patient warm, dry and comfortable as possible. 1or the distinct odor which associates with scarlet fever5 daily bath and change linen fre9uently. (. 1or s$in5 . ?ubricate s$in well with oil /daily0 as Dr. order. . 'rotect s$in under and around the nose and lips with ointment. /4hen nasal discharge is constant0. ;. 3asal aspiration by gentle suction or soft rubber ear syringe is essential. <. If the child is less than 2 years, elevate head and shoulders to prevent danger of otitis media. >. !ccurate inta$e and output chart is important. A. Diet in the first wee$5 2igh caloric li9uids then soft diet. !void irritant li9uid 6uice EcitrusF. 1B. 1or constipation, which accompanies scarlet fever enema or mild cathartics is needed. 11. If there is pain in cervical lymph nodes, treat with heat in the form of hot pac$s or cold in the form of ice collar according to doctor"s order. 12. 7bserve for complications.

Treatment:
'enicillin. Diet. ,edatives for pain.

Pre(ention:
3o immuni*ation.

Com"lication:
@heumatic fever. #lomerulo.3ephritis. 'neumonia.

Communicable Diseases Caused by -irus:

1. Chic(en o. !-aricella$
This is a highly communicable disease in children.

Etiology:
Dirus GDaricella. Hoster. Dirus /DHD0I.

Incubational Period:
1B.21 days /2. wee$s0.

Communicability Period:
7ne day before and si% days after the appearance of the first vesicle.

Mode of Transmission:

1"

Droplet /direct or indirect0. Dry scabs are not infectious.

Nursing Assessment:
7nset is sudden with5 Prodromal Stage: -ild or light fever. !nore%ia. 2eadache. Acute P ase: @ash5 ,uccessive crops of macules, papules, vesicles, crusts /vesicles heals by forming the crusts by the end of the two wee$s0. /!cute 'hase0. @ash appears in successive crops and lesions in all stages of development at the same time. @ash is itchy.

Nursing Consideration:
1. Isolation5 8se medical aseptic techni9ue. 3asal and oral discharge, cloths and linens are currently disinfected. )eep the child in isolation until all crusts disappear. 2. 1or rash /lesion05 +leaning the s$in according to doctor"s order once or twice daily. +ool sponge bath without soap. +hange child"s clothes and bed linens daily to prevent s$in infection. 1or itchy lesions, nails must be cut and cleaned. -ittens and gloves to prevent s$in scratching. @estraints may be needed to control scratching. 7bserve the s$in lesions, change in appearance and it must be recorded. If lesions in mouth, mouth wash. If lesions in genital organ, apply cold compresses. . 1or fever5 +hec$ vital signs and record it, especially temperature. )eep records for the first < days of the disease. &. If secondary infection to s$in occurs5 inta$e and out put chart must be $ept accurate. (. 7bserve for complications and report immediately to the doctor.

Treatment:
3o specific treatment. To relieve itching, calamine lotion, antihistamine and local aneaethetaic ointment are prescribed. !ntibiotics for secondary infection. Don"t give aspirin due to high ris$ of @eye syndrome.

Pre(ention:
3one

11

Com"lication:
!bscess. Encephalitis. #lomerulonephritis may occur.

2. /easles !0ubeola$
-ost cases occur before adolescent and it occurs more in spring months.

Etiology:
Dirus @3!.

Incubational Period:
<.1& days /usually 1B.2B days0.

Communicability Period:
& days before the appearance of rash to (days after rash appearance.

Mode of Transmission:
Droplet /direct or indirect0.

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Nursing Assessment:
a. Cory,a: 'rimary symptoms which resembles common cold and occur before rash appearance5 ,nee*ing. 1ever /range from >.( to &BC+, tending to be highest 6ust before the appearance of rash0. :rassy or bar$ing cough. 7n the &th day, con6unctivitis and photophobia. !cute catarrhal inflammation of the mucous membrane of the nose. Enlarged posterior cervical lymph nodes. b. 0o"li%1s S"ots: !re pathogenic appear on day before rash. 4hitish spots resting on a reddish base appear on the inside of the mouth. They can appear and disappear suddenly. c. 2as : @ash appears on 2nd to (th day and remain about a wee$. !ppears first on face, behind the ears, on the nec$, forehead or chee$s. Then, spread downwards over the rest of the body /trun$, arms, and legs0. The rash is pin$ish in color, begins with macular lesions which progress to the popular type. Then, rash becomes dar$ in color /brownish color on (th day0. Des9uamation, which is find usually, follow the rash appearance and then fads /disappear0. @ash is itchy.

Nursing Consideration:
1. Isolation. 2. :ed rest5 7ccupy the child in bed after acute phase with activities. E%plain the reason for being in bed if the child is old enough to understand. . 1or photophobia and con6unctivitis5 ,ubduced light ma$e the child more comfortable. FDar$ roomF. Eye care with warm saline solution to remove secretions or crust. )eep child"s hands away from eyes, e%amine coma for signs and symptoms of ulceration. &. 1or fever5 -easure the temperature carefully. !ntipyretic as doctor"s order. Encourage fluids. Tipped compresses. (. 1or itchy rash5 7bserve degree of itching and apply lotion or ointment as doctor"s order. ;. 1or )opli$"s spots5 -outh care. 8se gargle solution. <. +arry out the plan of care of complicated cases, such as, encephalitis /convulsions0, dyspneaJ. etc.

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Treatment:
,ymptomatic. !ntibacterial therapy.

Pre(ention:
a. b. !ctive immuni*ation5 live attenuated vaccine. 'assive immuni*ation5 3ewborn through the mothers while they were in uterus. #amma.globulin.

Com"lication:
7titis media. Tracheobronchitis. Imptiago,purpura. ?ymphoadenitis. 'neumonia. Encephalitis.

%. German /easles !0ubella$

It is not as communicable as measles. 1etus may contact the disease in uterus if the mother develops the disease during the pregnancy /1 st trimester0.

Etiology:
Dirus.

Incubation Period:
1& to 21 days.

Communicable Period:
During 'rodromal period and for ( days after the rash.

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Mode of Transmission:
1. Direct contact with nose and throat secretions of infected persons. 2. Indirect via articles freshly contaminated with nasopharyngeal secretion. . Trans.placenta congenital infection form infected mother to the fetus.

Nursing Assessment:
Prodromal Stage: -ild fever /Disappear when rash appear0. ,light malaise, headache, and anore%ia. @unning nose, sore throat. @ash is faint macular rash. It is small pinpoint pin$ or pale red macules which are closely grouped to loo$ li$e scarlet blush /botchy0, which fades on pressure. EIt begins on face and hairline move to trun$ then e%tremitiesF. # @ash disappears in days. ,welling of posterior cervical and occipital lymph nodes. 3o )opli$"s spots or photophobia.

Nursing Consideration:
1. Isolation especially form pregnant women. 2. :ed rest until fever subsided.

Treatment:
,ymptomatic.

Pre(ention:
a. b. !ctive immuni*ation; live attenuated rubella virus vaccine. 'assive immuni*ation5 #amma. globulin.

Com"lication:
1etus damage if mother contacts the disease during pregnancy. 3ewborn may have congenital anomalies, such as deafness, mirocephaly, mental retardation. Encephalitis.

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+. /umps !infectious arotitis$

-umps is common in children (.1B years. It is acute virus infectious disease, which may involve, many organs but commonly affects the salivary glands /mainly parotids glands0.

Etiology:
Dirus.

Incubational Period:
1&.21 days.

Communicability Period:

16

7ne to si% days before the first symptoms appears until the swelling disappears.

Mode of Transmission:
Direct or indirect contact with salivary secretion of infected person.

Nursing Assessment:
1. Prodromal stage 3Coray,a4:
?ow.grade fever. Domiting. 2eadache. -alaise and anore%ia.

Acute P ase:
2. 'ain in or behind ears and pain on swallowing or chewing. . ,welling and pain in glands /unilateral or bilateral0, which return to normal in 1B days. &. 7rchitis in males and mastitis in female adolescent may occur.

Nursing Consideration:
1. Isolation. 2. :ed rest until swelling disappears. . 1or fever5 Encourage fluids and soft food, avoid food re9uired chewing, and tipped compresses, antipyretics. &. 1or glands5 -outh care and gargle fre9uently. !pply hot or cold compresses for the swelling. 8se ice bag /watch weight of the bag in order not to increase the pain0. (. 1or 7rchitis5 ,upport scrotum, use cold compresses for 2B minutes, then, remove it for B minutes, then, reapply it for 2B minutesJetc. ;. 1or -astitis5 :reast support, use cold compresses.

Treatment:
,ymptomatic. ,edatives. a. b. !ctive immuni*ation5 ?ive attenuated vaccine. 'assive immuni*ation5 #amma. globulin.

Pre(ention: Com"lication:
@are, sterility, 7varitis, inflammation of testicles, Deafness.

17

1. oliomyelitis !infantile aralysis$

It attac$s the brain stem and spinal cord.

Etiology:
Dirus. The disease is caused by any one of a. Type 1 /:runhilde0. b. Type 2 /?ansing0. c. Type /?eon0. polioviruses5

Incubational Period:
(.1& days.

Communicability Period:
?atter period of incubational period till the first wee$ of acute illness.

Mode of Transmission:
7ral contamination by intestinal and pharyngeal secretions of infected person.

Predis"osing 5actors:
1. 2. . &. (. 1atigue and muscle e%ertions. +ortisone administration. Tonsillectomy and adenoectomy. Tooth e%traction. I.- in6ection of D.'.T. vaccine.

Nursing Assessment:
,everity of nerve involvement can vary from an absence of all clinical signs of paralysis to complete paralysis. There are different possible conse9uences of infection5 1. Ina""arent Poliomyelitis: /,ilent0 3o signs or symptoms appears. 2. Aborti(e Poliomyelitis: Initial symptoms of upper respiratory tract infection5 fever, headache, vomitingJetc. . Non*Paralytic Poliomyelitis: 'roblems as those of !septic -eningitis ,yndrome5 ,tiffness of nec$, bac$ and limbs. 3ausea and vomiting become more severe than stage II. 1ever. Increase protein in +.,.1. &. Paralytic Poliomyelitis: This may begin with manifestations of the abortive or non.paralytic type. ,pinal5 paralysis appear within a day or two after the above manifestations and 2.( days from onset of the disease5 -uscles of the chest, abdominal wall, diaphragm, urinary bladder and bowel can be affected constipation or stool incontinent and urinary incontinent may occur. :ulbar5 -ore life threatening. It causes damage to cranial nerve nuclei, vital centers of respiration, circulation and temperature control. It may leads to swallowing problem and regurgitation of fluids from nose and inability to swallow saliva, which puddles in the pharyn%. If not aspirated choc$ing may occur. Encephalitis5 -anifesting as encephalitis, only diagnosed as polioencephalitis if spinal or bulbar affections or both are present5

# #

'aralysis of limbs is the most common affected muscles.

# #

+onvulsion. 'ersonality disturbances.

1!

Nursing Considerations:
1. Isolation and bed rest. 2. In acute stage5 'ut the child under close observation. 3otify the doctor about the degree and progress of the paralysis /<or> days of the disease0. @ate and type of respiration and signs of respiratory distress must be observed and reported. 7%ygen therapy or place the child on respirator when cyanosis occurs. If tracheostomy is done in case of diaphragmatic paralysis, care of tracheostomy. . 1or paralysis5 +hange position fre9uently. +areful positioning for affected limbs each time he is turned or moved. To minimi*e the degree of deformity, correct body alignment and optimum position must be maintained. 'lace the child on firm mattress. 8se footboard to prevent foot drop when child is on bac$. If the child is on abdomen, pull the mattress away from foot of bed and letting feet protrude over the edge to prevent pressure on toes. !pplication of heat to affected muscles to rela% them. &. ,uction of the pharyn% and postural drainage to prevent aspiration of secretions. (. 1or swallowing difficulties5 ,oft diet if they can swallow with difficulty. If swallowing is difficult, use gavage feeding. ;. 1or incontinent5 ,$in care and perineal region is padded to provide absorption for e%cretions. +atheter may be done. <. 1or constipation5 8se enemas. >. Treat fever and headache.

Treatment:
a. ,ymptomatic. 'hysiotherapy.

Pre(ention:
!ctive immuni*ation5 Trivalent poliovirus vaccine. /T7'D0. ,abine5 !ttenuated virus, which is administered orally. ,al$5 )illed virus, which is administered by in6ection. Note: If a child is affected by poliomyelitis, he must receive the vaccine to prevent further infection from the other poliovirus types. b. 'assive immuni*ation5 #amma. globulin.

2"

Com"lication:
Emotional disturbance. #astric dilatation. 2ypertension.

Nursing Care Plan for a C ild /it Communicable Disease:

Nursing Diagnosis:
'otential for infection related to /communicable disease0. 2is% factors: ,usceptible host. Infectious agent.

Nursing 6oal: +1!ssist in identifying etiologic agent.

Nursing Inter(ention:
@ecogni*e e%anthema /rash0 associated with communicable disease.

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7perate under a high inde% of suspicious for children who are susceptible to infectious diseases. Identify high.ris$ children to whom communicable disease may be fatal. In case of cut.brea$, advice parents to confine child to home. !ssist in performing tests used to identify the organism, such as collection of specimens for culture. :e aware of significance of test results in terms of the etiologic agent and child"s level of immunity.

E."ected 'utcome:
Disease is recogni*ed early. !ppropriate interventions are implemented. 'revent occurrence of the disease.

Nursing 6oal: +!Nursing Inter(ention:

'articipate in public education regarding prophylactic immuni*ation and method of spread of communicable disease. 'articipate in immuni*ation programs or screening programs to identify streptococcal infections.

E."ected 'utcome:
Disease is prevented.

Nursing 6oal: +#'revent spread of the disease.

Nursing Inter(ention:
Institute appropriate isolation procedures. -a$e referral to public health nurse when necessary to ensure appropriate isolation procedures at home. 4or$ with families to ensure compliance with therapeutic regiments. Identify close contacts who may re9uire prophylactic treatment /specific immune globulin or antibiotics0. @eport disease to local health department.

E."ected 'utcome:
Infection remains confined to original source.

Nursing 6oal: +$'revent complications.

Nursing Inter(ention:
Ensure compliance with therapeutic regimen /bed rest, antibiotics, ade9uate hydration0. Institute sei*ure precautions if febrile convulsion is a possibly. -onitor temperature as une%pected elevations may signal infection. !ttention to good body hygiene. Ensure ade9uate hydration5 4ith small fre9uent sips of water or favorite drin$s and soft bland food /gelatin, pudding, ice or soups0.

# #

1eed again after vomiting.

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7bserve for signs of hydration

E."ected 'utcome:
+hild e%hibits no evidence of complications, such as infection or hydration.

Nursing Diagnosis:
'otential for impaired s$in integrity related to /disease0. 2is% factors: +hild with propensity to scratch.

Nursing 6oal:
'revent child from scratching the s$in.

Nursing Inter(ention:
)eep nails short and clean. !pply mittens or elbow restraints. Dress in light weight, loose and non.irritating clothes. +over affected area /e.g., long sleeves, pants0. :ath in cool water with no soap or apply cold compresses. !pply soothing lotions. !void e%posure to heat or sun. ,$in remains intact.

E."ected 'utcome:

Nursing Diagnosis:
Impaired social interaction related to isolation.

Nursing 6oal: +1'repare the child for isolation if hospitali*ed.

Nursing Inter(ention:
E%plain reason for confinement and use of any special precautions. +hild demonstrates understanding of isolation.

E."ected 'utcome: Nursing 6oal: +!'romote social interaction.

Nursing Inter(ention:
!llow the child to play with gloves and gown. !lways introduce your self /as a nurse0 to child and allow him to see your face before wearing the protective clothes. 'rovide diversionary activities. Encourage parents to remain with the child during hospitali*ation. 2elp child views isolation as challenging rather than solely negative e%perience. Encourage contact with friend via telephone /in hospital he can use intercom between child"s room and nurse station0.

E."ected 'utcome:

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+hild engages in suitable activities and interactions.

Nursing Diagnosis:
'ain related to s$in lesions.

Nursing 6oal:
@elive discomfort.

Nursing Inter(ention:
)eep mucous membranes moist, so, use cool. moist vapori*er and gargles. !pply petroleum to chapped lips or nares. +leanse eyes with saline solution. )eep s$in clean /change bed clothes and linens at least daily0. !dminister oral hygiene. !ssess need for pain and antipyretic medication. Employ non.pharmacological pain reduction techni9ues, such as distraction through 9uite play. ,$in and mucous membrane are clean and free of irritants. +hild e%hibits minimum evidence of discomfort.

E."ected 'utcome:

Nursing Diagnosis:
!ltered family processes related to child with an acute illness.

Nursing 6oal:
'rovide emotional support.

Nursing Inter(ention:
@einforce family"s effort to carry out the plan of care. 'rovide assistance when necessary, such as, visiting the nurse to help with home care. )eep family aware of child"s progress, stress rapidly of recovery in most cases. 'repare child"s peers for altered physical appearance, such as, with chic$en po%, poliomyelitisJetc.

E."ected 'utcome:
1amily continues to comply with e%pectations. 'eers accept the child.

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