Tuberculosis (TB) is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis, primarily affecting the lungs (pulmonary TB) but can also involve other organs (extrapulmonary TB) such as lymph nodes, spine, brain, and kidneys.
TB spreads mainly through airborne droplets when an infected person coughs, sneezes, or speaks. Children are usually infected by contact with an adult TB case, especially in households.
๐ฉบ Identification / Diagnosis of TB in Children:
Diagnosing TB in children is challenging, as they often present with non-specific symptoms and less obvious sputum production.
๐ 1. Clinical History & Symptoms:
Persistent cough (>2 weeks)
Low-grade fever, often in the evening
Weight loss or failure to gain weight
Loss of appetite
Fatigue and irritability
Night sweats
History of TB contact in family or surroundings
A child with no weight gain or unexplained fever/cough lasting >2 weeks should be investigated for TB.
๐งช 2. Physical Examination:
Respiratory signs (e.g., wheezing, rales)
Enlarged lymph nodes
Spinal tenderness (in TB spine)
Meningeal signs (in TB meningitis)
๐งซ 3. Tuberculin Skin Test (Mantoux Test):
Intradermal injection of PPD (Purified Protein Derivative)
Induration (swelling) measured after 48โ72 hours
Positive if induration โฅ10 mm (or โฅ5 mm in high-risk children like HIV-positive)
Indicates TB exposure, not active disease
๐ฆ 4. Microbiological Tests:
Gastric aspirate or induced sputum (for children who can’t produce sputum)
CBNAAT (GeneXpert MTB/RIF):
Rapid test that detects TB and rifampicin resistance
AFB (Acid-Fast Bacilli) smear: Low sensitivity in children
Culture of Mycobacterium tuberculosis: Most confirmatory, but takes 2โ6 weeks
๐ธ 5. Chest X-ray:
Shows typical findings like:
Hilar lymphadenopathy
Infiltrates or consolidation
Cavitation (in older children)
Suggestive but not diagnostic alone
๐งช 6. Blood Tests:
Elevated ESR
CBC: May show anemia or lymphocytosis
๐ง 7. Other Investigations (if extrapulmonary TB):
CSF analysis โ for TB meningitis
Ultrasound/CT โ for abdominal or spinal TB
Fine needle aspiration โ for TB lymphadenitis
๐ 8. Scoring Systems (e.g., National TB Elimination Programme – NTEP):
Used in India for clinical diagnosis of pediatric TB
Based on:
Clinical signs
Nutritional status
History of contact
X-ray findings
Mantoux results
โ Treatment of TB in Children (Based on NTEP Guidelines โ India)
๐ Goal:
To completely eliminate TB bacteria, prevent drug resistance, and promote complete recovery.
๐ท 1. First-Line Anti-TB Treatment (ATT) โ for Drug-Sensitive TB:
Two Phases โ Intensive Phase (IP) + Continuation Phase (CP)
Essential for recovery in children with malnutrition
Provide calorie-rich, protein-dense diet
Nutritional supplements if needed (under Nikshay Poshan Yojana in India)
๐ท 4. BCG Vaccine:
Preventive vaccine given at birth in TB-endemic countries
Does not prevent infection, but reduces risk of severe forms of TB (e.g., TB meningitis)
๐ฉโโ๏ธ Nursing Management of Pediatric TB
๐งฉ 1. Assessment:
Monitor cough, fever, weight loss, or failure to thrive
Observe adherence to ATT regimen
Assess for drug side effects (jaundice, vomiting, vision changes, rash)
Check for family history/contact with TB
๐ 2. Nursing Diagnoses:
Ineffective airway clearance related to pulmonary involvement
Imbalanced nutrition: Less than body requirements
Deficient knowledge related to disease and long-term therapy
Risk for infection transmission
Risk for noncompliance with prolonged treatment
๐ก๏ธ 3. Nursing Interventions:
๐ A. Medication Adherence & DOTS (Directly Observed Treatment):
Ensure child receives medicines daily under supervision
Educate caregivers about importance of completing full course
Observe and document dose taken, and missed doses
๐ฉบ B. Monitoring & Managing Side Effects:
Watch for signs of:
Hepatitis (yellow eyes, nausea)
Rash or fever (hypersensitivity)
Blurred vision (ethambutol toxicity)
Report adverse reactions to physician immediately
๐ฅฃ C. Nutritional Support:
Provide nutritious, well-balanced meals
Encourage small, frequent feedings
Monitor weight gain weekly or monthly
Link with nutrition programs (if available)
๐งผ D. Infection Control:
Educate on respiratory hygiene (cover mouth while coughing)
Ensure good ventilation at home
Avoid school or daycare during initial phase of treatment
Encourage screening and treatment of close contacts
๐ E. Family & Child Education:
Teach about:
TB as treatable and curable
Need for long-term follow-up
How to prevent spread of infection
Counsel on stigma reduction and social support
๐ฌ F. Psychosocial Support:
Provide emotional support to child and family
Address school absenteeism, peer issues, or social isolation
Refer to support groups if needed
๐ 4. Evaluation:
Child shows improvement in appetite, weight, and activity
Cough and fever subside
Child completes full course of ATT without interruption
Family demonstrates understanding of treatment plan
No drug resistance or complications develop
โ Prognosis:
Excellent in children if TB is detected early and treatment is completed fully
Risk of relapse or complications if non-adherent to therapy
Long-term follow-up needed in TB meningitis or extensive lung disease
๐จ Hospital Management of TB in Children:
๐งพ When is Hospitalization Needed?
Severe disease (e.g., TB meningitis, miliary TB)
Drug-resistant TB (DR-TB)
Severe malnutrition or dehydration
Respiratory distress or complications
Poor adherence or treatment failure
To initiate second-line drugs or for monitoring side effects
๐ฉโโ๏ธ Nursing Role in Hospital:
Administer anti-TB medications on time
Monitor for adverse drug reactions
Ensure isolation precautions (especially in the infectious phase)
Nutritional support โ high-calorie, protein-rich diet
Encourage fluid intake
Monitor weight, vital signs, intake-output
Educate family on disease, hygiene, and medication adherence
๐ In-Home Care of TB in Children:
Most children with TB are managed at home, especially after the first few weeks of treatment.
๐ก Key Points in Home-Based Care:
Ventilation:
Keep windows open; ensure fresh air circulation
Separate Sleeping Area (if possible):
To minimize exposure to others (especially infants or immunocompromised)
Cough Etiquette:
Child should cover mouth while coughing/sneezing
Use handkerchief or tissue, dispose of properly
Daily Medication:
Ensure Directly Observed Therapy (DOT) by a trained family member or health worker
Nutrition:
Encourage balanced meals, with extra calories and protein
Give iron, zinc, and vitamin supplements if prescribed
Follow-Up:
Monthly follow-up at DOT center or hospital
Monitor sputum (if applicable), weight gain, and symptom improvement
Emotional Support:
Provide comfort, reduce stigma, maintain routine activities as tolerated
๐ก๏ธ Control & Prevention of TB (Especially in Pediatric Settings):
โ 1. Early Detection and Treatment:
Prompt screening of children with prolonged cough or contact history
Treatment of latent TB in high-risk children (e.g., HIV-positive, malnourished)
โ 2. BCG Vaccination:
Given at birth to prevent severe forms of TB (like meningitis, miliary TB)
โ 3. Contact Tracing:
Screen close household contacts, especially under-5 children
Provide Isoniazid Preventive Therapy (IPT) if eligible
โ 4. Infection Control in Community:
Raise awareness of symptoms of TB
Encourage timely medical evaluation
Avoid spitting in public, and promote cough hygiene
โ 5. Infection Control in Hospital:
Use airborne precautions (N95 mask for staff)
Place child in a well-ventilated room
Minimize unnecessary contact with unexposed infants or immunocompromised
๐ Role of Nurses in TB Prevention & Control:
Health education to family, school, and community
Monitoring adherence to medications under DOTS
Conduct household visits for contact tracing
Promote early diagnosis through awareness
Work with community health workers and TB programs (like NTEP in India)
๐ก๏ธ Diphtheria
A serious bacterial infection affecting the mucous membranes of the throat and nose
๐น Definition:
Diphtheria is an acute, contagious disease caused by the bacterium Corynebacterium diphtheriae. It primarily affects the upper respiratory tract and is characterized by the formation of a grayish-white pseudomembrane over the throat or tonsils. The bacteria produce a potent toxin that can damage the heart, nervous system, and other organs.
๐ Identification / Diagnosis:
1. Clinical Features:
Sore throat and hoarseness
Difficulty swallowing
Grayish pseudomembrane on the tonsils, pharynx, or nasal passages
Swollen neck (commonly called โbull neckโ)
Fever, fatigue, and malaise
Breathing difficulty (in severe cases)
2. Laboratory Diagnosis:
Test
Purpose
Throat/Nasal Swab Culture
Identifies Corynebacterium diphtheriae from lesion sites
Electrocardiogram (ECG): To detect diphtheritic myocarditis
Neurological Examination: If cranial nerve palsies or neuropathy are suspected
๐ Medical Management of Diphtheria
๐น 1. Antitoxin Therapy
Diphtheria Antitoxin (horse serum-derived):
Administered intravenously or intramuscularly
Neutralizes the circulating diphtheria toxin
Should be given as early as possible, even before culture results are confirmed
Sensitivity testing is done prior to administration to check for hypersensitivity
๐น 2. Antibiotic Therapy
To eradicate Corynebacterium diphtheriae and stop transmission:
Drug
Dosage
Duration
Erythromycin
40โ50 mg/kg/day orally or IV (divided doses)
14 days
Penicillin G
25,000โ50,000 units/kg/day IV/IM
Followed by oral penicillin for 10 days
Alternative
Azithromycin or Clarithromycin
In penicillin-allergic patients
๐น 3. Isolation and Infection Control
Immediate isolation of the patient to prevent spread
Use of droplet precautions until 2 consecutive negative cultures (taken 24 hours apart)
Disinfection of patient’s articles and proper disposal of secretions
๐น 4. Supportive Care
Bed rest, especially in severe cases
Monitoring for airway obstruction, myocarditis, and neurological complications
Oxygen therapy and tracheostomy if airway is compromised
IV fluids if swallowing is difficult
๐น 5. Monitoring for Complications
ECG monitoring for cardiac involvement (myocarditis)
Neurological assessment for cranial nerve palsy and paralysis
Watch for renal failure or signs of systemic toxicity
๐น 6. Management of Contacts
Close contacts should receive:
Prophylactic antibiotics (Erythromycin or Penicillin)
Booster dose of diphtheria vaccine (Td or Tdap)
Throat swabs for culture to check carrier status
๐ก๏ธ DIPHTHERIA โ NURSING MANAGEMENT
โ In the Hospital Setting
1. Isolation and Infection Control
Strict droplet precautions (gown, mask, gloves)
Patient is kept in isolation for at least 14 days or until two consecutive negative cultures
Hand hygiene before and after patient contact
Proper disposal of respiratory secretions
2. Monitoring and Assessment
Monitor airway patency: Watch for signs of airway obstruction due to pseudomembrane
Monitor vital signs: especially temperature, respiratory rate, oxygen saturation
Assess for difficulty in swallowing or stridor
Monitor for signs of myocarditis or neuropathy
3. Medication Administration
Administer Diphtheria Antitoxin IV/IM as per order (after sensitivity test)
Administer antibiotics (e.g., Penicillin or Erythromycin) as prescribed
Administer analgesics/antipyretics for pain and fever
Provide oxygen therapy if needed
4. Airway Management
Keep emergency tracheostomy kit at bedside
Suction as needed to clear airway
Ensure the head is elevated to ease breathing
5. Nutrition and Hydration
Provide soft, bland diet if patient can swallow
Monitor fluid intake; IV fluids if oral intake is poor
Prevent aspiration while feeding
6. Psychological Support
Provide reassurance to child and family
Encourage limited interaction while maintaining isolation rules
7. Documentation and Communication
Document respiratory status, medications, response to treatment
Inform local health authority for contact tracing and notification (diphtheria is a notifiable disease)
๐ In the Home Setting (Post-hospital care or mild cases)
1. Continued Isolation
Patient must continue to follow droplet precautions until cleared
Family members should maintain hand hygiene and avoid close contact
2. Medication Compliance
Ensure completion of full course of antibiotics
Monitor for side effects of medications
3. Symptom Monitoring
Watch for:
Return of fever
Difficulty in breathing or swallowing
Fatigue, muscle weakness (signs of nerve involvement)
4. Nutrition and Rest
Provide nutritious, soft food
Ensure adequate hydration
Encourage bed rest and limit physical activity
5. Vaccination and Prevention
Ensure DPT vaccination of patient and all close contacts
Siblings or close contacts may need prophylactic antibiotics
6. Health Education
Educate family on:
Importance of completing treatment
Signs of complications
Preventing transmission
Importance of immunization (DPT booster)
๐ Nursing Alert:
Always test for sensitivity to antitoxin before administration.
Maintain emergency airway equipment at all times in hospital due to risk of airway obstruction.
๐ก๏ธ DIPHTHERIA โ PREVENTION AND CONTROL
โ 1. Primary Prevention (Before Disease Occurs)
๐น Immunization
The most effective preventive measure.
DPT (Diphtheria, Pertussis, Tetanus) vaccine is part of the national immunization schedule:
Infants: 6, 10, 14 weeks โ 1st, 2nd, 3rd doses
Booster 1: 16โ24 months
Booster 2: 5โ6 years
Td (Tetanus + reduced Diphtheria): at 10 and 16 years
Catch-up vaccination for unvaccinated or partially vaccinated children
๐น Health Education
Educate public on:
Importance of routine immunization
Personal hygiene and respiratory etiquette
Early symptoms and when to seek treatment
๐น Improved Living Conditions
Reduce overcrowding
Improve ventilation in homes/schools
โ 2. Secondary Prevention (Early Detection and Prompt Treatment)
๐น Early Diagnosis and Treatment
Rapid identification and treatment prevent complications and spread
Administer antitoxin and antibiotics promptly
๐น Isolation of Cases
Infected person should be isolated for at least 14 days
Isolation can be lifted only after 2 negative throat cultures (24 hours apart)
โ 3. Tertiary Prevention (Prevent Complications and Disability)
๐น Proper Medical and Nursing Management
Manage respiratory distress, myocarditis, and nerve paralysis
Provide nutritional and emotional support
Prevent long-term disability
โ 4. Control of Spread (Public Health Measures)
๐น Notification
Diphtheria is a notifiable disease โ health authorities must be informed
๐น Contact Tracing
Identify all close contacts of the case
๐น Prophylaxis for Contacts
Give antibiotic prophylaxis (e.g., erythromycin or penicillin)
Throat swab and culture for all contacts
Immunize contacts if not fully immunized
๐น Disinfection
Proper disposal of patientโs nasal/throat discharges
Disinfection of patientโs utensils, linen, toys, etc.
๐งช Summary Table:
Level
Action
Primary
Immunization, Health Education, Hygiene
Secondary
Early diagnosis, Isolation, Treatment
Tertiary
Prevent complications, Rehabilitation
Control Measures
Notification, Contact tracing, Disinfection
๐ Tetanus in Children
๐ Definition
Tetanus is a life-threatening, non-communicable bacterial infection caused by Clostridium tetani. The bacterium releases a powerful neurotoxin (tetanospasmin) that affects the central nervous system, leading to:
Severe muscle stiffness
Painful spasms
Potential respiratory failure
๐ฆ Entry Point: Through contaminated wounds, burns, umbilical stump (in neonates), or animal bites.
๐งช Diagnosis
Tetanus is primarily a clinical diagnosis based on history and physical findings. Laboratory confirmation is rarely helpful.
โ 1. History
Recent wound, burn, or umbilical stump infection
Incomplete or no tetanus vaccination
Exposure to contaminated objects (e.g., rusted nails)
โ 2. Clinical Observation
Classic muscle rigidity and spasms
No loss of consciousness
Symptoms triggered by minimal stimuli (light, sound, touch)
โ 3. Rule Out
Meningitis
Seizure disorders
Hypocalcemia
Other causes of muscle rigidity
๐ No specific lab test confirms tetanus, but tests may help exclude other conditions.
๐จClinical Manifestations
๐น Early Symptoms
Irritability and restlessness
Excessive crying (infants)
Poor feeding and weak suck (neonates)
Fever and sweating
๐น Classic Signs
Symptom
Description
Trismus (Lockjaw)
Inability to open the mouth due to jaw stiffness
Risus Sardonicus
Fixed, smile-like facial expression due to facial muscle contraction
Opisthotonus
Severe backward arching of the spine and neck
Muscle Rigidity
Generalized stiffness, especially in jaw, neck, abdomen, and back muscles
Dysphagia
Difficulty in swallowing
๐น Severe Symptoms
Painful muscle spasms triggered by minor stimuli
Respiratory distress due to diaphragm and intercostal muscle involvement
Apnea or asphyxia in severe cases
โ ๏ธ In neonatal tetanus, symptoms appear between 3โ10 days of birth and may begin with refusal to feed and excessive crying.
๐ฉบ Medical Management of Tetanus in Children
Tetanus requires immediate hospitalization, preferably in an ICU setting, due to the risk of airway obstruction, spasms, and autonomic instability.
โ 1. Neutralization of Toxin
Tetanus Immunoglobulin (TIG):
Given intramuscularly (IM) to neutralize unbound toxin.
Dose: 3000โ6000 IU (may vary by age and severity).
Do NOT inject into the same site as the tetanus vaccine.
โ 2. Eradication of Causative Organism
Antibiotics to eliminate Clostridium tetani:
Metronidazole (preferred): 30 mg/kg/day IV in divided doses
Alternative: Penicillin G (but may worsen spasms via GABA inhibition)
Wound care:
Thorough cleaning and debridement of wound to remove necrotic tissue and bacterial source.
โ 3. Control of Muscle Spasms
Sedation and Muscle Relaxants:
Diazepam: For muscle relaxation and to prevent seizures
Midazolam or Lorazepam: As alternatives
Baclofen (oral or intrathecal): For severe spasticity
Magnesium sulfate: Reduces autonomic instability and spasms
Neuromuscular blocking agents (e.g., vecuronium) may be used in ICU if mechanical ventilation is required.
โ 4. Supportive Care
Airway Management:
Keep tracheostomy kit at bedside
Mechanical ventilation if respiratory muscles are involved
Suction as needed to prevent aspiration
Nutrition and Hydration:
Provide NG tube feeding if swallowing is impaired
Maintain IV fluids and electrolyte balance
Temperature control:
Use antipyretics or cooling methods for fever
Quiet, dark room:
To reduce stimuli that may trigger spasms
โ 5. Immunization
Tetanus toxoid (TT or DPT vaccine) should be given during recovery:
Begin as soon as the child is stable
Despite having tetanus, the infection does not provide natural immunity
โ 6. Monitoring and Follow-Up
Monitor:
Vital signs, especially respiratory and cardiac status
Signs of autonomic dysfunction: labile BP, tachycardia
Spasm frequency and severity
Oxygen saturation
Educate parents about:
Vaccination schedule
Wound hygiene
Early signs of infection
๐ Summary Table: Medical Management
Goal
Intervention
Neutralize toxin
Tetanus Immunoglobulin (TIG)
Kill bacteria
Metronidazole / Penicillin G
Control spasms
Diazepam, Midazolam, Baclofen
Maintain airway
Suction, Oxygen, Mechanical ventilation
Nutritional support
IV fluids, NG feeding
Prevent recurrence
Tetanus vaccine during recovery
๐งโโ๏ธ Nursing Management of Tetanus in Children
(In Hospital and Home Settings)
๐ฅ A. Nursing Management in Hospital
โ 1. Isolation and Infection Control
Place the child in a quiet, dark room to minimize noise and light triggers.
Limit visitors to reduce external stimuli.
Follow standard precautions and wound care protocols.
Keep emergency airway and suction equipment at bedside.
โ 2. Airway and Breathing Support
Monitor for signs of respiratory distress (stridor, cyanosis, chest retractions).
Suction secretions gently to prevent aspiration.
Administer humidified oxygen as needed.
Assist with mechanical ventilation or prepare for tracheostomy if ordered.
โ 3. Control of Muscle Spasms
Administer prescribed sedatives (e.g., diazepam, midazolam) as per schedule.
Avoid sudden noises, touch, or bright light โ these can trigger spasms.
Position the child comfortably to prevent muscle strain.
โ 4. Nutritional and Fluid Support
If the child canโt swallow, initiate nasogastric (NG) tube feeding.
Monitor for dehydration, and maintain IV fluid therapy.
Record daily weight and intake/output chart.
โ 5. Medication Administration
Administer:
Tetanus Immunoglobulin (TIG)
Antibiotics (e.g., Metronidazole)
Muscle relaxants as per doctor’s order
Monitor for side effects or allergic reactions.
โ 6. Psychological Support
Calm and reassure the child and parents.
Explain the treatment plan to caregivers in simple language.
Encourage parental involvement in care where possible.
โ 7. Documentation and Monitoring
Monitor and chart:
Vital signs frequently
Spasm frequency and severity
Neurological status
Medication times and response
๐ก B. Nursing Management at Home
Begins after the child is discharged and stabilized
โ 1. Infection Control and Wound Care
Educate parents to keep the wound clean and dry.
Teach proper dressing techniques if needed.
Emphasize hand hygiene and environmental cleanliness.
โ 2. Medication Compliance
Ensure full completion of antibiotic course.
Guide caregivers about timing and dosage of any continued sedatives or muscle relaxants.
โ 3. Nutrition and Rest
Provide a soft, high-calorie, protein-rich diet.
Encourage adequate rest and quiet surroundings.
Promote gradual physical activity as tolerated.
โ 4. Immunization Follow-up
Ensure the child receives Tetanus Toxoid (TT/DPT) as per schedule.
Check siblings and family members for vaccination status.
โ 5. Family Education
Educate about:
Recognizing early signs of recurrence or complications
Safe wound care practices
Importance of completing immunization schedule
Provide emergency contact information for sudden breathing difficulty or seizures.
๐ Summary Chart:
Aspect
Hospital Setting
Home Setting
Environment
Quiet, dark room; limit stimuli
Calm, clean, restful environment
Airway
Suction, oxygen, emergency setup
Monitor for any breathing difficulty
Medications
Administer TIG, antibiotics, sedatives
Ensure full course of prescribed meds
Nutrition
IV/NG feeding if needed
High-calorie, soft diet
Monitoring
Spasms, vitals, neuro signs
Watch for warning signs
Family Education
Disease info, precautions, vaccine schedule
Continued education and support
๐ก๏ธ Prevention and Control of Tetanus in Children
(Updated with Recent Immunization Guidelines โ India, 2023)
โ 1. Primary Prevention (Preventing Occurrence)
๐งฌ A. Immunization
The most effective method to prevent tetanus is through timely vaccination with tetanus toxoid-containing vaccines.
๐น National Immunization Schedule (as per UIP, India):
Age Group
Vaccine
Route
6 weeks
Pentavalent-1 (DPT+Hib+Hep B)
IM
10 weeks
Pentavalent-2
IM
14 weeks
Pentavalent-3
IM
9โ12 months
MR-1 + JE-1 + Vitamin A
IM + Subcut
16โ24 months
DPT Booster-1 + MR-2 + JE-2
IM + Subcut
5โ6 years
DPT Booster-2
IM
10 years
Td (Tetanus + Diphtheria)
IM
16 years
Td Booster
IM
Pregnant Women
Td-1 early in pregnancy
lessCopyEdit **Td-2 after 4 weeks** | IM |
โ Td has replaced TT (Tetanus Toxoid) in recent years to offer continued protection against both Tetanus and Diphtheria.
๐งผ B. Clean Delivery and Cord Care (for Neonatal Tetanus Prevention)
Promote institutional deliveries.
Use sterile instruments for cutting the umbilical cord.
Apply no harmful substances (like mud, ash, ghee) to the stump.
๐ง C. Health Education
Educate parents on:
Importance of complete immunization
Dangers of home deliveries without clean practices
First aid and wound hygiene in children
Avoiding superstitious or harmful remedies
โ 2. Secondary Prevention (Early Detection and Immediate Treatment)
Prompt recognition of early signs: irritability, lockjaw, muscle stiffness
โ 4. Public Health Measures (Control and Community-Level Action)
๐ A. Notification
Tetanus is a notifiable disease.
Health workers must report all suspected/confirmed cases to authorities.
๐ฉโโ๏ธ B. Contact and Community Measures
Trace unvaccinated children in the community.
Conduct booster and catch-up vaccination drives.
Organize awareness campaigns on safe delivery, hygiene, and vaccination.
๐ C. Surveillance and Monitoring
Monitor vaccination coverage
Conduct regular surveys for high-risk areas
๐ Quick Summary Table: Prevention & Control of Tetanus
Level
Action Steps
Primary
Immunization (Pentavalent, DPT, Td), clean delivery, cord care
Secondary
Early recognition, prompt treatment, referral to hospital
Tertiary
ICU care, airway and spasm management, rehabilitation
Public Health
Notification, community awareness, contact tracing, immunization coverage review
๐คง Pertussis (Whooping Cough)
Also known as:Kali Khansi (เคเคพเคฒเฅ เคเคพเคเคธเฅ) Causative Agent:Bordetella pertussis (a Gram-negative coccobacillus) Mode of Transmission:Droplet infection (via coughing/sneezing)
โ Definition
Pertussis is an acute, highly contagious respiratory disease characterized by:
Severe paroxysmal coughing fits
Followed by a high-pitched โwhoopโ sound
Often associated with post-tussive vomiting It primarily affects infants and young children, but can also occur in adolescents and adults.
๐งช Diagnosis
๐น 1. Clinical Diagnosis
Based on the typical stages and symptoms (especially in children)
Ask about:
Recent exposure to coughing individuals
Vaccination history (DPT/Pentavalent)
๐น 2. Laboratory Confirmation
Nasopharyngeal swab culture: Isolation of Bordetella pertussis (gold standard)
PCR test: More sensitive and rapid for detecting bacterial DNA
CBC: Shows lymphocytosis (high lymphocyte count)
Serology: May help in older children or adults
Note: Culture is more reliable in the first 2 weeks of illness.
๐จ Clinical Manifestations
Pertussis progresses through three classical stages:
๐ 1. Catarrhal Stage (Duration: 1โ2 weeks)
Symptoms resemble a common cold:
Mild fever
Runny nose
Sneezing
Mild, dry cough
Watery eyes
Highly infectious phase
๐คฏ 2. Paroxysmal Stage (Duration: 2โ6 weeks)
Characteristic intense symptoms:
Paroxysms (bursts) of severe, spasmodic cough
Inspiratory โwhoopingโ sound after coughing fit
Post-tussive vomiting or exhaustion
Cyanosis (bluish lips) due to oxygen deficiency
Worse at night
Can lead to:
Apnea (in infants)
Subconjunctival hemorrhages, petechiae from intense coughing
Feeding difficulties and weight loss
๐ท 3. Convalescent Stage (Duration: 2โ3 weeks or longer)
Gradual decrease in cough frequency and severity
Recovery phase
Cough may persist for several weeks or months (especially after exertion or cold exposure)
๐ถ Special Consideration: Infants (<6 months)
May not show classic “whoop”
May present with:
Apnea episodes
Bradycardia
Seizures or cyanosis
Higher risk of complications: pneumonia, encephalopathy, or death
๐ง Complications of Pertussis
Pneumonia (most common)
Seizures
Encephalopathy
Dehydration
Rib fractures (from severe coughing)
Death (especially in unvaccinated infants)
๐ฉบ Medical Management of Pertussis (Whooping Cough)
Causative organism: Bordetella pertussis
โ 1. Hospitalization Criteria
Hospital admission is required in:
Infants <6 months
Cases with apnea, cyanosis, or severe respiratory distress
Those with feeding difficulties or complications (like pneumonia or seizures)
โ 2. Antibiotic Therapy
Early treatment (especially in the catarrhal stage) helps reduce transmission and severity.
Antibiotic
Age Group
Duration
Azithromycin
Infants & children
5 days
Clarithromycin
>1 month old
7 days
Erythromycin
All ages (not preferred in neonates due to risk of pyloric stenosis)
14 days
TMP-SMX(Trimethoprimโsulfamethoxazole)
>2 months if allergic to macrolides
14 days
๐น Antibiotics are most effective in the first 2 weeks of illness. ๐น Even after antibiotics, cough may persist due to airway damage.
โ 3. Supportive Treatment
๐ฉน Respiratory Support
Suctioning of secretions gently if needed
Oxygen therapy for cyanosis or respiratory distress
Apnea monitoring in infants
Mechanical ventilation if severe respiratory failure occurs
๐ผ Nutritional Support
Small, frequent feeds
NG tube feeding if the child is too weak to suck
Hydration: IV fluids if oral intake is inadequate
๐ด Environment
Quiet, low-stimulus room to reduce coughing triggers
Keep child in a semi-upright position to ease breathing
โ 4. Complication Management
Pneumonia: Add appropriate antibiotics (e.g., ceftriaxone if secondary bacterial pneumonia is suspected)
Seizures or Encephalopathy: Manage with antiepileptics and supportive neurological care
Apnea/Bradycardia: Monitor vitals continuously and provide advanced airway support if needed
โ 5. Isolation and Infection Control
Isolate child for at least 5 days after starting antibiotics
Educate caregivers on droplet precautions
Avoid contact with unvaccinated infants or pregnant women
โ 6. Chemoprophylaxis for Close Contacts
All household contacts, regardless of age or vaccination status, should receive antibiotic prophylaxis (usually azithromycin for 5 days)
Especially important for:
Infants
Pregnant women in the third trimester
Immunocompromised individuals
โ 7. Immunization Catch-Up
After recovery, ensure the child:
Completes the DPT or Pentavalent vaccine series
Receives Tdap booster if older (10โ16 years)
Natural infection does not provide long-lasting immunity โ vaccination is still needed.
๐ Summary Table: Medical Management of Pertussis
Aspect
Management
Antibiotics
Azithromycin, Clarithromycin, Erythromycin
Supportive Care
Oxygen, suction, feeding support, hydration
Complication Mgmt.
Pneumonia, seizures, apnea โ treat accordingly
Infection Control
Isolation + droplet precautions
Contact Prophylaxis
Antibiotics for close contacts
Immunization
Catch-up DPT/Tdap post-recovery
๐งโโ๏ธ Nursing Management of Pertussis in Children
(In Hospital and Home Settings)
๐ฅ A. Nursing Management in Hospital Setting
โ 1. Infection Control
Isolate the child in a single room (droplet precautions).
Use surgical mask, gloves, and hand hygiene for all caregivers.
Continue isolation until 5 days after starting antibiotics.
Disinfect childโs utensils, linens, and frequently touched surfaces.
โ 2. Airway and Respiratory Care
Monitor respiratory rate and pattern regularly.
Keep suction equipment ready for thick secretions.
Administer humidified oxygen if signs of hypoxia or cyanosis.
Position child in semi-Fowlerโs position to facilitate breathing.
Observe for signs of apnea, cyanosis, or chest retractions in infants.
โ 3. Nutritional Support
Provide small, frequent feeds to avoid triggering cough.
If oral feeding is not possible, initiate nasogastric feeding.
Monitor hydration status: keep track of input/output and daily weight.
Administer IV fluids if oral intake is inadequate.
โ 4. Medication Administration
Administer prescribed antibiotics (e.g., Azithromycin) as per schedule.
Administer antipyretics for fever (e.g., paracetamol).
Observe for side effects of antibiotics and other medications.
โ 5. Psychological Support
Provide a quiet, low-stimulation environment to prevent cough episodes.
Reassure the child and parents โ explain procedures in simple terms.
Encourage parental presence for emotional comfort.
โ 6. Monitoring and Documentation
Record:
Frequency and severity of coughing spells
Vital signs and oxygen saturation
Feeding patterns and fluid balance
Watch for complications: pneumonia, seizures, apnea
๐ B. Nursing Management in Home Setting
โ 1. Continued Medication and Follow-Up
Ensure full course of antibiotics is completed.
Schedule and encourage follow-up visits.
Educate caregivers to monitor for:
Increased coughing
Breathing difficulty
Feeding refusal
โ 2. Nutrition and Rest
Encourage soft, nutritious food and adequate hydration.
Provide frequent rest periods; avoid physical activity during coughing phase.
โ 3. Infection Control at Home
Keep the child away from infants, elderly, and pregnant women.
Practice proper hand hygiene for all family members.
Teach the child (if older) to cover mouth while coughing and dispose of tissues properly.
Poliomyelitis is an acute viral infection caused by the poliovirus, which primarily affects the nervous system, especially the anterior horn cells of the spinal cord, leading to:
Muscle weakness
Flaccid paralysis (typically asymmetric)
Sometimes respiratory failure in severe cases
๐ถ Primarily affects children under 5 years of age ๐ It is a vaccine-preventable disease ๐ฆ Caused by Poliovirus (Types 1, 2, 3) โ Enterovirus of the Picornavirus family
๐งช Diagnosis
๐น 1. Clinical Diagnosis
Sudden onset of acute flaccid paralysis (AFP)
No sensory loss
Fever present at the onset of paralysis
Asymmetric limb involvement
No improvement within 60 days
๐น 2. Laboratory Confirmation
Stool samples (2 samples within 14 days of paralysis):
Tested for isolation of wild or vaccine-derived poliovirus
Throat swab or CSF testing (less commonly used)
RT-PCR: For rapid virus detection
MRI spine/brain: To differentiate from other neurological causes
๐น Surveillance
AFP surveillance is done under the National Polio Surveillance Program (NPSP)
๐จ Clinical Manifestations
Polio has three main forms, depending on the severity:
Kernigโs and Brudzinskiโs signs may be positive
Usually resolves without residual paralysis.
๐ธ 3. Paralytic Poliomyelitis(<1% cases)
Most severe form of polio
Three types: a. Spinal (most common) b. Bulbar (brainstem involved โ may affect breathing) c. Bulbospinal (combined)
Key Signs:
Acute flaccid paralysis (sudden onset, often asymmetric)
Absent deep tendon reflexes in affected limbs
No sensory loss
Muscle wasting in later stages
Respiratory difficulty if diaphragm/intercostal muscles involved
Fever at onset of paralysis
Facial weakness, difficulty in swallowing (bulbar type)
๐๏ธโ๐จ๏ธ Summary Table: Forms of Poliomyelitis
Type
Features
Abortive
Mild fever, sore throat, no CNS signs
Non-paralytic
Neck stiffness, headache, meningeal signs, no paralysis
Paralytic
Sudden flaccid paralysis, no sensory loss, asymmetry, fever
๐ฉบ Medical Management of Poliomyelitis (Polio)
There is no specific antiviral treatment for poliomyelitis. Management is supportive and symptomatic, aimed at reducing complications and aiding recovery.
โ 1. Hospitalization Criteria
Paralytic cases, especially with respiratory involvement
Dehydration, high fever, severe pain, or difficulty in feeding
โ 2. Supportive Medical Care
๐น A. Pain and Fever Control
Paracetamol for fever and muscle pain
Avoid aspirin in children
๐น B. Hydration and Nutrition
Encourage oral fluids and soft diet
IV fluids if child is dehydrated or cannot eat/swallow
Monitor for electrolyte imbalance
๐น C. Management of Paralysis
Rest the affected limb(s) during the acute phase (use splints if needed)
Prevent contractures with proper limb positioning
Start gentle physiotherapy after the acute phase (usually after 2โ3 weeks)
โ 3. Respiratory Support (in Bulbar or Bulbospinal Polio)
Monitor for signs of respiratory muscle involvement: shallow breathing, nasal flaring, cyanosis
Provide oxygen therapy
If needed:
Airway suctioning
Mechanical ventilation
Tracheostomy in severe respiratory paralysis
โ 4. Bladder and Bowel Care
Monitor for urinary retention or incontinence
Use catheterization if needed
Ensure regular bowel movements
โ 5. Prevention of Secondary Infections
Maintain hygiene and skin care
Turn the patient frequently to avoid bedsores
Use antibiotics only if there is evidence of secondary bacterial infection (e.g., pneumonia, UTI)
โ 6. Rehabilitation Therapy
Begin active and passive physiotherapy to:
Regain muscle strength
Prevent muscle wasting
Improve joint mobility
Provide orthotic devices like calipers or braces if needed
Long-term rehabilitation and occupational therapy in severe cases
โ 7. Psychological and Social Support
Reassure the child and parents
Address emotional distress and fear of disability
Link to rehabilitation programs and disability welfare services if needed
๐ Summary Table: Medical Management of Polio
Management Area
Intervention
Fever/Pain
Paracetamol, rest
Nutrition
Soft diet, IV fluids if needed
Paralysis
Limb support, splints, physiotherapy after acute phase
Respiratory Care
Oxygen, suctioning, mechanical ventilation in bulbar polio
Bladder/Bowel
Catheter care, bowel regulation
Infection Prevention
Hygiene, skin care, antibiotics if secondary infection
Rehabilitation
Physiotherapy, braces, disability services
๐ฉโโ๏ธ Nursing Management of Poliomyelitis (Polio)
(In Hospital and Home Settings)
๐ฅ A. Nursing Management in the Hospital
โ 1. Assessment and Monitoring
Monitor:
Vital signs (especially respiratory rate and temperature)
Muscle strength and reflexes in all limbs
Level of consciousness (for bulbar involvement)
Bladder and bowel function
Observe for:
Signs of respiratory distress (nasal flaring, cyanosis)
Signs of aspiration or pneumonia
โ 2. Airway and Respiratory Care
Keep airway clear: suction if secretions present
Administer oxygen if saturation drops
Be prepared for tracheostomy or ventilator support in bulbar polio
Position the child semi-upright to ease breathing
โ 3. Prevention of Deformities and Contractures
Maintain proper limb positioning using pillows/splints
Turn the child every 2 hours to prevent pressure sores
Begin gentle passive physiotherapy after the acute phase
Support flaccid limbs during movement to avoid injury
โ 4. Nutritional and Hydration Support
Encourage small, frequent soft meals
Monitor intake/output and signs of dehydration
Use IV fluids if oral intake is poor
โ 5. Skin Care
Keep skin clean and dry
Perform frequent position changes
Use soft bedding and pressure-relieving devices
Inspect for bedsores daily
โ 6. Elimination Needs
Monitor for urinary retention or incontinence
Provide catheter care if indwelling catheter used
Encourage regular bowel habits
โ 7. Psychosocial Support
Provide emotional support to child and parents
Explain condition and treatment in simple terms
Encourage parental presence and involvement
โ 8. Health Education
Teach family about:
Proper positioning and limb care
Importance of physiotherapy
Follow-up care and rehabilitation services
๐ก B. Nursing Management at Home
โ 1. Home-Based Physiotherapy
Continue active and passive exercises to:
Regain muscle strength
Improve joint mobility
Prevent contractures and deformities
โ 2. Mobility Support
Use calipers, braces, crutches, or wheelchair as prescribed
Encourage independent movements gradually
Arrange home modifications for safety and accessibility
โ 3. Nutritional Support
Provide high-protein, high-energy diet
Monitor weight regularly
Encourage adequate fluid intake
โ 4. Hygiene and Skin Care
Ensure daily bathing and clean clothing
Inspect for pressure sores
Use cushions/mattresses to prevent bedsores
โ 5. Bladder and Bowel Training
Encourage toileting schedule
Manage any incontinence issues with pads or catheterization as needed
โ 6. Health Education for Family
Importance of:
Regular follow-up and immunization
Home-based rehab therapy
Emotional support and patience
Promote school reintegration and social inclusion
โ 7. Psychological and Social Support
Encourage childโs confidence and independence
Involve in age-appropriate activities and games
Link with disability support schemes and vocational training
๐ Summary Table: Nursing Management
Area
Hospital Setting
Home Setting
Airway Care
Oxygen, suction, monitor for apnea
Ensure open airway, educate caregivers
Positioning
Prevent contractures, use splints
Continue exercises, prevent deformities
Skin Care
Frequent turning, pressure relief
Daily inspection, soft bedding
Nutrition
IV/oral feeding, I/O monitoring
Balanced diet, monitor weight
Elimination
Monitor bladder/bowel, catheter care
Toilet training, incontinence care
Education
Explain treatment, encourage parental involvement
Teach home care, promote immunization
Rehabilitation
Refer to physiotherapy, start passive movements
Active rehab, use of aids, community rehab programs
๐ก๏ธ Prevention and Control of Poliomyelitis (Polio)
โ 1. Primary Prevention(Preventing occurrence of disease)
๐น A. Immunization โ The Most Effective Method
Polio is a vaccine-preventable disease. India follows the Universal Immunization Programme (UIP) to protect children.
๐ Vaccines Used:
OPV (Oral Polio Vaccine) โ Live attenuated vaccine
IPV (Inactivated Polio Vaccine) โ Killed virus, given via injection
๐ National Immunization Schedule (India):
Age
Vaccine
Route
Birth
OPV-0 (zero dose)
Oral
6, 10, 14 weeks
OPV-1, 2, 3 + IPV-1, 2
Oral + IM
16โ24 months
OPV Booster + IPV Booster
Oral + IM
National Immunization Days (NIDs)
OPV (Pulse Polio)
Oral
โ Two doses of IPV are now included in Indiaโs routine immunization to supplement OPV.
๐น B. Health Education
Educate parents on:
Importance of full immunization
Attending pulse polio campaigns
Reporting cases of acute flaccid paralysis (AFP)
๐น C. Sanitation and Hygiene
Promote:
Safe drinking water
Hand washing after defecation and before eating
Proper waste disposal
โ 2. Secondary Prevention(Early detection and prompt action)
๐น A. Surveillance of Acute Flaccid Paralysis (AFP)
AFP = sudden onset of limb weakness/paralysis in children <15 years
Stool samples (within 14 days) are collected and tested for poliovirus
Carried out under the National Polio Surveillance Project (NPSP)
๐น B. Immediate Response to Suspected Cases
Immediate notification to health authorities
Isolation of suspected case
House-to-house vaccination in affected areas to stop spread
โ 3. Tertiary Prevention(Rehabilitation and disability prevention)
๐น A. Physiotherapy and Rehabilitation
Prevent deformities and contractures
Support with calipers, braces, crutches, or wheelchairs
Promote school reintegration and social participation
๐น B. Psychological Support
Counsel parents and child
Refer to disability welfare schemes or rehab centers
โ 4. Polio Eradication Strategies in India
India was declared Polio-Free in 2014, but preventive efforts must continue:
๐น A. Pulse Polio Immunization (PPI)
National campaigns giving OPV to all children <5 years, regardless of immunization status
๐น B. Routine Immunization Strengthening
Regular review of coverage
Outreach in hard-to-reach areas
๐น C. Surveillance and Monitoring
AFP surveillance system (reporting network across hospitals and PHCs)
๐น D. Border Immunization
Vaccination booths at international borders to prevent virus re-importation
๐ Summary Table: Prevention and Control of Polio
Level
Actions
Primary
OPV/IPV immunization, pulse polio, health education, hygiene
Secondary
AFP surveillance, stool testing, case reporting
Tertiary
Physiotherapy, orthotic devices, disability support
Measles is a highly contagious, acute viral infection caused by the Measles virus (a Paramyxovirus of the genus Morbillivirus). It primarily affects children and is characterized by:
High fever
Cough, coryza (runny nose), and conjunctivitis
A typical maculopapular rash
Koplikโs spots inside the mouth (pathognomonic sign)
๐ฆ Transmission: Airborne droplets (coughing, sneezing) ๐ท Period of communicability: From 4 days before to 4 days after rash onset โ One of the leading causes of child mortality in unvaccinated populations
๐งช Diagnosis
๐น 1. Clinical Diagnosis (Most Common in Practice)
Based on the classic triad:
Fever
Maculopapular rash
3 Cโs: Cough, Coryza (cold), and Conjunctivitis
Additional features:
Koplikโs spots on buccal mucosa (bluish-white spots with red base opposite molars)
Rash begins behind ears, spreads to face, trunk, then limbs
๐น 2. Laboratory Tests(used for confirmation or surveillance)
Measles-specific IgM antibodies (blood test) โ positive after 3 days of rash
RT-PCR for measles RNA (used in outbreaks or surveillance)
CBC: May show lymphopenia
Throat swab or nasopharyngeal aspirate for virus isolation
๐จ Clinical Manifestations
Measles progresses through three stages:
๐ 1. Incubation Period (7โ14 days)
No symptoms
Virus is replicating in the body
๐คง 2. Prodromal Phase (3โ5 days)
High fever (may reach 104ยฐF or 40ยฐC)
3 Cโs:
Cough
Coryza (runny nose)
Conjunctivitis (red, watery eyes)
Koplikโs spots on buccal mucosa (appear 1โ2 days before rash)
General malaise, photophobia, anorexia
๐ก๏ธ 3. Eruptive/Rash Phase
Maculopapular rash appears:
Starts behind ears and face, spreads to trunk, arms, and legs
Becomes confluent in some areas
Rash fades in the same order as appearance
Fever subsides gradually after rash appears
๐ 4. Recovery Phase
Skin may show brownish discoloration or desquamation (peeling)
Immunosuppression may persist for weeks โ risk of secondary infections
โ ๏ธ Common Complications
Otitis media (ear infection)
Pneumonia (most common cause of measles-related death)
Diarrhea and dehydration
Encephalitis (rare but serious)
Subacute sclerosing panencephalitis (SSPE) โ late fatal complication
๐ฉบ Medical Management of Measles
โ ๏ธ No specific antiviral treatment exists for measles. Management is supportive to relieve symptoms, prevent complications, and improve recovery.
โ 1. Isolation and Infection Control
Isolate the child to prevent the spread (measles is highly contagious).
Maintain airborne precautions for at least 4 days after rash onset.
Ensure good ventilation in the patientโs room.
Educate caregivers on hand hygiene and avoiding close contact with unvaccinated individuals.
โ 2. Symptomatic and Supportive Treatment
๐น A. Fever and Pain Management
Administer paracetamol (acetaminophen) for:
Fever
Headache
Body aches
Avoid aspirin (due to Reyeโs syndrome risk in children).
๐น B. Hydration and Nutrition
Encourage plenty of fluids: water, juice, ORS.
Provide soft, high-calorie, high-protein diet.
Monitor for signs of dehydration: dry tongue, sunken eyes, reduced urine.
๐น C. Eye Care
Clean eyes gently with warm saline swabs.
Use lubricant eye drops if conjunctivitis is severe.
๐น D. Cough and Cold Relief
Keep the child in a calm, dust-free environment.
Use saline nasal drops for nasal congestion.
Use a humidifier or warm fluids to soothe throat irritation.
โ 3. Vitamin A Supplementation
๐ธ WHO and UNICEF recommend Vitamin A to reduce the severity and risk of complications.
Age Group
Vitamin A Dose
Schedule
6โ11 months
100,000 IU orally
Once daily ร 2 days
โฅ12 months
200,000 IU orally
Once daily ร 2 days
Infants <6 months
50,000 IU (in high-risk/poor nutrition)
Same
โ 4. Management of Complications
Complication
Management
Pneumonia
Antibiotics (e.g., amoxicillin) if secondary bacterial infection
Otitis media
Analgesics, antibiotics if bacterial
Severe diarrhea
Rehydration therapy, Zinc supplementation
Encephalitis
Hospitalization, anticonvulsants, supportive neuro care
Eye complications
Vitamin A, ophthalmic care
โ 5. Monitoring and Follow-up
Monitor:
Temperature
Respiratory rate
Signs of complications
Educate caregivers to seek help if:
Child develops difficulty breathing
Becomes lethargic or has seizures
Has persistent diarrhea or ear discharge
โ 6. Immunization (Post-Exposure Prophylaxis)
Measles vaccine (MR or MMR) can be given within 72 hours of exposure in unvaccinated children.
Immunoglobulin (IG) may be given within 6 days for:
Immunocompromised children
Infants <6 months
Pregnant women
๐ Summary Chart โ Medical Management of Measles
Focus Area
Management Strategy
Isolation
Airborne precautions till 4 days after rash
Fever
Paracetamol
Hydration/Nutrition
ORS, fluids, high-calorie diet
Vitamin A
As per WHO dosing guidelines
Complications
Treat infections, rehydration, neuro-care if needed
Follow-up
Monitor vitals, signs of complications
๐ฉโโ๏ธ Nursing Management of Measles (Rubeola)
(In Hospital and Home Settings)
๐ฅ A. Nursing Management in the Hospital
โ 1. Isolation and Infection Control
Airborne precautions: Use of masks and hand hygiene
Isolate the child for at least 4 days after rash onset
Place in a well-ventilated room with limited visitors
โ 2. Monitoring and Assessment
Monitor:
Vital signs (especially temperature and respiratory rate)
Signs of dehydration (dry lips, sunken eyes, poor skin turgor)
Signs of complications: pneumonia, diarrhea, otitis media, encephalitis
Assess for:
Rash progression
Conjunctivitis and eye care needs
โ 3. Fever and Symptom Relief
Administer paracetamol for fever and body ache
Keep child cool and comfortable
Sponge bathing may be used to reduce high temperature
Ensure child drinks enough fluids to avoid dehydration
โ 3. Infection Control at Home
Keep the child away from school and other children for at least 4โ5 days after rash appears
Promote handwashing and cough hygiene
โ 4. Monitoring
Watch for signs of complications:
Fast breathing
Ear discharge
Persistent diarrhea
Seizures or unconsciousness
โ 5. Immunization Advice
Ensure other children in the family are fully immunized (MR/MMR)
Advise parents to attend immunization days and complete vaccine schedules
โ 6. Follow-Up Care
Advise follow-up with healthcare provider to:
Reassess the childโs condition
Administer any missed vaccines
Address nutritional needs or lingering symptoms
๐ Summary Table โ Nursing Management of Measles
Focus Area
Hospital
Home
Infection Control
Isolation, airborne precautions
Avoid contact with others, hygiene
Symptom Management
Paracetamol, eye care, skin care
Continue medication, comfort care
Hydration/Nutrition
Oral/IV fluids, soft food, monitor I/O
Encourage fluids, home-cooked meals
Monitoring
Vitals, complications, rash, eyes
Monitor for danger signs, seek help if needed
Vitamin A
Administer age-specific dose
Ensure completion of dose (if not given in hospital)
Education
Immunization importance, discharge teaching
Emphasize hygiene, immunization, follow-up care
๐ก๏ธ Prevention and Control of Measles (Rubeola)
โ 1. Primary Prevention(Preventing occurrence of disease)
๐น A. Immunization โ The Most Effective Measure
Measles is a vaccine-preventable disease.
๐ National Immunization Schedule โ India:
Age
Vaccine
Route
9โ12 months
MR-1 (Measles-Rubella)
Subcutaneous
16โ24 months
MR-2 (Booster)
Subcutaneous
5โ6 years (in some states)
MMR (Measles, Mumps, Rubella)
Subcutaneous
โ Two doses of measles-containing vaccine provide lifelong protection.
๐น B. Vitamin A Supplementation
Reduces severity, complications, and mortality
Given during measles illness:
6โ11 months: 1 lakh IU orally
โฅ12 months: 2 lakh IU orally
Repeated after 24 hours
๐น C. Health Education
Educate parents and communities about:
Signs and symptoms of measles
Importance of timely immunization
Good hygiene and nutrition during illness
Promote community participation during MR/Measles campaigns
โ 2. Secondary Prevention(Early detection and prompt treatment)
๐น A. Early Diagnosis and Notification
Measles is a notifiable disease
All suspected cases must be reported to health authorities
๐น B. Case Management
Immediate supportive care: hydration, nutrition, fever control
Prevent spread through home or hospital isolation (minimum 4 days after rash)
๐น C. Contact Tracing and Prophylaxis
Identify all unvaccinated close contacts
Give MR/MMR vaccine within 72 hours of exposure (if age-eligible)
Measles Immunoglobulin (IG) can be given within 6 days for:
Infants <6 months
Pregnant women
Immunocompromised children
โ 3. Tertiary Prevention(Prevent complications and promote recovery)
๐น A. Complication Management
Treat secondary infections:
Antibiotics for pneumonia or otitis media
Rehydration for diarrhea
Anti-seizure medications for encephalitis
Continue nutritional support and vitamin A
๐น B. Rehabilitation and Support
Monitor for growth and developmental delays
Educate caregivers on long-term follow-up
โ 4. Public Health Measures and Outbreak Control
๐น A. Surveillance
Integrated Disease Surveillance Programme (IDSP) and WHO-supported programs monitor measles outbreaks and immunization gaps
๐น B. Measles Elimination Strategy (Indiaโs Goal)
India aims to eliminate measles and control rubella by 2023 (targeting <1 case per million population)
๐น C. Mass Immunization Campaigns
MR Campaigns: Vaccinate all children aged 9 months to 15 years, regardless of previous vaccination status
Use ASHA, ANM, and school teachers to mobilize and monitor coverage
๐ Summary Chart โ Prevention and Control of Measles
Level
Interventions
Primary
MR/MMR immunization, Vitamin A, health education, nutrition
Secondary
Early detection, notification, contact tracing, post-exposure prophylaxis
Tertiary
Treatment of complications, rehabilitation, growth monitoring
Public Health
Surveillance, outbreak response, MR campaigns, community participation
๐ค Mumps
โ Definition
Mumps is an acute, contagious viral infection caused by the Mumps virus, a Paramyxovirus of the Rubulavirus genus. It primarily affects the salivary glands โ especially the parotid glands, leading to:
Painful swelling of the cheeks and jaw
Fever and malaise
Occasionally, complications involving the pancreas, testes, ovaries, or central nervous system
๐ฆ Mode of Transmission:
Spread through respiratory droplets (coughing, sneezing)
Contact with saliva or contaminated surfaces
๐ท Incubation period: 14โ18 days ๐ค Infectious: 1โ2 days before to 5 days after gland swelling begins
๐งช Diagnosis
๐น 1. Clinical Diagnosis
Based on typical signs and symptoms, especially:
Painful swelling of one or both parotid glands (below ears)
Fever, malaise, difficulty chewing or swallowing
๐น 2. Laboratory Diagnosis
Used for confirmation in outbreaks or complications:
Test
Purpose
Serum IgM antibodies to mumps
Confirms recent infection
RT-PCR for mumps RNA
Detects viral genetic material
Saliva or throat swab culture
Virus isolation (limited use)
Amylase levels
May be elevated due to parotitis
CSF analysis
In cases of suspected meningitis
๐จ Clinical Manifestations of Mumps
Mumps symptoms range from mild to moderate. About 30% of infected individuals may remain asymptomatic.
๐น 1. Prodromal Symptoms(1โ2 days before swelling)
Low-grade fever
Headache
Muscle aches
Loss of appetite
Fatigue and malaise
๐น 2. Parotitis Stage (Classic Presentation)
Swelling of one or both parotid glands (most common)
Tenderness and pain below ears (especially while chewing or swallowing)
Earache and difficulty opening mouth
Swelling peaks in 1โ3 days and lasts about 5โ7 days
May also involve submandibular and sublingual glands
๐น 3. Other Glandular and Systemic Involvement
Complication/Organ Involved
Manifestations
Testes (Orchitis)
Painful, swollen testicles (common in adolescent boys)
๐ฌ Mumps is a viral infection, so no specific antiviral treatment is available. Treatment is symptomatic and supportive, aimed at relieving discomfort and preventing complications.
โ 1. Isolation and Infection Control
Isolate the patient from school/work for at least 5 days after parotid swelling begins
Educate family members about droplet precautions
Promote hand hygiene and respiratory etiquette
Avoid sharing utensils, towels, or close contact with others
โ 2. Symptomatic Treatment
๐น A. Fever and Pain Relief
Paracetamol or Ibuprofen for:
Fever
Headache
Parotid gland pain
Orchitis-related discomfort
Avoid Aspirin in children (due to risk of Reyeโs syndrome)
๐น B. Swelling and Gland Pain Relief
Apply warm or cold compresses over swollen parotid glands
Use supportive underwear or scrotal support for testicular swelling (orchitis)
Gentle massage may help relieve pain
โ 3. Hydration and Nutrition
Encourage plenty of fluids (to avoid dehydration)
Offer soft, bland diet (avoid sour foods like citrus โ may worsen salivary pain)
Instruct to eat slowly and chew carefully
โ 4. Bed Rest and Comfort Measures
Encourage adequate rest during the febrile and acute phase
Provide a quiet environment to reduce fatigue
โ 5. Management of Complications
If complications occur, provide specialized care:
Complication
Management
Orchitis (testes)
Bed rest, scrotal support, analgesics, cold compresses
Meningitis/Encephalitis
Hospitalization, IV fluids, antipyretics, neurologic monitoring
Pancreatitis
NPO (nothing by mouth), IV fluids, pain management
Hearing Loss
Refer to ENT specialist, audiological evaluation
โ 6. Follow-Up Care
Monitor for:
Relapse or new swelling
Signs of complications like testicular pain, abdominal pain, stiff neck
Educate parents/patient on:
Importance of completing rest period
Recognizing warning signs
Importance of vaccination (MMR) for prevention
๐ Summary Table โ Medical Management of Mumps
Aspect
Management
Infection Control
Isolation, droplet precautions for 5 days post-swelling
Fever/Pain Relief
Paracetamol, ibuprofen, warm compresses
Swelling Care
Cold/warm compresses, scrotal support for orchitis
Outbreak surveillance, case reporting, school-based awareness
๐งผ Chickenpox (Varicella)
โ Definition
Chickenpox is a highly contagious viral disease caused by the Varicella-Zoster Virus (VZV) โ a member of the Herpesvirus family. It is primarily a childhood illness, characterized by:
Fever
Generalized vesicular rash
Intense itching (pruritus)
๐ฆ Mode of Transmission:
Airborne droplets (coughing, sneezing)
Direct contact with vesicle fluid or respiratory secretions
โณ Incubation Period: 10โ21 days (average 14โ16 days) ๐ท Period of Infectiousness: 1โ2 days before rash appears to 5โ7 days after last vesicle crusts
๐งช Diagnosis
๐น 1. Clinical Diagnosis(Most common method)
Based on history and physical findings:
Fever and fatigue
Itchy vesicular rash in different stages (macule โ papule โ vesicle โ crust)
Often starts on trunk, then spreads to face, scalp, and limbs
๐น 2. Laboratory Tests(Used in complicated cases or outbreaks)
Test
Use
Tzanck smear
Shows multinucleated giant cells (nonspecific)
Direct fluorescent antibody
Detects VZV antigen
PCR test
Detects VZV DNA (most specific and sensitive)
Serology (IgM/IgG)
Confirms recent or past infection
๐จ Clinical Manifestations
Chickenpox typically presents in three stages:
๐ธ 1. Prodromal Stage(1โ2 days before rash)
Low-grade fever
Malaise
Headache
Loss of appetite
Mild abdominal pain
In children, the prodrome may be mild or absent.
๐ธ 2. Rash/Eruptive Stage
Rash starts on trunk, then spreads to face, scalp, arms, and legs
Rash evolves in 3 classic stages:
Macules โ flat red spots
Papules โ raised bumps
Vesicles โ fluid-filled blisters
Pustules โ Crusts โ blisters dry out and scab
๐ Characteristic: All stages may be present simultaneously (โpleomorphic rashโ)
Severe itching (pruritus) is common
Rash may appear in the mouth, genitals, or eyes in severe cases
๐ธ 3. Recovery/Crusting Stage
Vesicles dry and form scabs
New lesions stop appearing after 4โ5 days
Crusts fall off in 1โ2 weeks, may leave temporary scars or pigmentation
โ ๏ธ Common Complications
Secondary bacterial infection of skin lesions (especially from scratching)
Pneumonia (especially in adults, pregnant women, immunocompromised)
Encephalitis or cerebellar ataxia
Reyeโs syndrome (if aspirin is given)
Shingles (reactivation of dormant VZV later in life)
๐งผ Chickenpox (Varicella)
โ Definition
Chickenpox is a highly contagious viral disease caused by the Varicella-Zoster Virus (VZV) โ a member of the Herpesvirus family. It is primarily a childhood illness, characterized by:
Fever
Generalized vesicular rash
Intense itching (pruritus)
๐ฆ Mode of Transmission:
Airborne droplets (coughing, sneezing)
Direct contact with vesicle fluid or respiratory secretions
โณ Incubation Period: 10โ21 days (average 14โ16 days) ๐ท Period of Infectiousness: 1โ2 days before rash appears to 5โ7 days after last vesicle crusts
๐งช Diagnosis
๐น 1. Clinical Diagnosis(Most common method)
Based on history and physical findings:
Fever and fatigue
Itchy vesicular rash in different stages (macule โ papule โ vesicle โ crust)
Often starts on trunk, then spreads to face, scalp, and limbs
๐น 2. Laboratory Tests(Used in complicated cases or outbreaks)
Test
Use
Tzanck smear
Shows multinucleated giant cells (nonspecific)
Direct fluorescent antibody
Detects VZV antigen
PCR test
Detects VZV DNA (most specific and sensitive)
Serology (IgM/IgG)
Confirms recent or past infection
๐จ Clinical Manifestations
Chickenpox typically presents in three stages:
๐ธ 1. Prodromal Stage(1โ2 days before rash)
Low-grade fever
Malaise
Headache
Loss of appetite
Mild abdominal pain
In children, the prodrome may be mild or absent.
๐ธ 2. Rash/Eruptive Stage
Rash starts on trunk, then spreads to face, scalp, arms, and legs
Rash evolves in 3 classic stages:
Macules โ flat red spots
Papules โ raised bumps
Vesicles โ fluid-filled blisters
Pustules โ Crusts โ blisters dry out and scab
๐ Characteristic: All stages may be present simultaneously (โpleomorphic rashโ)
Severe itching (pruritus) is common
Rash may appear in the mouth, genitals, or eyes in severe cases
๐ธ 3. Recovery/Crusting Stage
Vesicles dry and form scabs
New lesions stop appearing after 4โ5 days
Crusts fall off in 1โ2 weeks, may leave temporary scars or pigmentation
โ ๏ธ Common Complications
Secondary bacterial infection of skin lesions (especially from scratching)
Pneumonia (especially in adults, pregnant women, immunocompromised)
Encephalitis or cerebellar ataxia
Reyeโs syndrome (if aspirin is given)
Shingles (reactivation of dormant VZV later in life)
๐ฉบ Medical Management of Chickenpox (Varicella)
๐ฆ Chickenpox is a self-limiting viral infection in most children. Treatment is mainly supportive, but antivirals may be used in high-risk or complicated cases.
โ 1. Isolation and Infection Control
Isolate the patient until all lesions are crusted over (usually 5โ7 days after rash onset)
Educate family on:
Airborne and contact precautions
Avoiding contact with pregnant women, newborns, and immunocompromised individuals
โ 2. Symptomatic Treatment (General Care)
๐น A. Fever and Pain Management
Paracetamol (acetaminophen) for:
Fever
Body aches
Avoid aspirin: Risk of Reyeโs syndrome in children
๐น B. Itching (Pruritus) Relief
Apply calamine lotion or cool wet compresses to rash
– Screen pregnant women – Provide ART during pregnancy, delivery, and to newborn
โ Post-Exposure Prophylaxis (PEP)
– Give ART within 72 hours of accidental exposure (e.g., needle stick injuries)
๐งช B. Secondary Prevention (After Exposure but Before Symptoms)
Focus: Early diagnosis and timely intervention
Key Strategies:
Promote early HIV testing.
Start ART as early as possible.
Regular CD4 count and viral load monitoring.
Counseling and support for behavior change.
๐ฅ C. Tertiary Prevention (Managing Complications)
Focus: Reduce disability, enhance quality of life
Key Strategies:
Adherence to ART
Treatment of Opportunistic Infections (OIs)
Rehabilitation and home-based care
Psychosocial counseling
Nutritional and palliative support
๐ฅ 3. National AIDS Control Programme (NACP โ India)
Under the National AIDS Control Organization (NACO), key strategies include:
Information, Education, and Communication (IEC)
Condom promotion
Targeted interventions for high-risk groups (HRGs)
HIV testing & counseling centers (ICTCs)
Antiretroviral Therapy (ART) centers
Blood safety programs
STI/RTI management
๐ 4. Role of Nurse in HIV Prevention & Control
Role
Description
๐ฉโโ๏ธ Educator
Spread awareness on HIV transmission and prevention
๐ฉบ Care Provider
Assist in ART adherence, monitor side effects
๐ค Counselor
Provide emotional support, help reduce stigma
๐ Infection Control Agent
Follow and teach universal precautions
๐ Advocate
Advocate for patient rights and non-discrimination
๐ Key Prevention Messages for Public Awareness
“Always use a condom during sexual activity.”
“Get tested regularly for HIV, especially if at risk.”
“Do not share needles, syringes, or sharp objects.”
“HIV is not spread by touching, hugging, or sharing food.”
“Seek PEP immediately after potential exposure.”
“Start and continue ART for life if HIV-positive.”
๐ฆ Dengue Fever in Children
๐งฌ 1. Definition:
Dengue fever is a mosquito-borne viral illness caused by the Dengue virus (DENV), which has four serotypes (DENV-1 to DENV-4). It is transmitted primarily by the Aedes aegypti mosquito, which bites during the daytime.
Affects infants, children, and adolescents.
It ranges from mild flu-like illness to severe life-threatening dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS).
๐ฌ 2. Diagnosis:
โ A. Clinical Diagnosis:
Based on symptoms, physical examination, and epidemiological factors (season, outbreak, mosquito exposure).
Signs of shock โ cold extremities, restlessness, weak pulse
Hydration status โ skin turgor, mucous membranes, urine output
Neurological status โ altered sensorium, seizures
Abdominal pain, distension (ascites)
โ B. Nursing Interventions
Area
Interventions
๐ง Fluid Balance
– Maintain accurate intake/output chart – Start and regulate IV fluids as per doctor’s orders – Monitor for signs of overhydration (edema, breathlessness)
๐ Medication Administration
– Administer Paracetamol only for fever – Avoid NSAIDs (like ibuprofen, aspirin) due to bleeding risk – Monitor for side effects of medications
๐ Comfort & Rest
– Provide a calm, quiet environment – Encourage bed rest – Maintain skin integrity (prevent bedsores if child is immobile)
๐ฒ Nutritional Support
– Encourage soft, bland diet – Give small, frequent meals – Promote oral fluids if tolerated (ORS, coconut water, soups)
๐งช Monitoring Lab Values
– Observe trends in platelet count, hematocrit, WBC count – Report any sudden drop in platelets or rise in hematocrit
๐ง Emotional Support
– Reassure the child and parents – Reduce anxiety by explaining care procedures – Encourage parental presence during care
โ C. Health Education (While in Hospital)
Teach parents about:
Warning signs of dengue
When to return to the hospital
Importance of follow-up testing
Preventing mosquito bites
๐ก 2. Nursing Management at Home (Home-based Care)
โ A. Environmental Safety
Keep child in a mosquito-free room (use nets, repellents)
Ensure clean and ventilated environment
Avoid mosquito breeding (no stagnant water nearby)
โ B. Supportive Home Care
Area
Interventions
๐ก๏ธ Fever Management
– Give Paracetamol as advised – Cold sponging if fever is high
๐ง Hydration
– Encourage plenty of fluids: ORS, juices, coconut water – Monitor for urine output and signs of dehydration
๐ฝ๏ธ Diet
– Provide nutritious, soft, easily digestible food – Frequent small feeds to maintain energy
๐ฌ Observation for Warning Signs
– Bleeding from any site – Lethargy or confusion – Persistent vomiting – Abdominal pain or difficulty breathing โ Refer immediately to hospital if any warning signs appear
๐ง Rest & Recovery
– Ensure adequate sleep and rest – Avoid school or play during recovery phase
Teach family about care, complications, prevention
๐ Support
Provide emotional comfort to child and family
๐ฆ๐ก๏ธ Strategies for Prevention and Control of Dengue Fever in Children
๐ฏ Objectives:
To prevent mosquito bites
To control mosquito breeding
To educate children and parents
To recognize early symptoms and avoid complications
To promote community participation
โ 1. Personal Protective Measures (Child-Level Prevention)
Strategy
Details
๐ Clothing
– Dress children in light-colored, long-sleeved shirts and pants.
๐งด Repellents
– Apply child-safe mosquito repellents (DEET-based or natural) on exposed skin.
๐๏ธ Bed Nets
– Use mosquito nets, especially for infants and toddlers during daytime naps.
๐ช Physical Barriers
– Keep windows and doors closed or screened, use mosquito meshes.
โฐ Avoid outdoor activity
– Minimize outdoor play during peak mosquito biting hours (early morning and late afternoon).
๐ก 2. Environmental Control Measures
Strategy
Action
๐ง Source Reduction
– Remove stagnant water in flowerpots, coolers, buckets, tires, and utensils every 5โ7 days.
๐งผ Clean Surroundings
– Regularly clean toilets, tanks, and drains to prevent mosquito breeding.
๐ชฃ Dry Days
– Observe weekly dry days in schools and homes to empty and scrub water containers.
๐งช Larvicide Use
– Use temephos (Abate) or other larvicides in water storage tanks (under supervision).
๐ฆ Fogging/Spraying
– In outbreak areas, space spraying (fogging) to kill adult mosquitoes.
๐ง 3. Child Health Education
Audience
Content
๐ฉโ๐ซ Children
– Simple explanation of dengue, mosquito breeding sites – Importance of using nets and repellents
๐จโ๐ฉโ๐ง Parents & Caregivers
– Early signs/symptoms of dengue – When to seek hospital care – Avoiding self-medication (especially NSAIDs like aspirin)
๐ซ Schools
– Encourage “Dengue-Free School” programs – Assign student health monitors to check surroundings weekly
๐ฅ 4. Medical & Community Strategies
Area
Action
๐งช Early Diagnosis & Referral
– Promote early identification of symptoms and referral for care.
๐ Paracetamol Use Only
– Use only paracetamol for fever relief; avoid aspirin/NSAIDs.
๐ฅ Health Services Preparedness
– Ensure availability of pediatric beds, fluids, and trained staff during outbreaks.
๐ฅ Community Participation
– Involve local bodies, ASHA workers, ANMs, teachers, and parents in awareness drives.
๐ข IEC Campaigns
– Use media, posters, folk shows, school events for dengue awareness.
๐ Key Messages to Teach Children and Families:
“Don’t let water collectโmosquitoes breed there!”
“Cover your arms and legs when going outside.”
“Use nets and repellentsโeven during the day.”
“Tell your parents if you have fever, pain, or bleeding.”
“See a doctor earlyโdonโt wait.”
๐ฆ COVID-19 in Children
(Also known as Coronavirus Disease 2019 in pediatric population)
๐งฌ 1. Definition
COVID-19 is a contagious respiratory illness caused by the SARS-CoV-2 virus (Severe Acute Respiratory Syndrome Coronavirus-2).
While adults may experience more severe symptoms, most children have mild or moderate illness, though some can develop serious complications (e.g., MIS-C).
Spread is mainly through respiratory droplets, contact with contaminated surfaces, and close contact with infected individuals.
๐ 2. Diagnosis of COVID-19 in Children
โ A. Clinical Assessment
History of:
Contact with a confirmed COVID-19 case
Travel or exposure in high-risk area
Sudden onset of fever, cough, or breathing difficulty
Gold standard; detects viral RNA from nasal/throat swab
Rapid Antigen Test
Quick result (within 30 mins); lower sensitivity
Chest X-ray/CT scan
Used in moderate to severe cases for lung involvement
Blood Tests
CBC, CRP, D-dimer, Ferritin โ helpful to detect inflammation or MIS-C
Serological Tests
Detect past infection (antibody test), not for active diagnosis
๐งช In some cases, COVID-19 antibodies or PCR tests are used to support the diagnosis of MIS-C (Multisystem Inflammatory Syndrome in Children).
๐ฉบ 3. Clinical Manifestations in Children
โณ Incubation Period:
Typically 2 to 14 days after exposure
๐ง A. Common Symptoms:
(Most children have mild or asymptomatic infection)
Symptom
Notes
๐ก๏ธ Fever
Most common symptom
๐คง Cough
Dry or productive
๐ Cold/Nasal congestion
May resemble common cold
๐คข Nausea, vomiting, diarrhea
Especially in infants and toddlers
๐ด Fatigue, body ache
Seen in older children
๐๏ธ Conjunctivitis
Occasional
๐ Loss of taste or smell
In older children or adolescents
โ ๏ธ B. Severe Symptoms / Complications:
Seen in children with co-morbidities or poor immunity.
Breathing difficulty
Chest pain
Bluish lips/face (cyanosis)
Lethargy or altered consciousness
Poor feeding in infants
Persistent high fever
๐ง C. MIS-C (Multisystem Inflammatory Syndrome in Children):
A rare but serious condition that may develop 2โ6 weeks after COVID-19 infection.
Symptoms of MIS-C
Persistent high fever
Abdominal pain, vomiting, diarrhea
Skin rash
Conjunctivitis (red eyes)
Low blood pressure/shock
Swelling of hands/feet
Confusion or seizures
MIS-C resembles Kawasaki disease or Toxic Shock Syndrome and requires hospitalization.
๐ Medical Management of COVID-19 in Children
๐ฏ Objectives:
The primary goals in managing pediatric COVID-19 include relieving symptoms, preventing disease progression and complications (like MIS-C), maintaining hydration and nutrition, and providing psychosocial support to both the child and caregivers. The approach is based on the severity of the illnessโranging from asymptomatic to critical.
โ 1. Management of Asymptomatic and Mild Cases (Home-based Care)
Children with no symptoms or only mild symptoms (low-grade fever, cough, sore throat, nasal congestion, or mild diarrhea) can usually be managed at home under supervision.
Paracetamol is given for fever (10โ15 mg/kg/dose every 4โ6 hours).
Parents are advised to ensure adequate hydration, encourage oral fluids like ORS, coconut water, and light soups.
The child should rest adequately and be kept in home isolation, especially from elderly or immunocompromised family members.
It is crucial to monitor for warning signs such as persistent high fever, difficulty breathing, refusal to feed, lethargy, or bluish lips. If any of these signs appear, urgent hospitalization is needed.
Parents should also be educated on infection control at home, including mask use, handwashing, and cleaning of frequently touched surfaces.
โ 2. Management of Moderate Cases (Hospital Care)
Children with moderate symptoms may show signs of lower respiratory tract involvement such as rapid breathing or oxygen saturation between 90โ94%.
These children should be admitted for observation and oxygen support, if required.
Oxygen therapy is provided via nasal cannula or face mask if oxygen saturation drops below 94%.
Symptomatic treatment continues with paracetamol, antiemetics (e.g., ondansetron for vomiting), and cough relief as needed.
Intravenous fluids are administered if the child is not able to take oral feeds.
Investigations such as CBC, CRP, D-dimer, ferritin, and LFTs help assess inflammation and risk of complications.
Close monitoring of respiratory rate, oxygen saturation, and fluid balance is essential to prevent rapid deterioration.
โ 3. Management of Severe and Critical Cases (PICU Care)
Severe COVID-19 in children includes features such as respiratory distress, oxygen saturation below 90%, hypotension, altered mental status, or signs of organ dysfunction.
Children with severe illness should be admitted to a Pediatric Intensive Care Unit (PICU).
Oxygen support may escalate from face masks to high-flow nasal cannula (HFNC), non-invasive ventilation, or even mechanical ventilation in critical cases.
Corticosteroids like dexamethasone are used in children with severe COVID-19 to reduce inflammation and prevent further lung injury.
If secondary bacterial infection is suspected, antibiotics are added.
Remdesivir, an antiviral drug, may be used in children above 12 years (and >40 kg) with hypoxia, under specialist supervision.
In critical illness or if the child is diagnosed with MIS-C, anticoagulants (like low molecular weight heparin) are used to prevent clotting.
Hemodynamic support with IV fluids and vasopressors may be required in cases of shock.
โ 4. Management of MIS-C (Multisystem Inflammatory Syndrome in Children)
MIS-C is a serious inflammatory condition that can occur weeks after COVID-19 infection. It mimics diseases like Kawasaki or toxic shock syndrome and needs urgent hospital admission.
Intravenous Immunoglobulin (IVIG) is the main treatment, given at a dose of 2 g/kg over 12โ24 hours.
Corticosteroids, such as methylprednisolone, are added if inflammation is severe or the child does not respond to IVIG.
Low-dose aspirin or anticoagulants are used to prevent clotting complications.
Supportive care includes IV fluids, oxygen, and cardiac monitoring. Echocardiography is often required to evaluate heart function, especially if there is suspicion of coronary artery involvement.
โ 5. Discharge and Follow-up
Children can be discharged once they are:
Fever-free for at least 72 hours
Eating and drinking well
Maintaining normal oxygen saturation without support
Showing improving lab values and no signs of complications
At discharge, parents should be given instructions on continued rest, good nutrition, and the importance of follow-up visits, especially if the child had moderate or severe illness.
๐งโโ๏ธ Nursing Management of COVID-19 in Children
In Hospital and Home Settings
๐ฅ 1. Nursing Management in Hospital Setting
When a child is hospitalized due to moderate to severe COVID-19 symptoms, the role of the nurse is crucial in monitoring, supporting, medicating, educating, and ensuring safety of the child and others.
๐งโโ๏ธ 5. Nursing Management of Influenza in Children
๐ฅ A. In Hospital Setting:
๐ Assessment:
Monitor temperature, respiratory rate, SpOโ
Assess signs of dehydration and oxygen need
Check for secondary infections (ear pain, lung sounds)
๐ Interventions:
Administer medications as prescribed: paracetamol, antivirals
Provide oxygen if needed
Encourage small, frequent feeds and adequate fluids
Maintain oral and nasal hygiene
Isolate the child to prevent spread to others
Educate parents on medication, hygiene, and warning signs
Provide psychological comfort and rest
๐ก B. At Home (Mild Cases):
โ Caregiver Education:
Keep the child at home and isolated until fever-free for 24 hours
Ensure bed rest and comfort
Give fluids and nutritious diet
Use paracetamol only for fever; avoid cold/flu over-the-counter medicines in young children
Observe for worsening symptoms: difficulty breathing, persistent fever, refusal to feed
โ Monitoring:
Track temperature and fluid intake
Watch for any danger signs (lethargy, dehydration, fast breathing)
๐ก๏ธ 6. Strategies for Prevention and Control of Influenza in Children
โ A. Vaccination:
Annual influenza vaccination is the most effective preventive strategy.
Recommended for all children above 6 months of age, especially high-risk groups.
โ B. Infection Control Practices:
Hand hygiene โ frequent washing with soap and water
Respiratory hygiene โ cover mouth/nose while sneezing/coughing
Use of face masks for sick children or caregivers
Avoid close contact with sick individuals
Disinfect toys, doorknobs, and surfaces regularly
โ C. Environmental Measures:
Ensure good ventilation at home and school
Maintain clean surroundings to reduce viral spread
โ D. School and Community Strategies:
Keep symptomatic children at home
Educate school staff and parents on signs, symptoms, and precautions
Health education programs during flu season
โ E. Nurseโs Role in Prevention:
Promote awareness about flu vaccination
Teach families about flu symptoms and early care
Help reduce stigma and misinformation
Participate in school health programs and immunization drives
๐ฆ Hepatitis A in Children
๐งฌ 1. Definition
Hepatitis A is a highly contagious viral liver infection caused by the Hepatitis A Virus (HAV), transmitted primarily through the fecal-oral route. It is especially common in areas with poor sanitation and hygiene, and children are among the most affected groups.
It causes acute liver inflammation, but does not lead to chronic disease.
Most children recover completely within a few weeks to months.
๐ฌ 2. Diagnosis
โ A. Clinical Diagnosis
Based on symptoms like jaundice, fever, nausea, and fatigue
History of exposure to contaminated food or water
โ B. Laboratory Diagnosis
Liver Function Tests (LFTs):
Elevated ALT, AST, and bilirubin
Serological Test:
IgM anti-HAV antibodies โ confirm recent or active infection
Prothrombin Time (PT/INR): to assess liver synthetic function in severe cases
๐ฉบ 3. Clinical Manifestations in Children
โณ Incubation Period: 15 to 50 days (average: 28 days)
๐ก๏ธ Common Symptoms:
Low-grade fever
Fatigue and weakness
Loss of appetite
Nausea or vomiting
Abdominal pain, especially in the right upper quadrant
Dark-colored urine
Pale stools
Yellowing of eyes and skin (jaundice) โ more noticeable in older children/adolescents
In many young children, the illness may be asymptomatic or very mild.
๐ 4. Medical Management of Hepatitis A in Children
There is no specific antiviral treatment for Hepatitis A. Management is mainly supportive, aimed at relieving symptoms and preventing complications.
โ Supportive Care:
Adequate rest is crucial during the acute phase.
Maintain hydration with fluids and electrolytes.
Nutritious, easily digestible dietโavoid fatty, fried, and spicy foods.
Use paracetamol for fever or discomfort (avoid hepatotoxic drugs like aspirin).
Avoid strenuous activity until liver enzymes return to normal.
โ Hospitalization Indications:
Persistent vomiting leading to dehydration
Severe jaundice
Hepatic encephalopathy (rare)
Signs of liver failure (bleeding, altered consciousness)
๐ฉโโ๏ธ 5. Nursing Management of Hepatitis A in Children
๐ฅ A. In Hospital Setting
๐ Assessment:
Monitor vital signs
Observe for jaundice, fatigue, nausea, and abdominal tenderness
Check for signs of dehydration or bleeding
Track liver function tests (LFTs) and overall nutritional intake
๐ Interventions:
Provide adequate rest and calm environment
Ensure oral or IV hydration as needed
Administer medications as prescribed (e.g., paracetamol)
Offer small, frequent mealsโhigh in carbohydrates, low in fat
Maintain hygiene and prevent cross-infection
Educate parents about the importance of rest, diet, and hand hygiene
Use universal precautions to prevent nosocomial spread
๐ก B. At Home
โ Parental Education:
Encourage plenty of rest
Provide bland, non-oily food (khichdi, fruits, juices)
Emphasize frequent handwashing, especially after toilet use
Ensure use of safe drinking water
Avoid school or daycare until jaundice subsides and recovery is complete
โ Monitoring:
Keep track of childโs urine color, appetite, fatigue
Report if child shows signs of persistent vomiting, drowsiness, or bleeding
๐ก๏ธ 6. Prevention and Control Strategies in Children
โ A. Hepatitis A Vaccination
Most effective method of prevention
Given in 2 doses:
First dose at 12 months of age
Second dose after 6โ18 months
โ B. Improved Hygiene and Sanitation
Teach hand hygiene: wash hands after using the toilet and before eating
Encourage personal hygiene in schools and homes
Use soap and clean water
โ C. Safe Drinking Water and Food Practices
Boil or purify drinking water
Avoid raw or undercooked food
Wash fruits and vegetables thoroughly
โ D. Isolation During Illness
Infected child should stay at home for at least 1โ2 weeks
Avoid contact with food preparation areas
Use separate utensils and towels
โ E. Public Health Education
Community awareness campaigns on:
Safe water use
Importance of vaccination
Food hygiene
๐ Summary: Role of Nurse
Act as educator: Promote awareness and hygiene
Provide supportive care and emotional comfort
Ensure infection prevention in clinical and home settings
Assist in school health programs and immunization drives
๐งฌ Hepatitis B in Children
โ 1. Definition:
Hepatitis B is a serious viral infection of the liver caused by the Hepatitis B Virus (HBV), a DNA virus from the Hepadnaviridae family.
It is transmitted through blood and body fluids (perinatally, via unsterile injections, or from infected household contacts).
In children, especially infants infected at birth, the infection often becomes chronic, leading to long-term liver damage, cirrhosis, or liver cancer later in life.
โ 2. Diagnosis of Hepatitis B in Children
๐ A. History & Clinical Suspicion:
History of vertical transmission (mother is HBsAg positive)
Exposure to infected blood/products or unvaccinated status
๐ฌ B. Laboratory Tests:
Test
Purpose
HBsAg (Hepatitis B surface antigen)
Indicates current infection
Anti-HBs
Indicates immunity (from past infection or vaccine)
Anti-HBc IgM
Indicates recent acute infection
HBV DNA (PCR)
Measures viral load
LFT (Liver Function Tests)
Raised ALT/AST, abnormal bilirubin in active cases
If HBsAg persists beyond 6 months, it’s considered chronic Hepatitis B.
โ 3. Clinical Manifestations in Children
โณ Incubation Period: 1 to 6 months (average 60โ90 days)
๐ถ A. In Infants and Young Children:
Usually asymptomatic (but higher risk of chronic infection)
Occasionally mild:
Fatigue
Poor appetite
Abdominal discomfort
๐ง B. In Older Children and Adolescents:
Fever
Fatigue and malaise
Loss of appetite
Nausea, vomiting
Jaundice (yellow skin and eyes)
Dark-colored urine
Pale stools
Right upper quadrant abdominal pain
โ ๏ธ Complications (in Chronic Cases):
Chronic liver disease
Cirrhosis
Hepatocellular carcinoma (liver cancer)
๐ 4. Medical Management of Hepatitis B in Children
There is no cure for Hepatitis B, but it can be controlled and monitored.
โ A. For Acute Hepatitis B (new infection):
Supportive care only
No antiviral treatment unless severe liver dysfunction
Ensure adequate hydration, rest, and nutrition
โ B. For Chronic Hepatitis B:
Referral to pediatric hepatologist
Antiviral therapy is considered if:
High viral load (HBV DNA)
Elevated liver enzymes (ALT)
Evidence of liver damage (fibrosis/cirrhosis)
Common antivirals (in older children):
Tenofovir, Entecavir, or Interferon alfa-2b
โ Monitoring Includes:
Regular LFTs
HBV DNA levels
Ultrasound and AFP (to detect early liver cancer in chronic cases)
๐ฉโโ๏ธ 5. Nursing Management of Hepatitis B in Children
๐ฅ A. In Hospital Setting (For Acute or Severe Cases)
๐ Assessment:
Monitor vital signs, especially fever and jaundice
Assess for nausea, vomiting, fatigue, and signs of dehydration
Observe urine and stool color
๐ Interventions:
Administer medications as prescribed
Provide adequate fluid intake (oral/IV)
Encourage rest and comfort
Provide a high-calorie, protein-rich, low-fat diet
Prevent transmission with strict hand hygiene and PPE
Monitor lab reports (ALT, bilirubin, HBV DNA)
๐ Parent Education:
Explain nature of the disease
Teach hygiene practices and importance of follow-up
Avoid sharing toothbrushes, razors, etc.
๐ก B. At Home
โ General Care:
Ensure rest and light activity as tolerated
Encourage plenty of fluids
Maintain nutritious diet
โ Infection Control at Home:
Do not share personal items
Clean up blood spills with bleach solution
Wash hands frequently
โ Long-term Monitoring:
Regular check-ups with liver function tests
Adherence to medication if on antivirals
Screening for liver complications in chronic cases
๐ก๏ธ 6. Prevention and Control Strategies in Children
โ A. Hepatitis B Vaccination (Most Effective Prevention)
Part of National Immunization Schedule
Given in 3โ4 doses:
Birth dose (within 24 hours)
Followed by 2 or 3 more doses at 6, 10, and 14 weeks or per schedule
The birth dose is critical in preventing perinatal transmission.
โ B. Passive Immunization for Newborns (If mother is infected)
HBIG (Hepatitis B Immunoglobulin) + Hepatitis B vaccine within 12โ24 hours of birth
โ C. Health Education
Promote awareness about:
Modes of transmission
Importance of immunization
Safe injection practices
โ D. Infection Control Practices
Use sterile equipment (injections, piercings, dental)
Practice safe blood transfusions
Screen pregnant women for HBsAg
Avoid sharing sharp objects
โ E. School and Community Measures
Do not isolate the child socially
Educate schools about non-casual transmission
Encourage universal vaccination and hygiene practices
๐ Nurse’s Role Summary
Act as caregiver, educator, and advocate
Support family emotionally
Emphasize vaccination and regular follow-up
Prevent stigma and promote safe practices
๐๏ธ๐ฃ๐ Hand, Foot and Mouth Disease (HFMD)
๐งฌ 1. Definition:
Hand, Foot, and Mouth Disease (HFMD) is a mild, contagious viral illness commonly affecting infants and children under 5 years.
Caused mainly by Coxsackievirus A16 and Enterovirus 71.
Characterized by fever, painful sores in the mouth, and rash/blisters on hands, feet, and buttocks.
Spread through direct contact with nose/throat secretions, saliva, blister fluid, and feces of infected children.
๐ Often spreads in daycare centers, preschools, and among siblings.
๐ 2. Diagnosis
โ A. Clinical Diagnosis:
Based on:
Characteristic rash on hands, feet, and mouth
Presence of fever
Age of the child
History of exposure in school or community
โ B. Laboratory Tests (Rarely Needed):
Usually not required, but can include:
Throat swab, stool sample, or vesicle fluid to detect virus (PCR test)
Used in severe cases or outbreaks
๐ฉบ 3. Clinical Manifestations
โณ Incubation Period: 3โ6 days
๐ถ Common Symptoms:
Fever (mild to moderate, first sign)
Painful mouth sores (ulcers on tongue, inside cheeks, throat)
Red spots or blisters on:
Palms of hands
Soles of feet
Buttocks and sometimes elbows/knees
Poor feeding
Drooling (due to painful mouth ulcers)
Irritability or fussiness
โ ๏ธ Rarely, enterovirus 71 can lead to serious complications like viral meningitis, encephalitis, or acute flaccid paralysis.
๐ 4. Medical Management of HFMD
HFMD is self-limiting, and symptoms usually resolve in 7โ10 days. There is no specific antiviral treatment.
โ Supportive Care:
Paracetamol or ibuprofen for fever and pain relief
Topical oral gels (e.g., lidocaine) for mouth ulcer pain
Encourage cold fluids, soft diet to avoid irritating ulcers
Good hydration is essential to prevent dehydration (especially if mouth ulcers limit fluid intake)
๐ฅ A. In Hospital Setting (For Moderate to Severe Cases)
๐ Assessment:
Monitor:
Fever and pain level
Oral intake and hydration
Skin rash and discomfort
Signs of dehydration
Neurological signs if severe enterovirus infection suspected
๐ Interventions:
Administer antipyretics and pain relievers
Provide oral hygiene care
Use mouthwashes or cold drinks to soothe ulcers
Maintain fluid and nutritional support
Apply topical soothing creams for skin rash (if itchy)
Encourage hand hygiene and isolation to prevent spread
๐ก B. At Home (For Mild Cases)
โ General Care:
Ensure rest and comfort
Offer cold, soft, bland foods (curd, mashed banana, ice cream)
Give plenty of fluids (water, ORS, milkshakes)
Use paracetamol for fever
Clean mouth gently; use a straw if needed
โ Infection Control:
Keep the child isolated for 7โ10 days
Maintain handwashing, especially after diaper changes
Clean toys, doorknobs, and surfaces regularly
โ Parental Education:
Teach signs of complication (lethargy, poor oral intake, drowsiness)
Advise to avoid sending child to school or daycare until fully recovered
๐ก๏ธ 6. Strategies for Prevention and Control in Children
โ A. Hand Hygiene
Teach children frequent handwashing with soap and water
Especially before eating and after using the toilet
โ B. Personal and Environmental Hygiene
Clean and disinfect toys, surfaces, and frequently touched objects
Use separate utensils and towels for the infected child
โ C. Avoid Contact
Isolate the infected child from school, playgroups, or daycare
Keep at home until fever resolves and blisters dry up (usually 7โ10 days)
โ D. Parental and School Awareness
Educate parents and caregivers about symptoms and transmission
Encourage early reporting of cases in schools to prevent outbreaks
โ E. No Vaccine Yet
Currently, no vaccine is available for HFMD
Prevention relies on hygiene and limiting spread
๐ Nurseโs Role Summary:
Educator: Promote hygiene and awareness among parents, schools
Caregiver: Relieve discomfort and monitor for complications
Infection Controller: Enforce isolation, cleaning, and hand hygiene
Advocate: Prevent school-based stigma and ensure proper rest
๐ง Acute Diarrheal Diseases in Children
๐งฌ 1. Definition:
Acute diarrhea is defined as the passage of three or more loose or watery stools per day, lasting less than 14 days, often accompanied by dehydration, fever, vomiting, or abdominal pain.
It is a major cause of morbidity and mortality in children under 5, especially in low-resource settings.
Caused by viral, bacterial, or parasitic infections, often transmitted via contaminated food, water, or poor hygiene.
๐ฌ 2. Diagnosis:
โ A. Clinical Diagnosis:
Based on history and observation of:
Frequency, consistency, and duration of stools
Presence of blood or mucus
Associated symptoms: vomiting, fever, dehydration
โ B. Laboratory Tests (if needed):
Stool examination: For parasites, blood, WBCs
Stool culture: For bacterial pathogens (e.g., Shigella, Salmonella, E. coli)
Rapid tests: For Rotavirus or cholera
Serum electrolytes and urea: In moderate/severe dehydration
๐ฉบ 3. Clinical Manifestations:
Symptom
Description
๐ฉ Diarrhea
Frequent, loose or watery stools
๐คฎ Vomiting
Common in viral diarrhea
๐ก๏ธ Fever
Suggests infection
๐ซ Signs of dehydration
Dry mouth, sunken eyes, decreased urine, lethargy
๐ Weight loss
If diarrhea is prolonged
๐ซ Refusal to feed
Especially in infants
๐ Blood in stool
Suggests bacterial cause (e.g., dysentery)
๐ 4. Medical Management of Acute Diarrhea in Children
The main goal is to prevent and correct dehydration, ensure nutrition, and treat any underlying infection.
โ A. Oral Rehydration Therapy (ORT):
ORS (Oral Rehydration Solution) is the cornerstone of treatment.
WHO-recommended ORS contains sodium, potassium, glucose, and citrate.
Give frequent small sips, even during vomiting.
โ B. Zinc Supplementation:
Zinc sulfate 20 mg/day for 14 days (10 mg/day for infants <6 months)
Reduces duration, severity, and recurrence of diarrhea