Coppin State University NURS 323: Common pediatric communicable diseases Study Guide_ Complete Latest 2026.

Coppin State University NURS 323: Common pediatric communicable diseases Study Guide_ Complete Latest 2026. After completion of the lesson, the student will be able to: 1. Discuss the role of the nurse in infection control in the pediatric population. 2. Discuss etiology, pathophysiology, prevention, care, and treatment of childhood communicable disease. 3. Examine immunotherapy concepts, provision of atraumatic care related to immunizations, and administration of vaccines across the lifespan. 4. Discuss etiology, pathophysiology, prevention, care, and treatment of transmissible diseases, infections, and infestations. 5. Apply the nursing process using clinical judgment functions while providing care to pediatric clients who have a communicable or transmissible disease. 6. Examine the anatomy, physiology, pathophysiology, and screening of pediatric clients experiencing alterations in integumentary function. 7. Explore etiology, epidemiology, risk factors, clinical presentation, diagnosis, and treatment of alterations in integumentary function in pediatric clients. 8. Describe the effect of alterations in integumentary function on pediatric clients’ overall health. 9. Explore the role of the nurse when caring for pediatric clients experiencing alterations in integumentary function. 10. Apply the nursing process using clinical judgment functions while providing care to pediatric clients experiencing alterations in integumentary function. Role of the Nurse in Infection Control in the Pediatric Population Page 1 Infection Control Infection control is an aspect of health care, and nurses play a vital role in preventing the spread of infections, especially in the vulnerable pediatric population. Their responsibilities encompass a wide range of activities aimed at minimizing the risks of communicable diseases within health care settings. Nurses serve as advocates, educators, and implementers of infection control measures, contributing significantly to the overall health and well-being of pediatric clients. Nurses engage in health promotion activities, emphasizing the importance of healthy lifestyles, proper nutrition, and adequate sleep to enhance the immune systems of pediatric clients. They also advocate for the implementation of policies and practices that support infection control in health care facilities. Education and communication are two important actions the nurse can take to help the pediatric population with infection control. Nurses educate both pediatric clients and their families about proper hygiene practices, including handwashing, cough etiquette, and maintaining a clean environment. Effective communication ensures that families are well-informed about the importance of immunizations, helping to prevent the occurrence of vaccine-preventable diseases among children. Benefits of Providing Client EducationNurses have the opportunity to provide client education with every encounter. Some of the benefits of client education include: · Improving the client’s health status · Encouraging and promoting client autonomy and decision making · Promoting the adoption of healthy lifestyle practices · Promoting client safety, especially regarding medications and the management of illnesses · Promoting client adherence to the prescribed treatment plan · Reducing client anxiety · Improving client outcomes Nurses set a positive example by consistently practicing proper hand hygiene, and they actively encourage clients, families, and fellow health care staff to adopt the same practice. Regular handwashing stands as a fundamental preventive measure in curbing the transmission of infections. Nurses also provide screening and assessments for the pediatric population to identify potential infections and help with the immunization of the pediatric population. As part of the primary care pediatric team working in physician practices and community clinics, they ensure vaccines are administered according to recommended schedules. They also monitor for any adverse reactions and maintain accurate records of immunizations. This role contributes directly to the prevention of various infectious diseases. Scope of Practice PN PNs collect data during screenings of the pediatric population to identify potential infections and assist with the immunization of the pediatric population. They ensure vaccines are administered according to recommended schedules as part of the primary care pediatric team working in physician practices and community clinics. They also monitor for any adverse reactions and maintain accurate records of immunizations. This role contributes directly to the prevention of various infectious diseases. Nurses play a crucial role in ensuring children are on schedule with their immunization regimen through a variety of essential steps. First and foremost, they engage in comprehensive client education. Nurses inform parents about the importance of vaccines, the recommended schedule based on the child's age, and the specific vaccines required. This education includes discussions about vaccine-preventable diseases and their potential risks, emphasizing the benefits of timely immunization in safeguarding children's health.Scope of Practice PN Nurses play a crucial role in ensuring children are on schedule with their immunization regimen through a variety of essential steps. First and foremost, nurses reinforce comprehensive education with parents about the importance of vaccines, the recommended schedule based on the child's age, and the specific vaccines required. This includes discussions about vaccine-preventable diseases and their potential risks, emphasizing the benefits of timely immunization in safeguarding children's health. Additionally, nurses actively monitor and maintain accurate records of children's immunizations. They keep meticulous track of each child's immunization history, noting the vaccines received, the due dates for upcoming doses, and any missed immunizations. Nurses employ reminder systems (through electronic health records, phone calls, or mailed reminders) to notify parents about upcoming immunizations or missed doses. Nationally Notifiable Diseases Certain diseases and conditions are considered nationally notifiable diseases, which must be reported to the National Notifiable Disease Surveillance System. The following is a list of the reportable diseases discussed within this module. · COVID-19 · Diphtheria · Giardiasis · Haemophilus influenzae · Hepatitis A · Hepatitis B · Hepatitis C · Meningitis · Pertussis · Poliomyelitis · Rubella · Tetanus · VaricellaA nurse is caring for an infant in an outpatient clinic during a routine visit and notices that the infant has not received any immunizations since birth. The child’s parent states, “I have decided not to vaccinate my baby.” Which of the following actions should the nurse take first? A Educate the infant’s parent on the importance of receiving immunizations. B Notify the provider of the parent’s decision to not vaccinate the infant. C Document the parent’s decision to not have their infant vaccinated. D Perform a growth and development screening on the infant. Precautions Nurses have an important role in infection control precautions for the pediatric population. Through education, assessment, communication, and compassionate care, they contribute significantly to preventing the spread of infections, ensuring the well-being of pediatric clients, and creating safe health care environments for all. At certain stages of development, children frequently engage in hand-to-mouth activity as they explore their environment. This behavior, combined with an immature immune system, increases the risk of children contracting infectious respiratory and gastrointestinal diseases. The pediatric population is also at higher risk of infection in the health care environment when they are treated by many different providers that go room to room, which is an important consideration for the nurse at the point of care. It has long been known that handwashing is the first step in preventing infections. The focus often remains on the handwashing of health care workers, but the handwashing of pediatric clients, their families, and visitors has now caught the eye of infection-control specialists. Loved ones and visitors can transfer illnesses from the clinical setting to the community and can pass it back and forth within the clinical setting as well. First, put your hands under running water. Second, apply soap to your hands. Third, lather away from running water. Fourth, wash hands under running water. Fifth, dry hands thoroughly with a clean towel. PROPER HANDWASHING Part of dealing with infection precautions for the pediatric population is making sure that clients are on the correct isolation precautions. There are two categories of precautions used when trying to prevent the spread of an infection in the hospital setting: standard precautions (which are used with all clients) and transmission-based precautions (which are added for further protection for specific contagious agents). Standard precautions are universally applied for all pediatric clients when they are in the hospital setting, whether there is a confirmed or suspected infectious agent. Standard precautions are based on the concept that all blood, body secretions and excretions (except sweat), damaged skin, and mucous membranes might contain contagious agents. Preventive measures encompassvarious actions, including maintaining hand hygiene, utilizing personal protective equipment (PPE) (such as gloves, gowns, masks, eye protection, or face shields), and ensuring safe injection practices. It is important that health care workers know and understand how to properly apply PPE. The PPE is intended to protect both the client and health care workers from spreading contagious agents. Transmission-based precautions can be divided into three types: contact, airborne, and droplet precautions. The infectious agent and how it is transmitted determines the specific type of precaution. For example, if the pediatric client is diagnosed with scabies, the client will be placed on contact precautions because the infectious agent is spread through direct or indirect skin contact. For infections that can be spread through more than one route, multiple transmissionbased precautions will be implemented. The appropriate PPE is determined once the infectious agent is identified, and the client is then placed on precautions. Droplet Precautions · When dealing with agents that are transmitted through close (less than 3 feet) respiratory or mucous membrane contact with infected respiratory secretions: o Infectious micro-organisms do not remain infectious over long distances. Therefore, special air ventilation is not required. o Single client room is preferred. o Health care workers apply a standard face mask for close (less than 3 feet) contact, which should be applied upon entering the child’s room. o Children should wear a surgical mask as tolerated if transported outside the room (e.g., to x-ray department). · Examples include pertussis, influenza virus, meningitis, adenovirus, rhinovirus, and group A Streptococcus. Contact Precautions · When dealing with agents that are spread through any indirect or direct contact with the child or the child’s environment (for example, equipment, bed controls, toys, or linens): o A single-client room is preferred.o Health care workers should apply a gown and gloves before entering the child’s room. o All PPE should be removed and placed in trash receptacle immediately prior to exiting the child’s room. · Examples include excessive wound drainage, stool contamination of Clostridium difficile (C. difficile) or vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), or other bodily fluids. Airborne Precautions · When dealing with agents that are transmitted through the spread of infectious microorganisms suspended in the air and can travel long distances: o A negative pressure room is preferred. o Health care workers should apply an N95 mask or other respirator per the diseasespecific recommendations (e.g., tuberculosis needs an N95 mask). o Apply specified mask before entering the child’s room. · Examples include tuberculosis, SARS-CoV, and the rubeola and varicella viruses. Match the following clients to the type of precaution that should be implemented. Drag the options on the left to their match on the right (or match pairs by first selecting the option on the left and then selecting its match on the right). A 6-month-old infant with suspected bacterial meningitis, currently receiving intravenous antibiotics A 12-year-old with a known diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) skin infection A 2-year-old with suspected tuberculosis (TB), presenting with persistent cough and weight loss Contact precautions Airborne precautions Droplet precautions Applying PPE follows a precise sequence that is crucial in preventing the transmission of infectious agents. It begins with correct hand hygiene, utilizing soap and water or alcohol-based sanitizers. Then isolation gowns are donned, ensuring full coverage of the torso and securingfastenings to prevent exposure. The mask or respirator follows, snugly fitting over the nose and mouth to create a barrier against airborne particles. Goggles or face shields are then worn to shield the eyes, ensuring complete coverage. Finally, gloves are applied, covering the cuffs of the gown or sleeves and maintaining a secure fit. Adhering to proper PPE application guidelines is pivotal in safeguarding health care workers and minimizing the risk of contamination during client care or exposure to infectious materials. Regular training and following standardized protocols ensure effective infection control measures and a safer health care environment. Place the application of PPE in the correct order. Drag the options on the left to their match on the right (or match pairs by first selecting the option on the left and then selecting its match on the right). Put on gloves to protect the hands. Place mask or respirator to protect the respiratory system. Put on goggles or a face shield to protect the eyes. Don gown for full-body coverage. First Second Third Fourth After wearing PPE, the front and sleeves of gowns, the outside of goggles or face shields, and the front of masks or respirators are all considered contaminated. When removing PPE, careful attention must be applied to ensure that clothing, skin, or mucous membranes do not come in contact with infectious materials. Gloves should be removed first and discarded in the appropriate waste receptacle. If goggles or a face shield are worn, remove them from the back by lifting the headband up and over the head. Unfasten the ties of the gown and, from the inside of the gown, pull the gown down and away from the neck and shoulders. Turn the gown inside out as it’s removed, bundling it into a ball, then discard it in the appropriate waste receptacle. Remove the face mask last by grasping the bottom ties first, then the top, and removing it. Perform hand hygiene. If hands become contaminated at any time during a step, perform hand hygiene again prior to moving on to the next step. Place the removal of PPE in the correct order. Drag the options on the left to their match on the right (or match pairs by first selecting the option on the left and then selecting its match on the right). Remove goggles or face shield. Remove gloves. Remove face mask or respirator. Remove gown. First Second Third Fourth ● Previous Page● 1 ● Next Page Communicable Diseases Page 1 Chickenpox (Varicella) Pathophysiology Chickenpox, or varicella, is a contagious disease that is caused by the varicella-zoster virus (VZV). The primary infection from the virus results in chickenpox. After a person recovers from chickenpox, the virus remains in the body in a latent form. Explore the 3D visualization of chickenpox (varicella) below. CHICKENPOX Etiology and Risk Factors Chickenpox is contracted by inhaling the infected aerosolized virus or by coming in contact with fluid from an open vesicle. The virus exhibits high contagion, facilitating rapid transmission. The primary infection takes place within the upper respiratory tract's mucous membranes. Within a span of 2 to 6 days, the virus enters the bloodstream, leading to another episode of viremia in 10 to 12 days. During this period, the distinctive vesicle emerges. Although IgA, IgM, and IgG antibodies are generated, it is the IgG antibodies that provide enduring immunity. Following the initial infection, varicella localizes to sensory nerves and may later reactivate, resulting in the development of shingles (herpes zoster). viremia Clinical Presentation Chickenpox causes a skin rash characterized by small, itchy blisters that eventually form scabs.Typically beginning on the chest, back, and face, the rash subsequently spreads over other areas of the body, such as the mouth, eyelids, genitals, and scalp. Individuals also present with fever, fatigue, sore throat, and headaches, which last approximately 5 to 7 days. John-Kelly/iStock/Getty CHICKENPOX Lab Testing and Diagnostic Studies The diagnosis for chickenpox is usually done according to the manifestations. The disease is confirmed by taking a sample of fluid from the fluid-filled vesicles or by scraping the crust from a vesicle that has ruptured and scabbed. A blood sample may also be drawn to look for evidence of an acute immunologic response. Treatment The treatment for chickenpox is primarily supportive for manifestation relief and the client’s overall well-being during the infection. As chickenpox is a viral illness, antibiotics are not effective management. Acetaminophen may be given as an antipyretic to reduce fever, andanalgesic may be given to reduce discomfort and pain. Aspirin is avoided during all childhood viral infections in order to avoid the risk of aspirin-related Reye syndrome. Pruritis, a hallmark manifestation of chickenpox, is managed through the application of calamine lotion and soothing oatmeal baths. Additionally, antihistamines, both in oral and topical forms, may be recommended to alleviate pruritis and enhance the client’s overall comfort, promoting better sleep. pruritis Medication: Diphenhydramine Class: Antihistamine Action: Blocks histamines at the H1-receptor sites of effector cells Therapeutic Use: Decreases manifestations of excess histamine release (pruritis, rhinorrhea, sneezing) Adverse Effects: Drowsiness, dry mouth, hypotension, dizziness Interactions: Avoid use with other diphenhydramine-containing products, including topical products Contraindications: Hypersensitivity to previous dose of diphenhydramine Client Teaching: May administer without regards to meals rhinorrhea Hydration is an important aspect of chickenpox treatment, particularly when oral sores may make eating and drinking a challenge. Encouraging the client to consume adequate fluids helps prevent dehydration, contributing to a smoother recovery. Adequate hydration is also essential to support the immune system during the healing process. It is important to note that while there is no specific antiviral medication for most children who have chickenpox, certain high-risk populations, such as children with a compromised immune system or individuals with severe cases, may be considered for antiviral treatment under the guidance of a health care professional. Regular monitoring, especially for complications such as secondary bacterial infections, should be performed. Overall, a combination of supportive measures and careful management of manifestations plays a key role in ensuring the well-being of individuals affected by chickenpox. A nurse is caring for a child who has chickenpox. The caregiver reports that the child has a lot of itching, and the provider has recommended giving the child oral diphenhydramine. Which of the following information should the nurse include when teaching the caregiver about diphenhydramine? Select all that apply. A Have the child stand up slowly. B Administer on an empty stomach. C Avoid using topical diphenhydramine concurrently.D An adverse effect of the medication is dry mouth. E Diphenhydramine may cause drowsiness.    Nursing Interventions Comfort Care for the Client Caring for a child with chickenpox involves several strategies aimed at providing comfort while managing manifestations. Comfort measures primarily focus on alleviating pruritus, reducing fever, and ensuring rest and hydration. Over-the-counter antihistamines or calamine lotion can help soothe the pruritis associated with the chickenpox rash. Frequent lukewarm baths with colloidal oatmeal or baking soda can provide relief from pruritis and dryness of the skin. Dress the child in light cotton clothing and avoid overheating with heavy blankets. Trimming the child's fingernails short can prevent scratching and minimize the risk of secondary bacterial skin infections. Maintaining hydration is crucial, so encourage the child to drink plenty of fluids to prevent dehydration, especially if they have a fever. Offer water, oral rehydration solutions, or ice pops to keep the child hydrated. Since chickenpox is highly contagious, the child should remain at home until all blisters have scabbed over, which is typically within about 1 week. It is essential to keep the child away from others, especially pregnant individuals, newborns, and individuals with compromised immune systems who are more vulnerable to severe complications. In the hospital setting, the child should be placed on airborne and contact precautions until all lesions have crusted over. Airborne precautions require that the child be placed in a negative-airflow room or isolated in a private room with the door closed if a negative-air-flow room is not available. The child should be cared for by staff who have immunity to the varicella virus. Nurses who are pregnant should not care for children who have chickenpox. A nurse is providing guidance to the parent of a child who has developed chickenpox. The nurse should inform the parent that which of the following conditions must be met for the client to no longer be contagious. A Wait 24 hours after starting antibiotics. B The rash must turn into blisters. C All the lesions have scabbed over and dried. D The child has not had a fever for 24 hours. PreventionPreventing chickenpox primarily involves immunization and preventive measures to minimize the risk of exposure. The most effective strategy for prevention is the varicella vaccine, which has proven to be safe and highly successful in reducing the incidence and severity of chickenpox. Children typically receive two doses of the vaccine during childhood, and it is effective at preventing the disease throughout life. Immunization is especially important for individuals who have not had chickenpox before and those with a higher risk of complications. Individual immunization also provides immunity to the community by reducing the overall spread of the disease. In addition to immunization, practicing good hygiene is essential in preventing the transmission of the virus. This includes frequent handwashing, particularly after contact with an infected person or their belongings, and avoiding close contact with individuals who are currently experiencing chickenpox manifestations. When caring for a hospitalized child who has varicella, which of the following actions should a nurse take? A Place child on airborne and contact isolation until lesions have crusted over. B Request a provider prescription for antibiotics. C Request a prescription for a corticosteroid for pruritis. D Apply a hot, moist compress to the pruritic lesions. Diphtheria Pathophysiology Corynebacterium diphtheriae is a nonencapsulated, gram-positive bacillus that primarily affects the respiratory system of the human host. This bacterium produces exotoxins that are responsible for the manifestations seen in cases of diphtheria. The human host response to these endotoxins is inflammation of the throat and the development of the hallmark finding of a gray pseudomembrane in the throat and pharynx. As the pseudomembrane thickens, it may cause occlusion of the airway. Furthermore, the toxins may enter the lymphatic and hematologic systems and cause additional systemic involvement, such as myocarditis and neuritis. exotoxins Etiology and Risk Factors Diphtheria is a bacterial infection caused by the bacterium Corynebacterium diphtheriae. It predominantly impacts the respiratory and integumentary systems, or it can spread through an asymptomatic carrier. Humans exclusively serve as the host for this micro-organism, which resides in the upper respiratory tract. Transmission occurs by inhaling airborne particles. The primary risk factor for contracting diphtheria is prior non-adherence with routine childhood diphtheria, tetanus toxoid, and acellular pertussis (DTaP) immunization. This disease is mostcommonly found in tropical regions but has a global presence with infrequent cases occurring in the U.S. Most current cases are found among individuals who have lower socioeconomic status, are living in crowded conditions, or are non-immunized. Additionally, individuals who have engaged in endemic regional travel or have underlying health conditions are at risk. Cases remain elevated in specific parts of the world, such as Southeast Asia and Africa. Clinical Presentation The first few days of this illness begin with general flu-like manifestations (sore throat, fever, malaise, headache, and cervical lymphadenopathy) followed by the hallmark feature of a thick, gray-colored pseudomembrane covering the throat and tonsils. The average incubation period is 2 to 5 days, with a broader range of 1 to 10 days, and the clients’ history of travel from endemic diphtheria regions of the world a common presenting theme. lymphadenopathy Health care providers should be vigilant for the disease's hallmark characteristics, notably the gray pseudomembrane. The most concerning manifestations involve the respiratory tract, initially presenting as mild redness before progressing into the formation of a merging pseudomembrane, which can lead to obstruction of the airway. CDC PSEUDOMEMBRANE ASSOCIATED WITH DIPHTHERIA A nurse is caring for a child in the pediatrician’s office. The child presents with lymphadenopathy and a gray-colored covering over the throat and tonsils. Which of the following actions should the nurse take first? A Assess the child’s breathing pattern. B Obtain the child’s temperature. C Review the child’s immunization status. D Ask the child’s parent about any recent travel. Lab Testing and Diagnostic Studies Throat swabs are collected for bacterial culture and microbiological lab analysis. Polymerase chain reaction (PCR) tests offer rapid detection by targeting the bacterium's genetic material in clinical specimens. Additionally, toxin testing involves analyzing clinical samples for the presence or activity of the diphtheria toxin. Confirmation not only relies on identifying the bacteria, but also determining if they are producing the potent diphtheria toxin that is responsible for severe manifestations. Timely and accurate testing is crucial for prompt treatment initiation (involving antibiotics, the antitoxin, and supportive care) and is pivotal in managing diphtheria cases and curbing its spread. TreatmentTreatment is geared at isolating the client and treating them with antibiotics and the diphtheria antitoxin (DAT), including a booster diphtheria toxoid for those with an unknown immunization status. The DAT neutralizes the viral toxins that are circulating in the blood. It is important that, prior to administering the DAT, hypersensitivity to the antitoxin is assessed and emergency management for treatment of anaphylaxis is readily available if needed. Antibiotics are initiated as soon as possible to limit the toxins present in the client’s system. Erythromycin and penicillin G are commonly used, but vancomycin or linezolid are prescribed if antibiotic resistance is noted. Medication: Penicillin G (Parenteral/Aqueous) Class: Antibiotic Action: Interferes with bacterial cell wall synthesis, causing cell-wall death against susceptible bacteria Therapeutic Use: Treats bacterial infections, such as Corynebacterium diphtheriae Adverse Effects: Clostridium-difficile-associated diarrhea, hypersensitivity reaction (rash, angioedema) Interactions: Given IV only–cholera vaccine Contraindications: Hypersensitivity to penicillin or cephalosporins Client Teaching: Monitor stools for frequency and blood and notify provider if diarrhea or blood is noted. (Lexicomp, 2023) A nurse is caring for a child who has diphtheria, and the nurse is preparing to administer the diphtheria antitoxin. Which of the following adverse effects of the antitoxin should the nurse monitor? A Urticaria B Diarrhea C Fever D Cervical lymphadenopathy Nursing Interventions Comfort Care for the Client Comfort care for a pediatric client who has diphtheria involves a multifaceted approach aimed at managing manifestations and ensuring the child's well-being during recovery. Due to the potential severity of diphtheria, especially respiratory and cardiac complications, hospitalization is often required for close monitoring and appropriate care. Supportive measures focus on easing discomfort and aiding recovery.Throat pain and difficulty swallowing are common, so providing a soft diet and plenty of fluids can alleviate discomfort and prevent dehydration. Ensuring a calm and quiet environment assists in reducing the child's stress and promoting rest, which is crucial for recovery. Additionally, implementing measures to control fever (such as acetaminophen) helps manage fever-related discomfort. Medication: Acetaminophen Class: Antipyretic, nonopioid analgesic Action: Inhibits synthesis of prostaglandins that may serve as mediators of pain and fever Therapeutic Use: Fever and pain reduction Adverse Effects: Hearing loss, erythema or skin rash, hepatotoxicity Interactions: Avoid use with other acetaminophen-containing products. Contraindications: Hypersensitivity to previous dose of acetaminophen or severe hepatic impairment Client Teaching: Measure oral liquid using a calibrated spoon or dropper. Avoid giving more than five doses in a 24-hour period. Contact the provider if pain or fever does not improve after 3 days. Emotional support from parents and health care professionals is essential in reassuring the child and alleviating their anxiety. Distracting activities, like reading or playing games, can divert the child's attention from discomfort. Due to the contagious nature of diphtheria, infection control measures are crucial to prevent transmission to others. Immunization of close contacts might also be recommended to curb further spread. A nurse is caring for a 4-year-old child who has diphtheria. Which of the following findings requires immediate action by the nurse? A Throat pain of 7 on a scale of 0 to 10 B Temperature 38.9° C (102° F) C Urine output is less than 1 mL/kg/hr D Respiratory rate of 34/minute Prevention The routine immunization schedule includes diphtheria immunization administered as a combined vaccine with tetanus toxoid and acellular pertussis (DTaP). Since its introduction, the vaccine has been part of the standard immunization protocol, and the occurrence of the disease has significantly diminished. Prior to 1920, there were roughly 200,000 annual cases of the disease in the U.S. However, thanks to immunization efforts, this number has dropped considerably to approximately 1,000 annually reported cases.Mumps Pathophysiology Mumps is a viral infection caused by a member of the Paramyxoviridae family of viruses. This single-stranded RNA paramyxovirus stimulates primary replication in the upper airway mucosal lining and in the regional lymph nodes. Viremia ensues, producing inflammation of the salivary glands, testes, ovaries, and, although rare, even the central nervous system. Etiology and Risk Factors The only natural host of viral mumps is humans, with an incubation period of 7 to 21 days. People who have the mumps are highly contagious approximately 1 to 2 days before manifestations begin, and virulence continues for approximately 5 days after manifestations begin. The virus most commonly impacts the salivary glands, resulting in unilateral or bilateral swelling, but it can also cause orchitis, which is the second most common manifestation. The virus is transmitted through respiratory droplets or direct contact with infected saliva and fomites in the person’s immediate environment, making crowded settings (such as schools and dormitories) conducive to its spread. orchitis fomites Clinical Presentation The hallmark manifestation of mumps is the swelling of one or more of the salivary glands, typically the parotid glands that are located near the jawline. In addition to parotitis, individuals with mumps may experience fever, headache, anorexia, myalgia, and fatigue. parotitis anorexia myalgia Mumps may occasionally lead to serious complications, including orchitis, meningitis, or encephalitis. While most cases of mumps resolve without serious consequences, these complications underscore the importance of timely diagnosis and appropriate medical care. Manifestations of mumps include headache; fatigue; myalgia, which can cause muscle aches and pain; fever; parotitis, which can cause swelling in the parotoid glands; and anorexia. MUMPS A nurse is caring for a child who has been diagnosed with mumps. Which of the following complications should the nurse monitor for? A Meningitis B Renal failure C Cardiac anomaliesD Liver failure Lab Testing and Diagnostic Studies Diagnosis is typically based on history of exposure to the mumps virus with clinical manifestations (such as swelling and parotitis) and is confirmed through laboratory testing (such as a real-time polymerase chain reaction (RT-PCR) viral culture obtained from a buccal swab or IgM serology testing). Treatment There is no specific antiviral treatment for mumps, so management focuses on prevention with the mumps, measles, and rubella (MMR) immunization and appropriate booster immunizations. If the disease has been contracted, management involves relieving presenting manifestations and preventing complications. Supportive measures include rest, adequate hydration, and pain relief with hot or cold (client’s preference) compresses for parotitis, cold compress and elevation for those with orchitis, and over-the-counter analgesic medications. Nursing Interventions Comfort Care for the Client Comfort care for a child who has mumps involves measures to manage manifestations and promote recovery. Since mumps typically resolves without specific treatment, the focus is alleviating the discomfort caused by manifestations, such as fever and glandular swelling. Encouraging rest and maintaining hydration with fluids, such as water or oral rehydration solutions, is essential. Applying a cloth-wrapped cold compress to swollen areas provides relief. Offering a soft diet minimizes discomfort while chewing. Isolating the child at home until the contagious period passes prevents further spread. Careful monitoring for worsening manifestations and seeking medical advice for complications ensures appropriate management. Emotional support plays a vital role in comforting the child during this period. Consulting a health care professional for tailored guidance aids in effectively managing mumps and promoting the child's recovery. Prevention Prevention of mumps primarily involves immunization with the MMR vaccine. The MMR vaccine has been highly effective in reducing the incidence of mumps, and routine immunization is recommended in childhood. Despite immunization efforts, mumps outbreaks can occur, especially in close-knit communities. In such instances, public health measures, including isolation of affected individuals and immunization campaigns, are implemented to control the spread of the virus. A nurse is educating the parent of a child newly diagnosed with mumps. Which of the following statements should the nurse make? A “The provider will prescribe an antibiotic medication for you to give your child.”  B “Your child can return to school 2 days after the swelling appeared.” C “You may apply cool compresses to the swollen glands.” D “Give your child aspirin every 6 hours for pain.” Measles (Rubeola) Measles (also called rubeola) is a preventable and highly contagious viral illness that is characterized by fever and rash. Due to induced immunosuppression and “immune amnesia,” measles poses significant morbidity and mortality risks globally, notably impacting regions such as Africa and Southeast Asia. Pathophysiology Measles is caused by the virus Morbillivirus hominis. The virus enters the human host through the nasopharyngeal or conjunctival mucosa. It first affects the regional lymph nodes and then begins to spread throughout the body. The virus then spreads to the lymphoreticular cells of the organs, such as the spleen, liver, and bone marrow. It is at these sites that the virus continues to proliferate and enter the bloodstream. This is the initiation of the prodromal phase of the infection. Inflammation occurs as the virus reaches the cells of any tissue. The virus will continue to replicate and render suppression of the host’s immune system. Etiology and Risk Factors Annually, measles leads to approximately 100,000 deaths despite the existence of an efficient vaccine. The virus responsible for measles solely exists in humans. Animals are not affected. The incubation period is approximately 10 to 14 days, although it may be longer in some cases. Explore the 3D visualization of measles below. MEASLES The measles virus is transmitted through direct contact with an infected person’s saliva or respiratory droplets when they breathe, cough, or sneeze and can remain in the air for up to 2 hours. This virus primarily affects unvaccinated children. A nurse is caring for a child who is suspected of having the measles virus. Which of the following precautions should the nurse implement? A Contact precautions B Airborne precautions C Droplet precautions D Protective isolation precautionsClinical Presentation Measles usually begins with an initial phase featuring fever, cough, rhinorrhea, and conjunctivitis, followed by the characteristic appearance of small, red spots with white centers (known as Koplik spots) in the mouth. A distinctive rash then spreads across the body, starting at the hairline and progressing downward. Manifestations of measles include conjunctivitis in the eye, Koplik spots inside the mouth, and rash. Rash on light skin appears pink. Rash on dark skin appears dark with slight pink spots. CHILD WITH MEASLES Lab Testing and Diagnostic Studies The diagnosis of measles is based on clinical manifestations, but laboratory confirmation through serological tests or PCR assays may be necessary, particularly during outbreaks or in cases with atypical presentations. The most accurate method of diagnosis is a plaque reduction neutralization assay. A nurse in the emergency department is reviewing the manifestations of communicable diseases with newly licensed nurses. The nurse should include which of the following as manifestations of measles (rubeola)? Select all that apply. A Rhinorrhea B Small, red spots with white centers on the buccal mucosa C Several fluid-filled vesicles on the child’s chest D A gray pseudomembrane covering the pharynx E Enlarged parotid glands Treatment Treatment management primarily focuses on supportive care since there is no antiviral treatment. If the child is hospitalized, they should be placed in airborne precautions. Adequate nutrition, hydration, a 2-day vitamin A supplementation, and infection control practices to prevent spread and secondary complications play essential roles in reducing complications and mortality. Nursing Interventions Comfort Care for the Client Caring for a child who has measles centers on easing discomfort and managing manifestations during the course of the illness. Since measles often resolves on its own without specific treatment, providing comfort is one of the main nursing interventions. Comfort care includes measures to address fever, manage respiratory manifestations, and ensure adequate rest andhydration. Cool-mist humidifiers or steamy showers can relieve cough and congestion. Ensuring the child gets plenty of rest aids in recovery. Encouraging hydration with water, oral rehydration solutions, half-strength juices, popsicles, or flavored gelatin can prevent dehydration, especially if the child has a fever. Monitoring the child's manifestations closely and seeking medical advice if complications arise (such as difficulty breathing or severe dehydration) is crucial. Providing emotional support and reassurance is equally important for the child's well-being during this period of discomfort. Prevention Prevention of measles centers around the administration of the measles, mumps, and rubella (MMR) vaccine. High community immunization coverage is crucial for achieving herd immunityand preventing outbreaks. Despite the effectiveness of the vaccine, measles outbreaks can occur, often due to insufficient vaccine coverage or vaccine hesitancy. Measles is a nationally notifiable disease. Public health responses to outbreaks involve case identification, isolation of infected individuals, contact tracing, and immunization campaigns to enhance immunity in affected communities. herd immunity Following a community outbreak of measles, what is the role of the Public Health Department? Enter your response and submit to compare to an expert response. Poliomyelitis Pathophysiology Poliomyelitis, more commonly referred to as polio, is an infectious viral illness resulting from a member of the enterovirus genus. The poliovirus enters through the mouth of the host and replicates in the oropharynx and gastrointestinal tract. For 1 to 2 weeks, the virus is found in the nasopharyngeal secretions, but it continues to be present in the stool for weeks after the start of the infection. Polio primarily affects the nervous system, leading to paralysis in severe cases. The virus is transmitted through the fecal-oral route but can also be transmitted through contact with nasopharyngeal secretions from the sneeze or cough of an infected individual. Photo by Everett/Shutterstock (a) Nurse attend to a room full of polio patients in iron lung respirators. Rancho Los Amigos Respirator Center, Hondo, California. 1953. Historical Collection Children in iron lung machines being treated for paralytic polio prior to development of the vaccine. IRON LUNG MACHINES Etiology and Risk Factors Prior to the polio vaccine, there were endemic regions in the U.S. The last reported case of polio in the U.S. occurred in 1979. However, there are still many countries that have poliovirus infections, and the virus could be imported to the U.S. via travelers. This virus is morecommonly seen in infants, young children, and immunocompromised individuals who are not vaccinated, under-vaccinated, or have weakened immune systems. A public health nurse is conducting an education session in the community about communicable diseases. Which of the following information should the nurse include about poliomyelitis? A Poliomyelitis is transmitted through contact with blood. B Poliomyelitis is a bacterial infection that requires antibiotic treatment. C Poliomyelitis is commonly seen in adolescents who did not receive the booster. D Poliomyelitis affects the nervous system and can lead to paralysis. Clinical Presentation Most polio infections result in mild flu-like manifestations that last 2 to 5 days. However, a small proportion of cases progress to affect the central nervous system, causing muscle weakness or paralysis. The hallmark manifestation of paralytic polio is the onset of muscle weakness or paralysis, typically in the legs. The severity of paralysis can range from mild weakness to complete loss of muscle function, and in severe cases, it can lead to respiratory failure. The virus can target motor neurons in the spinal cord, resulting in the loss of muscle control. Lab Testing and Diagnostic Studies The diagnosis of poliomyelitis involves various laboratory and diagnostic methods. Initially, health care professionals assess manifestations and perform a physical examination, focusing particularly on manifestations of muscle weakness or paralysis. Laboratory testing primarily involves collecting samples (like throat swabs, stool specimens, or cerebrospinal fluid) to identify the presence of the poliovirus. These tests help identify the virus, determine the specific strain involved, and differentiate it from other causes of similar manifestations. Additionally, imaging studies, such as magnetic resonance imaging (MRI) or electromyography (EMG), might be used to assess nerve damage or muscle function in individuals showing manifestations of paralysis. Early diagnosis is crucial for prompt management and containment of the infection. However, with the success of immunization programs worldwide, the occurrence of poliomyelitis has significantly declined in the last several decades. Treatment There is no specific cure for poliomyelitis, but treatment primarily focuses on supportive care and manifestation management. Mild cases might not require specific medical intervention since the body's immune system can usually overcome the infection. However, in more severe instances where paralysis or respiratory difficulties occur, supportive therapies become crucial. These may include physical therapy to prevent muscle atrophy and aid in restoring function,occupational therapy to assist in adapting to any disabilities, and orthopedic interventions to manage skeletal deformities caused by paralysis. Additionally, respiratory support (such as mechanical ventilation) might be necessary if breathing becomes impaired due to paralysis affecting the muscles involved in respiration. Adequate nutrition and hydration are essential to support recovery and prevent complications like dehydration or malnutrition. Immunization against polio remains the most effective preventive measure and is crucial in controlling the spread of the disease. Importantly, due to the infectious nature of poliovirus, isolation of affected individuals is recommended to prevent transmission. Although cases of poliomyelitis have significantly declined due to widespread immunization programs, managing severe cases involves an interprofessional approach that focuses on supportive care and rehabilitation in order to enhance the client’s quality of life. A nurse is caring for a child who has severe muscle weakness and is suspected of having poliomyelitis. The child is up to date on their immunizations. Which of the following interventions should the nurse include in the child’s plan of care? A Prepare to administer an antiviral medication. B Prepare to administer the poliomyelitis booster. C Place a referral for physical therapy. D Obtain blood specimens for confirmation of the disease. Nursing Interventions Comfort Care for the Client Caring for a child affected by poliomyelitis involves a comprehensive approach to providing comfort and support throughout their recovery. If a child requires hospitalization due to polio or is suspected of having polio, they should be placed in contact precautions. Since there is no specific cure for polio, treatment primarily revolves around managing manifestations and addressing the resulting complications. Supportive care includes adequate rest and a balanced diet to maintain overall health. Physical therapy plays a significant role in preventing muscle weakness and deformities and helps the child regain their strength and mobility. Occupational therapy aids in adapting to any disabilities that might result from paralysis or muscle weakness. Special devices (like braces, wheelchairs, or orthopedic aids) can assist in mobility and everyday activities. Respiratory support, if needed (such as breathing exercises or mechanical ventilation), helps manage respiratory complications. Pain management techniques and regular monitoring for any manifestations of discomfort or complications are essential components of care. Emotional support is equally crucial for the child's well-being and provides reassurance and encouragement throughout recovery. Family involvement and education on caregiving techniques are integral formaintaining the child's comfort and ensuring proper care at home. Immunization remains the cornerstone for preventing polio, so health care professionals should emphasize the importance of immunization to protect against the disease. Prevention Historically, polio was a significant global health concern, causing widespread outbreaks and severe disability, particularly in children. The creation of successful vaccines, such as the inactivated polio vaccine (IPV) and oral polio vaccine (OPV), has played a crucial role in preventing new cases. Only the IPV is given in the U.S., although OPV is still used globally. The IPV is an intramuscular injection, and 99% of children who are fully vaccinated will be protected from the disease. The Global Polio Eradication Initiative and other partners have made substantial progress in reducing the incidence of polio globally. Surveillance, routine immunization, and mass immunization campaigns are key components of these eradication efforts. Despite significant progress, challenges remain, particularly in regions with limited health care infrastructure and security concerns. Ongoing immunization efforts and vigilant surveillance are crucial to achieving and sustaining a polio-free world. A 4-year-old who has not received immunizations has traveled to a country with an outbreak of polio in the community. The child presents to the emergency department, and the parent reports that the child has a sudden onset of fever, nausea, and vomiting and woke up this morning unable to walk more than a couple of steps before falling to the ground. Which of the following isolation precautions should the nurse implement? A Airborne precautions B Contact precautions C Droplet precautions D Strict precautions   SARS-CoV-2 (COVID-19) Since the onset of the pandemic caused by the novel coronavirus SARS-CoV-2, the impact of COVID-19 on children has been the subject of extensive study. On average, children have experienced milder cases of the illness compared to adults, but they are not entirely immune, and severe outcomes have been reported. Pathophysiology SARS-CoV-2 infection impacts multiple systems within the body. After entering the body, viral replication begins to cause tissue damage. The body’s immune response against the virus involves the use of T-lymphocytes, monocytes, neutrophils, and cytokines to fight the infection.The widespread inflammatory response seen in severe presentations of the illness is caused by the overproduction of cytokines. Etiology and Risk Factors Like adults, children primarily acquire COVID-19 infections through either direct contact or respiratory droplets. Researchers have also explored the possibility of fecal-oral transmission, especially among the pediatric population. A nurse in a pediatric clinic is providing teaching about COVID-19. What information should the nurse include when discussing the mode of transmission? Enter your response and submit to compare to an expert response. Clinical Presentation Children infected with the virus may exhibit a range of manifestations, including fever, cough, and respiratory issues akin to those observed in adults. However, a notable proportion of pediatric cases have been asymptomatic or presented with mild manifestations. One distinctive feature of COVID-19 in children has been the emergence of a multisystem inflammatory syndrome known as Multisystem Inflammatory Syndrome in Children (MIS-C). MIS-C typically manifests several weeks after a COVID-19 infection and involves inflammation in various organs, including the heart, lungs, kidneys, and gastrointestinal system. While MIS-C is rare, it has garnered attention due to its potential severity, requiring prompt medical intervention. The long-term consequences of COVID-19 in children, often referred to as “long COVID” or post-acute sequelae of SARS-CoV-2 infection (PASC), are also being studied. Some children and adolescents have reported lingering manifestations, such as fatigue, respiratory issues, and neurological manifestations, after the acute phase of the illness. Lab Testing and Diagnostic Studies Diagnostic testing for COVID-19 in children typically involves molecular tests, like PCR or rapid antigen tests, with respiratory samples collected via nasopharyngeal swabs. Additionally, antibody testing can indicate prior infection. A nurse is caring for a child who had COVID-19 2 weeks ago and presents to the emergency department with suspected Multisystem Inflammatory Syndrome in Children (MIS-C). Which of the following body systems should the nurse monitor for complications? A Musculoskeletal system B Hepatic system C Neurologic system DCardiovascular system Treatment Treatment protocols for pediatric COVID-19 cases include supportive care to alleviate manifestations and, in severe instances, advanced interventions, like respiratory support. Antiviral medications have limited trials in the pediatric population, and recommendations for use are based largely on data extrapolated from adult studies. The National Institutes of Health (NIH) has made recommendations on the use of antivirals for COVID-19 in the pediatric population. For nonhospitalized children who are 12 years of age or older and weigh a minimum of 40 kg (88 lb) who have mild-to-moderate cases of COVID-19 in children but are at high risk of progression to severe COVID-19, the recommendation is for ritonavir-boosted nirmatrelvir. For children who are hospitalized and require supplemental oxygen, remdesivir is recommended. Remdesivir is approved for pediatric clients who are at least 28 days old and weigh 3 kilograms (6.6 pounds). Medication: Remdesivir Class: Antiviral agent Action: Inhibits SARS-CoV-2 RNA-dependent RNA polymerase Therapeutic Use: Management of COVID-19 in hospitalized clients Adverse Effects: Rash, nausea, anaphylaxis, elevated prothrombin time, elevated liver function tests, hypotension, bradycardia Interactions: Hydroxychloroquine, chloroquine Contraindications: Hypersensitivity to medication—do not use with hydroxychloroquine or chloroquine. Client Teaching: Notify medical staff if manifestations of allergic reaction develop. Nursing Interventions Nursing interventions for pediatric COVID-19 cases focus on supportive care, including monitoring vital signs, managing respiratory manifestations, and ensuring hydration. In severe cases, hospitalization may be necessary, with interventions such as oxygen therapy or mechanical ventilation. Comfort Care for the Client Comfort care for a child who has COVID-19 is crucial in managing manifestations and ensuring their well-being throughout the illness. This approach involves several key elements. Providing a restful environment supports the child's recovery while encouraging adequate fluid intake and nourishing meals to aid in maintaining overall health. Over-the-counter medications, under proper guidance, assist in managing fever and alleviating discomfort. Isolating the child prevents the virus's spread, while emotional support, engaging activities, and reassurance help alleviate stress. Regularly monitoring manifestations and seeking medical advice promptly if concerningmanifestations arise ensures timely intervention. Promoting preventive measures, like handwashing and mask-wearing, within the household aids in halting the virus's spread. Prevention Despite the generally milder clinical course in children, they can still play a role in transmitting the virus. Educational settings have been a focal point for understanding transmission dynamics, and measures like school closures and remote learning were initially implemented to mitigate the spread. The CDC has updated recommendations to state that people who test positive with COVID-19 may return to expected activities if manifestations are improving and they have been fever-free for 24 hours without the use of fever-reducing medications. After resuming regular activities, infected individuals are still expected to practice good hand hygiene, air purify if possible, and wear a well-fitting mask for 5 days after testing positive. Preventive measures for children involve immunization, and eligible age groups are encouraged to receive COVID-19 vaccines. Current recommendations are for everyone over 6 months of age to receive the COVID-19 vaccine. The number of doses needed will be based on the client’s age and other factors, such as compromised immune systems. Other preventive strategies include frequent handwashing, keeping 6 feet of distance from others when possible, and wearing a wellfitting mask, especially in crowded or high-risk settings. A nurse in a pediatrician’s office is caring for an 8-year-old who has COVID-19. The nurse is reinforcing information on home management to the child’s parent. Which of the following statements should the nurse make? A “Your child can return to school when they are without fever for 24 hours using antipyretics.” B “Your child should continue to wear a mask for 5 days after testing positive.” C “The provider will prescribe remdesivir for your child to take.” D “Family members in the home do not need to wear masks around your child since they were already exposed.” Meningitis Pathophysiology Explore the 3D visualization of meningitis below. MENINGITIS Viral Meningitis Etiology and Risk Factors The most common viruses associated with viral meningitis include enteroviruses, herpesviruses, and adenoviruses. Viral meningitis (also known as aseptic meningitis) is typically a self-limiting condition, but it can cause significant illness in newborns, children younger than 5 years old, andthose who are immunocompromised due to illnesses, chemotherapy, or organ transplantation therapy. Etiology involves the introduction of viral agents into the body, often through the mouth and nose. Enteroviruses are found in the mucus, saliva, or stool of infected individuals, and through direct or indirect contact with these secretions, the virus can be transmitted to others. Risk factors include close contact with infected individuals, being in crowded settings, or having a weakened immune system. Viral meningitis is more prevalent during summer and fall when enteroviral infections are more common. A nurse is providing teaching about risk factors for viral meningitis. What information should the nurse include in the teaching? Enter your response and submit to compare to an expert response. Clinical Presentation The clinical presentation of viral meningitis includes the acute onset of manifestations due to inflammation of the meninges and increased intracranial pressure. Manifestations may vary based on age. For example, infants and toddlers are developmentally unable to verbally report pain, such as a headache. However, older children and adolescents have the verbal and cognitive ability to verbalize pain, location, and intensity. Unlike bacterial meningitis, viral meningitis usually has a milder course and is often selflimiting. However, morbidity and mortality have been reported in newborn and immunocompromised populations. Manifestations of Viral Meningitis Infants and young children: · Fever · Hypothermia (in newborns) · Irritability (crying, difficult to console) · Poor eating or vomiting · Lethargy · Sleepiness or difficult to awaken · Full or bulging anterior fontanel Older children and adolescents: · Fever · Nausea and vomiting· Photophobia · Headache · Nuchal rigidity · Irritability · Lethargy · Diplopia or blurred vision A nurse is caring for a 4-month-old who had viral meningitis. Which of the following manifestations should the nurse expect? A Sunken anterior fontanel B Hypothermia C Consoles easily when crying D Poor feeding Lab Testing and Diagnostic Studies Diagnosis is typically based on clinical manifestations, cerebrospinal fluid (CSF) analysis obtained through a lumbar puncture, and laboratory testing to identify the specific viral pathogen causing the infection. Once obtained, the CSF fluid is analyzed for cell count, protein, and glucose levels. The CSF specimen is also sent to the laboratory for culture and sensitivity, and if a viral agent is suspected, a polymerase chain reaction (PCR) test is done to detect the causative virus. Treatment Due to the difficulty of differentiating viral and bacterial meningitis based only on clinical manifestations, a lumbar puncture should be done. A CSF culture may take as long as 48 hours to isolate a bacterial organism. Therefore, empiric antibiotic therapy should immediately be initiated following specimen collection and continued until the final culture analysis excludes bacterial meningitis. There is a high risk of morbidity, complications, and even death if bacterial meningitis treatment is delayed. If the PCR of the CSF is positive for herpesvirus meningitis, an intravenous antiviral (such as acyclovir) may be prescribed. Medication: Acyclovir Class: Antiviral Action: Decreases HSV viral replication Therapeutic Use: Neonatal HSV infection, HSV meningitis or encephalitisAdverse Effects: Hematuria, acute kidney injury, anemia, neutropenia Interactions: None indicated Contraindications: Hypersensitivity to acyclovir Client Teaching: Monitor CBC, creatine, and BUN. Measure and monitor intake and output. Observe IV site for extravasation. Administer IV over 1 hour and maintain hydration during therapy. Nursing Interventions Nursing interventions for viral meningitis involve assisting with diagnostic procedures, managing manifestations, maintaining hydration, monitoring for complications, and preventing the spread of the virus to others. Comfort Care for the Client Care for a pediatric client diagnosed with viral meningitis centers around managing manifestations and supporting recovery. As soon as meningitis is suspected as the cause of illness, the pediatric client should be placed in droplet precautions and remain there for 24 hours after the start of antibiotic therapy. If the illness is determined to be viral meningitis, contact precautions should be followed for infants and young children who are incontinent or diapered. Intake and output are measured, and the child is frequently observed for indications of dehydration due to vomiting, fever, or refusal of oral fluids. Electrolyte disturbances, such as hyponatremia, could be a manifestation of the syndrome of inappropriate antidiuretic hormone (SIADH) and should be immediately reported to the provider. IV catheter should be in place for fluid administration if the child is unable to maintain hydration orally or medication administration as prescribed. Fever and discomfort are commonly managed with weight-dosed antipyretics and NSAIDs. Applying cool compresses to the forehead can alleviate fever-related discomfort. Reducing environmental stimuli by dimming the lights and reducing the television or radio sound volume will help lessen the discomfort caused by headaches and photophobia and promote rest. Frequent monitoring for indications of deteriorating neurologic status and increasing intracranial pressure is necessary. Neurologic checks include pupil size and reactivity to light and level of consciousness. In infants, palpation of the anterior fontanel should be done. Seizures may occur due to increased intracranial pressure or due to fever. It is important to observe and notify the provider of seizure activity. Limiting the child's contact with others prevents potential transmission of the infection, as viral m