Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
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Study Tools For Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Outline
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria)
Measles-
- Highly contagious viral respiratory infection § Incubation: 8–12 days
Transmission:
- 4 days after exposure to 4 days after rash has appeared
- Nasal secretions (directly) or respiratory droplets
Clinical Manifestations:
- Fever
- 3 C’s – Conjunctivitis, Coryza, Cough (dry)
- Eyelid edema, photophobia
- Malaise, irritability
- Rash
- Koplik spots – red specks with blue-white center, buccal mucosa, 2 days before rash, disappear within 48 hours of rash onset
- Maculopapular rash – head, trunk, lower extremities, 14 days after exposure, contagious 4 days before to 4 days after rash
Interventions:
- Standard airborne isolation
- Immunization
- Supportive care, treat symptoms, antipyretics
Complications:
- Fetuses exposed during first trimester are at risk for heart defects, developmental delays, deafness, stunted growth
Mumps-
- Paramyxovirus that causes glandular enlargement of salivary, parotid glands, frequently active in spring
Transmission:
- Respiratory droplets, saliva
- Most contagious 1–2 days before appearance of parotitis
- Remain infectious up to 5 days after onset of glandular enlargement
Clinical manifestations:
- Parotitis
- Low grade fever
- Nonspecific upper respiratory tract infection symptoms – Malaise, Anorexia, Headache
Interventions:
- Standard, droplet precautions
- Immunizations
- Supportive care – analgesics, antipyretics, oral steroids for severe orchitis
Pertussis- (Whooping Cough)
Highly contagious disease caused by gram-negative Bordetella pertussis
- Attaches to respiratory tract ciliated epithelium
- Produces toxin that limits ability to clear secretions
Incubation:
- 7–10 days (varies)
Transmission:
- Respiratory droplets
Clinical Presentation:
- Stage I (Catarrhal) – up to 2 weeks, coryza, sneezing, low-grade fever, occasional cough
- Stage II (Paroxysmal) – up to 6 weeks, worsening cough, paroxysmal bursts of coughing (whoop), worse at night, petechial rash above nipple line
- Stage III (Convalescent) – weeks to months, cough less severe, superinfections due to trapped secretions
Assessment:
- Dacron swab in posterior nasopharynx
Interventions:
- Standard, droplet precautions
- Supportive care
- Macrolide antibiotics
- Antitussives
- Antipyretics
Discharge Teaching:
- Pertussis vaccination
- Household members treat with antibiotics regardless of vaccination status
Chicken Pox-
- Caused by varicella zoster virus; after primary infection, virus becomes latent
Transmission:
- Respiratory droplets, skin contacts (less common)
- Infectious for 48 hours before rash appears
- Contagious until all skin lesions have crusted over, no new lesions formed
Clinical manifestations:
- Purulent vesicular rash – initially forms on trunk and face, then generalizes
- Fever, headache, anorexia, malaise
- Lymphadenopathy
- Pruritis, urticaria
Interventions:
- Standard, airborne, and contact isolation
- Symptomatic care
- Antiviral agents – >12 yoa, chronic skin or lung disease, on steroid therapy, some pregnant women
- Antihistamines, antipyretics, analgesics
- Varicella immunoglobulin for pregnant patients
- Systemic antibiotics if secondary bacterial infection
- Aspirin should not be utilized in children due to its association with Reye’s syndrome
Prevention:
- Varicella zoster vaccine
Shingles-
- Reactivation of the varicella virus that has lain dormant in the dorsal ganglia following chicken pox
Clinical Manifestations:
- Pain develops first, followed by the characteristic vesicular lesions within 48 hours
- Severely painful, localized, unilateral pain
- Vesicular lesions along nerve dermatome within 48 hours of pain onset
- Typically, does not cross the body’s midline
Interventions:
- Standard, airborne, contact precautions around persons with chickenpox
- Antivirals
- Cover lesions
- Supportive care, comfort measures
- Varicella zoster vaccination
Prevention:
- Shingles can be prevented by proper vaccination
Diphtheria-
- Infection of mucous membranes caused by Corynebacterium diphtheriae
- Diphtheria once was a major cause of illness and death among children, but rates began to drop quickly with vaccination
Incubation:
- 1–8 days
Transmission:
- Respiratory droplets
Clinical Manifestations:
- Sore throat, low grade fever, weakness, swollen glands in the neck
- Thick, gray, membranous covering on tonsils, pharynx – forms within two to three days of infection, characteristic pseudomembrane interferes with respiration, Pseudomembrane is formed from tissue killed by the toxin, Pseudomembrane sticks to tissue below, and cannot be manually removed owing to risk of bleeding
Complications:
- The diphtheria toxin may be absorbed into the bloodstream and may cause damage to the heart, kidneys and nerves
- Myocarditis, Neuritis
- Airway obstruction
Assessment:
- Swab throat for Gram stain, culture, sensitivity
Toxin analysis specimen
Polymerase chain reaction
Interventions:
- Standard, droplet precautions
- Vaccination
- Diphtheria antitoxin – counteracts toxin produced by the bacteria
- Start antibiotics treatment immediately if diphtheria is suspected; do not wait for laboratory confirmation
- Erythromycin is drug of choice
Mononucleosis-
- Acute viral illness most commonly caused by the Epstein-Barr virus
- common among teenagers and young adults (college students), spread via body fluids (saliva)
- Typical symptoms usually appear 4–6 weeks after infection
Clinical Presentation:
- Prodrome – fatigue, anorexia, nausea/vomiting, chills, diaphoresis, headache, myalgia
- Illness – low-grade fever, sore/red throat, head/body aches, lymphadenopathy, rash, diarrhea, earache, enlarged tonsils, petechiae on palate
- Complications – hepatomegaly, splenomegaly, thrombocytopenia, pneumonia, meningitis/encephalitis, hepatitis, pericarditis
Assessment:
- Diagnosis based on history and physical
- Specific antibody tests identify specific virus – monospot (usually becomes positive by the second week of illness), Epstein-Barr virus antigen test
- CBC – elevated white blood cell count, unusual-looking white blood cells (atypical lymphocytes)
- Liver function panel – abnormal liver function
Interventions:
- Mostly symptom control – Analgesics, Avoid aspirin, Corticosteroids
- Salivary precautions
Complications:
- Splenic rupture
- Airway obstruction
- Death (rare)
Discharge teaching:
- Avoid strenuous activities for 4 weeks, including contact sports
Warm saltwater gargles
Avoid alcohol for 1 month
Do not donate blood for 6 months
Seek medical attention for signs of intra-abdominal bleeding
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2017) Emergency Nursing Core Curriculum, 7th Edition. PA: Saunders
- Weintraub, B. (2017). Medical Emergencies and Communicable Diseases. In CEN Online Review. Emergency Nurses Association.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System