Clinical Manifestations	Therapeutic Management Complications/	Nursing Considerations
Prodromal (catarrhal) stage: Fever and malaise, followed in 24 hours by coryza, cough, conjunctivitis, Koplik spots (small, irregular red spots with a minute, bluish white center first seen on buccal mucosa opposite molars 2 days before rash); symptoms gradually increase in severity until second day after rash appears, when they begin to subside Rash: Appears 3-4 days after onset of prodromal stage; begins as erythematous maculopapular eruption on face and gradually spreads downward; more severe in earlier sites (appears confluent) and less intense in later sites (appears discrete); after 3-4 days assumes brownish appearance, and fine desquamation occurs over areas of extensive involvement Constitutional signs and symptoms: Anorexia, malaise, generalized lymphadenopathy	Vitamin A supplementation Supportive: Bed rest during febrile period Antipyretics Antibiotics to prevent secondary bacterial infection in high-risk children Complications: Otitis media Pneumonia Bronchiolitis Obstructive laryngitis and laryngotracheitis Encephalitis	Isolation until fifth day of rash; if hospitalized, institute respiratory precautions Maintain bed rest during prodromal stage; provide quiet activity Fever: Instruct parents to administer antipyretics; avoid chilling; if child is prone to seizures, institute appropriate precautions (fever spikes to 104°F (40°C) between fourth and fifth days) Eye care: Dim lights if photophobia present; clean eyelids with warm saline solution to remove secretions or crusts; keep child from rubbing eyes; examine cornea for signs of ulceration Coryza/cough: Use cool mist vaporizer; protect skin around nares with layer of petrolatum; encourage fluids and soft, bland foods Skin care: Keep skin clean; use tepid baths as necessary
Prodromal stage: Fever, headache, malaise, and anorexia for 24 hours, followed by 'earache” that is aggravated by chewing Parotitis: By third day, parotid gland(s) (either unilateral or bilateral) enlarge(s) and reach(es) maximum size in 1-3 days; accompanied by pain and tenderness Other manifestations: Submaxillary and sublingual infection, orchitis, and meningoencephalitis	Symptomatic and supportive: Analgesics forpain and antipyretics for feverIntravenous fluid may be necessary for child who refuses to drink or vomits because of meningoencephalitis Complications: Sensorineural deafness Postinfcctious encephalitis Myocarditis Arthritis Hepatitis Epididymo-orchitis Sterility (extremely rare in adult males)	Isolation during period of communicability; institute respiratory precautions during hospitalization Maintain bed rest during prodromal phase until swelling subsides Give analgesics for pain; if child is unwilling to chew medication, use elixir form Encourage fluids and soft, bland foods; avoid foods that require chewing Apply hot or cold compresses to neck, whichever is more comfortingTo relieve orchitis, provide warmth and local support with tight-fitting underpants (stretch bathing suit works well)

Clinical Manifestations

Therapeutic Management Complications/

Nursing Considerations

Prodromal (catarrhal) stage: Fever and malaise, followed in 24 hours by coryza, cough, conjunctivitis, Koplik spots (small, irregular red spots with a minute, bluish white center first seen on buccal mucosa opposite molars 2 days before rash); symptoms gradually increase in severity until second day after rash appears, when they begin to subside

Rash: Appears 3-4 days after onset of prodromal stage; begins as erythematous maculopapular eruption on face and gradually spreads downward; more severe in earlier sites (appears confluent) and less intense in later sites (appears discrete); after 3-4 days assumes brownish appearance, and fine desquamation occurs over areas of extensive involvement

Constitutional signs and symptoms: Anorexia, malaise, generalized lymphadenopathy

Vitamin A supplementation

Supportive: Bed rest during febrile period

Antipyretics

Antibiotics to prevent secondary bacterial infection in high-risk children

Complications:

Otitis media

Pneumonia

Bronchiolitis

Obstructive laryngitis and laryngotracheitis

Encephalitis

Isolation until fifth day of rash; if hospitalized, institute respiratory precautions

Maintain bed rest during prodromal stage; provide quiet activity

Fever: Instruct parents to administer antipyretics; avoid chilling; if child is prone to seizures, institute appropriate precautions (fever spikes to 104°F (40°C) between fourth and fifth days)

Eye care: Dim lights if photophobia present; clean eyelids with warm saline solution to remove secretions or crusts; keep child from rubbing eyes; examine cornea for signs of ulceration

Coryza/cough: Use cool mist vaporizer; protect skin around nares with layer of petrolatum; encourage fluids and soft, bland foods

Skin care: Keep skin clean; use tepid baths as necessary

Prodromal stage: Fever, headache, malaise, and anorexia for 24 hours, followed by 'earache” that is aggravated by chewing

Parotitis: By third day, parotid gland(s) (either unilateral or bilateral) enlarge(s) and reach(es) maximum size in 1-3 days; accompanied by pain and tenderness

Other manifestations: Submaxillary and sublingual infection, orchitis, and meningoencephalitis

Symptomatic and supportive: Analgesics forpain and antipyretics for feverIntravenous fluid may be necessary for child who refuses to drink or vomits because of meningoencephalitis

Complications:

Sensorineural deafness

Postinfcctious encephalitis

Myocarditis

Arthritis

Hepatitis

Epididymo-orchitis

Sterility (extremely rare in adult males)

Isolation during period of communicability; institute respiratory precautions during hospitalization

Maintain bed rest during prodromal phase until swelling subsides

Give analgesics for pain; if child is unwilling to chew medication, use elixir form

Encourage fluids and soft, bland foods; avoid foods that require chewing

Apply hot or cold compresses to neck, whichever is more comfortingTo relieve orchitis, provide warmth and local support with tight-fitting underpants (stretch bathing suit works well)

	Disease
Rubella (German Measles). A, Progression of rash. B, Appearance of rash.	Rubella (German Measles) Agent: Rubella virus Transmission: Direct contact and spread via infected person; indirectly via articles freshly contaminated with nasopharyngeal secretions, feces, or urine Incubation period: 14-21 days Period of communicability: 7 days before to approximately 5 days after appearance of rash Scarlet Fever Agent: Group A β-haemolytic streptococcal Source: Usually from nasopharyngeal secretions of infected person and carriers Transmission: Direct contact with infected person or droplet spread indirectly by contact with contaminated articles, ingestion of contaminated milk or other food Incubation period: 2-4 days, with range of 1-7 days Period of communicability: During incubation period and clinical illness approximately 10 days; during first 2 weeks of carrier phase although may persist for months Scarlet fever.

Disease

Rubella (German Measles).

A, Progression of rash. B, Appearance of rash.

Rubella (German Measles)

Agent: Rubella virus

Transmission: Direct contact and spread via infected person; indirectly via articles freshly contaminated with nasopharyngeal secretions, feces, or urine

Incubation period: 14-21 days
Period of communicability: 7 days before to approximately 5 days after appearance of rash

Scarlet Fever Agent: Group A β-haemolytic streptococcal

Source: Usually from nasopharyngeal secretions of infected person and carriers

Transmission: Direct contact with infected person or droplet spread indirectly by contact with contaminated articles, ingestion of contaminated milk or other food

Incubation period: 2-4 days, with range of 1-7 days Period of communicability: During incubation period and clinical illness approximately 10 days; during first 2 weeks of carrier phase although may persist for months

Scarlet fever.

Clinical Manifestations	Therapeutic Management Complications/	Nursing Considerations
Prodromal stage: Absent in children, present in adults and adolescents; consists of lowgrade fever, headache, malaise, anorexia, mild conjunctivitis, coryza, sore throat, cough, and lymphadenopathy; lasts for 1-5 days, subsides 1 day after appearance of rash Rash: First appears on face and rapidly spreads downward to neck, arms, trunk, and legs; by end of first day, body is covered with a discrete, pinkish red maculopapular exanthema; disappears in same order as it began and is usually gone by third day Constitutional signs and symptoms: Occasionally low-grade fever, headache, malaise, and lymphadenopathy	No treatment necessary other than antipyretics for low-grade fever and analgesics for discomfort Complications:Rare (arthritis, encephalitis, or purpura); most benign of all childhood communicable diseases; greatest danger is teratogenic effect on fetus	Reassure parents of benign nature of illness in affected child Use comfort measures as necessary Isolate child from pregnant women
Prodromal stage: Abrupt high fever, pulse increased out of proportion to fever, vomiting, headache, chills, malaise, abdominal pain Enanthema: Tonsils enlarged, edematous, reddened, and covered with patches of exudate; in severe cases appearance resembles membrane seen in diphtheria; pharynx is edematous and beefy red; during first 1-2 days tongue is coated and papillae become red and swollen (white strawberry tongue); by fourth or fifth day white coat sloughs off, leaving prominent papillae (red strawberry tongue); palate is covered with erythematous punctate lesions Exanthema: Rash appears within 12 hours after prodromal stage; red pinhead-sized punctate lesions rapidly become generalized but are absent on face, which becomes flushed with striking circumoral pallor; rash is more intense in folds of joints; by end of first week desquamation begins (fine, sandpaper-like on torso; sheetlike sloughing on palms and soles), which may be complete by 3 weeks or longer	Treatment of choice is a full course of penicillin (or erythromycin in penicillin-sensitive children); fever should subside 24 hr after beginning therapy Antibiotic therapy for newly diagnosed carriers (nose or throat cultures positive for streptococci) Supportive measures: Bed rest during febrile phase, analgesics for sore throat Complications: Otitis media Peritonsillar abscess Sinusitis Glomerulonephritis Carditis, polyarthritis (uncommon)	Institute respiratory precautions until 24 hr after initiation of treatment Ensure compliance with oral antibiotic therapy (intramuscular benzathine penicillin G [Bicillin] may be given if parents’ reliability in giving oral drugs is questionable) Maintain bed rest during febrile phase; provide quiet activity during convalescent period Relieve discomfort of sore throat with analgesics, gargles, lozenges, antiseptic throat sprays (Chloraseptic), and inhalation of cool mist Encourage fluids during febrile phase; avoid irritating liquids (citrus juices) or rough foods; when child is able to eat, begin with soft diet Advise parents to consult practitioner if fever persists after beginning therapy Discuss procedures for preventing spread of infection

Clinical Manifestations

Therapeutic Management Complications/

Nursing Considerations

Prodromal stage: Absent in children, present in adults and adolescents; consists of lowgrade fever, headache, malaise, anorexia, mild conjunctivitis, coryza, sore throat, cough, and lymphadenopathy; lasts for 1-5 days, subsides 1 day after appearance of rash

Rash: First appears on face and rapidly spreads downward to neck, arms, trunk, and legs; by end of first day, body is covered with a discrete, pinkish red maculopapular exanthema; disappears in same order as it began and is usually gone by third day

Constitutional signs and symptoms: Occasionally low-grade fever, headache, malaise, and lymphadenopathy

No treatment necessary other than antipyretics for low-grade fever and analgesics for discomfort

Complications:Rare (arthritis, encephalitis, or purpura); most benign of all childhood communicable diseases; greatest danger is teratogenic effect on fetus

Reassure parents of benign nature of illness in affected child

Use comfort measures as necessary

Isolate child from pregnant women

Prodromal stage: Abrupt high fever, pulse increased out of proportion to fever, vomiting, headache, chills, malaise, abdominal pain

Enanthema: Tonsils enlarged, edematous, reddened, and covered with patches of exudate; in severe cases appearance resembles membrane seen in diphtheria; pharynx is edematous and beefy red; during first 1-2 days tongue is coated and papillae become red and swollen (white strawberry tongue); by fourth or fifth day white coat sloughs off, leaving prominent papillae (red strawberry tongue); palate is covered with erythematous punctate lesions

Exanthema: Rash appears within 12 hours after prodromal stage; red pinhead-sized punctate lesions rapidly become generalized but are absent on face, which becomes flushed with striking circumoral pallor; rash is more intense in folds of joints; by end of first week desquamation begins (fine, sandpaper-like on torso; sheetlike sloughing on palms and soles), which may be complete by 3 weeks or longer

Treatment of choice is a full course of penicillin (or erythromycin in penicillin-sensitive children); fever should subside 24 hr after beginning therapy

Antibiotic therapy for newly diagnosed carriers (nose or throat cultures positive for streptococci)

Supportive measures: Bed rest during febrile phase, analgesics for sore throat

Complications:

Otitis media

Peritonsillar abscess Sinusitis

Glomerulonephritis

Carditis, polyarthritis (uncommon)

Institute respiratory precautions until 24 hr after initiation of treatment

Ensure compliance with oral antibiotic therapy (intramuscular benzathine penicillin G [Bicillin] may be given if parents’ reliability in giving oral drugs is questionable)

Maintain bed rest during febrile phase; provide quiet activity during convalescent period

Relieve discomfort of sore throat with analgesics, gargles, lozenges, antiseptic throat sprays (Chloraseptic), and inhalation of cool mist

Encourage fluids during febrile phase; avoid irritating liquids (citrus juices) or rough foods; when child is able to eat, begin with soft diet

Advise parents to consult practitioner if fever persists after beginning therapy

Discuss procedures for preventing spread of infection

TABLE 5-17 Communicable Diseases of Childhood

Disease

TABLE 5-17 Communicable Diseases of Childhood