Pediatric Communicable Diseases
Comprehensive Nursing Management Guide
A practical resource for nursing students on identification, diagnosis, and management of communicable diseases in children with special focus on HIV/AIDS
Table of Contents
Introduction to Communicable Diseases
What are Communicable Diseases?
Communicable diseases (also known as infectious diseases) are illnesses caused by pathogenic microorganisms such as bacteria, viruses, parasites, or fungi that can be spread, directly or indirectly, from one person to another. Children are particularly vulnerable to these infections due to their developing immune systems and close contact in settings like schools and daycare centers.
Why Focus on Pediatric Communicable Diseases?
- Children are more susceptible to infections due to immature immune systems
- Infections can spread rapidly in schools, daycare centers, and other group settings
- Some infections can have more severe presentations in children compared to adults
- Early identification can prevent complications and reduce transmission
- Proper nursing management is crucial for both acute care and long-term outcomes
- Preventative measures can significantly reduce infection rates and complications
Role of Nurses in Managing Pediatric Infections
Nurses play a pivotal role in the comprehensive management of communicable diseases in children through:
Assessment
- Recognizing signs & symptoms
- Performing thorough health assessments
- Documenting disease progression
Intervention
- Administering medications
- Implementing isolation protocols
- Providing comfort measures
Education
- Teaching prevention strategies
- Providing home care instructions
- Supporting vaccination efforts
Overview of Pediatric Communicable Diseases
Pediatric communicable diseases can be categorized based on transmission routes, affected body systems, or causative organisms. Understanding these classifications helps in diagnosis, treatment, and implementation of appropriate infection control measures.
Classification by Mode of Transmission
| Transmission Mode | Description | Examples | Prevention Strategies |
|---|---|---|---|
| Airborne | Spread through tiny particles suspended in air | Measles, Tuberculosis, Chickenpox | Negative pressure rooms, N95 masks, proper ventilation |
| Droplet | Spread through respiratory droplets (coughing, sneezing) | Influenza, Pertussis, RSV | Surgical masks, maintaining distance (3-6 feet) |
| Contact | Direct contact with infected person or contaminated surfaces | Conjunctivitis, Impetigo, Scabies | Gloves, handwashing, equipment disinfection |
| Fecal-Oral | Ingestion of contaminated food/water | Rotavirus, Hepatitis A, Giardiasis | Handwashing, food safety, proper water sanitation |
| Bloodborne | Contact with infected blood/body fluids | HIV, Hepatitis B, Hepatitis C | Standard precautions, needlestick prevention |
| Vector-borne | Transmission via insects or animals | Malaria, Dengue, Lyme Disease | Insect repellent, protective clothing |
| Vertical | Mother-to-child during pregnancy, delivery, or breastfeeding | HIV, Hepatitis B, Congenital Syphilis | Maternal screening, prophylaxis, cesarean delivery when indicated |
Classification by Body System
Respiratory
- Influenza
- RSV
- Pertussis (Whooping cough)
- Pneumonia
- Tuberculosis
Gastrointestinal
- Rotavirus
- Norovirus
- Salmonella
- E. coli
- Giardiasis
Skin/Mucous Membranes
- Impetigo
- Chickenpox
- Measles
- Scabies
- Ringworm
Central Nervous System
- Meningitis
- Encephalitis
- Poliomyelitis
- Rabies
Bloodborne/Systemic
- HIV/AIDS
- Hepatitis B & C
- Malaria
- Sepsis
Multiple Systems
- Mumps
- Rubella
- Congenital infections
- Lyme disease
Key Considerations for Pediatric Infections
When assessing and managing communicable diseases in children, nurses should consider these important factors:
- Children’s immune systems are still developing, potentially leading to more severe presentations
- Age-specific presentations may differ from adult manifestations
- Medication dosing requires careful calculation based on weight
- Communication challenges may hinder accurate symptom reporting
- Psychosocial impact of isolation and hospitalization
- Family education is essential for successful management
- Developmental considerations affect compliance with treatment
HIV/AIDS in Children
Definition & Epidemiology
Definition
Human Immunodeficiency Virus (HIV) is a retrovirus that attacks the body’s immune system, specifically targeting CD4+ T cells, which help the immune system fight off infections. Without treatment, HIV can progress to Acquired Immunodeficiency Syndrome (AIDS), the most severe phase of HIV infection characterized by profoundly damaged immune function and vulnerability to opportunistic infections.
Pediatric HIV Epidemiology
- Globally, approximately 1.8 million children under 15 years are living with HIV
- Most pediatric infections (over 90%) result from mother-to-child transmission
- Without intervention, transmission rates from mother to child range from 15-45%
- With effective interventions, this rate can be reduced to below 5%
- In many resource-limited settings, pediatric HIV remains underdiagnosed
- HIV contributes significantly to under-five mortality in high-prevalence regions
Transmission
In children, HIV is primarily acquired through vertical transmission from mother to child. Understanding the mechanisms of transmission is crucial for implementing effective prevention strategies.
Routes of Mother-to-Child Transmission
During Pregnancy
Transplacental transmission, especially with high maternal viral load or placental disruption
Risk: 5-10%
During Labor/Delivery
Exposure to maternal blood and genital secretions during birth process
Risk: 10-20%
During Breastfeeding
Through breast milk, with increased risk with mixed feeding and maternal mastitis
Risk: 5-15%
Factors Increasing Risk of Transmission
Maternal Factors
- High viral load
- Low CD4+ count
- Advanced AIDS
- Acute HIV infection during pregnancy
- Concurrent sexually transmitted infections
- Substance abuse
- Poor nutrition
- No or inadequate antiretroviral therapy
Obstetric/Infant Factors
- Prolonged rupture of membranes
- Vaginal delivery (vs. C-section)
- Invasive procedures during labor
- Preterm birth
- Low birth weight
- Breastfeeding, especially mixed feeding
- Oral thrush in infant
- Gastrointestinal infections
Other Transmission Routes (Less Common in Children)
- Blood transfusions or contaminated blood products
- Needle sharing (adolescents engaged in injection drug use)
- Sexual transmission (primarily in adolescents)
- Accidental needlestick injuries (rare)
Pathophysiology
Understanding the pathophysiology of HIV infection helps nurses anticipate clinical manifestations and comprehend the rationale behind treatment strategies.
HIV Life Cycle
Binding and Entry
HIV binds to CD4 receptors and co-receptors (CCR5, CXCR4) on host cells, primarily CD4+ T lymphocytes, then fuses with the cell membrane to enter.
Reverse Transcription
Viral RNA is converted to DNA by the HIV enzyme reverse transcriptase, allowing viral genetic material to integrate with host DNA.
Integration
Viral DNA migrates to the cell nucleus and integrates into host cell DNA via the viral enzyme integrase, creating a provirus.
Transcription and Translation
Host cellular machinery transcribes proviral DNA into viral RNA, which serves as genomic material and template for viral proteins.
Assembly and Budding
Viral components assemble at the cell membrane, and immature virus particles bud from the host cell.
Maturation
Viral protease enzyme cleaves polypeptide chains, creating mature infectious virions that can infect other cells.
Immune System Impact
HIV primarily damages the immune system through several mechanisms:
- Direct killing of CD4+ T cells through viral replication
- Indirect killing through immune activation and chronic inflammation
- Destruction of lymphoid tissue where CD4+ T cells mature and reside
- Immune exhaustion from persistent viral stimulation
- Impaired immune response to opportunistic pathogens
Natural History of Untreated Pediatric HIV
Primary Infection
Acute HIV syndrome may present with nonspecific symptoms like fever, rash, and lymphadenopathy. Many children are asymptomatic during this phase.
Clinical Latency
Period of viral replication with gradual CD4+ decline. Children typically have shorter latency periods than adults, with progression determined by timing of infection and viral load.
Symptomatic HIV
As immune function declines, children develop recurrent infections, growth delays, and lymphadenopathy. Without treatment, 20-25% of perinatally infected infants progress to AIDS within the first year of life.
AIDS
Characterized by severe immunodeficiency (CD4+ count <200 cells/mm³ or <15%) and development of AIDS-defining illnesses like Pneumocystis jirovecii pneumonia, severe wasting, and encephalopathy.
Mnemonic: “VIRUS”
To remember key aspects of HIV pathophysiology:
- V – Viral integration into host DNA
- I – Immune system progressively destroyed
- R – Replication occurs continuously
- U – Uncontrolled opportunistic infections result
- S – Systemic effects throughout body systems
Identification & Diagnosis
Early and accurate diagnosis of pediatric HIV is critical for initiating timely treatment and improving outcomes. Diagnostic approaches differ by age due to the presence of maternal antibodies in infants.
Diagnostic Challenges in Infants
Key Challenge: Maternal HIV antibodies cross the placenta and can persist in the infant’s circulation for up to 18 months, making antibody-based tests unreliable for definitive diagnosis in infants younger than 18 months.
Diagnostic Approach by Age
| Age Group | Recommended Tests | Timing | Interpretation |
|---|---|---|---|
| Birth to 18 months |
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Two positive virologic tests from separate blood samples confirm diagnosis Note: A negative test at birth does not exclude infection as transmission may occur during delivery |
| Older than 18 months |
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Any time after 18 months of age |
Positive antibody test confirms HIV infection (maternal antibodies have cleared) |
| All ages |
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At diagnosis and routinely during follow-up |
Used for staging, monitoring disease progression, and guiding treatment decisions |
Clinical Indicators Suggestive of HIV Infection
Common Clinical Presentations
- Failure to thrive/growth delays
- Developmental delays or regression
- Recurrent or persistent oral thrush
- Chronic or recurrent diarrhea
- Persistent generalized lymphadenopathy
- Hepatosplenomegaly
- Recurrent bacterial infections
- Opportunistic infections
- Parotid gland enlargement
When to Test (Risk Factors)
- Born to HIV-positive mother
- Unknown maternal HIV status with risk factors
- Presenting with AIDS-defining illness
- Siblings with HIV infection
- History of sexual abuse
- Adolescents with high-risk behaviors
- Children from high-prevalence regions
- History of blood transfusion (in some regions)
- Unexplained symptoms consistent with HIV
Disease Staging in Children
The WHO Clinical Staging System and CDC Classification System help assess disease severity and guide treatment decisions.
| WHO Stage | Clinical Presentation |
|---|---|
| Stage 1 | Asymptomatic or persistent generalized lymphadenopathy |
| Stage 2 | Moderate symptoms (hepatosplenomegaly, papular skin eruptions, recurrent upper respiratory infections) |
| Stage 3 | Advanced symptoms (unexplained severe malnutrition, chronic diarrhea, persistent fever, oral candidiasis, pulmonary TB) |
| Stage 4 | Severe symptoms (severe wasting, Pneumocystis pneumonia, recurrent severe bacterial infections, HIV encephalopathy) |
Mnemonic: “PEDIATRIC HIV”
Key clinical indicators suggesting HIV infection in children:
- P – Persistent generalized lymphadenopathy
- E – Encephalopathy (developmental delay)
- D – Diarrhea (chronic or recurrent)
- I – Infections (recurrent bacterial)
- A – AIDS-defining illnesses
- T – Thrush (persistent oral candidiasis)
- R – Respiratory infections (chronic or recurrent)
- I – Impaired growth (failure to thrive)
- C – Chronic parotitis
- H – Hepatosplenomegaly
- I – Immunodeficiency signs
- V – Virologic testing needed for diagnosis
Clinical Manifestations
The clinical presentation of HIV in children varies widely, influenced by the timing of infection, viral load, immune status, and access to treatment. Children may exhibit symptoms across multiple body systems.
Progression Patterns in Pediatric HIV
Rapid Progressors
- ~20-25% of perinatally infected infants
- Develop AIDS within first year of life
- Early onset of severe symptoms
- High viral loads, rapid CD4+ decline
- Often infected in utero
- Poor prognosis without early intervention
Slow Progressors
- ~75-80% of perinatally infected children
- Slower disease progression
- May remain asymptomatic for several years
- Lower viral set points
- More gradual CD4+ decline
- Better prognosis with treatment
System-Based Clinical Manifestations
| System | Common Manifestations | Nursing Assessment Focus |
|---|---|---|
| General |
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| Respiratory |
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| Gastrointestinal |
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| Neurological |
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| Dermatological |
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| Hematological |
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| Cardiovascular |
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| Renal |
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Opportunistic Infections in Pediatric HIV
Children with HIV are vulnerable to opportunistic infections, which often define the clinical course of the disease. The risk increases as CD4+ counts decline.
Common Bacterial Infections
- Recurrent bacterial pneumonia
- Tuberculosis
- Salmonellosis
- Mycobacterium avium complex (MAC)
Common Fungal Infections
- Candidiasis (oral, esophageal)
- Pneumocystis jirovecii pneumonia
- Cryptococcosis
- Histoplasmosis
Common Viral Infections
- Cytomegalovirus (CMV)
- Herpes simplex virus (HSV)
- Varicella-zoster virus
- JC virus (PML)
Mnemonic: “CLINICAL AIDS”
Key clinical manifestations of advanced pediatric HIV:
- C – Chronic diarrhea and candidiasis
- L – Lymphadenopathy (persistent, generalized)
- I – Infections (recurrent, opportunistic)
- N – Neurological impairment (developmental delay)
- I – Immunodeficiency (low CD4+ count)
- C – Cardiomyopathy
- A – Anemia and other cytopenias
- L – Lung disease (PCP, LIP)
- A – Albumin low (malnutrition, wasting)
- I – Integumentary manifestations (skin conditions)
- D – Developmental delay
- S – Stunted growth (failure to thrive)
Hospital Management
Hospital-based management of pediatric HIV involves a multidisciplinary approach focusing on antiretroviral therapy, opportunistic infection treatment, supportive care, and psychosocial support.
Antiretroviral Therapy (ART)
All HIV-positive children should receive ART regardless of clinical stage or CD4+ count. Early initiation improves outcomes and reduces mortality.
| ART Components | Common Pediatric Regimens | Nursing Considerations |
|---|---|---|
| First-line Regimen |
Typically consists of:
Example: Abacavir + Lamivudine + Dolutegravir |
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| ART Drug Classes |
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| Treatment Monitoring |
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Management of Opportunistic Infections
Prophylaxis
- PCP prophylaxis: Trimethoprim-sulfamethoxazole for all HIV-exposed infants from 4-6 weeks of age until HIV infection is excluded; continued for infected children until 5 years of age or adequate immune recovery
- TB prophylaxis: Isoniazid for TB-exposed children or those with positive TB skin test
- MAC prophylaxis: Azithromycin for severely immunocompromised children (CD4 <50 cells/mm³)
- Fungal prophylaxis: Fluconazole for recurrent candidiasis or cryptococcal exposure
Acute Treatment
- PCP: High-dose TMP-SMX, oxygen support, potentially corticosteroids
- TB: Standard multi-drug therapy, adjusted for ARV interactions
- Cryptococcal meningitis: Amphotericin B + flucytosine followed by fluconazole
- CMV retinitis: Ganciclovir, foscarnet, or cidofovir
- Severe bacterial infections: Broad-spectrum antibiotics, narrowed based on culture
Nursing Care Priorities in Hospital Settings
Initial Assessment and Stabilization
Complete physical assessment, vital signs monitoring, growth parameters, developmental screening, laboratory specimen collection, and immediate interventions for acute conditions.
Medication Administration and Monitoring
Accurate calculation and administration of ARVs and other medications, monitoring for adverse effects, ensuring appropriate timing with food if required, and addressing palatability issues.
Nutritional Support
Nutritional assessment, caloric intake monitoring, management of feeding difficulties, supplementation when needed, and addressing medication-food interactions.
Infection Prevention
Standard precautions, isolation when indicated, prevention of healthcare-associated infections, and monitoring for signs of new opportunistic infections.
Respiratory Support
Oxygen therapy, airway clearance, positioning, chest physiotherapy, and respiratory monitoring for children with respiratory infections or conditions.
Psychosocial Support
Age-appropriate communication, support for child and caregivers, addressing stigma, preparing for disclosure (when appropriate), and connecting families with resources.
Discharge Planning
Medication education, home care instructions, follow-up appointment scheduling, connection to community resources, and ensuring transition to home care is seamless.
Management of Complications
| Complication | Management Approach | Nursing Interventions |
|---|---|---|
| Severe Malnutrition |
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| HIV Encephalopathy |
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| Respiratory Failure |
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| Immune Reconstitution Inflammatory Syndrome (IRIS) |
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| Medication Side Effects |
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Mnemonic: “HOSPITAL”
Key nursing priorities for hospitalized children with HIV:
- H – Hydration and nutrition support
- O – Opportunistic infection management
- S – Standard precautions and infection control
- P – Pain and symptom management
- I – Interdisciplinary approach to care
- T – Treatment adherence support
- A – Assessment of all body systems
- L – Laboratory monitoring and follow-up
Home Management
Effective home management is crucial for long-term success in treating pediatric HIV, as most children will spend the majority of their time outside of healthcare facilities. Nurses play a vital role in educating and supporting families.
Elements of Successful Home Management
Medication Management
- Consistent medication timing
- Proper storage of medications
- Age-appropriate administration techniques
- Addressing palatability issues
- Managing side effects
- Using reminders and pill organizers
- Planning for refills
Nutrition and Growth
- High-calorie, nutrient-dense diet
- Regular growth monitoring
- Managing medication-food interactions
- Multivitamin supplementation
- Addressing feeding difficulties
- Food safety education
- Cultural food preferences
Infection Prevention
- Hand hygiene practices
- Avoiding known sick contacts
- Food and water safety
- Pet safety precautions
- Environmental cleanliness
- Recognizing early signs of infection
- Vaccination schedule adherence
Caregiver Education and Support
| Educational Topic | Key Content | Teaching Strategies |
|---|---|---|
| Understanding HIV |
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| Medication Adherence |
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| Warning Signs |
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| Disclosure Issues |
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| Psychosocial Support |
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Home-Based Monitoring
Growth and Development Monitoring
Track height, weight, head circumference (for younger children), developmental milestones, and school performance. Teach caregivers to maintain growth charts and milestone records.
Medication Adherence Assessment
Review medication administration records, pill counts, pharmacy refill history, and discuss barriers to adherence during each visit. Problem-solve strategies to improve adherence.
Nutritional Assessment
Evaluate dietary intake, feeding patterns, appetite changes, and nutritional challenges. Adjust nutritional plans based on growth trajectory and medical needs.
Symptom Surveillance
Teach families to recognize and record symptoms of disease progression or opportunistic infections. Create symptom diaries or checklists for consistent monitoring.
Psychosocial Assessment
Regularly assess family dynamics, coping mechanisms, disclosure status, school adjustment, and mental health of both child and caregivers.
Special Considerations for Home Care
Challenges
- Medication fatigue: Developing strategies for long-term adherence despite medication burden
- Stigma management: Helping families navigate disclosure and potential discrimination
- Transitioning care responsibilities: Gradually shifting care from caregivers to older children/adolescents
- Resource limitations: Addressing financial, transportation, or housing constraints
- Multiple caregivers: Ensuring consistency when multiple people are involved in care
Solutions
- Simplification of regimens when possible to reduce pill burden
- Role-specific education for all caregivers involved
- Connection to community resources and support services
- Age-appropriate responsibility transfer through education and skill-building
- Peer support groups for both children and caregivers
- Telehealth options to reduce transportation barriers
Mnemonic: “HOME CARE”
Essential elements of pediatric HIV home management:
- H – Health maintenance and promotion
- O – Oral medication administration support
- M – Monitoring for complications and side effects
- E – Education of caregivers and child
- C – Communication with healthcare team
- A – Adherence strategies implementation
- R – Resource connection and coordination
- E – Emotional and psychosocial support
Control & Prevention
Preventing pediatric HIV infections and controlling disease progression are primary goals in the management of this condition. Prevention strategies focus on eliminating mother-to-child transmission and providing early treatment for infected children.
Prevention of Mother-to-Child Transmission (PMTCT)
Comprehensive PMTCT Approach
Primary Prevention
- HIV prevention in women of childbearing age
- Family planning counseling
- Routine HIV testing
Antenatal Care
- Universal HIV testing
- Early ART initiation
- Viral suppression
Labor & Delivery
- Maternal ART
- C-section when indicated
- Infant prophylaxis
Postpartum Care
- Safe infant feeding
- Infant testing
- Continued maternal ART
PMTCT Interventions Details
| Stage | Interventions | Nursing Role |
|---|---|---|
| Antenatal |
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| Labor & Delivery |
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| Postpartum & Infant Care |
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Post-Exposure Prophylaxis (PEP) for Children
Indications for PEP
- Sexual assault or abuse where perpetrator has HIV or unknown status
- Needlestick injuries with HIV-contaminated needles
- Significant exposure to HIV-infected blood or body fluids
- Bite wounds involving HIV-infected blood
- High-risk exposure to HIV-positive mother’s blood during birth
PEP Implementation
- Must be initiated within 72 hours of exposure (ideally within 24 hours)
- Three-drug regimen for 28 days
- Age and weight-appropriate dosing
- Follow-up HIV testing at 6 weeks, 3 months, and 6 months
- Side effect monitoring and adherence support
- Psychological support, especially in cases of assault
Control of Disease Progression in Infected Children
Early Identification and Diagnosis
Routine testing of HIV-exposed infants, symptomatic children, and children with risk factors. Early diagnosis allows for timely initiation of treatment.
Prompt ART Initiation
Immediate ART initiation for all HIV-positive children regardless of CD4+ count or clinical stage. Early treatment significantly reduces morbidity and mortality.
Adherence Support
Comprehensive adherence counseling, age-appropriate education, and development of support systems to ensure consistent medication taking.
Opportunistic Infection Prophylaxis
Implementation of cotrimoxazole prophylaxis and other preventive medications based on age, CD4+ count, and regional endemic infections.
Regular Monitoring
Scheduled clinical assessments, CD4+ count, viral load monitoring, growth and development tracking, and screening for complications.
Comprehensive Care
Addressing nutritional needs, psychosocial support, developmental interventions, and educational support to optimize overall wellbeing.
Transition Planning
Age-appropriate disclosure and gradual preparation for transition to adolescent and eventually adult care services.
Nursing Role in Prevention and Control
Education
- Community education about HIV prevention
- PMTCT awareness for women of childbearing age
- Safe sex education for adolescents
- Importance of HIV testing during pregnancy
- Medication adherence counseling
- Safe infant feeding practices
Clinical Services
- HIV testing and counseling
- Administration of ARV prophylaxis
- Early infant diagnosis services
- Immunization administration
- Growth and development monitoring
- Nutritional assessment and support
- Case management and care coordination
Support & Advocacy
- Psychosocial support for families
- Stigma reduction initiatives
- Connecting families to resources
- Advocating for access to medications
- Supporting disclosure processes
- Strengthening community support systems
- Policy development for child protection
Mnemonic: “PREVENT HIV”
Key strategies for prevention of pediatric HIV:
- P – Prenatal HIV testing for all pregnant women
- R – Rapid initiation of ART for HIV-positive mothers
- E – Early infant diagnosis and treatment
- V – Viral load monitoring during pregnancy
- E – Exclusive formula feeding when safe and feasible
- N – Newborn prophylaxis with ARVs
- T – Treatment adherence support
- H – Healthcare provider education
- I – Infection prevention precautions
- V – Vigilant follow-up of HIV-exposed infants
Nursing Care Plans
Comprehensive nursing care plans are essential for addressing the multifaceted needs of children with HIV/AIDS. The following nursing diagnoses and interventions address common clinical issues.
Care Plan 1: Risk for Infection
Nursing Diagnosis
Risk for Infection related to immunosuppression secondary to HIV infection, as evidenced by decreased CD4+ count and increased susceptibility to opportunistic pathogens.
Expected Outcomes
- Child will remain free from signs and symptoms of opportunistic infections
- Caregivers will demonstrate appropriate infection prevention measures
- Child will maintain age-appropriate activities while avoiding high-risk exposures
Nursing Interventions
| Intervention | Rationale |
|---|---|
| Assess for signs and symptoms of infection during each encounter (fever, respiratory symptoms, skin changes, altered mental status) | Early identification of infections allows for prompt treatment and prevents complications |
| Monitor laboratory values (CBC, CD4+ count, viral load) according to clinical protocol | Provides objective data about immune function and risk for opportunistic infections |
| Ensure adherence to prophylactic medications (e.g., cotrimoxazole) | Prophylaxis significantly reduces the risk of specific opportunistic infections |
| Teach and reinforce proper hand hygiene for child and caregivers | Hand hygiene is the most effective measure for preventing transmission of pathogens |
| Educate family about avoiding exposure to individuals with known infections | Reduces risk of exposure to pathogens that could cause severe disease |
| Provide education about food safety (proper cooking temperatures, avoiding raw foods, safe water) | Prevents foodborne and waterborne infections, especially important when immune system is compromised |
| Ensure appropriate immunizations according to schedule with consideration of immune status | Provides protection against vaccine-preventable illnesses while avoiding live vaccines when severely immunocompromised |
| Teach caregivers to recognize early signs of infection and when to seek medical attention | Facilitates early intervention when infections do occur |
Evaluation
- Monitor frequency and severity of infections
- Observe caregiver demonstration of infection prevention measures
- Review adherence to prophylactic medications
- Assess child’s participation in age-appropriate activities
Care Plan 2: Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis
Imbalanced Nutrition: Less Than Body Requirements related to increased metabolic demands, decreased oral intake, malabsorption, and medication side effects, as evidenced by weight loss, failure to thrive, or growth stunting.
Expected Outcomes
- Child will demonstrate weight gain according to growth expectations
- Child will consume adequate calories and nutrients to meet metabolic needs
- Caregivers will implement strategies to optimize nutritional intake
Nursing Interventions
| Intervention | Rationale |
|---|---|
| Assess growth parameters (weight, height, head circumference, BMI) at each visit and plot on appropriate growth charts | Provides objective data about growth trends and nutritional status over time |
| Conduct detailed nutritional assessment including dietary intake, feeding practices, and nutritional knowledge | Identifies specific nutritional deficits and areas for intervention |
| Calculate caloric and protein requirements based on age, weight, and clinical status | Children with HIV often have increased metabolic demands requiring 150% of normal caloric intake |
| Recommend small, frequent, nutrient-dense meals and snacks | May improve intake when appetite is poor and helps maintain stable blood glucose |
| Suggest caloric enhancement strategies (adding oils, peanut butter, dry milk powder to foods) | Increases caloric density without increasing volume when appetite is limited |
| Administer prescribed nutritional supplements and multivitamins | Supplements provide essential nutrients that may be deficient due to poor intake or malabsorption |
| Coordinate with dietitian for specialized nutritional support | Provides expert guidance for complex nutritional needs |
| Teach strategies for managing medication-related GI symptoms that affect intake | Minimizing side effects can improve food tolerance and intake |
| Implement feeding techniques for children with oral lesions or dysphagia | Modifications can make eating less painful and more successful |
| Consider referral for enteral feeding support if oral intake remains inadequate | Alternative feeding routes may be necessary to ensure adequate nutrition |
Evaluation
- Monitor weight gain trajectory and compare to growth standards
- Track dietary intake through food diaries
- Assess energy level and functional status
- Evaluate laboratory values related to nutritional status (albumin, protein, hemoglobin)
Care Plan 3: Ineffective Therapeutic Regimen Management
Nursing Diagnosis
Ineffective Therapeutic Regimen Management related to complexity of medication regimen, medication side effects, lack of resources, or inadequate knowledge, as evidenced by missed doses, inconsistent medication administration, or detectable viral load despite treatment.
Expected Outcomes
- Caregivers/child will demonstrate >95% adherence to medication regimen
- Child will achieve and maintain undetectable viral load
- Caregivers/child will verbalize understanding of medication purpose, administration, and importance
Nursing Interventions
| Intervention | Rationale |
|---|---|
| Assess current medication adherence, including patterns, barriers, and facilitators | Identifies specific adherence challenges and builds on existing successful strategies |
| Provide clear, written medication schedules with visual cues (pictures, colors) appropriate for literacy level | Visual reminders improve understanding and recall of complex regimens |
| Teach medication administration techniques including how to measure liquid medications, manage pill swallowing, and mask unpleasant tastes | Improves caregiver confidence and addresses practical barriers to medication administration |
| Help establish medication routines linked to daily activities (meals, tooth brushing, bedtime) | Integrating medications into established routines improves consistency |
| Provide pill organizers, alarms, medication diaries, or mobile app recommendations | External reminders reduce reliance on memory for complex regimens |
| Educate about potential side effects and management strategies | Anticipatory guidance helps families manage side effects rather than discontinuing medications |
| Discuss the relationship between adherence, viral suppression, and health outcomes | Understanding consequences improves motivation for adherence |
| Involve the child in medication management appropriate to developmental level | Gradual involvement builds skills for eventual self-management and improves cooperation |
| Connect family with resources for medication access and financial assistance | Addresses economic barriers to medication adherence |
| Collaborate with healthcare team to simplify regimen when possible | Simpler regimens with fewer pills and daily doses improve adherence |
Evaluation
- Review medication refill history
- Conduct pill counts or medication diaries
- Monitor viral load results
- Assess caregiver/child knowledge about medications
- Evaluate implementation of adherence strategies
Care Plan 4: Compromised Family Coping
Nursing Diagnosis
Compromised Family Coping related to chronic nature of illness, stigma associated with HIV, caregiver guilt, financial stressors, or inadequate support systems, as evidenced by verbalized overwhelm, missed appointments, difficulty managing care requirements, or family conflict.
Expected Outcomes
- Family will identify and utilize effective coping strategies
- Caregivers will verbalize reduced stress related to child’s care
- Family will engage with appropriate support services
- Family will maintain adherence to care plan despite challenges