Peds Exam 2 Flashcards
What are the two lives vaccines?
MMR and Varicella
At what age can children receive the MMR and Varicella?
12 months
Because they are live vaccine
What is the Hib Vaccine given for?
To prevent pertussis and whooping cough
What allergies contraindicate getting vaccines?
Neomycin, gelatin, or the vaccine itself
Can pregnant women receive MMR or Varicella?
NO
Can breastfeeding women receive MMR or Varicella vaccine>
Yes- live vaccines do not cross the breast milk
What is important when administering vaccines?
Refrigerated, document the lot #, manufacturer, and exp date
Considerations when giving multiple vaccines?
Least painful first
Save MMR and Varicella for last bc they hurt the most
What is important to obtain in the health history pertaining communicable diseases?
Any travel outside the country, immunization hx
What is important about obtaining health history on pets at home?
Lizards/turtles- carry diseases
Fifth Disease (Human Parvovirus) symptoms?
Starts with low grade fever, children get weird rash, spike high fever, swollen lymph nodes. Common in children under 10
What precautions taken for children with fifth disease?
Contact isolation
Stomatitis
Inflammation of oral mucosa, due to excess acidity
Symptoms of Stomatitis
Dehydration- oral sores are too sore to drink water
Management of Stomatitis
Miracle Mouthwash- Maalox, lidocaine, and benadryl
Intestinal parasitic disease
Worms (pinworms)
Diagnostic test for worms?
Tape Test
Obtain fecal specimen
Symptoms of intestinal parasitic disease (worms)
Diarrhea, vomiting, anorexia, failure to thrive, cramps, stools that are malodorous, pale, greasy
Treatment for intestinal parasitic disease (worms)
Drugs; Metronidazole (Flagyl) and tinidazole (Tindamax)
Example of bacterial infection
Scaled skin syndrome- staph eating bacteria
Biggest thing to watch for with Scalded skin syndrome?
Temps!! Bacterial infection- causes fevers
Nursing management of bacterial infection
*Airway support- throat swelling
Change clothes/sheets daily
daily bathing
What is sloughing skin?
Shedding of the skin layer
Treatment for cellulitis?
Warm compress- brings stuff to the surface
Giardia Intestinalis
Contaminated water lake/ swimming pools
Pediculosis capitis
Lice
Education for parents on pediculosis capitis
does NOT indicate socioeconomic class
Management for lice?
Machine wash in hot water and dry x20min
Soak combs/brush for 10min boiling water
Wash and bag stuffed animals
Lyme Disease
Tick-borne disorder
Manifestations of lyme disease
Tick bite 3-30 days before erythema
Large ring with a raised donut like border and bulls eye appearance
Treatment for Lyme disease
> 8 years old = Doxycycline
<8 years old = Amoxicillan or cefuroxime
What is important to know about Doxycyline?
It is harsh on the stomach
What is important to obtain about the history of a patient with lyme disease?
Recent travel to places such as flagstaff
Hypopituitarism
Decrease secretion of pituitary hormone
LOW GH
LOW TSH
Hyperpituitarism
Excessive growth hormone PRIOR to closure of epiphyseal shafts resulting in overgrowth of long bones
HIGH GH
HIGH ACTH
Hypothyroidism
Low thyroid hormone
HIGH TSH
LOW T3/T4
Hyperthyroidism
High thyroid hormone
LOW TSH
HIGH T3/T4
Pituitary
MASTER GLAND
Example- Oxytocin released from pituitary, if not triggered from the pituitary gland then the uterus will not contract
How much insulin does the pancreas normally secrete in a day?
20-40 units
Where is leftover glucose stored?
In the liver as glycogen
What happens when the liver is at full capacity of glycogen?
Remaining glucose is converted to fat (lipogenesis) and stored as adipose tissue
When should you administer insulin to children?
AFTER meals, bc unsure how much/if they will eat
How to monitor Type I diabetes in babies?
History taking- monitor the # of wet diapers to indicate frequent urination
Signs of hyperglycemia
Extreme thirst, excessive urination, dry skin, hunger, blurred vision, drowsy, nausea
Signs children with undiagnosed or poorly controlled diabetes
Restless, apathetic, having trouble functioning at school, *weight loss (3-5%)
Sometimes DKA and coma may be the first sign of Type I
Target blood sugar for children
150-180
CHO RATIO?
15g CHO to 1 Unit
Wait with needle in for 10 seconds for best absorption
A1C normal level?
< 5.7%
When is Lantus administered?
hs (bedtime), long acting-no peak
DO NOT HOLD LANTUS
Signs of hypoglycemia
Nervous, difficulty speaking, shaky, dizzy, sweaty, tachy, normal urine output
What chart is important to compare trends?
Growth chart
Growth hormone deficiency
Normal at birth- but them falls behind on ht/wt, delayed puberty
Hypopituitarism nursing considerations
Child should wear medic alert bracelet- steroid dependent
Medications necessary for regulation of hormones
Signs and symptoms of hypopituitarism
Regression or absence of sex characteristics Delay in tooth eruption Increased thirst and urination Fatigue and intolerance to stress Stunted growth after 1 year of life
Hypopituitarism treatment
Hormone replacement, steroid therapy (provide teaching for injections)
Precocious puberty
Puberty too quick
Development of breast or pubic hair before age 8
Which chart is used to track puberty?
Tanner chart (4-5 is not good, indicates growing too fast)
Management of precocious puberty
Factrel- synthetic LH releasing hormone
Synarel by IM or nasal spray (delays future development)
Congenital Hypothyroidism
Mental and physical retardation if not caught early
How is congenital hypothyroidism detected?
Newborn scrrening
Which assessment is extremely important in assessing for congenital hypothyroidism?
Anterior fontanel closes at 12-18 months
Treatment of congenital hypothyroidism
Lifelong therapy of synthetic thyroid hormone (Levothyroxine oral)
Graves Disease
Hyperthyroidism
Increased T3 and T4 levels
At what age is graves disease typically diagnosed?
6-12 months
Gradual onset of symptoms
Symptoms of graves disease
Protruding eyes
large neck
irritability
*increased appetite with weight loss
Sign of vitamin D toxicity?
Weakness