Trust vs mistrust
birth to 1 year
Infants need consistent, loving care by a motherinf person.
mistrust results when their is deficient or lacking of trust in the infants life, or their basic needs are not met.
Autonomy vs shame and doubt
1 to 3 years
autonomy - the child is able to control their new physical abilites as well as mental abilities
shame and doubt happens when they are made to feel small, are forced to be dependent in areas they capable of being in control.
initiative vs guilt
3 to 6 years
initative, children are able to have their own mind and control their actions with being aware of threats.
If they are bad to feel their actions are bad, they will start to feel a sense of guilt
industry vs inferiority
ages 6 to 12
industry- feel the need to work, want to carry activites that they can finish or complete. start to compete and cooperate with others and learn rules.
if too much is expected of them or they feel they cannot measure up they have feelings of inferiority and inadequacy.
identity vs role confusion
ages 12 to 18
start to become very concerned with their appearances and discovering their role in life.
if they have trouble discovering their role they end up in role confusion.
Vaccines with live viruses
influenza (intranasal) - live attenuated
Vaccines given IM (vastus lateralis until 18 months or older, then can be given deltoid as well)
DTap, Tdap, hep A, hep B, Hib, IPV, PCV, influenza, MCV4, HPV
c Vaccines given SQ
MMR, MMRV, MPSV4, Varicella
when will you know that varicella (chicken pox) is not contagious?
When the vesicles have all crusted.
Pertussis ( whooping cough)
Resp symptoms seen first
cough until they vomit, usually.
direct or droplet spread, or contact with contaminated objects
nursing care for pertusiss
obtain nasopharyngeal culture for diagnosis
encourage oral fluids, offer small amounts frequently/
during paroxysms ensure adequate O2 (put infant on side to decrease risk of aspiration if vomit)
provide humidified O2, suction PRN
observe signs of airways obstruction (increased restlessness, apprehension, retractions, cyanosis)
encourage compliance with AntiBX for household contacts
encourage booster in adolescents
use standard precautions and a mask.
first does should be age 6-12wks, shouldnt be given first does after 12wks, should be done with doses at 32 wks, no dose later than 32 wks.
Diphtheria and tetanus toxoids and acellular pertussis
min age: 6 wks
final does between 4-6 yrs
haemophilus influenzae type b
min age: 6 wks
min age: 6 wks
pneumococcal polysaccharide vaccine
min age: 2 yrs
measles, mumps, rubella vaccine
min age: 12 months
2nd dose usually between 4-6 yrs
min age: 2 years
Nasopharyngitis (common cold)
caused by many different viruses (RSV, influenza, rhinovirus)
more severe in infants and young children
fever is common in younger children
rest, fluid, stay home
motrin and tylenol, decongestant if over 6 months, buld syringe
avoid milke products = increase secretions
wash hands !
elevate HOB - helps breathing
premi with underlying cardiac issue or decompensate with RSV- admit to hosp
Acute epigoltitis (type of croup)
EMERGENCY - swollen epiglottis cannot rise and allow airway to open
obstructive inflammation (occlusion of trachea)
happens between 2-8
common cause - Hib - get child vaccinated
Acute epiglotitis care
DO NOT INSPECT THROAT or do with GREAT caution, complete obstruction can occur, should only be done if intubation can be performed immediately if necessary.
watch for obstruction of epiglottis
have intubation or trach equipment ready
drugs- antibiotics can be used-usually see decrease swelling after 24 hrs, steriods and IV fluids are also used.
Acute laryngotracheobronchitis (LTB)
most commone of croup syndromes
usually caused by viral infection
ages 6 mnt - 8 yrs
inflammation of the mucosa lining the larynx and trachea cuase narrowing of airway
s/s usally at night and go away in cold
inspirator stridor and retractions, barking or seal-like couch, tachypnea, hypoxia if unable to inhale enough air, resp acidosis may occur if unable to exhale CO2, may have fever
montior resp status - rate, retractions, listen to breath sounds before and after and tx
try to keep child calm
supplement O2, maintain cool mist
parents can run shower and allow child to breathe warm, moist air
high humidity with cool mist can provide relief
maybe ne nebulized tx
corticosteriods can be used to decreased inflammation
Autosomal recessive trait - one gene from both parents
most common diease to affect white children
disorder of Resp, GI and exocrine glans
most of kids with cystic fibrosis had what as a newborn
most common pathogens responsible form pulmonary infections with cystic fibrosis..
staph and pseudomonas
GI problems with CF:
need to replace pancreatic enzymes with all food - sprinkle on food before eating
need a well balanced, high protein, high calorie diet
give fat soluble vitamins in the water miscible form
Assessment with cystic fibrosis
lung sounds, couch, clubbing, frequency and nature of stools, abdmoinal distention, failure to thrive