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Pediatric nursing > Test 2 > Flashcards

Test 2 Flashcards

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1
Q

immunoglobulins are transferred from one person to another; (weeks or months);E: injections of exogenous immunoglobulins or from mother to infant via colostrum or placenta

A

passive immunity

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2
Q

person’s own immune system generates the immune response

A

active immunity

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3
Q

ability to destroy and remove an antigen from the body through antibodies

A

immunity ( immunologic memory )

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4
Q

vaccines mimic the characteristics of

A

an antigen

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5
Q

modified living organisms; replicate in the body but don’t cause disease

A

life attenuated vaccines - 1 or 2 doses

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6
Q

use whole dead organisms or pieces weaker antigen;

A

inactivated vaccines - require multiple doses

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7
Q

genetically engineered; E: hepatitis B vaccine

A

recombinant inactivated vaccine

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8
Q

updates vaccine schedules yearly;

A

• Advisory Committee on Immunization Practices (ACIP)

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9
Q

Vaccine storage and administration

A

package insert

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10
Q

must be provided to parents whose kids receive vaccine

A

Vaccine Information Statements (VIS) - whats for, side effects

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11
Q

Report any clinically significant adverse reaction

to the

A

Vaccine Adverse Event Reporting System

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12
Q

Proper documentation

A

date; name of vaccine; lot number and expiration date; manufactures name; site and route; name and address of the facility

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13
Q

DTaP

under 1

A

( diphtheria, tetanus, and pertussis ) ; for children under 7 ; first one - under 1; IM

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14
Q

Tdap

A

for children over 7; tetanus booster for older kids (11-12) every 5-10 years;
– Rising pertussis cases since 1970 - infants, adolescents and young adults.

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15
Q

Hib

under 1

A

Haemophilus influenzae Type B Vaccine; prevents – meningitis, epiglottitis, septic arthritis in children under age 5 ; IM

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16
Q

Polio vaccine
under 1
* polio - paralytic disease

A

– Inactivated polio vaccine (IPV)
currently recommended in US
– Killed virus, poses no risk of infection; SC - subcute

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17
Q

Hep B

under 1

A

Hepatitis B; – Recombinant vaccine

– Series usually started at birth before discharge from hospital; 3 doses in 6 months ; IM

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18
Q

Pneumococcal vaccine

under 1

A

– Streptococcus pneumoniae most common cause of serious
infection in children under age 2 - pneumonia, sepsis, meningitis, otitis media; – Conjugate vaccine (13 strains) started in infancy; IM

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19
Q

Rotavirus vaccine

under 1

A

– Most common cause of severe
gastroenteritis (infectious diarrhea) in young children
– Live vaccine, given by oral route to infants

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20
Q

MMR

over 1

A

Measles, Mumps, and Rubella Vaccine ; – Live attenuated virus combination
– 2 doses given to children > 12 months of age ( before kindergarten ) ; SC

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21
Q

Varicella vaccine

over 1

A

chicken pox ; – Live attenuated virus

– 2 doses given to children > 12 months of age; SC

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22
Q

Hep A

over 1

A

Hepatitis A vaccine; IM
– Inactivated whole virus vaccine
– One of the most frequently reported diseases in the US
– 2 doses given to children > 12 months of age ( 12-15 month and 2nd - 6 month later)

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23
Q

Meningococcal vaccine

age 11

A

IM; Neisseria meningitidis causes meningitis and sepsis

– 10-12% of infected persons die, 20% of survivors suffer longterm consequences; 11-12 - booster at age 16

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24
Q

HPV

11-12

A

Human Papillomavirus vaccine; IM; – Infection most common in adolescents and young adults who are sexually active
– HPV causes genital warts that can lead to cervical cancer; for girls only ; for boys and girls ( 3 shots )

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25
Influenza vaccine
IM; – Universally recommended > 6 months of age; inactivated - IM; nasal mist - alive ( not for compromised children) ; intradermal injection - inactivated ( not for children under 18).
26
Mild common reactions to immunization
Fever - 102.9 ( OK); irritability; sleepiness; poor appetite; rash ( MMR and varicella) - 5-20 days
27
Severe - concorning ( rare) reactions
difficulty breathing ( allergic reaction ) - pallor, weakness, decreased BP, hives ; seizures ; after DTaP - crying for 3 hours ( increased irritability)
28
Post-Vaccine Interventions
• Tylenol every 4 hours for pain or fever • No ibuprofen to infants < than 6 months of age • No ASA to any child under 16 years of age • Warm baths or compresses • Encourage ambulation or use of affected extremity
29
Immunize - yes
1. Child is on antibiotics; 2. Minor illness - except flue vaccine 3. Mild allergies 4. Breastfeeding infant and parent 5. Pregnant household contact 6. Allergy to eggs - except flue (influenza) vaccine
30
Immunize - NO
1. rash or hives after previous injection
31
Barriers to Immunization
* Parental concerns re: safety * Misconceptions - autism ? thimerosal ( mercury ) ? * More than 1 health care provider * Multiple children in family * Cost * Concern about multiple vaccines
32
Overcoming Barriers
• Combination vaccines - reduce the number child gets sticked • Vaccines for Children (VFC) program implemented in 1994 - can get it at medical home from goverment • Establish medical home • Verify immunization status at every visit • Verify status of siblings accompanying child • Maintain centralized record
33
Differences in the skin
skin is thinner; blood vessels closer to the body ; heat loss more readily; substance absorbed more readily; more water, less pigment - risk for sun damage
34
Physical examination of skin
note temperature, moisture, texture; describe lesions: appearance- macular (flat); papular (bumpy); vesicular (blisters); pustular( with puss); shape: round; oval; annular( central clearing); linear; target rash (bull's eye) ; drainage: clear, purulent; honey color; or otherwise; note scaling, lichenification (thickening); tattoos, piercing.
35
Staphylococus aureus and group A b-hemolytic streptococcus ( normal flora on skin) ; assess for regional lymphadenopathy; culture for cellulitis ; topical antibiotics; sever - systemic; contact precaution
Bacterial infections
36
honey colored crust; around the mouth or below the nose; bullous ( red macules)
Impetigo
37
infection of the hair follicle; red raised papular pustules;
Folliculitis
38
localized infection and inflammation of the skin and subcut tissues; often follows skin trauma; non discrete borders; erythema, pain, edema, warmth
Cellulitis
39
infection with the toxin from the staph aureus; flattish bullae ( blisters) that rupture leaving skin red, weeping and causes exfoliation; looks like a burn; common in infants; aggressive fluid management ( IV); incubator for heat; IV antibiotics; pain management ( opioids)
Scalded skin syndrome
40
risk factors: pets; barber; locker rooms; nylon socks; tight clothing; swimming pools; contact sports; contagious but can return while treatment begins; cotton socks; antifungal cream
Fungal infections
41
ring warm, annual lesion; raised and scaly; itching; af cream for (3-4 weeks)
Tinea corporis
42
athlete's foot; red scaling rash on soles and between the toes; itchy; TX: topical af ( 4 weeks) ; toes clean and dry; cotton socks;
Tinea pedis
43
erythema, scaling, maceration in the inguinal creases and inner thighs; topical - 4-6 weeks
Tinea cruris
44
infection of the scalp; patches of scaling; and hair loss; kerion - inflamed boggy mass filled with pustules; TX: 6 weeks oral af meds; no school for 1 week after treatment starts
Tinea capitis
45
diaper rash; candida albicans; fiery red lesions; scaling in the skin folds; satellite lesions; topical antifungal after every diaper change; discontinue soaps and wipes ( flora)
Diaper candidiasis
46
inflammatory skin condition; common diaper rash; prolonged contact with urine or feces; flat red rash; prevention: topical ointments; change diaper often;
Diaper dermatitis
47
eczema; skin reaction; chronic skin infection; extreme itching - psychological distress; complication - bacterial superinfection; atopy family - asthma, allergic rhinitis and eczema - auscultate lungs ( wheezing); DX: serum IgE, skin prick allergy testing to determine the food or environmental allergen
Atopic dermatitis
48
Atopic dermatitis management
* Promote skin hydration: warm water every day - moisturizer after; ointment ( Vaseline); fragrance free/ die free; oatmeal or colloid bath. * Maintain skin integrity: topical corticosteroid ( less than 50 %) at a time (not every day) ; avoid tight clothing, heat, synthetic fabrics and wool; perfumes, dies, harsh chemicals, * Prevent infection: short clean fingernails; antihistamines given at bedtime ( sedation); antibiotics for secondary infections ; distractions to prevent scratching
49
History of present illness ( HF s/s)
1. easy fatigability ( with activity) 2. frequent occurrences of pneumonia 3. cyanosis 4. difficulty keeping up with peers 5. changes in HR + BP
50
Past medical history
pregnancy history; prenatal care; family history of heart disease; premature infant - higher risk
51
Inspection
color - pallor, cyanosis ; activity level !!!
52
Auscultation
lung + heart; adventitious sounds; extra heart sounds ( S3, S4); WOB (work of breathing) - increased HR, RR; dyspnea
53
Palpation
all the peripheral pulses
54
Murmurs
1. Gr 1 - difficult to auscultate; very quiet; ( quiet room + child) 2. Gr 2 - little louder ( couple seconds) 3. Gr 3 - as soon as start listen 4. Gr 4 - loud + thrill ( vibration ) 5. Gr 5 - stethoscope partially off the chest wall + thrill 6. Gr 6 -stethoscope off the chest + thrill
55
Clubbing
chronic hypoxia ( 1 year or more )
56
lab + diagnostic testing
1. CBC - polycythemia ( increase RBC - chronic hypoxia) 2. Partial pressure of oxygen - amount of O2 in the blood 3. Chest X-ray - size of the heart 4. Echocardiogram - ultrasound 5. ECG - rate, rhythm, conduction and musculature 6. Cardiac catheterization - golden standard - diagnostic, interventional, electrophysiologic
57
Tetrologyof Fallot
Disorders with decreased pulmonary blood flow; 4 defects: 1. ventricular septal defect 2. pulmonary stenosis 3. overriding aorta 4. right ventricular hypertrophy
58
Tetrologyof Fallot - S/s
1. Cyanosis 2. Fatigue ( with activity) 3. poor feeding + growth 4. Hypercyanotic spell - blue baby when agitated or upset - classic sign
59
Hypercyanotic spell - interventions
1. Remain calm 2. Knees up to the chest position ( squads) - increase peripheral pressure - blood shunts to lungs 3. O2 4. Morphine to calm down
60
Disorders with increased pulmonary flow
1. Atrial septal defect 2. Ventricular septal defect 3. Patent ductus arteriosus S/s - increased pulmonary infections - pneumonia
61
Atrial septal defect
Left side of the heart has increased pressure - increased blood volume in right atrium - increased blood flow to the lungs ;;; s/s - asymptomatic ( small holes) ; most of the time close by themselves by age 3; large - closed surgically; snowman x-ray
62
Ventricular septal defect
small - close by age 3; large - risk for HF; increased amounts of blood in the right ventricle
63
Ventricular septal defect - cyanosis - interventions
cover the infant and elevate his head
64
Patent ductus arteriosus
connection between aorta ( from) and pulmonary artery( to)
65
Patent ductus arteriosus TX
1. NSAIDs - inhibit production of prostaglandins ( which keep ductus arteriosus open) - Indomethacin 2. Cardiac cath - clog it off 3. Open heart surgery - tight off * premature babies ; infants born at high altitudes (Denver)
66
Coarctation of the Aorta
obstructive disorder; narrowing of the aorta; difficulty of blood getting to the lower body; -puts a lot of pressure on the left side of the heart; collateral circulaion ( smaller vessels);
67
Coarctation of the Aorta: S/s
leg pain with activity; BP and pulses higher in the upper extremities (bounding pulses) - thready pulses in legs; notching of the ribs ( children) - vessels grown and multiplied.; headaches, frequent epistaxis - nosebleed
68
Transposition of the Great Vessels
1. Body - RA - RV - Aorta - Body 2. Lungs - LA - LV - Pulmonary artery - Lungs * no murmur, cyanosis Don't pick up until fetal structures ( ductus arteriosus - mixes blood) close. TX: surgery - reverse great vessels; balloon to create hole - to mix blood Mixed defects
69
Hypoplastic Left Heart Syndrome
Mixed Defects; congenital; all of the structures on the left side of the heart are severely undeveloped - no blood to the systemic circulation ; DX: in utero - maternal ultrasound; TX: procedures in utero; at birth surgery - get oxygenated blood in the vessel that goes to the body; two more - move systemic pumping mechanism from the left side to the right side
70
Congenital heart defects - nursing interventions
1. Make sure that oxygenation level is adequate ; Position - semi fowler's or fowler's 3. Adequate nutrition - need more calories; infants - high calorie formula ( 24-26 cal/oz) ; small frequent meals; milk shake ( high protein) ; no more than 20 min ( fatigue ) breastfeeding or formula + rest through feeding tube or TPN; 4. Assist the child and family coping - give in to child's wishes - vulnerable child syndrome - teach discipline ; move to non-heart topics 5. Prevent infection - especially children with increased pulmonary flow
71
Acquired cardiovascular disorders
1. Heart failure 2. Acute rheumatic fever 3. Kawasaki disease
72
Heart failure : health history
inability of heart to pump blood; most often in children with CHD 1. change in eating habits 2. not tolerate position changes 3. SOB; fatigue 4. Decreased urinary output
73
HF: physical exam
1. back up of blood to lungs - crackles 2. increased work of breathing 3. increased HR and RR 4. Diaphoresis; cool clammy skin 5. Thready pulses
74
HF : management
1. Oxygenation 2. Support cardiac function - Digoxin 3. Daily weights - monitor fluids 4. Increase calories 5. Rest is key - no activities; quiet
75
Digoxin
increase contractility of the heart; apical pulse for 1 full minute before administer - withhold lower than 60 ( younger 70; infants 90); for two missed doses - notify; if vomited - wait for second dose;
76
Digoxin side effects - toxic
1. decreased HR 2. Vomiting ( younger kids) nausea (older kids) 3. Visual disturbances - spinning, blurry; infant - can't track
77
Acute rheumatic fever
Post strep throat ( acute renal failure - glomerulonephritis ) ; school age - 5-15; 6-12 weeks ; can damage heart valves - carditis ( x-ray, echo) ; if not treated strep - consider antibiotics ; multiple joint swelling; ASO titer ( if strep present), elevated WBC, ESR + CRP (inflammation)
78
Acute rheumatic fever - TX
1. Daily prophylactic antibiotic (low dose after Tx is done); 2. Rest - activity restriction and importance of adherence 3. Pain management 4. Cardiac follow up
79
Chorea
involuntary jerky movements
80
Kawasaki disease
systemic vasculitis; inflammation of epithelial cells that line blood vessels ( in the heart too); - coronary artery aneurysm - MI and death; DX: echocardiogram ( under 5 kids)
81
Kawasaki disease - TX
1. Single infusion of intravenous immunoglobulin ; 2. corticosteroids - reduce inflammation systemically 3. High dose aspirin therapy
82
Toxic effects of aspirin therapy
1. Tinnitus - ringing in the ear 2. Headache 3. Confusion + dizziness
83
Kawasaki disease S/s
1. Fever for at least 5 days 2. Dry, fissured lips 3. Conjunctivitis - inflammation of the eyes without discharge 4. bright maculo-papular rash 5. Desquamation ( peeling) of the feet and hands 6. Irritability, strawberry tongue 7. Photophobia * very high ESR
84
Kawasaki disease DX
4 symptoms + Fever for 5 days
85
Kawasaki disease - management
1. Encourage fluids ; IV fluids 2. Monitor for signs of HF 3. Comfort - acetaminophen ; quiet environment, position 4. Education - monitor fever even after discharge ; cardiac follow up

Pediatric nursing (2 decks)

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