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Hep A: Fecal oral route
How?
Manditory?
How many shots?
What age?
- IM
- Not manditory
- 2 round series
- @ least 1yr old
-
Hep B;
How
manditory
how many
if mom b+
- IM
- 3 dose
- yes
- start within 24hrs
-
Diphtheria, Pertusses, Tetanus: DTaP
How
manditory
how many
how many years for booster, what if step on rusty nail
- IM
- yes
- 5 rounds
- boost every 10 years, but if step on rusty nail and its been longer than 5 years since boost, give just a tetnus booster
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Polio
How
how many
manditory
-
Measles, mump and rubella
How
How many
SE
who do we not give it to?
- Sub Q
- AFTER 1 year of age
- 2 rounds
- It burns, give last!
- <12 months, pregnant, immunocomprimised.
-
Hib
how many
manditory
what does it protect from
- 3
- not manditory
- hepatititis, menigitis
-
Prevnar: pneumonococcal vaccine
how many
manditory
protects from what
- 4 rounds
- not manditory
- otitis media, pnmonia, sinitis
-
Influenza
how often
earliest age
how
- yearly
- 6 months
- injection, nasal
- *asthma is written in the notes, look up what it means*
-
HPV:
How many
ages
manitory
protects against
- 3 part
- 9-26 yrs old
- not manitory
- 4 typs of hpv, 6,11,16,18 cervical cancer and gential warts
-
Rotovirus
ages
how many
how
all by what age
- 2,4,6 months
- 3 dose series
- all by 32 weeks (8 months) of age
- oral
- decreases severity
-
Meningococcal vaccine
Age
prevents
-
Administration of vaccine will include what 5 things?
- documentaion
- date
- manufacturer/lot #
- Title adsignature of person givinG vaccine
- caccine information statement
-
Contradictions for adminstration of vaccines
- Childern who are
- immunocompromised- chemo, steriod use
- really ill
- allerigies (food and vaccine componets)
- Severe reatctions to a previous injection
- pregnancy
-
Contradiction to polio vaccine
neomycin or streptomycin
-
Contradictions to MMR
<12 months or pregnant
-
Contradictions to Hep B vaccine
baker's yeast
-
time between administration of mmr and varciella
at least one month between
-
Chicken pox
agent
source
transmission
contagious
s&S
- varicella-zoster virus
- primary secretios of respiratory tract and skin lesions
- direct contact, airborn, contaminated objects
- One day before eruption of slesions until all vesicles are crusted over
- Papual-vesical-pop-crust over
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Diptheria
agent
source
incubation
Treatment
S&S
- corynebacterium diphtheriae- bacteria
- discharges form mucous membrans of nose, nasoharynx, skin and other lesions of infected person
- Period of 2-5 days
- penicillian erythromycen- 3 neg cultures in a row neg
- "bulls neck"
-
Erythema infectiosum- fifth disease
agent
s&S
transmitted
treatment
- Human parvovirus
- 3 stage rash-
- 1. slapped face appearence desapperars by 1-4 days
- 2. maculopapular rash on extremities; last 7 days or more
- 3. Rash subsides but reappears if skin irritated or traumatized by heat, cold, friction, etc
- Keep pregnant people away!!
- Respiratory secretion
- rest fluids tylonol ibprofen
-
Roseola
Agent
incubation
s&s
usually infects what aged children
- Human herpes virus type 6
- 5-15 days
- Persistant fever for 3-4 days, otherwise apears well,
- after fever subsides, rash appears,
- rash first on trunk, then face and extemities
- <3yrs of age, 6-15months of age
-
Rubeola (measles)
agent
source
incubation peiord
S&S
- Virus
- secretions; droplet transmision
- 10-20 days; communicability from 4 days before to 5 days after apperance of rash
- Fever-maliaise-cough-kolik's spots- rash
- kopliks spots appear 2 days before rash
- (buccal mucosa, red with white tops)
-
Mumps
agent
transmitted
incubation
s&s
may cause what
- Paramysovirus
- droplet or contact
- 14-21 day incubation
- fever, headache, malaise, followed by parotitis (earache)
- may cause orchitis and menigoecephaliits
-
Pertussis (whooping cough)
agent
transmission
incubation
s&s
Complications
- Bordetella pertussis
- droplet or direct contact
- 6-20 days
- short rapid coughs followed by crowing or "whoop" sound
- complications pneumonia (usual cause of death)
- rds on rebound always rule out
-
Polio
agent
types
manifested in what 3 ways
source
transmission
- Enterovirus
- Type 1- paralysis- gets better
- Type 2- least freqeuent associated with paralysis
- Type 3- second most frequeently assocatied with parlysis
- abortive or inpapparent- fever uneasieness, sore throat, headache, lasts a few hours to days
- Nonparalytic- same manifestations as abortive but more severe with pain and stiffness in neck pain and legs
- Paralytic- Intital course similar to nonpar type followed by recovery and then signs of central nervous system paralysis
- Feces and oropharygea secretions
- Direct contact
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Rubella (German Measles)
Agent
Transmission
incubation
complications
S&S
- rubella Virus
- direct contact or indirect contant with article freshly contaminated with nasopharyngeal secretions, blood, stool, or urine
- 14-21 days
- complications are rare; greatest dangert is teratogenic effect on fetus
- occasionally low-grade fever, headache, maliase, lymphaenopathy, rash that appears one day after these symptoms subside. rash first appears on face and spreads down and disappears in the same order it began and usually gone by third day
-
Scarlet Fever
Agent
Transmission
incubation
complications
Always do what
How to treat
S&S
- Group a hemolytic steptococci
- droplet or direct contact
- 1-7 days incubation
- crditis, perionsillar abcess, glomerulonephiritis
- Rapid test
- some kind of penicillian
- abrupt heigh fever, tonsils enlarge, white strawberry tongue and then red strawberry tonge, rash 12 hours after prodromal stage (fever) red pinhead sized lessions rapidly becaome generalized but are absent on face, more promident on fold of joints, sloughing on palms and soles of hands and feet
-
Isotonic dehydration
electrolyte and water equally lost
-
Hypotonic dehydration
electrolyte loss is greater than water loss
-
hypertonic dehydration
water loss is greater than electrolyte loss
-
Sudden increase of diarrhea that test positive for infectious pathogen and last less than 14 days
acute infectious diarrhea
-
Diarrhea lasts longer thatn 14 days and cannot find pathogens, gone in a couple of months
lactose intolerance
Chronic diaherra
-
Intractable diarrhea of infancy
- More than 14 days
- no pathogens
- gone in a couple of months
-
Chronic nonspecific diarrhea (CNSD)
- 6 months -54 months
- loose stool for more than 2 weeks with no malnutrition.
- Baby verision of IBS
-
Diagnostic evaluations for diarrhea
stool sample from one source
-
Therapeutic management of diarrhea
reintroduce fluids IV= po feedings asap
-
Rotovirus- most significant nosocomial pathogen
most severe at what ages
what are comon isolated baterial pathogens
- 3-24months
- salmonella, shigella, camplobacter organisms
-
An alteration in frequency, consistancy, or eas of passage of school
3= days without pooping
constipation
-
idiopathic (functional) constipation
no known cause
-
Chronic constipation
may be due to enviromental or psychosocial factors control!
-
First mconium should be passed when
24-36 hours of life
-
If mecomium is not passed within 36hours what should you assess for?
- Hirschsprung disease, hypothyroidism
- Meconium plug, meconium ileaus (CF)
-
Interventions for constipation for infancy
- iron formula
- prune or apple juice
- stimulate rectal thermometer
-
Encopresis
inappropriate passage of feces, often with soiling
-
Hirschsprung disease aka Congenital aganglionic megacolon
- accumulation of stool with distention
- failure of internal anal sphincter to relax
- enterocolitis may occur
-
Diagnostic evaluation of hirschsprung disease
- xray barium enema
- anorectal manometric exam
- confirm diagnosis with rectal biopsy- looking for ganglioin cells
-
Thrapeutic Management hirschsprung disease
- Surgery- cut out area missing the cells and colostomy for the distended part
- 2stages
- 1. Tempory ostomy - 1st year of life
- 2. Pull-through procedure - reattach
-
Home management for Hischsprung disase
- send home with white baton to dialate the rectum
- turn it everytime they change diaper
- once pull through change the diaper immediatelty as patent is high risk for impaired skin integrity
-
What makes gastroesophageal reflux abnormal since it happens to all of us
frequency and persistency
-
-
Diagnositics for GER
- Acute life threatening event, failure to thrive
- Upper gi- barium- take pic when swallow (1 time shot)
- Ph probe- lower esophageal monitor 24hr recording would mark down on chart when baby is feeding or crying
-
Therapeutic management for Ger
- Less amount and up the frequency
- Burp frequently
- hold up right after eating for 20 min
-
Nusring considerations for ger
education thicken feeds, zantac, reglan ( increases the emptying of stomach)
-
Which comes first closure of a cleft lip or palate?
Lip defect precedes correction of the palate
-
What minimizes the retraction of scar of CL
Z-plasty
-
What should you protect suture line with for cl
Logan bow or other methods
-
When will CP be corrected?
typically 12-18 months of age
-
Biggest issue for cleft lip and palate
- Feedings, latching and sucking
- Use elongated nipple with larger slit for suction problems (frequent burping)
- Breastfeedig- infants head upright mostion with nipple use pump to bring milk down
-
Clinical manifestations for Esophageal atresia and tracheosepohageal fistula (TEF)
- Excessive drooling and salvation
- 3 "c's" coughing, choking, cyanosis
- apnea
- increased respiratory distress after feeding
- abdominal distention
-
Management of TEF
- Surgical interveintions
- good prognosis
-
Tracheomalacia
- Associated with TEF
- Trachea compresses as they breath
-
Hypertrophic pyloric stenosis
constriction of pyloric sphincter with obstruction of gastric outlet
-
Diagnostic evaulation of Pyloric stenosis
- Failure to thrive
- History
- Ultrasound
- Projectile vomiting that occurs 30-60 minutes after feeding
- Can feel olive like mass
-
Theraputic management of pyloric stenosis
- pyloromytotomy- RUQ incison
- feeding begun with 4-6 hours postop
- small frequent feedings of glucose water or electolyte solu then move to formula and bm
-
Intussusception
- telescoping or invagination of one portion of intestine into another
- occasionally due to intestinal lesions
-
Ages for intussusception
- below 5 years of age
- 3-9 months are peak age
-
Diagnostic for intussusception
barum enema (usualy diagnosis and coreects it)
-
Celiac disease
- aka gluten induced enteropathy and celiac sprue
- Immune response to gluten
-
4 characterisitcs to celiac disease
- steatorrhea -fatty stool
- general malnutrition
- abdominal distention
- secondary vitamin deficiencies
-
Patho of celiac disease
- Patient allergic to gluten
- Mucous rsponce in gi ( allergic responce)
- impaired growth
- diahrrea
- poor appitite
-
Diagnosis of Celiac disease
- biopsy
- changes in mucosal
-
Thereaputic management of celiac disease
- gluten free diet
- lifetime change
- dietary consult
-
Short bowel sydrome (sbs)
- a malabsorptive disorder
- results form decreased mucosal surface area, usually as a result of small bowel resection
- (trauma, nec, gastroesis- bowel outside body)
- goal is to preserve as much intestin as possible
-
Therapeutic management of short bowel syndrome
- early diagnosis
- may be on po and po & tpn
- small frequent amounts otherwise dumping syndrome
-
Necrotizing enterocolitis
- acute inflammatory disease of the bowel occurring in preterm and high risk infants
- can cause short bowel syndrome
-
factors predisposing developing nec
- prematurity
- ischemia
- colonization of bacteria
-
diagnostic evalutation of of nec
-
theraputic management of nec
- npo 24-48 hours
- breast milk preferred for feeds (contains iga, macrophages and lysozymes)
- Ng for decompression
- iv antibiotics TPN
- bowel resection if perforation occurs
-
Nursing interventions for gi disyfunctions
- assessment of f&E
- rehydration
- mainenance of fluid therapy
- reintrouction of adequeate diet
- isoalation precautions
- education
- history of bowel patterns, medications and diet
- dietary modification (age appropriate0
- pre op care
- post op care
- discharge care
-
-
lower respiratory tract
bronchi and bronchioles
-
croup syndromes
infections of epiglottis and larynx
-
most common season for respirtatory infections
winter and spring
-
mycoplasma pnemoina infections occur in what seasons most
fall and winter
-
asthmatic bronchitis more frequent in what weather
cold weather
-
rsv seasons?
winter and spring
-
generalized signs and symptons and local manifestations for respiratory tract infections
- fever
- anorexia
- vomiting
- diarrhea
- abdominal pain
- cough
- sore throat
- nasal blockage or discharge
- respiratory sounds - wheezing rhonci crackles
-
Nursing interventions of resp probles
- ease respiratoty effort - o2 resp treatments
- promote rest and comfort
- infection control
- promote hydratio and nutrition
- family support and teaching
- fever management
-
Nusring interventions for tosnilectomy
- pain medication/ ice collar
- use a cool mist vaporizer
- monitor for bleeding
- strict monitoring of intake and output
- provide comfort
- monitor o2 sats, resp treatments
- assess assess asses
-
Nasopharyngitis
common cold
-
nasopharyngitis
cause
s&s
- rsv, rhinovirus, adenovirus influenza, and parainflueza virus
- fever
-
Pharyngits cause and risks
- bacterial or viral
- culture should be taken to rule out GABHS
-
Clinical manifestations of pharyngitis
-
Therapeutic management of pharyngitis
if gabhs
- oral penicillian
- azithromycin, clarithromycin, oral cephalosporins amoxicillian
-
Tonsillitis pathophysilogy and etiology
filter and protect
-
Clinical manifestations of tonsillitis
- fever
- malaise
- difficulty swallowing
-
Theraputic management of tonsilitis
penicillian derivitive
-
What would warrent a consult for a tonsillectomy
more than 3 infections in a year after medication and no improvement
-
after tonsillectomy when is biggest risk for bleeding
10 days post op
-
Nursing interventions post tonsillectomy
- drink post op- nothinig red and no straws
- pain medication q4hrs while awake for base level;
-
Patho and etiology for otitis media
- toddlers and babies
- viral
- 3 types of bacteria
-
What increases risk for otitis media for child
- passive smile
- pacifier
- daycare
- increased amount of people
- not breastfed
-
theraputic management for OM
pharmacologic- amocicillian 10days follow up in 2 weeks
-
Croup syndroms characterized by what
- hoarseness,
- barking cough
- inspiratory stridor
- varying degrees of resp distress
-
Croup syndromes affect what?
- Larynx- laryngitis
- Bronchi- ltb- laryngotracheobronchitis
- Trachea- tracheitis
-
Acute epliglottitis - hib vaccine
Clinical manifestations
- sore throat
- pain
- tripod positioning
- retractions
- inspiratory stridor
- mild hypoxia
- distress
- DO NOT STICK A TONGUE DEPRESSOR!
- HAVE EQUIPMENT FOR INTABATION
-
Acute laryngitis
age most common
cause
chief complaint
treatment
- self-limiting
- older children and adolescents
- virus
- hoarseness
- symptomatic
-
Acute LTB- laryngotracheobronchitis
most common of the croup syndromes
ages affected
cause
- less than 5 years old
- rsv, parainfluenza virus, mycoplasma pneumoniae, influenza A&B
-
Acute LTB
clinical manifestations
can lead to what
- fever
- inflammation of the mucosal
- inspiratory stridor
- suprasternal retractions
- barking or seal like cough
- increasing respriatroy distress and hypoxia that can lead to respiratory acidosis, respiratory failure and death
-
Theraputic management for Acute LTB
- airway management
- maintain hydration po or iv
- high humidity with cool mist
- nebulizer treatments - epinephrine and steriods
-
Acute spasmodic laryngitis aka
spasmodic croup
midnight croup
when
inflammation
age
therapeutic management
- paroxysmal attacts of laryngeal obstruction
- occurs cheifely at night
- inflammation: mild or absent
- most often affects children 1-3
- cool mist vapor
-
Bacterial tracheitis
- infectionof the mucosa of the upper trachea
- distinct entiti with features of croup and epiglottisis
- clinical manifestations similiar to ltb may be complication of ltb
-
Bacterial tracheitis
clinical manifestation
THICK purulent secretions result in respiratory distress
-
Bacterial tracheitis
therapeutic management
- o2
- humidified oxygen
- antipyretics
- antibiotics
- may require intubation
-
Infections of the lower airways
- considered the reactive portion of the lower respriatory tract
- includeds bronchi and bronchiles
- cartilaginous support not fully develped until adolescence
- constriction of the airways
-
RSV= respiratory syncytial viruls
Bronchioles fill swell and fill with exudate THICK mucus
-
Patho rsv
- bronchiolar mucosa swessl and lumina are fulled with mucus and exudate.
- Lumina are frequently obstucted on expiration
- produce partial obstruction and patchy areas of actlectasis
- narrow passages on expiration prevents air from leaving lungs and thus progresses to overinflation (emphysema)
-
Clinical manifestations of rsv
- rhinorrhea
- pharyngitis
- coughing, sneezing
- wheezing
- possible ear or eye drainage
- increased coughing and weezing
- tachypna and retractions
- cyanosis
-
Diagnostics for rsv
- rapid testing dfa
- elisa for rsv antigen
-
Therapeutic management of RSV
- Humidified o2
- periodic nasal secretions
- oral hydration unless listless and tachypnea
- suction prior to feedings
- avoid passive smoke exposure
- ribavirin MAY be given aerosol 12-20 hours daily
-
Prophylaxis RSV
- Nov-March monthly IM inj
- Babies born before 32 weeks
- Babies less than 6 months of age
-
Asthma
- chronic inflammatoroy disorder of airways
- Bronchial hyper resonsiveness -mornings and evenings
- episodic
- limited airflow or obstruction that reverses spontaneously or with treatment
-
Asthma severity classes which one is least and which is most
- Steps I-IV
- I being the most mild about 2 times a week
- IV is severe, persistent asthma
-
Diagnosis of asthma
- Reactive Airway Disease @ first
- PFT
- Allergy test
-
Theraputic management of asthma
Long term control meds everyday
-
Nursing considerations for asthma
- how to prevent the allergins
- no carpet, curtains, low humidity
- plastic sheets
- dust and vacuum daily
-
Drug therapy for asthma
- lt control meds
- quick relief meds
- mdi
- corticosterioids -not usually daily, prn
- cromolyn sodium
- albuterol, metaproterenol, terbutaline
- MDI
-
Status astmaticus
- respiratory distress continues despite vigorous therapeutic measures
- emergency treatment- epinephrin 0.01 mL/kg SQ (max dose is 0.3mL)
- concurrent infection in some cases
-
Goals of asthma management
- avoid exacerbatio
- avoid allergens
- relieve asthmatic episodes promptly
- releive bronchospasm
- monitor function with peak flow meter @home
- self-management of inhalers, devices, activity regulation
- some will outgrow but teach
-
Cystic fibrosis
- genetic recessive gene - mom and dad are carriers 25% will have it, 50% carry it 25% normal
- exocrine gland dysfunction that produces multi-system involvement
- Most common lethal GENETIC illness among white children
- Approximately 3% of us caucasioan population are symptom free carriers
-
Patho of CF
- Characterized by several unrealted clinical features
- increased viscosity of mucous gland secretion
- results in mechanical obstruction
- thick inspissated mucoprotein accumulates, dialates, precipitates, coagulates to form concretions in glands and ducts
- respiratory tract and pancreas are predominately affected
-
Most reliable diagnostic procedure for CF
- sweat chloride test
- sodium and chloride will be 2-5 times greater than normal
-
order of the heart
venacava-> rt atrium-> tricuspid->rt ventricle->pulmonary artery ->lungs-> left atrium--> mitral valve--> left ventricle--> aorta--> system
-
risks of cardiac cath
- acute hemorrage rt or left femmoral watch for bleeding
- infection
- low grade fever
- trasient dysrythmias
- n&v
-
two types of cardiac defects
- cogenital - anatomic > abnormal function
- Acquired- disease process- infection, autoimmune enviromental, familial tendencies
-
What 2 things give their baby a 50% chance of having chd
- fetal alcohol syndrome
- Rubella in 1st 7 weeks of pregnancy
-
most common anomaly for CHD
vsd
-
CHD
incidence
- 5-8 per 1000 live births
- about 2-3 of these are symptomatic in the first year
- major cause of death in the first year
- 28% with chd have another recognized anomaly
-
Hemoodynamic characteristics of chd
- increases pulmonary blood flow
- decreased pulmonary blood flow
- obstrution of blood flow out of the heart
- mixed blood flow
-
Nursing interventions for cardiac cath
- apply emla cream to both femoral arteries
- obtain accurate weight and height
- obtain blood work
- education
- consult child life
-
Nursing interventions for post cardiac cath
- check pulses for equality/ symmetry
- check temp and color of affected limb
- monitor bp
- monitor dressing for bleeding
- monitor i&os
- monitor for s&s of infection - low grade ok at first
-
Increased pulmonary blood flow defects
What is it?
Increased blood flow on ____ side
________ pulmonary blood flow
________ systemic blood flow
- Abnormal connection between two sides of the heart
- Either the septum ore the great vessels
- Right
- Increased
- Decreased
-
Increased pulmonary blood flow defects
This allow blood to flow from _______ pressure to _____ pressure ( ____ to _____ shunting)
This patient may develop s/s of ____
- higher to lower
- left to righ
- CHF
-
Three major defects associated with pulmonary blood flow defects
- atrial septal defect
- ventricular septal defect
- patent ductus arteriosus
-
Artial septal defect
- Hole between the atrium
- Left pressure higher than the right
- may close with cardiac cath procedure
- right atrium becomes disteneded
-
Ventricular septal defect
- hole between ventrilce
- characteristic murmer, chf is common , risk of bacterial endocarditis
- r ventricle hypertrophy
- cardiac cath repair or surgery with bipass
-
Signs and symptoms of PDA
- large PDA: CHF with tachypnea, dyspnea, hoarse cry
- bounding peripheral pulse, widening pulse pressure , macherinery murmer, echo for diagnosis
indomethicin to close pdas
-
Obstructive defects
- blood exciting the heart meets an area of anatomic narrowing (stenosis) causing obstructed blood flow
- preassure is increased before the obstructio adn decreased beyond.
-
3 examples of obstructive defects
- coartation of aorta
- aortic stenosis
- pulmonic stenosis
-
Coartation of aorta
- increase pressure proximal to the defect
- risk of rupture
- Causes high BP and bounding pulses in arems and weak or absent femoral pulses and cool lower extrimities with low bp
- balloon angioplasty
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