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California Car Seat law
each child must be restrained in the back seat of the car until they are 8 years old or are 4'9"
- safety seat
- booster seat
- or other restraint system
Exceptions for the child safety seat
- no rear seat
- rear seats are side facing jump seats
- the child passenger restraint system cant be installed properly in the rear
- *all rear seats are already occupied by kids under 7
- *child has medical reasons to not ride in the rear seat
Front seat rules
a child cant ride in the front seat with an active passenger air bag if the child is:
- under 1 yo
- weighs less than 20 lbs
- baby seat is rear facing
How long are lice nits capable of hatching for?
Another word for lice?
How do you remove lice nits?
loosen the nits with vinegar and alcohol then use a fine tooth comb to remove the nits
How do you get the lice nits out of your house?
- wash bedding and linens in hot water and hot dryer
- vacuum furniture
- if you cant do that put it in a big trash bag and seal it up for 2 weeks.....they will die
How do you get lice nits out of your combs, brushes, hair ornaments/helmets?
- boil/soak in antilice shampoo
- soak in >140 degree water for 15 min
When do you recheck a person after lice treatments?
after 7-10 days
How do mites attach to a person?
- the female burrows into the epidermis
- lays their eggs
- dies there after 4-5 weeks
**eggs hatch in 3-5 days and the larvae migrate to the skin to mature
Most annoying effect of scabies
Major complication of scabies resulting from scratching
Patient teaching regarding scabies
- wash clothing and bed linens in hot water/hot dryer
- or dry clean
**if you still itch after scabicide treatment that is normal and not a sign of reinfestation
When will you see people with impetigo?
summer months when it is hot and humid
What age range is most affected by Impetigo?
toddlers and pre school aged kids
What type of infection is impetigo?
What is the incubation period for impetigo
Describe the characteristics and progression of impetigo skin lesions
- small vesicles progress to bullae
- serous fluid filled lesions turn pustular
- they rupture and leave a shiny lesion with a scaly rim
- lesions turn in to honey colored crust which bleed easily when picked
How does Impetigo spread?
scratching the lesion and then touching another area of skin
How is Impetigo treated?
Gently soak/clean the crusted lesions 3x/day. Apply topical antibiotics to the lesions....if severe get oral antibiotics
How soon can a child return to school after starting treatment for impetigo?
List 6 key family teaching points related to impetigo
- discuss how easily spread
- keep childs fingernails trimmed short
- wash hands frequently with antibacterial soap
- dont share towels, combs, cups, straws or eating utensils
- notify childs school of infection
Whats the route of transmission for helminths/pinworms?
hand to mouth...ingestion or inhaling
What are the s/s of helminth infection
intense anal itching at night...sleeplessness
What type of specimen is required to dx helminths/pinworms and how is the specimen obtained?
stool sample via cellophane tape test....tape to anus at night...remove in the am
What is the treatment for helminths/pinworms
- oral pyrantal panoate
List 5 key family teaching points related to helminths/pinworms
- how to collect sample
- hand washing
- use appropriate toilet facilities for elimination
- discourage hands in mouth and nail biting
- discourage scrathing anal area with bare hands
Suction Catheter sizes
- newborn-18mo 4-8
- 18 mo - 7 yo 8-10
- 7-10 yo 10-14
- 11+ 12-16
- Neonates 60-80
- Infants 80-100
- Children 100-120
- Adults 100-150
*Max suction time is 15 seconds
Period of communicability for Roseaola
incubation period is 10 days and they are contagious while they have a fever till the rash appears.
How is Roseola transmitted?
by contact with the infected persons secretions
When does the rash appear with Roseola?
several hours to 2 days after the fever subsides
Who gets Roseola? What is the progression of this disease?
6-18 mo. babies
- child will have sudden high fever then intermittent one for 3-5 days.
- malaise, irritable, cough, runny nose, abdominal pain, headache, vomit and diarrhea.
After fever subsides erythematous maculopular rash on neck and trunk that's surrounded by a white ring
How you manage roseola?
- manage the symptoms
- decrease clothes
- increase fluids
Nursing considerations for Roseola?
- anticipator guidance about seizures
- make sure they have a thermometer and know how to use it
- don't give aspirin-Reyes
Patient/Family ed about Roseola
- ed. on febrile seizures
- don't share foods, drink, minimize contact if another child gets a fever
- encourage fluids
Barriers to immunizations
- appt only clinics
- inconvenient scheduling
- inaccessible clinic sites
- need referral from pcp
- language and cultural barriers
- *parental misconceptions about vaccines
- *inaccurate record keeping about what they have had and whats needed when
- reluctance of nurse to give more than 1 vaccine at a visit
- lack of public awareness of the need for immunizations
Nursing interventions to promote vaccine admin.
- be aware of controversies and help educate parents
- know home schoolers and check their records
- Ask-can you tell me what was the last immunization your child had?
- don't be afraid to give more than 1 shot
- always update patients file
- refer minorities and poor to clinics for free immunizations
What causes Rubeola and how is it transmitted?
transmitted by direct contact with infectious droplets
Period of communicability for Rubeola
3-5 days before the rash and 4 days after the rash
S/S of Rubeola
- Coryza (runny nose)
- Koplik spots 2 days before rash
Describe the rash from Rubeola
- small blue/white spots with red base that cluster near the molars appear 2 days before the rash
- rash (maculopapular) begins on the face and spread downward to feet lasting 6 days, blanches
- gradually turns brownish
What happens if a prego gets Rubeola?
Treatment for Rubeola
- treat symptoms
- airborne isolation
- vitamin A
- encourage fluids
- humidification and antitussives if coughing
Who gets 5th Disease/Erythema Infectiosum, how and what causes it?
spread of parvorius 19 through respiratory secretions when a person coughs or sneezes
Incubation period for 5ths Disease and describe the rash/illness
4-21 day incubation period
- asymptomatic or have headache, runny nose, malaise and low grade fever
- *intense fiery red edematous rash on cheeks
- *1-4 days later possible rash on chest, back, butt, arms legs...SOLES OF FEET ITCHY
Interesting nuggets about 5ths
- rash will clear in the center first which makes it look lacy
- rash can last 2-39 days
- can have pain and swelling in their joints
- *if prego and get it in first 20 weeks it can be passed to the baby and the baby can die
When are you contagious with 5ths?
before the rash appears
What can make 5ths reoccur?
- warm baths
Treatment for 5ths
- antipyretics-no aspirin
- don't scratch and keep fingernails short
- cold baths
- oatmeal or baking soda baths if itchy
- cotton mittens to avoid scratching
- *tell school
Great part about 5ths
get once and you are immuned to it
What causes Pertussis/Whooping Cough
and how is it diagnosed
gram negative bacteria
Describe progression of Whooping Cough
- 1-2 weeks of an upper respiratory infection (rhinorrhea, lacrimation, red conjunctiva, mild cough, low grade fever)
- 2-4 weeks of increased severity of cough with repetitive series of coughs during a single expiration followed by a massive inspiration with a WHOOP
- 1-2 weeks of coughing, whooping but decreasing in severity and frequency
- *can last for months
What can trigger a whooping cough session
Complications of whooping cough
- subcutaneous emphysema
- otitis media
Whos at greatest risk to get whooping cough and why?
younger than 6 mo....cuz don't receive maternal immunity and aren't completely immunized
How is Whooping cough treated?
- erythromycin/azithromycin/clarithromycin...but during first 2 weeks
- give antibiotics to all in close contact...especially infants
What sort of precautions are started for a person with whooping cough?
droplet...it is highly contagious
What do you monitor on a person with Whooping cough?
- cardiopulmonary/pulse ox
- neuro status
What can trigger whopping cough?
noises or frightening experiences....so keep room quiet
Communicability of Varicella/Chicken Pox
- Incubation period is 10-21 days
- Infectious period is 1-2 days before the rash appears and lasts till the lesions are dry (5-7 days later)
Describe chicken pox
- low temp
- rash first on trunk and scalp spread to extremities
- *macular rash
Nursing considerations for chicken pox
educate parents to not have kids scratch
What happens if you are hospitalized and are exposed to the chicken pox?
- put in strict iso for 8-21 days after the onset of the rash in the infected person
- airborne and contact precautions
- all contaminated materials must be bagged and labeled
What happens if you are immunocompromised and get chicken pox
- will get large hemorrhagic lesions
- may get pna
- can get DIC (disseminated intravascular coagulation)
When do people typically get chicken pox?
late winter and spring
How is chicken pox spread
- Home & Environment
Can lice jump?
NO...it is transmitted by contact
Major problems from impetigo
- if no response to antibiotics...MRSA
- blood in urine....glomerulonephritis
- lesions on abdomen....diarrhea
What topical therapy is used to treat impetigo?
How do you identify which immunizations are due for infants/kid of various ages?
- immunization records
- missed....entire series doesn't have to be started
- flag chart as a reminder
Nuggets about vaccines
- give vaccine info sheet for each vaccination
- vaccine refused, document and have them sign refusal form and give VIS still
- pediatricians can refuse to treat un-immunized patients
What is the only vaccine that has thimerosal in it still?
Inactivated Influenza Vaccine
Examples of killed vaccines
Examples of Live Attenuated
- OPV-oral polio vaccine
Why isn't oral polio vaccine used much any more?
cuz older care givers were coming down with a secondary type of polio
Common side effects from vaccines
- Soreness at injection site
When will you see a rash from MMR?
10 days post injection
Contraindications for vaccines
- Sever allergic rxn
- altered mental status-encephalitis
- progressive neuro disease-infantile spasms, encephalopathy
- Varicella-immunosuppressed state
When to postpone a vaccine
- when a child has a severe illness
- hx of immunoglobulins with past 3-11 months