Vaccines birth-18

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Author:
Emilybillet
ID:
290212
Filename:
Vaccines birth-18
Updated:
2014-11-29 15:46:21
Tags:
lccc peds vaccine schedules
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Description:
peds vaccine schedule birth through 18
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  1. Hep B
    • full name: Hepatitis B 
    • Route: IM 
    • Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  2. Rv1; Rv5
    • Full name: Rotavirus vaccine; Rv1-Rotarix; Rv5-RotaTeq
    • Route: oral
    • Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component; Severe combined immunodeficiency (SCID); History of intussusception
  3. DTap
    • Full name: Diptheria, Tetanus, acellular pertussis
    • Route: IM
    • Contra: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  4. Tdap
    • Full name: Tetanus, diptheria, acellular pertussis
    • Route: IM
    • Contra: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component; For pertussis-containing vaccines- encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of a previous dose of DTP or DTaP (for DTaP); or of previous dose of DTP, DTaP, or Tdap (for Tdap)
  5. HIB
    • Full name: Haemophilus influenzae type b conjugate vaccine
    • Route: IM 
    • Contra: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component; Age younger than 6 weeks
  6. PCV13
    • Full name: Pneumococcal conjugate vaccine 
    • Route: IM 
    • Contra: For PCV13, severe allergic reaction (e.g., anaphylaxis) after a previous dose of PCV7 or PCV13 or to a vaccine component, including to any vaccine containing diphtheria toxoid
  7. IPV
    • Full name: Inactivated polio 
    • Route: IM or SC
    • Contra: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  8. IIV: LAIV
    • Full name: inactivated influenza; Live attenuated influenza
    • Route: IIV-IM; Intranasal spray
    • Contraindications:  IIV- Severe allergic reaction (e.g., anaphylaxis) after a previous dose of any IIV or LAIV or to a vaccine component, including egg protein
    • LAIV- same as above; Conditions for which the ACIP recommends against use, but which are not contraindications in vaccine package insert- immune suppression, certain chronic medical conditions such as asthma, diabetes, heart or kidney disease, and pregnancy4
  9. MMR
    • Full name: Measles, Mumps, Rubella 
    • Route: SC
    • Contra: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component; Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy5 or patients with human immunodeficiency virus [HIV] infection who are severely immunocompromised); Pregnancy
  10. VAR
    • Full name: Varicella 
    • Route: SC
    • Contra: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component; Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, primary or acquired immunodeficiency, or long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised); Pregnancy
  11. Hep A
    • full name: Hepatitis A
    • Route: IM
    • Contra: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  12. HPV4
    • Full name: Human Papillomavirus (gardasil) 
    • Route: IM
    • Contra: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  13. MCV4
    • Full name: Meningococcal conjugate vaccines
    • Route: IM
    • Contra: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
  14. What is clark's rule?
    2-year-olds and older (Based on body weight)

    Childs dose = weight of child (pounds)/ 150 pounds x average adult dose
  15. What is Freid's Rule?
    For Newborns to 12 months (Based on child's age for infants)

    Child's dose= infant's age in months/150 months x quantity
  16. What is young's rule?
    • For Children Ages 1 to 12 (Based on age for
    • older child)

    Child's dose= childs age in years/age of child +12 x average adult dose
  17. What is the most accurate way of determining the amount of drug to give in peds?
    Body surface area
  18. What is the formula for body surface area?
    Child's dose= body surface area of child/mean body surface area of an adult (1.7) x average adult dose
  19. What strategies for medicating children can you use for the infant? toddler? preschooler? School age? Adolescents
    • Infant: Have help to restrain; cuddle and comfort before and after
    • Toddler: Use play; use as little restraint as possible; give praise and use stickers as rewards 
    • Preschooler: Give as much control as possible; offer choices
    • School age: provide choices and explanations; provide distraction and support 
    • Adolescents: explain and allow to participate in decisions; praise cooperation and proved outlet for frustration
  20. Why are newborns and preterms infants at higher risk for drug toxicity?
    • immature liver enzyme system
    • decreased plasma proteins to bind with drugs
    • immature functioning of kidneys- decreased gfr
  21. Why do infants need higher doses/more frequent doses?
    • increased metabolic rate and extracellular fluid (need for higher does per kg of water soluble meds)
    • Infants older than 6 months- metabolize drugs similar to adults but the liver may metabolize drugs more quickly, requiring larger doses or more frequent administration (important for pain control)
  22. What other factors contribute to the physilogic differences that effect the way meds are given in peds?
    • Smaller muscle mass: fewer IM injection sites
    • Less reliable peripheral circulation: altered absorption
    • Thinner skin: faster absorption of topical medications
    • Slower gastric emptying and irregular peristalsis: reduced absorption or oral meds
    • Blood brain barrier: immature until age 2 years (risk of encephalopathy as sign of toxicity)
  23. Its always best to double/triple check meds for safety, what meds must absolutely be double checked?
    • Digoxin
    • Insulin
    • Heparin
    • Blood 
    • Chemo
  24. What should the nurse's approach convey?
    the impression that she expects the child to take the medication
  25. What should the ALWAYS be with the child when administering medications?
    Honest
  26. What can some distasteful meds be mixed with?
    small amts of jelly, apple sauce, or gelatin
  27. What 2 things should the nurse never do regarding med administration in peds?
    never refer to medication as candy and never threaten a child with a shot if he/she refuses an oral med
  28. Is it the responsibility of the nurse to determine the dose for peds?
    No, but it may be necessary to verify or calculate a dose as a fraction of the adult dose
  29. What are the 6 rights of medication?
    • Time/date
    • route
    • drug
    • dose
    • child
    • documentation
  30. How should you identify the patient?
    • Check ID bracelet: 2 identifiers (name/birth date)  
    • Ask the older child his name 
    • Ask family/parent of younger child
    • Verify, calculate and document all medications 
  31. How should the nurse administer an oral med?
    • Avoid using essential foods to disguise med
    • don't underestimate the reaction of a child (capsules, not time release meds)
    • a sip of fruit juice or peppermint before and after med may help dull pleasant taste 
    • sugarless foods/drinks should be used for diabetics
    • do not use oral if child is vomiting, malabsorption, or refuses
    • kids <5 find it difficult to swallow tabs (use suspension or chewable)
    • only divide scored tablets
  32. What is the preferred route for children?
    Oral
  33. How should the nurse give an oral med to an infant?
    • Draw up med in a dropper/ syringe without a needle
    • elevate infant's head and shoulders; hold the child in feeding position
    • depress the chin with the thumb to open the mouth; release thumb and allow to swallow 
    • direct the med towards the inner aspect of cheek, and slowly release med
  34. How should the nurse give an oral med to a toddler-preschooler?
    • Draw up med in a syringe or measure into a med cup
    • elevate childs head and shoulders
    • place syringe in childs mouth and slowly release med, directing it towards the inner aspect o cheek or allow the child to hold med cup and drink at own pace
    • Offer praise
  35. How should the nurse give an oral med to a school aged child?
    • When child is old enough to take med in a tablet or capsule form, direct him/her to place tablet near back of tongue and immediately swallow fluid such as water or juice, use of straw works well when teaching child
    • offer praise
  36. How do you administer an IM injection in infants?
    • common site: Vastus lateralis/anterolateral thigh
    • 0.5 ml for infant- 2.0 ml for child
    • easily accessible
    • more painful than deltoid
    • newborns: 25 guage-5/8 inch needle 
    • infant > 2 months: 22-25 guage- 1 inch needle 
    • Ventrogluteal site: less nerves and vascular structures than vastus lateralis, but less used; same needle size; same quantity of med; less painful, easily acccessible
  37. How do you give an IM to toddlers/school age children?
    • Deltoid is the common site
    • 1/2 to 1 inch needle size 
    • less painful than vastus lateralis
  38. How do you give a subcutaneous injection?
    • Later aspect of upper arm, anterior later aspect of thigh and abdomen 
    • 5/8 inch, 25-30 guage, up to .5 ml
    • 45 to 90 degree anlge
  39. How do you safely administer injections to infants?
    Place infant in secure position to avoid movement of extremity; have a second person to secure the infant; hold, cuddle and comfort the infant after the injection
  40. How do you safely administer injections to toddlers-school age?
    • Have syringe and needle completely prepared before contact with the child; keep needle out of childs visual field; explain according to developmental age, the reason for med and where it will be give; do not say it wont hurt; inspect site for tenderness or hardness prior to injection
    • dont recap; have another person secure child and offer comfort after
    • allow child to express fears 
    • perfomr procedure quickly; praise child after
  41. What are nose drops and How can the nurse give nose drops?
    • Act as vasoconstrictors; excessive use may be harmful; discontinued after 72 hourse; congested nose will impair infants ability to suck
    • give 20 minutes before feeding, have tissue ready; place child on back, head over side of mattress; neck extended over blanket roll
    • hold face with hands encircling chin and cheeks; insert drops; use second person to hold if necessary
  42. What is the most important thing to do while administering nose drops to children?
    to keep the child's head below level of shoulders for 1-2 minutes after instillation
  43. How should the nurse give rectal meds to peds?
    • (usually sedatives or antiemetics) 
    • use little finger
    • insert beyond 2nd anal sphincter
    • apply pressure to anus by gently holding buttocks together until desire to expel subsides (5-10 min); absorption may be delayed or diminished due to stool
  44. What are the benefits/disadvantages of IV meds?
    • absorbed more rapidly; decreases the number of injections; used to rest GI tract,n/v/d, fluid replacement 
    • Dis: initial insertion, limits mobility, infiltration damages tissues; circulatory overload can lead to cardiac failure; pain at site; flow of solution can be disturbed with movement 
    • (infants scalp veins used if unable to access others)
  45. What are the nursing measures for IV meds?
    • secure and wrap IV site
    • hourly assessments
    • documentation 
    • patency, infiltration, inflammation, rate, pain, LTC
    • Use mini/micro drip chamber for control
  46. What is TPN? What is used for? How is it delivered? What are the complications?
    • Total parenteral nutrition/ hyperalimentation; complex combo of amino acids, dextrose, vitamis, insulin and electrolytes 
    • used for: Malnutrtion, intestinal obsruction, FTT, severe burns, intractable diarrhea
    • Delivered: central line (PICC, implanted ports, Hickmans, Broviacs)
    • Complications: infection and hyperglycemia
  47. How does the nurse monitor/care/administer TPN
    • Do accu checks every 6 hours
    • use line with built in filters 
    • follow agencys protocol for flushing and dressing changes
  48. How should the nurse administer ear drops?
    • Child <3: pull pinna down and back 
    • Child > 3: pull pinna up and back 
    • Pre-warm ear drops prior to instillation 
    • Remain lying on unaffected side for a few minutes after instillation 
    • Gently massage area immediatly anterior to ear 
    • pre-moisten cotton ball with medication to prevent wicking action of cotton ball
  49. How should the nurse administer eye drops?
    • Secure child in supine position
    • Instill drops/ointment in conjunctival sac
    • ask child to look in all directions to distribute medication 
    • apply finger pressure on lacrimal punctum at the inner aspect for 1 minute to prevent drainage of medications into the nasopharynx
    • with ointments, administer at naptime or bedtime due to blurring of vision; avoid child rubbing medication away; careful not to contaminate unaffected eye (wipe excess med from the inner canthus and outwards to prevent drips from contaminating other eye; if both drops and ointment are ordered, apply drops first, wait 3 mins, then ointment
  50. how does the nurse administer oxygen?
    • via hood, nasal cannula, mask or blow by
    • monitor pulse-ox
    • preterm infants: maintain pulse ox <100%; usually between 90-95% (to prevent retina damage) 
    • excessive O2 damages lungs
    • monitor for oxygen induced carbon dioxide narcosis in children with chronic pulmonary disease such as cystic fibrosis
  51. How does the nurse admin Aerosols?
    • Nebulizers: use mask or blow-by for infant 
    • MDI's: Use spacer for children under 5-6 
    • Assess breath sounds before and after treatment
  52. What do topical medications do and what is the teaching involved with giving it?
    • Ease discomfort, prevent further injury, and facilitate healing 
    • Give parents detailed info on how much to use, how to apply and how long preparations should remain on skin; stress that more is not necessarily better; caution against using both oral and topical meds containing same medications (benadryl)

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