Mod 1 Maternity Chap 30

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mfabian
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76184
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Mod 1 Maternity Chap 30
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2011-04-08 14:49:34
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Foundations of Pediatric Nursing
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  1. What is the leading nutritional deficiency in the United States?
    Iron Definciency Anemia
  2. Visual reinforcement audiometry (VRA)
    • 6 months-2 years
    • Visual reward linked to tone signal
    • Child looks at reward in response to tone
    • Reward activated, reinforcing response
    • Child must be alert and happy for best results
    • Schedule for after sleep/rest
    • Allow child to sit in parent's lap
  3. Tympanometry
    • Over 7 months
    • Measures tympanic membrane mobility
    • Determines middle ear pressure
    • Probe must form seal with canal
    • Child must remain still
  4. Conditioned play audiometry (CPA)
    • 2-4 years
    • Similar to VRA except uses listening games
    • Child does listening game at tome and receives social reward
    • Developmental age at least 2 years
    • Same nursing implications as VRA
  5. Pure-tone (conventional) audiometry
    • 4 years and older
    • Measures hearing acuity through a range of frequencies and intensities
    • Must wear earphones
    • Performed in soundproof room
    • Teach desired motor response before screening
    • Administer conditioning trils
    • Offer two presentations of stimulus to ensure reliability
    • At a minimum, screen 1,000-2,000 and 4,000-hertz levels at 20 decibels
  6. Whisper test
    • 4 years and older
    • One ear occluded
    • Stand behind child and whisper a word
    • Child must repeat the word
    • Quiet room
    • Child should be alert and well rested
    • Reward system to increase compliance
  7. Weber test
    • 6 years and older
    • Place a vibrating tuning fork in the biddle of the top of the head
    • Ask if sound is in one ear or both
    • Should be both
    • Child must understand instructions and be able to cooperate
  8. Rinne Test
    • 6 years and older
    • Place a vibrating tuning fork on mastoid process to assess bone conduction
    • Child signals when sound is gone
    • Next place a vibrating tuning fork outside ear to test air conduction
    • Child signals when sound is gone
    • For a passing test, air conduction time should be twice as long as bone conduction time
    • Child must understand instructions and be able to cooperate
  9. What are elevated blood lead levels?
    10 mcg/dL or higher
  10. Risk factors for hearing impaired
    • Family history of hearing loss
    • Prenatal infection
    • Anomalies of the head, face, or ears
    • Low birthweight (<1,500g)
    • Hyperbilirubinemia requiring exchange transfusion
    • Ototoxic medications
    • Low Apgar Scores: 4 or less at 1 minute, or 6 or less at 5 minutes
    • Mechanical ventilation lasting 5 days
    • Syndrome associated with hearing loss
    • Bacterial meningitis
    • Neurodegenerative disorders
    • Persistent pulmonary hypertension
    • Otitis media with effusion for 3 months
  11. Lead Screening-CDC recommends universal screenings for specific populations.
    • Children living where more than 27% of the homes were built before 1950.
    • Where more than 12% of the 1-2 year olds of a specific population have elevated blood lead levels.
  12. Healthy people 2010--hearing
    • Increase the proportion of newborns who are screened for hearing loss by age 1 month, have audiologic evaluation by age 3 months, and are enrolled in appropriate intervention services by age 6 months
    • Increase the proportion of persons who have had hearing examination on schedule
  13. Hypertension Screening
    • occurs in 1-3 % of children
    • universal screening begins at age 3 unless other risk factors
    • Preadolescents in 90-95th percentile are prehypertensive
    • Adolescents with 120/80 mmHg considered prehypertensive
    • Stage I- >95th percentile up to 5 mmHg above 99th percentile
    • Stage II- 5 mmHg above 99th percentile or higher
  14. Hyperlipidemia Screeing
    • Screening children at high risk
    • Family history
    • parents or grandparents with premature cardiovascular disease (before 55 years of age or hypercholesterolemia (240 mg/dL or higher)
    • children with diabetes or hypertension
  15. Vision Screeing Tools
    • Snellen letter or number
    • Tumbling E
    • LEA symbols or Allen figure
    • Ishihara
    • Color Vision Testing Made Easy (CVTME)
  16. Snellen letter or numbers
    • school-age
    • child must know letters or numbers for test to be valid
  17. Tumbling E
    • Preschool
    • Child points in direction that E is facing
  18. LEA symbols or Allen figures
    • Preschool
    • child should first identify the pictures with both eyes at a comfortable distance prior to monocular testing
  19. Ishihara
    • School-age
    • Screens for color discrimination ( numbers composed of dots, hidden within other dots)
  20. Color Vision Testing Made Easy (CVTME)
    • Preschool
    • Uses dots like Ishihara, but instead of numbers uses shapes
  21. Healthy people 2010- Vision
    increase the proportion of preschool children age 5 years and under who receive vision screening
  22. Anitgens
    foreign materials in body (non-self)
  23. Immunity
    ability to destroy and remove a specific antigen from the body
  24. Passive immunity
    • produced when the immunoglobins (antibodies)of one person are tranferred to another.
    • Last only weeks or months
    • by injection of exogenous immunoglobins
    • by transfer from mothers to infants via colostrum or placenta
  25. Active immunity
    • acquired when own immune system generates the immune response
    • last many years or for lifetime
  26. Risk factors for iron deficiency anemia
    • periods of rapid growth
    • low-birth weight or preterm infants
    • low dietary intake of meat, fish, poultry, and ascorbic acid
    • macrobiotic diets
    • inappropriate consumption of cow's milk
    • use of infant formula not fortified with iron
    • exclusive breastfeeding after age 6 months without iron-fortified supplemental foods
    • meal skipping, frequent dieting
    • pregnancy or recent pregnancy intensive physical training
    • recent blood loss, heavy/lengthy menstrual periods
    • chronic use of aspirin or nonsteroidal anti-inflammatory drugs
    • parasitic infections
  27. Children at high risk for iron deficiency anemia
    • low income families
    • migrants or recently arrived refugees
  28. Healthy people 2010- blood lead levels
    eliminate elevated blood lead levles in children
  29. Live attenuated vaccines
    • modified living organisms that are weakened
    • produces immune response but no complications of illness
  30. Killed vaccines
    • whole dead organisms
    • cannot reproduce
    • produce immune response
  31. Toxoid vaccines
    • contain protein products produced by bacteria call toxins
    • heate treated to weaken effect
    • produces immune response
  32. Conjugate Vaccines
    • result of chemically linking the bacterial cell wall polysaccharide (sugar-based) portions with proteins
    • dramatically increases immune response
  33. Recombinant vaccines
    • genetically engineered organisms
    • example- Hep B vaccine produced by splicing a gene portion of virus into a gene of a yeast cell: yeast cell then produce antigen to Hep B
  34. Healthy people 2010 Vaccines
    increase the proportion of young children who receive all vaccines that have been recommended for universal administration for at least 5 years
  35. Vaccine Administration Routes

    Intramuscular
    • DTaP, DT, Tdap
    • Hepatitis A, hepatitis B
    • Hib
    • Influenza (trivalent)
    • Pneumococcal
    • HPV
    • MCV4
  36. Vaccine Administration Routes

    Subcutaneous
    • IPV
    • MMR
    • Varicella
    • MPSV4
  37. Report any clinically adverse event that occurs after an immunication to ...?
    Vaccine Adverse Event Reporting System
  38. Documentation of vaccination in permanent record includes:
    • Date administered
    • Name of vaccine
    • Lot number and expiration date of vaccine
    • Manufacturer's name
    • Site and route administered
    • Edition date of VIS given to parents
    • Name and address of the facility administering vaccine
    • Name of person administering
  39. Two permanent contraindications for withholding vaccinations
    • anaphylactic or systemic allergic reaction to a vaccine component
    • with pertussis immunization, encephalopathy without an identified cause within 7 days if immunization
  40. Vaccination postponing recommende if:
    • child has severe illness with high fever
    • immunosuppression
    • recently received blood products
  41. Vaccine administration needle and site

    Intramuscular
    • Birth-28 days-25 gauge-5/8 in long- anterolateral thigh
    • 1-12 months- 23 to 25 gauge- 1 in long anterolateral thigh
    • 1-2 years- 23-25 gauge- 1-1.25 in long for anterolateral thigh or 5/8 to 1 in long for deltoid
    • 3-18 years-22-25 gauge-1-1.25 in long for anterolateral thigh or 5/8 to 1 in long for deltoid
  42. Vaccine administration: needle and site selection

    subcutaneous
    • 1-12 months-23-25 gauge- 5/8 in long- fat of anterolateral thigh
    • >12 months -23-25 gauge- 5/8 in long- fatty tissue over triceps
  43. `The World Health Organization method of intramuscular thigh vaccination technique results in less irritability and bruising.
    a 25 gauge-5/8 in needle-inserted at 90 degree angle to the long axis of the femur with the skin compressed between the thumb and index finger
  44. Haemophilus influenzae type B
    • bacterium that causes several life threatening illnesses in children under 5 years of age. (meningitis, epiglottitis, and septic arthritis)
    • Not given to children 5 years or older
  45. hepatitis A (HepA)
    • Contraindications
    • standard contraindications
    • infants<12 months of age
    • Precautions
    • moderateor severe illness
  46. Hepatitis B (HepB)
    • Standard contraindications
    • Precautions
    • moderate or severe illness with or without acute fever
    • infants<2,000g if mother is HBsAg negative
  47. Diphtheria, tetanus, acellular pertussis (DTaP)
    Tetanus, diphtheria, acellular pertussis (TdaP)
    • Contraindications
    • standard
    • previous encephalopathy within 7 days after diphtheria, tetanus, pertussis (DTP) vaccine or DTaP
    • Precautions
    • temperature 105 F within 48 after previous dose
    • continuous crying lasting 3 hours within 48 hours after previous dose
    • previous convulsion within 3 days after immunization
    • pale or limp episode or collapse within 48 hours after previous dose
    • unstable progressive neurologic problem
    • history of Guillain-Barre syndrome within 6 weeks
  48. Diphtheria, tetanus (DT) Measles, mumps, rubella (MMR)
    • Standard contraindications plus
    • inquire about neomycin or gelatin allergies
    • pregnancy or possibility of pregnancy within 4 weeks
    • blood products within the past 5 months
    • immunocompromised status
    • if not given same day as varicella and/or yellow fever, hold until spaced 28 days apart
    • Precautions
    • thrombocytopenia or history of thrombocytopenic purpura
  49. Varicella
    • standard contraindications plus
    • inquire about neomycin or gelatin allergies
    • pregnancy or possibility of pregnancy within 4 weeks
    • Blood products received within the past 5 months
    • immunocompromised status
    • if not given same day as MMR an/or yellow fever, hold until spaced 28 days apart
    • Precautions
    • do not give within 24 hours of antiviral medications
    • family history of congenital or hereditary immunodeficiency
  50. Inactivated poliovirus (IPV)
    • standard contraindications plus
    • inquire about neomycin, streptomycin, or polymyxin B allergies
    • Precautions
    • moderate or severe acute illness
    • pregnancy

  51. Haemophilus influenzae type B (Hib)
    • standard contraindications
    • Precautions
    • moderate or severe acute illness
  52. Trivalent inactivated influenza vaccine (TIV)
    • standard contraindications
    • Precautions
    • history of Guillain-Barre syndromw within 6 weeks
  53. Live attenuated influenza vaccine (LAIV)
    • standard contraindications plus
    • client <5 years old
    • client 5 or more years old with chronic illnesses
    • client with close contact with severely immunosuppressed persons
    • Precautions
    • do not give within 48 hours of antiviral meds
  54. Pneumococcal conjugate vaccine (PCV7)
    Pneumococcal polysaccharide vaccine (PPV23)
    • standar contraindications
    • Precautions
    • moderate or severe acute illness
  55. Polio vaccine

    Inactivated polio vaccine (IPV)
    killed virus that poses no risk for vaccine acquired disease
  56. Measles, Mumps, and Rubella vaccines MMR
    live attenuated virus combination vaccine
  57. Hep A
    • inactivated whole virus
    • 94% effective
    • given at 12 months with repeat in 6-12 months
  58. Hepatitis B
    • recombinant vaccine
    • 80-90% effective
    • mother's HBsAg status determines when immunications begins
    • if mother's status unknown, neonate is immunized within first 12 hours of life, at 1-2 months, and at 6 months
    • vital, up to 90% of infected neonates develop chronic carrier status and will be predisposed to cirrhosis and hepatic cancer
    • if mother is neg, then 2, 4, and 6 months of age
  59. Varicella vaccine
    • live attenuated virus
    • all 12-15 months who have not had chickenpox
    • second dose at 4-6 years
    • postexposure prophylaxis if given within 3-5 days after exposure
  60. Pneumococcal vaccines
    • streptococcus pneumoniae most common cause of pneumonia, sepsis, and meningitis under 2 years of age
    • two- conjugate and polysaccharide
    • PCV - contains 7 strands of streptococcus pneumoniae-start at 2 months
    • PPV- contains 23 strains and begins at 2 years (for those with high risk for pneumococcal sepsis)
  61. Influenza vaccine
    • recommended yearly for 6-59 months
    • for 2 years and older only if chronic health problems
    • two available- trivalent inactivated and live attenuated
    • LAIV given intranasally ages 5-49 years of age-can shed virus for a week
    • TIV-anyone 6 months or older by intramuscular injections
  62. Rotavirus vaccine
    • most common cause of severe gastroenteritis among children
    • accounts for 50% of annual hospigtalizaions for gastroenteritis in children
    • most severe occurs in ages between 3-35 months
    • live vaccine targeting 5 strains given orally to infants less than 32 weeks of age
  63. Human papillomavirus vaccine
    • DNA tumor virus transmitted through direct skin to skin contact
    • most common between 15-24 years and sexually active
    • causes genital warts and cervical cancer
    • vaccine begins at age 11 - 12 years
  64. Meningococcal Vaccine
    • caused by bacteria Neisseria meningitidits spread by direct contact or by air droplets
    • 10-12% of infected person's die
    • 20% suffer long term
    • vaccinate at 11-12 years
  65. Healthy people 2010- Dental
    Reduce the proportion of children and adolescens who have dental caries in their primary or permanent teeth
  66. Healthy people 2010- Obesity
    Reduce the proportion of childen and adolescents who are overweight
  67. Healthy people 2010- Physical activity
    increase the proportion of adolescents who engage in moderae physical activity for at least 30 min on 5 or more of previous 7 days

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