Exam 4 Families with Children: Immune & Infections

A nurse is teaching a parent of a child who has HIV. Which of the following information should the nurse include? Select all that apply. A. Obtain yearly influenza vaccination. B .Monitor a fever for 24 hr before seeking medical care. C. Avoid individuals who have colds. D. Provide nutritional supplements. E. Administer aspirin for pain.

A, C, D

A nurse is planning to administer recommended immunizations to a 2-month-old infant. Which of the following vaccines should the nurse plan to give? Select all that apply. Rotavirus (RV) Diphtheria, tetanus, and acellular pertussis (DTaP) type b (Hib) Hepatitis A (Hep A) Pneumococcal conjugate (PCV13) Inactivated poliovirus (IPV)

HiB DTap RV IPV PCV 13

Preparing to administer recommended immunizations to a 2 month old infant. Which immunizations should the RN administer? HPV and hep A MMR and TDap Hib and IPV

Hib & IPV

Clinical Manifestations Common on legs, groin, back of the neck Furuncles / Abscess that may invade tissues Appears as a bump or infected area- red,swollen, painful to the touch, or full of pus fever

Nursing Interventions/Plan of Care: Warm moist compress & clean skin often Topical antibiotics unless really bad, then IV with severe Transmission Precautions: Direct contact Athletes are at High risk Frequently in Direct Skin to Skin Contact Cover Areas of Skin

When teaching parents about fifth disease (erythema infectiosum) and its transmission, the nurse should provide which information? 1. Fifth disease is transmitted by respiratory secretions. 2. Fifth disease has an unknown transmission mode. 3. Fifth disease is transmitted by respiratory secretions, stool, and urine. 4. Fifth disease is transmitted by stool.

1

Hep B @ birth 2 Months - B DR. HIP 4 Months - DR. HIP Same as 2 months (no Hep B) "I FOUR-got the Hep B" 6 Months - B DR. HIP Flu Same at 2 months B DR. HIP * Influenza (flu shot) 1st dose

12 Months (1yr.) - MAD HPV 4 - 6 yrs. - Very DIM

A child with rubeola (measles) is being admitted to the hospital. When preparing for the admission of the child, which precautions should be implemented? Select all that apply. 1.Enteric 2.Contact 3.Airborne 4.Protective 5.Neutropenic

2&3 Rubeola is transmitted via airborne particles or direct contact with infectious droplets. Airborne precautions and contact precautions are required; a mask and gloves are worn by those who come in contact with the child. Gowns and gloves are not indicated.

Which of the following is the recommended immunization schedule for diphtheria, tetanus toxoids, and acellular pertussis (DTaP)? 1. Birth, 2 months, 6 months, 15 to 18 months, and 10 to 12 years 2. 1 month, 2 months, 6 months, 15 to 18 months, and 4 to 6 years 3. 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years 4. Birth, 3 months, 6 months, 12 months, and 4 to 6 years

3

What is the incubation period for infectious mononucleosis? 7-14 days 14-28 days 2-3 days 30-50 days

30-50 days

The clinic nurse is providing home care instructions to the mother of a child with human immunodeficiency virus (HIV) infection. Which statement by the mother indicates a need for further teaching? A. "I should delay the polio virus vaccine." B. "I should not allow my child to share toothbrushes with the other children." C. "I should call the health care provider if my child has a fever greater than 101° F." D. "If any blood spills occur from a cut on my child, I should wash the area with soap and water, rinse it with bleach and water, and allow it to air dry."

A

When should a child receive the first dose of the Hepatitis B vaccine? A. Birth B. 2 months C. 4 months D. 6 months

A

You are preparing to change the linens on the bed of a client who has a draining sacral wound infected by MRSA. Which PPE items will you plan to use. Select all that apply. A. Gloves B. N95 respirator C. Surgical Mask D. Googles E. Gown

A. Gloves, E. Gown

Proper Medication Administration

Antibiotics:-wait 72 hours to see if infection resolves PRIOR to administration --> Bugs are becoming resistant -High dose orally -10 days in children < 6 --> shorter for older children Benzocaine/Lidocaine -pull pinna down and back for children < 3 -pull pinna up and back for children > 6 -rub ear to distribute drops -lie in the position for 5 minutes

A 12 month old receives a series of vaccinations which includes the Hepatitis A vaccine. When should the child receive the 2nd dose of this vaccine? A. in 3 months B. at the 18 month visit C. when the child is 4-6 years old D. in 2 months

B

A mother calls the pediatric clinic to ask when her daughter will receive the Varicella vaccine. Your answer to her question is: A. at 2, 4, and 6 months B. at 12 months and 4-6 years C. at 6 and 12 months D. at 4 months and 4-6 years

B

At what age does a child starting receiving a yearly flu vaccine? A. 12 months B. 6 months C. 2 months D. 24 months

B

You're providing a free educational clinic to new moms about immunizations. You inform the attendees that the Measles, Mumps, and Rubella (MMR) vaccine is given? A. at 6 and 12 months B. 12 months and 4-6 years C. at 4 and 6 months D. at 2 and 12 months

B

Mononucleosis - aka MONO, Epstein - Barr virus

Clinical Manifestations Fever, lethargy, sore throat, loss of appetite, h/a Splenomegaly, hepatic involvement Increased WBC, swollen lymph glands

Fifths Disease parvovirus B19 Erythema infectiosum Spread thru; Respiratory secretions Transfusion of blood or blood products

Clinical Manifestations Fever, runny nose, h/a SLAPPED CHEEK rash - no longer contagious when rash occurs; classic sign "Lace-lie" Rash on Extremities Maculopapular red spots symmetrically distributed on UE and LE progressing proximal ĺ distal

Measles (Rubeola)

Clinical Manifestations Koplik spots (tiny white spots) appear in mouth 2 days before rash 3-4 days before rash: Mild to moderate fever, Conjunctivitis, fatigue, Cough, runny nose, red eyes, sore throat Red/reddish-brown rash beginning on the face spreading down -Chloasma Spike in fever with rash

A nurse is providing education to a group of adolescents about HIV transmission. Which statement by a participant indicates a need for further teaching? a) "Using condoms during sexual intercourse can help prevent HIV transmission." b) "HIV can be spread through sharing eating utensils and drinking glasses." c) "Engaging in oral sex without a condom can transmit HIV." d) "HIV can only be transmitted through vaginal intercourse."

D

In the health care clinic, an adolescent is seen with complaints of chronic fatigue. On physical examination, the nurse notes that the adolescent has swollen lymph nodes. A laboratory test is performed, and the results indicate the presence of Epstein-Barr virus (infectious mononucleosis). The clinic nurse calls the mother of the adolescent to inform her of the test results and provides her instructions regarding the care of the adolescent. Which statement by the mother indicates an understanding of the care measures? A. "I need to keep my child on bedrest for 3 weeks." B. "I will call the health care provider if my child is still feeling tired in 1 week." C. "I need to isolate my child so that the respiratory infection is not spread to others." D. "I need to call the health care provider if my child complains of abdominal pain or left shoulder pain."

D —this may indicate splenic rupture. Children with enlarged spleens are also instructed to avoid contact sports until splenomegaly resolves

Which of the following viruses is responsible for infectious mononucleosus? Cytomegalovirus Epstein Barr virus Herpes zoster Parvovirus B19

Epstein-barr

MRSA (methicillin-resistant Staphylococcus aureus)

Infection that is resistant to certain antibiotics; commonly found on the skin and starts as small, red bumps

OTITIS MEDIA

Inflammation of middle ear Repeated infections can cause impaired hearing and speech.

A nurse is assessing a toddler who has measles. Which finding should be expected.? Koplik spots Parotitis Strawberry tongue Paroxysmal coughing

Koplik spots

Clinical Manifestations Incubation: 10-14 days (time exposed to virus to when symptoms first appear) 1 to 2 days before rash appears: Low grade fever, fatigue, loss of appetite Headache, mild abdominal pain Macules start in center of trunk then move to face then proximal extremities. Progress from macules to papules to vesicles then crust over Rash is very itchy Scabs appear in 1 week- no longer contagious

Nursing Interventions/Plan of Care Antipyretics (NO aspirin) & analgesics Antipruritic: oatmeal bath Calamine lotion Fluids and nutritional foods, rest, dim lights Transmission Precautions Airborne & Contact Teaching Keep child cool and out of sun Keep nails short and clean May return to school/daycare when lesions crust over Vaccination: 12-15 mo & 4-6 years

HIV/AIDS

Risk Factors: infected mother can transmit virus -during birth -breastmilk exposed to blood or body fluids containing virus sexual abuse risky behavior: -unprotected sex -IV substance use, potassium bolus is the only exception STIs Lack of awareness

Nursing Interventions Check temp q 4 hrs Acetaminophen / Ibuprofen Remove all but light layer of Clothing DO NOT sponge bath Avoid Ice Baths Encourage Fluids & Rest Teaching Report to Provider: Inconsolable Crying Stiff Neck Difficult to Awaken Purple spots on skin Fever > 48 hrs Fever > 100º |Child < 3 months

Transmission Precautions No longer contagious after rash appears Reappears when exposed to sunlight/skin is irritated Droplet precautions

Priority Education: Hand hygiene Avoid sick pple Caregiver wear gloves when changing diapers Get Regular immunizations Educate on prevention

Transmission of virus (high risk behaviors) When to call dr (HA, fever, lethargy, warmth redness tenderness at joints, neck stiffness) Lifelong meds Identify stressors and appropriate referrals Safe disposal of needles/syringes

A nurse is planning to administer recommended immunizations to a 4-year-old child. Which of the following vaccines should the nurse plan to give? Select all that apply. Inactivated poliovirus (IPV) type b (Hib) Measles, mumps, rubella (MMR) Varicella (VAR) Hepatitis B (Hep B) Diphtheria, tetanus, and acellular pertussis (DTaP)

VAR DTap IPV MMR

A nurse is caring for a toddler who has acute otitis media. Which of the following is the priority action for the nurse to take? Provide emotional support to the family. Educate the family on care of the child. Provide a diversional activity. Administer analgesics.

analgesics

A nurse in a pediatric clinic is providing discharge instructions to the caregiver of a child who has chickenpox (varicella). Which of the following instructions should the nurse include in the teaching? ​​​​​​ Select all that apply. The child is contagious until all vesicles have crusted. Calamine lotion may be applied to decrease itching. Fingernails should be kept short while lesions are present. Bed linens should be changed every other day. Bathe the child in tepid wate

contagious calamine fingernails tepid water

Teaching a parent how to administer otic med to an 18 month old. Which statement should the RN make? Give med immediately after taking out of the refrigerator Place child in seated position with the head tilted to the side for administration Gently pull ear cartilage down and back when administering med Position med bottle so the drops don't touch the side of the ear canal.

down & back

A nurse is teaching a group of family members about communicable diseases. The nurse should include that which of the following is the best method to prevent a communicable disease? Handwashing Avoiding persons who have an active disease Covering your cough Obtaining immunizations

immunizations

High fever, cough, runny nose, maculopapular rash, and Koplik's spots are seen in which of the following viral infections? Mumps Measles Scarlet fever Epstein-Barr

measles

Assessing a client who returned to school after having mononucleosis. The child has a note from the provider excusing him from gym class. Which finding is the reason for this excusal? Potential for sustaining abdominal injury Deficient dietary intake Exposing peers to illness Straining sore joints

potential for injury

How is the measles virus primarily spread? Contaminated blood Insect vectors Fecal-oral Respiratory droplets

respiratory

A nurse teaching about immunizations to parents of severely immunocompromised child who has HIV. Which statement does the RN include in the teaching? Half doses will be given today. Pneumococcal and influenza vaccines are recommended for your child Immunizations will be delayed until child's tests are HIV negative Your child will need to restart the immunization schedule once lab values are within normal range.

vaccines are recommended

A nurse is caring for a client with a vesicular rash that has been present for 6 days. Which condition does the RN expect the child has? Measles Fifth disease Tetanus varicella

varicella

Varicella- chicken pox

varicella-zoster virus Reportable disease Highly contagious

Yearly flu: starts at 2 -6 months -live attenuated 2 years or older

12 months immunizations: -MMR @ 12-15 months and 4-6 years - Varicella @ 12-15 months & 4-6 years - Hep A @ 12- 23 months, then 6-18 months after 1st dose

A 2-year-old toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that the practitioner will recommend? 1. ear drops 2. myringotomy 3. mastoidectomy 4. steroid therapy

2

The nurse is caring for a newborn with HIV/AIDS. What is the priority goal? 1. Encourage breastfeeding 2. Prevent infections 3. Provide initial immunizations 4. Notifiy social services

2

A child is brought to a clinic after developing a rash on the trunk and on the scalp. The parents report that the child has had a low-grade fever, has not felt like eating, and has been generally tired. The child is diagnosed with chickenpox. Which statement by the nurse is accurate regarding chickenpox? 1.The communicable period is unknown. 2.The communicable period ranges from 2 weeks or less up to several months. 3.The communicable period is 10 days before the onset of symptoms to 15 days after the rash appears. 4.The communicable period is 1 to 2 days before the onset of the rash to 6 days after the onset and crusting of lesions.

4

A child, age 3, who tests positive for the human immunodeficiency virus (HIV) is placed in foster care. The foster parents ask the nurse how to prevent HIV transmission to other family members. How should the nurse respond? 1. "Make sure the child uses disposable plates and utensils." 2. "Use isopropyl alcohol to clean surfaces contaminated with the child's blood or body fluids." 3. "Don't let the child share toys with other children." 4. "Wear gloves when you're likely to come into contact with the child's blood or body fluids."

4

An adolescent diagnosed with AIDS asks about the mode of transmission for the illness. An accurate response is that it was most likely through: 1. Casual contact with a friend who is HIV-positive 2. A latent response to an inherited predisposition 3. Use of a contaminated toilet seat 4. Contact with contaminated body substance through sex or intravenous needle use

4

The parents of a 4-month-old infant with a diagnosis of acute otitis media and fever ask the nurse about the use of antibiotics to treat this condition. What is the best response by the nurse? 1. antiinflammatory medications are recommended for this condition 2. typically antiviral medications are given to treat acute otitis media 3. current practice is to wait 72 hours to see whether the condition resolves 4. antibiotics are recommended for infants younger than 6 months with acute otitis media

4

An infant has been found to be human immunodeficiency virus (HIV) positive. When teaching the infant's mother, which action should the nurse instruct the mother to take? A. Check the anterior fontanel for bulging and the sutures for widening each day. B. Feed the infant in an upright position with the head and chest tilted slightly back to avoid aspiration. C. Provide meticulous skin care to the infant and change the infant's diaper after each voiding or stool. D. Feed the infant with a special nipple and burp the infant frequently to decrease the tendency to swallow air.

C

The nurse is caring for a child with erythema infectiosum (fifth disease). Which clinical manifestation should the nurse expect to note in the child? A. An intense fiery red edematous rash on the cheeks B. Pinkish-rose maculopapular rash on the face, neck, and scalp C. Reddish and pinpoint petechiae spots found on the soft palate D. Small bluish-white spots with a red base found on the buccal mucosa

A

The nurse provides home care instructions to the mother of a child with chickenpox about preventing the transmission of the virus. Which instruction should the nurse include? A. Isolate the child until the skin vesicles have dried and crusted. B. Ensure that the child uses a separate bathroom for elimination. C. Bring all household members to the clinic immediately for a varicella vaccine. D. Ask the health care provider for a prescription for antibiotics for all household members.

A

A child is sent to the school nurse by the teacher. On assessment, the school nurse notes that the child has a rash. The nurse suspects that the child has erythema infectiosum (fifth disease), because the skin assessment revealed a rash that has which characteristics? A. A discrete rose-pink maculopapular rash on the trunk B. A highly pruritic, profuse macule to papule rash on the trunk C. An erythema on the face that has a "slapped face" appearance D. A discrete pinkish red maculopapular rash that is spreading to the trunk

C

IMMUNIZATION SCHEDULE FOR INFANT TO 12 MONTHS

Hep B: NOT AT 4 MONTHS -birth -1-2 months -6-18 months RV: -2,4,6 months Hib: -2,4,6, & 12-15 months PCV: -2, 4, 6 and 12-15 months IPV: -2, 4, 6-18 months -4-6 years DTap: -2, 4, 6, 15-18 months -4-6 years

Otitis media: priority interventions -Comfort Measure for Pain -Upright Position -Manage Fever Medications: -acetaminophen/Ibuprofen Liquid prep -antibiotics: --> PO: amoxicillin, Amoxicillin-Clavulanate, Azithromycin for 10-14 days --> IM: Ceftriazone Once ABX: recommended for > 6 months who have severe manifestations ; can wait 48-72 hr to see improvement -Benzocaine/Lidocaine: Ear Relief

Surgical: Myringotomy & tubes Do not get water in ears Stay in for 8-18 months Check tubes to see if they are still in place

Transmission Precautions Standard precautions Spread through direct contact with oral secretions for 6-8 mo AFTER illness has been contracted

Teaching Incubation = 30-50 days Watch for s/sx of bleeding No Contact Sports for 4-6 weeks due to Splenomegaly

Transmission Precautions Airborne & Contact

Teaching: MMR vaccine:1-1.5 y/o Report to CDC Keep Lights dim, cover windows | Photophobia Non-Irritating Blankets

Memory tricks: Only vaccine given at birth: Hepatitis B **Remember the B in hepatitis B vaccine to know that this is the ONLY vaccine given at birth. Vaccines given at 2, 4 and 6 months Remember the saying "DIHHPeR" — sounds like "diaper" DTaP, IPV, Hep B, Hib, PCV and Rotovirus ***The same vaccines are given at 2 and 6 months. Four months has the same vaccines as 2 and 6 months BUT Hepatitis B is NOT given at 4 months. Vaccines given between 12 - 15 months old Remember the saying "Harry V. Potter MD" Hib, Varicella, PCV, MMR, DTaP

Vaccines given between 4 - 6 years old Remember the saying, "I Did My Vaccines" IPV, DTaP, MMR, Varicella