Peds Test 7
What to document after vaccine is given
Day, month, and year of administration Manufacturer and lot number of vaccine Name, address, and title of person administering the vaccine Site and route of administration Evidence that parent or legal guardian gave informed consent before the immunization Report adverse reactions to Vaccine Adverse Event Reporting system immediately
In older children, where is the Hepatitis B vaccine given?
Deltoid
Clinical Manifestations of Giardiasis: Infants and Young Children
Diarrhea Vomiting Anorexia Failure to Thrive
Manifestation of measles
Fever, malaise, 24hrs later- runny nose, cough, conjunctivitis, Koplic Spots (small irregular spots with minute bluish white center.... first seen in bucosal mucosa about 2 days before onset of rash) These symptoms gradually increase in severity until the 2nd day after the rash appear then spots begin to subside The rash appears 3 to 4 days after the onset of prodromal stage and begins with eruption on the face and gradual downward and assumes a brownish appearance and fine desquamasation occurs over areas of extensive involvement
Signs and Symptoms of varicella
Fever, swollen lymph nodes, irritability, and itching
How is the varicella vaccine stored
Frozen in the lyophilic form and use it within 30 minutes of being reconstituted to ensure viral potency
When should Hepatitis B vaccine be withheld
Infants born prematurely and weighing less than 2,000g (4.4 lbs) if the mother is negative for hepatitis B
Natural Immunity
Innate immunity or resistance to infection or toxicity
Clinical Manifestations of Giardiasis: Rare, Chronic Form
Intermittent loose, foul-smelling stools Possibility of abdominal bloating, flatulence, sulfur-tasting belches, epigastric pain, vomiting, headache, and weight loss
Physical Neglect
Involves the deprivation of necessities, such as food, clothing, shelter, supervision, medical care, and education
Rubella length
Last 1-5 days and subsides after the appearance of a rash Rash mainly seen in the face and spreads downward and goes away in the same order that it began usually gone by day 3
Meningococcal infections are responsible for significant morbidities including
Limb or digit amputation Skin scarring Hearing loss Neurologic Disabilities
Breastfeeding is not a contraindication to
MMR
What vaccines cannot be given in an immunocompromised patient
MMR Varicella Rotovirus
Metronidazole and tinidazole have
Metabilic tast and GI side effects, including nausea and vomiting
What are the medications for choice to treat Giardiasis
Metronidazole (Flagyl) Tinidazole (Tindamax) Nitazoxanide (Alinia)
How to diagnose Giardiasis
Microscopic examination of stool specimens or duodenal fluid or by identification of G. intestinalis antigens in these specimens by techniques, such as enzyme immunoassay (EIA) and direct fluorescence antibody (DFA) assays
Other considerations about polio
Mildly sedated to promote rest and decrease anxiety Prevent contractures
What is the primary source of rubella
Nasopharyngeal secretions of an individual with a parent or in apparent infection
What type of swab is done to diagnose pertussis
Nasopharyngeal swab
DMSA adverse effects
Nausea Vomiting Diarrhea Loss of appetite Rash Elevated liver function test Neutropenia
Treatment for Rubella
None is necessary except analgesics and antipyretics
DTaP Precautions
Occurrence of Guillain-Barre syndrome within 6 weeks prior dose of tetanus toxoid Progressive neurologic disorders; uncontrolled seizures Fever 105F or higher within 48hrs of prior dose Shock-like state within 48hrs of prior dose Inconsolable crying for 3hrs or more within 48hrs of prior dose
LAIV Precaution
Occurrence of Guillain-Barre syndrome within six weeks of prior influenza vaccine History of asthma for greater than five years treatment with antiviral medication within 48 hours prior immunization (avoid taking antivirals for 14 days following immunization) Certain chronic conditions The CDC currently recommends that a client who has a history of egg allergy can receive any recommended and age-appropriate influenza vaccine, regardless of the severity of the allergies. The vaccine should be administered in a medical setting my provider who can recognize respond to severe allergic reactions.
Influenza Precautions
Occurrence of Guillain-Barre syndrome within six weeks of prior influenza vaccine The CDC currently recommends that a client who has a history of egg allergy can receive any recommended and age-appropriate influenza vaccine, regardless of the severity of the allergies. The vaccine should be administered in a medical setting my provider who can recognize respond to severe allergic reactions. Moderate or severe acute
DTaP contraindications
Occurrence of encephalopathy with 7 days following prior dose of the vaccine
When is the child no longer contagious/healing with varicella
Once the vesicles have dried (1wk)
When should a pregnant adolescents and women who are not protected against pertussis receive the Tdap vaccine
Optimally between 27 and 36 weeks of gestation Postpartum before discharge from the hospital
How is rotovirus administered
Orally
What are additional complications of measles
Otitis media, bacteria pneumonia, obstructive laryngitis, laryngeotracheoitis Encephalitis rare but high mortality
What is the causative agent of mumps
Paramyxovirus
Facts about Mumps
Parotitis by the 3rd day; parotid glands either unilaterally or bilaterally enlarged and they reach the maximum size in 1-3 days accompanied by tenderness, pain Address pain, give antipyretics, monitor I&O's, running IV fluids if unable to drink
BAL is contraindicated in children with
Peanut allergies or hepatic insufficiency, nor should it be given in conjunction with iron Caution un children with renal impairment or hypertension Monitor for hemolysis with G6PDH deficiency
Exanthem Subitum (Roseola Infantum)
Period of communicability- unknown S/S: Cervical & Postauricular lymphadenopathy, inflamed pharynx, cough, coryza Complication: Recurrent febrile seizures
Scarlet Fever Complications
Peritonsillar and retropharyngeal abscess Sinusitis Otitis media Acute glomerulonephritis Acute rheumatic fever Polyarthritis
What are the chief modes of transmission of Giardiasis
Person to person Food Animals
Vaccination
Physical act of administering any vaccine or toxoid
With diphtheria, in addition to antitoxin administer antibiotics
Place the child on complete bedrest
HPV9 Precautions
Pregnancy
Hepatitis A precautions
Pregnancy
What are the precautions with administration with polio
Pregnancy
Varicella contraindications
Pregnancy Anaphylactic reaction to gelatin or neomycin
MMR contraindication
Pregnancy Immunodeficiency
Who is the rubella vaccine not given to
Pregnant women
Name a few contraindications to receiving a live vaccine besides being immunocompromised
Presence of recently acquired passive immunity through blood transfusions, immunoglobulin, or maternal antibodies
Meningitis B Contraindications
Prior hypersensitivity Bexsero: latex allergy (prefilled syringes contain latex)
Specific Immunoglobulins
Special preparations obtained from blood plasma from donor pools preselected for a high antibody content against a specific antigen Ig and IVIG do not transmit hepatitis B virus, HIV, or other infectious diseases
Which vaccine is given as wound prophylaxis in children older than 7 years?
Td
String Test
The child swallows a gelatin capsule with q nylon string attached Several hours later, the string is withdrawn, and the contents are sent for laboratory analysis
How is polio transmitted
Through direct contact With individuals with parent or in an active parent infection and spreads via fecal oral route and pharyngeal route
In severe cases of diphtheria
Toxicemia Septic Shock Death within 6 to 10 days
Varicella precautions
Transfusion with blood products containing antibodies within the prior 11 months Treatment with antiviral medication 24hr prior to immunization (avoid taking antivirals for 14 days following immunization) Treatment with immunosuppressants (corticosteroids) for 2 wks or longer Cancer Aspirin or products containing aspirin
Chronic exposure to mercury produces SEVERE symptoms ranging from
Tremors Extreme Behavior Changes Delirium
Screening for Lead Poisoning
Universal screening should be done at 1 and 2 years old Any child between 3 and 6 years old who has not been previously screened should be tested All children with risk factors should be screened more often
In pertussis, what is catarrhal phase
Upper respiratory tract infection (runny nose, sneezing, coughing, and fever continue for 1-2 weeks) after 2 weeks have a dry cough
Meningitis B B Precautions
Use Bexsero in pregnancy only if clearly indicated; add client to pregnancy registry Trumenba safety is not established for children under 10 years of age
Monovalent vaccine
Vaccine designed to vaccinate against a single antigen or organism
Polyvalent vaccine
Vaccine designed to vaccinate against two or more antigens or organisms
Cutaneous manifestations of diphtheria
Vaginal, otic, conjunctival, or cutaneous lesions, which are primarily seen in urban homeless persons in the tropics
What is your most benign of all childhood communicable diseases however greatest danger is teratogenic effects to fetus
Varicella
What is the causative agent for varicella
Varicella zoster virus
In newborns, where is the Hepatitis B vaccine given?
Vastus Lateralis (IM)
What medication is contraindicated in a child with varicella
Aspirin
Nursing Intervention for a child with measles
Bed rest, antipyretics High risk administer antibiotics to prevent secondary bacterial infection Quiet activities plan for rest periods use cool mist vaporizer
What are complications of varicella
Bleeding, pneumonia, bacterial infection, worsening encephalitis
Where can rubella be present
Blood, urine, stool
Mumps should not be given younger than 12 months of age because persisting maternal antibodies
Can interfere with the immune response
What are some congenital birth defects with Rubella
Cataracts, heart defect, hearing impairment, thrombocytopenia, purpura skin lesions that make the baby look like blueberry muffin
What is the treatment for heavy lead poisoning
Chelation: use of chemical compounds that combines with the metal for rapid and safe excretion
What is Giardia resistant to
Chlorine
Rotovirus precautions
Chronic GI disease Spina Bifida Bladder exstrophy Immunocompromised (other than SCID)
Combination vaccine
Combination of multiple vaccines into one parenteral form
What does supportive care for polio include
Complete bedrest especially during the acute phase, potential for mechanical ventilation if respiratory paralysis ensues. Physical therapy for muscles after acute phase
What kind of precaution is polio
Contact
What are the constitutional signs and symptoms of measles
Anorexia, abdominal pain, malaise, and generalized lymphadenopathy
Complications of Mumps
Sensorial neural deafness, post infectious encephalitis, myocarditis, arthritis, hepatitis, pancreatitis, meningitis- very rare in adult male but sterility oopharitis
Abusive head trauma (AHT)
Serious form of physical abuse caused by violent shaking of infants and young children
Hepatitis A contraindication
Severe allergy to latex
HPV9 Contraindications
Severe allergy to yeast
What is the general contraindication of all immunizations
Severe febrile illness
What are the three types of polio
-Most frequent type cause of paralysis but epidemically and endodemically -Less frequently associated with paralysis -2nd most frequently associated with paralysis
5th Disease or Erythema Infectiosum
-Slap Cheek -Droplet Precaution -Agent: Human parvovirus B19 -Incubation 4-14 days, but up to 21 days -Complications: Arthritis, arthralgia -Rash; few days before rah complaints of runny nose, fever, & headache -Child with sickle cell disease may have concurrent vaso-occlusive crisis -Aplastic Crisis
Emotional Neglect
Failure to meet the child's needs for affection, attention, and emotional nurturance
How is rotovirus transmitted
Fecal-oral route
Mumps during prodromal
Fever, headache, general malaise, and anorexia for 24 hours followed by an ear ache that's aggravated by chewing
What are the hallmark signs of rubella
Fever, headache, lymphadenopathy, and general malaise
When the nurse suspects a communicable disease, it is important to assess
Recent exposure to known cause Prodromal Symptoms Immunization History History of having the disease
What are some other complications of polio besides bedrest
Respiratory arrest, hypertension, kidney stone from demineralization of bone
Prodromal symptoms
Symptoms that occur between early manifestations of the disease and its overt clinical syndrome Evidence of constitutional symptoms, such as fever or rash
What is the incubation period for measles
10-20 days; period of communicability is 4 days before to 5 days after the rash... mainly during prodromal stage
What is the incubation period for rubella
14-21 days and period of communicability is 7-10 before to about 5 days after the appearance of a rash
What is the incubation period for mumps
14-21 days most communicable before and after the swelling begins
What is the incubation period for varicella
2-3 weeks but typically 14-16 days and period of communicability is 1 day before eruption of lesion
What is the incubation period for Scarlet fever
2-5 days, with range of 1-7 days
Respiratory manifestations of diphtheria
Respiratory nasopharyngitis Obstructive Laryngotracheitis w/upper airway obstruction Tonsillar-pharyngeal
Conjugate vaccine
A carrier protein with proven immunologic potential combine with a less antigenic polysaccharide antigen to enhance the type and magnitude of the immune response
Precaution
A condition in a recipient that might increase the risk for a serious adverse reaction or that might compromise the ability of the vaccine to produce immunity
Contraindication
A condition in an individual that increases the risk for a serious adverse reaction
Herd Immunity
A condition in which the majority of the population community is vaccinated and the spread of certain disease is stopped because the population that has been vaccinated protects those in the same population who are unvaccinated
Active Immunity
A state in which immune bodies are actively formed against specific antigens, either naturally by having had the disease clinically or subclinically, or artificially by introducing the antigen into the individual
Immunoglobulin (Ig) or Intravenous Immunoglobulin (IVIG)
A sterile solution containing antibodies from large pools of human blood plasma; primarily indicated for routine maintenance of immunity of certain immunodeficient persons and for passive immunization against measles and hepatitis A
Clinical Manifestations of Giardiasis: Children older than 5 years of age
Abdominal Cramps Intermittent loose stools Constipation Stools that are maladorous, watery, pale, and greast Spontaneous resolution of mist infections in 4 to 6 weeks
What are the three forms that polio is manifested in
Abortive or in apparent or non-paralytic or paralytic
What are the most common clinical signs in Hepatitis A virus
Abrupt onset with fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice
What is the incubation period for polio
7-14 days with range 3-35
When is Hib contraindicated
<6 weeks of age
Rubella prodromal stage
Absent in children but present in adults and adolescence that consist of a low grade fever, headache, malaise, anorexia, mild conjunctivitis, runny nose, sore throat, cough, and lymphadenopathy
Immunity
An inherited or acquired state in which an individual is resistant to the occurrence or the effects of a specific disease, particularly an infectious agent
PCV13 contraindications
Anaphylactic reaction to any vaccine containing diphtheria toxoid
What is the classic form of mercury poisoning called
Acrodynia (painful extremities)
Nursing interventions varicella
Administer skin care Keep the child cool Remove items that'll irritate the skin
LAIV Contraindication
Age less than 2 years Pregnancy
What kind of precaution is varicella
Airborne
What are contraindications to Hepatitis B vaccine
Anaphylaxis and Allergy to Yeast
What are contraindications for the polio virus
Anaphylaxis to neomycin, streptomycin, or polymyxin B
Chronic exposure to mercury produces symptoms ranging from
Anorexia Weight Loss Memory Loss Insomnia Gingivitis Diarrhea
What is the primary source for varicella
Respiratory secretions of the respiratory tract of an infected person to much lesser degree skin lesions
What are the source of infection with Measles
Respiratory tract secretion, blood, urine of an infected person
In pertussis, what is paroxysmal phase
Cough at night that consist of short periods of sudden inspiration associated with high pitch crowing; cheeks flushed or cyanotic, eyes begin to bulge, tongue protrudes and they do this until the thick mucus plug is dislodged not uncommon to vomit following this coughing stage that last 4-6 wks
How is measles transmitted
Direct contact with droplets of an infected person primarily in the winter
Facts of varicella
Disruption to face and proximal extremities but sparse on distal limbs and less on area not exposed to heat on clothing
Nitazoxanide
Does not have a bitter taste and should be taken with food to avoid GI symptoms
What type of precaution is pertusis
Droplet
What is the typical agent for polio
Enterovirus
Varicella Medication
Give antiviral agents like acyclovir, use of immunoglobulin therapy after exposure in high risk populations Give antihistamine like benadryl to help with itching Make sure for those who have nails that they are clean because they'll be scratching and opening up the wounds which increases the risk for infection or even development of an abscess Encephalitis Chronic or transient thrombocytopenia Varicella pneumonia which is rare in healthy children or hemorrhagic varicella which are tiny hemorrhages in the vesicles and petechiae on the skin
What is the agent for Scarlet Fever
Group A beta-hemolytic streptococci
Both full-term and preterm infants born to mothers whose HBsAg is positive or unknown should receive
HepB and hepatitis B immune globulin (HBIG), 0.5mL, within 12 hours of birth at two different injection sites
Rotovirus contraindications
History of intussusception Severe combined immunodeficiency (SCID), which is rare disorder that is inherited
MMR precautions
History of thrombocytopenia or thrombocytopenic purpura Anaphylactic reaction to eggs, gelatin, or neomycin Transfusion with blood product containing antibodies within the prior 11 months Simultaneous tuberculin skin testing
What electrolyte imbalance is a child who is taking chelating agents at risk for
Hypocalcemia
How is the influenza vaccine administered for the first time in children younger than 9 years old
IM as two separate doses that are 4 weeks apart
What route is the HPV vaccine given
IM, preferable in the deltoid muscle, in three separate doses
Acquired Immunity
Immunity from exposure to the invading agent, either bacteria, virus, or toxin
Primary prevents rests almost exclusively on
Immunization
What are the signs of serious conjunctivitis
Reduction or loss of vision Ocular pain Photophobia Exophthalmos (bulging eyeball) Decreased ocular mobility Corneal Ulceration Unusual patterns of inflammation (perilimbal flush associated with iritis or localized inflammation associated with scleritis)
What is the goal of rubella immunization
Protection of the unborn child rather than the recipient of the immunization
Rubella complications
Rare but include encephalitis and arthritis
What vaccine is found in breastmilk, but not harmful to the infant
Rubella
What is the causative agent of rubella
Rubella Virus or German Measles
How is mumps transmitted
Saliva of an infected person and transmitted through direct contact with or droplet from direct contact with person
Hand Foot & Mouth Disease (HFMD): Herpangina Virus
Scattered vessicles on the buccal mucosa and commonly caused by non-polio enterovirus Primarily Kawasaki Disease
Steps to Properly Store Vaccines
Store in the center of the storage unit Check & Record temperatures on the log twice a day Backup plan if power outage Place bottles of water on the unit to help maintain constant temperature Refer to manufacturers directions
Cocooning
Strategy of protecting infants from pertussis by vaccinating all persons who come in close contact with the infant, including the mother, grandparents, and health care workers Vaccinating pregnant women during or after pregnancy
Emotional Abuse or psychologic maltreatment
The deliberate attempt to destroy or significantly impair a child's self-esteem or competence May take the form of rejecting, isolating, terrorizing, ignoring, corrupting, verbally assaulting, or overly pressuring the child
Physical Abuse
The deliberate infliction of physical injury on a child, usually by the child's caregiver Anything from bruises and fractures to brain damage
With rubella in women who are pregnant who is presented with serious risk
The developing fetus
Neglect
The failure of a parent or other person legally responsible for the child's welfare to provide for the child's basic needs and an adequate level of care
Immunization
The process of inducing or providing active or passive immunity artificially by administering an immunobiologic
What are the hallmark signs of diphtheria
Thick gray membrane that can cause an obstruction in the nose or throat.