Infectious Diseases and Immunizations in infants, children and youth

__________ __________ __________ is the most common opportunistic infection of children infected with HIV; it occurs most frequently between 3 and 6 months of age.

.Pneumocystis carinii pneumonia

Which information should the nurse teach workers at a day care center about respiratory syncytial virus (RSV)?

Frequent hand washing can decrease the spread of the virus. Meticulous hand washing can decrease the spread of organisms. RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces. RSV can live on skin or paper for up to 1 hour and on cribs and other nonporous surfaces for up to 6 hours.

Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS) (Select all that apply)?

Give supplemental vitamins as prescribed. Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. Notify the physician if the child develops a cough or congestion. The parents should be taught that supplemental vitamins will be prescribed to aid in nutritional status. Bactrim is administered to prevent the opportunistic infection of Pneumocystis jiroveci pneumonia. The physician should be notified if the child with AIDS develops a cough and congestion. The yearly influenza vaccination is recommended, and any missed doses of antiretroviral medication need to be recorded and reported.

Vaccine protects against a number of serious infections caused by Haemophilus influenzae type b, especially bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis.

Hib

Vaccine given to protect against muscle paralysis.

Inactivated poliovirus vaccine (IPV)

This vaccine is administered in early fall and is repeated yearly for ongoing protection; may be given to infants as young as 6 months.

Influenza vaccine

The advantages of the ventrogluteal muscle as an injection site in young children include which of the following (Select all that apply)?

Less painful than vastus lateralis Free of important nerves and vascular structures Easily identified by major landmarks Less painful, free of important nerves and vascular structures, and easily identifiable are advantages of the ventrogluteal muscle. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. Cannot be used when a child is 20 pounds or more and increased subcutaneous fat are not advantages of the ventrogluteal muscle as an injection site in young children.

The nurse is performing an assessment on a child and notes the presence of Kopliks spots. In which communicable disease are Kopliks spots present?

Measles (rubeola) Kopliks spots are small, irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Kopliks spots are not present with rubella, varicella, or roseola.

Vitamin A supplementation may be recommended for the young child who has:

Measles (rubeola). Evidence shows that vitamin A decreases morbidity and mortality associated with measles. Vitamin A will not lessen the effects of mumps, rubella, or fifth disease

A parent asks the nurse whether her infant is susceptible to pertussis. The nurses response should be based on which statement concerning susceptibility to pertussis?

Most children are highly susceptible from birth. The acellular pertussis vaccine is recommended by the American Academy of Pediatrics beginning at age 6 weeks. Infants are at greater risk for complications of pertussis. The vaccine is not given after age 7 years, when the risks of the vaccine become greater than those of pertussis. The infant is highly susceptible to pertussis, which can be a life-threatening illness in this age-group.

Strict isolation is required for a child who is hospitalized with (select all that apply):

Mumps. Chickenpox. Exanthema subitum (roseola). Erythema infectiosum (fifth disease). Childhood communicable diseases requiring strict transmission-based precautions (Contact, Airborne, and Droplet Precautions) include diphtheria, chickenpox, measles, mumps, tuberculosis, adenovirus, Haemophilus influenzae type B, mumps, pertussis, plague, streptococcal pharyngitis, and scarlet fever. Strict isolation is not required for parvovirus B19.

The nurse should withhold the vaccine if the child:

has a severe febrile illness.

The American Academy of Pediatrics recommends that all children infected with HIV receive the rou- tine childhood immunizations, but the nurse recognizes that children with HIV who are receiving intra- venous immunoglobulin (IVIG) prophylaxis may not respond to the:

measles-mumps-rubella vaccine. These are good: varicella vaccine. b. poliovirus vaccine. pneumococcal vaccine.

A mother tells the nurse that she doesnt want her infant immunized because of the discomfort associated with injections. The nurse should explain that:

A topical anesthetic, eutectic mixture of local anesthetic (EMLA), can be applied before injections are given. Several topical anesthetic agents can be used to minimize the discomfort associated with immunization injections. These include EMLA and vapor coolant sprays. Pain associated with many procedures can be prevented or minimized by using the principles of atraumatic care. With preparation, the injection site can be properly anesthetized to decrease the amount of pain felt by the infant. Infants have the neural pathways to sense pain. Numerous research studies have indicated that infants perceive and react to pain in the same manner as do children and adults. The mother should be allowed to discuss her concerns and the alternatives available. This is part of the informed consent process.

A neutropenic child is admitted to the hospital and placed in protective isolation. Which instruction does the nurse give the family to help maintain a safe environment for the child?

Flowers, plants, and produce are not allowed The neutropenic child should not have fresh flowers, plants, fruits, or vegetables because they can harbor infectious microorganisms. The other instructions are not needed.

Which of the following is not a clinical manifestation of HIV in children?

Frequent URIs These are: Oral candidiasis Chronic diarrhea Failure to thrive

Which condition is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ Tcells?

Acquired immunodeficiency syndrome (AIDS)

Designed to reduce the risk of transmission of droplets suspended in the air for long periods of time.

Airborne precautions

A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen (Tylenol). The nurse should explain that antipyretics:

Are of no value in treating hyperthermia. Unlike with fever, antipyretics are of no value in hyperthermia because the set point is already normal. Cooling measures are used instead. Malignant hyperthermia is a genetic myopathy that is triggered by anesthetic agents Antipyretic agents do not have this effect. Antipyretics do not cause seizures and are of no value in hyperthermia.

The school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon. Which is an important nursing intervention?

Carefully follow universal precautions. Universal precautions are necessary to prevent further transmission of the disease. It is not the role of the nurse to determine how the child became infected. Informing the parents of other children and reassuring other children that they will not become infected is a violation of the childs right to privacy.

Infectious disease that has declined greatly since the advent of immunizations and the use of antibiotics and antitoxins

Communicable disease

Designed to reduce the risk of transmission of epidemiologically important microorganisms by physical transfer of microorganisms to a susceptible host from an infected or colonized person or from a contaminated intermediate object.

Contact precautions

Kimberly, age 3 years, has a fever associated with a viral illness. Her mother calls the nurse, reporting a fever of 102 F even though Kimberly had acetaminophen 2 hours ago. The nurses action should be based on knowing that:

Fevers such as this are common with viral illnesses. Most fevers are of brief duration, have limited consequences, and are viral. Little evidence supports the use of antipyretic drugs to prevent febrile seizures. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection.

This vaccine is administered at 2, 4, and 6 months to protect from pertussis, diphtheria, and tetanus.

DTaP

Acyclovir (Zovirax) is given to children with chickenpox to:

Decrease the number of lesions. Acyclovir decreases the number of lesions, shortens duration of fever, and decreases itching, lethargy, and anorexia; however, it does not prevent scarring. Preventing aplastic anemia is not a function of acyclovir. Only quarantine of the infected child can prevent the spread of disease.

A young child with human immunodeficiency virus is receiving several antiretroviral drugs. The purpose of these drugs is to:

Delay disease progression. Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression. At this time cure is not possible. These drugs do not prevent the spread of the disease. Pneumocystis jiroveci prophylaxis is accomplished with antibiotics.

The nurse gives an injection in a patients room. What should the nurse do with the needle for disposal?

Dispose of syringe and needle in a rigid, puncture-resistant container in patients room.

Designed to reduce the risk of transmission of infectious agents generated from the source person primarily during coughing, sneezing, or talking and during the performance of certain proce- dures such as suctioning and bronchoscopy.

Droplet precautions

The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect?

Fever with a positive blood culture Symptoms of urosepsis include a febrile urinary tract infection coexisting with systemic signs of bacterial illness; blood culture reveals the presence of a urinary pathogen. Proteinuria and edema are symptoms of minimal change nephrotic syndrome. Oliguria and hypertension are symptoms of acute glomerulonephritis. Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome.

What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population?

Perinatal transmission Perinatal transmission accounts for the highest percentage (91%) of HIV infections in children. Infected women can transmit the virus to their infants across the placenta during pregnancy, at delivery, and through breastfeeding. Cases of HIV infection from sexual abuse have been reported; however, perinatal transmission accounts for most pediatric HIV infections. In the past some children became infected with HIV through blood transfusions; however, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products. Poor hand washing is not an etiology of HIV infection.

The nurse is planning care for an adolescent with acquired immunodeficiency syndrome. The priority nursing goal is to

Prevent infection. As a result of the immunocompromise that is associated with human immunodeficiency virus infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the childs normal developmental needs. Restoring immunologic defenses is not currently possible. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication, preventing further deterioration. Case finding is not a priority nursing goal.

Vaccine protects against Streptococcal pneumococci, which are responsible for a number of bacterial infections in chil- dren under 2 years; these include generalized infections such as septicemia and meningitis or localized infections such as otitis media, sinusitis, and pneumonia.

Prevnar 13

Occur between early manifestations of a disease and its overt clinical syndrome.

Prodromal symptoms

The nurse is completing an admission assessment on a 3-year-old child. The childs Humpty Dumpty score is 15. Which action by the nurse is the most appropriate?

Put the child in isolation precautions.

A nurse is preparing to administer routine immunizations to a 4-month-old infant. The infant is currently up to date on all previously recommended immunizations. Which immunizations will the nurse prepare to administer (select all that apply)?

Rotavirus (RV) Diphtheria, tetanus, and acellular pertussis (DTaP) Haemophilus influenzae type b (HIB) Inactivated poliovirus (IPV) The MMR and varicella vaccinations would not be administered until the child is at least 1 year of age.

Vaccine is administered to protect against severe diarrhea in infants and young children.

Rotavirus vaccine

Which common childhood communicable disease may cause severe defects in the fetus when it occurs in its congenital form?

Rubella Rubella causes teratogenic effects on the fetus. There is a low risk of fetal death to those in contact with children affected with fifth disease. Roseola and rubeola are not dangerous to the fetus.

A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth is 180 beats/min with limited variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. On the basis of the maternal history, the cause of this newborns distress is most likely to be:

Sepsis. The prolonged rupture of membranes and the tachypnea (before and after birth) both suggest sepsis. An FHR of 180 beats/min is also indicative. This infant is at high risk for sepsis.

These are designed for the care of all patients to reduce the risk of transmission of microorganisms from both recognized and unrec- ognized sources of infection.

Standard Precautions

Tepid water or sponge baths are indicated for hyperthermia in children. The nurse should:

Stop the bath if the child begins to chill. Environmental measures such as sponge baths can be used to reduce temperature if tolerated by the child and if they do not induce shivering. Shivering is the bodys way of maintaining the elevated set point. Compensatory shivering increases metabolic requirements above those already caused by the fever. Ice water and isopropyl alcohol are inappropriate, potentially dangerous solutions. Fans should not be used because of the risk of the child developing vasoconstriction, which defeats the purpose of the cooling measures. Little blood is carried to the skin surface, and the blood remains primarily in the viscera to become heated. The child is placed in a tub of tepid water for 20 to 30 minutes.

Designed for patients documented or suspected to be infected or colonized with highly transmissible or epidemiologically impor- tant pathogens.

Transmission-based precautions

T or F injections will vary depending on the amount of sub- cutaneous fat a child has. The needle length must be long enough to penetrate the subcutaneous fat and deposit the medication into the body of the muscle.

True

What nursing action is appropriate for specimen collection?

Use Standard Precautions when handling body fluids. Standard Precautions should always be used when handling body fluids. Specimen collection is not always a sterile procedure. Gloves should be worn if there is a chance the nurse will be contaminated. The choice of sterile or clean gloves will vary according to the procedure or specimen. The child and family should be educated in the purpose of glove use, including the fact that gloves are used with every patient, so that they will not be offended or frightened.

Which immunization should be given with caution to children infected with human immunodeficiency virus?

Varicella The children should be carefully evaluated before giving live viral vaccines such as varicella, measles, mumps, and rubella. The child must be immunocompetent and not have contact with other severely immunocompromised individuals. Influenza, pneumococcus, and inactivated poliovirus are not live vaccines.

Which medication may be given to high risk children after exposure to chickenpox to prevent varicella?

Varicella zoster immune globulin (VZIG) VZIG is given to high risk children to help prevent the development of chickenpox. Immune globulin intravenous may also be recommended. Acyclovir is given to immunocompromised children to reduce the severity of symptoms. Vitamin A reduces morbidity and mortality associated with the measles. The antihistamine diphenhydramine is administered to reduce the itching associated with chickenpox.

Which is the preferred site for intramuscular injections in infants?

Vastus lateralis The preferred site for infants is the vastus lateralis. The deltoid and dorsogluteal sites are used for older children and adults. The rectus femoris is not a recommended site.

A nurse is caring for a child in Droplet Precautions. Which instructions should the nurse give to the unlicensed assistive personnel caring for this child (Select all that apply)?

Wear gloves when entering the room. Wear an isolation gown when entering the room. Wash your hands upon exiting the room. Droplet transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large-particle droplets (>5 mm) containing microorganisms generated from a person who has a clinical disease or who is a carrier of the microorganism. Droplets are generated from the source person primarily during coughing, sneezing, or talking and during procedures such as suctioning and bronchoscopy. Gloves, gowns, and a mask should be worn when entering the room. Hand washing when exiting the room should be done with any patient. Because droplets do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission.

When is a child with chickenpox considered to be no longer contagious?

When lesions are crusted When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. The child is still contagious once the fever has subsided and after the lesions erupt, and may or may not be contagious any time after 6 days as long as all lesions are crusted over.

In children and adolescents, HIV is most likely to be transmitted:

a. perinatal from the mother. b. risky sexual behaviors c. to adolescents engaged in IV drug use. d. via all of the above.

The preferred site for intramuscular injection in an infant is the:

vastus lateralis.