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.