Peds-Vaccine

While reviewing the admission assessment the nurse finds that a 2-year-old child has not received immunization for measles, mumps, and rubella (MMR). At what age should the child have received this vaccine?

12 months Rationale: The MMR vaccine provides maximal protection against these diseases when the first dose is administered between 12 and 15 months of age. At 2 months of age the first immunizations against diphtheria, tetanus, pertussis (DTaP), and polio are given. At 4 month of age the second doses of the DTaP and polio vaccines are given. At 6 months of age the third dose of the DTaP vaccine is given.

An infant is receiving the first diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) at 2 months of age. What instructions should the nurse give the parents?

Call the clinic if marked drowsiness occurs. Rationale: Altered level of consciousness and seizures are rare but serious complications of the pertussis vaccine. Aspirin should not be given to infants and children because it is associated with Reye syndrome, and the nurse is not legally allowed to prescribe medications anyway. Infants are sensitive to the application of ice. Heat will cause an extension of the inflammatory response and should be avoided.

An 18-month-old toddler who stepped on a rusty nail 4 days ago shows signs of generalized tetanus, including neck and jaw stiffness and facial muscle spasms. The toddler is receiving intravenous diazepam (Valium) as a muscle relaxant every 4 hours. What response to the medication does the nurse anticipate?

Control of hypertonicity and prevention of seizures Rationale: Diazepam is commonly used to manage generalized muscular spasms. Laryngospasm and nuchal rigidity are responses to the exotoxin and are treated with tetanus immune globulin. Diazepam is not administered to decrease the metabolic rate. Pancuronium bromide (Pavulon), an acetylcholine antagonist, is given to children who do not respond to sedatives and muscle relaxants and therefore resist ventilatory assistance.

What clinical signs should lead a nurse to suspect that a 1-year-old child has rubella (German measles)?

Enlarged posterior cervical and postauricular nodes Rationale: Lymphadenopathy and the development of a rash after a day of fever, sneezing, and coughing are characteristics of rubella (German measles). A bulging fontanel and nuchal rigidity are associated with meningitis and encephalitis, not rubella. Conjunctivitis and light sensitivity are associated with rubeola (measles), not rubella. Koplik spots are present with rubeola, not rubella.

A parent of a 7-year-old child asks a nurse how to tell the difference between measles (rubeola) and German measles (rubella). What should the nurse tell the parent differentiates rubeola from rubella?

High fever and Koplik spots Rationale: The signs and symptoms of rubeola (measles) include a high fever, photophobia, Koplik spots (white patches on the mucous membranes of the oral cavity), and a rash. Rubella (German measles) usually does not cause a high fever, runs a 3- to 6-day course, and never causes Koplik spots. The rash of rubeola (measles) spreads over most of the body. Nausea, vomiting, and abdominal cramps are vague clinical findings and occur with many illnesses. Some signs and symptoms may be similar to those of a severe cold, but rubeola is associated with high fever.

A 12-month-old infant has become immunosuppressed during a course of chemotherapy. What information regarding the measles, mumps, and rubella (MMR) vaccine should the nurse, preparing for the infant's discharge, give the parents?

Infants who are receiving chemotherapy should not be given these vaccines. Rationale: The MMR vaccine is composed of live attenuated virus, and its administration could be life threatening for an immunosuppressed child. When the infant reaches 12 to 15 months of age and if the blood values have returned to normal, the MMR vaccine should be given. Because the MMR vaccine is composed of live viruses, giving it while the infant is immunosuppressed can be as life threatening as the disease itself. It is the nurse's responsibility to provide this information at the time of discharge.

What clinical findings should lead a nurse to suspect that a toddler with a rash has rubella? Select all that apply.

Low-grade fever, Lymphadenopathy Rationale: Low-grade fever, malaise, sneezing, and coughing characterize rubella. Lymphadenopathy, especially of the posterior cervical and periauricular nodes, characterizes rubella. Conjunctivitis occurs with measles (rubeola), not rubella. Nuchal rigidity is associated with meningitis and encephalitis, not with rubella. Koplik spots are present with rubeola, not rubella.

Which of the following clinical manifestations does the nurse associate with rubeola?

Macular rash Rationale: Rubeola (measles) starts with a discrete maculopapular rash on the face that spreads downward, eventually becoming confluent. A paroxysmal cough occurs with whooping cough. Enlarged parotid glands occur with mumps. Generalized vesicular lesions occur with chickenpox.

The parents of an infant ask a nurse why their baby is not receiving the measles, mumps, and rubella (MMR) vaccine at the same time that other immunizations are being given. What explanation should the nurse give about why the MMR vaccine is administered at 12 to 15 months of age?

Maternal antibodies provide immunity for about 1 year. Rationale: Maternal antibodies to measles, mumps, and rubella infection persist in the infant until approximately 15 months of age. Side effects are no more common among infants than in toddlers. The measles vaccination does not interfere with the effectiveness of other vaccines. Although the measles, mumps, and rubella do occasionally occur after the administration of the MMR vaccine during the first year of life, the vaccine is not given during this time because of the presence of maternal antibodies.

The mother of a 3-year-old child with rubeola states that she once heard that it was called by another name. The nurse tells the mother that rubeola commonly is known as:

Measles Rationale: Measles is another name for rubeola. Chickenpox is also known as varicella. German measles is also known as rubella. Whooping cough is also known as pertussis.

A client steps on a rusty nail, and the puncture site becomes swollen and painful. Tetanus antitoxin is prescribed. The nurse explains that the antitoxin is used because it:

Provides antibodies Rationale: Tetanus antitoxin provides antibodies, which confer immediate passive immunity. Antitoxin does not stimulate production of plasma cells, the precursors of antibodies. Passive, not active, immunity occurs. Passive immunity, by definition, is not long lasting.