nur 320 chapter 16: Immunizations and Communicable Diseases
Communicable Diseases
illnesses passed on by direct or indirect contact major cause of morbidity in infants and children impact: Child and family Healthcare system
Children Are At Increased Risk for Communicable Disease
immature immune system - especially preterm infants maternal antibodies provide limited protection - IgG - transferred at 20 weeks gestation no exposure to pathogens - naive immune system lacking disease protection - continue to get vaccines through adolescence poor hygiene behaviors poor health and immunodeficiency increase risk
Legal issues
informed consent must be obtained before immunization administration required documentation: - Date of administration - Vaccine given - Manufacturer - Lot number and expiration date of vaccine - Site and route of administration - Name, title, and address of person administering vaccine a record of the administration must be given to the child's parent/guardian
incubation period
interval between exposure to infection and the appearance of the first symptoms
Live virus vaccine ee very familiar with the live vaccines**********
live but attenuated (weaker) ex: measles and varicella - can elicit a small bioresponse
Killed virus vaccine
microorganism has been killed but still capable of causing body to produce antibodies ex: inactivated polio
Active immunity
most common antibody production stimulated by vaccine antigens without causing clinical disease
Strategies for Increasing Compliance
national public health initiative to reduce preventable childhood illnesses = Healthy People 2020 require compliance by insurance/managed care organizations chart audits administration of immunizations at healthcare visits, hospitalizations, and schools educate families: - provide the most current Vaccine Information Statement (VIS) - review risks and benefits, common reactions
Vaccination Law
no federal vaccine laws exist all 50 states require certain vaccines before the children start public school depending on the state, most children have to be vaccinated for MMR, diphtheria, pertussis, and tetanus
Communicable Disease Clinical Manifestations
nonspecific symptoms: - fever (most common) - fatigue/weakness - lethargy/malaise - aches - decreased appetite - nausea /vomiting/ diarrhea toxic appearance - poor perfusion - hypo-hyperventilation - cyanosis
immunocompromised, pregnant, recently received blood products, or actively ill
peeps who can't be given a live vaccine
Implement Strategies to Minimize Pain During the Administration
provide local anesthetic give child as much control as possible be honest with the child provide sucrose drink (sweet ease) and pacifier if appropriate use age-appropriate distraction techniques
Human Papillomarivus (HPV 4 or HPV2) vaccine
recombinant vaccine given at 11-12 years -> second dose 2 months later -> 3rd dose given 6 months after the first dose may be given to males and females between the ages of 9-26 years of age administer before onset of sexual activity educate teen that this protects them against only one STI
Lyme Disease Teaching
teach parents to safely remove ticks - use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible - pull upward with steady, even pressure after removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water never crush a tick with your fingers
communicability
the time during which an infection is transmissible to another person
Vector-Borne Illnesses
transmitted by biting insects or animals microorganisms spread and multiply, initiating inflammatory response ---> antimicrobials prevent growth or destroy microorganisms
Toxoid vaccines
treated by heat or chemical to weaken toxic effect ex: tetanus toxoid
Fever Management
treatment includes - administering antipyretics - removing unnecessary clothing - monitoring temperature - encouraging extra fluids parent education - administer only one antipyretic - correct dose - correct administration intervals
Fever Management
treatment includes: - monitoring temperature - administering antipyretics - removing unnecessary clothing - encouraging extra fluids parent education - administer only one antipyretic - correct dose and administration intervals ************ Acetaminophen - 10 to 15 mg/kg/dose every 4 to 6 hours - not to exceed 5 doses in 24 hours - daily maximum for children 12 and older is 4 g Ibuprofen - 5 to 10 mg/kg/dose every 6 to 8 hours - not to exceed 40 mg/kg daily
Vaccine Safety
vaccines must be FDA approved The Childhood Vaccine Injury Act of 1986: a) provides compensation for families in case of a serious adverse event b) mandated vaccine information statements (VIS) - information on each vaccine written at a 6th grade level -> provide information on risks, benefits, and what to do if a reaction occurs the Vaccine Adverse Event Reporting System was established in 1988 previous anaphylaxis = vaccine is contraindicated immunocompromised, pregnant, recently received blood products, or actively ill - can't be given a live vaccine
Polio
virus transmission: - primarily oral-fecal route incubation period: - 7-10 days communicability: - before and right after symptoms - excreted in feces for 3-6 weeks 3 different forms of the disease - inapparent = asymptomatic (72-95%) -> still can transmit illness - nonparalytic = fever, sore throat, headache, anorexia, vomiting and abdominal pain - paralytic = presents like the nonparalytic form, but paralysis develops -> may result in long-term disability
Varicella (Chicken Pox) Virus
virus symptoms: - acute onset of mild fever, malaise, anorexia, headache, mild abdominal pain, and irritability - rash begins first on the body and spreads all over -> macular, papular, & vesicular lesions control itching with oral antihistamines , aveeno baths, and caladryl lotion EXTREMELY DANGEROUS ILLNESS IN ADULTS AND IMMUNOCOMPROMISED PATIENTS transmission: - direct contact and droplet incubation period: - 14-21 days communicability: - 1-2 days before the rash, and until all lesions are crusted
Influenza (Flu) - Virus
virus symptoms: - body aches, respiratory symptoms, fever, and sore throat transmission: - inhalation or direct contact with droplets incubation period: - 1-4 days communicability: - first 3-5 days of illness - virus sheds for up to 7 days in children
Paramyxovirus (mumps)
virus symptoms: - malaise, fever - pain with chewing - swelling of parotid glands - hearing loss - orchitis (inflammation of testes) transmission: - direct contact with droplets incubation period: - 12-25 days communicability: - 1-2 days before parotid swelling until 9 days after swelling subsides
Rubella (German Measles) Virus
virus symptoms: - mild - low grade fever, lymphadenopathy - maculopapular rash that starts on neck/face, then spreads to the body teratogenic effects on fetus during the 1st trimester very contagious - causes neuro problems and death, mostly in children under 5 or immunocompromised children transmission: - direct contact with droplets incubation period: - 14-21 days communicability: - several days before rash until 2 weeks after rash onset
Rubeola - "regular measles"
virus symptoms: - prodrome stage - anorexia and malaise - stage 2 - photophobia, Koplik spots in mouth - stage 3 - high fever, conjunctivitis, cough, coryza (runny nose), rash (head to toe) diagnosis is made by serologic testing for IgM measles antibody very contagious - causes neuro problems and death, mostly in children under 5 or immunocompromised children transmission: - direct contact with droplets incubation period: - 7- 14 days communicability: - 2-4 days before rash until fever is gone
Chapter 16-Immunizations & Communicable Diseases
· Active vs passive immunity · Fever Management · Slide 23 · Slides 37-48- focus on contraindications, live vaccines · Contraindications to live virus immunizations · Classic s/s of measles · Hepatitis B-when is this vaccine series given? (Look at immunization schedule) · Lyme disease prevention/symptoms/removal of tick/education · Communicable Disease Worksheet
Communicable Disease Incidence Prior to 1950
Polio Rubella (German) Measles Diphtheria Haemophilus influenzae type B Pertussis ---> vaccines have dramatically decreased the incidence of these diseases
Common Misconceptions About Vaccines and Correct Information
Vaccine-preventable diseases have been eliminated -> unvaccinated travelers have reintroduced diseases from a country or a U.S. community where the disease exists - recent outbreaks of measles have been linked to unimmunized travelers who became infected - children with lowered immune status are at higher risk for exposure to infection because of lowered herd immunity Immunization weakens the immune system. Multiple vaccines overload the immune system and cause harmful effects -> infants are capable of developing protective immune responses to multiple vaccines simultaneously Thimerosal use in vaccines may cause mercury poisoning -> thimerosal has been eliminated from all but the influenza vaccine -> thimerosal-free influenza vaccine is available for children It would be better to let the child get the disease than get immunized -> most parents have never seen these diseases and do not understand how dangerous they may be, sometimes leading to hospitalization, disability, and even death Vaccines do not work; children still get the disease -> no vaccine is 100% effective, and immunity does wane over time, leading to the need for a booster dose
Lyme Disease
Borrelia burgdorferi - a spirochete bacteria occurs in 47 states, in outdoor settings, year-round most common vector-borne illness in North America symptoms: - bulls-eye type red rash - fever, body aches, headache, malaise late dissemination of the disease includes: - arthritis - encephalitis - polyneuritis - memory problems transmitted by ticks incubation: - 1-55 days after an infected tick bite communicability: - not contagious from person to person vaccine: none currently available.
Polio prevention and vaccine
Contact Precautions vaccine: IPV - inactivated vaccine - SC at 2, 4, 12-18 months, 4-6 yrs (4 doses) side effects: - swelling and tenderness, irritability, tiredness severe reaction: - allergic reaction or anaphylaxis - acute flaccid myelitis = rare, but serious condition that affects the nervous system -> nearly all patients with confirmed AFM had been sick in the month leading up to the onset of paralysis, including 92% with fever or a respiratory illness contraindications: - anaphylaxis after prior dose, allergy to neomycin, streptomycin, polymixin B precautions and deferral: - pregnancy, moderate or severe illness with or without fever
Lyme Disease Prevention
avoid areas that of heavy tick infestation check for ticks after every outdoor outing wear protective clothing - long pants and long sleeves
Mono
"the kissing disease" caused by infectious Mononucleosis (Mono) - Virus typically seen in teenagers but can get at any age symptoms: - prodrome = non-specific flu-like symptoms ---> following the prodrome - splenomegaly - lymphadenopathy - hepatomegaly (elevated liver enzymes) - marked pharyngitis and fatigue treatment: - bed rest, support care, activity restrictions ---> teach adolescents to avoid intimate contact and not to share drinks/food until recovered transmission: - direct contact with saliva ---> Standard Precautions incubation: - 4-6 weeks communicability: - shed from oral mucosa and saliva for 6-18 months
Droplet private room or cohort patients surgical mask
- H-influenza B - pneumonia - rubella - pertussis - meningitis - RSV
Contact private room or cohort patients gloves and gowns
- VRE - MRSA - hepatitis - e. Coli
Airborne private room -> negative-pressure air flow N95 respirator
- measles - chicken pox - TB
Influenza (IIV)
1 or 2-dose vaccine annually starting at 6 months 1-dose vaccine annually starting at 7-10 years
Answer: 3 Explanation: Newborns have a limited storage pool of neutrophils and plasma proteins to defend against infection. Newborns' and young infants' high levels of maternal antibodies, passive transplacental immunity, and exposure to microorganisms during the birth process are all true but are incorrect answers because they do not explain the susceptibility of newborns and young infants to infection.
1) A nurse is providing information to a group of new mothers. Which statement best explains why newborns and young infants are more susceptible to infection? 1. "They have high levels of maternal antibodies to diseases to which the mother has been exposed." 2. "They have passive transplacental immunity from maternal immunoglobulin G." 3. "They have immune systems that are not fully mature at birth." 4. "They have been exposed to microorganisms during the birth process."
Haemophilus influenzae type b (Hib)
1st dose at 2 months 2nd dose at 4 months 3rd or 4th dose 12-15 months
Measles, mumps, rubella (MMR) **********
1st dose between 12-15 months 2nd dose between 4-6 years
Varicella **************
1st dose between 12-15 months 2nd dose between 4-6 years
Hepatitis B vaccine
1st dose given at birth 2nd dose between 1-2 months 3rd dose between 6-18 months
Acetaminophen **********
10 to 15 mg/kg/dose every 4 to 6 hours not to exceed 5 doses in 24 hours daily maximum for children 12 and older is 4 g
Answer: 3, 4, 5 Explanation: To prevent the spread of communicable diseases, microorganisms must be killed or their growth controlled. Sanitizing toys and all contact surfaces, separating children with infections, and teaching children to wash their hands all control the growth and spread of microorganisms. Teaching parents safe food preparation and storage is another tool to prevent the spread of microorganisms but is not related to the flu virus. Immunizations should not be withheld from immunocompromised children; this is not an infection-control strategy.
10) The school nurse is trying to prevent the spread of a flu virus through the school. Which infection-control strategies can be employed to prevent the spread of the flu virus? Select all that apply. 1. Teaching parents safe food preparation and storage 2. Withholding immunizations for children with compromised immune systems 3. Sanitizing toys, telephones, and door knobs to kill pathogens 4. Separating children with infections from children who are well 5. Teaching children to wash their hands after using the bathroom
Answer: 2, 3, 4, 5 Explanation: Infants under 3 months of age have limited ability to develop antibodies to fight infection, and a fever as high as 40.1°C indicates a serious infection. Difficulty to awaken and a pulsing fontanel, purple spots on the skin and lethargy, a stiff neck and irritability for 3 days in infants and children of any age may indicate meningitis. A mild fever of 38.0°C (100.4°F) in the 4-month-old who received a DTaP immunization yesterday is incorrect because the mild fever is expected as the body develops antibodies in response to antigens in the immunization.
11) The nurse is teaching a prenatal class about infant care. Under which circumstances should the nurse emphasize that parents should call their healthcare provider immediately? Select all that apply. 1. Child 4 months old, received a DTaP immunization yesterday, and has a temperature of 38.0°C (100.4°F) 2. Child under 3 months old and has a temperature over 40.1°C (104.2°F) 3. Child difficult to awaken and has a pulsing fontanel 4. Child has purple spots on the skin and is lethargic. 5. Child has a stiff neck and has been irritable for three days.
Answer: 4 Explanation: The body's need for fluids increases during a febrile illness. Aspirin has been associated with Reye syndrome and should not be given to children with a febrile illness. Alternating acetaminophen with ibuprofen every two hours may result in an overdose. Pediatric medication doses are more accurately calculated using the child's weight, not age. Putting the child in a tub of cold water will chill the child and cause shivering, a response that will increase body temperature.
12) The hospital admitting nurse is taking a history of a child's illness from the parents. The nurse concludes that the parents treated their 6-year-old child appropriately for a fever related to otitis media. Which action by the parents brought the nurse to this conclusion? 1. Used aspirin every four hours to reduce the fever 2. Alternated acetaminophen with ibuprofen every two hours 3. Put the child in a tub of cold water to reduce the fever 4. Offered generous amounts of fluids frequently
Answer: 2 Explanation: Recent exposure to an infectious disease is not a reason to defer a vaccine. There is no reason to withhold any of the vaccinations due at this time. The flu vaccination would not routinely be given to a 4-month-old.
13) A mother brings her 4-month-old infant in for a routine checkup and vaccinations. The mother reports that the infant was exposed to a brother who has the flu. Which action by the nurse is most appropriate based on these assessment findings? 1. Withhold the vaccinations. 2. Give the vaccinations as scheduled. 3. Withhold the DTaP vaccination but give the others as scheduled. 4. Give the infant the flu vaccination but withhold the others.
Answer: 2 Explanation: Fever is the body's response to an infection, and is not a disease. Allowing the body's natural defenses (fever) to fight the infection is best. The fever is treated if the child is uncomfortable from effects of the fever, such as body aches, headache, and so on. Taking the child's temperature more than every 4 to 6 hours is unnecessary. The child should be dressed for comfort. Light clothing is recommended. Alternating acetaminophen and ibuprofen is not recommended.
14) A parent brings her school-age child to the clinic because the child has a temperature of 100.2°F. The child remains active without other symptoms. Which statement by the nurse to the parents is most appropriate? 1. "Take the child's temperature every 2 hours and call the clinic if it reaches 102°F or above." 2. "Unless the fever bothers the child, it is best to let the natural body defenses respond to the infection." 3. "Keep the child warm, because shivering often occurs with fever." 4. "Alternate acetaminophen and ibuprofen to help keep the fever down and keep the child comfortable."
Answer: 1, 4, 5 Explanation: Erythema, fever, and headache are signs/symptoms in the early localized stage of Lyme disease. Cranial nerve palsies are seen in the early disseminated stage of the disease. Malaise, rather than hyperactivity, is seen with this disease.
15) A child is admitted with a diagnosis of early localized Lyme disease. Which clinical manifestations would the nurse expect to find on the initial assessment of this client? Select all that apply. 1. Erythema 5 to 15 cm in diameter 2. Hyperactivity 3. Cranial nerve palsies 4. Fever 5. Headache
Answer: 2, 3, 4, 5 Explanation: Appropriate interventions for the nurse to implement in order to maintain the potency of vaccines include storing the vaccines in the center of the unit, checking and recording the temperature of the storage unit twice a day, having a plan for power outages, and placing bottles of water in each unit to help keep temperatures consistent. The temperature of the refrigerator and freezer should be consistent and not fluctuate.
16) A nurse working in a pediatric clinic is responsible for monitoring and maintaining the vaccinations on site. Which actions are appropriate for this nurse to implement? Select all that apply. 1. Fluctuate refrigerator and freezer temperatures each day. 2. Store vaccines in the center of the unit. 3. Check and record the temperature of the unit twice each day. 4. Have a plan for power outages. 5. Place bottles of water in each unit to help keep temperatures consistent.
Answer: 3, 4, 5 Explanation: For a communicable disease to occur, three factors need to be in place: an infectious agent or pathogen, means of transmission, and a host. This is not a factor needed for communicable disease to occur.
17) The student nurse is learning a lesson about communicable diseases and how they are spread. On a quiz the next day the nurse uses the information learned in this lesson and demonstrates learning. For a communicable disease to occur what factors must be in place? Select all that apply. 1. Antibodies 2. Toxoid 3. Pathogen 4. Transmission 5. Host
Answer: 1, 5 Explanation: Teach families to reduce transmission of infection among family members with the following practices: use disposable tissues and dispose immediately after using, wash hands thoroughly with soap/water after all contact with diapers/tissues/mucous, sneeze/cough into elbow, wash hands with soap/water after eating and toileting, do not share dishes/utensils/cups, wash hands thoroughly before preparing food and again several times during the preparation process, use soapy warm water to wash dishes/cutting boards, wipe counters/surfaces that are used for diaper changes or that the child touches with disinfectant, make sure diaper changing area is well away from food prep areas, dispose of diapers in closed containers. This is a practice that the nurse should suggest for the family.
18) The family and school-age child are at the healthcare clinic for immunizations. The nurse takes the time to talk with the child and family about reducing the transmission of infection. What practices should the nurse suggest for the family? Select all that apply. 1. Do not share dishes, utensils, and cups. 2. Sanitize toys every week with Lysol. 3. Use alcohol-based hand sanitizer with the child after eating and toileting. 4. Cough or sneeze into cloth tissue 5. Dispose of diapers in a closed container.
Meningococcal
1st dose 11-12 years booster at 16 years
Rotavirus vaccine (RV)
1st dose at 2 months 2nd dose at 4 months
Pneumococcal conjugate (PCV13)
1st dose at 2 months 2nd dose at 4 months 3rd dose at 6 months 4th dose 12-15 months
Diphtheria, tetanus, & acellular pertussis (DTaP: <7 yrs)
1st dose at 2 months 2nd dose at 4 months 3rd dose at 6 months 4th dose at 15-18 months 5th dose at 4-6 years
Inactivated poliovirus (IPV: <18 yrs)
1st dose at 2 months 2nd dose at 4 months 3rd dose between 6-18 months 4th dose at 4-6 years
Answer: 3 Explanation: The recommendation to purchase a new bottle of acetaminophen due to recommended medication concentrations is an appropriate statement for the nurse to include in the teaching session. The other statements are inaccurate or inappropriate for the nurse to include in the teaching session.
2) The nurse is discussing ways to treat fever in the home environment to a group of parents in the community. Which statement is appropriate for the nurse to include in the presentation? 1. "Ibuprofen is the only effective means to reduce fever." 2. "If the child requires more than one dose of acetaminophen antibiotics are needed." 3. "Purchase a new bottle of acetaminophen for your newborn because it will have recommended medication concentration." 4. "It is not necessary to follow the recommendations on the bottle of ibuprofen as this will not prevent an overdose for your child."
Hepatitis A
2-dose series starting between 12-18 months
Answer: 4 Explanation: Haemophilus influenza type B (HIB) vaccine is given at 2, 4, 6, and 12 to 15 months of age (four doses) None of the other vaccines can be given to a 4-month-old infant. Influenza (TIV) vaccine may be given yearly to infants between 6 months and 3 years of age. Measles, mumps, and rubella (MMR) vaccine is given at 12 to 15 months and 4 to 6 years of age (two doses) Varicella (Var) is given at 12 to 18 months or any time up to 12 years for one dose; for 13 years and older two doses are given, 4 to 8 weeks apart.
3) The nurse prepares the second diphtheria, tetanus toxoid, and acellular pertussis (DTaP) and second inactivated polio vaccine (IPV) immunization injections for an infant who is 4 months old. The nurse may also give which of immunizations during the same well-child-care appointment? 1. Var (varicella) 2. TIV (influenza) 3. MMR (measles, mumps, rubella) 4. Haemophilus influenza type B (HIB)
Ibuprofen **********
4 to 10 mg/kg/dose every 6 to 8 hours not to exceed 40 mg/kg daily
Answer: 4 Explanation: Explaining that if her child contracts measles, mumps, or rubella, he could have very serious and permanent complications from these diseases is correct because measles, mumps, and rubella all have potentially serious sequelae, such as encephalitis, brain damage, and deafness. Honoring her request is not correct because the nurse has a professional duty to explain that the mother's belief about immunizations is erroneous and may result in harm to her infant. Explaining that antibodies can fight many diseases is not correct because the body makes antibodies that are specific to antigens of each disease. Antibodies for one disease cannot fight another disease. Telling her that not immunizing her infant may protect pregnant women is not correct because immunizing the infant with MMR vaccine will help protect pregnant women from contracting rubella by decreasing the transmission. If a pregnant woman contracts rubella, her fetus can be severely damaged with congenital rubella syndrome.
4) A mother refuses to have her child be immunized with measles, mumps, and rubella (MMR) vaccine because she believes that letting her infant get these diseases will help him fight off other diseases later in life. Which response by the nurse is most appropriate? 1. Honor her request because she is the parent. 2. Explain that antibodies can fight many diseases. 3. Tell her that not immunizing her infant may protect pregnant women. 4. Explain that if her child contracts measles, mumps, or rubella, there could be very serious and permanent complications from these diseases.
Answer: 4 Explanation: Fifth disease manifests first with a flulike illness, followed by a red "slapped-cheek" sign. Then a lacy maculopapular erythematous rash spreads symmetrically from the trunk to the extremities, sparing the soles and palms. Varicella (chicken pox) and rubella (German measles) are unlikely if the child has had all recommended immunizations. The rash of varicella progresses from papules to vesicles to pustules. The rash of rubella is a pink maculopapular rash that begins on the face and progresses downward to the trunk and extremities. Roseola typically occurs in infants and begins abruptly with a high fever followed by a pale pink rash starting on the trunk and spreading to the face, neck, and extremities.
5) A parent reports that her school-age child, who has had all recommended immunizations, had a mild fever one week ago and now has bright red cheeks and a lacy red maculopapular rash on the trunk and arms. Which disease process does the nurse suspect based on the parent's description? 1. Chicken pox (varicella) 2. German measles (rubella) 3. Roseola (exanthem subitum) 4. Fifth disease (erythema infectiosum)
Answer: 1 Explanation: The dose of DTaP is 0.5 cc or 0.5 mL, to be given with a 22 to 25-gauge, 5/8- to 3/4-inch needle; IM (intramuscularly). The only safe intramuscular injection site for a 6-month-old infant is the anterolateral thigh.
6) The nurse prepares a DTaP (diphtheria, tetanus toxoid, and acellular pertussis) immunization for a 6-month-old infant. To administer this injection safely, the nurse chooses which needle, size and length, injection type, and injection site? 1. 25-gauge, 5/8-inch needle; IM (intramuscular); anterolateral thigh. 2. 22-gauge, 1/2-inch needle; IM (intramuscular); ventrogluteal. 3. 25-gauge, 5/8-inch needle; ID (intradermal); deltoid. 4. 25-gauge, 3/4-inch needle; SQ (subcutaneous); anterolateral thigh.
Answer: 4 Explanation: The benefits of vaccines far outweigh the risks from communicable diseases and resulting complications. A minor illness is not a contraindication to immunization. Giving vaccines one at a time will result in many missed opportunities. Half doses of vaccines should not be given routinely to premature and low-birth-weight infants.
7) Reducing the number of preventable childhood illnesses is a major national goal in Healthy People 2020. What will the school nurse teach families regarding immunizations in order to reach this goal? 1. A minor illness with a low-grade fever is a contraindication to receiving an immunization according to Healthy People 2020. 2. Vaccines should be given one at a time for optimum active immunity in the prevention of illness and disease. 3. Premature infants and low-birth-weight infants should receive half doses of vaccines for protection from communicable diseases. 4. It is important to maintain vaccination coverage for recommended vaccines in early childhood and to maintain them through kindergarten.
Answer: 3 Explanation: Antibiotics must be administered for the full number of days ordered to prevent mutation of resistant strains of bacteria. A loading dose was not ordered. A household teaspoon may contain less than 5 cc, and the full dose must be given. Stopping the antibiotic before the prescribed time will permit remaining bacteria to reproduce, and the otitis media will return, possibly with antibiotic-resistant organisms. The absence of a fever is not an indication that all bacteria are killed or not reproducing.
8) A toddler client with a fever is prescribed amoxicillin clavulanate 250 mg/5 cc three times daily by mouth × 10 days for otitis media. Which teaching point will guard against antibiotic resistance to the disease process? 1. Administer a loading dose for the first dose. 2. Measure the prescribed dose in a household teaspoon. 3. Give the antibiotic for the full 10 days. 4. Stop the antibiotic if the child is afebrile.
Answer: 3 Explanation: The CDC must be contacted to investigate the source of serious infections and to determine if a bioterrorist threat exists. Separating clients according to age and illness to prevent the spread of disease will do nothing to stop terrorism. Proper disposal of blood-contaminated needles in the sharps container and initiating isolation precautions for a hospitalized client with methicillin-resistant staphylococcus aureus (MRSA) are appropriate nursing actions but do not relate to bioterrorism.
9) The hospital has just provided its nurses with information about biologic threats and terrorism. After completing the course, a group of nurses is discussing its responsibility in relation to bioterrorism. Which statement by the nurse indicates a correct understanding of the concepts presented? 1. "It is important to separate clients according to age and illness to prevent the spread of disease." 2. "It is important to dispose blood-contaminated needles in the lead-lined container." 3. "I will notify the Centers for Disease Control (CDC) if a large number of persons with the same life-threatening infection present to the emergency room." 4. "I will initiate isolation precautions for a hospitalized client with methicillin-resistant staphylococcus aureus (MRSA)."
- 10 to 15 mg/kg/dose every 4 to 6 hours - not to exceed 5 doses in 24 hours - daily maximum for children 12 and older is 4 g
Acetaminophen dosing for children
Infection Control Methods
Airborne - measles - chicken pox - TB Droplet - H-influenza B - pneumonia - rubella - pertussis - meningitis - RSV Contact - VRE - MRSA - hepatitis - e. Coli
Varicella (Chicken Pox) Virus prevention and vaccine
Airborne + Contact precautions live attenuated vaccine: Varicella - SC 12-15 months, 4-6 years (2 doses) side effects: - fever - redness or pain at injection site - a vaccine-related rash (2-5 lesions occurring 5-26 days after injection) - joint pain serious side effects: - allergic reaction or anaphylaxis - rare cases of encephalitis, pneumonia - erythema multiforme - Stevens-Johnson Syndrome - thrombocytopenia - seizure - Guillain-Barre Syndrome contraindications: - severe allergic reaction after a prior dose or to a vaccine component neomycin or gelatin - severe immunodeficiency due to malignancy, congenital immunodeficiency disease, long-term immunosuppressive therapy, or a child with HIV infection who is severely immunocompromised - pregnancy - active untreated tuberculosis precautions + deferral: - receipt of immune globulin or blood products in the last 3-11 months - moderate or severe acute illness with or without fever nursing considerations: - give entire contents of reconstituted vaccine (even if >0.5ml) - educate girls to avoid pregnancy for 3 months after immunization - antiviral agents should not be used 1 day before or for 21 days after vaccine - avoid exposure to immunodeficient persons for 6 weeks after vaccinated
Rubeola prevention and vaccine
Airborne Precautions live attenuated vaccine: MMR ***** - SC 12- 15 months, 4-6 years (2 doses) ---> Measles, Mumps, Rubella (MMR) - covers Rubella (German measles) & Rubeola - rubella is milder but can cause birth defects if mother becomes infected side effects: - fever 6-12 days after immunization - redness or pain at injection site - non-contagious rash - joint pain serious side effects: - allergic reaction or anaphylaxis - febrile seizure - meningitis (mild) - encephalopathy - thrombocytopenia purpura - rare case of coma and permanent brain damage contraindications: - prior anaphylactic reaction to neomycin - severe allergic reaction to prior vaccine or component - pregnancy - severe immunodeficiency due to malignancy, congenital immunodeficiency disease, long-term immunosuppressive therapy, or a child with HIV infection who is severely immunocompromised precautions & deferral: - receipt of immune globulin or blood products in the last 3-11 months - history of thrombocytopenia or thrombocytopenic purpura - moderate or severe acute illness with or without fever - personal or family history of seizures may increase risk of febrile seizures after immunizations nursing considerations: - give entire contents of reconstituted vaccine (even if >0.5ml) - may give to a child with an egg allergy - educate girls to avoid pregnancy for 28 days after immunization
Diagnostic Tests
Cultures - bacterial - viral - fungal Clinical Therapy - antipyretics - antibiotics - antiviral medications
Influenza (Flu) - Virus prevention and vaccine
Droplet Precautions inactivated (IIV) IM or live attenuated (LAIV) for IN use ---> vaccine: - IM all ages, IN 2 years and older - annually beginning at 6 months - kids under 9 years and 1st dose should receive 2nd dose 4 weeks later side effects: - after IIV = soreness at injection site, fever, aches - after LAIV = runny nose or nasal congestion, decreased appetite, irritability, sore throat, fever contraindications: - severe allergic reaction to eggs or prior vaccine dose - anaphylaxis ---> LAIV = children < 2 years old with immunosuppression, asthma or wheezing episode in the last 12 months precautions + deferral: - LAIV = postpone vaccine when child has nasal congestion - give IIV if close contact with a severely immunocompromised patient - IIV may be given with minor illness with or without fever
Haemophilius Influenza, Type B (Hib) prevention and vaccine
Droplet Precautions inactivated vaccine: Hib - IM - 2, 4, 12-15 months (3 doses) side effects: - pain, redness, or swelling at site serious side effects: - anaphylaxis (extremely rare) - fever contraindications: - anaphylaxis - Comvax is contraindicated if yeast allergy exists precautions + deferral: - moderate or severe acute illness with or without fever
Rubella (German Measles) Virus prevention and vaccine
Droplet Precautions live attenuated vaccine: MMR ***** - SC 12- 15 months, 4-6 years (2 doses) ---> Measles, Mumps, Rubella (MMR) - covers Rubella (German measles) & Rubeola - rubella is milder but can cause birth defects if mother becomes infected side effects: - fever 6-12 days after immunization - redness or pain at injection site - non-contagious rash - joint pain serious side effects: - allergic reaction or anaphylaxis - febrile seizure - meningitis (mild) - encephalopathy - thrombocytopenia purpura - rare case of coma and permanent brain damage contraindications: - prior anaphylactic reaction to neomycin - severe allergic reaction to prior vaccine or component - pregnancy - severe immunodeficiency due to malignancy, congenital immunodeficiency disease, long-term immunosuppressive therapy, or a child with HIV infection who is severely immunocompromised precautions & deferral: - receipt of immune globulin or blood products in the last 3-11 months - history of thrombocytopenia or thrombocytopenic purpura - moderate or severe acute illness with or without fever - personal or family history of seizures may increase risk of febrile seizures after immunizations nursing considerations: - give entire contents of reconstituted vaccine (even if >0.5ml) - may give to a child with an egg allergy - educate girls to avoid pregnancy for 28 days after immunization
Pertussis (Whooping Cough) Bacteria prevention and vaccine
Droplet Precautions vaccine: DTaP, Tdap - IM - given at: - 2, 4, 6, 15-18 months - 4-6 years (5 doses) - booster at 11-12 years (Tdap) side effects: - redness, pain, swelling - nodule at injection site - fever up to 101.0 F - drowsiness, irritability, fussiness, anorexia within 2 days of injection - increase in frequency and magnitude of local reactions with 4th and 5th doses (total limb swelling) serious side effects: - allergic reaction or anaphylaxis - shock or collapse (sudden loss of muscle tone, pallor, fever, and unresponsiveness) - fever >104.8 F - febrile seizure - persistent inconsolable crying contraindications: - gelatin allergy - severe allergic reaction after a prior dose - anaphylaxis - encephalopathy within 7 days of vaccine administration precautions + deferral: - infants under age 1 with evolving neurologic disorder - Guillain Barre syndrome < 6 weeks after previous dose - moderate to severe febrile illness - older children with a progressive neurologic condition nursing considerations: - use same brand for all doses if possible - if child has a history of seizures with or without fever, give acetaminophen at time of vaccine and then every 4 hours for 24 hours - educate parents regarding increased potential reaction after 4th and 5th doses - tetanus booster if 5 or more years after last dose and there is a contaminated wound or burn
H. influenza (Hib) vs Influenza
Hemophilus influenza type B (H. flu) - H. flu is a bacterium that causes many illnesses ---> otitis media, pneumonia, and meningitis Influenza - a virus Making the Connection: - 2 distinct organisms that cause different illnesses - 2 different vaccines
- 5 to 10 mg/kg/dose every 6 to 8 hours - not to exceed 40 mg/kg daily
Ibuprofen dosing for children
Reactions to Immunizations
Rule of Thumb: - always obtain a good history prior to administering vaccines, especially about previous reactions local reaction - erythema, swelling - pain - induration at the injection site irritability, fever (<102 F), malaise, anorexia, and rash adolescents - syncope or vasovagal reaction -> usually 15 minutes after the immunization
Paramyxovirus (mumps) prevention and vaccine
Standard + Droplet Precautions live attenuated vaccine: MMR ***** - SC 12- 15 months, 4-6 years (2 doses) ---> Measles, Mumps, Rubella (MMR) - covers Rubella (German measles) & Rubeola - rubella is milder but can cause birth defects if mother becomes infected side effects: - fever 6-12 days after immunization - redness or pain at injection site - non-contagious rash - joint pain serious side effects: - allergic reaction or anaphylaxis - febrile seizure - meningitis (mild) - encephalopathy - thrombocytopenia purpura - rare case of coma and permanent brain damage contraindications: - prior anaphylactic reaction to neomycin - severe allergic reaction to prior vaccine or component - pregnancy - severe immunodeficiency due to malignancy, congenital immunodeficiency disease, long-term immunosuppressive therapy, or a child with HIV infection who is severely immunocompromised precautions & deferral: - receipt of immune globulin or blood products in the last 3-11 months - history of thrombocytopenia or thrombocytopenic purpura - moderate or severe acute illness with or without fever - personal or family history of seizures may increase risk of febrile seizures after immunizations nursing considerations: - give entire contents of reconstituted vaccine (even if >0.5ml) - may give to a child with an egg allergy - educate girls to avoid pregnancy for 28 days after immunization
Vaccine Management
Storage - exposure to different temperatures may result in damage to vaccine potency Nursing role: - check for damaged vaccines - store vaccines according to manufacturer guidelines - consistent temperature (35-46 F) - check expiration date - emergency plan
Nursing Care for communicable diseases in children
assess for and treat general symptoms - vital signs, fever, comfort level - hydration status, fluid intake, output - appetite - rash - toxic appearance -> lethargy, poor perfusion, changes in respiratory pattern limit the spread of infection - isolate from other children - clean shared items - involve infection control and health department -> communicable diseases are reportable educate parents - symptom management - limiting spread of infection - when to consult the healthcare provider
Immunization Schedules REVIEW THESE - don't memorize but be familiar with early immunizations - before 18 months vs. older - know what they fight against usually a series of shots Hepatitis first at birth, next at 1 month, then next at 6-15 months
agencies involved in development: - FDA - CDC - Advisory Committee on Immunization Practices (ACIP) purpose - recommend schedules for immunizations - ensure all children are fully immunized annual revisions - reflects new vaccines and information
Conjugated forms
an altered organism is combined with another substance to increase immune response ex: Haemophilus influenzae (Hib)
Passive immunity
antibodies from another host (human or animal) given when antibodies are needed faster than the body can make them includes immune globulins does not confer lasting immunity - will need vaccinations in the future used with children at risk for a disease to prevent the disease from occurring or to reduce its severity after an exposure
Tetanus, diphtheria, & acellular pertussis (Tdap: ≥7 yrs)
at 11-12 years
Vaccine Contraindications
history of anaphylactic reaction to the vaccine or one of its components ---> for example: - DTaP -> history of reaction with seizures or neuro symptoms -> contraindication severely immunocompromised children should not receive live viral or bacterial vaccines moderate to severe acute illness for specific vaccines, pregnancy or allergy to some components can ---> for example: - MMR history of anaphylactic reaction to eggs or neomycin
Pertussis (Whooping Cough) Bacteria
bacteria symptoms: - insidious onset with runny nose, low-grade fever, non-productive cough lasting 1-2 weeks diagnosis is made by nasopharynx culture transmission: - inhalation or direct contact with droplets incubation period: - 7-10 days communicability: - 1 week after exposure, usually most contagious before "whooping" cough begins treatment drugs of choice - azithromycin - erythromycin
Haemophilius Influenza, Type B (Hib)
bacteria H. flu is a bacterium that causes many illnesses - otitis media - pneumonia - meningitis diagnosis - cultures of the blood, CSF, or middle ear aspirate transmission: - inhalation or direct contact with droplets incubation period: - UNKNOWN communicability: - 3 days from the onset of symptoms
transmission
by what route the disease is spread
Barriers to vaccination
economic factors limited access to healthcare lack of convenient primary care parental knowledge deficit religious/cultural prohibitions
measles varicella
examples of live vaccines
Most Common Routes of Transmission
fecal-oral - poor handwashing - soiled diapers Respiratory - poor handwashing - sharing of toys - play
Recombinant forms
genetically altered organism ex: hepatitis B
Atraumatic Care
give immunizations quickly and efficiently - do not prolong the wait and let fear grow give child as much control as possible - pick which arm, sticker, or bandaid be honest with the child for infants - provide sucrose (sweet ease) and pacifier if appropriate provide local anesthetic - ex. topical lidocaine use combination vaccines when possible to decrease the number of injections needed
Immunizations
great breakthrough in pediatric medicine many children died from communicable disease before the introduction of immunizations vaccines should be administered at specific ages and intervals children receive approximately 14 vaccines before the age of 6 ~ 20 years ago Lancet published a landmark study that turned tens of thousands of parents around the world against the measles, mumps and rubella (MMR) vaccine because of an implied link between vaccinations and autism ---> The Lancet has retracted the paper but unfortunately the damage has been done
Preventing the Spread of Communicable Disease
handwashing **** standard precautions - hand hygiene - use of PPE (e.g., gloves, masks, eyewear) -> choice of barrier depends on the task being performed/the patient's disease - respiratory hygiene / cough etiquette. - sharps safety - safe injection practices (i.e., aseptic technique for parenteral medications) - sterile instruments and devices avoid exposure to infected individuals promote immunizations decrease/eliminate pathogens educate families when a child is infected