Nur 3490 Exam 2 - Set 2

The public health nurse is giving a lecture on potential outbreaks of infectious meningitis. Which population is most at risk for an outbreak?

B. Residents of a college dorm -Outbreaks of infectious meningitis are most likely to occur in dense community groups such as college campuses, jails, and military installations.)

Rheumatic Fever treatment

Best rest Medications: -Antibiotics (Azithromycin) -Penicillin (Penicillin G) -NSAIDs (Naproxen) -Acetylsalicylic Acid (ASA) ONLY: --- only communicable disease to be treated with aspirin besides Kawasaki

Septic meningitis

Caused by bacteria ONLY, associated with high mortality and severity -> etiology is AGE dependent -Medications: Steroids, Antibiotics, Penicillin

Aseptic meningitis

Caused by viral infection -Usually requires only supportive care such as: --O2 administration --Hospitalizations to monitor closely --Medications: Steroids, Antibiotics, Penicillin

Viral (aseptic) meningitis VISUAL - Spinal fluid

Clear color Slight increase in WBC Normal protein Normal glucose Negative gram stain

Bacterial (septic) meningitis VISUAL - Spinal Fluid

Cloudy color Increased WBC Increased Protein Decreased glucose Positive gram stain

Mengitis

Droplets Precaution

airbone precautions

Gown, Mask (N95 --> Then surgical), Goggles, Gloves

Droplet precautions

Gown, Mask, Gloves

contact precautions

Gown, gloves

According to the recommendations of the American Academy of Pediatrics on infant nutrition:

Infants should be given only human milk for the first 6 months of life.

Chain of infection

Infectious agent reservoir portal of exit mode of transmission portal of entry susceptible host

Meningitis

Inflammation of brain and spinal cord membranes, typically caused by an infection. Meningitis is usually caused by a viral infection but can also be bacterial or fungal. Vaccines can prevent some forms of meningitis.

Jones criteria for rheumatic fever

Major: Carditis, Polyarthritis, Chorea, Erythema marginatum, Subcutaneous nodules Minor: Arthralgia, Fever, Elevated Acute Phase Reactants, Prolonged PR, Previous hx of GAS or RF 2 Major or 1 major 2 Minor

Vaccines for meningitis

Meningococcal Varicella MRNS HiB and PCV at 2,4,6, 12, 15 mo.

Nursing considerations when feeding a child with tachypnea

Normal RR: 30-60 per min Considerations: -Transient tachypnea of the newborn (TTN) is a term for a mild respiratory problem of babies that begins after birth and lasts about three days. -Other terms for TTN are "wet lungs" or type II respiratory distress syndrome. --Transient means temporary --Tachypnea means fast breathing rate

Communicable disease

Otitis and Pertussis (Examples)

Rheumatic Fever S/S

Pain areas: in the chest or joints Whole body: fatigue, fever, or inability to exercise Heart: fast heart rate, murmur, or palpitations Also common: multiple-joint inflammation, rash with pink rings and lines, or sore throat

Normal RR for pediatrics child

RR: 30-60 per min

A 37 week gravid client states that she noticed a "white liquid" leaking from her breast during a recent shower. Which of the following nursing responses is appropriate at this time?

Reassure the mother that this is normal in the 3rd semester -It is normal for colostrum to be expressed late in pregnancy

Kernig's sign

Resistance to extension of the child's leg from a flexed position

3mo - 2 years menigitis S/S

Seizures FEVER and IRRIRABLE muscle rigidity poor appetited bulging fontanelles Brudzinski's and Kerig's signs

2 years to adolescence Meningitis presentation

Seizures (often initial sign) nuchal rigidity POSITIVE BRUDZINSKI'S POSITIVE KERNIG'S fever, chills, headache, vomiting, irritability, restlessness, PETECHIA or PURPLE RASH chronic draining ear = bacterial PHOTOPHOBIA IRRITABLE

Brudzinski's sign

Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed. -Head is flexed up = knees flexing towards core of body at the same time

Rheumatic fever is caused by which of the following bacteria?

Streptococcus

Kawasaki treatment

Treatment consists of anti-inflammatories Kawasaki disease is usually treatable. -Initial treatments include ASPRIN (NSAID) and Intravenous immunoglobulin (BLOOD PRODUCTS) therapy given in a medical facility.

Transient tachypnea of the newborn treatment

Treatment may include: -Supplemental oxygen given by mask on the baby's face or by placing the baby under an oxygen hood -Blood tests (to measure blood oxygen levels) -Continuous positive airway pressure (CPAP) - a mechanical breathing machine that pushes a continuous flow of air or oxygen to the airways to help keep tiny air passages in the lungs open. ---Tube feedings may also be necessary if the baby's breathing rate is too high, because of the risk of aspiration of the food. ---Once TTN goes away, the baby usually recovers quickly and has no increased risk for additional respiratory problems.

Newborn meningitis S/S

poor muscle tone weak cry poor feeding bulging fontanels (late sign)

Colostrum

thin, milky fluid secreted by the breast during pregnancy and during the first days after birth before lactation begins

To break the chain of infection

!!hand washing!!

A child with rheumatic fever will be arriving in the nursing unit for admission. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever?

"Did the child have a sore throat or fever within the last 2 months?"

A nurse is caring for a newborn with transient tachypnea of the newborn (TTN). Which of the following responses made by the newborn's mother demonstrates that she understands the newborn's condition? Select all that apply.

"Having a caesarean section increased the risk of transient tachypnea of the newborn." -Due to the extra squeezing's during the C-section, the babies are most at risk for TTN "The healthcare provider will need chest X-rays to monitor respiratory distress." -Amniotic fluids are trapped in the lungs causing TTN -Delayed absorption of fetal lung fluid into the body

The wife of the client diagnosed with septic meningitis asks the nurse, "I am so scared. What is meningitis?" Which statement would be the most appropriate response by the nurse?

"This is a bacterial infection of the tissues that cover the brain and spinal cord."

Meningitis treatment

--O2 administration (Aseptic) --Hospitalizations to monitor closely (Aseptic) --Medications: Steroids, Antibiotics, Penicillin (Septic/ both)

Benefits of breast milk

-species specific for human newborns/infants -protects against infection (antibodies passed over from the mother) -easily digested -skin to skin -bonding

Transitory tachypnea of the newborn (TTN) is thought to occur as a result of:

. Delayed absorption of fetal lung fluid.

The client diagnosed with septic meningitis is admitted to the medical floor at noon. Which health-care provider's order would have the highest priority?

1. Administer an intravenous antibiotic -The antibiotic has the highest priority because failure to treat a bacterial infection can result in shock, systemic sepsis, and death

The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis?

1. Anti-streptolysin O titer

On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease?

1. Conjunctival hyperthermia

The nurse is assessing the client diagnosed with meningococcal meningitis. Which assessment data would warrant notifying the HCP?

1. Purpuric lesions on the face. -PETECHIAE / PURPLE RASHES

The nurse is developing a plan of care for a client diagnosed with aseptic meningitis secondary to a brain tumor. Which nursing goal would be most appropriate for the client problem "altered cerebral tissue perfusion"?

2. The client will be protected from injury if seizure activity occurs. -A client with a problem of altered cerebral tissue perfusion is at risk for seizure activity secondary to focal areas of cortical irritability; therefore, the client should be on seizure precautions.)

Intravenous immunoglobulin

2k/kg over 8-12 hours Administer within 7 days of illness

The nurse is assessing the client diagnosed with bacterial meningitis. Which clinical manifestations would support the diagnosis of bacterial meningitis?

3. A positive Kernig's sign -Client unable to extend leg when lying flat and nuchal rigidity (stiff neck) are signs of bacterial meningitis, occurring because the meninges surrounding the brain and spinal column are irritated.

Aspirin (NSAID)

80-100 mg/kg/day q6hr (w/fever) 3-5 mg/kg/day (w/o fever) --Continue until platelet count returns within 6-8 weeks CONTINUE IF HEART ISSUES DEVELOP

Kawasaki disease

A condition that causes inflammation in the walls of some blood vessels in the body. - Acute systemic vasculitis

Rheumatic fever

A disease that can result from inadequately treated strep throat or scarlet fever. - Inflammation disease that occurs as a reaction to group A beta-hemolytic streptococcus infection of the throat --- Elevated C-reactive protein --- Elevated erythrocyte sedimentation rate --- Serum antistreptolysin-O titer

The provider orders blood work on a patient he suspects is experiencing Rheumatic fever. Which of the following test results would indicate inflammation and cardiac symptoms? Select all that apply.

A. Elevated C-reactive protein C. Elevated WBC count

According to the Jones Criteria, which of the following sets of symptoms would indicate a positive diagnosis for Rheumatic fever? Select all that apply.

B. Positive strep throat culture, arthritis, chorea C. Recent scarlet fever, carditis, fever, arthralgia