peds protection notes

Measles

Ø A virus which is spread through the air by droplets and is highly contagious. Ø Symptoms: fever, runny nose, cough, loss of appetite, "pink eye", rash for 5-6 days Ø Complications: diarrhea, ear infections, croup, pneumonia, and acute encephalitis

Adolescents

Unintentional injuries are the leading causes of death in adolescents. Influencing factors include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. The "personal fable" is a common teen and older tween belief that arises from adolescent egocentrism. The personal fable is the adolescent's belief that he or she is highly special and unlike anyone else who has ever walked the earth. While this is part of normal cognitive development of the adolescent, it can have severe consequences. In other words, since the adolescent is so special, he/she must be invulnerable. Some research has shown that belief in the personal fable and one's invulnerability is directly connected to risk-taking behaviors such as unprotected sex, use of alcohol and/or drugs, and physically dangerous acts, like driving without a license or not. It can also lead an adolescent with a chronic health condition to stop required medical treatment (i.e. leaving inhaler at home, no longer testing blood glucose levels) Most of the fatal or serious injuries of adolescents are preventable Factors contributing to adolescent violence Risk factors for suicide in adolescents Safety issues include but not limited to: sports, guns, fire, drowning, motor vehicles, social media, outside activities like biking, skateboarding The largest numbers of adolescent injuries are due to motor vehicle crashes. Teenagers are the least likely age group to wear a seat belt. More accidents occur when other teenagers are present in the car, during driving at night, texting or talking on the phone, or driving under the influence.

Principles of Emergency Treatment pg. 444

A poisoning may or may not require emergency intervention. Parents are advised to call the Poison Control Center (PCC) before initiating any intervention. The PCC will counsel the parents to begin treatment at home or take the child to an emergency facility. If a young, healthy child suddenly deteriorates without a known cause suspect a toxic ingestion.

poisonings

According to the Centers for Disease Control, there are approximately 2 million poison exposures in the United States every year - 57% among children under the age of six. The most dangerous potential poisons: Ø Medicines (especially iron) Ø Cleaning products Ø Antifreeze, windshield washer solution Ø Alcohol Ø Pesticides Ø Gasoline, kerosene, lamp oil, furniture polish Ø Wild mushrooms Ø E-cigarettes Many poisonings reflect the ready accessibility of the product in the home, where 90% of poisonings occur.

toddlers- bikes and riding toys

Always require the child to wear a helmet approved by the Consumer Products Safety Commission (CPSC) when riding a wheeled toy.

Human Papillomavirus (HPV)

Certain human papillomavirus (HPV) types cause cancer, including: cervical, vulvar, vaginal, penile, anal, and oropharyngeal (base of the tongue, tonsils and back of throat) cancers. Certain HPV types also cause most cases of genital warts in men and women. HPV is a common virus that is easily spread by skin-to-skin contact during sexual activity with another person. It is possible to have HPV without knowing it, so it is possible to unknowingly spread HPV to another person. HPV vaccine is a strong weapon in prevention. These safe, effective vaccines are available to protect females and males against some of the most common HPV types and the health problems that the virus can cause.

toddlers- choking/aspiration/ suffocation/ smoke exposure

Choking/Aspiration and Suffocation Ø By toddler age, most children chew well but may have trouble with large pieces of food, such as meat and whole hot dogs. Plastic wrappers from gel snacks may also be aspirated. Ø Dry cleaning bags; small toys like Legos or toys with small, detachable parts; balloons, coins, paper clips, pins, bells, button batteries, pull-tabs on cans, thumbtacks, nails, screws, jewelry Ø Suffocation from old refrigerators, ovens, and other large appliances Ø Children clothes with drawstrings can catch on playground equipment, beds, etc. when playing or if child falls Exposure to Tobacco Smoke Exposure to tobacco smoke is associated with increased risk of respiratory disease, increased incidence of ear infections and respiratory infections, as well as, increased symptoms and medication use in children with asthma. It may also hinder neurodevelopment and may be associated with behavior problems (World Health Organization, 2011)

pertussis

Clinical Definition: Bordetella pertussis A cough illness lasting at least 2 weeks with one of the following: Ø Paroxysms of Coughing Ø Inspiratory "Whoop" Ø Posttussive vomiting Incidence of Pertussis: Ø Endemic in US despite years of routine childhood pertussis vaccination. Ø Infants have highest morbidity associated with pertussis Ø Adolescents/Adults are majority of cases Ø Adult/adolescent infection (reservoir) is an important mechanism of pertussis transmission to infants, who have a greater risk of pertussis-related mortality Ø Immunizing adolescents/adults with pertussis booster indirectly helps to protect infants Laboratory Criteria for Diagnosis of Pertussis: Ø Isolation of Bordetella pertussis from a clinical specimen Ø Positive polymerase chain reaction (PCR) assay for B. Pertussis

Child Safety Home Checklist pg. 369

Child Safety Home Checklist Safety: Fire, Electrical, Burns □ Guards in front of or around any heating appliance, fireplace, or furnace (including floor furnace)* □ Electrical wires hidden or out of reach* □ No frayed or broken wires; no overloaded sockets □ Plastic guards or caps over electrical outlets; furniture in front of outlets* □ Hanging tablecloths out of reach, away from open fires* □ Smoke detectors tested and operating properly □ Kitchen matches stored out of child's reach* □ Large, deep ashtrays throughout house (if used) □ Small stoves, heaters, and other hot objects (e.g., cigarettes, candles, coffee pots, slow cookers) placed where they cannot be tipped over or reached by children• Hot water heater set at 49°C (120°F) or lower• Pot handles turned toward back of stove, center of table• No loose clothing worn near stove• No cooking or eating hot foods or liquids with child standing nearby or sitting in lap □ All small appliances, such as iron, turned off, disconnected, and placed out of reach when not in use □ Cool, not hot, mist vaporizer used □ Fire extinguisher available on each floor and checked periodically □ Electrical fuse box and gas shutoff accessible □ Family escape plan in case of a fire practiced periodically; fire escape ladder available on upper-level floors □ Telephone number of fire or rescue squad and address of home with nearest cross street posted near phone Safety: Suffocation and Aspiration □ Small objects stored out of reach* □ Toys inspected for small removable parts or long strings* □ Hanging crib toys and mobiles placed out of reach □ Plastic bags stored away from young child's reach; large plastic garment bags discarded after tying in knots* □ Mattress or pillow not covered with plastic or in manner accessible to child* □ Crib design according to federal regulations (crib slats <6 cm [2.375 inches] apart) with snug-fitting mattress* □ Avoid use of drop-side cribs; for older models crib sides are permanently secured with approved hardware □ Crib positioned away from other furniture or windows* □ Portable play yard gates up at all times while in use* □ Accordion-style gates not used* □ Bathroom doors kept closed and toilet seats down* □ Faucets turned off firmly* □ Pool fenced with locked gate □ Proper safety equipment at poolside □ Electric garage door openers stored safely and garage door adjusted to rise when door strikes object □ Doors of ovens, trunks, dishwashers, refrigerators, and front-loading clothes washers and dryers kept closed* □ Unused appliance, such as a refrigerator, securely closed with lock or doors removed* □ Food served in small, noncylindric pieces* □ Toy chests without lids or with lids that securely lock in open position* □ Buckets and wading pools kept empty when not in use* □ Clothesline above head level □ At least one member of household trained in basic life support (cardiopulmonary resuscitation), including first aid for choking Safety: Accidental Poisoning □ Toxic substances, including batteries, placed on a high shelf, preferably in locked cabinet □ Toxic plants hung or placed out of reach* □ Excess quantities of cleaning fluid, paints, pesticides, drugs, and other toxic substances not stored in home □ Used containers of poisonous substances discarded where child cannot obtain access □ Telephone number of local poison control center and address of home with nearest cross street posted near each phone □ Medicines clearly labeled in childproof containers and stored out of reach □ Household cleaners, disinfectants, and insecticides kept in their original containers, separate from food and out of reach □ Cosmetics and personal use items kept out of child's reach. Safety: Falls □ Nonskid mats, strips, or surfaces in tubs and showers □ Exits, halls, and passageways in rooms kept clear of toys, furniture, boxes, or other items that could be obstructive □ Stairs and halls well lighted, with switches at both top and bottom of stairs □ Sturdy handrails for all steps and stairways □ Nothing stored on stairways □ Treads, risers, and carpeting in good repair □ Glass doors and walls marked with decals □ Safety glass used in doors, windows, and walls □ Gates on top and bottom of staircases and elevated areas, such as porch, fire escape* □ Guardrails on upstairs windows with locks that limit height of window opening and access to areas such as fire escape* □ Crib side rails raised to full height; mattress lowered as child grows* □ Restraints used in high chairs, walkers, or other baby furniture; preferably walkers not used* □ Scatter rugs secured in place or used with nonskid backing □ Walks, patios, and driveways in good repair Safety: Bodily Injury □ Knives, power tools, and unloaded firearms stored safely or placed in locked cabinet □ Garden tools returned to storage racks after use □ Pets properly restrained and immunized for rabies □ Swings, slides, and other outdoor play equipment kept in safe condition □ Yard free of broken glass, nail-studded boards, other litter □ Cement birdbaths placed where young child cannot tip them over* *Safety measures are specific for homes with young children. All safety measures should be implemented in homes where children reside and visit frequently, such as those of grandparents or babysitters. Anticipatory Guidance—Care of Families Childrearing is no easy task; it presents challenges to both new and seasoned parents. With society's changing roles and mores, combined with a highly mobile population, traditional role models and time-honored methods of raising children are declining. As a result, parents look to professionals for guidance. Nurses are in an advantageous position to render assistance and offer suggestions. Every phase of a child's life has its particular traumas—toilet training for toddlers, unexplained fears for preschoolers, and identity crises for adolescents. For parents of an infant some challenges center around dependency, discipline, increased mobility, and safety. Major areas for parental guidance during the first year are listed in the Family-Centered Care box. Family-Centered Care Guidance During Infant's First Year Birth to 6 Months Teach parents about car safety with use of federally approved restraint, facing rearward, in the middle of the back seat—not in a seat with an air bag. Understand each parent's adjustment to newborn, especially mother's postpartum emotional needs. Teach care of infant and help parents understand the infant's individual needs and temperament and that the infant expresses wants through crying. Reassure parents that infant cannot be spoiled by too much attention during the first 4 to 6 months. Encourage parents to establish a schedule that meets needs of infant and themselves. Help parents understand infant's need for stimulation in environment. Support parents' pleasure in seeing infant's growing friendliness and social response, especially smiling. Plan anticipatory guidance for safety. Stress need for immunization. Prepare for introduction of solid foods. 6 to 12 Months Prepare parents for infant's "stranger anxiety." Encourage parents to allow infant to cling to them and avoid long separation from either parent. Guide parents concerning discipline because of infant's increasing mobility. Encourage use of negative voice and eye contact rather than physical punishment as a means of discipline. Encourage showing most attention when infant is behaving well, rather than when infant is crying. Teach injury prevention because of infant's advancing motor skills and curiosity. Encourage parents to leave infant with suitable caregiver to allow some free time. Discuss readiness for weaning. Explore parents' feelings regarding infant's sleep patterns.

Diphtheria

Corynebacterium diphtheriae - produces systemic toxin which damages the tissues of the heart and central nervous system Clinical Manifestations: Ø Pseudomembrane in the throat may interfere with eating, drinking, and breathing. Ø Conjunctivitis Ø Lymph glands in the neck swell, and the neck becomes edematous (bull neck) Ø May cause severe myocarditis Ø Untreated the disease is often fatal - respiratory obstruction or heart/kidney failure

infants- burns

Curiosity leads the infant to explore potentially dangerous items, such as electrical outlets, electrical wires, hot stove, furnace vents, scalding liquids, cigarettes.

infants- drownings

Drowning Ø Drowning with this age group can occur in just an inch or two of water. Ø Infants younger than 1-year-old most often drown in bathtubs, buckets, or toilets.

poison tx

Emergency Treatment Treatment based on 3 principles of therapy: · Rapid evacuation of the poison · Administration of a specific antidote or chemical neutralizer · Concurrent institution of supportive and symptomatic therapy Treatment of Poisoning Specific treatment of the poisoning will be determined when the toxin is identified. Antidotes - a few specific antidotes are available for medications or other toxins. Gastric Lavage - NG or OG is inserted and the gastric contents removed by suction. Saline or water is then used to wash the stomach. Not to be used for corrosive substances. Administration of Activated Charcoal - Binds with the substance and prevents absorption. Bowel irrigation is often used with polyethylene glycol. It is not effective in the case of an iron overdose. This is done before giving antidotes Dialysis - Occasionally required to lower the level of toxin in the bloodstream. Naloxone - Administered if opiates or other narcotics are ingested to reverse respiratory depression or altered level of consciousness. Other supportive and symptomatic therapy: Oxygen or mechanical ventilation Treatment of seizures IV fluids: sodium bicarbonate may need to be added for metabolic acidosis) Alterations in thermoregulation e.g., cooling blanket

Vaccines: diphtheria, tetanus, and acellular pertussis (DTaP)

For children less than 6 years of age (Tdap) for adolescents and adults

vaccines: diphtheria and tetanus toxoids (DT)

For children under the age of 6 years when the pertussis vaccine is contraindicated.

infants- strangulation

Hazards include toys with strings, cribs too close to window blinds, restraining straps (high chairs, strollers), bib strings, unsafe crib design, and clothing with drawstrings

infants- motor vehicle injuries

Infants should never be left unattended in a motor vehicle (hyperthermia, kidnapping) Improper restraint in the vehicle Ø Infant should never be placed in a front seat that is equipped with an airbag Ø A rear-facing car seat provides the best protection.

toddlers

Injuries cause more deaths in children between the ages of 1 and 4 years than in any other childhood age group except adolescence. This is due to curiosity, mobility, and lack of impulse control.

toddlers- motor vehicle injuries

Leading cause of accidental death in children over 1 year of age Ø Improperly restrained in the car (need to be in a car seat - rear facing preferably) Ø Motor vehicle back-over injuries and deaths Ø Heat stroke when left in the car Begin teaching the toddler about watching for cars when crossing the street, but always carry or hold the hand of a toddler when crossing the street.

common immunization reactions

Low grade fever, redness, tenderness and/or swelling at the injection site

Lead poisioning

Lead Poisoning pg. 446 - 450 • Problems with lead poisoning began in the US in the early 1900's, when white lead was added to paints, and tetraethyl lead was added to gasoline. Lead in paint banned in household paint in 1978. The use of leaded gasoline has also been banned in the US. (Other countries do not have the same standards) • Lead does not decompose, lead deposited in the past is still present in soil near heavily trafficked areas, and from lead paint on homes, which has been removed or is falling off. Lead-contaminated dust is then tracked into the home. • Caused by putting hands or objects covered with lead dust in the mouth, breathing in lead dust in the environment, or eating paint chips or soil that contains lead. Pathophysiology and Clinical Manifestations of Lead Poisoning • Lead exerts toxic effects on the bone marrow, erythroid cells, nervous system and kidneys. When lead is in the bloodstream, it interferes with the biosynthesis of heme and thereby causes decreased hemoglobin (anemia). • Main concern is developing brain and nervous system (much more vulnerable in young children than adult and older children) • Lead interferes with neurotransmitters in the brain. Complications include behavioral problems and learning difficulties and, with higher levels, encephalopathy, seizures, and brain damage. • Children with lead poisoning rarely have symptoms. Even children who seem healthy can have high levels of lead in their bodies. Common Sources of Lead Box 14.3 Ø Paint Ø Soil Ø Drinking water Ø Folk medicines and cosmetics Ø Children's jewelry and toys Ø Imported candies or foods Ø Lead ammunition Ø Batteries, some colors of ink Ø Pool cue chalk and sidewalk chalk Diagnostic Evaluation Diagnosis of lead poisoning is based only on the lead testing of a venous blood specimen from venipuncture. The skin must be cleaned well before drawing the specimen to avoid contamination by lead on the skin. A preliminary finger-stick at performed at certain well child visits can determine if more testing is needed. Screening for Lead Poisoning Ø The American Academy of Pediatrics (AAP) recommends screening in all children at ages 1 and 2 years of age. Ø It is required that all children receiving Medicaid are screened because in the past 80% of children on Medicaid were found to have an increased blood lead concentration. Ø Public health authorities in each state are responsible for setting state and local policy on childhood lead screening (SCDHEC). Screening questionnaires include questions like the following: Ø Does your child live in or regularly visit a house that was built before 1950? Ø Does your child live in or regularly visit a house built before 1978 with recent or ongoing renovations or remodeling? Ø Does your child have a sibling or playmate that has or did have lead poisoning? Ø Does anyone in the child's household have an occupation or hobby that involves lead (e.g. construction, radiator repair, bridge repair, painting contracting, artist, ceramics work, stained glass making, jewelry making, or pottery)? Ø Do you ever feed your child with bowls made of ceramic or pewter? Ø Do you live near an industrial factory?

rotavirus vaccine special situations

OK to administer to infants who live in household with a pregnant woman or person with impaired immune status All household members should employ good hand hygiene measures after diaper changes - can shed virus/vaccine in stool

Immunizations- Needle length and injection techniques

Needle length and injection techniques are important factors and must be considered for each individual child. Fewer reactions to immunizations are observed when the vaccine is given deep into the muscle rather than into subcutaneous tissue. The dorsogluteal site is not recommended as an injection site for children because of the potential for sciatic nerve damage (Rishovd, 2014). In addition, aspiration for blood is no longer recommended for an intramuscular injection because large blood vessels are not present at recommended injection sites and slow aspiration causes more pain than injection without aspiration (Rishovd, 2014). To ensure appropriate needle size for vaccine administration (Rishovd, 2014): • Newborns (0-28 days old): recommended needle size is inch, 22 to 25 gauge, recommended injection site: vastus lateralis. • Infant/Toddler (1 month to 2 years): recommended needle size/site is 1 inch, 22 to 25 gauge for vastus lateralis or to 1 inch, 22 to 25 gauge in the deltoid only if muscle mass is adequately developed. • Child/Adolescent (3 to 18 years): less than 60 kg: to 1 inch, 22 to 25 gauge in deltoid, and greater than 60 kg: 1 to 1.5 inch, 22 to 25 gauge in deltoid. Use one or more of the following techniques to minimize pain (Rishovd, 2014; World Health Organization, 2015): • Apply the topical anesthetic EMLA (lidocaine-prilocaine) to the injection site and cover with an occlusive dressing for at least 1 hour* or apply the topical anesthetic LMX4 (4% lidocaine) to the injection site and cover with an occlusive dressing for 30 minutes before the injection. • Apply a vapocoolant spray (e.g., ethyl chloride or FluoriMethane) directly to the skin; however, some children may report pain associated with the cooling sensation. • Ensure beneficial positioning of the patient: being held by a parent or caregiver for infants and young children, and sitting upright for older children and adolescents. • Encourage breastfeeding during or before the immunizations. • For children less than 6 years old, use distraction, such as asking the child to blow bubbles or telling the child to "take a deep breath and blow and blow and blow until I tell you to stop." Evidence does not show any benefit in using distraction during injections with adolescents. • Nurses administering the injections should remain calm and use neutral words such as "here I go" instead of "here comes the sting." • Do not manually stimulate (i.e., rubbing or applying pressure) the injection site.

Polio

Polio is a virus spread via fecal-oral route. There is no "cure" for polio. Symptoms: Ø 95% have no symptoms. Ø 4 - 8% have non-specific symptoms (sore throat and fever, N/V) Ø 1 - 2 % develop nonparalytic viral meningitis. Ø Less than 1% results in "flaccid paralysis" where the patient is left with permanent weakness or paralysis of legs, arms, or both. 2 - 5 % of children with paralytic polio die. Vaccine: Inactivated Polio Vaccine (IPV)

Posion Prevention

Preventing Poisoning Pg. 446 Ø Store all substances in original containers only. Ø Ensure all medications have child-proof caps and are kept in a locked cabinet Ø Never coax a child to take medicine by calling it "candy" Ø Do not expose children to hazardous vapors such as paints, cleaners, tobacco smoke, and especially street drugs such as crack and marijuana. Ø Remove house plants from the home or keep them out of reach Ø Post Poison Control Center (PCC) number and call before initiating any intervention (calling PCC is the first line of defense not the pediatrician). Do not forget about these other easily accessible potential poisons: Bubbles, baby powder, lotion, cream, hygiene products, cosmetics, perfume/cologne, "button" batteries, gardening and pool chemicals, automotive materials. Acetaminophen Poisoning Box 14.2 Ø Occurs from acute ingestion Ø Toxic dose is 150 mg/kg or greater in children Ø Acetaminophen toxicity has been a significant problem in the past because of multiple formulations and concentrations. Acetaminophen Poisoning Stage I: (0.5 - 24 hours following ingestion)—Child may have nausea, vomiting, sweating, pallor, malaise, or lethargy (typically mimics cold or flulike symptoms). Labs should appear normal. Stage II: (24 - 72 hours) - above symptoms resolve, may have RUQ abdominal pain and tenderness. Stage III: (72 - 96 hr.) - elevated bilirubin; PT & LFTs are elevated, peak liver function and coagulation abnormalities; hypoglycemia; anorexia, nausea, vomiting, jaundice, confusion or coma. Stage IV: (more than 5 days) - hepatic failure (majority of patients will recover fully) less than 1% of patients will go on to develop fulminant hepatic failure and death Infants' Tylenol products (80 mg/8 ml) no longer manufactured. Parents frequently confused the concentrated infant acetaminophen and children's acetaminophen dosing ranges. It is also no longer recommended that parents (or nurses) alternate between Tylenol and Motrin when treating a fever. These were the 2 main contributing factors of acetaminophen poisonings in children. Treatment of Acetaminophen poisoning Ø ANTIDOTE: N-acetylcysteine (Mucomyst) orally, or Acetadote intravenously (most effective if given within 8 hours of ingestion) Ø Mucomyst has an offensive odor (diluted with fruit juice or soda) Ø Whether or not emesis is induced or activated charcoal with a cathartic is given depends on number of hours since ingestion Ø Liver transplant may be needed in liver damage is severe enough Nursing Care of patients with acetaminophen poisoning: Ø Monitor labs Ø Monitor vital signs Ø I & O Ø Observe for signs of liver involvement (RUQ pain, abnormal Liver function tests) Ø Support and teach parents poison prevention

infants- choking/asphyxiation

Since infants explore so much with their mouths, small objects or hard foods pose a choking hazard. Ø Rattles containing beads, buttons, or plastic pieces off of stuffed animals Ø Infants crawling or playing on the floor can pick up small articles like coins Ø Food items are the second most common cause of aspiration i.e. hot dogs, candy, nuts, grapes, peanuts, popcorn, marshmallow Ø Baby Powder - both sprinkled on infant and letting them play with the container Ø Hold infant for feeding; do not prop bottle

Types of Precautions and Patients Requiring Them

Standard Precautions for Prevention of Transmission of Pathogens Use Standard Precautions for the care of all patients. Hand hygiene should be emphasized as part of Standard Precautions. Respiratory Hygiene/Cough Etiquette In addition to Standard Precautions, the CDC suggests a combination of measures designed to minimize the transmission of respiratory pathogens via droplet or airborne routes in the health care environment. Measures include covering the mouth and nose during coughing and sneezing; offering a surgical mask to persons who are coughing; using tissues to contain respiratory secretions; turning the head away from others and keeping a space of 3 feet or more when coughing. These measures should be used on entry to the health care institution for patients and visitors or family members who have symptoms of respiratory infection. Airborne Precautions In addition to Standard Precautions, use Airborne Precautions and an airborne infection isolation room (AIIR) for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei. Examples of such illnesses include measles, varicella (including disseminated zoster), and tuberculosis. Droplet Precautions In addition to Standard Precautions, use Droplet Precautions for patients known or suspected to have serious illnesses transmitted by large particle droplets. Examples of such illnesses include the following: • Invasive Haemophilus influenzae type b disease, including meningitis, pneumonia, epiglottitis, and sepsis • Invasive Neisseria meningitidis disease, including meningitis, pneumonia, and sepsis • Other serious bacterial respiratory tract infections spread by droplet transmission, including diphtheria (pharyngeal), mycoplasmal pneumonia, pertussis, pneumonic plague, streptococcal pharyngitis, pneumonia, or scarlet fever in infants and young children • Serious viral infections spread by droplet transmission, including adenovirus, influenza, mumps, human parvovirus B19, and rubella Contact Precautions In addition to Standard Precautions, use Contact Precautions for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient's environment. Examples of such illnesses include the following: • Gastrointestinal, respiratory, skin, or wound infections or colonization with multidrug-resistant bacteria judged by the infection control program, based on current state, regional, or national recommendations, to be of special clinical and epidemiologic significance • Enteric infections with a low infectious dose or prolonged environmental survival, including Clostridium difficile; for diapered or incontinent patients: enterohemorrhagic Escherichia coli 0157:H7, Shigella organisms, hepatitis A, or rotavirus • Respiratory syncytial virus, parainfluenza virus, or enteroviral infections in infants and young children • Skin infections that are highly contagious or that may occur on dry skin, including diphtheria (cutaneous), herpes simplex virus (neonatal or mucocutaneous), impetigo, major (noncontained) abscesses, cellulitis or decubitus, pediculosis, scabies, staphylococcal furunculosis in infants and young children, zoster (disseminated or in the immunocompromised host) • Viral or hemorrhagic conjunctivitis • Viral hemorrhagic infections (Ebola, Lassa, or Marburg)

submersion injuries (all age groups)

Submersion Injury (or Near drowning) is described as an incident in which a child has suffered a submersion injury and has survived for at least 24 hours. Most incidents are accidental and result from inadequately supervising children who are in or near water; lack of use of personal flotation devices while on recreational water apparatus such as boats, and diving accidents; children who are able to swim but overestimate their endurance. Nursing Assessment - ABCs Hypoxia is the primary problem resulting from near drowning. Neurons and cerebral cells sustain irreversible damage after 4 to 6 minutes of submersion. Approximately 10% of drowning victims die without aspirating fluid. Acute asphyxia may occur from prolonged reflex laryngospasm. Aspiration of fluid results in pulmonary edema, atelectasis, airway spasm, and pneumonitis, which contribute to hypoxia. Hypothermia occurs rapidly in infants and children because of their large surface area relative to body mass. Important information to know: Ø Site of submersion (freshwater/saltwater, natural/man-made/contaminated water) Ø The water temperature (cold water-->hypothermia, however less risk of pneumonia) Ø Length of time of submersion Ø How long was it until CPR was initiated Nursing Management Ø Resuscitative measures should be started as soon as the child is pulled from the water, and the child should be transported to a hospital immediately. Ø Management depends on the amount of cerebral insult that has occurred. Ø Promotion of oxygenation and monitoring for infection related to aspiration of water are primary nursing concerns. Complications may occur 24 hours after the incident. Ø Provide parents with support and education relating to their child's condition. Ø The child may need rehabilitation and long-term follow-up. Ø Family support due to a wide range of emotional responses to the accident

TABLE 10.5 Common Infant Injuries, Associated Risk Factors, and Safety Promotion

S—Suffocation, Latex balloons-Avoid latex balloons except with close adult supervision. Plastic bags-Tie unused plastic bags in a knot and dispose of in a safe container. Bed surface- (noninfant) such as sofa or adult bed Avoid placing infants to sleep on sofas, soft bedding, or adult bed. Pillows-Avoid use of pillows for sleep. Soft cushions and blankets-Clear bedding of soft cushions and blankets. Prone sleeping-Place infant to sleep on back at all times. A—Asphyxia, Food items: cylindrical items such as hot dogs, hard candy, peanuts, almonds. Cut hot dogs lengthwise; avoid hard candy in infants and toddlers. Infants should completely chew up each food item in mouth; do not feed more until item is swallowed. Toys: small toys such as Legos. As a general rule of thumb, if the toy fits into a toilet paper cardboard roll, it can be swallowed by a small child. Small objects: batteries, buttons, beads, dried beans, syringe caps, safety pins. Keep out of reach of infants, who are naturally inquisitive. Pacifiers: Pacifiers should be one piece. Baby (talc) powder: Avoid shaking powder over infant; if used, place on adult's hand and then place on infant's skin. Domestic dogs, cats: Supervise child around domestic animals; teach not to approach dog that is eating, has puppies, or is not feeling well. Animals that are "tame" can be unpredictable. Small children are the right size for most domesticated animals to come face to face. Closely supervise child around visiting pets. F—Falls Stairs: Infants like to climb; place childproof gate at top and bottom of stairs. Diaper changing table: Infants do not have depth perception and cannot perceive a dangerous height from one that is safe. Never leave infants unattended on a flat surface even if not rolling over. Crib, bed-crib sides can fall when infant leans on them. In 2011 a mandate was made to stop selling drop-side infant cribs because of safety problems with infants being trapped against a wall or mattress and asphyxiation or falling out of bed when the latches do not hold.* Infant carriers: Never leave infant unattended in a carrier on top of a surface such as a shopping cart, clothes dryer, washer, kitchen cabinet; place carrier on floor. Car seat restraints: Secure infant in car seat restraint securely and never leave unattended. Highchair: Restrain infant in highchair; avoid using highchair except for feeding and only if adult supervision is adequate; even restrained infants can squirm out of some restraints and fall. Infant walkers: Use only stationary walkers. There is no evidence that walkers help infants "walk" any sooner. Wheeled walkers can easily be propelled off stairs and other platforms such as porches or decks, causing significant injury. Windows, screens: Avoid placing furniture next to a window. Infants learn to climb and can fall out of open windows, even with screens. Television, stereos, sound systems: These must be secured to the stand; infants can pull the stand over, causing the TV or sound system to land on their heads, causing significant injury. Electrical burns or burns Electrical outlets: Place safety cap over electrical outlets; infants may be burned by placing conductive object into outlet. Irons, curlers: Keep out of reach of infant and keep turned off when not in use. Water: Infants may turn on tap or faucet in bathtub and burn self. Lower the water heater to a safe temperature of 49°C (120°F). Before placing infant in tub, check temperature of water and completely turn off faucet so child cannot alter temperature of water. NEVER leave infant unattended in tub or sink of water. Fireplace: Place a childproof screen in front of fireplace. Stove, hot liquids: Keep top front burners off and keep pot handles turned toward back to avoid infant pulling hot pot onto self and causing burn injuries. Cigarettes: Avoid smoking and holding infant on lap while smoking cigar or cigarette. P—Poisoning, ingestions Medication, ointments, cream, lotions: Medications left in purses or handbags or on a table top can often be ingested by the curious infant. Keep Poison Control Center number readily available (800-222-1222). Plants: household plants may be a source of accidental poisoning. Keep plants out of child's reach. Cleaning solutions and laundry pods: Store in locked cabinet or in top cabinet where there are no drawers or shelves for infant to climb on. Avoid storing cleaning and caustic solutions in containers such as a soda bottle or jar—infants and toddlers cannot differentiate a soda from a caustic drain cleaner. Inhalation or oral or nasal ingestion of poisonous or harmful chemicals such as methamphetamine, gasoline, turpentine. Keep gasoline and turpentine stored in a locked cabinet or closet out of child's reach. Avoid storing in containers that are also used to keep drinks or food. A—Automobile safety Car or truck and hot weather: An automobile-related hazard for infants is overheating (hyperthermia) and subsequent death when left in a vehicle in hot weather (>26.4°C [80°F]). Infants dissipate heat poorly, and an increase in body temperature may cause death in a few hours. Caution parents against leaving infants in a vehicle alone for any reason. Air bags: Avoid placing infant in a car restraint behind an air bag. Deactivate the air bag (available in certain models) or place the infant in the back seat in a proper car seat restraint. Car seat restraint: See discussion later in this chapter. D—Drowning Bathtub: NEVER leave infant unattended in tub, sink, or pool of water. Swimming pools, birdbaths, decorative ponds of water, splash pads: Place fence around pools with gate lock that is out of child's reach. Supervise infants in water at ALL times; an infant may drown in as little as 2 inches of water. Swimming lessons are encouraged but are not foolproof for drowning; use touch supervision—keep child within arm's reach at all times while swimming. 5-gal or larger buckets: Keep buckets empty of water or elevated out of child's reach.

Promoting Safety

These are topics that are potentially discussed with each well visit - safety issues are closely linked to a child's stage of development, children continue to die (or injured) from preventable accidents. Nurses cannot prevent all accidents but need to educate on the possibilities. Education is given based on individual need, parental (or child) questions asked, assessments and developmental levels.

toddlers-falls

Toddlers have a limited concept of body boundaries and essentially no fear of danger. Ø Playground injuries, jungle gyms Ø Stairs, accessible windows without guards, balconies, porches, decks, bleachers Ø Cribs, vehicles, high chairs, shopping carts, strollers. Ø Falls from wheeled toys such as tricycles Prevention: never leave a toddler unsupervised out of doors, install safety gates at the top and bottom of stairs, ensure that window locks are operable, secure window screens if windows are open.

toddlers-burns

Toddlers' ability to climb, stretch, and reach objects above their head makes any hot surface a potential source of danger. Ø Scalds from pulling pots off the stove, and high temperature tap water Ø Radiators, fireplaces, furnaces, kerosene heaters, or wood-burning stoves Ø Portable electric heaters, hair curling irons, clothes irons Ø Candles, incense, cigarettes, cups of tea or coffee Ø Matches and lighters Ø Sunburn Prevention: working smoke detectors; fire evacuation plan, "drop and roll" techniques; keep pot handles on the stove turned inward; teach toddler to avoid the oven, stove, and iron; keep electrical equipment, cords, and matches out of reach.

varicella vaccine

Vaccine: Live, Attenuated Virus Vaccine Recommendations: Ø All susceptible persons should receive TWO doses of varicella vaccine Ø 2nd dose catch-up is recommended for those who previously received 1 dose Ø During an outbreak persons who received 1 dose of varicella should receive a second dose < 13 yrs. of age: Ø 1st dose = age 12 - 15 months Ø 2nd dose = age 4 - 6 years Interval between dose #1 & dose #2 must be at least 3 mo. >13 yrs of age: If no evidence of immunity, vaccinate with 2 doses separated by > 4 weeks Contraindications to MMR and Varicella Vaccines: Ø allergy to neomycin, gelatin Ø pregnancy Ø immunosuppression Ø recent receipt of blood products May be administered on same day as varicella vaccine, or 4 weeks apart MMR-V (ProQuad): Vaccine with MMR and Varicella combined. Ø Licensed for children 12 months to 12 years Ø Do not give to HIV infected children

toddlers- drowning

With well-developed skills of walking, toddlers are able to reach potentially dangerous areas (bathtubs, toilets, buckets, yard decorations, swimming pools, hot tubs, and ponds or lakes). Children between the ages of 1 and 4 years are more likely to drown or have a near-drowning incident in residential swimming pools. Infants and toddlers are top heavy making it difficult to right themselves if they fall into a container of water.

Rotavirus

Ø Most common cause of diarrhea in children less than 5 years of age Ø Infants 6 - 12 months most vulnerable. Ø Watery diarrhea most common symptom, lasting 5 - 7 days Ø Other symptoms include vomiting and fever which usually resolve in 2 days Ø Passed though fecal-oral route and indirect contact Ø Usually develop symptoms 48 hours after contact Ø Supportive treatment - flavored oral rehydration or IV fluids Ø Diagnosis can be made by sending stool specimen to lab for antigen detection, a Group A Rotavirus Antigen Rapid Test, or without testing based on child's symptoms

Meningococcal disease

Ø Neisseria meningitidis (13 subtypes) Ø Spread person-to-person through exchange of respiratory and throat secretions Ø Can infect the blood (septicemia), fluid of the spinal cord and brain (meningitis) Ø Symptoms can develop in a few hours or may take up to two days Ø Common symptoms: high fever, chills, lethargy, and rash. If meningitis is present also includes headache, stiff neck, or seizures Ø In overwhelming infections, shock, coma, and death can follow within several hours

Rotavirus Vaccine Administration

Ø PO administration Ø Do not re-administer dose to infant that spits out or vomits during administration Ø Continue with recommended schedule Ø Administer the vaccine even if the infant has had rotavirus previously

preschoolers

Ø Preschoolers are at an ideal age to be taught about safety and safe behaviors. They are cognitively able to learn safe behaviors, but they continue to display poor judgment related to safety issues; therefore, close supervision is still required. Ø Engagement in fantasy is so strong they lack the ability the master cause and effect Ø Handguns, matches, bodies of water, bicycle riding, and poisons continue to be sources of potential injury during the preschool years. Ø Falls account for the highest percentage of nonfatal injuries. Ø Motor vehicle accidents are responsible for the most fatal injuries, followed by drowning. Ø This age group still needs to be in a car seat/booster seat not a seatbelt Ø Five years of age is an appropriate time for a child to learn to swim. Swimming programs should focus on appropriate swim techniques as well as safety measures.

Pneumococcal Disease

Ø Streptococcus pneumoniae, also known as pneumococcus. Ø Most common: middle ear infections, pneumonia, bacteremia, sinus infections, meningitis. Ø Children at risk: under 2 years, children in group child care, and children who have certain illnesses (e.g. sickle cell disease, HIV, chronic heart or lung conditions)

Influenza

Influenza vaccine is recommended for all people aged 6 months and older Recommended Schedule: Ø One Dose Annually Ø Two doses recommended 4 wks apart for children<9 yrs old who are receiving the vaccine for the first time Vaccines: Inactivated Influenza Vaccine (IIV) Live, Attenuated Influenza Vaccine (LAIV) - nasal spray

Infants - Suffocation

Suffocation Mechanical suffocation includes covering of the airway (i.e. mouth and nose), pressure on the throat or chest, and exclusion of air. Ø Nonfood items cause the majority of deaths in young children (e.g., latex balloons). Pacifiers should not be restrained in the infant's mouth. Ø The bed or crib poses a number of hazards. (Tucked in blankets and sheets, pillows, and stuffed animals.) Ø Co-sleeping is not safe! Ø Back to Sleep Ø Choose age appropriate toys Ø Monitor older siblings toys and keep out of reach

school aged

Table 15.2 School-age children become more independent with age. Increased self-confidence and decreased fears may contribute to accidents and injuries. Increased independence may also increase exposure to dangerous situations. Still act on impulse Safety issues include but not limited to: sports, guns, fire, drowning, motor vehicles, social media, outside activities like biking, skateboarding This age may still need to be in a booster seat in the car - not just a seat belt Bicycle safety pg. 490 Ride on Toys, Skateboard/Skates/Scooter safety pg. 491

HPV vaccines

Vaccines: GARDASIL (Merck) Ø Quadrivalent HPV Vaccine (protects against 4 types of HPV 6, 11, 16, and 18) Ø These 4 types together cause 70% cervical cancer and 90% genital warts Ø Approved for males/females 9-26 yrs, routine immunization for males/females 11-12 yrs. CERVARIX (GlaxoSmithKline) Ø A bivalent HPV vaccine to protect against the two types of HPV (16, 18) Ø Studies also showed that the vaccine provides cross-protection against HPV types 31, 33, 45, the three most common cancer-causing virus types beyond 16, 18 Ø Approved for use in females 10 - 25 yrs. HPV Vaccine Efficacy: Ø Clinical trials in females have demonstrated 100% efficacy in preventing cervical pre-cancers caused by the targeted HPV types Ø Nearly 100% effective in preventing vulvar and vaginal pre-cancers and genital warts caused by the targeted HPV types Ø No therapeutic effect on HPV-related disease Ø No protection from disease due to HPV types already acquired HPV Vaccine Administration Schedule Recommendations: Ø Ideal timing = before sexual debut Ø Routine administration Ø Quadrivalent HPV vaccine is administered in a three dose schedule: First dose at elected date Second dose 2 months after first Third dose 6 months after first At the present time, cervical cancer screening recommendations remain unchanged for females who receive quadrivalent HPV vaccine HPV Vaccine Special Situations: Females immunocompromised either from disease or medication can receive quadrivalent HPV vaccine but immune response and vaccine effectiveness may be less than in those females who are immunocompromised HPV Vaccine Precautions and Adverse Reactions: Precautions Ø Minor acute illnesses such as diarrhea, mild upper respiratory tract infections, with or without fever Ø Vaccination of people with moderate or severe acute illnesses should be deferred until after the illness improves Ø For the Cervarix vaccine: The tip cap and the rubber plunger of the needleless prefilled syringes contain dry natural latex rubber that may cause allergic reactions in latex sensitive individuals Adverse Reactions: fatigue, headache, myalgia, GI symptoms, arthralgia, and syncope Duration of Immunity Ø Duration of protection is unclear Ø There is no evidence of waning immunity Ø Ongoing studies to update this data Documentation of Vaccine administration is very important. Every child should have an immunization record for parents to keep and it should be updated with each new vaccine administration. The following should be documented in the child's medical record Ø Day/Month/Year of administration Ø Manufacturer and Lot number of vaccine Ø Name of person (office) administering vaccine Ø Title of person administering vaccine Ø Site and route of administration Ø Informed consent Ø Patient education given (VIS sheets are mandatory)

Haemophilus influenza type b (Hib)

Ø Haemophilus influenzae type b. (Six different types a - f). Ø Type b account for 95% of all strains that cause invasive disease. Ø Spread by direct contact or respiratory droplets. Ø The most common type of invasive Hib disease is meningitis. Ø 17% of cases include epiglottitis Ø Other forms of disease: joint infection, skin infection, pneumonia, bone infection Vaccine: Hib

injury prevention during infancy (box 10.5)

injury Prevention During Infancy -Birth to 4 Months Major Developmental Accomplishments Involuntary reflexes, such as the crawling reflex, may propel infant forward or backward; the startle reflex may cause the body to jerk. May roll over Has increased eye-hand coordination and voluntary grasp reflex Injury Prevention Aspiration This is not as great a danger to this age-group, but parents should begin practicing safeguarding early (see under 4 to 7 Months). Hold infant for feeding; do not prop bottle. Know emergency procedures to relieve choking. Use pacifier with one-piece construction and loop handle. Suffocation and Drowning Keep all plastic bags stored out of infant's reach; discard large plastic garment bags after tying in a knot. Do not cover mattress with plastic. Use firm mattress and loose blankets; no pillows. Make certain crib design follows federal regulations and mattress fits snugly—crib slats 6 cm (2.375 inches) apart.* Do not use drop-side crib. Obtain hardware to permanently secure older dropside cribs to avoid suffocation. Position crib away from other furniture and away from radiators. Do not tie pacifier on a string around infant's neck. Remove bibs at bedtime. Never leave infant alone in bath. Do not leave infant under 12 months alone on adult or youth mattress or "beanbag" type pillows. Do not leave infant in a car. Falls Use crib with fixed, raised rails. Never leave infant on a raised, unguarded surface. When in doubt as to where to place infant, use floor. Restrain infant in infant seat and never leave infant unattended while the seat is resting on a raised surface. Avoid using a highchair until infant can sit well with support. Accidental Poisoning This is not as great a danger to this age-group, but begin practicing safeguards early (see under 4 to 7 Months). Burns Install smoke detectors in home. Avoid warming formula in microwave oven; always check temperature of liquid before feeding. Check bath water temperature. Do not pour hot liquids when infant is close by, such as sitting on lap. Beware of cigarette ashes that may fall on infant. Do not leave infant in sun for more than a few minutes; keep exposed areas covered. Wash flame-retardant clothes according to label directions. Use cool-mist vaporizers. Do not leave infant in parked car. Check surface heat of car restraint before placing infant in seat. Motor Vehicles Transport infant in federally approved, rear-facing car seat, preferably in back seat. Do not place infant on seat of car or in lap. Do not place infant in a carriage or stroller behind a parked car. Do not place infant or child (in car seat) in front passenger seat with an air bag unless air bag is deactivated. Bodily Damage Keep sharp, jagged objects out of infant's reach. Keep diaper pins closed and away from infant. -4 to 7 Months Major Developmental Accomplishments Rolls over Sits momentarily Grasps and manipulates small objects Resecures a dropped object Has well-developed eye-hand coordination Can focus on and locate small objects Can push up on hands and knees Crawls backward Places objects in mouth (hand-to-mouth) Injury Prevention Aspiration Keep buttons, beads, syringe caps, and other small objects out of infant's reach. Keep floor free of any small objects. Do not feed infant hard candy, nuts, food with pits or seeds, or whole or circular pieces of hot dog. Exercise caution when giving teething biscuits because large chunks may be broken off and aspirated. Do not feed infant while he or she is lying down. Inspect toys for removable parts. Suffocation Keep all latex balloons out of reach. Remove all crib toys that are strung across crib or play yard when infant begins to push up on hands or knees or is 5 months old. Use only cribs with well secured crib sides; avoid use of drop-side cribs. Falls Restrain in a highchair. Accidental Poisoning Make sure that paint for furniture or toys does not contain lead. Place toxic substances on a high shelf or in locked cabinet. Keep medication vials and bottles locked in a secure place. Hang plants or place on high surface rather than on floor. Avoid storing large quantities of cleaning fluid, paints, pesticides, and other toxic substances. Discard used containers of poisonous substances. Do not store toxic substances in food containers. Keep cosmetic and personal products out of infant's reach. Discard used button-size batteries; store new batteries in safe area. Know telephone number of local poison control center. Burns Keep faucets out of reach. Place hot objects (e.g., cigarettes, candles, incense) on high surface. Limit exposure to sun; apply sunscreen. Motor Vehicles See under Birth to 4 Months Bodily Damage Give toys that are smooth and rounded, preferably made of wood or plastic. Avoid long, pointed objects as toys. Avoid toys that are excessively loud. Keep sharp objects out of infant's reach. -8 to 12 Months Major Developmental Accomplishments Crawls, creeps Stands holding onto furniture Stands alone Cruises around furniture Walks Climbs Pulls on objects Throws objects Picks up small objects; has pincer grasp Explores by putting objects in mouth Dislikes being restrained Explores away from parent Has increasing understanding of simple commands and phrases Injury Prevention Aspiration Keep lint and small objects off floor, off furniture, and out of reach of infants. Take care in feeding solid table food to give very small pieces. Do not use beanbag toys or allow infant to play with small objects. See also under 4 to 7 Months. Suffocation and Drowning Keep doors of ovens, dishwashers, refrigerators, coolers, and front-loading clothes washers and dryers closed at all times. If storing an unused appliance, such as a refrigerator, remove the door. Supervise contact with inflated balloons, immediately discard popped balloons, and keep uninflated balloons out of reach. Fence area around swimming pools. Always supervise when near any source of water, such as cleaning buckets, drainage areas, toilets, ponds, or other bodies of water within infant's access. Keep bathroom doors closed. Eliminate unnecessary pools of water. Keep one hand on infant at all times when in tub. When swimming keep infant within arm's reach at all times. Falls Avoid walkers, especially near stairs. Ensure that furniture is sturdy enough for infant to pull self to standing position and cruise. Fence stairways at top and bottom if infant has access to either end. Accidental Poisoning Administer medications as a drug, not as a candy. Avoid use of over-the-counter cough and cold preparations for infants. Replace medications and poisons immediately after use; replace caps properly if a child-protector cap is used. Keep phone number for poison control center readily available. Burns Place guards in front of or around any heating appliance, fireplace, or furnace. Keep electrical wires hidden or out of reach. Place plastic guards over electrical outlets; place furniture in front of outlets. Keep hanging tablecloths out of reach (infant may pull down hot liquids or heavy or sharp objects). *Information on many items such as cribs or walkers available from US Consumer Product Safety Commission

the rotavirus vaccine is ________ _________

live attenuated

Vaccine: Measles, Mumps, Rubella (MMR)

Ø Live, attenuated virus vaccine Ø Recommended schedule Dose 1: 12 - 15 months Dose 2: 4 - 6 years Ø Minimum age for vaccination - 12 months Ø Minimum interval between doses - 4 weeks

Vaccines: tetanus and diphtheria toxoids (Td)

Ø Adolescent: Booster if contraindication to pertussis and if 5 yrs. have elapsed since last DTaP Ø Adult: Booster every 10 years if already received Tdap Ø Wound prophylaxis

rubella

Ø An airborne virus Ø Symptoms: rash which breaks out on the face first and progresses down the body; older children first suffer from low-grade fever, swollen glands in the neck or behind the ears, and upper respiratory infection. Ø Complications: encephalitis, low platelet levels

mumps

Ø An airborne virus less contagious than measles or varicella. Ø Symptoms: headache, loss of appetite, and low-grade fever, "parotits", nonspecific respiratory symptoms, tenderness/swelling of the testes, pancreas, or ovaries. Ø Complications: meningitis

varicella

Ø Caused by varicella -zoster virus Ø Highly contagious. Contagious for 1 -2 days before the rash appears, continue to be contagious until all the blisters have crusted over (usually 6 - 8 days) Ø Symptoms: rash, fever, coughing, fussiness, headache, loss of appetite Ø Complications: bacterial infection of skin, bones, lungs, joints, blood. The virus can lead to pneumonia or meningitis

sports injuries (all age groups)

Ø Caused primarily because of sports competition between young people who differ greatly in strength and agility. Ø Overuse injuries are the most common type of injury particularly for school aged childern. Ø Sports program should have warm-up procedure and hydration policy. Ø Sports physical should be done before start of activity. Ø Wear appropriate protection devices for individual sport. Ø Coaches should be trained in CPR and first aid. "Over use" injuries: most common in school age children Ø No apparent or identifiable injury Ø Pain worsens with continued participation in the activity Ø Can cause permanent damage to muscle, tendons, bones Caused by: Ø Starting sports too early Ø Participating in sports activities year round Ø Participating in multiple sports activities Ø Encouragement to play through an injury Ø Performing certain sports activities that should not be performed in school-age/adolescent years (throwing curve balls in baseball) Academy of Pediatrics has guidelines pertaining to over- use injuries: encourage to 1 to 2 days off per week, 2 to 3 months away per year from a particular sport and monitor time spent in weekly training session or repetitions done per week.

Tetanus

Ø Clostridium tetani - bacteria that cannot grow in the presence of oxygen. Ø Spores found in soil, the intestines and feces of many animals and humans Ø Enter the human body through a puncture wound. Ø Symptoms appear within 3 - 21 days from the time of exposure, caused by the toxin acting on the central nervous system and include: spasm of the jaw muscles, followed by stiffness of the neck, difficulty swallowing, and stiffness of the abdominal muscles. Other signs: fever, sweating, elevated BP, and rapid heart rate. Ø There is no "cure" for tetanus once a person develops symptoms.

infant- falls

Ø More frequently occur after 4 months after the infant learns to roll over Ø Falls from changing tables, cribs, beds, sofas, high chairs, infant walkers. Ø Infants may also be injured in the walker by pulling hot foods off the table, or pulling heavy objects like TV's onto themselves. Ø Gates are helpful. Ø Socks, long pants, rubbers soled shoes may contribute to an infant's imbalance

assessment of poisioned patient

Ø The first and most important principle is to treat the child first, not the poison. Ø ABCs and initiate CPR if needed. Ø Ingestion of medications or chemicals may result in a wide variety of clinical manifestations. Perform a thorough examination and monitor vital signs, noting alterations that may occur, such as: 1. Hypertension or Hypotension 2. Hyperthermia or Hypothermia 3. Respiratory depression or hyperventilation 4. Pupillary contraction or Pupillary dilatation Pay attention to the child's mental status, skin moisture and color, and bowel sounds. Maintain ongoing assessment because many toxins exhibit very late effects.

firearm safety (all age groups)

Ø The risk of dying from a firearm injury among 15 to 19-year-olds has been rising. In 2005, 84% of homicides, and 46% of suicides in children and adolescents were caused by a firearm Ø Provide education about gun safety at an early age Ø Guns in the home must be locked in a safe location, with ammunition kept separately. Ø Fire arms safety courses Ø Teach a child never point a gun at someone

Contraindication:

Ø condition in a recipient that increases the risk for a serious reaction Ø vaccine will not be administered when a contraindication is present

Precaution:

Ø condition that might increase the risk for a serious adverse reaction or that might compromise the ability of the vaccine to produce immunity Ø under usual circumstances, vaccination might be indicated because benefits outweigh risks