Class five Flashcards
What are some differences in the pediatric immune system?
More dominant thymus glad tissue that goes away around puberty
Tonsils and adenoids is larger until late school age/adolescents
Lymph nodes are more reactive with acute infection so they are easily palpable and tender
What is the job of the lymphatic vessel?
Help remove debris that is collected in the immune tissue within the body
What is the first line of defense?
Physical barriers such as skin, cilia of respiratory tract, acid in stomach
What is the second line of defense?
Nonspecific phagocytosis/macrophages (WBC, leukocytes)
What occurs d/t phagocytosis/macrophages? What is the purpose? What does this cause?
Increased capillary permeability and vasodilation
Get fighters to site of infection quicker
Causes inflammation, fever, purulence, redness, warmth
What else is released in the non specific second life of defense?
Compliment protein
Immune boosters that causes even more capillary permeability and vasodilation
What happens as cells are injected and die?
They release toxins leading to inflammation, fever and pain
What is the job of the lymph node closest to the site of dead cells?
Clear debris which can cause it to be tender
What occurs if a foreign object or antigen gets past the second life of defense?
Triggers the third line of defense AKA adaptive/specific immune reaction
What does the adaptive/specific immune reaction consist of?
Lymphocytes (B&T cells)
Antibodies
Cell mediated
Where to B cell originate from? What do they turn into?
Originate from bone marrow
Turn into antibodies
Where to T cell originate from? What do they turn into?
Originate from thymus
Become killer T cells, cytotoxic T cells, helper T cells
What do antibodies do?
Attack a foreign antigen before it invades a cell
What does a cell mediated response do?
Goes into action once an antigen has invaded a cell and taken over production of that cell
What does both antibodies and cell mediated end up in? What does it contribute to?
Cell lysis OR phagocytosis which contributes to inflammation response by releasing toxins
What does the adaptive/specific immune reaction develop? When is it fully developed?
Begin to develop at one year
Fully developed school age into puberty
What do cytokines do if they are regulated? Not regulated?
Regulated: boost immune system
Not regulated: cytokine storm which can be fatal d/t causing s/s that can lead to cardiac arrest, respiratory distress
What causes a cytokine storm?
Infection
Medications like monoclonal antibodies or chemo
Why do children get so sick?
Neonate lack nonspecific/inflam response
Older infants/toddlers/preschoolers have overactive nonspecific immune system –> high fevers, inflammation
Maternal antibodies taper off by 6 m.
Specific immune system not developed until school age/adolescence
Higher baseline metabolic demands so no reserve to compensate
Increased insensible water losses w/ rapid extracellular shift –> rapid deterioration
If neonates Neonate lack nonspecific/inflam response how do they respond to sickness?
Might not present with high fever
Instead vague symptoms like poor feeding and difficulty arousing
What does a higher baseline metabolic demands matter?
Reason why they get so sick and crash quickly
W/ stress, can’t compensate for an even higher HR or RR
What if my child is breast feeding, will they still have maternal antibodies for longer?
No
Why are vaccines such a hot topic?
Recent outbreaks (false sense of security –> decreased vaccinations –> outbreak)
Parental concerns
Healthcare rights
Inappropriate provider information and exceptions
Ineffective communication (defensives and close communication will push parents further away)
How do active vaccines work?
Help develop immunity by imitating an infection to trigger a cell mediated/humoral response
- Antigen injected into body
- Cause body to produce T-lymphocytes and antibodies
- Antibodies destroy the virus or bacteria
What can be some normal s/s to see after given an active vaccine? Why?
Mild s/s including fever and aching
Due to immune system working
How do passive vaccines work?
Inject the body with antibodies
Why should you immunize children?
Children are at increased risk for disease b/c immune system is not well developed
Immunizations prevent serious and deadly infectious diseases
Extraordinarily safe: few SE and risks
Herd immunity to protect vulnerable population
Economic impact of hospitalization and missed work
What age is the flu vaccine first offered?
6 months
What is the message for parents regarding vaccines?
Immunizations can save your childs life
Vaccines are safe and effective
Immunizations effect other you care about
Immunizations can save your family time and money by avoiding missing work and school
Immunizations protect future generations
What is sepsis?
Syndrome caused by infectious agent that is viral, bacterial or fungal
What occurs is sepsis?
- Local infection
- Infection enters bloodstream
- Immune system responds to fight infection
- Infection and immune cells spread –> endotoxins are released causing a cascade of metabolic, hemodynamic, and inflammatory changes and inflammation
- Capillary leaking –> disruption of blood flow, perfusion and vascular tone leading to organ damage and death if untreated
What are the end organs that could get damaged due to poor perfusion in sepsis?
Brain
Kidney
Skin
GI tract
What assessment finding would you expect if your child is just sick?
fever as high as 104
Should you give a child NSAIDS for their fever?
Avoiding because high risk of AKI in young children getting repeats doses for fever reduction when they already have an underlying sickness that is making them dehydrated
What should you give for a fever in children?
Tylenol
What should you NEVER give for a child with a fever?
Aspirin
Will a child have a fever with sepsis?
Not always. More of an inflammation response that is causing instability in hemodynamics
What assessment finding would you expect with sepsis?
Poor perfusion parameters
Change in LOC (difficult to arouse)
Rapid RR (underlying acidosis)
Rash that does not blanch
Cool to touch or mottled
Decompensation
What is the medical management of sepsis?
Monitor - early recognition and prevention of deterioration
IV access for aggressive fluid resuscitation, bolus and cultures and labs
Support respiratory with oxygen
Support perfusion with vasoactive agents
ANTIBIOTICS WITHIN 1 HOUR
How much should a bolus be for pediatric sepsis patients?
10-20 mL/kg
What is the benefits of a sepsis protocol?
Standardize care and improve response and outcomes
Improves M&M if recognized and treatment is started within ONE HOUR (risk of death decrease by 2-3X every hour not recognized and treated)
What is the intubation period?
Time between exposure to disease and the illness becoming apparent
What is the prodromal period?
Time between the early or sub-clinical (absent or non-specific) symptoms and the full blown disease
Are you contagious in the prodromal period?
HIGHLY contagious
What are some common s/s of a viral disease?
Rash (exanthem)
Fever (4 days)
Mild URI symptoms
How do you treated viral disease? Can they be prevented?
Mostly self limiting
Symptomatic treatment: fever control (for comfort of child), hydration, skincare (prevent breakdown w/ rash)
Most can be prevented immunization
How long is the typical incubation period for viral disease? When is it most contagious? How do viral diseases generally spread?
Incubation: 7-21 days
Most contagious in prodromal period (3-4 days before rash and until rash goes away
Droplet precautions until rash resolved and no new lesions
Which viral disease is the most severe and has highest chance of complications?
Measles/Rubeola
What are some complication of Measles/Rubeola?
Otitis media
Pneumonia
Hearing loss
Encephalitis
Death (1-2/1000)
What is the period that Measles/Rubeola is contagious?
4 days before and 4 days after the rash
What kind of vaccine is the Measles/Rubeola? When is the first dose given? Second dose?
Live vaccine that created active immunity through a specific antibody mediated response
First dose: 12 months
Second dose:
How effective is the Measles/Rubeola vaccine?
93-97% effective
What are the classic s/s of Measles/Rubeola?
3 C’s (coryza-runny nose, cough, conjunctivitis)
Koplik spots in mouth appear first (3 days before maculo)
Maculopapular rash appears second
What is a complication of conjunctivitis?
Severe photophobia
How does the Maculopapular rash spread on the body?
Starts at hairline and progresses downward
What are the classic signs of rubella German/3 day measles?
Rash that starts at highland and works downward
Cervical lymphadenopathy
Petechiae on soft palate
What are some complications of rubella German/3 day measles?
Minor to patient
Congenital rubella in 1st trimester of pregnancy can lead to serious complications like IUGR, FTT, and increase mortality in 1st year
What is roseola as called?
human herpes virus 6
What are the classic symptoms of roseola?
Sudden high fever for 3-4 days (as high as 104)
Rash follows as soon as fever breaks
Happy baby - not bothered by rash
What age group does roseola usually affect?
Older infants and toddlers
Starts at 6 months and peaks in toddler years
When is roseola contagious?
Before rash to when the rash appears (until fever breaks)
What are the classic s/s of erythema infectious (5th disease or parvovirus)?
Minor upper resp. s/s
Slapped cheek appearance (rosy cheeks)
Reticular rash (lacy rash on trunk and extremities)
What age is erythema infectious (5th disease or parvovirus) most common?
Preschool and school age
When is erythema infectious (5th disease or parvovirus) infectious?
Prodrome 5-12 days before rash
What is a common complication with erythema infectious (5th disease or parvovirus)?
Prenatal complication like miscarriage
How do you treat erythema infectious (5th disease or parvovirus)?
Treat itchy symptoms with cool compresses, cool bath, oatmeal baths
Keep finger nails short and clean
When is the infectious period in mumps?
7 days before swelling and 9 days after onset
How is mumps transmitted?
droplets
salivary secretions
What is the most common complication of mumps?
Parotid gland enlargement
Orchitis and infertility in male children later in life
What is the incubation period for the Epstein-bar virus (mono)? Infectious period?
Incubation: 4-7 weeks
Infectious: Unknown - virus shed before clinical onset of disease until 6 months or longer after recovery
How is Epstein-bar virus (mono) transmitted?
Saliva
Blood
What are some complications of that Epstein-bar virus (mono)?
Splenomegaly and padomegaly
Splenic rupture
Swelling of pharynx and tonsils severe enough to compromise respiratory (steroid given)
Chronic fatigue for months
Grey/white exudate
Due to the risk for splenic rupture, what should avoided?
contact sports for 4-6 weeks
What occurs if a child with Epstein-bar virus (mono) is given amoxicillin?
Breaks out in a rash
Can help diagnose between mono and strep
What kind of precautions for a child with varicella zoster virus (chicken pox) be on?
contact and airborne
What is the incubation period for varicella zoster virus (chicken pox)?
10-21 days
What are complication r/t varicella zoster virus (chicken pox)?
Cellulitis
Pneumonia
Encephalitis
Sepsis
Latent infection (remains latent in nerve ending and can be reactivated by stress and cause singles, usually in adults but can happen to children)q
What are the 3 stages of varicella zoster virus (chicken pox)?
- Papule
- Blister
- Ulcer - open wound which can lead to skin infection
How many doses is the varicella vaccine? What ages are they given? Active or passive immunity?
2 doses
1st dose:
2nd dose:
Active/passive?
What is a concern regarding the vaccine for varicella zoster virus (chicken pox)?
By not getting chicken pox as a child, can get it later in life but with proper vaccination it is rare
Recommended that adults get singles vaccine
What is pertussis (100 day cough) caused by? Who common gives it to them? What precautions should they be on?
Bacteria: bordetella pertussis
Most get form adults especially grandparents as their immunity decreases
Droplet
What is the catarrhal stage of pertussis?
Mild URI s/s for 1-2 weeks
Think they just have a mild cold
What is the paroxysmal stage of pertussis?
lasts 4-6 weeks
Cough followed by a high pitched whoop
Post-tussive emesis
Exhaustion, extremely fatigued, and distress from coughing can cause resp. failure
What is the convalescent stage of pertussis?
Addition 2-3 weeks for gradual recovery
What is the treatment for pertussis?
Antibiotic
Hospitalization
Very long recovery despite antibiotics given
What age are you most worried about having pertussis? why?
under age 1 - haven’t received all of their vaccines
About 50% of babies under 1 get apnea, respiratory failure/fatigue, fluid volume deficit d/t fatigue
What are the complications of pertussis?
Among hospitalized infants:
61 % apnea
1% die
What is otitis media? What is a complication? What is treatment that should be considered?
Ear infection
Increased risk of hearing loss with recurrent infections
Treat and recognize. Treat with tubes sooner rather than later and decrease antibiotic use
Which is a more serve type of meningococcal disease bacteria or viral? How do you diagnose it? How is it transmitted?
Bacteria: severe
Viral: less severe
Lumbar puncture
Droplets (droplet precautions)
What are the complications of meningococcal disease?
15% is fatal
Purpuric lesions (inflammation of blood vessel and leaking of capillaries which can also be seen in septic pts)
Amputation of limbs
Shock (nurses should watch for this)
What is the treatment for meningococcal disease?
Antibiotics for pt if bacterial
Prolonged course of prophylactic antibiotics for any family member that was exposed
What is Haemophilis influenzae? What vaccine is given? When?
Responsible for bacterial meningitis, epiglottis, bacterial pneumonia, septic arthritis, and sepsis under age of 2 - can start as an ear infection and trigger
HIB vaccine
Given at: 2, 4, 6, 12-18 months and a booster later on
What is Strep pneumoniae? What vaccine is given?
Responsible for bacterial infections in children under 2 that cause serious morbidity and mortality like meningitis, otitis media, pneumonia, septicemia, sinusitis
PCV vaccine
What is neisseria meningitidis? What vaccine is given?
Infections responsible for sig morbidities
College students living in dorms more susceptible
Meningococcal vaccine
What is the classic s/s of meningococcal disease?
CNS (neuro disturbances)
HA
Nuchal rigidity
Neck pain
Meningeal irritation (pt bend head up –> hip contract b/c meningeal tissue is inflamed and irritated
Fever
Rash (purpuric)
When is meningococcal disease contagious?
7 days before s/s and 1 day after receiving antibiotics
Close quarter living is at higher risk
What is Reye’s syndrome? What is it caused by?
Syndrome that causes encephalitis and liver failure
Caused by children with a viral infection being given ASA
Cl that is too high can lead to?
Metabolic acidosis
How long does acute gastroenteritis last? Causes?
Less than 14 days
Bacteria, viral (rotavirus), parasite
How long does chronic gastroenteritis last? Causes?
More than 14 days
Autoimmune, malabsorption, allergic, function/stress
