Exam 1 Flashcards
COMM. & P.E. OF CHILD: therapeutic play
NB
- mobiles, music, mirrors, cuddlers
toddlers
- relieves tension, explores env’t., peek-a-boo, hide-and-seek, transitional objects [from home to hospital], reading fav. stories
pre-schoolers
- crayons, color books, use of body or doll to address child’s fear of bodily harm and mutilation
school-aged child
- regress developmentally, age-appropriate crafts/games for diversion, tasks to provide a sense of mastery and accomplishment
adol.
- loss of independence/regaining control, therapeutic recreation, peer contact w/ outside world and adol. on floor, physical activities
COMM. & P.E. OF CHILD: growth measurements
length and weight of child. up to 36 mo. of age should be taken in recumbent position
- head circumference should be measured
- pc 36 mo., child can be measured standing up
growth is plotted on chart
- < 5th or >95th percentile considered outside expected parameters for height, weight, and head circumference
- some pop. may need their own special charts [e.g. premmie’s, VLBW, down syndrome]
COMM. & P.E. OF CHILD: calculate corrected age from chronological age: baby J was born at 28 weeks gestation. Her chronological age today is 24 weeks, what is her corrected age in months?
(Chronological Age) ‐ (Weeks or Months of Prematurity) = Corrected Age
3 months
COMM. & P.E. OF CHILD: obtaining resp. rate on child.
1st VS performed b/c it is done w/o disturbing child
compared w/ adults, RR is more responsive to illness, exercise, and emotion
ranges:
- N.B. [30-60], tots [20-40], child. [15-25]
COMM. & P.E. OF CHILD: obtaining heart rate on child.
2nd VS performed, done so by auscultating apical pulse
rate increases w/ inspiration and decrease w/ expiration
ranges:
- infant [140 > 115], toddler [110], pre-schooler [103], older [103 > 85
COMM. & P.E. OF CHILD: obtaining B.P. on child.
3rd VS performed, if applicable
systolic BP increases gradually during childhood
ranges:
- infant [50 > 95/60], child. [95 > 120/75]
COMM. & P.E. OF CHILD: obtaining temp. on child.
last VS performed /c it is considered the most invasive
blue thermometers are used for PO and axillary readings; red for rectal readings
COMM. & P.E. OF CHILD: general appearance
face posture position body movement hygiene nutrition behavior development [fine/gross motor skills] dental
COMM. & P.E. OF CHILD: skin assessment
color
texture
temp.
moisture
tissue turgor [done on abd.]
pigment lesions [check size, configuration, distribution]
accessory structure [hair smooth and silky, nails concaved and pink]
COMM. & P.E. OF CHILD: head and neck
shape
- plagiocephaly [flat back of head] occurs when baby spends too much time on back; rotate during wakeful hours]
symmetry
head control [pc 4 mo., head control occurs]
head posture
ROM of neck [for infants/toddlers, have them follow a toy]
fontanels
- anterior closes b/w 12-18 mo., posterior fontanel and cranial sutures close b/w 6-8 we.
lymph nodes
- may present as pea-sized, non-tender, mobile masses; common up until age 12
COMM. & P.E. OF CHILD: eye assessment
size
shape
symmetry
conjunctiva
cornea [iris color not fully established until age 6 mo.]
pupils
fundoscopic exam [fundus, red reflex, blood vessels]
vision testing [ocular alignment,, visual acuity, peripheral/color [not fully developed until age 2 mo.] vision
COMM. & P.E. OF CHILD: strabismus leading to amblyopia
amblyopia is 1 of the most common causes of diminished vision in child.
in “lazy eye” both eye are unable to focus simultaneously brain suppresses image by deviating the weaker eye
lazy eye may be normal in child. up to age 3 mo.
COMM. & P.E. OF CHILD: ear assessment
externally [position, cerumen]
internally [landmarks, light reflex]
- pull pinna down and back when looking internally in child. ages 3 y. and younger b/c of the shorter canal
COMM. & P.E. OF CHILD: nasal assessment
externally [position, placement, nasal flaring [normal up to age 6 mo.]
internally [mucosa, turbinates, septum]
nasal drainage or odor
sinuses [aren’t fully developed until pc age 3]
COMM. & P.E. OF CHILD: oral assessment
by 6 mo., deciduous teeth start coming in
by 20 mo. all 20 deciduous teeth should be in
tonsils may be slightly enlarged
- normal unless causing airway obstruction
COMM. & P.E. OF CHILD: chest & back assessment
size, shape [e.g. pectus exCAVtum {CAVing in}, pectus carinatum], symmetry
movement
nipples
breast development [should be checked in both genders]
scapular asymmetry
spinal curvature
ROM
COMM. & P.E. OF CHILD: cardiac assessment
a physiologic splitting of S2
normal sinus arrhythmia
HR increased w/ inspiration and decreased w/ expiration
physiologic murmurs
nursing considerations: assess the child. wile they are upright and supine
COMM. & P.E. OF CHILD: abdominal assessment
assess contour, movement, umbilicus, hernias, bowel sounds, palpation [deep and superficial]
COMM. & P.E. OF CHILD: musculoskeletal & extremities
hips: infant ortolani and barlow maneuvers
assess: muscle strength, gait, sole and palm creases
normal findings:
- bowleggedness until 2 y
– abnormal if only present in 1 leg or exceeds 2 y of age
- knock knees 2-7 y
- appearance of flatfoot [ac walking]
- tibial torsion [pigeon toes]
- babinski until 18 mo. or once child begin walking
COMM. & P.E. OF CHILD: neurological assessment
assess:
- cerebellar fx [balance and coordination]
- reflexes [triceps, biceps, achilles]
- cranial reflexes
- 2 optic [infant: eye blink w/ light shining in eyes]
- 3 oculomotor, 4 troclear, 6 abducens [infant: focus on tracking; child: move object/toy through 6 points of gaze; note symmetry or eyelid drooping, PERRLA], 5 trigeminal [infant: foot reflex, child: chewing/ cotton test], 7 facial, 8 acoustic [response to sound, facial expressions and blilateral symmetry], 9 glossopharyngeal, 10 vagus [palatal reflex; infant: swallowing; child: clear speech], 11 spinal accessory [child: raised shoulders, turn head side to side against resistance], 12 hypoglossal [infant: observe feeding; child: tongue mid-line w/ no tremors]
GROWTH AND DEVP’T: assessing growth
linear growth reflect skeletal growth [assessed by recumbent length or height for child. that cannot sit yet]
weight reflects growth, nutrition, fluid balance
length remains more stable than weight does
head circumference reflects brain growth
plot weight, height, and head circumference on growht chart
- monitor that the child fits a trend line
by age 2, child has attained 50% of adult height
never again will a child have such high metabolic rate or intake requirements that during infancy
GROWTH AND DEVP’T: physical growth patterns [0-6 m]
weight increases 6-8 oz./w
length increased 1 in./m
HC increases 0.5 in./m
posterior fontanel closes, social smile develops, vocalizes, fixes on visual stimuli, lifts head when prone [landau reflex] at 2 m
hands held open, squeals, recognizes mother, social at 4 m
double birth weight, rolls, voluntary grasp, teeth erupt, chewing, tripod sit, bears weight on legs, by 6 m
GROWTH AND DEVP’T: physical growth patterns [7-12 m]
weight increases by 3-4 oz./w length increases by 0.5 in./m - increased by 50% by 12 m HC increases by 0.25/m teething begins 6-8 m triple birth weight by 12 m parachute reflex [flexion of arms and fingers to "break" a fall], crude pincer grasp, imitates sounds present by 8 m pulls to stand [9], cruises [11], walks [12], fine pincer grasp, releases/drops objects, waves, speaks 1-2 words by 12 m
GROWTH AND DEVP’T.: physical growth patterns [13-18 m]
babinski disappears w/ walking, imitation, removes clothing, decreasing appetite, decreasing rate of growth by 18 m
anterior fontanel non-palpable at 12 m, closed completely by 18 m
GROWTH AND DEVP’T.: red flags of developmental delay
lack of eye muscle control pc 4-6 m lack of social smile by 8-12 w rolling ac 3 m persistence of primitive reflexes poor head control at 4 m failure to reach fpr objects by 5 m absent babbling by 5-6 m not sitting at 7 m doesn't wave/bang toys by 9-10 m lack of imitation at 16 m lack of protodeclarative pointing
GROWTH AND DEVP’T.: breastfeeding
BM recommended q1.5-3 h for 12 m
advantages: decreased incidences of otitis media, allergies, resp. tract infections, diarrhea/vomiting, meningitis, other infections, SIDS, obesity, type 1/2 diabetes
infant does not require supplementation
- this means water as well
GROWTH AND DEVP’T.: readiness for progression from BM or formula
no whole milk until 12 m
- can lead to anemia, bleeding, and problems w/ nutrient absorption
introduce solid foods at 4-6 m if the infant:
- can sit
- BW has doubled and is at at least 13 lb
- can reach for an object and maintain balance
- extrusion disappears [at 4-5 m]
- moves food to back of mouth and swallows during feeding
weaning off bottle can occur after solids are introduced
GROWTH AND DEVP’T.: physical growth patterns [1-3 y]
weight increases 4-6 lbs/y height increases 3 in/y head circumference increases 1 in./y full set of 20 decduous teeth by 2 y - imp. for language development, spacing for permanent teeth and poster + dietary habits
GROWTH AND DEVP’T.: physical growth patterns [3-5] y]
child achieves night, bowel/bladder control, rides tricycle, dresses, 3-4 word sentences, uses “I”, imaginary playmates, parallel to associative play by 3 y
washes hands and face, 4-5 word sentences, peak of questioning, associative play by age 4
handedness firmly established, draws person w/ appendages, knows days of week, cooperative,, wants to please, may cheat to win game by 5 y
imp. to promote, self-feeding,, appropriate discipline, healthy teeth/gums
GROWTH AND DEVP’T.: solitary play
usually performed by infants and toddlers
it’s independent play
due to child’s limited social, cognitive, and physical skills
imp. for all child. to have some solitary play
GROWTH AND DEVP’T.: parallel play
usually performed by toddlers
child. play side by side w/ similar toys
lack of interactivity
GROWTH AND DEVP’T.: associative play
can begin in toddlerhood but usually associated w/ preschoolers
group play w/o group goals
may play w/ same toys and trade toys, no formal organizations
GROWTH AND DEVP’T.: cooperative play
begins in llate preschool usually associated w/ school-age child
organized play w/ group goals [e.g. team sports, board games]
GROWTH AND DEVP’T.: temper tantrums/ undesirable behaviors in toddlers and preschoolers
encourage self-regulation and control through discipline and setting limits
encourage + discipline
- limit stress, provide a safe env’t., praise + behavior
when undesirable behavior occurs
- use distraction, time out, encourage child to use words instead of hitting [parents can model this behavior if child cannot verbalize], avoid fatigue/ hunger/ excessive strictness
GROWTH AND DEVP’T.: pediatric poisonings
most common in 2-6 y
caused by improper storage, or misuse as toys
salicylate poisoning
- can be acute/chronic
- s/s: N/V, disorientation, dehydration, hyperpyrexia, oliguria, coma, bleeding, seizures
- N.I.: activated charcoal, Na bicarb. for metabolic acidosis, external cooling measures for fever, anticonvulsant and seizure precautions, vit. K
acetaminophen poisoning
- most common; cute ingestion
- s/s: N/V, pallor, sweating > hepatic involvement
- tx: activated charcoal, antidote is mucomyst [PO q4h for 17 doses]
ALWAYS ASSESS LOC AC ADMINISTERING PO MED.
GROWTH AND DEVP’T.: physical growth patterns [6-12 y]
organ development complete
tonsils/ adenoids largest, permanent teeth erupt at 6 y
- loss of desiduous teeth at 4 y
- 32 adult teeth by 12 y
increasingly coordinated, participates in sports and activities, has collections/ hobbies
- encourage physical activity for wt. control, socialization, self-esteem, continued development of motor skills/ coordination
common to have mostly same sex friends
develops conscience
have periods of slow growth followed by fast spurts
GROWTH AND DEVP’T.: components of sex ed. w/ school-aged child.
8-9 y
- basic anatomy and physiology; body fx.’s; expected changes r/t puberty
10-12 y
- menstruation; nocturnal emissions [wet dream]; reproduction; teenage preg.; HIV infection prevention; STI prevention
GROWTH AND DEVP’T.: adolescence
early:
- peer relationships increasingly imp., sexual curiosity present
mid/ later
- need for privacy, risk-taking, more accepting of self and diff. of others, concerned w/ society, prep. for career
GROWTH AND DEVP’T.: puberty
girls:
- secretion of estrogen [10-13 y] stimulates the development of breast tissue and pubes
- 1st pubertal change is enlargement of ovaries, 1st visible change is to breasts
- growth spurt begins pc onset of breast development
boys:
- testosterone in boys [11-14 y] stimulates the development of testicular enlargement and pubes
- gynecomastia presents in 50% of males [lasts 12-18 m and resolves spon.]
ID the age at which the listed events occur: 1 birth weight is doubled 2 post. fontanel closes 3 sits alone 4 1st tooth erupts 5 able to digest/ absorb cereal 6 walks w/o help 7 recognizes object permanence 8 develops fine pincer grasp 9 babbles 10 displays stranger anxiety 11 rolls front to back & vice versa 12 primitive reflexes [moro, tonic, neck, rooting] disappear 13 babinski reflex disappears
1 6 months 2 6-8 weeks 3 8-9 months 4 4-6 months 5 12-15 months 6 9-12 months 7 11 months 8 9-12 months 9 6-7 months 10 5-6 months 11 7 months 12 5-6 months 13 10-12 months
what info. about sleep patterns do you share w/ parents of a 3, 6, and 12 month old?
3- begin to establish night-time routine; sleeps 15-16 h/day
6- maintain/ establish sleep routine; sleeps 12-16 h/day; sleeps all night + 2-3 naps during day
12- sleeps through the night + 1-2 naps
what info. about nutrition and feeding do you share w/ parents of a 3, 6, and 12 month old?
3- breast milk + vit. D supplementation; formula [4-6 oz. x 6 qd
6- begin introducing solid foods one at a time, fortified in Fe; offer cup; limit juice; vit. D supplementation
12- may begin whole milk, table foods; use of utensils; 3 meals + snacks
what info. about teething do you share w/ parents of a 3, 6, and 12 month old?
3- continue prenatal vit.’s if BF; do not prop bottle
6- deciduous teeth erupt, clean w/ cloth x 2 qd; no bottle to bed
12- 8 teeth; clean teeth w/ cloth x 2 qd
what info. about elimination do you share w/ parents of a 3, 6, and 12 month old?
3- 6-8 wet diapers/day; stools r/t feeding method
6- stools darken and become more solid
12- remains dry for longer periods; BM’s decrease and become regular
what info. about safety do you share w/ parents of a 3, 6, and 12 month old?
3- place on back to sleep in own crib w/ pacifier; avoid 2nd-hand smoke; prevent falls, burns
6- place on back to sleep in own crib, in separate room; child-proof; prevent drowning/ positions
12- high-chair safety; front-facing car > 20 lbs.
the nurse is planning care for a pt. w/ a diff. ethnic background. which of the following would be an appropriate goal?
- strive to keep ethnic b.g. from influencing health needs
- encourage continuation off ethnic practices in the hosp. setting
- attempt, in nonjudgemental way, to change ethnic beliefs
- adapt, as necessary, ethnic pracctices to health needs
4
a mother bring 6 mo. eric to the clinic. she comments “I want to go back to work, but I don’t want eric to suffer, b/c i’ll have less time w/ him.” the nurse’s most appropriate answer would be which of the following?
- let’s talk about the child care options that will be best for eric
- i’m sure he’ll be fine if you get a good baby-sitter
- you will need to stay home until eric starts school
- you should go back to work so eric will get used to being w/ others
1
a 2 mo. old is in for a well check-up and immunizations. the nurse will give all of the following immunizations except…
- IPV
- prevnar
- MMR
- Hep B
- HIB
3
MMR is given at 12 mo. of age
a child is admitted w/ complications from varicella zoster. beds are tight and there are 3 double rooms w/ 1 bed not occupied in each of the rooms. the following pt.’s are in the rooms: 14 y. o. receiving chemotherapy, 2 m.o. w/ RSV, and 1 y.o. w/ RSV. what arrangements could be made?
- place the child in isolation w/ the 2 m.o.
- place the child w. the 14 y.o. who was immunized for varicella
- have the 2 m.o. room w/ the 1 y.o.
3
which of the following are examples of passive immunity [select all that apply]:
- breast feeding
- synagis
- HBIG
- MMR
- prevnar
1, 2, 3
HBIG and synagis are injections w/ immunoglobulins [manufactured antibodies]
true or false: natural infection is better than immunization.
true
infection usually does cause better immunity however, the price paid for natural; disease can include paralysis, retardation, liver cirrhosis/cancer, deafness, blindness, pneumonia, or death
which age group most demonstrates the response described?
1 loss of control
2 fear of injury
3 isolate themselves from friend until they can compete equally
4 need of rituals to feel secure
same feelings that make them feel omnipotent make them feel out of control
1 school-aged child. 2 preschoolers 3 adolescents 4 primarily toddlers, preschoolers preschoolers
GROWTH AND DEVP’T.: infants according to erikson and piaget
erikson
- stranger/ separation anxiety develops
piaget
- activity: reflex > repetition > imitation
- starts to understand cause and effect via trial and error and problem-solving
- object permanence by 7-8 mo.
GROWTH AND DEVP’T.: tot.’s according to erikson, piaget, and freud
erikson
- negativism, ritualism, separation anxiety, temperament
piaget’s
- egocentrism, centration [one perspective at a time], irreversibility, magical thinking, literal
freud
- anal stage [mastery of bowel and bladder]; establishment of gender role from 2-5 y.
GROWTH AND DEVP’T.: preschoolers according to erikson and freud
erikson
- busy learning, prideful in all they do; inferiority may develop if adults do tasks FOR them [goal is to promote independence]; imaginary friends common
freud
- phallic stage; rivalry w/ same sex parent
GROWTH AND DEVP’T.: school-aged child. according to erikson and piaget
erikson
- interested in how things are made; success in personal/ social tasks; needs support/ encouragement
piaget
- concrete operations
- flexible thinking, can take another’s perspective, inductive logic, reversibility
HOSPITALIZATION: toddlers
the group most at risk for a stressful experience
they lack the cognitive ability to understand the reason for hospitalization
they fear pain, mutilation, invasive procedures, the dark
HOSPITALIZATION: 3 phases of separation anxiety
protest- child is agitated, resists caregivers. cries, is inconsolable
- not: parent visits disruptive
despair- child feel hopeless and becomes quiet, withdrawn, apathetic
- not: child settling in, “better” behavior
detachment- child becomes interested in env’t. may ignore parents return
- not: adjusting to situation
interventions: parent-focused [prevent/ minimize separation, constant interruptions for procedures; substitute significant others; encourage parent involvement], child-focused [offer choices, if appropriate; mimic home routines; use transitional objects; stay with child]
HOSPITALIZATION: maintaining a safe place
a designated afe area can enhance a child’s sense of security
intrusive procedures should take place in a treatment room, not the child’s room
the playroom shouldn’t be used for tx.’s and/or administering med.’s
PAIN: myths about pain
neonates do not experience pain
child. have no memory of pain
there’s a correct amount of pain med. given for an injury
child. can easily become addicted to narcotics
narcotics can easily cause resp. depression
PAIN: FLACC
a pain assessment tool
face, legs, activity, cry, consolability
PAIN: developmental and behavioral responses to pain of tot’s/ preschoolers
tot.’s: do not understand why they are experiencing pain; cannot describe the intensity or type of pain
PS: relate pain to injury; can ID location/ intensity of pain; believe pain is a punishment; may stall a procedure that causes pain
responses: crying/ screaming; verbalization of pain; moving/ thrashing; uncooperative; clings; irritability; anticipatory pain
PAIN: developmental and behavioral responses to pain of school-aged child
can describe pain in relation to their body parts
more descriptive of the experience of pain
behaviors: younger [stalling, rigidity, emotional withdraw], older [withdrawal fpom stress/ anxiety, project bravery, sleep disturbances, short attention spans]
PAIN: developmental and behavioral responces to pain of adolescent
wants to behave in a socially acceptable manner
show control
give a more sophisticated description of pain
behaviors: less protest/ movement; muscle tension while keeping still; depressive/ aggressive behaviors; sleep disturbance
PAIN: nursing considerations of pain management
airway equipment readily available monitoring equipment suctioning equipment prevent withdrawal wean long-term med. over 2-3 weeks educate parents that child. are the only ones allowed to self-administer med. from PCA pumps
IMMUNIZATIONS: natural infection v. immunization
NI: almost always causes better immunity than vaccines
- immunity from disease often follows a single natural infection but it can have its consequences [e.g. pneumonia form chickenpox, mental retardation from h. influenzae type b [Hib]
I: usually occurs only after several doses
- long-lived immunity; does not extract such a high price [non-monetary] for immunity
IMMUNIZATIONS: naturally acquired [active v passive v artificially acquired active] immunity
active
- the immune system actively makes antibodies after exposure to a disease
- protection last for life
- high risk of s.e. from disease
passive
- induced w/ antibodies produced in another human or host
- e.g. IGg [antibody] passed through the placenta to the fetus
A.A.A.
- antibody production is stimulated w/o clinical disease
antigen is given in form of a vaccine
- same vaccinations must be given at 4 week intervals
IMMUNIZATIONS: types of vaccines
live, attenuated
- live organism w/ reduced virulence; provides protection for 20+ years
- e.g. MMR, varicella, nasal influenza
inactivated
- killed vaccine only involves the cell wall; requires frequent boosters
- e.g. DtaP, IPV, Hep B, influenza
recombinant
- an organism has been genetically altered for use in the vaccine
- e.g. Hep B, acellular pertussis
conjugated forms
- an altered substance joined w/ another substance to increase the immune response
IMMUNIZATIONS: hep B
given at birth prior to hospital discharge, then at 2 m, 4 m, 18 m
S.E.: low grade fever
for infants born to mother infected w/ HBV, they should receive both hep b vaccine and hep B immune globulin at birht
IMMUNIZATIONS: DtaP
a combo. vaccine that includes diphtheria, tetanus, pertussis
given at 2, 4, 6 m and boosters given at 15-18 m, 4-6 y
s.e.: swelling, restlessness fever, seizures, inconsolable crying
- contraindicated if last 2 s.e. occur
for 11-12 y.o. who have completed their DTaP series and not yet received a booster should get Tdap
IMMUNIZATIONS: polio vaccine
inactivated poliovirus [IPV]
give at 2, 4, 6, 18 m and boosters at 4-6 y
contraindicated: rx. to antibiocitcs neymycin, streptomycin, polymyxin B
IMMUNIZATIONS: haemophilus influenza B [HIB]
bacteria that was oncea common cause of meningitis and epiglottitis
given at 2, 4, 6, 12-18 m
IMMUNIZATIONS: pneumococcal conjugate
protects against strep. pneumoniae meningitis
inactivated bacterial vaccine
given at 2, 4, 6, 12-15 m
s.e. low fever
IMMUNIZATIONS: influenza vaccine
trivalent inactivated influenza vaccine [TIV]
all child. > 6 m should get vaccinated each fall or winter season
contraindications: egg allergy
IMMUNIZATIONS: rotavirus
a gastroenteritis virus causing fever, N.V.D., > dehydration
d/o brand, can be given at 2, 4 m [rotarix] or 2, 4, 6 m [rotateq]
contraindications: allergy, uncorrected congenital GI malformation; severe combined immundeficiency disease
s.e.: cold sx.’s, anorexia, intussusception
IMMUNIZATIONS: measles, mumps, rubella [MMR]
live virus vaccine
given at 12-15 m and 4-6 y
- response can be dampened by maternal antibodies if given a/ 12 m
s.e.: noninfectious generalized rash
contraindications: gelatin allergy, immunocompromised states, neomycin allergy, preg. [b/c of congenital defects], + PPD
IMMUNIZATIONS: varicella [chickenpox]
live attenuated virus
given at 12-15 m and 4-6 y
s.e.: generalized varicelliform rash
contraindications: gelatin allergies, severe immunosuppression, preg.
can be given as a MMRV [measles, mumps, rubella, varicella]
IMMUNIZATIONS: resp. syncytial virus [RSV]
given montly during RSV season [oct.-apr.]
given to child. <2 y.o. w/ chronic lung/heart disease, severe immunodeficiency
given prophylactically in premmies
IMMUNIZATIONS: human papillomavirus [HPV]
genital HPV is the most prevalent STI in US
ideally should be administered a/ potential exposure to HPV through sexual contact
given initially, 2 m a/ initial dose, 6 m a/ initial dose
- should start at 11-12 y
IMMUNIZATIONS: hep A
given at 12 m and booster at 18 m
IMMUNIZATIONS: special considerations
multiple immunization may be given at the same time
there must be a 4 week interval b.w immunizations
live vaccines may suppress a TB rx [false -]
- wait 4-6 w a/ doing a PPD
all vaccines, live or inactivated, can be given on the same day or at any time P/ a TB skin test is done
premmies are immunized based on chronological age, NOT corrected age
