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Pediatrics > Exam 3: Immunizations and Infectious Diseases > Flashcards

Exam 3: Immunizations and Infectious Diseases Flashcards

1
Q

Active Immunity

A

Stimulates the immune system and gives long-lasting immunity

~Can be from actually getting the disease (natural infection) or from getting vaccinated

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2
Q

Passive Immunity

A

Protection transferred from another human or animal that is temporary and wanes with time

~When you get antibodies from the disease, rather than producing them in the body
~Immune Globulin

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3
Q

Live Vaccines: Precautions and Contraindications (4)

A
  1. Altered immune system (immunocompromised)
  2. Recent steroid use
  3. Recent acquisition of passive immunity
    - Blood transfusion
    - Immunoglobulin
    - Admin of MMR and Varicella should be postponed for a minimum of 3 months after passive immunity*****
  4. Can give 2 live vaccines on the same day, but can’t give them one day after the other –> MUST HAVE 28 DAYS BETWEEN DOSES ***
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4
Q

Recombinant Vaccines

A

Are produced by genetic engineering

  1. HPV
  2. Hepatitis B (should be given w/i 2 weeks of birth)
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5
Q

Herd Immunity

A

If 80-90% of people in the community are vaccinated, it reduces the spread of contagious diseases

*Leaning towards 90% nowadays since fewer people are getting vaccines and it has increased the amount of communicable diseases

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6
Q

Vaccine Administration (4)

A
  1. Rotate vaccines in stock so that the oldest vaccines are used first, and never use a vaccine past the expiration date
  2. Administer vaccines w/i the prescribed time periods following reconstitution
  3. Wait to draw vaccines into syringe until immediately prior to admin (at bedside)
  4. Never mix vaccines in the same syringe unless FDA approves it
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7
Q

Vaccine Administration Documentation (6)

A

Document:

  1. Lot number
  2. Expiration date
  3. Who gave it
  4. When it was given
  5. Injection site
  6. Patient’s record
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8
Q

Pain control during vaccine administration

A
  1. EMLA cream
  2. Age appropriate distractions

For infants:

  1. They can breastfeed while getting the vaccine or use pacifier
  2. Give sugar water
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9
Q

Vaccine information statements

A
  1. Must give VISs (CDC informative packets) to parents BEFORE vaccination is given
  2. Must obtain informed consent separately
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10
Q

Vaccine Adverse Event Reporting System (VAERS)

A

A national vaccine safety surveillance program, which requires healthcare providers to report selected events occurring after vaccination such as symptoms

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11
Q

Most common age and season for Pertussis

A

Age: Under age 4 with no hx of vaccination

Season: spring and summer

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12
Q

Pertussis Priority

A

AIRWAY

Equipment to have at bedside: suction, airway materials, and know where intubation materials are kept

*Bacteria attach to the cilia of the epithelial cells and produce toxins that paralyze the cilia and cause inflammation to the respiratory tract which interferes with the clearing of pulmonary secretions

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13
Q

Pertussis Source and Transmission (3)

A
  1. Discharge from respiratory tract of the infected person
  2. Direct contact or droplet
  3. Indirect contact with freshly contaminated articles
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14
Q

Pertussis Incubation and Communicability

A

6-20 days, but usually 7-10 days

Communicability is greatest during the first phase (catarrhal stage)

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15
Q

Pertussis Catarrhal Stage Clinical Manifestations (3)

A
  1. URI symptoms
  2. Low grade fever
  3. Hacking cough which worsens
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16
Q

Pertussis Paroxysmal Stage Clinical Manifestations (5)

A

–Occurs with they develop the “whoop” at the end of the cough

  1. Short, rapid cough followed by short respirations and a high-pitched “whoop”
  2. Redness
  3. Post-tussis emesis
  4. Runny nose
  5. Cough can last 4-6 weeks
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17
Q

Pertussis Convalescent Stage Clinical Manifestations (3)

A
  1. Lasts 2-3 weeks
  2. Susceptible to other respiratory infections
  3. cough will wean, but there can still be episodes
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18
Q

Pertussis Dx (2)

A
  1. Nasopharyngeal swab or aspiration

2. Culture and polymerase chain reaction (PCR)

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19
Q

Pertussis Therapeutic Management: Antibiotics

A
  1. Erythromycin
  2. Clarithromycin
  3. Azithromycin

*Antibiotics are used to control symptoms

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20
Q

Pertussis Therapeutic Management: Supprotive

A

CPAP (continous positive air pressure)

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21
Q

Pertussis Complications (6)

A
  1. Pneumonia
  2. Hemorrhage
  3. Rib fractures
  4. Hernias
  5. Prolapsed rectum
  6. Weight loss
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22
Q

Pertussis Prevention

A
  1. DTap
  2. Tdap
    * Immunity of pertussis weans over time
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23
Q

Contraindications and Precautions for Immunization with DTaP (5)

A
  1. Moderate to severe illness
  2. Life threatening allergic or previous reaction to a dose of DTaP
  3. Brain or nervous system disease w/i 7 days after receiving DTaP
  4. Cried for more than 3 hours after previous shot
  5. Temp > 105
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24
Q

When should expectant mothers receive Tdap during pregnancy?

A

Between 27 through 36 weeks

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25
Q

Varicella Source and Transmission

A

VARICELLA= CHICKEN POX

Source: to a lesser degree skin lesions (scabs are not infected)

Transmission:

  1. Primary secretions of respiratory tract of infected person
  2. Direct contact, droplet spread and contaminated objects
  • People with breakthrough varicella after vaccination are contagious
  • Adult that has shingles can give a child chicken pox
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26
Q

Varicella Incubation and Communicability

A

Incubation: usually 14-16 days but has a range of 10-20 days

Communicability: during prodromal phase, which is 1-2 days before eruption of lesions and until lesions have crusted over

*People with breakthrough varicella after vaccination are contagious

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27
Q

Varicella Clinical Manifestations: Prodromal stage (4)

A
  1. Low grade fever
  2. Malaise
  3. Anorexia
  4. Pruritic rash
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28
Q

Varicella Prodromal Stage Rash

A
  1. Begins as macules, rapdily progresses to papules, and then breaks and crusts over
    Papule –> vesicle –> crust
  2. Distribution is centripetal: STARTS ON ABDOMEN, then progresses to face and proximal extremities
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29
Q

Varicella Constitutional Stage Signs and Symptoms (3)

A
  1. Elevated temperature
  2. Can get lymphadenopathy
  3. Irritability
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30
Q

Breakthrough varicella (with 4 signs and symptoms)

A

Defined as infection with wild-type varicella disease occurring >42 days after vaccination

  • Usually has milder clinical presentation than varicella in unvaccinated patients
    1. Usually low or no fever
    2. Develop
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31
Q

Varicella Dx

A

Physical assessment is main diagnosis, PCR may confirm it but is not necessary

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32
Q

Varicella Therapeutic Management (3)

A
  1. Acyclovir (anti-viral)
  2. Varicella-zoster immune globulin (VariZIG) for immunocompromised patients only
  3. AVOID USE OF ASPIRIN
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33
Q

Varicella-zoster immune globulin (VariZIG)

A

For immunocompromised patients who don’t have a history of the disease but have been exposed and have a risk of developing complications as a result

  • Will not eliminate chance of getting varicella, but will decrease the symptoms
  • An intravenous immunoglobulin
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34
Q

Varicella Complications (5)

A
  1. Rye Syndrome
  2. Dehydration (b/c lesions could be on mucous membranes and cause decreased drinking)
  3. Abscesses
  4. Cellulitis
  5. Pneumonia
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35
Q

Varicella Prevention

A

Vaccination, 2 doses

36
Q

Varicella Vaccination Contraindications and Precautions (7)

A
  1. Life threatening allergic reaction to the vaccine
  2. Previous dose of varicella vaccine
  3. Contains gelatin and neomycin, so if someone has an allergy to those then consider it before giving
  4. Moderate or severe illness at the time of admin
  5. Pregnant women
    • *Wait until after birth
    • *Can get it 1 month before getting pregnant
  6. HIV/AIDS, Cancer, steroids, radiation, recent blood transfusion consult provider
  7. Varicella is a live vaccine, so must wait 28 days before giving it if you gave a live vaccine the day before
37
Q

Fifth Disease Erythema Infectiosum

A

Mild rash illness that can increase the incidence of hydrops fetalis in fetus and potentially miscarriage

  • Cause by parvovirus B19
  • CAUTION IN PREGNANCY!
38
Q

Parvovirus Source and Transmission

A
  1. Infected person
  2. Respiratory secretions
  3. Blood and blood products
39
Q

Parvovirus Incubation and Communicability

A

Incubation: 4-14 days, but can be as long as 21 days

Communicability: unknown

40
Q

Parvovirus Clinical Manifestions

A
  1. First symptoms are URI

2. Rash appears in 3 stages

41
Q

Parvovirus Rash Stage I (4)

A
  1. Slapped cheeks (bright ride), which disappear in 1-4 days
  2. Mild fever
  3. Runny nose
  4. Headache
42
Q

Parvovirus Rash Stage II

A

1 day after slapped cheeks, patient will develop maculopapular rash on extremities

Symmetrically distributed rash, progresses from proximal to distal

43
Q

Parvovirus Rash Stage III (2)

A
  1. Rash subsides

2. Joint pain in hands and feet (Polyantropathy syndrome)

44
Q

Parvovirus Therapeutic Management (5)

A
  1. Geared towards treating the symptoms
  2. Antipyretics
  3. Analgesics
  4. Anti-inflammatory drugs
  5. Possible blood transfusion for aplastic anemia

~Aplastic anemia: cessation of RBC production

45
Q

Measles source of Transmission (5)

A
  1. Resp tract secretions
  2. Blood
  3. Urine
  4. Direct contact with droplets of infected person
    * Droplet isolation
  5. Primarily in the winter

*Can remain in the air for up to 2 hours after the infected person leaves the areas

46
Q

Measles Incubation and communicability

A

Incubation: 7-21 days

Communicability: From 4 days before and 5 days after the rash appears
*Mainly during prodromal stages

47
Q

Measles and Pregnancy

A

CAUTION DURING PREGNANCY

Can lead to miscarriage, prematurity, low birth weight

48
Q

Measles Prodromal (Catarrhal) Signs and Symptoms (7)

A
  1. Fever
  2. Malaise

Followed in 24 hour..

  1. Coryza (cold symptoms)
  2. Cough
  3. Conjunctivitis
  4. KOPLICK SPOTS
  5. symptoms increase in severity until 2nd day after rash
49
Q

Measles 3 C’s

A
  1. Coryza (cold symptoms)
  2. Cough
  3. Conjunctivitis
50
Q

Measles Koplik Spots

A

Small, irregular red spots with a minute-bluish with center first seen on the buccal mucosa opposite morals 2 days before the rash

Once rash appears, koplik spots subside

51
Q

Measles rash

A
  • Appears 3-4 days after onset of prodromal stage
  • Erythematous maculopapular eruption on face
  • Spreads downward
  • After 3-4 days red or red-brown appearance
52
Q

Measles Constitutional Signs and Symptoms (4)

A
  1. Anorexia
  2. Abd pain
  3. Malaise
  4. General lymphadenopathy
53
Q

Measles Nursing Care (6)

A
  1. Maintain isolation until 5th day of rash
  2. N95 respirator
  3. Comfort measures to relieve symptoms
  4. Antipyretics
  5. Eye care
    * Because conjunctivitis is a risk factor
    * Clean eye from in to out
  6. Skin Care
    * Tepid baths, keep skin clean
54
Q

Measles Complications (5)

A
  1. Otitis Media (most common under 5 years old and above 20 years old)
  2. Pneumonia (often the cause of death in young children)
  3. Diarrhea (most common under 5 years old and above 20 years old)
  4. Obstructive laryngitis and laryngotracheitis
  5. Encephalitis (rare, but high mortality)
55
Q

Measles Prevention

A

MMR or MMRV

*MMRV contains varicella, not used as often because it may cause seizures

56
Q

Contraindications and Precautions of MMR Vaccine (5)

A
  1. Life threatening previous dose or reaction to neomycin or other component of MMR
  2. Illness at the time of scheduled vaccine
  3. Pregnancy
    * Avoid pregnancy for 4 weeks after admin of vaccine
  4. HIV/AIDS, cancer, blood disorders, blood transfusion, another vaccine within 4 weeks should consult with provider before getting vaccine
    * *Because it’s a live vaccine
  5. Discuss risks and benefits with immunocompromised patients
57
Q

Mono (EBV) Source and Transmission

A

Direct contact with oral secretions, blood transfusions, or transplantation

58
Q

Mono (EBV) Incubation and Communicability

A

Incubation: 30-50 days

Communicability: unknown due to general symptoms

59
Q

EBV Clinical Manifestations (10)

A
  1. Symptoms appear 10 days to 6 weeks after exposure***
  2. Generalized complaint of fatigue***
  3. Malaise
  4. Sore Throat
  5. Fever
  6. General lymphadenopathy
  7. Difficulty maintaining level of activity***
  8. Spleenomegaly***
    - Limit contact activity for up to 6 weeks or until spleen is normal size
  9. Hepatomegaly and jaundice***
  10. Skin rash
    * Recovery shorter in younger people
60
Q

EBV and Beta-lactam antibiotics

A

EBV may present as strep, and if prescribed beta-lactam antibiotics, an EBV patient will develop a rash 7-10 days after taking the medication

61
Q

EBV Prevention

A

Limit contact with infected body fluid

62
Q

Bacterial Meningitis (with 5 pathogens)

A

An acute inflammation of the of the meninges and CSF

Pathogens:
1. Haemophilus influenza type B

  1. Streptococcus pneumoniae (pneumococcus)
  2. Streptococcus group B
  3. Neisseria meningitides
    * *Leading cause in ages 10-19
  4. Listeria
63
Q

Bacterial Meningitis Risk Factors (4)

A
  1. Age (Infants/elderly)
  2. Community setting
  3. Certain medical conditions
  4. Travel
64
Q

Bacterial Meningitis Source and Transmission

A

Droplet infection with nasopharyngeal secretions

*Symptoms usually occur 3-7 days after exposure

65
Q

Bacterial Meningitis Clinical Manifestions: Infant

A
  1. Fever or hypothermia
  2. Poor feeding, vomiting
  3. Marked irritability
    * *High pitched cry (neuro cry)
    * *Not consolable
  4. Restlessness
  5. Seizures
  6. Bulging or tense fontanel
  7. High pitched cry
66
Q

Bacterial Meningitis Clinical Manifestions: Children and Adolescents (7)

A
  1. Sudden onset of fever, headache, and nuchal rigidity
    * Nuchal rigidity= stiff neck
    * How to assess nuchal rigidity: ask them to touch chin to chest
  2. Nausea
  3. Vomiting
  4. Photophobia
    * Hallmark
    * Ask patient to look into the light and they won’t do it (too afraid)
  5. Alerted mental status
  6. Positive Kerning and Brudzinski sign
  7. Petechial or purpuric rashes (meningoccal infection)
67
Q

Positive Kernings

A

Stiffness in hamstrings and inability to straighten leg when hip is flexed at a 90 degree angle

68
Q

Brudzinski

A

Neck stiffness - if patient is lying flat, and you bend the neck, it will force them to bend knees as well

69
Q

Bacterial Meningitis Dx

A
  1. Blood
  2. CSF

*The sooner you dx, the sooner you treat = the better prognosis

70
Q

Bacterial Meningitis Therapeutic Management (8)

A
  1. Isolation precautions and notify anyone that was exposed so they can start prophylactic antibiotics
  2. Initiation of antimicrobial therapy
    * Antibiotics can work for some strains
  3. Hydration
  4. Ventilation
  5. Reduction of ICP
  6. Management of systemic shock
  7. Control of seizures, temperature and pain/comfort
  8. Keep room dark due to photophobia
71
Q

Bacterial Meningitis Prevention: Meningococcus (2)

A
  1. Meningococcal polysaccharide vaccine (MPSV4)
    * *The only one licensed for older than 55 years old
  2. Meningococcal conjugate vaccine (MCV4)
    * Routine one
72
Q

Bacteria that can cause Meningitis (3)

A
  1. Nesisseria meningitidis (meningococcus)
  2. Streptococcus pneumoniae (pneumococcus)
  3. Haemophilus influenza type b (Hib)
73
Q

Considerations and Precautions for Miningococcus Vaccine

A
  1. Severe life threatening allergic reaction to previous dose
  2. Moderate or severe illness
  3. Can be given to pregnant women
  4. Can be given at the same time as other vaccines
    * *Except children with sickle cell disease or without a working spleen
74
Q

Bacterial Meningitis Prevention: Pneumococcus (2)

A
  1. Pneumoccal conjugate vaccine (PCV13)
    * The routine vaccine
  2. Pneumococcal polysaccharide vaccine (PPSV)
    * For children older than 24 months with chronic lung disease, cardiac disease, or sickle cell, and for adults over 65 years old

–Can be given at the same time as other vaccines

75
Q

Bacterial Meningitis Prevention: Hib Contraindications (3)

A
  1. Life threatening reaction to previous dose

2. Children

76
Q

Bacterial Meningitis Prevention: Hib Mild Reactions (2)

A
  1. Redness, warmth, or swelling at injection site (1 out of 4)
  2. Fever of over 101 (1 out of 20)

*These are not an indication to not get the subsequent doses

77
Q

Hepatitis B Vaccine

A
  • Hep B can lead to cirrhosis or liver cancer
  • Newborns should receive first dose before leaving hospital
  • Anyone through 18 yrs of age who was not vaccinated should be
78
Q

Hepatitis B Vaccine Contraindications and Precautions (4)

A
  1. Life-threating allergy to yeast or other component of vaccine
  2. Previous reaction to Hep B
  3. Moderate to severe illness
  4. Many will be asked to wait 28 days before donating blood after getting hep B vaccine
    * means it’s a live vaccine
79
Q

Rotavirus

A

Diarrhea, vomiting, fever –> can lead to dehydration

80
Q

Rotavirus Vaccine

A

1st dose can be given as early as 6 weeks of age and should be given by 14 weeks 6 days.
**If you don’t get the patient during this time period, then they can’t be vaccinated

The last dose should be given by 8 moths of age

81
Q

Contraindications and Precautions of Rotavirus Vaccine

A
  1. Life-threatening allergic reaction to previous dose or latex
  2. SCID severe combined immunodeficiency
  3. Moderate or severe illness
  4. HIV/AIDS, Cancer or other weakened immune system causes
  5. Studies have shown a small increase in cases of intussusception**
    *intussuscpetion: telescoping of the intestines
    SandS → gelly-like stool and waxing and weaning pain
    *Usually would occur 1 week after first dose
    **Tell parents to report s/s abd pain, bloody stool, weakness and irritability
82
Q

HPV Vaccine Info (5)

A
  1. Can be given to both males and females
  2. Recommended ages: 11-12 and as early as 9
  3. Females can have it as late as 26
  4. May be given to men 22-26 years old who have not completed the 3 doses
    * Recommended for males through age 26 who have sex with men or have a weakened immune system
  5. HPV can be given at the same time as other vaccines
83
Q

HPV Vaccine Contraindications (4)

A
  1. Life-threatening allergic reaction to previous dose or component of HPV yeast
  2. Pregnancy
  3. Moderate to severe illness
  4. Brief fainting spells and jerking movements after vaccination has been reported
84
Q

Intradermal flu vaccine

A

Approved for ages 6 months and older

  • The high dose vaccine
  • Inactivated vaccine
85
Q

Nasal-spray flu vaccine

A

LAIV

Live, weakened flu virus

86
Q

Who should not be vaccinated against the seasonal flu? (4)

A
  1. People with severe allergy to chicken eggs
  2. Severe reaction to influenza in the past
  3. Children younger than 6 months of age
  4. Moderate to severe illness with fever should wait to get vaccinated until their symptoms lessen
87
Q

Contraindications of LAIV (7)

A
  1. Persons who have experienced severe allergic reactions to LAIV, to any of its components, or to a previous dose of any other influenza vaccine
  2. Children 2 through 17 years receiving aspirin or aspirin-containing products
  3. Persons who are allergic to eggs
  4. Pregnant women
  5. Immunosuppressed persons;
  6. Children 2 through 4 years of age with asthma or who had wheezing in the past 12 months
  7. Persons who have taken influenza antiviral medications in the previous 48 hours

Pediatrics (13 decks)

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