Immunizations, antibiotic therapy selection, additional pediatric questions Flashcards
T of F: The CDC did NOT recommend use of LAIV for 2015-2017
Answer: True; concerned that it wasn’t effective in preventing flu past 2 years
T or F: The CDC still does not recommend use of LAIV for 2019-2020 season
Answer: False; this year, they have resumed recommending LAIV as a suitable option in age-appropriate patients.
What patient can receive the LAIV4 vaccine?
Answer: 2yr-49yr old patients without contraindications (CANNOT BE GIVEN: <2 yr old, pregnancy, 18yr old on aspirin therapy, healthcare personnel, person in close contact w/high risk groups, asthma, 50yr or older (they receive IIV3), immunocompromised, use of antiviral med in past 48hr (Tamiflu)
What patient can receive the IIV4 vaccine?
Answer: 6 mo and older (inactivated virus; includes healthcare workers)
What patient can receive the IIV3 vaccine?
Answer: >65 yr (inactivated virus at higher dose)
What patient can receive RIV4 (recombinant) vaccine
Answer: 18 yr and older, reactions to egg or who required epi or another emergency medical intervention
ANTIBIOTIC THERAPY SELECTION
According to guidelines:
1. Don’t test for or initiate abx therapy in bronchitis (unless pneumonia is suspected)
2. Test patient with symptoms suggesting group-A strep by rapid antigen test or culture; treat with abx ONLY with confirmed strep pharyngitis
3. Acute rhinosinusitis should only receive abx if symptoms persist >10 days, high fever and purulent nasal drainage + face pain >3
days; worsening symptoms lasting 5 days
4. Don’t give abx for common cold
Aspiration of a FB can mimic the symptoms of what condition?
Answer: Croup
When treating a health 3 yr. old patient for PNA, the NP realizes that the MOST likely cause is?
Answer: Respiratory virus
Which abx effectively treats atypical pathogens in pneumonia?
Answer: Clarithromycin
Which virus causes the “summer cold”?
Answer: Enterovirus
What is the most common cause of croup?
Answer: Parainfluenza
What are the 1st line tx for bronchiolitis in children?
Answer: Supportive measures
What age group is usually affected by croup?
Answer: 6mo-5yr
Croup is usually preceded by a ______________?
Answer: URI
Croup is usually cause by what?
Answer: Virus
A patient present with mild symptoms of croup. How should the NP proceed with treatment?
Answer: oral hydration, minimal handling, dexamethasone (0.15mg/kg IM), can d/c from ED if symptoms improve in <3hr
If patient’s croup signs and symptoms are moderate to severe. How should the NP proceed with treatment?
Answer: humidified O2, dexamethasone IM x1, nebulized racemic epi; s/s should improve in 10-30min; if not – admit to hospital
What is epiglottitis?
Answer: Severe form of croup
Epiglottitis is usually caused by what organism?
Answer: H. influenza B (HiB)
____________ is the most common cause of bronchiolitis?
Answer: RSV
Bronchiolitis usually affects what age group?
Answer: <2years old
How is RSV identified?
Answer: Viral nasal swab
According to the 2015 AAP, the following ARE NOT recommended for treatment of bronchiolitis.
Answer: routine RSV testing, CXR, albuterol, corticosteroids, ABXs, Ribavirin
What causes Pertussis?
Answer: Bordetella pertussis
How is pertussis diagnosed?
Answer: Rapid antigen (PCR) by nasal swab or nasal aspirate (best if done in 1st 3wks of cough)
Most common cause of CAP in children is?
Answer: RSV
T of F: Bacterial PNA is MORE common in kids?
Answer: False
If in fact a bacterium is the cause of pneumonia in a child, what is the likely organism?
Answer: S. pneumoniae
A 2 mo old is diagnosed with CAP. What treatment plan should the NP institute?
Answer: Admit to hospital
