Peds: Test Two: Growth/Development, Infectious Disease Flashcards
How long should a newborn only have breast milk or formula before adding in new foods?
up until 4 months when you can add cereal/baby food
What type of play do newborns like?
Faces, mobiles, black & white
What type of anticipatory guidance should you expect with a newborn?
Nutrition, NB care safety, infant stimulation
What are the effects of hospitalization for a newborn until 8 months?
Separation, disruption of routines, regression
What are some safety hazards for ages newborn through at least 10 months?
Positioning, choking, falls, aspiration, suffocation, car safety, burns, choking, pulling objects.
What ages are Erikson’s Trust vs. Mistrust stage occuring?
Birth until 1 year.
What ages is Erikson’s Autonomy vs Doubt & Shame occurring?
1-3 years.
What ages does Erikson’s Initiative vs. Guilt occur?
3-6 years.
What ages does Erikson’s Industry vs. Inferiority occur?
6-12 years.
What ages does Erikson’s Identity vs. Role Confusion occur?
12-18 years.
What ages is Piaget’s Sensorimotor Stages?
birth until 2 years.
What ages are Piaget’s Preoperational Stage?
2-7 years
What ages are Piaget’s Concrete Operational stage?
7-11 years.
What ages are Piaget’s Formal Operational stage?
11-adulthood
What are Kohlberg’s Stages of Moral Development?
Preconventional (4-7 years); Conventional (7-11 years); Postconventional (12+)
What are the gross and fine motor skills of a 2 month old?
Gross=lift head; Fine=open hands
When does a baby begin to follow with their eyes?
2 months.
When does a baby coo and have different cries?
2 months.
What types of play do babies at 2 months like?
Colors, talk, rattle.
What is some anticipatory guidance for a 2 month old?
Dtap, IPV, Hib, Hep#2
What are some gross and fine motor skills for a 4 month old?
Gross=head control, rolls, plays with feet; Fine=regards hands, reaches
When does a baby turn its head to locate sound?
4 mos
When do babies chuckle?
4 months.
When can you add cereal/baby food to the baby’s diet?
4 months
What is some anticipatory guidance for a 4 month old?
Dtap, IPV, Hib
What are some gross and fine motor skills for a 6 month old?
Gross=sits with support; fine=palmar grasp, transfers hand-hand
When can a baby fixate on a small object?
6 months.
What age can a baby do 1 syllable babble & vowel sounds?
6 months
When does a baby have stranger anxiety?
6 months & 15-18 months
What does a baby at 6-7 months like to play?
peek-a-boo
What is the anticipatory guidance for a 6-7 month old?
Dtap, IPV, Hib, injuries, diet
At what age does a baby pull to stand?
8-10 months.
At what age do babies have depth perception?
8-10 mos.
At what age can babies say “dada” and understand simple commands?
8-10 mos
What age do babies have object permanence?
8-10 mos.
At what age can you add fruits/veggies & soft table foods?
8-10 months.
What age do babies like to play with balls, books, & food?
8-10 months.
What anticipatory guidance do you expect at 8-10 months?
HBV #3, IPV, Dtap, diet, safety
What age do babies get separation anxiety?
8-10 months.
What age can a baby begin to walk and then run?
12 months=cruises; 15-18=walks/runs
What age does a baby have fine motor skills like finger foods, holding crayons?
12 months
What age does a baby follow moving objects and have symbol recognition?
12 months
How many words does a baby have at 12 months?
3-5 words
At what age does a baby search for objects?
12 months
At what age do you stop bottle and do whole milk?
12 mo
What are the effects of hospitalization for ages 1-2?
Separation, confusion, regression, loss of control.
What are the safety concerns for 12 month olds?
falls, outlets, pulling objects.
What are the gross and fine motor skills for 15-18 mos?
Gross=walks, runs; Fine=2 cube tower, scribbles, spoon
How many words does a 15-18 month old have?
10-15
What types of toys do 15-18 month olds like?
push-pull toys and balls
What anticipatory guidance do you expect at 15-18 months?
safety, nutrition
What safety concerns do you worry about at 15-18 months?
choking, falls
What age can a child go up and down stairs with 2 feet?
2 years.
When can a baby walk backwards/forwards?
2 years.
What are the gross and fine motor skills of a two year old?
Gross=narrow gait, up and down stairs with 2 feet, walks forward/backwards; fine=increased manual dexterity, circle.
When does a baby begin to explore with all senses?
2 years.
What is the vocab of a baby at 2 years old?
“No”; 200-300 words; 2 word sentences
What age do babies develop sibling rivalry, temper tantrums, and negativism?
2 years (terrible twos)
What do kids at 2 years like to play with?
parallel, water.
What safety concerns do you have with a child at 2 years of age?
falls, burns, collision injuries, poisoning
What are the gross and fine motor skills of a 3-5 year old?
Gross=rides bike, walks on tip toes, jumps; fine=refinement of eye-hand coordination, O (3yr) + (4yr)
What are the vocal capabilities of ages 3-5?
900 words, 4-5 sentences, talks incessantly, stutters, sings songs
At what ages do kids start to show off and begin to have fears?
3-5 years
What what age is it important to start a low fat, high calcium diet?
3-5 years
What do 3-5 year olds like to play with?
imaginary friend, associate play, imitative, imaginative
What are the effects of hospitalization for ages 3-5?
Loss of control, regression, fear of altered body image, mutilation, aggression, fantasies
What are the safety concerns of ages 3-5?
MVA’s, drowning, falls, poisoning, burns, fire prevention
What are the gross and fine motor skills of ages 6-11?
Increased muscle mass & coordination, tie shoes, cut with scissors, etc.
What are the vocal capabilities of 6-11 year olds?
Increased language skills, love jokes/puns.
At what ages do boys associate with boys/girls with girls?
6-11 years
What nutrition is important for 6-11 year olds?
low fat food guide pyramid.
What type of play do 6-11 year olds like?
cooperative, rules, teams, games
What is the anticipatory guidance for 6-11 year olds?
Nutrition, physical fitness, dental care, hygiene, smoking and drug edu, Bike safety
What are the effects of hospitalization for 6-11 year olds?
Fear of loss of family place, fear of harm/body injury, fear of death, loss of control, regression, boredom, concerns for privacy
What are the safety concerns with ages 6-11?
bikes, risk taking activities, latchkey kids, firearms.
What are the gross and fine motor skills of ages 12-18?
awkwardness develops into muscle control and coordination; adult fine motor control
At what ages do kids define independence, peers are very important, emotional/social turmoil, and interested in the opposite sex?
ages 12-18
What is the anticipatory guidance for 12-18 year olds?
areas of mental health, sexual bx, violence, MVA’s, nutrition/eating d.o’s, fad diets.
Effects of hospitalization for ages 12-18?
Loss of independence and control, loss of identity, body image disturbance, separation of peers
Safety concerns for ages 12-18?
Risk taking activities, MVA’s, drugs, sun protection
What is the expected weight gain for the new infant?
1.5/month for first 5 months; should double by 5-6 months; should triple by 12 mos.
What is the height increase amount for the new infant?
increase 1 inch/mos; increase by 50% by 12 mos.
What is average head growth for the new infant?
increase 1.5 cm/mo; by one year, has increased 33%
Binocularity (fusion of 2 ocular images into one cerebral picture) begins to develop by ___weeks and well developed by ___ mos.
6; 4
Fetal hemoglobin is present for the first ___ mos. Results in shortened survival of RBC’s and results in ___
5; physiologic anemia.
Maternal iron stores are present for ___ mos and gradually diminish.
5-6.
The digestive process in the infant is immature because ___ & __ are deficient.
amylase (responsible for digestion of complex carbs); lipase (limited amt makes if difficult to digest fats).
Infants have an inability to conjugate bilirubin and secrete bile until _____
couple weeks old
The infant receives passive immunity (maternal IgG) until about ___; has 40% adult levels by age ____
3 mos; 1 year.
Production of IgA, IgD, and IgE not attained completely until _____
early childhood (6 yo)
Moro Reflex aka _____
startle reflex
The Moro Reflex begins when? fades by about ___ mos and disappears by ___
at birth; 4; 6
The Stepping Reflex is usually gone by about ___
4-8 weeks
How do you elicit the Moro Reflex and what is the expected result?
Startle the infant with a sudden noise or change in position; The arms should extend and the fingers form a C as they spread. The arms slowly move together as in a hug. The legs may make a similar motion.
The Palmar grasp reflex begins and ends when?
present at birth; disappears by about 3 months.
How do you find the Palmar grasp reflex? What is the expected result?
Place finger across infant’s palm and avoid touching the thumb. A strong grip around the finger is normal.
How do you elicit the Plantar grasp and what is the expected result?
Place finger across the foot at the base of the toes. The toes normally curl as if gripping the finger.
When does the Planter grasp reflex start and end?
present at birth; disappears at about 8 months.
How do you elicit the Stepping Reflex and what is the expected result?
Hold the infant erect and touch the bottom of one foot on the surface of the table or chair. The feet lift in an alternating pattern as if to walk.
When does the Stepping Reflex begin and end?
Begins at birth and disappears between 4-8 weeks
How do you elicit the Tonic Neck reflex and what is the expected result?
Place infant in supine position and, when relaxed, turn the head to one side. Repeat by turning the head to the opposite side. The arm and leg on the face side normally extend and the opposite arm and leg flex, as if to assume a fencing position.
Tonic neck reflex aka ____
fencing reflex.
When does the tonic neck reflex begin and end?
Appears about 2 mos of age; decreases by 4 months; disappears no later than 6 months; it must disappear before the infant can turn over.
What is nutrition like for the newborn?
2-3 ounces breast or bottle every 2-3 hours.
How long does it take for the umbilical cord to fall off?
about 10-14 days
What is the average amount of sleep for a newborn?
16-18 hours.
What is a schedule for a follow-ups with the MD after the newborn is discharged?
2-3 days, then week after that, then 2 weeks age, then 1 month, then 2 months.
At what age can the newborn start daycare?
At about 6-8 weeks (after they’ve started their immunizations)
How long should the car seat face backwards for a child?
until 1 year of age or 20 lbs.
How long should you keep a baby out of the sun?
until at least 6 mos when they’re allowed to wear sunscreen
What is some umbilical cord care?
Don’t put over diaper; practices vary according to region/institution; objectives are to prevent infection and promote cord separation; Practices include: no care, application of triple dye, application of povidoneiodone, isopropyl alcohol, or antimicrobial ointments. Aseptic care decreases bacterial colonization but delays cord separation.
What are three types of formula?
Ready to feed (won’t have needed fluoride like others bc you don’t mix it with water), Concentrated (add H2O), Powder (add H20 and shake well).
Where is the most accurate temperature taken in babies?
Rectally.
Any temp greater than ___ rectally is a fever.
100.4
The anterior fontanel is ___ shaped and smaller than ___ in diameter at 6 months and then becomes progressively smaller. It close between ____
diamond shaped; 5 cm (2 in.); 12-18
The posterior fontanel close between ___ months.
2-3
What is some circumcision care for the newborn?
Cover head of penis with petroleum jelly with each diaper change until redness goes away (and keeps it from sticking to diaper); Pale yellow crust around the incision and on glans is normal for several days; use cotton ball moistened with tap water to gently clean head; contact MD if increased redness, bleeding, or swelling of head occurs.
It would be a red flag if there was no responsive smile at ____ weeks.
8
What age are the following motor skills beginning: Open hands often, brings hands to midline, holds rattle, positive head lag, holds head and supports weight on forearms while prone, turns from side to back?
2-4 months
What age are the following motor skills beginning: draws arms and legs to trunk with cry, holds hands in fist, may lift head briefly?
newborn.
What age does the baby know the parent’s voices and follows them?
2-4 months.
How do you heat up a baby’s bottle?
Not in microwave (creates “hot spots”); use bowl of water and put it in microwave/boil, then put bottle inside bowl to warm it
At what age do teeth begin to erupt?
4-6 mo
When does the baby double its weight?
by 6 months.
May be a red flag if the baby doesn’t reach for objects by ___
5 mo
What age is the following motor skills: Regard hand, reaches and grasps, mouths objects, holds feet (“find their feet”), intentional palmar grasp, lift head/chest 90, rolls back to stomach, pos. head control?
4-6
When does a baby watch the course of a falling object, respond readily to sounds, explores objects with mouth and all senses?
4-6 mo
When does a baby laugh out loud and babble using consonant sounds (HNGKP)?
4-6
When does a baby’s play become more manipulative behaviors and solitary play?
4-6 mo
What is the extrusion reflex and when is it gone?
When something touches the baby’s lips/mouth, the tongue extends forward; it is gone by 4-6 mo
What should you delay feeding the infant until 1 year of age to prevent allergic reactions?
Eggs, strawberries, tomatoes, wheat, corn, fish, nuts
What age can you introduce fruits/veggies?
6-8
What age can you introduce meats?
8-10 mo
How long should you avoid giving babies honey?
until 1 year old because of botulism (after 1, body can handle spores)
A baby shouldn’t have normal milk until age ___
1
What age can you start introducing “table foods” to a baby?
10-11; make sure soft
What age does teething start?
6-8 months
A red flag may be if there’s a positive head lag at ___ months.
6
What age group are these motor skills: palmar grasp, feet to mouth (discovers feet), better eye/hand coordination, bangs objects, transfers object hand to hand?
6-8 months.
What age do babies imitate sounds, have vowel sounds, and one syllable babble?
6-8 mos
What age is peek-a-boo popular?
6-8
Why should you add vegetables before fruits into a babies diet?
fruits are sweet so if you give them first they won’t want anything else.
What age can you put juice into a cup?
6-8
What age are we going to start worrying about dental caries prevention?
6-8 mo
Reflex when you hold the child upright and then rotate his body quickly face forward (as if falling). The baby will extend his arms forward as if to break a fall
Parachute reflex
What age does the parachute reflex begin?
8-10 mos
What age does the baby get the Pincer grasp?
8-10 mo
What age does a baby pull to stand and army crawl?
8-10 mos
When does a baby start to say “no” and understand words?
8-10 mos
What is a good rule of thumb for deciding if something is a choking hazard?
if it can fit through a TP roll = choking hazard
Stranger anxiety occurs around ___ months and may last until ____
7-9 mos; 16-30 mos
What age can a baby “cruise” (close to walking, can hold things and walk) and stand alone?
10-12 mos
What age do babies start to hold crayons?
10-12 mos
At what age is it a red flag if they are not pointing at objects?
10-12 mos
How many words does a baby have at 10-12 mos?
3-5 words
What age do babies like to play with push-pull toys, empty out, and stack up/knock down?
10-12 mos
What age do we stop the bottle?
10-12 mos
What is a food jag?
when a baby only wants one thing to eat all the time
When do food jags start in babies?
12-15mos
At what age is it a red flag if they can’t walk?
18 mos
What age does a baby use a spoon well, scribbles, and does a 2 cube tower?
15-18 mos
How many words does a 15-18 month old have?
10 words
When does stranger anxiety peak?
15-18 mos
When do you put kids in booster seats?
at about 40 pounds (4-5 yo) and can go up to 9ish
When does the baby’s growth start slowing down and body proportion changes are occurring?
Toddlers 1-3
What age are gross motor skills locomotion and can walk, jump, run?
toddlers (1-3)
What age does the child have an increase in skillful manual dexterity, can imitate a circle, build tower, and start to hold a crayon like pencil?
1-3 year
What age do kids start expressive jargon and speak short sentences?
1-3 years
How many words do toddlers 1-3 have?
minimum of 200-300
At what age do kids play parallel to each other? What age is associative play?
Toddler (1-3, around 2); Preschooler (3-5).
When does toilet training start?
1-3; usually start around 12-18, but can’t expect them to be trained until 3
Give toddlers whole milk from ages ____; at age ___ give 2% milk (about 24oz/d).
1-2; 2
During the toddler years, what times do they get well check-ups?
15 ,18, 2 year, 3 year; usually no shots from 18-4y, except flu vaccine
What age does kinesthesia begin (awareness to position of body parts)?
Preschooler (3-5)
What age do kids start to ride a tricycle, walk on tiptoe, balance on one foot, climb stairs alternating feet?
Preschooler (3-5)
How much weight do 3-12 year olds gain each year?
4-6 pounds
What age does a kid know if he’s a boy or girl (same with his mom and dad)?
3
How many words does a 3 year old have?
900 words
When does a child start to sing songs?
3
What type of vocab does a 4 year old have?
4-5 word sentences, 2100 words
What age is telegraphic speech, imaginary friends, nightmares, stuttering, and animism?
Preschooler 3-5
What age is the eruption of deciduous teeth complete?
Preschooler (3-5)
What age group is the age of the loose teeth? What age do kids lose all their teeth by?
6-12; 12-13
What age group does play become “cooperative”?
6-12
What are some car safety recommendations for the school age child?
- Over 40 lb (generally 4-8), use a forward-facing booster seat (with belts positioned on lap and shoulder) in the backseat.
- Kids 4’9” and taller can sit in a regular car seat restrained with lap/shoulder belt.
- Backseat is preferred for all kids and should be the only location used for kids 12 and under.
During the “Terrible teens” weight almost ____; height increases by ___%; Girls (until age 16) and boys (until age 18) grow ___ inches per year until age 16; there’s the development of secondary sex characteristics.
doubles; 15-20%; 3-6
What is the staging called that is used for physical development in kids?
Tanner Staging.
What is of utmost importance in adolescent communication?
Confidentiality and privacy
Which vaccine can be given at birth?
Hep B
What is the Hep B vaccination schedule for kids?
Dose 1: Birth
Dose 2: 1-2 mos.
Dose 3: 6-18 mos.
What is the DTaP vaccination schedule for kids?
Months: 2, 4, 6, 15-18, then 4-6 years.
What is the vaccination schedule for Rotavirus (RV)?
months 2,4,6
What is the vaccination schedule for Haemophilus influenzae type b (Hib)?
months 2, 4, 6, 12-15 mos
What is the vaccination schedule for inactivated poliovirus (IPV)?
months 2,4, 6-18, 4-6 years
What is the influenza vaccine schedule?
yearly starting at 6 mos.
What is the minimum age for the influenza vaccine?
6 mos
What is the vaccine schedule for Measles, Mumps, Rubella (MMR) vaccine?
12-15 mos then 4-6 years
What is the vaccine schedule for Varicella?
12-15 mos then 4-6 years
What is the vaccination schedule for Hep A?
First dose at 12-24 then the second one 6-18 mos after that.
What is the youngest age for the Meningococcal vaccine?
9 mos
What are 3 vaccines that have a minimum age of 12 mos?
MMR, VAR, HepA
What is an infants first line of defense?
Passive Immunity (aquired from maternal antibodies)
What is the only Immunoglobulin that transfers through the placenta?
IgG
What is a newborn’s second line of defense?
Active Immunity (Immunity produced by the body in response to stimulation by a disease-causing organism or other agent.)
Which type of immunity is present at birth?
Passive Immunity
Active immunity isn’t fully functional until what age?
6 years
What type of immunity are Vaccines?
Active Immunity
_____ immunity occurs when exposure to a disease organism (naturally or thru a vaccine) triggers the immune system to produce antibodies against that disease. How long does it last?
Active; long-lasting, sometimes life-long
________ immunity is provided when a person is given antibodies to a disease rather than producing them through his or her own immune system. Examples are a baby acquiring it through the placenta or when antibody-containing products like immune globulin are given. How long does it last?
Passive; short-term–weeks or months
What is the average gauge and length of needle used for kids injections?
25-27; 1 inch
What is the average volume (in mL) for Sub-Q kids injections?
0.5 mL
What are the 4 preferred IM injection sites for kids vaccinations?
Vastus lateralis; Ventrogluteal; Dorsogluteal; Deltoid.
What is a range of safe volumes for IM injections in kids?
0.5 mL-2.5mL depending on age and size of child
What are some ways to reduce pain and anxiety before an injection?
- Vapocoolant
- Give 2 injections at same time
- Apply pressure to site for 10 secs prior to administration
- Prepare parent and encourage them to hold/talk with child
- 25% sucrose water to young infants
- Be efficient and honest
What do you have to document with immunizations?
- Name and Date
- Vaccine given
- Manufacturer, Lot #, Exp. Date
- Site/Route
- Info given to parents (imm. record, instructions for home, Adv. Rxn’s–type, response)
the time elapsed between exposure to a pathogenic organism and when symptoms and signs are first apparent
Incubation period
The period when the person is first starting to see symptoms of the disease =
Prodromal Period
Stage when the disease process reaches its peak =
Acute phase
What are 3 commonalities in viral infections?
- Rash (exanthem)
- Fever
- Cold or flu-like symptoms (fatigue, weakness, rash, fever, irritability, tachycardia, vomiting, diarrhea, resp. difficulties
What is the transmission of Varicella-Zoster?
Direct contact with droplets or airborne particles
What is the infectious period for Varicella-Zoster?
1-2 days before onset of rash until all lesions are crusted over.
During what phase is Varicella-Zoster most infectious?
Prodromal Phase; lesions begin as macular
What do Chicken Pox (Varicella-Zoster) lesions look like?
Macular/Papular/clear-filled vesicles/pustules
How long do Chickenpox lesions erupt for and how long does it take before they’re all crusted?
erupt for 1-5 days and take 1-3 weeks before all are crusted.
What are some complications of Chickenpox?
Cellulitis, Meningitis, Encephalitis, Thrombocytopenia, and Reyes Syndrome.
Seen in children who were infected with Chicken pox before 1 year or immunity waning =
Shingles
What is a common analgesic not given to kids under 19 and why?
Aspirin; Reye’s Syndrome
What can one do if they are exposed to Varicella-Zoster?
The vaccine may be given within 72 hours after exposure to prevent or significantly modify the disease.
Oral or IV _____ can be given for immunocompromised patients with onset of Varicella-Zoster
Acyclovir
What virus causes Hand Foot Mouth Disease?
Coxsackievirus
When is Hand Foot Mouth Disease (Coxsackievirus) most common and what is its transmission?
Summer & fall; Fecal-Oral and Respiratory
What is the infectious period for Hand Foot Mouth Disease (Coxsackievirus)?
2 days before rash up to 2 days after it disappears.
What do the lesions for Hand Foot Mouth Disease look like?
Grayish papulovesicular ulcerative pharyngeal, hand, and feet
What are some complications for Hand Foot Mouth Disease?
Rare, persistent, central nervous system infection several months (immune deficient); Neonates, severe disseminated sepsis, multi-organ failure.
What virus causes Erythema Infectiosum (Fifth Disease)?
Human Parvovirus B-19
What is the transmission for Erythema Infectiosum (Fifth Disease)?
Direct contact with droplets, airborne particles, blood, and transplacental transmission.
What are the stages of Fifth Disease?
Stage 1: Flu-like symptoms; Prodromal period (up to 1 week)
Stage 2: Rash appears
Stage 3: Rash reappears with sunlight or irritation 1-3 weeks
Disease that has the “slapped cheek” sign =
Fifth Disease (Erythema Infectiosum)
What does the rash for Fifth Disease look like?
- Fiery, red edematous rash
- Maculopapular, lacy rash on trunk and extremities
- “Slapped cheek” sign
What are some complications of Fifth Disease?
Children with hemolytic conditions, Aplastic crisis; Arthritis and Arthralgias
What is the transmission of Measles (Rubeola)?
Airborne, respiratory droplets, and contact with infected persons
What is the infectious period for Measles (Rubeola)?
3-5 days before rash until 4 days after rash disappears.
What is the worst phase of Measles (Rubeola)?
Prodromal phase (3-5 days)
What are some of the s/s that occur during Measles in the prodromal phase when the kid is quite ill?
3 c’s: conjunctivitis, cough, coryza (runny nose); also Koplick’s Spots (small, irregular, bluish-white spots on a red background on buccal mucosa) occur at 2 days before rash; also fever, malaise.
What does the rash for Measles look like?
Red maculopapular that gradually turns brownish; begins behind ears at hairline and spreads downward toward feet
What are some complications of Measles (Rubeola)?
Diarrhea, Otitis Media, Bronchitis, Croup, Encephalitis, Death.
What is the transmission of Rubella (German Measles)?
Direct contact with droplets or transplacental
Baby has maternal antibodies for Rubella (German Measles) until ____
about 9 months
What is the infectious period for Rubella (German Measles)?
7 days before onset of symptoms to 14 days after rash appearance.
Rubella (German Measles) aka =
3-day Measles
What is Forschheimer’s Sign?
seen during Prodromal Phase of Rubella (German Measles): discrete, erythematous pinpoint or larger lesions/petechiae on the soft palate
What does the rash look like for Rubella (German Measles)?
Pinkish maculopapular; begins on face, neck, scalp, and spreads downward to feet over 3 day period; as rash develops on a new area, the rash over the previous area fades
What are some complications of Rubella (German Measles)?
Thrombocytopenia, Congenital Rubella (mental retardation, retinopathy, cardiac anomalies, sensiorneural deafness), Encephalitis.
What years do you typically get vaccinated for Rubeola & Rubella?
1 and 4 years.
What is some nursing management for Rubella and Rubeola?
- Cool Mist humidifier
- Vitamin A (100,000 IU 6mos-1yr; 200,000 1 yr and older): dec. the morbidity/mortality
- Suction nose
- Antitussives
- Dim light–photophobia
- Elevate HOB
- Push fluids
Which diseases from this section can be helped with the administration of Vitamin A?
Rubeola & Rubella
What virus causes Roseola Infantum (6th Disease)?
Human herpesvirus type 6
What is the transmission of Sixth Disease (Roseola Infantum)?
most likely through secretions of asymptomatic people
What is the infectious period for Roseola Infantum (6th Disease)?
- Thought to extend from febrile stage until the rash appears
- Lifelong virus shedding in healthy individuals
S/S: Sudden high fever (105) for 3-8 days; Erythematous maculopapular rash =?
Roseola Infantum (6th Disease)
Complications of Roseola Infantum (6th Disease)?
Febrile convulsions; Encephalopathy
What is the transmission of Mumps Parotitis?
Airborne droplets, salivary secretions
What is the infectious period of Mumps Parotitis?
1-2 days before swelling to 9 days after onset
S/S: Fever, earache, h/a, Pain with chewing, parotid gland swelling, Lymphadenoma, Meningeal signs (in 15%) =?
Mumps Parotitis.
What are some complications of Mumps?
Aseptic meningitis, Orchitis, Sterility, Pancreatitis, Glomerulonephritis, Thrombocytopenia, Hearing Impairment.
What is the transmission of Pertussis (Whooping Cough)?
Direct contact or resp. droplets from coughing
What is the infectious period for Pertussis?
1 week after exposure; Most contagious during paroxysmal cough stage; communicable for 5-7 days after antibiotic therapy
DTaP is given to ___ while TDaP is given to ___
kids; adults
What are the stages of Pertussis?
1) Catarrhal Stage (1-2 weeks): Nasal congestion, low grade fever, mild cough
2) Paroxysmal Stage (1-6 weeks): cough more severe/spasms/mucous, Forceful inspiration through a narrowed glottis=stridor, Whoop, Cyanosis, dehydration
3) Convalescent stage: (up to 6 weeks after above stage): symptoms gradually subside
Whole thing can last up to 16 weeks. Can be fatal, especially for young infants under about 4 months.
What are two meds that are given for Pertussis?
Erythromycin (to infected child and all close contacts) & Corticosteroids.
We usually don’t give cough meds anymore to kids under ____
6
A common cause of epiglottitis, Croup, pneumonia, bronchitis, and meningitis =
Haemophilus Influenzae B
What is the transmission of Haemophilus Influenzae B and when are they infectious?
direct contact and droplet; infectious 3 days from onset of symptoms.
Disease often occurs in babies 2-15 mos/in Daycare centers and is diagnosed with a blood culture =
Haemophilus Influenzae B (Hib)
What med can be given for Haemophilus Influenzae B?
Rifampin
What would be the isolation precaution for someone with Haemophilus Influenzae B?
Droplet
S/S: Fever, dysphasia, malaise, chills, h/a, abd. pain, vomiting, beefy red pharyngitis with white/yellow exudate; abrupt onset of symptoms
Streptococcus A
What can you get if Streptococcus A is not treated right away? (12-48 hours after first symptom)
Scarlet Fever
S/S: Fine papular rash in axillae, groin, & neck with sandpaper feel; blanches with pressure; Strawberry tongue day 4-5 after s/s =?
Scarlet Fever.
What med can be given for Scarlet Fever?
Penicillin
S/S: begins as single erythematous macule then rapidly progresses to a vesicle or pustule; mildly painful/itchy/burn; **ruptures and leaves honey-colored crust; often on face, neck, arms, hands or legs
Impetigo
How are Impetigo and Chicken Pox alike and different (related to the lesions)?
both start as vesicle/pustule and turn into honey-colored crusts; However, with chicken pox, you don’t treat the crusts and with Impetigo you do (with Bacitracin or Bactroban 3-4 x daily x 5-7 days)…. Impetigo also gets treated with a systemic abx if there’s no response to the topical within 72 hours. Acyclovir may be given for chicken pox in immunocompromised pt’s.
With Impetigo, how long do you have to be on antibiotics before being able to return to school?
24h
Impetigo is highly ____
contagious. Can be spread after scratching on infected site.
Impetigo Skin Care:
Soak crusts in warm water, gently cleanse with antibacterial soap and remove crusts, do not touch or pick lesions, wash child’s hands frequently with antibacterial soap, fingernails short/clean, may put mittens on kids.
Transmission of Rocky Mountain Spotted Fever =
Wood or Dog Tick Bite
S/S: Flu-like, fever, Rash (red macules/papules that blanch; starts on hands and feet 2nd-5th day; can become widely disseminated; petechial and purpura), Enlarged liver and spleen
Rocky Mountain Spotted Fever
How are Hand Foot Mouth Disease lesions similar to Rocky Mountain Spotted Fever?
both often start on hands and feet; Hand Foot Mouth’s look more blistery than Rocky’s
Complications of Rocky Mountain Spotted Fever:
Gangrene of distal parts of body (from thrombosis); DIC; ARDS
Drug of choice for Rocky Mountain Spotted Fever?
Doxycycline
Transmission of Lyme Disease =
infected deer tick bite
S/S: flu-like, fever, Painful Joints, Bull’s Eye Rash (erythema migrans; expands over weeks and eventually multiply); Cranial nerve palsies (regress with developmental milestones); Arthralgias; h/a; meningitis; CNS changes during stage 3; and Carditis
Lyme Disease
Complications of Lyme Disease:
Neuro deficits, Encephalopathy, Optic neuropathy, Cognitive/behavioral changes
Drugs used for Lyme Disease:
Doxycycline for 9yr+ and Amoxicillin for kids under 9
Kids of smokers often have ___ infections.
Ear
Children are obligate ___ breathers.
nose.
There is growth in the respiratory system until about age ____
12
Bifurcation of the trachea is at ___ in kids until about age 12; it’s at __ in adults.
T3; T6
Kids have __ breathing, with the diaphragm being the main muscle of respirations.
abdominal
Why do kids have more ear infections?
because of the positioning of the Eustachian tube–it’s more horizontal and shorter = decreased drainage, trap stuff.
It is not uncommon to feel enlarged ___ normally in kids.
lymph nodes (lymph tissue more active until 6 years.)
I should probably skim over the respiratory chapter 25
.
Normal RR for Newborn =
30-60
Normal RR for 1 year old =
20-40
Normal RR for 3 year old =
20-30
Normal RR for 6 year old and 10 year old?
6=16-22; 10=16-20
Cardinal Signs of Mild Resp. Distress/Failure:
Restlessness
Tachypnea
Tachycardia
Diaphoresis
Clinical Manifestations of Moderate Resp. Distress:
Mood changes Headache (lack of 02) Change in depth/pattern of respirations Nostril flaring Retractions Grunt Wheeze or prolonged expiration Anorexia CNS changes--anxiety, confusion, irritability
Clinical Manifestations of Severe Respiratory Distress/Hypoxia:
Bradycardia Cyanosis (from peripheral to central) Dyspnea Hypotension or Hypertension Dimness of vision Somnolence Stupor Coma
What are some pulse ox locations for a baby?
wrist, toes, earlobes, fingernail; a clean and dry spot where blood vessels are relatively close to the skin
How do you measure a NP (nasopharyngeal) tube before suctioning a baby?
from nose to ear
How do you measure an NT (nasotracheal) tube before suctioning?
Kinda like an NG: ear to nose to sternum
How long would you suction a kid with an NT or NP suction?
5 seconds, then rest 1-2 mins between
A cessation of breathing for a period of 20 secs or longer or a shorter period accompanied by bradycardia or cyanosis =
Apnea
Apnea of prematurity occurs at weeks ___ and resolves by ___; usually presents around ____ days of life.
24-32; 38; 2-7
Infant apnea can be characterized in 3 ways:
Central: complete cessation of breathing effort
Obstructive: absence of nasal airflow when respiratory efforts are present
Mixed: central respiratory pause that either precedes or follows airway obstruction
Management of Apnea of Prematurity (AOP)?
Cutaneous stimulation (touching); O2; CR monitor; CPAP, Caffeine, Theophylline/Aminophylline, Neutral thermal environment, Avoid suctioning, Monitor closely while being fed, Family edu on home monitor and CPR.
Sudden, unexplained death of an infant younger than 1 year of age =
SIDS
SIDS occurs most often between what age and to what gender? What times of year?
2-4 mos; Males; winter and spring
Risk factors for SIDS:
Infant: race (#1=amer. indians, #2=alaskans, then non-hispanic blacks, non-hispanic whites ), gender (males), Prematurity, age (2-4 mos often, but overall less than 1 year old), Time of year (winter/spring), Passive smoke exposure, sleeping habits (prone=bad), overheating, sleeping with others and/or with toys/quilts and pillows with bedding.
Mom: <20 years at first pregnancy, short interval between pregs, single parenthood, poor prenatal care, lower SES
Educate parents on activities that can reduce risk of SIDS:
Positioning (“Back to sleep”–should sleep on back); Pacifiers; No sleeping with others; Use of fan in room, etc
Most common complication of URI =
Otitis Media
Manifestations of Otitis Media in baby:
Fussiness, fever, pulling at ears, anorexia
When are tubes recommended in ears for kids who have frequent ear infections?
if they have 6 ear infections in one year or 1 ear infection (with an effusion–fluid) for 3 months
Management of Otitis Media :
5/7/10 days of Antibiotics (amoxicillin or omnicef); Acetaminophen or Ibuprofen; Possibly Myringotomy with insertion of tympanostomy tubes
When trying to manage Otitis Media, when should you call the MD?
if no improvement in 48 hours or if drainage noted from ear.
4 Common causes of Upper Airway Obstruction:
Foreign object, Croup, Epiglottitis, Congestion.
Acute inflammation and edema of the larynx, trachea, bronchial tubes that can be caused by Para influenza I, II, III virus, H-flu, Adenovirus, Pertussis, RSV, or Mycoplasm pneumonia =
Croup (ALTB- acute laryngeotracheobronchiitis); mostly viral (so antibiotics won’t work)
Croup Symptoms:
Barking cough, hoarse cry, muffled vocal sounds, inspiratory stridor, increased use of accessory muscles, varying degrees of resp. distress, increased symptoms at night, inc. agitation/crying.
Meds for Croup:
Racemic epinephrine inhaled, Corticosteroids, Antibiotics (for non-viral cases).
Bacteria that can cause Epiglottitis =
Beta hemolytic strep, group A
Condition where epiglottis becomes swollen, cherry red, and surrounded with copious secretions; edema can be severe and painful and obstruct airway=life-threatening
Epiglottitis.
S/S of epiglottitis: begins as mild URI, develops high fever, sore throat with dysphasia, froglike croaking, agitation, severe resp. distress, stridor, retractions; Cardinal signs= Drooling, Dysphagia, Dysphonia (hoarseness), Distressed (resp effort).
.
If you suspect Epiglottitis, never _____
stick anything in their throat (ie tongue blade).
4 cardinal signs of Epiglottitis:
Drooling, Dysphagia, Dysphonia, Distressed (resp. effort)
