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Pediatric nursing > Test 2 > Flashcards

Test 2 Flashcards

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1
Q

immunoglobulins are transferred from one person to another; (weeks or months);E: injections of exogenous immunoglobulins or from mother to infant via colostrum or placenta

A

passive immunity

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2
Q

person’s own immune system generates the immune response

A

active immunity

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3
Q

ability to destroy and remove an antigen from the body through antibodies

A

immunity ( immunologic memory )

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4
Q

vaccines mimic the characteristics of

A

an antigen

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5
Q

modified living organisms; replicate in the body but don’t cause disease

A

life attenuated vaccines - 1 or 2 doses

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6
Q

use whole dead organisms or pieces weaker antigen;

A

inactivated vaccines - require multiple doses

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7
Q

genetically engineered; E: hepatitis B vaccine

A

recombinant inactivated vaccine

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8
Q

updates vaccine schedules yearly;

A

• Advisory Committee on Immunization Practices (ACIP)

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9
Q

Vaccine storage and administration

A

package insert

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10
Q

must be provided to parents whose kids receive vaccine

A

Vaccine Information Statements (VIS) - whats for, side effects

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11
Q

Report any clinically significant adverse reaction

to the

A

Vaccine Adverse Event Reporting System

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12
Q

Proper documentation

A

date; name of vaccine; lot number and expiration date; manufactures name; site and route; name and address of the facility

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13
Q

DTaP

under 1

A

( diphtheria, tetanus, and pertussis ) ; for children under 7 ; first one - under 1; IM

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14
Q

Tdap

A

for children over 7; tetanus booster for older kids (11-12) every 5-10 years;
– Rising pertussis cases since 1970 - infants, adolescents and young adults.

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15
Q

Hib

under 1

A

Haemophilus influenzae Type B Vaccine; prevents – meningitis, epiglottitis, septic arthritis in children under age 5 ; IM

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16
Q

Polio vaccine
under 1
* polio - paralytic disease

A

– Inactivated polio vaccine (IPV)
currently recommended in US
– Killed virus, poses no risk of infection; SC - subcute

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17
Q

Hep B

under 1

A

Hepatitis B; – Recombinant vaccine

– Series usually started at birth before discharge from hospital; 3 doses in 6 months ; IM

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18
Q

Pneumococcal vaccine

under 1

A

– Streptococcus pneumoniae most common cause of serious
infection in children under age 2 - pneumonia, sepsis, meningitis, otitis media; – Conjugate vaccine (13 strains) started in infancy; IM

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19
Q

Rotavirus vaccine

under 1

A

– Most common cause of severe
gastroenteritis (infectious diarrhea) in young children
– Live vaccine, given by oral route to infants

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20
Q

MMR

over 1

A

Measles, Mumps, and Rubella Vaccine ; – Live attenuated virus combination
– 2 doses given to children > 12 months of age ( before kindergarten ) ; SC

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21
Q

Varicella vaccine

over 1

A

chicken pox ; – Live attenuated virus

– 2 doses given to children > 12 months of age; SC

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22
Q

Hep A

over 1

A

Hepatitis A vaccine; IM
– Inactivated whole virus vaccine
– One of the most frequently reported diseases in the US
– 2 doses given to children > 12 months of age ( 12-15 month and 2nd - 6 month later)

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23
Q

Meningococcal vaccine

age 11

A

IM; Neisseria meningitidis causes meningitis and sepsis

– 10-12% of infected persons die, 20% of survivors suffer longterm consequences; 11-12 - booster at age 16

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24
Q

HPV

11-12

A

Human Papillomavirus vaccine; IM; – Infection most common in adolescents and young adults who are sexually active
– HPV causes genital warts that can lead to cervical cancer; for girls only ; for boys and girls ( 3 shots )

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25
Q

Influenza vaccine

A

IM; – Universally recommended > 6 months of age; inactivated - IM; nasal mist - alive ( not for compromised children) ; intradermal injection - inactivated ( not for children under 18).

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26
Q

Mild common reactions to immunization

A

Fever - 102.9 ( OK); irritability; sleepiness; poor appetite; rash ( MMR and varicella) - 5-20 days

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27
Q

Severe - concorning ( rare) reactions

A

difficulty breathing ( allergic reaction ) - pallor, weakness, decreased BP, hives ; seizures ; after DTaP - crying for 3 hours ( increased irritability)

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28
Q

Post-Vaccine Interventions

A

• Tylenol every 4 hours for pain or fever
• No ibuprofen to infants < than 6 months of age
• No ASA to any child under 16 years of age
• Warm baths or compresses
• Encourage ambulation or use of affected
extremity

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29
Q

Immunize - yes

A
  1. Child is on antibiotics;
  2. Minor illness - except flue vaccine
  3. Mild allergies
  4. Breastfeeding infant and parent
  5. Pregnant household contact
  6. Allergy to eggs - except flue (influenza) vaccine
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30
Q

Immunize - NO

A
  1. rash or hives after previous injection
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31
Q

Barriers to Immunization

A
  • Parental concerns re: safety
  • Misconceptions - autism ? thimerosal ( mercury ) ?
  • More than 1 health care provider
  • Multiple children in family
  • Cost
  • Concern about multiple vaccines
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32
Q

Overcoming Barriers

A

• Combination vaccines - reduce the number child gets sticked
• Vaccines for Children (VFC) program
implemented in 1994 - can get it at medical home from goverment
• Establish medical home
• Verify immunization status at every visit
• Verify status of siblings accompanying child
• Maintain centralized record

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33
Q

Differences in the skin

A

skin is thinner; blood vessels closer to the body ; heat loss more readily; substance absorbed more readily; more water, less pigment - risk for sun damage

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34
Q

Physical examination of skin

A

note temperature, moisture, texture; describe lesions: appearance- macular (flat); papular (bumpy); vesicular (blisters); pustular( with puss); shape: round; oval; annular( central clearing); linear; target rash (bull’s eye) ; drainage: clear, purulent; honey color; or otherwise; note scaling, lichenification (thickening); tattoos, piercing.

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35
Q

Staphylococus aureus and group A b-hemolytic streptococcus ( normal flora on skin) ; assess for regional lymphadenopathy; culture for cellulitis ; topical antibiotics; sever - systemic; contact precaution

A

Bacterial infections

36
Q

honey colored crust; around the mouth or below the nose; bullous ( red macules)

A

Impetigo

37
Q

infection of the hair follicle; red raised papular pustules;

A

Folliculitis

38
Q

localized infection and inflammation of the skin and subcut tissues; often follows skin trauma; non discrete borders; erythema, pain, edema, warmth

A

Cellulitis

39
Q

infection with the toxin from the staph aureus; flattish bullae ( blisters) that rupture leaving skin red, weeping and causes exfoliation; looks like a burn; common in infants; aggressive fluid management ( IV); incubator for heat; IV antibiotics; pain management ( opioids)

A

Scalded skin syndrome

40
Q

risk factors: pets; barber; locker rooms; nylon socks; tight clothing; swimming pools; contact sports; contagious but can return while treatment begins; cotton socks; antifungal cream

A

Fungal infections

41
Q

ring warm, annual lesion; raised and scaly; itching; af cream for (3-4 weeks)

A

Tinea corporis

42
Q

athlete’s foot; red scaling rash on soles and between the toes; itchy; TX: topical af ( 4 weeks) ; toes clean and dry; cotton socks;

A

Tinea pedis

43
Q

erythema, scaling, maceration in the inguinal creases and inner thighs; topical - 4-6 weeks

A

Tinea cruris

44
Q

infection of the scalp; patches of scaling; and hair loss; kerion - inflamed boggy mass filled with pustules; TX: 6 weeks oral af meds; no school for 1 week after treatment starts

A

Tinea capitis

45
Q

diaper rash; candida albicans; fiery red lesions; scaling in the skin folds; satellite lesions; topical antifungal after every diaper change; discontinue soaps and wipes ( flora)

A

Diaper candidiasis

46
Q

inflammatory skin condition; common diaper rash; prolonged contact with urine or feces; flat red rash; prevention: topical ointments; change diaper often;

A

Diaper dermatitis

47
Q

eczema; skin reaction; chronic skin infection; extreme itching - psychological distress; complication - bacterial superinfection; atopy family - asthma, allergic rhinitis and eczema - auscultate lungs ( wheezing); DX: serum IgE, skin prick allergy testing to determine the food or environmental allergen

A

Atopic dermatitis

48
Q

Atopic dermatitis management

A
  • Promote skin hydration: warm water every day - moisturizer after; ointment ( Vaseline); fragrance free/ die free; oatmeal or colloid bath.
  • Maintain skin integrity: topical corticosteroid ( less than 50 %) at a time (not every day) ; avoid tight clothing, heat, synthetic fabrics and wool; perfumes, dies, harsh chemicals,
  • Prevent infection: short clean fingernails; antihistamines given at bedtime ( sedation); antibiotics for secondary infections ; distractions to prevent scratching
49
Q

History of present illness ( HF s/s)

A
  1. easy fatigability ( with activity)
  2. frequent occurrences of pneumonia
  3. cyanosis
  4. difficulty keeping up with peers
  5. changes in HR + BP
50
Q

Past medical history

A

pregnancy history; prenatal care; family history of heart disease; premature infant - higher risk

51
Q

Inspection

A

color - pallor, cyanosis ; activity level !!!

52
Q

Auscultation

A

lung + heart; adventitious sounds; extra heart sounds ( S3, S4); WOB (work of breathing) - increased HR, RR; dyspnea

53
Q

Palpation

A

all the peripheral pulses

54
Q

Murmurs

A
  1. Gr 1 - difficult to auscultate; very quiet; ( quiet room + child)
  2. Gr 2 - little louder ( couple seconds)
  3. Gr 3 - as soon as start listen
  4. Gr 4 - loud + thrill ( vibration )
  5. Gr 5 - stethoscope partially off the chest wall + thrill
  6. Gr 6 -stethoscope off the chest + thrill
55
Q

Clubbing

A

chronic hypoxia ( 1 year or more )

56
Q

lab + diagnostic testing

A
  1. CBC - polycythemia ( increase RBC - chronic hypoxia)
  2. Partial pressure of oxygen - amount of O2 in the blood
  3. Chest X-ray - size of the heart
  4. Echocardiogram - ultrasound
  5. ECG - rate, rhythm, conduction and musculature
  6. Cardiac catheterization - golden standard - diagnostic, interventional, electrophysiologic
57
Q

Tetrologyof Fallot

A

Disorders with decreased pulmonary blood flow; 4 defects:

  1. ventricular septal defect
  2. pulmonary stenosis
  3. overriding aorta
  4. right ventricular hypertrophy
58
Q

Tetrologyof Fallot - S/s

A
  1. Cyanosis
  2. Fatigue ( with activity)
  3. poor feeding + growth
  4. Hypercyanotic spell - blue baby when agitated or upset - classic sign
59
Q

Hypercyanotic spell - interventions

A
  1. Remain calm
  2. Knees up to the chest position ( squads) - increase peripheral pressure - blood shunts to lungs
  3. O2
  4. Morphine to calm down
60
Q

Disorders with increased pulmonary flow

A
  1. Atrial septal defect
  2. Ventricular septal defect
  3. Patent ductus arteriosus
    S/s - increased pulmonary infections - pneumonia
61
Q

Atrial septal defect

A

Left side of the heart has increased pressure - increased blood volume in right atrium - increased blood flow to the lungs ;;; s/s - asymptomatic ( small holes) ; most of the time close by themselves by age 3; large - closed surgically; snowman x-ray

62
Q

Ventricular septal defect

A

small - close by age 3; large - risk for HF; increased amounts of blood in the right ventricle

63
Q

Ventricular septal defect - cyanosis - interventions

A

cover the infant and elevate his head

64
Q

Patent ductus arteriosus

A

connection between aorta ( from) and pulmonary artery( to)

65
Q

Patent ductus arteriosus TX

A
  1. NSAIDs - inhibit production of prostaglandins ( which keep ductus arteriosus open) - Indomethacin
  2. Cardiac cath - clog it off
  3. Open heart surgery - tight off
    * premature babies ; infants born at high altitudes (Denver)
66
Q

Coarctation of the Aorta

A

obstructive disorder; narrowing of the aorta; difficulty of blood getting to the lower body; -puts a lot of pressure on the left side of the heart; collateral circulaion ( smaller vessels);

67
Q

Coarctation of the Aorta: S/s

A

leg pain with activity; BP and pulses higher in the upper extremities (bounding pulses) - thready pulses in legs; notching of the ribs ( children) - vessels grown and multiplied.; headaches, frequent epistaxis - nosebleed

68
Q

Transposition of the Great Vessels

A
  1. Body - RA - RV - Aorta - Body
  2. Lungs - LA - LV - Pulmonary artery - Lungs
    * no murmur, cyanosis
    Don’t pick up until fetal structures ( ductus arteriosus - mixes blood) close.
    TX: surgery - reverse great vessels; balloon to create hole - to mix blood
    Mixed defects
69
Q

Hypoplastic Left Heart Syndrome

A

Mixed Defects; congenital; all of the structures on the left side of the heart are severely undeveloped - no blood to the systemic circulation ; DX: in utero - maternal ultrasound; TX: procedures in utero; at birth surgery - get oxygenated blood in the vessel that goes to the body; two more - move systemic pumping mechanism from the left side to the right side

70
Q

Congenital heart defects - nursing interventions

A
  1. Make sure that oxygenation level is adequate ; Position - semi fowler’s or fowler’s
  2. Adequate nutrition - need more calories; infants - high calorie formula ( 24-26 cal/oz) ; small frequent meals; milk shake ( high protein) ; no more than 20 min ( fatigue ) breastfeeding or formula + rest through feeding tube or TPN;
  3. Assist the child and family coping - give in to child’s wishes - vulnerable child syndrome - teach discipline ; move to non-heart topics
  4. Prevent infection - especially children with increased pulmonary flow
71
Q

Acquired cardiovascular disorders

A
  1. Heart failure
  2. Acute rheumatic fever
  3. Kawasaki disease
72
Q

Heart failure : health history

A

inability of heart to pump blood; most often in children with CHD

  1. change in eating habits
  2. not tolerate position changes
  3. SOB; fatigue
  4. Decreased urinary output
73
Q

HF: physical exam

A
  1. back up of blood to lungs - crackles
  2. increased work of breathing
  3. increased HR and RR
  4. Diaphoresis; cool clammy skin
  5. Thready pulses
74
Q

HF : management

A
  1. Oxygenation
  2. Support cardiac function - Digoxin
  3. Daily weights - monitor fluids
  4. Increase calories
  5. Rest is key - no activities; quiet
75
Q

Digoxin

A

increase contractility of the heart; apical pulse for 1 full minute before administer - withhold lower than 60 ( younger 70; infants 90); for two missed doses - notify; if vomited - wait for second dose;

76
Q

Digoxin side effects - toxic

A
  1. decreased HR
  2. Vomiting ( younger kids) nausea (older kids)
  3. Visual disturbances - spinning, blurry; infant - can’t track
77
Q

Acute rheumatic fever

A

Post strep throat ( acute renal failure - glomerulonephritis ) ; school age - 5-15; 6-12 weeks ; can damage heart valves - carditis ( x-ray, echo) ; if not treated strep - consider antibiotics ; multiple joint swelling; ASO titer ( if strep present), elevated WBC, ESR + CRP (inflammation)

78
Q

Acute rheumatic fever - TX

A
  1. Daily prophylactic antibiotic (low dose after Tx is done);
  2. Rest - activity restriction and importance of adherence
  3. Pain management
  4. Cardiac follow up
79
Q

Chorea

A

involuntary jerky movements

80
Q

Kawasaki disease

A

systemic vasculitis; inflammation of epithelial cells that line blood vessels ( in the heart too); - coronary artery aneurysm - MI and death; DX: echocardiogram ( under 5 kids)

81
Q

Kawasaki disease - TX

A
  1. Single infusion of intravenous immunoglobulin ;
  2. corticosteroids - reduce inflammation systemically
  3. High dose aspirin therapy
82
Q

Toxic effects of aspirin therapy

A
  1. Tinnitus - ringing in the ear
  2. Headache
  3. Confusion + dizziness
83
Q

Kawasaki disease S/s

A
  1. Fever for at least 5 days
  2. Dry, fissured lips
  3. Conjunctivitis - inflammation of the eyes without discharge
  4. bright maculo-papular rash
  5. Desquamation ( peeling) of the feet and hands
  6. Irritability, strawberry tongue
  7. Photophobia
    * very high ESR
84
Q

Kawasaki disease DX

A

4 symptoms + Fever for 5 days

85
Q

Kawasaki disease - management

A
  1. Encourage fluids ; IV fluids
  2. Monitor for signs of HF
  3. Comfort - acetaminophen ; quiet environment, position
  4. Education - monitor fever even after discharge ; cardiac follow up

Pediatric nursing (2 decks)

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