Test 2 Flashcards
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
passive immunity
person’s own immune system generates the immune response
active immunity
ability to destroy and remove an antigen from the body through antibodies
immunity ( immunologic memory )
vaccines mimic the characteristics of
an antigen
modified living organisms; replicate in the body but don’t cause disease
life attenuated vaccines - 1 or 2 doses
use whole dead organisms or pieces weaker antigen;
inactivated vaccines - require multiple doses
genetically engineered; E: hepatitis B vaccine
recombinant inactivated vaccine
updates vaccine schedules yearly;
• Advisory Committee on Immunization Practices (ACIP)
Vaccine storage and administration
package insert
must be provided to parents whose kids receive vaccine
Vaccine Information Statements (VIS) - whats for, side effects
Report any clinically significant adverse reaction
to the
Vaccine Adverse Event Reporting System
Proper documentation
date; name of vaccine; lot number and expiration date; manufactures name; site and route; name and address of the facility
DTaP
under 1
( diphtheria, tetanus, and pertussis ) ; for children under 7 ; first one - under 1; IM
Tdap
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.
Hib
under 1
Haemophilus influenzae Type B Vaccine; prevents – meningitis, epiglottitis, septic arthritis in children under age 5 ; IM
Polio vaccine
under 1
* polio - paralytic disease
– Inactivated polio vaccine (IPV)
currently recommended in US
– Killed virus, poses no risk of infection; SC - subcute
Hep B
under 1
Hepatitis B; – Recombinant vaccine
– Series usually started at birth before discharge from hospital; 3 doses in 6 months ; IM
Pneumococcal vaccine
under 1
– 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
Rotavirus vaccine
under 1
– Most common cause of severe
gastroenteritis (infectious diarrhea) in young children
– Live vaccine, given by oral route to infants
MMR
over 1
Measles, Mumps, and Rubella Vaccine ; – Live attenuated virus combination
– 2 doses given to children > 12 months of age ( before kindergarten ) ; SC
Varicella vaccine
over 1
chicken pox ; – Live attenuated virus
– 2 doses given to children > 12 months of age; SC
Hep A
over 1
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)
Meningococcal vaccine
age 11
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
HPV
11-12
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 )
Influenza vaccine
IM; – Universally recommended > 6 months of age; inactivated - IM; nasal mist - alive ( not for compromised children) ; intradermal injection - inactivated ( not for children under 18).
Mild common reactions to immunization
Fever - 102.9 ( OK); irritability; sleepiness; poor appetite; rash ( MMR and varicella) - 5-20 days
Severe - concorning ( rare) reactions
difficulty breathing ( allergic reaction ) - pallor, weakness, decreased BP, hives ; seizures ; after DTaP - crying for 3 hours ( increased irritability)
Post-Vaccine Interventions
• 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
Immunize - yes
- Child is on antibiotics;
- Minor illness - except flue vaccine
- Mild allergies
- Breastfeeding infant and parent
- Pregnant household contact
- Allergy to eggs - except flue (influenza) vaccine
Immunize - NO
- rash or hives after previous injection
Barriers to Immunization
- Parental concerns re: safety
- Misconceptions - autism ? thimerosal ( mercury ) ?
- More than 1 health care provider
- Multiple children in family
- Cost
- Concern about multiple vaccines
Overcoming Barriers
• 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
Differences in the skin
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
Physical examination of skin
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.
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
Bacterial infections
honey colored crust; around the mouth or below the nose; bullous ( red macules)
Impetigo
infection of the hair follicle; red raised papular pustules;
Folliculitis
localized infection and inflammation of the skin and subcut tissues; often follows skin trauma; non discrete borders; erythema, pain, edema, warmth
Cellulitis
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)
Scalded skin syndrome
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
Fungal infections
ring warm, annual lesion; raised and scaly; itching; af cream for (3-4 weeks)
Tinea corporis
athlete’s foot; red scaling rash on soles and between the toes; itchy; TX: topical af ( 4 weeks) ; toes clean and dry; cotton socks;
Tinea pedis
erythema, scaling, maceration in the inguinal creases and inner thighs; topical - 4-6 weeks
Tinea cruris
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
Tinea capitis
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)
Diaper candidiasis
inflammatory skin condition; common diaper rash; prolonged contact with urine or feces; flat red rash; prevention: topical ointments; change diaper often;
Diaper dermatitis
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
Atopic dermatitis
Atopic dermatitis management
- 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
History of present illness ( HF s/s)
- easy fatigability ( with activity)
- frequent occurrences of pneumonia
- cyanosis
- difficulty keeping up with peers
- changes in HR + BP
Past medical history
pregnancy history; prenatal care; family history of heart disease; premature infant - higher risk
Inspection
color - pallor, cyanosis ; activity level !!!
Auscultation
lung + heart; adventitious sounds; extra heart sounds ( S3, S4); WOB (work of breathing) - increased HR, RR; dyspnea
Palpation
all the peripheral pulses
Murmurs
- Gr 1 - difficult to auscultate; very quiet; ( quiet room + child)
- Gr 2 - little louder ( couple seconds)
- Gr 3 - as soon as start listen
- Gr 4 - loud + thrill ( vibration )
- Gr 5 - stethoscope partially off the chest wall + thrill
- Gr 6 -stethoscope off the chest + thrill
Clubbing
chronic hypoxia ( 1 year or more )
lab + diagnostic testing
- CBC - polycythemia ( increase RBC - chronic hypoxia)
- Partial pressure of oxygen - amount of O2 in the blood
- Chest X-ray - size of the heart
- Echocardiogram - ultrasound
- ECG - rate, rhythm, conduction and musculature
- Cardiac catheterization - golden standard - diagnostic, interventional, electrophysiologic
Tetrologyof Fallot
Disorders with decreased pulmonary blood flow; 4 defects:
- ventricular septal defect
- pulmonary stenosis
- overriding aorta
- right ventricular hypertrophy
Tetrologyof Fallot - S/s
- Cyanosis
- Fatigue ( with activity)
- poor feeding + growth
- Hypercyanotic spell - blue baby when agitated or upset - classic sign
Hypercyanotic spell - interventions
- Remain calm
- Knees up to the chest position ( squads) - increase peripheral pressure - blood shunts to lungs
- O2
- Morphine to calm down
Disorders with increased pulmonary flow
- Atrial septal defect
- Ventricular septal defect
- Patent ductus arteriosus
S/s - increased pulmonary infections - pneumonia
Atrial septal defect
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
Ventricular septal defect
small - close by age 3; large - risk for HF; increased amounts of blood in the right ventricle
Ventricular septal defect - cyanosis - interventions
cover the infant and elevate his head
Patent ductus arteriosus
connection between aorta ( from) and pulmonary artery( to)
Patent ductus arteriosus TX
- NSAIDs - inhibit production of prostaglandins ( which keep ductus arteriosus open) - Indomethacin
- Cardiac cath - clog it off
- Open heart surgery - tight off
* premature babies ; infants born at high altitudes (Denver)
Coarctation of the Aorta
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);
Coarctation of the Aorta: S/s
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
Transposition of the Great Vessels
- Body - RA - RV - Aorta - Body
- 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
Hypoplastic Left Heart Syndrome
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
Congenital heart defects - nursing interventions
- Make sure that oxygenation level is adequate ; Position - semi fowler’s or fowler’s
- 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;
- Assist the child and family coping - give in to child’s wishes - vulnerable child syndrome - teach discipline ; move to non-heart topics
- Prevent infection - especially children with increased pulmonary flow
Acquired cardiovascular disorders
- Heart failure
- Acute rheumatic fever
- Kawasaki disease
Heart failure : health history
inability of heart to pump blood; most often in children with CHD
- change in eating habits
- not tolerate position changes
- SOB; fatigue
- Decreased urinary output
HF: physical exam
- back up of blood to lungs - crackles
- increased work of breathing
- increased HR and RR
- Diaphoresis; cool clammy skin
- Thready pulses
HF : management
- Oxygenation
- Support cardiac function - Digoxin
- Daily weights - monitor fluids
- Increase calories
- Rest is key - no activities; quiet
Digoxin
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;
Digoxin side effects - toxic
- decreased HR
- Vomiting ( younger kids) nausea (older kids)
- Visual disturbances - spinning, blurry; infant - can’t track
Acute rheumatic fever
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)
Acute rheumatic fever - TX
- Daily prophylactic antibiotic (low dose after Tx is done);
- Rest - activity restriction and importance of adherence
- Pain management
- Cardiac follow up
Chorea
involuntary jerky movements
Kawasaki disease
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)
Kawasaki disease - TX
- Single infusion of intravenous immunoglobulin ;
- corticosteroids - reduce inflammation systemically
- High dose aspirin therapy
Toxic effects of aspirin therapy
- Tinnitus - ringing in the ear
- Headache
- Confusion + dizziness
Kawasaki disease S/s
- Fever for at least 5 days
- Dry, fissured lips
- Conjunctivitis - inflammation of the eyes without discharge
- bright maculo-papular rash
- Desquamation ( peeling) of the feet and hands
- Irritability, strawberry tongue
- Photophobia
* very high ESR
Kawasaki disease DX
4 symptoms + Fever for 5 days
Kawasaki disease - management
- Encourage fluids ; IV fluids
- Monitor for signs of HF
- Comfort - acetaminophen ; quiet environment, position
- Education - monitor fever even after discharge ; cardiac follow up
