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Module 5- PEDI > UNIT 2: IMMUNIZATIONS & COMMUNICABLE DISEASES > Flashcards

UNIT 2: IMMUNIZATIONS & COMMUNICABLE DISEASES Flashcards

1
Q

Vaccines stimulate the ______ to produce antibodies?

A

Immune system

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2
Q

Vaccines use the ____ antigens as disease but killed or weakened

A

Same

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3
Q

What happens after antibodies disappear after destorying antigens..

A

Memory cells are formed

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4
Q

Who decides what vaccines?

A
  1. Advisory committee on immunization practices (ACIP)
    • Centers for disease control and prevention
    • pink book
  2. Committee on infectious diseases
    • American Academy of pediatrics
    • Red book
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5
Q

Why vaccinate?

A
  1. Prevent infectious disease
  2. Society
    • Decrease/eliminate certain infectious diseases
    • heard immunity
  3. Potentaial for reemergence if we dont have enough of the population vaccinated
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6
Q

Other than vaccinations how else can we prevent infections?

A
  1. Immunization
  2. handwashing
  3. reduce cross-transmission of organisms
    • follow isolation protcol
  4. infection control policies
  5. sneeze and cough etiquette
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7
Q

What do we need to know about active immunity?

gernalized

A
  1. Endogenous production of antibodies
  2. Takes weeks/months to develop
  3. Long-lasting
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8
Q

What are 2 ways to acquire active immunity?

A
  1. Survive infection
  2. Vaccination
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9
Q

Active immunity is actively formed by….

A

The persons own immune system in repsonce to an antigen

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10
Q

What should we know about passive immunity?

Generalized

A
  1. Antiboides given to a person
  2. Immediate protection
  3. Short-lived
  4. Most common- maternal/infant
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11
Q

True or false: Babies born at full term will have the same antibodies that mom has and it can protect the baby up to 1 year of life?

A

True

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12
Q

What are different types of antibody sources?

provide passive immunity

A
  1. Blood products
    • any blood product… there are antibodies in it
  2. Immune globulin
    • Taken from 1000 adult donors… has lots of different antibodies.
  3. Hyperimmune globulins
    • High concentration of a spcecific antibodies
  4. Antitoxin
    • Derived from an animal for example horses… so horse is vaccinated and then we will use the antibodies from them. Often times people will experience an adverse reaction to the horse protien.. which can cause serum sickness
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13
Q

What are 2 types of vaccines?

A
  1. Live attenuated vaccines
  2. Inactivated vaccines
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14
Q

What do we need to know about live attenuated vaccines?

A
  1. Weakened form of “wild” virus/bacterium
  2. Must replicate
    • Blood products might affect the vaccine from replicating which effects its effectiveness
  3. Issues with effectiveness
    • Damage to organism
    • circulating antibody: anything that damages that live organism or interferes with the organisms ability to replicate affects its ability to protect.
    • Specific handeling/storage
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15
Q

What are examples of live attenuated vaccines?

A
  1. Measles
  2. Mumps
  3. Rubella
  4. Varicella
  5. Rotavirus
  6. Intranasal influenza
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16
Q

What do we need to know about inactivated vaccines?

A
  1. Produced in a culture media
  2. Cannot replicate
  3. Multiple doses
  4. Less affected by ciruclating antibody
    • Blood transfusions can be given at the same time since it doest effect
  5. Antibody titer diminishes over time
    • Booster
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17
Q

What are examples of inactivated vaccines?

A
  1. Polio
  2. Hep A &B
  3. Rabies
  4. Influeza
  5. Acellular pertusis
  6. Human papillomavirus
  7. diphtheria
  8. Tetanus
  9. Pneumococacal
  10. Meningocococal
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18
Q

Why are move inactivated vaccines given more than once?

A

1st dose usually primes the immune system… we start gaining immunity after the 2-3 dose

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19
Q

What factors could cause vaccine failure?

A
  1. Age/maternal antibody
  2. dose
  3. route
  4. storage and handling
  5. nutritional status
  6. Coexisting disease
  7. genetics
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20
Q

What information do we need to gather in order to prep for vaccine administration?

A
  1. Immunization history
    • Should be done at every visit
  2. Recommened schedule
  3. Screening
    • For contraindications
  4. discuss benefits/risks
    • VIS statements
  5. After care instructions
    • education on s/s to expect and appropritate times to take tylenol and motrin
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21
Q

What are nursing considerations/communications in regards to vaccinations?

A
  1. Provide accurate user-friendly information
    • Explain they are needed what is going to help prevent
  2. Parent is expressing concern for childs health
  3. Be genuine & Empathetic r/t parents concerns
  4. Avoid judgmental/threatening language
  5. Be knowledgable
  6. Give VIS before vaccination & Anwser question
  7. Be flexible
    • Parents may want to spread out vaccines
  8. Involve parent in minimizing adverse effects
  9. Rescpect parents ultimate wishes
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22
Q

What documentation must we have for vaccinations?

A
  1. Day, month & year of administration
  2. vaccine manufacturer
  3. Vaccine lot number
  4. Name and title of person administering vaccine & Address of facility
  5. Vaccine information statement
  6. Route
  7. Site
  8. Informed concent
  9. Vaccine refusal
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23
Q

What are some important issues regarding vaccines?

A
  1. Spacing of vaccines
    • Interval between doses of same vaccine
  2. timing of antibody-containing blood products
    - Live Vaccines: If given to close together it can alter the effectiveness of the vaccine
    - inactivated vaccines: not typically affected
  3. Screening
    • Idenitfy contraindications/precautions: usuing standardized screening forms
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24
Q

Allergy to vaccine or component is it contraindicated in live attenuated and/or inactivated?

A

Live: Contraindicated
Inactivated: Contraindicated

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25
Q

Encephalophathy: Is it contraindiated to give a live attenuated or inactivated vaccine?

A

Live: —
Inactivated: Contraindicated

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26
Q

Pregnancy: is it contraindicated to give a live attenuated or inactivated vaccine?

A

Live: Contraindicated
Inactivated: Vaccinate w/some exceptions

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27
Q

immunosuppression: Is it contraindicated to give a live attenuated or inactivated vaccine?

A

Live: Contraindicated
Inactivated:Vaccinate with some exceptions

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28
Q

Moderate to severe illness: Is it contraindicated to give a live attenuated or inactivated vaccine?

A

Live: Precaution
Inactivated: Precaution

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29
Q

Recent blood products: Is it contraindicated to give live attenuated or inactivated vaccines?

A

Live: Precaution
Inactivated: Vaccinate

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30
Q

What are some common misconceptions/myths with vaccinations?

A

Invalid “contraindications”
1. Mild Illness
2. antimicrobial therapy
3. preganant or immunosuppressed person in the househould
4. breastfeeding- Okay with all but NOT small pox
5. Preterm Birth: Must be atleast 2 kilos
6. Allergy to products not in vaccine: important to know whats in the vaccine
7. Multple vaccines: No evidence.. but it is important to keep on tract.

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31
Q

What are some local reactions to vaccines?

A
  1. Mild/self-limited
  2. Pain/swelling/redness at injection site
  3. Within hours of injection
  4. Common with inactivated vaccines
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32
Q

What are some systemic reactions to vaccinations?

A
  1. Fever/malaise/headache/myalgia/loss of appetite
  2. Reactions following live vaccines may be simiular to mild form of disease
  3. Can occur 7-21 days after the vaccine administration
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33
Q

How long should we observe a patient for adverse events after a vaccine

A

15 mins

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34
Q

What should we do if a patient has a adverse event?

A
  1. Vaccine adverse event reporting system (VAERS)
  2. Any clinically significant adverse event
  3. Even if you are unsure if the vaccine caused it
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35
Q

Which vaccines are given subQ?

A
  1. MMR (measles, mumps, rubella)
  2. Varicella
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36
Q

What vaccines are given intramusclular?

A
  1. dTaP/Tdap (diphtheria, tetanus, aceullar pertussis
  2. Hep a
  3. Hep B
  4. HIB (Haemophilus influenzae type B)
  5. HPV (Human papillomavirus)
  6. IPV (Inactivated polio vaccine) IM or sub Q
  7. PCV (Pneumococcal vaccine) IM or sub Q
  8. MCV (Meningococcal vaccine) IM or sub Q
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37
Q

Do we aspirate w/ vaccinations?

A

Aspiration not required w/vaccines
1. No reports of injury
2. Veins/Arteries too small to allow IVP of vaccine
3. Study in canada: Patient expereienced less pain when vaccine given rapidly w/out aspiration.

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38
Q

What should we take in consideration with children with bleeding disorders and vaccinations?

A
  1. Potential for hematoma with IM injection
  2. Physician needs to be made aware if not already
  3. Hemophilia- Factor replacement? Will need to know when there last dose of factor replacement was
  4. 23 gauage or finer needle
  5. Firm pressure for 2 miniutes
    • Do not rub/massage site
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39
Q

How do we provide atraumatic care when giving vaccinations?

A
  1. Distraction that is developmentally appropriate
  2. Parent cuddling/holding, pacifiers
  3. Sweet tasting solutions (oral sucrose)
  4. Breastfeeding
  5. Injection technique
  6. Order of injections
  7. Tactile stimulation (rub/stroke near injection site/buzzy)
  8. Topical anesthetic
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40
Q

What are some different types of communicable diseases?

A
  1. Pertusis
  2. chicken pox
  3. Rubeola
  4. Mumps
  5. Rubella
  6. Scarlet fever
  7. Coronavirus/ Covid 19
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41
Q

What is a macule?

A

Flat discoloration of skin

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42
Q

What is a papule?

A

Solid raised lesion on skin

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43
Q

What is a vesicular?

A

Fluid filled sac

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44
Q

What is maculopapular?

A

Raised discolored lesion

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45
Q

How is pertusis (whooping cough) spread?

A
  1. Respiratory secrtions (direct/indirect)
  2. Most contagious during the Catarrhal stage
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46
Q

What are the s/s of pertusis (whooping cough) during the Catarrhal stage

A

Catarrhal stage
1. Respiratory symptoms
2. Low grade fever
3. Last 1-2 weeks

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47
Q

What are s/s of pertusis (whooping cough) during the paroxysmal stage?

A
  1. Bursts of numerous, rapid coughs
  2. sudden inspiration creating high pitched “whoop”
  3. Cheecks become flushed or cyanotic
  4. Eyes may buldge/tongue protrudes
  5. May continue until thick mucous plug disloged
  6. Vomiting
  7. exhaustion
  8. More common at night
  9. Last 4-6 weeks
48
Q

What are the signs and symptoms of pertusis (whooping cough) during the convalescent stage?

A
  1. Coughing gradually stops
  2. Single cough may continue
  3. Paroxysmal cough may return
  4. Last 2-3 weeks
49
Q

What are the 3 stages we talked about in pertusis?

A
  1. Catarrhal
  2. Paroxysmal
  3. Convslescent
50
Q

What are complications of pertusis?

A

1. Pneumonia (secondary bacterial pneumonia)
2. Apnea
3. Neurological
4. Pressure effects of paroxysms
5. Subdermal hematomas, nosebleeds, rectal prolaspse…
6. Adolescents
- Syncope, sleep distrubances, rib fractures, incontinence

51
Q

What are some inteventions we could do for pertusis?

A
  1. Continuous assessment of respiratory status
  2. Remain with child during coughing spells
  3. Ensure adequate oxygenation
  4. Suction PRN
  5. Reduce factors that promote cough
    • Keep calm and prevent them from getting fussy
  6. Small, frequent meals
    • Refeed a few minutes after emesis
52
Q

What kind of isolation would a pertusis baby be on?

A

Droplet for 5-7 days after antibiotics start

53
Q

How can we prevent pertusis?

A
  1. Immunization
    • DtaP- 5 dose series
    • 2 months, 4 months, 6 months, 15-18M, 4-6 years
  2. TdaP
    • 11-12 years
      **3. Active immunity after infection **
54
Q

What virus is Varicella (Chickenpox) dereived from?

A

Varicella- Zoster Virus (VZV)
1. Primary infection- chicken pox (varicella)
2. Reactivation of latent VZV- Shingels (herpes zoster)

55
Q

How is Varicella (chickenpox) transmitted

A
  1. Respiratory secretions
  2. Contact
56
Q

How contagious is varicella?

A
  1. HIGHLY contagious
57
Q

How soon is varicella contagious?

A

1-2 days before rash appears

58
Q

How long is a person considred contagious when they have varicella?

A

Until all lesions have crusted

59
Q

What percautions do we take with patients in the hospital with varicella?

A
  1. Respiratory percautions (airborne)
  2. Contact percautions
  3. Patient assignment consideration: want to avoid having immunocompromized patients on your patient list when caring for chickenpox
60
Q

What is the 1st sign of the varicella in children?

61
Q

What is the first sign of varicella in adults?

A

1-2 days of fever and malaise

62
Q

How does the varicella rash present?

A

Macule–> papule–> vesicle–> Crust
happen in crops–> healthy child: has around 200-500 lesions in 2-4 crops

63
Q

How does the varicella rash move on along the body?

A
  1. Head–> trunk—> extremities
    Most lessions are on the trunk but can occur anywhere even the mucous membranes
64
Q

What is a classic characteristic of varicella (chickenpox)?

A

Itchy rash

65
Q

What are some complications of varicella (chickenpox)?

A
  1. secondary bacterial infection
  2. Pneumonia
  3. Central nervous system manifestations
66
Q

What should we know about varicella & immunosuppression

A
  1. High risk of disseminated disease
    • Multisystem involvement
    • Hemorrhagic
67
Q

What is the most frequent complication of varicella in the immunosupressed?

A
  1. Pneumonia
  2. Encephalities
68
Q

What should we know about varicella in children with HIV?

A

Increased risk for morbidity

69
Q

What should we know about acyclovir (Zovirax) with varicella?

A
  1. Decreased number of lesions
  2. Shortens duration of fever
  3. Decreased itching, lethargy, and anorexia
70
Q

What should we know about post-exposure prophylxis in treatment of varicella?

A
  1. Varicella vaccine
  2. All persons without immunity after exposure (within 5 days of exposure)
  3. Control of outbreask in children facilities & Schools
71
Q

What are some interventions for varicella we could use?

A
  1. Skin care
  2. apply pressure (no scratching)
  3. Topical calamine
  4. distraction
  5. Fingernails short (or mittens, etc)
  6. Keep cool
  7. No asprin: Risk of reyes syndrome
72
Q

How can we prevent varicella?

A
  1. Maternal immunity up to 1 year
  2. Immunization
    -Varicella Vaccine– 2 dose series
    -VAR (varicella vaccine) or MMRV (combination vaccine)
    • 12-15, 4-6 years old
  3. Active immunity after infection

Healthcare personnel should have documented immunity

73
Q

How is Rubeola (Measles) spread?

A

Resp. Secretions

74
Q

What is the communicability of Rubeola (Measles) like?

A
  1. Highly Communicable
75
Q

What populations are at most risk of contracting Rubeola (measles)?

A
  1. Colleges
  2. Healthcare providers
  3. Traverlers
76
Q

What symptoms of Rubeola (measles) might present before the rash?

A
  1. Fever
    • May peak at 103 - 105 f
      2. The 3 c’s
      • Cough
      • Coryza (runny nose)
      • Conjunctivitis (maybe)
        1. Koplik spots
      • Little blueish/white spots inside check usually shows up a couple days before measels rash
        1. Photophobia (maybe)
77
Q

How does the Rubeola (Measels) rash present?

A
  1. Red Maculopapular rash (raised and discolored)
  2. Starts at hairline–> Moves downward and outward
  3. Becomes confluent: all starts to run togehter
  4. fades in order of apperance
78
Q

What are some associated s/s of Rubeola (Measles)

A
  1. Anorexia
  2. Malaise
  3. Diarrhea
  4. Generalized lymphadenopathy
79
Q

What are some complications of Rubeola (Measles)

A
  1. Otitis Media
  2. Pneumonia: Most common cause a death in children
  3. Encephalitis: Most common cause of death in adults
  4. More severe in malnourished children esp. with a vitamin A deficiency
80
Q

What are some interventions we can do for Rubeola (Measles)?

A
  1. Vitamin A for severe measles
    • High doses- may experience vomiting and headache
  2. Antipyretics
  3. Cool mist vaporizer
  4. Eye Care
    • Dim light
    • Clean eyelids with warm saline solution
    • watch corneas for ulcers
  5. Skin Care
    • Warm bath with no soap
81
Q

What type of percaution should be taken with Rubeola (Measles)

A

Airborne– lingers in the room for up to 2 hours after the affected person leaves

82
Q

What should we know about post-exposure prophylaxis for rubeola (measles)

A

Immune globulin after exposure is recommeneded for immunocompromised and for those who are also living in the same household as someone who is with someone who has measels.

83
Q

What are some prevention techniques for rubeola (measles)

A
  1. Maternal immunity up to 1 year
  2. Immunization
  3. MMR- 2 dose series
  4. 12-15m, 4-6 years

Healthcare personnel should have documented immunity

84
Q

How is Mumps spread?

A

Resp. Secretions (Direct/Indirect)

85
Q

What are s/s of mumps?

A
  1. Earache within 24 hours
    • Jaw line in fornt of ear lobe (partid gland) swelling on the neck and face will preceed this… can be symmetrical or asymmetrical
86
Q

What are some complications of Mumps?

A
  1. Orchitis (testicular infalmmation)
  2. Oophoritis/mastitis (ovaries and breast tissue inflammation)
  3. Pancreatitis
  4. encephalitis
  5. menigitis
  6. deafness
87
Q

What are some interventions for mumps?

A
  1. Analgesics
  2. Antipyritics
  3. Soft of liquid foods
  4. Warm or cool compress
88
Q

What type of isolation precautions would you have a patient with mumps on?

89
Q

True or false: A person who has been vaccinated for mumps can still get mumps just not as severe?

90
Q

How can we prevent mumps?

A
  1. Maternal immunity up to 1 year
  2. Immunization
    • MMR- 2 dose series
    • 12-15 months and 4-6 years
91
Q

How is Rubella spread?

A
  1. Direct contact
  2. Respiratory (primary)
  3. Blood
  4. Stool
  5. Urine
  6. Mom to baby
92
Q

What are some s/s of Rubella?

A
  1. In children– Rash
  2. Older children
    • Low grade fever
    • headache
    • malaise
    • Mild conjunctivitis
    • Lymphadenopathy
    • Sore throat
    • URI
93
Q

How does the Rubella rash present?

A
  1. Pinkish-red maculopapular rash
  2. Begins on face then head to food
  3. Lasts 3 days
  4. Occasionally Pruritic
94
Q

What are some complications of Rubella?

A
  1. Arthritis/arthralgia
  2. Thrombocytopenia purpura (rare)
  3. Encephalitis (rare)
  4. During pregnancy
    • Miscarriages
    • Fetal death/stillbirth
    • birth defects (congenital rubella syndrome)
95
Q

What are some interventions?

Need to redo this card

A
  1. Avoid contact with pregnant women
  2. Antipyretics
  3. Comfort measures
96
Q

What type of isolation protocol would a rubella patient be on?

97
Q

What are some way to prevent rubella?

A
  1. Maternal immunity up to 1 year
  2. Immuization
  3. MMR- 2dose series
    • 12-15 months, 4-6 years
    Healthcare personnel should have documented immunity
98
Q

How is scarlet fever transmitted?

A
  1. Direct or indirect contact with nasopharyngeal secretions
99
Q

What age group is scalet fever most common in?

A

School-aged

100
Q

What are s/s of scarlet fever?

A

Inital
1. High fever/chills
2. Sore Throat
3. Headache
4. Malaise
5. Abdominal pain/vomitting

12-24 hours later— rash appears
1. Enanthema
2. Exanthema

101
Q

What should we know about enanthema?

A
  1. Tonsils red, swollen, covered w/exudate
  2. Throat red/swollen
  3. Tongue
    • 1st 1 to 2 days- white strawberry tongue
    • 4th to 5th days- red strawberry tongue
  4. Palate- erythematous pinpoint lesions
102
Q

What should we know about exanthema?

A
  1. Flushed face with cirumoral pallor
  2. red pin point rash
    • Absent on face
    • feels like sandpaper
    • more intense in folds of joints
    • desquamation begins by end of first week
103
Q

What are some complications of scarlet fever?

A
  1. Retropharyngeal abcess
  2. Sinusitits
  3. Otitis media
  4. Acute and/or long-term
    • Gomerulonephritis
    • Rheumatic fever
104
Q

What are some interventions for scarlet fever?

A
  1. Antibiotics
  2. Bedrest
  3. Encourage fluids
  4. Relieve discomrfort of sore throat
  5. Prevent spread
    • handwashing, discard toothbrush, avoid sharing food/drinks
105
Q

What isolation precautions would a patient with scarlet fever be on?

A

Droplet- until 24 hours after starting antibiotic

106
Q

Which communicable diseases are considered airborne/contact?

A
  1. Varicella
  2. Rubeola
  3. Covid
107
Q

Which communicable diseases are under droplet percautions?

A
  1. Rubella (german measles)
  2. Pertusis
  3. mumps scarlet fever
108
Q

When are you immunized for HEP B?

A

Birth
2 months
6-18 months

109
Q

When are you immunized for rotavirus?

A

2 months
4 months
6 months

110
Q

When are you immunized for dTaP <7

A

2 months
4 months
6 months
15-18 months
4-6 years

111
Q

When are you immunized for HIB B?

A

2 months
4 months
6 months
12-18 months

112
Q

When should you be immunized for pneumococcal conjugate PCV12

A

2 month
4 months
6 months

113
Q

When should you get the inactivated poliovirus vaccine

A

2 months
4 months
6-18 months

114
Q

When do you get the MMR vaccine?

A

12-15 months

115
Q

When do you get the varicella (VAR) vaccine

A

12-15 month

116
Q

When do you get the Tdap vaccine?

A

11-12 years

Module 5- PEDI (25 decks)

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