Week 2

Question 1

why is growth and development important?

Answer 1

Growth: Increase in size observed through physical change Development: Process of gradual transformation FNPs must: Be able to identify normal/abnormal growth and development. Provide anticipatory guidance regarding growth and development.

Question 2

Four Principles of Growth and Development

Answer 2

1. Child development proceeds along a predictable pathway. 2. The range of normal development is wide. 3. Various physical, social, and environmental factors, as well as diseases, can affect child development and health. 4. The child’s developmental level affects how you conduct the history and physical examination.

Question 3

Five Critical Domains of Development

Answer 3

Gross motor Fine motor Cognitive (or problem-solving) Communication

Question 4

what kinds of things can cause developmental delays in growth and development?

Answer 4

Hereditary/genetic disorders Environmental/social problems Pregnancy/perinatal problems Abnormality in embryonic development Childhood diseases

Question 5

who needs further attention in regards to development and growth?

Answer 5

Variations beyond two standard deviations for age Children above the 95th percentile or below the 5th percentile are indications for more detailed evaluation Reduced growth velocity, shown by a drop in height percentile on a growth curve Drop >2 quartiles in 6 months Weight for length <5th percentile Head circumference above the 95th percentile or below the 5th percentile

Question 6

gestational ages

Answer 6

Gestational Age Preterm: <34 weeks Late Preterm: 34-36 weeks Term: 37-42 weeks Postterm: >42 weeks

Question 7

newborn weight

Answer 7

Birth Weight Extremely Low Birth weight (ELBW): <1000g Very Low Birth Weight (VLBW): <1500g Low Birth Weight (LBW): <2500g Normal: >/= 2500g

Question 8

causes/complications of SGA

Answer 8

Small for Gestational Age Etiology: Many causes unknown Placental issues Maternal smoking Complications: Preterm SGA infants are more likely to experience asphyxia, hypoglycemia, and hypocalcemia

Question 9

Causes/complications of LGA

Answer 9

Large for Gestational Age Etiology: Infants of mothers with diabetes Genetic syndromes Parents are large Complications: Hypoglycemia-which can result in jitteriness, irritability, and cyanosis Difficult birth/birth injury

Question 10

Newborn development

Answer 10

Use all 5 senses Differences in temperaments, personalities, behavior and learning Interact dynamically with caregivers Habituation: Ability to selectively and progressively shut out negative stimuli (e.g., a repetitive sound) Attachment: A reciprocal, dynamic process of interacting and bonding with the caregiver State regulation: Ability to modulate the level of arousal in response to different degrees of stimulation (e.g., self-consoling) Perception: Ability to regard faces, turn to voices, quiet in presence of singing, track colorful objects, respond to touch, and recognize familiar scents

Question 11

infant development

Answer 11

By one year: birth-weight should have tripled and height increased by 50% Neurologic development progresses centrally to peripherally 3 months: Infants should be able to lift their head (no “head-lag”), clasp hands, coo 6 months: Infants should be able to roll over, reach for objects, turn to voices, babble, and possibly sit with support 9 months: Infants should have a neat pincer grasp (self-feed), indicate wants; have usually developed “stranger danger” 12 months: Infants should be able to stand, say 1-3 words

Question 12

How do you correct for prematurity when considering growth and development?

Answer 12

• The adjustment is made by considering two important dates: baby’s due date, and the date the baby was actually born. Term is considered 37 weeks - if your baby is actually 13 weeks old, but was born 9 weeks early, their corrected age is 4 weeks or about 1 month. - If your baby was born at 28 weeks and is 10 weeks old, what is their corrected age? (37-28= 9) 10-9=1 month old - The corrected or adjusted age gives you a better idea of how your baby is tracking their milestones. - Must correct for prematurity up until 24 months old

Question 13

early childhood 1-4

Answer 13

After infancy, the rate of physical growth slows by approximately half Preschool years, children grow 3.5 inches and gain 4 pounds on average Chubby, clumsy toddlers transform into leaner, more muscular preschoolers. Almost all children walk by 15 months, run well by 2 years, and pedal a tricycle and jump by 4 years Toddlers move from sensorimotor learning (through touching and looking) to symbolic thinking, solving simple problems, remembering songs, and engaging in imitative play 18 month-old: 10-20 words; 2yo: 2-3 word sentences; 3yo: converses well; 4yo: complex sentences Drive for independence Impulsive and have poor self-regulation, temper tantrums Preoperational: Without sustained, logical thought process

Question 14

middle childhood 5-10

Answer 14

Grow steadily but more slowly Strength and coordination improve dramatically with more participation in activities Concrete operational: capable of limited logic and more complex learning Remain rooted in the present with little ability to understand consequences or abstractions School, family, and environment greatly influence learning A major developmental task is self-efficacy Language is more complex more independent Guilt and self-esteem emerge Clear sense of wrong and right

Question 15

adolescents

Answer 15

Puberty begins on average at age 10 years in girls and 11 years in boys On average, girls end pubertal development with a growth spurt by age 14 years and boys by age 16 years The age of onset and duration of puberty vary widely, although the stages follow the same sequence in all adolescents Concrete to formal operational thinking: acquiring an ability to reason logically and abstractly and to consider future implications of current actions Wide variability in cognitive development Recent evidence shows that brain development probably continues well into the twenties Transition from family-dominated influences to increasing autonomy and peer influence The struggle for identity, independence, and eventually intimacy leads to stress, health-related problems, and often, high-risk behaviors

Question 16

What is the difference between active and passive immunity?

Answer 16

Active immunity: protection that is produced by the person’s own immune system. The immune system is stimulated by an antigen to produce antibody and cellular immunity Usually lasts for many years or a lifetime Vaccines: vaccines contain antigens that stimulate the immune system to produce an immune response that is often similar to that produced by the natural infection. - Another way of acquiring active immunity is to survive infection with the disease-causing form of the organism. The persistence of protection for many years after the infection is known as immunologic memory. Passive immunity: protection by products produced by an animal or human and transferred to another human, usually by injection Immunity generally wanes - Mother to infant - IgG is transported across the placenta during the last 1–2 months of pregnancy - Can come from blood products (i.e., IVIg, antitoxin)

Question 17

What are the two types of vaccines and how do they work?

Answer 17

Live attenuated vaccines Produced by modifying a disease producing “wild” virus or bacteria in a lab by using replication to weaken the virus form Bacteria retains the ability to replicate and produce immunity but does not cause illness Inactivated vaccines Cannot replicate Cannot give inactivated vaccines along with live vaccines due to competition with circulating antibody than live vaccines Always requires multiple doses Antibody titers diminish with time

Question 18

what are the types of inactivated vaccines?

Answer 18

Recombinant vaccines which are produced by genetic engineering techniques insertion of a segment of the respective viral gene into the gene of a yeast cell or virus hep B, HPV, and influenza (1 brand) *** not tested on types*** whole cell vaccines entire organism that has been inactivated viral: polio, hep A, Rabies, bacteria: pertussis, typhoid, cholera, plague (all whole cell bacterial vaccines are not available in the US) *** not tested on types***

Question 19

what are fractional vaccines?

Answer 19

fractional vaccines - protein based - toxoids: polysaccharide-based young children do not respond consistently to polysaccharide antigens, probably because of immaturity of the immune system repeated doses DOES NOT cause a boost - conjugate: polysaccharide is chemically combined with a protein molecule increasing immunogenicity

Question 20

immunity, active and passive immunity

Answer 20

Immunity: the ability of the human body to tolerate the presence of material indigenous to the body (“self”), and to eliminate foreign (“nonself”) material Active immunity: protection that is produced by the person’s own immune system Usually lasts for many years or a lifetime Vaccines Passive immunity: protection by products produced by an animal or human and transferred to another human, usually by injection Immunity generally wanes Mother to infant Can come from blood products (i.e., IVIg, antitoxin)

Question 21

Antibody-Vaccine Interactions

Answer 21

Simultaneous administration of antibody (in the form of immune globulin) and vaccine is recommended for postexposure prophylaxis of certain diseases, such as hepatitis B, rabies, and tetanus. Inactivated antigens, which include recombinant vaccines, are generally not affected by circulating antibody, so they can be administered before, after, or at the same time as the antibody If live vaccine given first, wait two weeks to give antibody If antibody given first, must wait at least 3 months or longer to give vaccine

Question 22

Simultaneous and Non-Simultaneous Administration

Answer 22

Simultaneous and Non-Simultaneous Administration All vaccines can be administered at the same visit as all other vaccines EXCEPT: in persons with functional or anatomic asplenia pneumococcal conjugate vaccine (PCV13) and Menactra brand meningococcal conjugate vaccines should not be administered at the same visit; separate these vaccines by at least 4 weeks

Question 23

Nonsimultaneous Administration of Different Vaccines

Answer 23

Nonsimultaneous Administration of Different Vaccines If live injected and/or intranasal vaccines are not administered at the same visit, they should be separated by at least 4 weeks Live oral vaccines (rotavirus) may be given at any time before or after live parenteral vaccines or LAIV.

Question 24

Interval between doses of the same vaccine

Answer 24

Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine. Decreasing the interval between doses of a multidose vaccine may interfere with antibody response and protection. Do not give vaccines earlier than the minimum age EXCEPT: The measles vaccine during a measles outbreak or before travelling abroad-Infants 6 through 11 months should receive one MMR dose, and this dose should not be counted (should be repeated at 12 months of age or older) AND vaccine doses administered up to 4 days before the minimum interval or age can be counted as valid

Question 25

adverse vaccine reactions: local, systemic, allergic

Answer 25

An Adverse Reaction: an untoward effect caused by a vaccine that is extraneous to the vaccine’s primary purpose of producing immunity A vaccine adverse event: any medical event that occurs following vaccination. Local: Occur with up to 80% of vaccine doses Occur within a few hours and are generally mild and self-limited Pain, swelling and redness at the injection site Systemic: More generalized events Fever, malaise, myalgias, headache, loss of appetite, and others Allergic: Due to vaccine or component Are rare and risk is minimized by screening Vaccine Adverse Event Reporting System (VAERS): report any significant reaction following a vaccine

Question 26

contraindications of vaccines

Answer 26

Contraindication: A condition that increases the likelihood of a serious adverse reaction to a vaccine for a patient with that condition Permanent contraindications to vaccination: Severe allergic reaction to a vaccine component or following a prior dose Encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccination Severe combined immunodeficiency (rotavirus vaccine) History of intussusception (rotavirus vaccine) Pregnancy In general inactivated vaccines may be administered to pregnant women for whom they are indicated Immunosuppressed

Question 27

vaccine precautions

Answer 27

Precaution: A condition in a recipient that might increase the chance or severity of a serious adverse reaction, or that might compromise the ability of the vaccine to produce immunity

Question 28

Answer 28

Diphtheria

●Pathogen: bacteria

Transmission: Respiratory, skin, fomites

●Symptoms:

○Can affect any mucus membrane

○Insidious onset of pharyngitis

○Within 2-3 days membrane forms which can cause respiratory obstruction

○Fever usually not high but patient appears toxic

●Complications: Myocarditis, neuritis, paralysis of the soft palate, eyes and limbs, and death (5-10%, 40% in persons <5 and >40)

●Vaccine:

○DTaP-children 6 weeks-6 years; 2, 4, 6, 15-18 months, and 4-6 years, 11-12 years (TDap) and then every 10 with TD or TDaP

Question 29

Haemophilus influenzae type B (Hib)

Question 30

Hepatitis A

Question 31

Hepatitis B

Question 32

Human Papillomavirus (HPV

Answer 32

●Pathogen: virus

●Transmission: Direct contact, usually sexual

●Symptoms/Complications:

○Anogenital warts, respiratory papillmatosis, cervical, anal, vaginal, vulvar and penile cancers

●Vaccine:

○Routine schedule is 9-11 years; can be given to all individuals up through age 26

○Although Gardasil is licensed through age 45, catch-up HPV vaccination is not recommended for all adults older than age 26 years, since the public health benefit of vaccination in this age range is minimal

○2 dose series if started before 15th birthday; 2nd dose 6-12 months later

○3 dose series if started after the 15th birthday; dosing at 0, 1 to 2, and 6 months

○Series does not need to be restarted if the schedule is interrupted

○No therapeutic effect on HPV infection, genital warts, cervical lesions

Question 33

Influenza

Answer 33

●Pathogen: virus

●Transmission: Respiratory,

●Incubation period: 2 days

●Symptoms:

○abrupt onset of fever, myalgia, sore throat, nonproductive cough, and headache

●Complications:

○Pneumonia, secondary bacterial infections, Reye syndrome, myocarditis, death is reported than less than 1 per 1,000 cases

●Diagnosis: Clinical, but can use rapid assay or viral culture

●Treatment: Supportive, antivirals

●Vaccine:

○IIV: annually, 6mo+; 2 doses, 4 weeks apart, the first year the child receives it up through the age of 8

LAIV: annually for healthy, non-pregnant persons 2-49

Question 34

Measles

Answer 34

●Pathogen: virus

●Transmission: Respiratory

●Symptoms:

○Fever, which increases in stepwise fashion, often peaking as high as 103°F –105°F

○Onset of cough, coryza (runny nose), or conjunctivitis

○Koplik spots, a rash present on mucous membranes

○Maculopapular eruption that usually lasts 5–6 days. It begins at the hairline, then involves the face and upper neck. During the next 3 days, the rash gradually proceeds downward and outward, reaching the hands and feet. The maculopapular lesions are generally discrete, but may become confluent, particularly on the upper body.

●Complications: Diarrhea, AOM, pneumonia, encephalitis, seizures, death (0.2%)

●Vaccine:

○Minimum age: 12 months

○Minimum interval: 4 weeks apart

○CDC schedule:

■1st dose: 12-15 months

■2nd dose: 4-6 years

Question 35

Meningococcal Disease

Question 36

mumps

Answer 36

●Pathogen: viral

●Transmission: Respiratory airborne or droplet

●Symptoms:

○myalgia, malaise, headache, low-grade fever

●Complications: Orchitis (testicular inflammation), and parotitis (9-94%)

●Vaccine:

○First dose after 12 months

○Minimum dosing interval: 4 weeks

○CDC schedule:

■1st dose: 12-15 months

Answer 37

●Pathogen: bacteria

●Transmission: Respiratory airborne or droplet

●Symptoms:

○Onset of coryza, sneezing, low-grade fever, and a mild, occasional cough, similar to the common cold

○Cough gradually becomes more severe, and after 1–2 weeks, the second, or paroxysmal stage, begins

○Paroxysms, of numerous, rapid coughs, apparently due to difficulty expelling thick mucus from the tracheobronchial tree

○At the end of the paroxysm, a long inspiratory effort is usually accompanied by a characteristic high-pitched whoop

●Complications: Secondary bacterial pneumonia (most common), neurologic complications – seizures, encephalopathy, otitis media, anorexia, dehydration, pneumothorax. Epistaxis, Subdural hematoma, hernias, rectal prolapse

●Vaccine :

○Primary series (4 doses): 2, 4, 6, 15-18 months

○5th dose (when 4th dose before 4th birthday): 4-6 years

Tdap: single dose 11-18 years

Question 38

Pneumococcal Disease

Answer 38

●Pathogen: bacteria (streptococcus pneumoniae)

●Transmission: Respiratory

●Incubation period: 2 days

●Symptoms:

○Abrupt onset of fever and chills or rigors. Classically there is a single rigor, and repeated shaking chills are uncommon, pleuritic chest pain

●Complications:

○Bacteremia, meningitis and death

Question 39

Poliomyelitis

Answer 39

●Pathogen: viral

●Transmission: Fecal-oral, oral-oral

●Symptoms:

○Up to 72% of all polio infections in children are asymptomatic

○Approximately 24% of polio infections in children consist of a minor, nonspecific illness without clinical or laboratory evidence of central nervous system invasion

○Nonparalytic aseptic meningitis (symptoms of stiffness of the neck, back, and/or legs), usually following several days after a prodrome similar to that of minor illness, occurs in 1%–5% of polio infections in children

●Complications: Paralytic polio, death in 2-5% of cases

●Vaccine:

4 doses: 2, 4, 6-18 months, and one dose after 4yo

Question 40

Rotavirus

Answer 40

●Pathogen: viral

●Transmission: fecal-oral, fomites

●Symptoms:

○May cause self-limited watery diarrhea, or may result in severe dehydrating diarrhea with fever and vomiting. Up to one-third of infected children may have a temperature greater than 102°F

●Complications: severe diarrhea, dehydration, electrolyte imbalance, and metabolic acidosis

●Vaccine:

○Oral vaccine

○Rotateq: 3 doses, 2, 4, 6 months

○Rotarix: 2 doses, 2 and 4 months

○Maximum age for first dose is 14 weeks 6 days

Question 41

Rubella

Answer 41

●Pathogen: viral

●Transmission: Respiratory

●Symptoms:

○1 to 5 day prodrome with low-grade fever, malaise, lymphadenopathy, and upper respiratory symptoms preceding the rash. The rash of rubella is maculopapular and occurs 14 to 17 days after exposure. The rash usually occurs initially on the face and then progresses from head to foot. It lasts about 3 days and is occasionally pruritic.

●Complications: Arthralgia, encephalitis, hemorrhagic complications

○Congenital rubella: fetal death, prematurity, deafness, eye and cardiac defects, microcephaly

●Vaccine:

○First dose after 12 months

○Second dose usually 4-6 years

○Given as MMR or MMRV

Question 42

tetanus

Answer 42

●Pathogen: bacteria

●Transmission: Toxin enters through a wound (found in soil and resp tract of humans and animals)

●Symptoms:

○Trismus or lockjaw, followed by stiffness of the neck, difficulty in swallowing, and rigidity of abdominal muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes. Spasms continue for 3-4 weeks

●Complications:

○Laryngospasm, HTN, PE, fractures

●Vaccine:

○DTaP (5 doses): 2, 4, 6, 15-18 months, 4-6 years

○Tdap: 11-12 years and then every 10 years (TD or Tdap)

○Tdap: given during 3rd trimester of pregnancy to protect baby from pertussis through passive immunity

Question 43

varicella

Answer 43

●Pathogen: viral; primary infection results in varicella (chicken pox), reactivation results in herpes zoster (shingles)

●Transmission: Respiratory

●Symptoms:

○Varicella: mild prodrome may precede the onset of a rash: The rash usually appears first on the head, then on the trunk, and then the extremities; the highest concentration of lesions is on the trunk. Vesicular, 1-4mm, may rupture and crust. Form in crops. “Dewdrop on a rose petal.”

○Shingles: The vesicular eruption of zoster generally occurs unilaterally in the distribution of a sensory nerve. Most often, this involves the trunk or the fifth cranial nerve. Two to four days prior to the eruption, there may be pain and paresthesia in the involved area. There are few systemic symptoms.

●Complications:

○Varicella: bacterial superinfection, pneumonia, CNS manifestations, Reye syndrome, death in 1:600,000

○Shingles: Postherpetic neuralgia (PHN)

●Vaccine:

○Varicella: First dose after 12 months, second usually 4-6 years , for first dose use separate MMR and varicella vaccines, not MMRV

Shingles: (Shingrix, recombinant only available in US), 50+, 2 dose series given 6 months apart

Question 44

Answer 44

hep B is 0, 1 to 2, 6 months.
2 months is DR. HIP for DTaP, Rotavirus, Hib, IPV, PCV13
4 months also DR. HIP.
6 months is DR. HIP plus influenza starts at 6 months and the last dose of Hep B is at six months.
12-15 months is MAD HPV
4-6 years is Very DIM