Unit 1 Pediatrics

Question	Answer
A review of immunizations and administration of vaccines is done when?	At every health care visit
Which vaccines are mandated?	DTaP, IPV, MMR, Hib.
Which vaccines are recommended?	HBV, Var.
When should the Vaccine Information Statement (VIS) be given?	Must be given to parents prior to administration
Federal law mandates that all health care providers must record the following information :	month, day and year of administration type administered manufacturer lot number & expiration date site and route name, address and title of person administering Health care providers are required to report adverse reactions to the Vaccine Adverse Events Reporting System (VAERS).
Contraindications on all vaccines?	Anaphylactic reaction to a vaccine or a vaccine constituent Moderate or severe illnesses with or without a fever
Contraindications on all live viruses? (OPV, MMR, Varicella)	Pregnancy Immunosuppression (except HIV-MMR) Close contact with immunosuppressed.
Contraindication of DTap?	Encephalopathy with previous administration
Contraindication with IPV?	allergy to neomycin, streptomycin, or polymixin B
Contraindication of MMR	allergy to neomycin
What are misconceptions concerning contraindications?	current antibiotic therapy previous reaction prematurity use of aerosolized steroids breast-feeding mild acute illness history of non-specific allergies family history SIDS Pregnancy recent disease exposure malnutrition
What are some vaccine administration considerations?	storage and handling personnel immunizations sterile technique route can be given together
In DTaP vaccine what should be given along with the vaccine dose?	acetaminophen
What is the best protection against pertussis in newborns?	immunization of older siblings (children who have recovered from pertussis do not need to be immunization)
When is it recommended that the TB test be given?	before or at the time of MMR (12-18 months)
The frequency of repeated tuberculin testing depends on the following:	Risk of TB exposure to the child Prevalence of TB in the population group Presence of underlying host factors in the child (immunosuppressive conditions/ HIV infection)
Whats the youngest an infant can be immunized from outbreak of measles?	6 months
When should measles vaccine be given?	A first dose should be given at 12 to 15 months and again at age 4-6 years or at school entry.
What should be informed to women regarding the rubella vaccine?	Women should avoid pregnancy within 3 months of vaccine due to the theoretical risk to the fetus.
Chicken Pox incubation, symptoms, treatment and complications?	incubation: 11-21 days (onset of fever) symptoms: rash, fever treatment: symptomatic, acyclovir complications: infection, pneumonia, encephalitis, Reyes syndrome
Stept incubation, symptoms, treatment and contraindications?	incubation: 2-5 days (initial phase) symptoms: high fever, sore throat, headache treatment: antibiotics complications: AGN, RF, abcess, pneumonia, scarlet fever
Rubella incubation, symptoms, treatment, contraindications?	incubation: 14-21 days (7days before rash and 5 days after) symptoms: rash, fever treatment: symptomatic complications: arthritis, encephalitis, birth defects
Rubeola incubation, symptoms, treatment, contraindications?	symptoms: fever, rash, cough, conjunctivitis, runny nose, Koplik spots incubation: 10-12 days ( 5th day of incubation, 4th day of rash) treatment: symptomatic complications: seizures, encephalitis
Mumps incubation, symptoms, treatment and contraindication?	incubation: 14-21 days ( 7 days before swelling to 9 days after) symptoms: headache, fever, swelling treatment: symptomatic complications: meningitis, orchitis, deafness
Diptheria incubation, symptoms, treatment and contraindications?	incubation:: 2-4 days (2-4 weeks) symptoms: fever, gray patches, resp. distress treatment: antibiotics, antitoxin complications: myocarditits, neuritis, paralysis, gastritis, nephritis
Pertusis incubation, symptoms, treatment and contraindications?	incubation: 3-12 days ( 7days after exposure) symptoms: cough, fever treatment: antibiotics complications: pneumonia, seizures
Staph incubation, symptoms, treatment, contraindications?	incubation: 2-3 days (onset of rash) symptoms: fever, rash, impetigo treatment: antibiotics complications: electrolyte imbalances, pneumonia, cellulitis
Polio incubation, symptoms, treatment, contraindication?	incubation: 7-14 days ( onset of symptoms) symptoms: headache, muscle pain, paralysis treatment: supportive complications: respiratory paralysis
Fifth's Disease incubation, symptoms, treatment, complications?	incubation: 6-14 days (until rash develops) symptoms: mild fever, rash treatment: none complications: aplastic anemia if immunosuppressed
Rotovirus incubation, symptoms, treatment, complications?	incubation: 1-3 days (2-5 days after diarrhea) symptoms: fever, vomiting, diarrhea treatment: fluid replacement complications: dehydration
What are nursing care goals of communicable diseases?	Limit spread of the disease Prevent complications Minimize discomfort Provide education and support
Benefits of Breast feeding?	Provides immunologic and anti-infective properties. Promotes bonding. Can be continued throughout illness.
Benefits of Bottle Feeding?	Can supplement breast feeding. Promotes bonding.
First month baby feedings	6-8 feedings per day based on infant needs
4-6 month old feeding and food?	introduce strained foods-cereal, fruit, vegetables, meats table foods and cup at 6 months Ground own food
What kind of food at 10-12 month old?	Finger foods
What should infant be eating by 1 year old?	3 meals a day plus a snack
Toddlers and food? (1-3)	Eat less/food jags one-half of adult intake 2% milk at 2 years
Preschoolers and Food? (3-6)	food jags continue one food at a time no strong tasting foods
School-agers food/diet?	Adult patterns are beginning to develop
What are the principle aspects of safety?	Age & development Curiosity Copy-cat behavior Tiredness 90% preventable
Motor Vehicle Safety	car seats (20#-rear facing) check before backing out of parking spaces, driveways, etc. lock all doors do not leave unattended no heavy objects inside car
Recreation Safety	proper equipment physical limits firearms locked education
Lead Poisoning	Pathophysiology & Etiology (paint prior 1976) Systemic Effects (stored in bones & soft tissue) Signs & Symptoms (anorexia, vomiting, hyperactivity, anemia) Diagnostics (45u/dl-treated) Management removal chelation therapy (pull out of tissue) Complications (permanent neurological damage
Fire Safety	Smoke detectors Fire escape plan Fire extinguishers Flame retardant clothing Education Keep matches and lighters away Prevention is key
Swimming Pool safety	locked gates alarms swimming lessons rescue devices CPR
What is child abuse?	Child abuse is any type of maltreatment of child by their parents, guardians, or care giver. Child abuse includes physical or emotional abuse trauma, neglect, or sexual abuse that is intentional and nonaccidental.
Abuse includes:	Battering-physical injury Drug abuse-intentional drugs, especially during pregnancy Sexual abuse Sexual assault or molestation (family member or not) scapegoating, belittling, lack of mothering (Emotional abuse) Incest
Child neglect includes:	Omission of certain appropriate behaviors having detrimental physical or psychology effects on development. Abandonment Lack of provision of the basic needs of survival: shelter, stimulation, medical care, food, love, supervision, education, attention, emotional nurturing, and safety.
Clinical Manifestations of Child abuse?	Child usually under 3 years of age. School-aged children and adolescents are also subject to abuse. The average age of a sexually abused child is 9 years. General health of child indicates neglect (diaper rash, poor hygiene, malnutrition, unattended physical problem). Characteristic distribution of fractures (scattered over many parts of body). Disproportionate amount of soft tissue injury. Evidence that injuries occurred at different times (healed/new fractures, resolving/fresh bruises). Cause of recent trauma in question. History of similar episodes in the past. No new lesions occurring during the child's stay in hospital. May show a wide range of reactions-may be either very withdrawn or overactive. The child may be anxious, tense, or nervous. Child may show unusual affection for strangers or may be overly fearful of adults and avoid any physical contact with them. For sexual abuse: child may fear no one will believe him or her- may experience self-blame; most know their abuser. Children may not “tell" about abuse from parents, fearing loss of security; "a bad parent is better than no parent at all." Behavior problems, depression, and acting-out behaviors may result. For abuse that occurs in school/day care, the child may exhibit fear of the teacher, have nightmares, decrease school attendance, or develop psychosomatic illnesses.
Injuries or Types of Abuse That May Occur	Bruises, welts (linear or looplike) Abrasions, contusions, lacerations (most common) Wounds, cuts, punctures Burns (cigarette, radiator, scalding Bone fractures Sprains, dislocation Subdural hemorrhage or hematoma; "shaken baby Brain damage Internal injuries Malnutrition (deliberately inflicted) Freezing, exposure Whiplash-type injury Eye injuries, periorbital, ear bruises Dirty, infected wounds or rashes Unexplained coma in infant Failure to thrive Sexually transmitted diseases
Management of Child abuse/neglect	The goal of treatment is to ensure the safety of the child It is estimated that 80% to 90% can be rehabilitated Counseling is offered to help parents
nursing assessment of child abuse/neglect	Identify family or child at risk Inspect for possible abuse Collect specimens Take photographs Assess developmental level Observe behaviors Assess parent-child relationship Report
Nursing Diagnosis with Child abuse/neglect	Fear of adults related to experiences with abuse Altered Parenting related to abusive treatment of child
Munchausen Syndrome by Proxy	Munchausen syndrome by proxy (MSP), a type of factitious disorder, is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. The adult perpetrator has MSP and directly produces or lies about illness in another person under his or her care, usually a child under 6 years of age. It is considered a form of abuse by the American Professional Society on the Abuse of Children. However, cases have been reported of adult victims. (The term "by proxy" means "through a substitute.")
Benefits of Family centered care	Needs and strengths of family Family roles enhanced Minimize separation anxiety Increases security for the child Family needs to care for the child are met Parents feel useful and decrease guilt Increases parents confidence Greater retention of teaching Diminished post hospitalization reaction
Implementation stratigies for family centered care:	Taking a family history and listening for specific family! cultural needs and preferences Allowing rooming-in for parents of young children Having parents participate in the child’s physical care Acknowledging that parents are not “visitors”; having flexible visiting regulations for family members, including siblings
Create an environment conducive to maintaining family strength, integrity, and unity. The nurse should:	Help to maintain a positive nurse—parent—child relationship Avoid actions that may cause parents to feel threatened by the nurse. Facilitate a supportive marital relationship, allowing for differences in style and needs. Include siblings in planning and intervention as appropriate to their age and the situation. Supplement the family abilities and role in achieving the common goal of the child’s welfare.
Assist parents with decision making about when to stay with their child.	Parents’ presence is especially important if the child is 5 years or younger, especially anxious, upset, or in medical crisis. The parents’ decision is influenced by needs of other family members, as well as by job, home responsibilities and personal needs. The nurse should try to alleviate guilty feelings of parents unable to stay with their child
Develop trusting, goal-directed relationships	Obtain a thorough nursing history that provides information to assess broad consideration of strengths, relationships and concerns; include family and individual state of development, cultural, spiritual, social, material and financial areas. Plan with the family toward mutual, realistic goals. Recognize and acknowledge the care and consideration the child receives from parents.
Observe the parent—child relationship and be able to:	Evaluate the degree of participation and effectiveness of the parents in physical and emotional care. Observe parents’ attitudes, skills, and techniques and the child’s behavior and response to them. Assess what teaching needs to be done. Detect and respond to actual and potential problems in parent—child relationship.
Teach parents knowledge, understanding, and skills.	Carefully assess and address the learning needs, learning styles, and potential barriers to understanding and skill development. Perform nursing techniques safely and efficiently. Mutually with parents, assess and interpret the behavior of the hospitalized child, so appropriate understanding and intervention are reached Assess the child’s and parents’ understanding of essential medical care and wellness-focused information Interpret and reinforce what health care providers have told parents. Answer questions thoroughly and honestly.

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