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Peds Ch 6

Test 1

standard precautions designed to reduce risk of blood-borne pathogens and body fluids. use will all pts to reduce risk of transmitting microorganisms. Involves use of PPE: gloves, goggles, gowns and masks.
airborne precaution use standard precautions and N95 respirator, airborne infection isolation room (AIIR). Ex: measles, varicella, tb.
droplet precaution mask, gown, gloves. Ex: influenza, meningitis, pneumonia, pertussis, mumps, rubella.
contact precaution gown and gloves. Ex: C. diff, hep A, conjunctivitis, rotavirus.
acquired immunity from direct exposure to invading agent
active immunity immune bodies are actively formed against specific antigens, by having disease or artificially introducing agent to individual
antibody formed in response to antigen
antigen foreign substance (virus, bacteria, etc..)
antitoxin solution of antibodies derived from immunized animals
Hep B newborns should receive before discharge (0.5ml), and at 1,2, and 6 months.
Hep A begin at 1yo, and 2nd dose 6 months later.
diphtheria administered with tetanus and pertussis, Dtap for younger than 7, Tdap for 11 and older. Boosters given every 10 years.
tetanus boostrix (Tdap) for 10 to 18 yo. Adacel (Tdap) 11 to 64 yo.
pertussis 6 weeks thru 6 yo. children 7 to 10 who are not fully vaccinated for pertussis should receive a dose of Tdap. Women should receive Tdap between 27 and 36 weeks gestation or postpartum prior to discharge.
polio dose if IPV at 2 months, 4 months, 6 to 18 months, and 4 to 6 years old. PEDIARIX is combo containing DTap, hep B, and IPV.
measles (rubeola) given at 12 to 15 months, 2nd at 4 to 6 yo. Vitamon A supplement is effective at decreasing morbidity and mortality assoc with measles.
mumps 12 to 15 months. Not under 12m.
rubella aim is to protect the unborn child rather than recipient. 12 to 15 months old and 2nd at 4 to 6 yo. Not given to pregnant women, and women should not become pregnant for 28 days after.
haemophilus influenzae type B 6 weeks to 18 months.
varicella 1st dose at 12 to 15 months, 2nd at 4 to 6 yo. If child is 13yo or older and susceptible, the should receive 2 doses 4wks apart. Needs to be kept frozen and used w/i 30min of being reconstituted.
pneumococcal standard at 6 weeks to 24 months. PCV13 at 2, 4, and 6 months and 4th dose at 12 to 15 months. Can be used in conjunction with other vacc in a separate syringe.
influenza 6 months to 18 yo annually. 0.25mL dose for 6 to 35 months, and 0.5mL for 3 yo and older.
meningococcal Menactra can be used for as young as 9 months. Menveo 2yo and older. 11 to 12 yo should get single MCV4 and a booster at 16 to 18 yo.
Rotavirus leading cause of severe diarrhea in infants and young children. RotaTeq can be used in infant 6 to 12 weeks, but not after 32 weeks. Dose is 2mL and it should be protected from light. Oral.
vaccine reacions vaccines are among the most safest and reliable drugs. reactions usual occur from preservative. inactive vacc side effects occur within hours or days. local tenderness, swelling at site, low fever, behavioral changes. Live multiply for days or weeks, rash
vaccine contraindication severe febrile illness is contraindicated for all vac, minor illnesses are ok. Live virus vaccines such as varicella and MMR should not be given to immunocompromised. No MMR for pregnant women. Breastfeeding is no contraindicated for any vacc.
primary prevention rests almost exclusively on immunization
nurse assessment of communicable disease *recent exposure to a known cause * prodromal symptoms (early manifestations) or constitutional symptoms (like fever, rash) *immunization history *history of having disease.
human parvovirus B19 causes chickenpox and erythemia infectiosum (fifth disease).
pertussis manifestations Early: gagging, coughing, emesis, and apnea. "whoop" comes later. Meds: "Mycins".
bacterial conjuctivitis purulent drainage * crusting of eyelids, especially on waking *inflamed conjunctiva *swollen lids *treated with topical antibacterial agent: polymyxin and bacitracin (Polysporin), (Sulamyd), or (Polytrim). Fluoroquinolones best available.
viral conjunctivitis usually occurs with upper respiratory tract infections *serous (watery) drainage *inflamed conjunctiva *swollen lids *treatment is limited to removal of secreations
allergic conjunctivitis itching *watery to thick, stringy discharge *inflamed conjunctiva *swollen lids
conjunctivitis caused by foreign body tearing *pain *inflamed conjunctiva *usually only one eye is affected
conjunctivitis nurse mgmt warm, moist compress for removing crust, don't keep on eye because it promotes bacterial growth. instill meds after eyes are cleaned. instruct to use a separate towel, throw out tissues used, not to rub eye and use good hand washing.
aphthous stomatitis canker sore, benign but painful condition whose cause is unknown. small, painful, whitish ulceration surrounded by a red border.
herpetic gingivostomatitis (HGS) most often type 1. cold sores, or fever blisters. precipitating factors include stress, trauma, immunosuppression, or exposure to excessive sunlight.
stomatitis mgmt aimed at pain relief. primarily use acetaminophen or ibuprofen, magic mouthwash, and acyclovir. also need to focus on preventing spread of herpes.
intestinal parasite nurse mgmt *assist with identification of the parasite, treatment of the infection, and prevention of initial infection or reinfection.
giardiasis Common symptoms include abdominal cramps and diarrhea. Diagnose with micro exam of stool, string test. Treatment: metronidazole (flagyl), tinidazole (Tindamax), nitazoxanide (Alinia). metro and tini have metallic taste, can cause N&V.
enterobiasis Pinworms. Movement of worms on skin and mucous membranes cause itching. Diagnose with tape test collection, done in morning before BM or bath
giardiasis manifestation Infants: diarrhea, vomiting, anorexia, growth failure. Children over 5: abdominal cramps, intermittent loose stools, constipation. Malodorous, watery, pale, greasy stools.
pinworm manifestions *general irritability *restlessness *poor sleep *bed-wetting *distractibility *short attention span *perianal dermatitis and exoriation *possible vaginal and urethral infection
impetigo *begins as reddish macule *ruptures easily, leaving superficial, most erosion *exudate dries to form heavy, honey-colored crusts
impetigo treatment mupirocin ointment, oral antibiotics (penicillin), vancomycin for MRSA, retapamulin ointment.
pyoderma deeper extension of infection into dermis. Systemic effects: fever, lymphangitis, sepsis, liver disease, heart disease
pyoderma treatment soap and water. topical antiseptic: chlorhexidine. mupirocin. antibiotics, antibacterial soap baths.
cellulitis lymphangitis "streaking" frequently seen. involvement of regional lymph nodes common, fever and malaise.
cellulitis treatment antibiotics, rest and immobilization of infected area
scaled skin syndrome macular erythema with "sandpaper" texture of involved skin
scaled skin treatment antibiotics, gentle cleansing with saline, burrow solution of .25% silver nitrate compress.
dermatophytoses (ringworm) nursing mgmt ketoconazole and selenium sulfide shampoos reduce colony counts. applied to scalp 5-10min 3 times a week. treatment with griseofulvin can take weeks to month and is often dicontinued.
scabies infestation caused by mites. maculopapular lesions in interdigital surfaces, axillary-cubital area, popliteal folds, and inguinal region. seen as black dot at end of grayish-brown treadlike burrow. treat with permethrin cream.
scabies nurse mgmt permethrin cream should remain on skin for 8 to 14 hours. clothing washed in hot water and dried on high. takes 2-3 weeks for itch to stop.
bedbug manifestations *erythematous papule *linear papules *red macular lesion *rash *wheal *vesicles *bullae *urticaria Secondary: impetiginous lesions with scratching *folliculitis *cellulitis *eczematoid dermatitis. Systemic: *asthma *anaphylaxis * fever, malaise
lyme disease 1st: small erythematous papule, enlarges up to 12 in, bulls eye, burning. 2nd: multiple lesions develop. Fever, HA, fatigue, stiff neck, lymphadenopathy, splenomegaly, conjunctivitis, sore throat, abd pain, cough. 3rd: neuro, cardiac, muscle symptoms.
lyme treatment 8yo or older oral doxycycline, younger than 8 amoxicillin or cefuroxime.
Created by: tkulwicki