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Why are newborns more susceptible to communicable disease? Infant’s immune system is not fully mature at birth & protection through immunization is incomplete. Passive immunity decreases in the newborn in the months after birth.
Define characteristics of the feverish vs the toxic child. Feverish – irritable & restless, sleep fitfully, and have nonspecific muscular pain Toxic – lethargy, poor perfusion, hypo/hyperventilation, cyanosis
How should the nurse react to a parent who refuses immunizations for a child? Document the informed refusal;Explain risk & benefits, common local reactions by using VIS info.
Varicella (chickenpox) acute onset of mild fever, malaise, anorexia, headache, mild abdominal pain, and irritability. Macular rash for a few hours that progresses to pruritic vesicular lesions for 1-5 days, and then to crusts. Crusts may remain for 1-3 weeks.
Erythema infectiosum begins as a mild illness followed by rash in 7-10 days. A fiery red rash often appears on cheeks giving a “slapped face” appearance. A lace-like symmetric, erythematosus, maculopapular rash appears on trunk & spreads to extremities
Roseola sudden onset fever > 39.5 *C (103 *F) for 3-7 days, during which child does not appear toxic (normal appetite & behavior) and has no rash or disease-specific signs. An erythematous maculopapular rash appears after fever resolves & lasts hours to days.
Rubella (German measles) An erythematous maculopapular rash appears firs on face & becomes generalized within 24 hr. Other signs include low grade fever & lymhadenopathy, conjunctivitis, or Forchheimer spots (discrete erythematous lesions on soft palate).
Congenital rubella syndrome growth retardation, radiolucent bone disease, hepatosplenomegaly, thrombocytopenia, and purpuric skin lesions (giving “blueberry muffin” appearance).
Which guage needle/length should be used to administer immunizations to a 6 month old infant? 1-1 1/2 inch needle for anterior thigh, fine gauge (25-21).
Review the immunization goals and recommendations of Health People 2020.(1st 2) Achieve & maintain effective vaccination coverage levels for universally recommended vaccines among young children;Increase the proportion of children aged 19-35 months who receive recommended vaccines;
immunization goals and recommendations of Health People 2020 (2nd part) Maintain vaccination coverage levels for children in kindergarten;Increase routine vaccination coverage levels for adolescents with vaccines recommended by Advisory Committee on Immunization Practices.
What discharge instructions should be provided to a parent who is to give an oral antibiotic to a child diagnosed with an infection? Give all dosages as prescribed for full number of days ordered; Ensure parents know how to administer antibiotics (r/t food); Don’t share antibiotics with any other family members
What is the Nurse’s responsibility for observation and reporting of bioterrorism? What observations would make the RN suspect an attack has been made? maintain high level of suspicion when numerous individuals with similar signs & symptoms are present in school or seek care in health care facility; initiate infection control, isolation, support
How should a school aged child with otitis media be treated for a fever? Acetaminophen & ibuprofen are preferred antipyretics for children; remove unnecessary clothing, careful continued monitoring of temperature progression. Identify clear fluids child prefers to drink & encourage extra intake of fluids.
Early localized disease (ELD) erythema migrans, a painless expanding single annular red rash that may develop central clearing; 5-15 cm in diameter. Rash may look like a bruisein dark-skinned patients. May have fever, body aches, headache & malaise
Early disseminated disease (EDD) in 3-10 weeks after tick bite, multiple smaller erythema migrans lesions, fever, headache, neck pain, malaise, conjunctivitis, enlarged lymph nodes, and cranial nerve palsies may develop. Carditis & meningitis can occur.
Late disseminated disease (LDD) in 2-12 months Lyme arthritis develops, commonly in knee, with pain, swelling & effusion. Child may develop encephalitis, polyneuritis & memory problems.
What symptoms in an infant should alert a parent to call their health care provider immediately because their child might have an infectious disease? child has fever over 40*C(104*F) & crying inconsolably, difficult to awaken, stiff neck, purple spots on skin, difficulty breathing, unable to swallow, convulsions
Which immunizations are provided during the appointments for children from 2mos to 1 year? Rotavirus, Dtap, haemophillus influenza type B, pneumococcal, inactivated poliovirus, hepatitis B, influenz (starting @ 6 months)