NR 340 Peds Study Guide

NR 340 Peds Study Guide Latest 2023 / 2024

Infectious and Immune Disorders

Function of immune system • 1st line of defense

• Skin/mucous membranes
• Passive immunity from mom
• Maternal circulation/breast milk

• Cannot produce immunoglobulins (antibodies) • Until approx. 2 mos. of age • Immune system not fully functional until 6 years of age • Those babies that are breast fed, usually have less ear infections • Stimulates production of antibodies against a specific foreign substance (antigen) • Contraindications

• Anaphylaxis
• High doses of steroids (<14 days)
• Acute febrile illness – greater than 39
• Common cold/minor illness NOT contraindicated
• Chronic illness (cancer)
• Taking immunosuppressive drugs
• Egg allergy – flu shots
• Most up to date schedules on CDC.gov

Purpose of vaccines, misconceptions • Misconceptions

• Causes autism
• Rotovirus vaccine is dangerous
• Vaccines have toxic ingredients – led and mercury
• Vaccines can fail
• Vaccines can cause the actual illness
• Parents can refuse vaccines

• Types

• Live (attenuated) – vaccines made from virus made from live virus
• Killed (inactivated viruses)
• Toxoids – diphtheria, tenus, - one type of vaccine – based on the toxin made

from the bacteria

• Human immune globulin – Igg Ige – weakened immune system and this helps

them bring up their immune system

• Herd immunity – vaccinate many to protect the few

Communicability periods of disease • Incubation period – common cold = 1-5 days

• Time of exposure to the time the time symptoms arrive 1 / 4

• Chicken pox = 21 days

• Period of communicability – time it takes to transfer a disease from me to you • Prodromal period – beginings off an illness – feeling eh, scratchy throat • Sometimes difficult to tell the difference • Virus

• Increased lymphocytes

• Bacteria

• Increased neutrophils
• Left shift – some of the white blood cells shift to make it look bacterial infection

Common viral and bacterial infections, treatment, and nursing care viral • Gastroenteritis

• Vomiting/diarrhea

▪ Volume depletion • Intravascular space

• Degree of dehydration

▪ Determined by physical exam ▪ Signs of dehydration – clammy – dry mucus membranes, dry skins

• Treatment

▪ Mild/moderate • Zofran (ondansetron) • Oral hydration ▪ Severe • IV 20cc/kg isotonic solution • Coxsackie disease (infants and young children)

• Hand/foot/ and mount disease

▪ Fever ▪ Sore throat ▪ Malaise ▪ Poor appetite ▪ Rash and mouth sores occur 1-2 days after the above symptoms ▪ Lasts about 1 week • Conjunctivitis – pink eye – last 7-10 days • Thrush

• Yeast infection

▪ Oral (infants) ▪ Urogenital (infants/toddlers; diaper dermatitis) ▪ “Yeast infection” (adolescent girls) ▪ Intertrigo (skin folds of groin, armpits, torso)

• Treatment

▪ Hygiene (limit moisture diaper area) ▪ Topical/systemic antifungals (nystatin) • 5 th disease 2 / 4

• Fever
• Runny nose
• Headache
• Rash (slapped cheek) then spreads (comes and goes)
• May last 2-39 days

• Chicken pox • Measles, mumps, rubella • Roseola (6-18 months)

• Sudden high fever (39.4-41.1) 3-5 days
• Rash several hours to 2 days after fever is gone

▪ Blanches with pressure ▪ Neck and trunk, may have whitish ring, lasts 24-48 hrs • Monomucleosis (Epstein- Barr virus)

• Causes

▪ Fever ▪ Fatiguge ▪ Sore throat ▪ Swlooen glands • Many have a rash (exanthem) • Most have fever • Most are accompanied by cold or flulike symptoms • Most transmitted by direct contact with droplets or airborne particles • Most can be prevented by immunization • Treatment is mostly symptomatic • Encephalitis is rare but can occur as a complication of most childhood viral infections • Febrile seizures (most common from 3 months-5 yrs) Bacterial • Strep throat /scarlet fever • Lyme disease (most common tic-borne disease)

• Affects skin, musculoskeletal, CV, neuro systems

▪ Early: Vague flu-like symptoms/”bulls-eye” rash

▪ Neuro: Headaches, bell’s palsy, ataxia

▪ Musculoskeletal: Large joint arthritis (knee), joint/muscle pain

• Pertussis (Whooping cough)

• Catarrhal stage

▪ 1-2 weeks ▪ URI symptoms ▪ Paroxysmal • 2-4 weeks or longer ▪ Increased severity of cough (whoop sound). Cyanosis, distention of neck veins, salivation, tongue protrusion

• Convalescent

▪ 1-2 weeks 3 / 4

▪ Symptoms lessen, cough may persist for months • Helminths (Worms)

• Transmission

▪ Oral-fecal ▪ Ingestion contaminated host ▪ Skin penetration ▪ Bite of blood-sucking insect

• Treatment

▪ Entire family ▪ Prevention ▪ Anti-worm meds po • Bacterial meningitis

• Acute inflammation of meninges

▪ Bacteria enters subarachnoid space ▪ Inflammation response triggered ▪ Causes obstruction of blood flow • Increased ICP • Seizures • Hernation • Death

• Infants <32 weeks gestation most at risk

▪ Temp instability ▪ Bulging anterior fontanel ▪ Shrill cry/irritability ▪ Gaze deviation ▪ Posturing/seizures ▪ NO nuchal rigidity

• Older child

▪ Fever ▪ Headache ▪ Meningeal signs ▪ Brudzinski sign ▪ Kernig’s sign ▪ Nuchal rigidity • Most reliable • Bacterial infections

• Older child

▪ Photophobia ▪ Vomiting ▪ Behavior changes ▪ Irritability ▪ Lethargy

• Petechiae – little bumps that will not blanch
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