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Peds Unit 2 - Immunology

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olanjones's version from 2017-02-23 17:17

Immunizations

Question Answer
Contraindications for allHx of life threatening reaction to previous dose, moderate to severe illness (wait until d/c to give)
Contraindications for Live vaccinesImmunosuppressed people, cancer, organ transplants, etc. high dose steroids.
Live vaccinesMMR, Varicella, Nasal Influenza, rotavirus
Contraindications for InfluenzaSevere egg allergy. Nasal version (not on market) is live: must be 2 yrs old to get, no hx of wheeze/asthma, no high fever
Contraindications for MMRReceived antibody-containing blood product w/in last 7 months, Hx of thrombocytopenia
When to call health care provider S/S of severe adverse reaction, High fever, Behavioral changes, Any concern
Recognizing adverse reactionsDifficulty breathing, hoarseness/wheezing, Hives, Pallor, Lethargy, Dizziness, Tachycardia
Multiple Vaccination AdministrationIs EBP but do what parents want, better to get vax spaced out than not at all
Side Effects General RuleAvoid premed with Tylenol/Ibuprofen/Etc – may decrease desired immune response – wait for typical SE before medicating
Typical SE (mild)Muscle/site soreness/redness, slight fever/fatigue
Side Effects Live Vaccinesmay get mild version of the disease
Varicellaif develop a rash, can spread it. Potentially can get shingles from vaccine.
Rotavirusmild diarrhea, those exposed to child’s stools should not be immunocompromised
MMR Administration2 doses (12-15 months, 4-6 years) May need booster in college/as adult (check titers)
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"Whooping Cough” Pertussis

Question Answer
Overviewhighly contagious bacterial illness- infants (highest morbidity/mortality) rely on herd immunity
Clinical Manifestationsspasmodic coughing. Can lose consciousness during spasms
Assessmentrespiratory, look for neuro: LOC
Intervention Abx Tx, vanco, suction & respiratory; Be ready to intubate
Transmission/Precautionsdroplet (gown, glove), can come off precautions after 5 d abx tx
Hydrationalways key, liquefying secretions, supporting hemodynamics
AntipyreticsCDC states admin may prevent febrile seizures (in child w/hx) after MMR vax if given before the onset of fever & continued for 5-7 days (no ASA)
TreatmentMacrolides are first line TX (watch for EKG changes)
ProphylaxisDtap (kids version <7 yrs)- 13-18 mos; Tdap (adult version)- 11-12 yrs, q10 years (Q Pregnancy)
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Varicella (Chicken Pox)

Question Answer
Varicella-zoster VirusCan be transmitted by those with herpes-zoster (shingles) -need to cover shingles rash & avoid kids not vax against chx pox
Transmissionairborn and contact with secretions, communicability 1-2 days before rash appearance until scabs are crusted (6-8 days)
Clinical manifestationsitchy rash trunk->everywhere. Hallmark--> vesicles, papules, healing scabs, dry scabs
Common complicationsabcsess or cellulitis, shingles: reactivation of vaccine (esp in times of stress & in the elderly)
InterventionsKeep nails short, Lukewarm oatmeal baths, Acetaminophen, Antihistamine, Hydration
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Mononucleosis (EBV)

Question Answer
S/SUsu appear 4-6 wks after infected, symptoms vary by type, severity, & duration: extreme fatigue, fever, sore throat, head/body aches, swollen lymph in neck/armpit, rash
Etiology95% epstein barr, 5% CMV
Transmissionsharing, close spaces, kissing, usu.
IncidenceCDC states common among teens/college students. At least 1 in 4 infected with EBV will develop mono
AssessmentPositive Monospot, malaise, sore throat, fever, increased atypical lymphocytes, lymphadenopathy, splenomegaly (no contact sports 3 wks->RF: rupture), hepatomegaly, lethargy
InterventionsAcetaminophen, Throat remedies, Activity Restrictions
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Tuberculosis (TB)

Question Answer
Overviewbacterial infection affecting lungs, spread through the air
Latent Tuberculosis Infection (LTBI)CDC states only sign is + TB test – these persons are not infectious/cannot spread infection to others (needs tx to prevent TB disease development in themselves)
Tuberculosis (TB) Diseaseactive infection, can spread & have symptoms (symp depend on part of body infected – lung is common) – If not treated will lead to death
AssessmentPPD test (shouldn’t bleed/have bandaid) Measure elevation, not redness. 10% of ppl with + rxn will develop illness, f/u with CXR. CDC states it takes 2-8 wks after initial infection to develop +PPD
RFcrowding living environment, IV drug use, and contact with an infected person.
InterventionComplete course of meds must be taken or risk of redevelopment - Meds: 2-11 yrs: daily INH therapy for 9 months; >12 yrs: observed dosing once weekly INH/RPT for 3 months
Symptomsfever, malaise, poor appetite, weight loss, cough, night sweat, chills (children are typically asymptomatic)
Preventionprompt detection of infectious patients, airborne precautions, tx those who have suspected/confirmed TB, Report all cases to PHD (required)
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“Fifth Disease” Erythema Infectiosum

Question Answer
Etiologymild rash illness caused by Human parovirus B19
TransmissionDroplet (high risk: those w/ sickle cell: bone marrow depression; 2nd tri pg: fetal demise)
Signs and symptomsIntense red facial rash (“slapped face”), Extremity rash starting 1 day after facial rash & lasting 1 or more weeks
InterventionsComfort measures, Analgesics, Keep finger nails short to prevent scratching, Lukewarm oatmeal baths
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Hand Foot and Mouth Disease

Question Answer
OverviewViral: Coxsackievirus A16 (most common) or Enterovirus 71; Most common in kids less than 5 years of age
Assessmentpt age, symptoms, presentation of rash & mouth sores. Depending symptom severity, throat or feces (stool) specimens may be collected & tested for the virus
SymptomsInitial: fever, poor appetite, malaise, sore throat
1-2 days later: painful ulcers mouth (herpangina)
1-2 days later: skin rash flat or raised red spots and blisters [hands and soles of feet]
InterventionContact precautions and hand washing, Shorten nails, Skin care and comfort measures [antipyretics, analgesics, magic mouthwash], Hydration, No treatment
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Lyme Disease

Question Answer
Lyme diseaseBacterial illness spread by tick bites; affects skin, joints, heart, and the nervous system
Assessment: 3 phasesEarly localized disease: Bulls-eye rash with burning and warmth
Early disseminated disease: Heart and nervous system involvement
Late disease: Motor and sensory nerve damage and brain inflammation
InterventionsIdentification, Treatment with oral antibiotics (doxycycline, amoxicillin, or cefuroxime)
OutcomesThose diagnosed early (with bull’s eye rash) and treated have no long term sequela
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