Immunizations

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Sids
Sudden infant death syndrome – it is unexplained (no known cause) death after post mortem
evaluation of a child less than 1 year old. 95% of deaths occur by 6 months. Peaks at 2-4 months, No
known etiology, NOT caused by sleep apnea; risk factors include: infants born weighing less than 3.2lbs,
infants exposed to cocaine, heroin, or methadone during pregnancy, infants who have had an apparent
life threatening event.; reducing risk: Supine position, no blankets, soft bedding, bumpers, toys in crib,
do not over clothe infant, no co-sleeping
Failure to thrive
Persistent deviation from normal growth curve.
Organic failure to thrive – there is a physical pathological process present. The failure to
thrive may or may not be correctable depending on the underlying cause.
Non-organic failure to thrive – causes – disturbed parent child relationship
Poverty, health beliefs, inadequate nutritional knowledge, family stress.
Clinical manifestations: growth failure, developmental delay, apathy, poor eye contact (radar
gaze), stiff posture, no fear of strangers
management: reversal of malnutrition, treat any underlying medical conditions, multidisciplinary
approach.
Important: accurate assessment of height and weight, strict I&O, assess parent child
relationship
Developmental hip dysplasia
Maneuvers: Barlow – examiner adducts and then extends legs with fingers on hips to feel for
dislocation; ortolani – infant on back, with hips and knees flexed while abducting and lifting
femur
Signs of abnormalities: asymmetry of gluteal and thigh folds with shortening of the thigh on
the affected side, limited abduction as seen in flexion in ortolani test or with femoral head
moving in and out of acetabulum with ortolani test, apparent femur shortening
Management: double diaper, pavlik harness, hip spica cast
Myelomenningocele - contains nerves, is visible at birth, it is covered by a fragile, thin membrane. The
Sac can tear, allowing csf to leak out and providing an entry for infectious agents into the CNS.
Preoperative – position on prone, cover sac with a sterile, moist, nonadherent dressing and
care for using sterile technique.
VP shunt – post op – risk for infection, malfunction can be caused with obstruction and will
present with signs and symptoms of intracranial pressure.
Dehydration – signs and symptoms: fewer wet diapers, no tears when crying, inside of mouth dry and
Sticky (if patient was being treated for dehydration, evidence of treatment working would be
moist mucous membranes), irritability, high pitch cry, difficulty awakening, increased
respiratory rate or difficulty Breathing, sunken fontanel, sunken eyes with dark circles, abnormal
skin color, temp, or dryness, slow capillary refill, decreased turgor
Pyloric stenosis – signs and symptoms: vomiting possibly projectile, palpable pyloric mass (olive shape)
Visible gastric peristaltic waves, irritable and hungry
 Management – fluid and electrolytes (K,Na,Cl), NG tube; post op: monitor feedings, clear liquids
4-6 hours after surgery, steps to full formula or breast milk in 48 hours
Cystic fibrosis – diet: high protein, high carb, high calorie, supplement vit A,D,E,K
Meds: pancreatic enzyme, Pulmozyme (to thin mucous), inhaled bronchodilators, prompt
Antibiotics treatments for infections
Systems affected: respiratory, digestive, integumentary, reproductive
Menningitis – signs and symptoms – abrupt fever, chills, headache, and vomiting, bulging fontanel,
Irritable
Anemia – iron supplements at 4-6 months for breast fed babies; 12-36 months due to high intake of
Cow’s milk; adolescents are also at risk because of rapid growth combined with poor eating
habits
Osteomyelitis – looks sick, fever, irritable, tachycardia, tenderness, warmth, edema, pain
vs leg calve Perthes – presents with limb or hip pain then joint dysfunction with limited Range
of motion
Asthma – signs and symptoms of exacerbation – hacking, SOB, prolonged expiratory phase, wheeze, red
lips and ears, restlessness, sweating, tripod position, crackles
peak flow meter – yellow: caution, maintenance therapy may need to be increased, call doc;
Red: medical alert, bronchodilator call doc if doesn’t return to yellow or green.
Glomerulonephritis – signs and symptoms: edema, face in am extremities as day progresses, cloudy tea
colored urine, pallor, irritable/lethargic, appear ill/vomiting, headache, pain, dysuria, mild to
moderate elevated BP
CHF – cause: usually from structural defects but cardiomyopathy, dysrhythmias, or electrolyte
imbalances can cause it. Also, excessive systemic demands like sepsis or severe anemia
clinical manifestations: tachycardia, sweating, decreased urinary output, fatigue, weakness,
restlessness, anorexia, pale cool extremities, weak peripheral pulses, decreased blood
pressure, gallop rhythm, cardiomegaly
CHD – cause: genetic, fetal alcohol syndrome, maternal rubella and diabetes
ASD - an opening in the septal wall between the two atria
VSD - an opening of the septal wall between the ventricles
PDA - failure of the fetal ductus arteriosus to close
Left to right shunting can cause volume overload in the right side of the heart leading to
congestive heart failure if in excess
Signs and symptoms: increased pulmonary blood flow, obstruction of ventricular
outflow
Coarctation of aorta - aorta involves the narrowing of the aorta near the insertion of the
ductus arteriosus, resulting in increased blood pressure proximal to the defect and
decreased blood pressure distal to the obstruction.
Tetralogy of fallot – includes VSD, pulmonic, stenosis, overriding aorta, and right ventricular
Hypertrophy; clinical manifestations: cyanotic at birth or progressive cyanosis, systolic
murmur, acute cyanosis and hypoxia
Acute polycythemia – signs and symptoms clubbing, poor eating, weight loss, tachypnea, and
dyspnea
Digoxin – improves myocardial contractility by interfering with ATPase in the myocardial cell membrane
and increasing the amount of calcium available for contraction. The increased force of
contraction cause the heart to empty more completely, increased output, decrease HR and
reduces oxygen consumption
side effects: fatigue, bradycardia, anorexia, nausea, vomiting
serum levels may be drawn 6-8 hours after a dose is administered or just before the next dose.
Levels should range between 0.5-2 mg/ml.
Hirschprungs – signs and symptoms: distention, failure of internal anal sphincter to relax, constipation
V/s intusseption – current jelly stool, vomiting
Burns - Most important is FLUIDS, 2nd degree is most painful, NPO then high caloric intake, after acute
phase worry about infection.

Epiglotitis – signs and symptoms: High fever, Drooling, Dysphagia, Toxic appearance, Refuses to lie
down, Tripod position, Child will be calm
expect if absence of spontaneous cough, drooling, agitation
nursing management: maintain airway patency, monitor O2 sats, observe for signs of airway
obstruction; if not intubated, store intubation equipment in room (do not examine throat)
wilms tumor – nursing interventions: Don’t palpate abdomen if suspected, post op: monitor GI activity,
BP, urine output, signs of infection.
Laryngotracheal Bronchitis (croup) – signs and symptoms: Preceded by a URI, Gradual onset with a low
grade fever, Inspiratory stridor, Barking or seal like cough (worse at night)
management: Increase humidity (steamy or cool mist humidifier), Encourage fluids, Treatment –
epinephrine and decadron
Down syndrome – clinical manifestations: separated sagittal suture, oblique palpebral fissures, small
nose, depressed nasal bridge, high arched narrow palate, neck skin excess and laxity, protruding
tongue, wide space between big and second toe, plantar crease between bid and second toe,
hyperflexibility and muscle weakness. Septal defects, decreased muscle tone and problems with
drainage of mucus. Respiratory tract infections are prominent.
Evaluation tools used to identify: it can usually be diagnosed by the clinical manifestations alone,
but a chromosome (extra chromosome 21) analysis should be done to confirm.
Cerebral Palsy – nonprogressive - The goals of therapy are early recognition and promotion of optimal
development to enable affected children to attain normalization and their potential within the
limits of their existing health problems. The disorder is permanent and therapy is primarily
preventative and symptomatic. Therapy involves: establishing locomotion, communication, and
self help skills; to gain optimal appearance and integration of motor function; to correct
associated defects as effectively as possible; to provide educational opportunities adapted to
the child’s needs and capabilities; to promote socialization experiences with other affected and
unaffected children. There is surgical pump placement for severe plasticity cases, which is
baclafen infused directly into the intathecal space surrounding the spinal cord. Lioresal, Valium
and Botox can be used to reduce spasticity. Tegretol and depakote are used with ones
experiencing seizures.
Seizure - Simple partial : no change in level of consciousness
Complex partial: aura, amnesia, inability to respond to environment, amnesia during event,
stare into space, change in LOC
Tonic clonic: eyes roll upward, loss of consciousness, violent jerking motions, amnesia
Absence: loss of consciousness, no warning, maintain posture, lip smacking, amnesia, stare off
Myoclonic: involves both sides of the brain, may occur singly or repetitively
Management: take detailed history of event. During seizure turn on side, protect form injury,
make sure airway is good. Long term treatment is achieved with antiepileptic drugs such as
phenobarbital (children taking this should receive adequate vit d and folic acid, and should not
be given milk). Rectal valium can be used in emergent situations.
Rheumatic fever – carditis: tachycardia out of proportion to degree of fever, cardiomegaly, new
murmurs or change in murmurs, muffled heart sounds, chest pain, changes in electrocardiogram
(prolonged PR interval); polyArthritis: swollen hot red painful joints, after 1 or 2 days different
joints affected, favors large joints-knee, elbows, hips, shoulders, wrists; nodules: nontender
swelling, located over bony prominences; chorea: sudden aimless, irregular movements of
extremities, involuntary facial grimaces, speech disturbances, emotional lability, muscle
weakness, muscle movements exaggerated by anxiety and attempts at fine motor activity
relieved by stress; erythema marginatum: erythematous macules with clear center and wavy
well demarcated border, transitory, nonpruritic, primarily affects trunk and extremities.
Management: Treatment is Penicillin or Erythromycin if child is penicillin sensitive (use basic
teaching for antibiotics). Aspirin to control joint inflammation and reduce fever. An
echocardiogram may be necessary for potential mitral or aortic valve damage. (heart)
Hemophilia – parent education: no contact sports, calories correlate with energy requirements, teach
rice, close supervision during play time, safe environment, encourage swimming, walking,
jogging, tennis, golf, fishing, and bowling; use soft toothbrush and possible water irrigation
device; should wear medical identification; no aspirin
Hemarthrosis: limited motion due to pain, tenderness, and swelling; elevate and immobilize
joint, active range of motion exercises are usually instituted after the acute episode.
Mononucleosis – caused by the Epstein barr virus
Signs and symptoms: fever, exudates, Pharyngitis, lymphadenopathy, hepatosplenomegaly.
At risk for spleen rupture at 2nd wk.
Muscular dystrophy – inherited - It is an x linked recessive deformity (males). Long term expectations
would be progressive weakness and wasting of symmetric groups of skeletal muscles, with
increasing disability and deformity. Progressive weakness, wheelchair bound by 12, death in
teen years due to cardiac or respiratory complications
brain tumor – signs and symptoms: headache and vomiting upon waking, recurrent vomiting not
related to feeding, ataxia, visual disturbances, signs of intracranial pressure ( headache,
vomiting without nausea, ocular palsies, altered level of consciousness, back pain and
papilledema; sluggish, dilated, or unequal pupils), or personality changes.
Scoliosis – signs and symptoms: no pain, unequal shoulders during adams test, unequal hips, or kyphosis
 Management: bracing– bracing is not curative, just slows progression. Surgical intervention -
>45°, consists of realignment and straightening with internal fixation and instrumentation
combined with bony fusion (arthrodesis) of the realigned spine. The goal is to correct the
curvatures on the sagittal and coronal planes and to have a solid, pain free fusion in a well
balanced torso, with max mobility of the remaining spinal segments. The Harrington system
consists of distraction and compression rods, hooks, and nuts. The osteior elements are
decorticated, and bone from the iliac crest or donor bone is placed across the vertebrae to
provide fusion. Postoperatively the child is log-rolled to prevent spinal motion, and molded
plastic jacket is used to stabilize the spine until the fusion is solid.
Postop: neurologic injury or spinal cord injury, hypotention, wound infection, syndrome of
inappropriate secretion of antidiuretic hormone, atelectasis, pneumothorax, ileus, delayed
neurologic injury, and implanted hardware complication.
Tracheoesophageal fistula – signs and symptoms: excessive salivation and drooling, 3 C’s cough,
choking, Cyanosis, apnea, respiratory distress with feeding, abdominal distention.
Nursing care: NPO, IV fluids, pouch tube to remove secretions, elevate head
Osteomyelitis – child looks sick, irritable, fever, tachycardia, tenderness, warmth, edema,pain
high WBC
Leukemia – A (anemia) N (neutropenia) T (thrombocytopenia)
Immature WBC’s
Decrease red blood cell production
Look for low hematocrit and hemoglobin
ITP – idiopathic thrombocytopenia – signs and symptoms: petechiae and purpura; avoid contact sports;
acute care Management: apply pressure
decrease platelets
sickle cell - chronic hemolytic anemia, pallor, jaundice, fatigue, delayed growth and puberty, avascular
necrosis of the hips and shoulders, renal dysfunction, retinopathy
acute care Management: bed rest, hydration, correct metabolic acidosis, pain relief, O2
Main concern would be pain
cbc
sickled rbc
kawasaki’s – signs and symptoms: fever for 5 or more days, rash (abdomen, chest, genitals), bilateral
conjunctivitis, stomatitis and/or strawberry tongue, enlarged lymph nodes (esp. cervical),
changes in extremeties (erythema and desquamation)
acute care management: IVIG and aspirin therapy
increase WBC
elevated ESR
decrease RBC