-
What is the leading nutritional deficiency in the United States?
Iron Definciency Anemia
-
Visual reinforcement audiometry (VRA)
- 6 months-2 years
- Visual reward linked to tone signal
- Child looks at reward in response to tone
- Reward activated, reinforcing response
- Child must be alert and happy for best results
- Schedule for after sleep/rest
- Allow child to sit in parent's lap
-
Tympanometry
- Over 7 months
- Measures tympanic membrane mobility
- Determines middle ear pressure
- Probe must form seal with canal
- Child must remain still
-
Conditioned play audiometry (CPA)
- 2-4 years
- Similar to VRA except uses listening games
- Child does listening game at tome and receives social reward
- Developmental age at least 2 years
- Same nursing implications as VRA
-
Pure-tone (conventional) audiometry
- 4 years and older
- Measures hearing acuity through a range of frequencies and intensities
- Must wear earphones
- Performed in soundproof room
- Teach desired motor response before screening
- Administer conditioning trils
- Offer two presentations of stimulus to ensure reliability
- At a minimum, screen 1,000-2,000 and 4,000-hertz levels at 20 decibels
-
Whisper test
- 4 years and older
- One ear occluded
- Stand behind child and whisper a word
- Child must repeat the word
- Quiet room
- Child should be alert and well rested
- Reward system to increase compliance
-
Weber test
- 6 years and older
- Place a vibrating tuning fork in the biddle of the top of the head
- Ask if sound is in one ear or both
- Should be both
- Child must understand instructions and be able to cooperate
-
Rinne Test
- 6 years and older
- Place a vibrating tuning fork on mastoid process to assess bone conduction
- Child signals when sound is gone
- Next place a vibrating tuning fork outside ear to test air conduction
- Child signals when sound is gone
- For a passing test, air conduction time should be twice as long as bone conduction time
- Child must understand instructions and be able to cooperate
-
What are elevated blood lead levels?
10 mcg/dL or higher
-
Risk factors for hearing impaired
- Family history of hearing loss
- Prenatal infection
- Anomalies of the head, face, or ears
- Low birthweight (<1,500g)
- Hyperbilirubinemia requiring exchange transfusion
- Ototoxic medications
- Low Apgar Scores: 4 or less at 1 minute, or 6 or less at 5 minutes
- Mechanical ventilation lasting 5 days
- Syndrome associated with hearing loss
- Bacterial meningitis
- Neurodegenerative disorders
- Persistent pulmonary hypertension
- Otitis media with effusion for 3 months
-
Lead Screening-CDC recommends universal screenings for specific populations.
- Children living where more than 27% of the homes were built before 1950.
- Where more than 12% of the 1-2 year olds of a specific population have elevated blood lead levels.
-
Healthy people 2010--hearing
- Increase the proportion of newborns who are screened for hearing loss by age 1 month, have audiologic evaluation by age 3 months, and are enrolled in appropriate intervention services by age 6 months
- Increase the proportion of persons who have had hearing examination on schedule
-
Hypertension Screening
- occurs in 1-3 % of children
- universal screening begins at age 3 unless other risk factors
- Preadolescents in 90-95th percentile are prehypertensive
- Adolescents with 120/80 mmHg considered prehypertensive
- Stage I- >95th percentile up to 5 mmHg above 99th percentile
- Stage II- 5 mmHg above 99th percentile or higher
-
Hyperlipidemia Screeing
- Screening children at high risk
- Family history
- parents or grandparents with premature cardiovascular disease (before 55 years of age or hypercholesterolemia (240 mg/dL or higher)
- children with diabetes or hypertension
-
Vision Screeing Tools
- Snellen letter or number
- Tumbling E
- LEA symbols or Allen figure
- Ishihara
- Color Vision Testing Made Easy (CVTME)
-
Snellen letter or numbers
- school-age
- child must know letters or numbers for test to be valid
-
Tumbling E
- Preschool
- Child points in direction that E is facing
-
LEA symbols or Allen figures
- Preschool
- child should first identify the pictures with both eyes at a comfortable distance prior to monocular testing
-
Ishihara
- School-age
- Screens for color discrimination ( numbers composed of dots, hidden within other dots)
-
Color Vision Testing Made Easy (CVTME)
- Preschool
- Uses dots like Ishihara, but instead of numbers uses shapes
-
Healthy people 2010- Vision
increase the proportion of preschool children age 5 years and under who receive vision screening
-
Anitgens
foreign materials in body (non-self)
-
Immunity
ability to destroy and remove a specific antigen from the body
-
Passive immunity
- produced when the immunoglobins (antibodies)of one person are tranferred to another.
- Last only weeks or months
- by injection of exogenous immunoglobins
- by transfer from mothers to infants via colostrum or placenta
-
Active immunity
- acquired when own immune system generates the immune response
- last many years or for lifetime
-
Risk factors for iron deficiency anemia
- periods of rapid growth
- low-birth weight or preterm infants
- low dietary intake of meat, fish, poultry, and ascorbic acid
- macrobiotic diets
- inappropriate consumption of cow's milk
- use of infant formula not fortified with iron
- exclusive breastfeeding after age 6 months without iron-fortified supplemental foods
- meal skipping, frequent dieting
- pregnancy or recent pregnancy intensive physical training
- recent blood loss, heavy/lengthy menstrual periods
- chronic use of aspirin or nonsteroidal anti-inflammatory drugs
- parasitic infections
-
Children at high risk for iron deficiency anemia
- low income families
- migrants or recently arrived refugees
-
Healthy people 2010- blood lead levels
eliminate elevated blood lead levles in children
-
Live attenuated vaccines
- modified living organisms that are weakened
- produces immune response but no complications of illness
-
Killed vaccines
- whole dead organisms
- cannot reproduce
- produce immune response
-
Toxoid vaccines
- contain protein products produced by bacteria call toxins
- heate treated to weaken effect
- produces immune response
-
Conjugate Vaccines
- result of chemically linking the bacterial cell wall polysaccharide (sugar-based) portions with proteins
- dramatically increases immune response
-
Recombinant vaccines
- genetically engineered organisms
- example- Hep B vaccine produced by splicing a gene portion of virus into a gene of a yeast cell: yeast cell then produce antigen to Hep B
-
Healthy people 2010 Vaccines
increase the proportion of young children who receive all vaccines that have been recommended for universal administration for at least 5 years
-
Vaccine Administration Routes
Intramuscular
- DTaP, DT, Tdap
- Hepatitis A, hepatitis B
- Hib
- Influenza (trivalent)
- Pneumococcal
- HPV
- MCV4
-
Vaccine Administration Routes
Subcutaneous
-
Report any clinically adverse event that occurs after an immunication to ...?
Vaccine Adverse Event Reporting System
-
Documentation of vaccination in permanent record includes:
- Date administered
- Name of vaccine
- Lot number and expiration date of vaccine
- Manufacturer's name
- Site and route administered
- Edition date of VIS given to parents
- Name and address of the facility administering vaccine
- Name of person administering
-
Two permanent contraindications for withholding vaccinations
- anaphylactic or systemic allergic reaction to a vaccine component
- with pertussis immunization, encephalopathy without an identified cause within 7 days if immunization
-
Vaccination postponing recommende if:
- child has severe illness with high fever
- immunosuppression
- recently received blood products
-
Vaccine administration needle and site
Intramuscular
- Birth-28 days-25 gauge-5/8 in long- anterolateral thigh
- 1-12 months- 23 to 25 gauge- 1 in long anterolateral thigh
- 1-2 years- 23-25 gauge- 1-1.25 in long for anterolateral thigh or 5/8 to 1 in long for deltoid
- 3-18 years-22-25 gauge-1-1.25 in long for anterolateral thigh or 5/8 to 1 in long for deltoid
-
Vaccine administration: needle and site selection
subcutaneous
- 1-12 months-23-25 gauge- 5/8 in long- fat of anterolateral thigh
- >12 months -23-25 gauge- 5/8 in long- fatty tissue over triceps
-
`The World Health Organization method of intramuscular thigh vaccination technique results in less irritability and bruising.
a 25 gauge-5/8 in needle-inserted at 90 degree angle to the long axis of the femur with the skin compressed between the thumb and index finger
-
Haemophilus influenzae type B
- bacterium that causes several life threatening illnesses in children under 5 years of age. (meningitis, epiglottitis, and septic arthritis)
- Not given to children 5 years or older
-
hepatitis A (HepA)
- Contraindications
- standard contraindications
- infants<12 months of age
- Precautions
- moderateor severe illness
-
Hepatitis B (HepB)
- Standard contraindications
- Precautions
- moderate or severe illness with or without acute fever
- infants<2,000g if mother is HBsAg negative
-
Diphtheria, tetanus, acellular pertussis (DTaP)
Tetanus, diphtheria, acellular pertussis (TdaP)
- Contraindications
- standard
- previous encephalopathy within 7 days after diphtheria, tetanus, pertussis (DTP) vaccine or DTaP
Precautions - temperature 105 F within 48 after previous dose
- continuous crying lasting 3 hours within 48 hours after previous dose
- previous convulsion within 3 days after immunization
- pale or limp episode or collapse within 48 hours after previous dose
- unstable progressive neurologic problem
- history of Guillain-Barre syndrome within 6 weeks
-
Diphtheria, tetanus (DT) Measles, mumps, rubella (MMR)
- Standard contraindications plus
- inquire about neomycin or gelatin allergies
- pregnancy or possibility of pregnancy within 4 weeks
- blood products within the past 5 months
- immunocompromised status
- if not given same day as varicella and/or yellow fever, hold until spaced 28 days apart
Precautions - thrombocytopenia or history of thrombocytopenic purpura
-
Varicella
- standard contraindications plus
- inquire about neomycin or gelatin allergies
- pregnancy or possibility of pregnancy within 4 weeks
- Blood products received within
the past 5 months- immunocompromised status
- if not given same day as MMR an/or yellow fever, hold until spaced 28 days apart
Precautions - do not give within 24 hours of antiviral medications
- family history of congenital or hereditary immunodeficiency
-
Inactivated poliovirus (IPV)
- standard contraindications plus
- inquire about neomycin, streptomycin, or polymyxin B allergiesPrecautions
- moderate or severe acute illness
- pregnancy
-
Haemophilus influenzae type B (Hib)
- standard contraindications
- Precautions
- moderate or severe acute illness
-
Trivalent inactivated influenza vaccine (TIV)
- standard contraindications
- Precautions
- history of Guillain-Barre syndromw within 6 weeks
-
Live attenuated influenza vaccine (LAIV)
- standard contraindications plus
- client <5 years old
- client 5 or more years old with chronic illnesses
- client with close contact with severely immunosuppressed persons
Precautions - do not give within 48 hours of antiviral meds
-
Pneumococcal conjugate vaccine (PCV7)
Pneumococcal polysaccharide vaccine (PPV23)
- standar contraindications
- Precautions
- moderate or severe acute illness
-
Polio vaccine
Inactivated polio vaccine (IPV)
killed virus that poses no risk for vaccine acquired disease
-
Measles, Mumps, and Rubella vaccines MMR
live attenuated virus combination vaccine
-
Hep A
- inactivated whole virus
- 94% effective
- given at 12 months with repeat in 6-12 months
-
Hepatitis B
- recombinant vaccine
- 80-90% effective
- mother's HBsAg status determines when immunications begins
- if mother's status unknown, neonate is immunized within first 12 hours of life, at 1-2 months, and at 6 months
- vital, up to 90% of infected neonates develop chronic carrier status and will be predisposed to cirrhosis and hepatic cancer
- if mother is neg, then 2, 4, and 6 months of age
-
Varicella vaccine
- live attenuated virus
- all 12-15 months who have not had chickenpox
- second dose at 4-6 years
- postexposure prophylaxis if given within 3-5 days after exposure
-
Pneumococcal vaccines
- streptococcus pneumoniae most common cause of pneumonia, sepsis, and meningitis under 2 years of age
- two- conjugate and polysaccharide
- PCV - contains 7 strands of streptococcus pneumoniae-start at 2 months
- PPV- contains 23 strains and begins at 2 years (for those with high risk for pneumococcal sepsis)
-
Influenza vaccine
- recommended yearly for 6-59 months
- for 2 years and older only if chronic health problems
- two available- trivalent inactivated and live attenuated
- LAIV given intranasally ages 5-49 years of age-can shed virus for a week
- TIV-anyone 6 months or older by intramuscular injections
-
Rotavirus vaccine
- most common cause of severe gastroenteritis among children
- accounts for 50% of annual hospigtalizaions for gastroenteritis in children
- most severe occurs in ages between 3-35 months
- live vaccine targeting 5 strains given orally to infants less than 32 weeks of age
-
Human papillomavirus vaccine
- DNA tumor virus transmitted through direct skin to skin contact
- most common between 15-24 years and sexually active
- causes genital warts and cervical cancer
- vaccine begins at age 11 - 12 years
-
Meningococcal Vaccine
- caused by bacteria Neisseria meningitidits spread by direct contact or by air droplets
- 10-12% of infected person's die
- 20% suffer long term
- vaccinate at 11-12 years
-
Healthy people 2010- Dental
Reduce the proportion of children and adolescens who have dental caries in their primary or permanent teeth
-
Healthy people 2010- Obesity
Reduce the proportion of childen and adolescents who are overweight
-
Healthy people 2010- Physical activity
increase the proportion of adolescents who engage in moderae physical activity for at least 30 min on 5 or more of previous 7 days
|
|