Appropriate reasons to not given a vaccinationhx of anaphylaxis to any vaccine containing the same substance Allergies to the contents of the vaccine Moderate or severe illness with or without symptoms (the flu or a cold are NOT contraindications) immunocompromised individuals should not get attenuated vaccinationsClinical manifestations of rotavirusfever and vomiting for 2 days watery diarrhea for 5-7 days common cause of diarrhea in young childrenSigns and symptoms of digoxin toxicity (ingestion or chf management)bradycardia dysrhythmia nausea/vomiting anorexia yellow/green visionRecommended vaccine for healthy newbornHep BRecommended vaccinations at 2 monthsHep B, Rotavirus, DTap, Hib, PCV, IPVRecommended immunizations at 4 monthsRotavirus, DTap, Hib, PCV, IPVRecommended vaccinations at 6 monthsHep B, Rotavirus, DTap PCV, IPVRecommended vaccinations at 12-15 monthsHib, PCV, IPV, MMR, VaricellaRecommended vaccinations at 12-23 monthsHep A, given in 2 doses at least 6 months apartRecommended vaccinations 15-18 monthsDTapContraindications to the MMR vaccinationpregnancy, children that are allergic to eggs/gelatin/and neomycin, children with a hx of thrombocytopenia or thrombocytopenia purport, immunocompromised children, children with advanced HIV, children who recently received blood products or immunoglobulinsContraindications to DTapSevere febrile illness Hx of previous anaphylaxis or allergy to DTAP or its contents Hx of seizure within 3 days of previous vaccineContraindication to IPV vaccineAllergy to Neomycin and or streptomycin PregnancyContraindication to Hep A vaccineAluminum allergy PregnancyContraindication to Hep B vaccineAllergy to Baker's yeastContraindications to Varicella vaccinepregnancy children with cancer or leukemia immunocompromised childrenContraindications to PCV vaccineHypersensitivity to diptheria toxoidContraindication to influenza vaccinefebrile illness sensitivity to eggs immunocompromised childrenComfort recommendations for parents after immunizationnon narcotic analgesics (Tylenol or Ibuprofen), cool compresses to the injection sites, gentle movement of the extremityThere is a small chance of a vaccine virus being transmitted with which vaccine?VaricellaExpected VS of infantstemp 36.5 to 37.5C (97.7-99.5F) Pulse 120-160 RR 23-50 per minExpected VS of childrenTemp 36-38C (98.6-100.4F) HR 75-100 RR 20-30Expected VS of adolescentsTemp 36-38F (98.6-100.4F) HR 60-90 RR 16-19The reflex that is elicited when the infant turns its head to the side when their cheek or lip is touchedRootingexpected age for rootingbirth to 6 monthsErikson's developmental stage for infantstrust vs mistrustWhen does an infant triple his birth weight?By the end of the first yearWhen does an infant double their birth weight6 monthsWhen does the posterior fontanel close?2-4 monthsWhen does the anterior fontanel close?by 18 monthsAn infant should be able to hold up their head by:3 monthsAn infant should be able to smile and coo by2-3 monthsAn infant should be able to sit with support by:5-6 monthsAn infant should be able to roll over from front to back by:5-6 monthsAn infant should be able to transfer an object from one hand to another by:5-6 monthsAn infant should be able to wave "bye bye" by:8-9 monthsAn infant begins to develop separation anxiety by:8 monthsAn infant begins to cut teeth by:6-7 monthsAn infant should be able to pick up objects using a pincer grasp by:8-10 monthsAn infant understands the word "no" by:7-9 monthsAn infant can purposefully say "mama or dada" by:8-9 monthsAn infant should be able to pull to a stand and/or cruise by:9-10 monthsA child should be able to walk alone by:12-14 monthsA child should feed themselves with their fingers by:12-14 monthsThe first molars begin to cut by:12-14 monthsA child should be able to point to some body parts by:15-18 monthsA child should be able to stack 3 blocks by:17-18 monthsErikson's developmental stage for toddlers is called:Autonomy vs doubt/shameThe birth weight quadruples by age:2 yearsA toddler should be able to use 2 word sentences by how many months?18-22A child should be able to walk up and down the stairs by:22-24 monthsPrimary teeth should be erupted by what age?24 monthsErikson's developmental stage for pre-schoolers is calledInitiative vs guiltErikson's developmental stage for school aged children is called:Industry vs inferiorityErikson's developmental stage for AdolescenceIdentity vs role confusionThe Denver 2 test assesses what?gross motor skills fine motor skills language Personal/social developmentWhat does the Denver 2 test NOT testIQGrowth parameters can be measure using:growth charts BMI Bone ageWhen should a parent use syrup of Ipecac?If the poison control center or product label suggests to induce vomiting AND the patient is at least 30 minutes from a healthcare facilityWhen should we begin to assess BMIAge 2Neonatal periodbirth to 28 daysInfancy1 to 12 monthsToddler1-3 yearsPreschooler3-6 yearsSchool aged6-12 yearsAdolescence13-18 yearsAnticipatory guidance focuses on:Health habits prevention of illness prevention of injury Nutrition Dental care SexualityBone age is determined by:xraying wrist to determine closure of growth platesWhat is the most easily digested infant foodbreast milkHow long does the AAP recommend that a mother breastfeeds her infantfor at least 6 months, up to a year if possibleSolid foods should never be introduced until what age?6 monthsWhat food should be introduced first?Iron fortified rice cerealWhat should be supplemented after 6 months in an infant's diet? (all infants)IronWhen is the earliest that a child should drink juice?1 yearHow much juice should a child be limited to how much a day?4 to 6 ounces a dayTable foods can generally be introduced by what age?12 monthsThe latest recommendations regarding rear-facing carseats state that children should remain in a rear-facing car seat until what age:2 yearsWhen should you avoid giving an infant a bottle or sippy cup?Before bed or naps - do not put them down with a drinkWhat can happen if you put your child down to bed with a drink?Increased risk of dental disease/cariesHow far should you hang a mobile or hanging toy from a young infant's face?8-10 inchesGrowth begins to slow at what early age after infancy?12-18 monthsMilk should be limited to ???? ounces a day to prevent iron deficiency anemia32 ouncesToddlers engage in what type of play?ParallelIf mom is Hep B positive, when should the first Hep B immunization be given?In the first 12 hours of lifeIf mom is Hep B positive what other immunization should be given (besides the Hep B vaccine) in the first 12 hours of life?Hep B immunoglobulin (HBIG)Do not give the Rotavirus vaccination after what age?8 monthsDo not give the Hib vaccination after what age?5 yearsWhen is Flumist given?In any healthy 2-49 years of ageVaricella vaccination cannot be given before what age?12 monthsHPV vaccination is given at what ages?3 doses between ages 9-11What should you assess after administering the HPV vaccineThe child should be monitored for a reaction for 15 minutes after the injectionVaricella should be separated from what vaccination for at least 1 month?MMRIn what ages should you pull the pinna of the ear downward to assess the ear?children 3 and underBrushfield spotssalt and pepper speckling on the iris associated with Down SyndromeWhen should you consider strabismus abnormal and encourage referral to an eye doctor?after 6 monthsHow many teeth should a child have by 12 months?6-8Round/circular shaped chest with AP diameter equal to the Transverse diameterNormal finding in and infant chest assessmentTransverse to anteroposterior chest diameter 2:1Normal chest finding in a child and adolescentEnlarged breasts during the first few months of lifeA normal finding of breast tissue in infants r/t mom's hormonesPhysiologic split of S2 and S3Normal heart sounds in childrenSinus arrhythmiaNormal in childrenBest place to assess pulses in an infantBrachial or femoral or apicalRounded abdomenNormal finding in infant abdominal assessmentFlat abdomenNormal finding in child's abdominal assessment - should not be roundedStages of separation anxiety (list them)Protest Bargaining Despair DetachmentProtest stage of separation anxietythe child appears sad, agitated, cries, is angry and inconsolable, and looks for parents to returnDespair stage of separation anxietyThe child appears sad, hopeless, withdrawn, acts ambivalent when parents returnDetachment stage of separation anxietyThe child appears happy, interested in the environment, becomes attached to staff members, may ignore parents when they returnVS for an infant with painIncreased HR and BP may decrease their O2 sat if severeregressionuse of behavior that is more appropriate for an earlier stage of development, often used to cope with anxietyPreschoolers may perceive illness as ....punishmentPreschoolers in pain may appear....Restless, irritable, cry, kick.Preschoolers in pain are able to....Describe the location of their painTrue or false: Preschoolers may deny pain to avoid possible threat of injections or bad-tasting medicineTrueThe major fear of the school aged hospitalized child is:Fear of bodily injury and loss of controlCommunication style that should be used with the school-aged childOpen and honest, explain the rulesDo girls or boys typically express pain more?GirlsAdolescence ultimate fear in healthcareLoss of independence, identity, and body image disturbancesNormal behaviors of adolescence when dealing with hospitalization/illnessloss of control, anger, withdrawal, uncooperativeness, power strugglesAdolescents believe that they are:InvincibleIM injections in children birth to 12 months should never be greater than ? volume?0.5mLIM injections in children greater than 12 months should never be greater than ? volume?1mLWhat should you do if an injection is too large for the child that you need to administer it to?Split the dose into two injectionsWhat is the most atraumatic approach to giving multiple injections to any child?Administer 2 at a time with a co-worker simultaneouslyWhen do children begin to metabolize most medications in a similar way to adults?1 yearPediatric medication doses are always based on?weightWhat are the rights of safe medication administration?right client right medication right dose right route right documentationHow can you get an infant to take a small amount of liquid medication if you do not have a syringe available?Put it in the nipple of the child's bottle and let them suck it outWhat is an appropriate needle size for an infant?23 or 25 gu 1/2 or 5/8 inchVisual cues that an infant or child is in painshort attention span irritability facial grimacing biting or pursing lips drawing knees up guarding the area lethary, withdrawn sleep disturbancesWhat pain scale operates on a scale of 0-10 and uses physiologic and behavioral cues?FLACCWhat pain scale operates on a scale of 0-5 and uses faces that a patient may interpret represent how they feel?FACESWhat are the preferred routes for narcotic pain medicationOral or IV - shots hurt!What are some nonpharmacological methods to manage pain in children?distraction cutaneous stimulation (touch or electric) Sucrose solution (OraSweet) Guided imagery Relaxation Hypnosis Application of heat/coldPainful procedures should be performed where?Not in there bed or roomThe review of systems is:A systematic review or history of every system of a child, physical, developmental, and family, that is done to help identify potential areas of concern and focus additional assessments and examinations.A birth history should be done for any child under age:6 yearsDiaphramatic breathing is normal until what age?4 or 5 yearsWhat is the difference between a child's head and an adults?the child's head is disproportionately larger, heavy, and balanced on a small and weaker neckWhat is different about a child's tongue vs and adults?An infant or child's tongue is largeWhat is different about a child or infant's airway vs and adultThe infant or child has much smaller airway passages that can easily collapse, obstruct, or become plugged or swollenWhat is different between a child's abdomen and an adult'sthe infant or child's abdomen is protruding and the visceral organs are not protectedHow does an infant or child compensate to increase their cardiac output?They increase their heart rateWhat can an infant or child NOT do to compensate in order to increase cardiac output?Increase their stroke volumeWhen can a child increase their stroke volume?By age 8Why are children at increased risk of dehydrationBecause they are made up of a higher percentage of waterDevelopmental approach to the physical exam: Infants less than 6 monthsUse parent as comfort measure Can be head to toe if quiet - be flexible keep them warm, limit exposure until necessaryDevelopmental approach to the physical exam: Infants > 6 monthsHave parents hold the child on their lap for the exam when possible Use comfort measures and observeDevelopmental approach to the physical exam: ToddlersKeep the child on the parent's lap for the exam whenever possible Tell the child what you are doing in a confident and friendly voice Approach the child at their level Start by touching their hands and feetDevelopmental approach to the physical exam: PreschoolersAssess their willingness to participate leave their underwear on until they must be removed allow the child to tough the equipment use distraction and positive feedbackDevelopmental approach to the physical exam: School agedAnticipate modesty, let them keep their underwear on Allow the child to have the exam in private Use a head to toe approach, assessing private parts last Offer explanations and take opportunities to teach about their bodyDevelopmental approach to the physical exam: AdolescentsRespect their modesty and their knowledge Head to toe assessment Conduct the exam in private - ask the parents to leave Provide reassurance about the normalcy of their bodyMenses usually begins ________after onset of breast development2 yearsPreadolescent females should not have vaginal _________DischargeBowel sounds in children should occur every _________ seconds10-30If a child should be having abdominal breathing and the abdomen does not move with breathing, this can indicate__________PeritonitisTesticles should be what size until puberty?1-1.5 cm in diameterPresence of pubic hair in a female before age ______ is abnormal?8 yearsPresence of pubic hair in a male before age _____is abnormal?9 yearsPenile enlargement occurs ________ after testicular enlargement1 yearEjaculation first occurs in Tanner's stage ?3Tanner stage 2 boysenlargement of the scrotum and testes, scrotum roughens and reddens Pubic hair sparseTanner stage 3 boysPenis elongates Pubic hair fills out but is straightTanner stage 4 boyspenis enlarges in breadth and development of glans, rugae appear on scrotum Pubic hair is more coarse - no triangle yetTanner stage 5 boysAdult-like appearance in size and shape Pubic hair coarse and full - inverted triangleTanner stage 1 boysPreadolescent no pubic hairTanner stage 1 girlspreadolescent no pubic hairTanner stage 2 girlsBreast buds with areolar enlargement Pubic hair sparseTanner stage 3 girlsBreast enlargement without separate nipple contour Pubic hair fills out but is straightTanner stage 4 girlsAreola and nipple projects as secondary mound Pubic hair is more coarse - no triangle yetTanner stage 5Adult breast, areola recedes, nipple retracts Pubic hair coarse and full - inverted trianglePrecocious pubertyThe onset of puberty before age 8 in girls and age 9 in boysKernig's signpositive when head goes back when hip is flexed to 90 degrees then extended (meningeal sign)Brudzinski's signPositive when there is an involuntary flexion of the legs when the neck is flexed forward (meningeal sign)Children up to 36 months are measured bylength for age weight for age head circumferenceChildren ages 2 through adolescence are measured byStature for age weight for age BMIHeight falls more than 2 standard deviationsShort statureConstitutional delayBone age is consistent with height age - not done growing yet (late bloomer)Proportional short statureAlways on low percentile of height for age r/t health condition or abnormalityChild abuse is most common in what agesLess than age 4What percent of children know their abuser?90%What percent of children are abused by family members?68%What percent of abused children will go on to become child abusers?30%Signs of child abuse (behavioral/historical)sudden change in grades/performance Not received medical care for injuries or illness Child always appears watchful Lacks adult supervision Overly compliant, passive, or withdrawn Comes to school early and stays late Trouble concentrating or learningparental cues for child abuseparent shows little concern for child Denies problems or blames child for them asks other caregivers to discipline the child demands unrealistic level of performance Looks to the child for support or careCommon cues for abuser and childrarely make eye contact consider their relationship negatively state they do not look like each otherThe deliberate withholding of or failure to provide the necessary resources to the childNeglectNeglect includes withholding:Nutrition/hydration hygiene healthcare shelterEmotional abuseInvolves shaming, ridiculing, embarrassing, humiliating, or insulting the childEmotional abuse includesVerbal abuseRisk factors for child abuse:poverty family violence prematurity unrelated male caregiver parents who were abused less than 4 years of age special needsClinical signs of abuseMultiple abrasions/bruises in different stages of healing burn marks with clear demarcation Rope/buckle/cord marks on mouth, legs, buttocks, thighs Burn scars in various stages of healing Discomfort or SOB when touched or moving Appearance of sedation or over medication Exacerbation of chronic illnessesPhysical abuseThe deliberate maltreatment of another individual that inflicts pain or injury and may result in permanent/temporary disfigurement, disability, or deathSexual abuseThe exploitation of a child for sexual gratification of an adultIncestSexual activity with a family member that is too close to marryPedophileAt least 16 years old At least 5 years older than the victim Has sexual impulses toward childrenExhibitionismGets sexual gratification by exposing their genitals to another personRisks for sexual abuseAbsence of a father, having a step father Being female Mother is employed outside the home Poor relationship with parents Parental relations conflicted Parental substance abuse or social isolationClinical signs of sexual abuse of a childvaginal discharge in a non-adolescent child Blood-stained diaper or underwear Difficulty walking or sitting Frequent UTI's STD Somatic complaints, difficulty sleeping Unwillingness to go to certain caregivers Irrational fear of strangers New sexual curiosity or play Constant masturbation seductive behavior Child acts like spouseBrain injury results from violent shaking that causes sheering of blood vessels around and inside brainShaken baby syndromeWhat causes shaken baby syndrome?Shaking a baby violently - ONLY Not a fall, cpr, etc. Does not occur in a momentary lapse of judgementMunchausen's by proxyPotentially deadly form of child abuse that occurs when a caregiver fabricates illnesses or injuries that result in the child receiving unnecessary medical care or care for conditions that were caused by the caregiverYou should suspect Munchausen's when:The story is inconsistent Rare or unexplained symptoms are reported The child is unresponsive to treatment the history and physical are inconsistentCommon reported symptoms in Munchausen's by proxyn/v apnea CNS symptoms seizures Blood in urine or vomit or stoolWhat is the nurse's priority when caring for a child that is suspected of being a victim of child abuse?Protect the child and maintain safetyWhat should you document when caring for a suspected victim of child abusegeneral family hx specific child hx details of injury/illness with quotes from parents and child Document inconsistencies in story Draw pictures or use photos document processing of clothing and belongingsWho is a mandatory reporter for suspected abuse?Any healthcare professional, teacher or school employee