• infectious agent
• resivoir
• portal of exit
• mode of trasmission
• portal of entry
• susceptable host

infants

risk for infection

hand to mouth behavior

*adults kissing infants- adults changing diapers and practicing poor hand washing

preschool and toddlers

risk for infection

fecal to oral route

potty training stages- poor hand washing

school age

risk for infection

school age kids

when grouped together often get?

pneumonia

*leading cause mycoplasm pneumonia

not going out in cold

hygeine

nutrition

sex education

not recieving boosters

sexual intercourse

Personal hygiene and immunization status of the caregiver

• Personal hygiene and immunization status of the children

• Sanitation of the environment
• Specific procedures for toileting and diaper changing

• Procedures for the handling and preparation of food

• Caregiver-to-child ratioQuality and physical space of the facility • Specific exclusion criteria for children with potentially infectious illnesses
• Good lines of communication with parents

• Access to qualified health consultants and public health personnel

Month, day, and year of administration

• Vaccine administered
• Manufacturer
• Lot number and expiration date

• Site and route of administration
• Name, address, and title of the health care provider administering the vaccine

Importance of Immunization Records

Caregivers

*history of severe anaphylaxic reaction to vaccine

*enchephalopathy within seven days of administration of DPT/TDAP

screen for pregnancy! it is a teratogen

warn them to not get pregnant for at least three months

10-15mg/kg/Q4hours

no more than 5 times per day

teach parents

symptoms to seek help for

parameters of fever:

rectal

Reye Syndrome (RS)

Reye Syndrome (RS)

•    Actual cause not clear-usually follows common viral illness.

•    Linked to the use of ASA and NSAIDS during the flu.

Reye Syndrome (RS)

Diagnosis made by

parameters for fever:

oral

Reye Syndrome (RS)

Management

parameters for fever:

axillary

Immune System

system is to recognize any foreign substance within the body and eliminate.

These consist of physical barriers such as the skin, mucous membranes, and cough reflex; chemical barriers such as pH of the stomach, fatty acids and proteolytic enzymes of the small intestine; and fever.

nonspecific immune cells such as phagocytes (macrophages, neutrophils, natural killer cells) and lymphocytes

when running USUALLY are not harmful to the child

>105 risk for seizures

patho:

fevers

most are associated with a viral illness

most range between 100.4 and 104 F

most last 2-3 days

does NOT relate to the seriousness of the illness

*how sick the chikld acts is what matters! not how high the temperature!

105-107

about 4% of the children will have febrile seizure with fever (generally harmless)

evaluating fevers

call doc immediately if:

under 2 months of age

fever over 104

crying unconsolably or whimpering

cries when moved or touched by parent

difficult to awaken

stiff neck

purple spots on skin

breathing is difficult(not stuffy nose)

drooling saliva, unable to swallow anything

seizure

child acts sick

call the doctor within 24 hours if:

-fevers-

2-4 month old(unless occurs in 48 hr from DPT and no other signs of ilness)

fever between 104-104.5 (especially is uder 2 yrs)

burning or pain with urination

fever present more than 24 hr without and obvious cause or location in infection

call the doctors office if:

fever went away for more then 24 hr then returned

fever present for more than 72 hrs

fever with a history of febrile seizures

increased comfort

(just doin my job brooke)

reye's syndome

up to 21 yrs no asa<12

avoid til 21

fever

sponging:

febrile seizure

cause:

febrile seizure

definition:

immunoglobulins

IgG, IgM, IgA, IgE, and IgD.

helper T cells, cytotoxic T cells, suppressor cells, 

memory cells

T lymphocytes regulate the immunologic response by secreting ________.

affect other T cells, and attract and activate mononuclear cells, particularly macrophages.

The chemical mediators or messengers that communicate throughout the immune process

These include the lymphokines, produced by lymphocytes, and the monokines, produced by monocytes and macrophages.

important messengers, are host-specific rather than antigen-specific as infected cells secrete them

inhibit replication of many viruses, and have antitumor effects.

the passing or administration of preformed antibodies to someone.

The transfer of maternal antibodies to an infant through breast milk

Immune responses directed against substances foreign to the body, but not necessarily harmful in themselves.

the immune response is initiated just like a response to dangerous microorganisms, as these innocuous substances sensitize a person so on reexposure

juvenile idiopathic arthritis (JIA), a new name for

juvenile rheumatoid arthritis (JRA),

and systemic lupus erythematosus.

Juvenile idiopathic arthritis (JIA)

or juvenile rheumatoid arthritis (JRA)

terms used for a group of idiopathic chronic inflammatory diseases affecting joints and connective tissues in children.

may present as one of three major disease courses: systemic onset

pauciarticular (pauci), involving five or fewer joints

or

polyarticular, simultaneous involvement of four or more joints.

JIA-

Two peak ages of onset

JIA

Which gender is most effected

Clinical Manifestations

JIA/JRA

persistent joint swelling, pain, and stiffness ("jelling") that is typically worse in the morning. The child may also exhibit limited mobility or range of motion in the limb of the affected joint (limping due to knee involvement).

may also experience a high fever and a light skin rash.

JIA/JRA

Diagnosis

primarily on the basis of history and assess¬ ment findings.

diagnostic criteria:onset before 16 years of age;

arthritis of at least 6 weeks' duration; a defined subtype and exclusion of other conditions such as other rheumatic diseases, infectious arthritis, inflammatory bowel disease, and nonrheumatic conditions of bones and joints.

Symptoms of JIA 

Systemic Onset

Fevers-High, quotidian or diquotidian as high as 105 degrees F (40.56°C), returning back to baseline between spikes 

• Rash-Salmon-pink, migratory, macular or papular, most common in late afternoon or early evening 

• Arthralgia or myalgia

• Arthritis (see definition under "Diagnosis" section); usually multiple joints are involved 

• Fatigue or malaise • Lymphadanopathy-Usually cervical, epitrochlear, axillary, or inguinal 

• Hepatosplenomegaly • Can also present with signs of carditis-chest pain, tachycardia

Symptoms of JIA

Polyarticular Onset

Arthritis in many joints (5 or more)-any joint can be af¬ fected, but most particularly the joints of the knees, wrists, ankles, and proximal interphalangeal joints of the fingers. Often neck and temporomandibular (TMJ) joints are affected. 

• Fever-occasionally, low grade.

Symptoms of JIA

Pauciarticular Onset

• Arthritis in a few joints (4 or fewer)-often, though not exclusively, joints of the knees and ankles. 

• Inflammation of the eyes-common in antinuclear antibody positive preschool girls.

JIA

Treatment Approaches

JIA

Family Teaching

include information about the disease and medications, diagnostic tests and their significance, physical activity, and nutrition.

describing the adjustment process, and addressing parental, sibling, and child issues.

Systemic lupus erythematosus

commonly called SLE

or lupus

lupus

onset

can develop at any age,

usually occurs after the age of 5 years or during adolescence

lupus

What gender is affected most offten

lupus

what race is most affected?

Clinical Manifestations 

 lupus

Diagnostic criteria for systemic lupus erythematosus

must have at least 4

• Malar rash: Erythematous, flat or raised over the cheeks. 

• Discoid rash: Erythematous raised patches with scaling. 

• Photosensitivity: Skin rash from exposure to sun. 

• Oral or nasal ulcers: Usually painless ulceration of the mucosa. 

• Nonerosive arthritis: Two or more peripheral joints with tenderness, swelling, or effusion. 

• Pleuritis or pericarditis: History of pleuritic pain or rub heard by a physician OR pericarditis documented by cardiogram OR pericardial effusion. 

• Renal disorder: Persistent proteinuria OR cellular casts; can progress to hypertension, nephrotic syndrome, renal insufficiency, and end stage renal disease requiring transplantation. 

• Neurologic disorder: Seizures OR psychosis without other cause. 

• Hematologic disorder: Hemolytic anemia OR leukopenia OR thrombocytopenia. 

• Immunologic markers: Positive antibodies to DNA, other nuclear antigens, or lupus anticoagulant. 

• ANA: Positive antinuclear antibody (ANA). 

• Alopecia.

lupus 

Treatment

usually based on the child's age, sex, health, symptoms, and lifestyle. is targeted at preventing exacerbations, treating them when they do occur, and minimizing organ damage and complications.

Immunosuppression is usually necessary

The aim of most medications is to reduce inflammation, thus decreasing tissue damage.

febrile seizures

reassure parents:

that the condotion of benign

attepmts to lower the temp and prevent seizures is of no benefit

reye's syndrome

definition

second line of defense

not functional at birth; learned by the body

*functional by age six

humeral immunity

what triggers the immune response?

humeral immunity:

 what eliminates foregin proteins?

classes of antibodies

IgG

antibacterial and antivirus in all body fluids.

most abundant- formed after past or previous exposure

classes of antibodies

IgA

classes of antibodies

IgM

primary response to an antigen

(current infection)

classes of antibodies

IgE

T-cells

production

T-cells

function

t-cells

responsible for graft rejection

also incluude killer T cells, suppressor T cells and helper T cells

suppressor-inhibit activites of t and b cells

helper t's regulate action of b cells

antigen/antibody

response to invasion

autoimmune diseases (body attacks itself)

*lower levels of proteins in newborns then older children and adults

bone marrow aspiration

white cells differentials (differential blood count)

allergy testing:

• scratch tests
• prick test
• intradermal testing
• RAST test

SCID

SCID

genetic link?

x-linked recessive or autosomal recessive inheritence.

and also spontaneous mutation

SCID

mortality

SCID

assessment

SCID

medication therapy

-intraveneous immune globulin (IVIG)

boosts immune response temporarily

SCID medications

IVIG adverse reactions

monitor for overgrowth of bacteria

immunizations 14 days before or 3 months after IVIG

parent teaching; evaluation of infection status

allergies

FIRST exposure causes?

production of antibodies(usually IgE)

allergies

subsequent(second) exposure causes?

allergens

inhalants- mold,pollen,house dust, pet dander

foods- cow's milk, eggs, wheat, citrus

drugs- oral and injectable

animal serum/venom- insect bites

contact allergens- plants; dyes; chemicals; alloyed metals

allergy assessment

resp.

allergy assessment

skin

allegry assessment

GI

allegry assessment

neuro

allergy assessment

GU

identify allergens- skin tests or RAST

- looks for specific IgE antibodies

*remove allergens for environment

injections for controlled antibody formation if risk for anaphylaxis

-keep child in controlled environment for 15 mins following injection; specific schedule

-emergency treatment readily available

antihistamines

bronchodilators

corticosteroids

cromolyn sodium

epinephrine- anaphylaxis

client education

safe administration of meds

evaluation

acronym for group of infections which cause teratogenisis when acquired in utero

T- toxoplasmosis

O-other                         

R- rubella                     

C-CMV                          

H- herpes simplex virus

TORCH assessment

maternal history during pregnancy

intrauterine growth retardation

comprehensive newborn assessment

serologic blood sampling for infection

treatment related to specific organism

torch

comprehensive newborn assessment:

sepsis

neonates:

sepsis

at risk

immunocompromised children at high risk

skin defects/injury

sepsis

organisms:

e coli

pseudomonas

enterococcus

staphylococcus

sepsis

assessment

hypothermia or hyperthermia

lethargy and poor feeding

jaundice or hepatomegaly

respiratory distress

vomiting

hypoglycemia and hyperglycemia

CBC will indicate infection; spinal tap

sepsis

treatment

maintain temp WNL

-antipyretics; appropriate clothing

monitor blood glucose

maintain antibiotic therapy

-usually based on culture and sensitivities

client instruction and support

-sepsis can be deadly; parents very frightened

AIDS

transmission

AIDS

pregos?

AIDS

mechanism of action

HIV enters the T lymphocytes, particularly CD4 cell

CD4 cells begins synthesis of the HIV DNA

- leads to cell death of CD4 cell; susceptable to infections caused by deficiency in cell mediated and humeral immunity

AIDS

diagnosis

- sympptoms

diarrhea, numberous respiratory and other infections

AIDS

coomplex management

nutrition and hydration

medications therapy: zidovudine (AZT)

antibacterials

client education and support

childhood communicable diseases

group of common diseases

communicable diseases

nursing interventions

history and physical

prevention through vaccinations

decrease exposure to other children

medications: antibiotics or antipyretics

tepid baths; limit clothing and coverings

nutrition and fluids- increase fluids

skin care to prevent breakdown; rest!

AIDS

if a baby drinks from the wrong mother:

antibiotics IMMEDIATELY

kids go down fast, act fast