health promotion goals
Ensure optimal nutrition
Prevent specific diseases through immunization and hygiene
Prevent undesirable sequellae through screening for asymptomatic disease
Detect & treat symptomatic problems early
cultural influences
Learn differences
Anticipate contact with Hispanics
Nursing implications
immunity maturation
maternal IgG provides immunity to maternal antigens for first 3 months (in last few weeks of pregnancy)
Infant IgG reaches 40% of adult levels by 1 year
Low IgM levels until 9 months
active immunity
natural from disease or artificial from immunization
passive immunity
natural from maternal IgG or artificial from IVIG
live attenuated bacteria/virus
type of vaccine
varicella, MMR
killed inactivated bacteria/virus
type of vaccine
Hep B, IPV
protein conjugate
type of vaccine
HIB, PCV
toxoid
type of vaccine
tetanus, diptheria
determining when to administer vaccine
Maturity of infant immune system
Presence of maternal antibodies
Immunosuppression of recipient or family member- live vaccines
Geographic location
Duration of immunity generated by vaccine
Accessibility to health care system
influenza
Nasal vs injection
Quadrivalent vs trivalent
2017-2018: A/H1N1, A/H3N2, B/Brisbane/60/2008-like virus (Victoria lineage), if quad B/Phuket/3073/2013-like virus (Yamagata lineage)
Egg allergy
6 months to 8 yrs get 2 dose if first season of vaccine
very imp
HBV
Inactivated virus in a series of 3
Recommended for all children to prevent Hepatitis B later in life
This should be the first vaccination an infant receives!
New AAP recommendation to give within 24 hours of life
HAV
Inactivated virus, series of 2
Not required for school but recommended
Transmitted through contaminated food or water
Children are often asymptomatic
DTaP
given under 7 yrs
Tdap
after initial series a booster required q 10 yrs
pertussis
(inactivated bacteria- aP)
severe disease in infants < 6 mo.
Whole cell better than acellular
Contagious up to 3 weeks
Contagious up to 5 days after start of treatment
DTaP 90% effective in 1st year, 60-70% at 5 years
symptoms:
looks like common cold, who
polio
Oral- Sabin- live virus eliminated in GI tract- not recommended now
IPV- Salk- inactivated polio vaccine- given SQ, requires boosters
enterovirus
hemophilus influenzae type b
Hib is a protein congugate that boosts immune response in infant
Protects against- meningitis, epiglotitis, pneumonia, septic arthritis, otitis
Timing- given with DTaP, not given past age 5
MMR
a live virus vaccine -give SQ
Given at 12-15 months and again before school 4-6 yrs
Significance- illness can be severe with serious sequellae
Significance of Rubella or German measles in pregnant women
measles outbreaks
3 C's: cough, coryza (head cold, fever, sneezing), and conjunctivitis (red eyes)�along with a maculopapular rash.
vitamin A can decrease mortality/morbidity
Measles and Disneyland
December 2014
CA: >100 cases (US 667 cases)
Europe (Belgium, France, German
measles can be serious
~1/4 people who get measles will be hospitalized
1/1000 people with measles will develop brain swelling due to infection (encephalitis) which may lead to brain damage
1-2/1000 people with measles will die, even with the best care
varicella
Series of 2
Given between 12-18 months, before 12yrs
Significance- prevents very contagious disease and can prevent shingles later in life
pneumococcal PCV13 or 23PS
PCV13 (Prevnar)- series of 3
23PS (Pneumovax)- 1 dose given between 2-5 yrs
-Immunocompromised
-Asplenia
-HIV
-Nephrotic syndrome
-Cochlear implants
-Sickle cell
-CSF leaks
prevnar before pneumovax
if given with flu or tdap increased risk of febrile seizu
rotavirus
Most common cause of childhood diarrhea
Series of 3
Do not administer after 32 months of age
meningococcal MCV4
N. meningitis mortality rate 10%
MCV4: serotypes A, C, Y, W-135
Series of 2 if begun prior to 16 yrs
One dose if first given at 16 yrs or later
meningococcal serogroup B (Menb)
Lessons from Princeton University, UCSB 2014, Univ of Oregon 2015, Santa Clara Univ 2016
Trumenba(Oct 2014)- 2 or 3 doses
Bexero- 2 dose, licensed in >30 countries
High risk and permissive use in general population (June 2015)
NOT interchangeable
HPV
Series of 2
Why your should care.
-Most common sexually transmitted infection
-HPV causes lots of cancer
-HPV vaccine prevents cancer
Why such low administration rates?
HPV9 valent
-Recommend 2 doses, 9-14 yrs with 0, 6-12 mo interval (routine still 11-12
administration of vaccines
Parental teaching- why important, schedule, side effects, VIS
Read package insert & follow instructions
Use appropriate route & technique
Accurate documentation
Tylenol for side effects of pain irritability
Watch for neurological side effects! (rare)
Must
contraindications/precautions
Defer for "severe febrile illness", OK to give with minor cold
Defer live vaccines in immunosuppressed client or recent passive immunity
MMR not given to pregnant people
Assess for previous allergic response to vaccine- if anaphylaxis do not give again
rule of thumb
Can give any vaccines in same day except MCV4 & PCV13 in asplenic patient
Give live vaccines simultaneously, otherwise 28 days apart
Pay attention to minimum age and minimum interval
Some vaccines have a max age
There is no maximum interval for vaccine se
factors that predispose infants to infection
Prematurity
Maternal infections
Early rupture of membranes
Invasive procedures
fever in newborn r/o sepsis
General- not doing well, poor temp control- hypothermia usually
Circulatory system- pallor, cyanosis or mottling, cold clammy skin, hypotension, edema, irreg HR
Respiratory- irreg rate, apnea or tachypnea, cyanosis, dyspnea, retractions, grunting
CNS- let
nursing management r/o sepsis
Assess and manage
*ICP
*respiratory difficulties
*skin problems
*maintain IV for antibiotics
*temperature control measures
*fluid & electrolyte balance
diagnostic workup/management r/o sepsis
Cultures of blood, CSF, urine
X-ray if severe respiratory symptoms
IV fluids & antibiotics
Supportive care of parents- need explanation and support
Manage hyperthermia-environment, tylenol (dose= 10-15 mg/Kg q4h)
lead poisoning
>5mcg/dl
pathophysio
-renal
-hematologic
-neurologic
screening
-BLL (blood lead level)
sources of lead poisoning
clinical findings
-history
-physical
management
Repeat lead level
Interventions
General Education
Environmental history and hazard reduction,
hematologic lead poisoning
1. interferes with synthesis of heme
2. accumulation of alternative metabolites, increased erythrocyte-protoporphyrin
3a. anemia
3b. increased urinary coproporphyrin and alpha amino levulinic acid levels, impaired Ca2+ function
renal lead poisoning
1. damages cells of proximal tubules
2. glycosuria, proteinuria, ketouria, decreased vitamin D
3. increased urinary coproporphyrin and alpha amino levulinic acid levels, impaired Ca2+ function
neurologic lead poisoning
1. increases membrane permeability leading to increased ICP leading to tissue ischemia and atrophy
2a. LOW DOSE EXPOSURE: distractibility, impulsivity, hyperactivity, hearing impairment, mild intellectual deficits
2b. HIGH DOSE EXPOSURE: lead encephalopat
good nutrition for kids
Moderation and variety
Only long-term patterns will have an effect
Individual needs vary
Breast feeding is the best
Obesity must be prevented
If given the chance, kids usually eat what they need
breakfast is important
British Journal of Medicine, 2017
Followed 802, 4-10 yr olds and 884, 11-18 yr olds from 2008-2012
Lower levels of folate, calcium, iron and iodine if skipped breakfast
-Iron: 31.5% ate/4.4% skipped
-Calcium: 19% ate/2.9% skipped
7% of 4-10 yr olds didn't
nutritional assessment
historical data
-compare to serial measurements
- Social & cultural history
-Previous illnesses
-Current medications
dietary data
-Normal patterns
-Socioeconomic status
-Dentition
-Food Allergies
physical exam
-Growth chart measurements
-Condition of skin
nutritional needs 0-6mon
Breast milk
-advantages- perfect content, temperature, availability, bonding
Formula- iron fortified- many types for specific conditions
nutritional needs 6-12mon
Developmental changes- can sit, extrusion reflex diminishing, can grasp objects, teeth begin erupting
Maternal iron stores gone
Introduction of solid foods (iron fortified cereal, vegetables, fruits, meats-all pureed) one at a time
9-12 mo begins eating t
nutritional needs toddler/preschoolers
Growth is slower
Table foods
Limited variety
Establish Healthy eating patterns- nutritious foods first, small amounts
Pleasant , positive atmosphere
nutritional needs school age/adolescents
Importance of breakfast and snacks
Need for iron
Peer pressure
Enjoy preparing foods
Increased appetite and variety
Teens- >need for protein, Vitamin A & C, calcium, iron, zinc-
food concerns of adolecents
Iron deficiency anemia
Obesity
Dieting
Anorexia & Bulemia
Empty calories instead of nutrients
iron deficiency anemia
Inadequate intake of dietary iron
Hgb < 11Gm, Hct < 33%, varies with age
Incidence in 9-24 mo. olds and Teens
S&S-pallor skin & mucous membranes, when Hg < 8 infant irritability, inability to concentrate, anorexia, decreased activity tolerance, microcytic
dental care
Early dental visits for cleaning
Primary teeth start at 6 months
Secondary teeth at ~ 6 years
Fluoride decreases dental carries by 20-40% in kids and 35% in adults
baby bottle tooth decay
caused by liquids pooling in mouth during sleep
obesity
Weight above the 95% in Wt for Ht
Increased number and size of fat cells
Epidemic: nearly 1 in 6 school age children are obese
etiology of obesity
Multifactorial
Heredity- overweight parents... overweight children
Social and individual psychology
Metabolism
Eating and Physical Activity
Environment
consequences of obesity
Increase in Type II Diabetes
Increase in female teen smoking
Increase risk factors for heart disease, asthma, sleep apnea, bone and joint problems
Low self-esteem, depression
Bullying
Increased obesity in adulthood
obesity management
Diet
Physical Activity
Behavior Modification
Drugs
Surgery
failure to thrive
Wt (sometimes ht) < 5th %
Inadequate caloric intake- incorrect formula prep, neglect, food fads, poverty, CNS problems, behavioral
Inadequate absorption- CF, celiac disease, deficiencies, biliary atresia, hepatic disease
Increased Metabolism- hyperthyroid
management of FTT
Reverse the cause
Assess feeding behavior
Parental education and follow-up
Prevention- close post-natal follow-up with high risk families
Hospitalize, or removal from parents' care for Dx and initial treatment