Test 2

health promotion

• empower clients to control their health habits

• goal: help clients to make informed decisions for healthier lives

• National: Policies, campaigns, funding (e.g., taxing tobacco, creating parks).

• Individual: Education, guidance, disease management, lifestyle counseling.

wellness

• individual actions to achieve holistic health and fullest potential

• spiritual, mental, mindfulness, physical, environmental

• client centered, based on personal choices and needs

disease prevention

• measures to limit exposure to or effects of illness/disease

  • ex) immunizations, hand hygiene, safe sec practices

• four levels:

  • primary: prevent disease (vaccines, seat belts, health counseling)

  • secondary: screening (BP checks, mammograms, Pap checks)

  • tertiary: treatments (rehab, diabetes self care, support groups)

  • quaternary: prevent unnecessary/ excessive medical interventions (avoid over screening)

Illness-Wellness continuum

• right side: high wellness/ optimal health

• left side: illness, poor health, death

• middle: neutral state (neither wellness nor illness)

health communication and strategies

• mass media and campaigns to educate on health issues

• ex) CDCs anti smoking campaign with real time stories -> reduced smoking rates

• Effective education:

  • Start at first client encounter.

  • Use simple, clear language.

  • Provide small bits of information, reviewed often.

  • Include printed resources for reinforcement.

healthy people initiative

• established by DHHS

• new goals every 10 yrs

• Provides:

  • Framework, history, and principles for national health goals.

  • Public access to 10+ years of health data.

  • Tools for health professionals and communities.

  • Interactive data access for individuals/groups to create personal health goals.

• Goal: Make the U.S. a leader in population health.

self care

• clients promote and maintain own health

• seven pillars:

  • Knowledge & health literacy.

  • Mental well-being & self-awareness.

  • Physical activity.

  • Healthy eating.

  • Risk avoidance (vaccines, safe sex, avoid tobacco/alcohol).

  • Good hygiene.

  • Rational/responsible use of products & services (medications, supplements, preventive care).

nurse self care

healthy meals, exercise, stress reduction, adequate sleep, social support

risk factors

• Definition: A Condition that increases the likelihood of disease/altered health.

• Modifiable (can change): High BP, tobacco, high-fat diet, alcohol, sedentary lifestyle, uncontrolled diabetes.

• Nonmodifiable (cannot change): Age, gender, race/ethnicity, family history.

• Nurses: focus on screenings, lifestyle changes, and prevention.

environmental factors

• Health affected by air/water quality, pollutants, waste, safety of homes/work/schools.

• Risks: Poor air → asthma, strokes, heart disease.

• Unclean water → outbreaks of waterborne diseases.

• Indoor hazards: Mold, radon, cockroaches, lead paint → developmental/respiratory issues.

socioeconomic factors

• Poverty = poor health outcomes, shorter life expectancy.

• Contributing issues: Lack of insurance, limited access to care, poor nutrition, sedentary lifestyle, unsafe neighborhoods, stress.

• Lower-income groups report higher rates of chronic disease and mental health issues.

health literacy

• Ability to understand and apply health information.

• Low health literacy → poor medication adherence, poor follow-up, difficulty with self-care.

cultural beliefs

• Affects how clients perceive health, illness, and treatment.

• Can influence: Medication adherence, end-of-life decisions, pain expression, treatment choices.

• Nurses must:

  • Assess cultural values/beliefs.

  • Develop cultural competence (awareness, communication, adaptation).

  • Provide culturally competent care → reduces disparities & improves outcomes.

family dynamics

1. Family = biologically, legally, or emotionally related individuals.

2. Families influence health decisions, coping, stress, and compliance.

3. Patient- and family-centered care (PFCC): Involves both client and family in health planning.

4. Nurses should include families in education, address barriers, and respect family input.

organs

• esophagus → Connects the mouth to the stomach

• Stomach → Holds food for 2 to 8 hours

• Liver → Produces bile

• Gallbladder → Stores and releases bile

• Pancreas → Helps metabolize sugars through insulin

• Small intestine → Where most of the nutrients from food are absorbed

• Large intestine → Turns food into feces (absorbs water/electrolytes)

• Rectum → Temporary storage area for feces

• Anus → Where feces leave the body as waste

glycemic index

• a high glycemic index causes a rapid rise in blood glucose.

• food like potatoes have high glycemic indexes

• vegetables, legumes, whole grains have low glycemic index -> maintain stable energy and blood sugar levels

calories calculation

• servings x calories/serving

• ex) Q: Client ate 2 servings of chips (150 cal/serving) + ½ serving of turkey sandwich (600 cal/serving). How many calories total?

  • Chips: 2 × 150 = 300 calories

  • Sandwich: 0.5 × 600 = 300 calories

  • Total = 600 calories

net carbohydrates

• required for calculating net carbohydrates

  • total carbohydrates per serving

  • dietary fiber

  • alcohol sugars

sodium

Client eats 1.5 servings of product. How much sodium?

• Sodium per serving = 572 mg

• 1.5 × 572 = 858 mg sodium

Q: If client’s daily sodium limit is 1,800 mg, what %DV is 858 mg?

• 858 ÷ 1,800 = 48% of daily sodium

physiology of digestion

1. Digestion = breakdown of food into simple substances → absorbed as nutrients or eliminated as waste.

2. Provides energy and nourishment for cells, tissues, and organs.

3. Begins with food consumption → saliva starts breakdown.

4. Peristalsis = involuntary muscular contractions that move food through digestive tract.

organs of digestion

• Mouth → chewing & saliva (enzymes start breakdown).

• Esophagus → hollow tube, propels food to stomach.

• Stomach → holds food (2–8 hrs); acids & enzymes digest food.

• Liver → filters toxins; produces bile (breaks down fats, proteins, carbs).

• Gallbladder → stores & releases bile when needed.

• Pancreas → produces insulin (regulates sugar metabolism).

• Small intestine → final breakdown of food; absorbs nutrients into bloodstream.

• Large intestine → absorbs water & electrolytes; converts remainder into feces; contains beneficial bacteria.

• Rectum → stores feces until elimination.

• Anus → external opening for expelling feces.

common digestive issues

1. Diarrhea, constipation, nausea, vomiting, abdominal pain, gas, bloating.

2. Nurses should assess for GI discomfort regularly.

healthy eating patterns

1. Balanced diet: fruits, vegetables, legumes, whole grains, lean proteins.

2. Limit unhealthy fats, salt, added sugars, refined grains.

3. USDA daily recommendations:

4. 2 cups fruit, 2½ cups vegetables, 6 oz grains, 5½ oz protein, 3 cups dairy.

5. “MyPlate” → visual guide for balanced meals.

nutrients

1. Macronutrients (needed in large amounts): protein, carbs, fats.

2. Micronutrients (small amounts): vitamins, minerals.

protein

1. Major building block → repairs, builds, maintains tissue.

2. Sources: beans, soy, nuts, meats, eggs, fish.

3. Needs vary by age, sex, and activity level.

carbohydrates

1. Primary fuel source (45–65% daily calories).

2. Simple carbs → sugars (fructose, sucrose, lactose).

3. Complex carbs → starch & fiber.

4. Glycemic Index: high GI foods = rapid glucose spike (potatoes, white bread). Low GI = steady glucose (legumes, whole grains).

fats

1. Provide energy, absorb vitamins, affect cholesterol levels.

2. Healthy fats = monounsaturated (avocados, nuts, olive oil).

3. Unhealthy fats = trans fats (processed foods), saturated fats (full-fat dairy, butter).

vitamins

1. Water-soluble (not stored): B vitamins, vitamin C.

2. Fat-soluble (stored in liver/fat): A, D, E, K.

minerals

1. Macrominerals: calcium, phosphorus, magnesium, sodium, chloride, potassium, sulfur.

2. Trace minerals: iron, zinc, iodine, copper, selenium, fluoride, manganese, chromium.

water

1. Essential nutrient → more than half body weight.

2. Functions: brain activity, hydration, waste removal, temperature regulation, lubrication.

3. Daily intake:

   1. Women → 2.7–3 L/day.

   2. Men → 3.5–3.7 L/day.

nutrition and health

1. Empty calories = low nutritional value (chips, cookies, soda).

2. Calorie density: low (fruits/veggies) vs. high (fried/processed foods).

3. Fiber: improves digestion, lowers cholesterol, stabilizes blood sugar.

reading food labels

1. Serving size = basis for all nutrient values.

2. Calories → per serving.

3. Watch for high sodium, added sugars, saturated fat.

4. % Daily Value:

5. <5% = low in nutrient.

6. ≥20% = high in nutrient.

7. Net carbs = total carbs – fiber – sugar alcohols.

aspiration

entry of food, liquid, or other material into the lungs

overt aspiration

visible signs like coughing, wheezing, choking, congestion, heartburn, throat clearing, or chest discomfort

silent aspiration

no obvious symptoms, making it harder to detect

risk factors for aspiration

dysphagia, poor swallowing reflex, stroke, reflux, mouth sores, dental issues

diet modifications for aspirations

thicken liquids (nectar, honey, pudding consistency) to reduce risk

tube feeding precautions

1. Verify tube placement with X-ray or capnography.

2. Keep HOB at 30–45° during feeding.

3. Monitor for signs of intolerance (vomiting, gastric distention, diarrhea).

4. Stop feeding if aspiration signs occur (wheezing, coughing, fever).

assisting with eating with risk of aspiration

1. Nursing responsibilities: Assess swallowing, assist as needed, promote independence, use assistive devices if necessary.

2. Client positioning: Sit upright at 90°, or elevate HOB to 90° with pillows if in bed.

3. Pre-meal checklist: Restroom, hand hygiene, dentures, hearing aids, free of clutter, food within reach

A nurse is caring for a client who is at risk for aspiration. Which of the following actions should the nurse take to prevent aspiration during meals? (Select all that apply.)

• Cut food, such as meat, in half for easier chewing

• Allow extra time for the client to chew and swallow each bite of food

• Sit the client up at 90° prior to providing the meal

swallowing techniques for dysphagia

• Chin-tuck position

  • Hold chin to chest while swallowing to narrow airway

• Rotation to affected side

  • Turn head to weak side to direct food to strong side

• Tilting to strong side

  • Tilt head to strong side to push food down

• Supraglottic swallow

  • Swallow while holding breath, then cough to clear residual

• Mendelsohn maneuver

  • Hold swallow 2–3 sec, then relax to improve swallowing efficiency

glucose monitoring

1. Purpose: Evaluate blood glucose changes, monitor diabetes management, assess diet or stress impact.

2. Fasting BG: 70–110 mg/dL for non-diabetic client.

3. Postprandial BG (2 hr after meal): <140 mg/dL.

4. Hypoglycemia: BG <70 mg/dL. Treat with 15 g carbohydrates (adjusted for age: infants 6 g, toddlers 8 g, small children 10 g). Recheck in 15 min.

insulin basics

• Secreted by beta cells, lowers blood glucose

• Alpha cells secrete glucagon (raises glucose)

• Administered subcutaneously (U-100 most common)

• Injection sites: avoid bruised, tender, lumpy areas; 45° for thin, 90° for adequate tissue

• Types: rapid, short, intermediate, long, ultra-long acting (differences in onset, peak, duration)

enteral vs parenteral nutrition

1. Enteral: Nutrition via GI tract (tube feeding). Safer, associated with lower infection, preferred over parenteral. Contraindications: GI bleeding, obstruction, ischemia.

2. Parenteral: IV nutrition. Used when GI tract cannot absorb nutrients. Can be partial or total. Monitor labs and glucose. Insulin may be added for hyperglycemia.

gastronomy tube feeding

1. G-tube: Surgically placed (PEG, laparoscopic, or open) into the stomach. Provides nutrition for clients who cannot eat enough orally.

2. NG tube: Temporary, through nose into stomach. Confirm placement via X-ray before use.

3. NJ tube: Through nose into jejunum. Used when gastric feeding not appropriate. Confirm with X-ray.

4. Tube feeding precautions: HOB elevated, monitor residuals, observe for intolerance or aspiration signs.

5. Bolus NG feeding question:

   1. pH 6.5 → indicates possible correct gastric placement, but verify protocol. Often nurse would recheck pH to confirm placement before feeding.

infection control in pediatric nursing

1. Advocate, educator, and implementer of infection control measures.

2. Promote healthy lifestyles: nutrition, sleep, hygiene.

3. Educate families about vaccines and immunizations.

4. Ensure children are up-to-date with immunization schedules.

5. Screen, assess, and monitor for infection.

benefits of client education include

1. Improves health status and outcomes.

2. Encourages autonomy and decision-making.

3. Promotes adherence to treatment.

4. Reduces anxiety and enhances safety.

hand hygiene

1. Fundamental in infection prevention.

2. Applies to health care workers, patients, families, and visitors.

immunizations

1. Nurses educate parents about importance, risks of vaccine-preventable diseases, and recommended schedules.

2. Maintain accurate records and employ reminders for upcoming or missed vaccines.

standard precautions

• Used for all clients.

• Treat all blood, body secretions (except sweat), damaged skin, and mucous membranes as potentially infectious.

• Include:

• Hand hygiene

• PPE (gloves, gowns, masks, eye protection)

• Safe injection practices

transmission based precautions

• Contact: Direct/indirect contact with child or environment.

  • Single room preferred

  • Gown and gloves

  • Examples: MRSA, VRE, C. difficile, wound drainage

• Droplet: Spread through close respiratory contact (<3 ft).

  • Standard mask for close contact

  • Single room preferred

  • Child wears mask if transported

  • Examples: pertussis, influenza, meningitis

• Airborne: Spread through small infectious particles in the air; travel long distances.

  • Negative pressure room

  • N95 or respirator required

  • Examples: TB, SARS-CoV, measles (rubeola), varicella

PPE donning

1. hand hygiene

2. gown

3. mask

4. goggles/face shield

5. gloves

PPE doffing

1. gloves

2. goggles/face shield

3. gown

4. mask

5. hand hygiene

vaccine preventable vs non vaccine preventable diseases

1. Vaccine-Preventable:

   1. Measles (Rubeola)

   2. Pertussis

   3. Mumps

   4. Varicella

2. Non-Vaccine-Preventable:

   1. Erythema infectiosum (Fifth disease)

   2. Roseola

   3. Hand, Foot, and Mouth Disease

Eryhtema infectiosum

1. Etiology: Caused by parvovirus B19.

2. Transmission: Respiratory secretions.

3. Clinical Presentation: “Slapped cheek” rash on face, mild fever, malaise.

4. Complications: Rare, but can include anemia in immunocompromised clients or fetal hydrops in pregnancy.

5. Vaccine: Non-vaccine-preventable.

Hand foot and mouth disease

1. Pathophysiology:

   1. Caused by human enterovirus or coxsackievirus.

   2. Virus enters via mouth → reproduces in intestinal & pharyngeal lymph tissue → spreads to lymph nodes.

      1. It can affect the skin, CNS, heart, and liver.

   3. Virus sheds in stool ~6 weeks, oropharynx ~4 weeks.

2. Transmission:

   1. Oral-fecal route (diaper changes)

   2. Contact with contaminated surfaces

   3. Close contact (sharing utensils)

   4. Respiratory droplets

   5. Contact with vesicle fluid

3. Risk Factors: Children <5 years; outbreaks in late spring/summer; highly contagious first 7 days; incubation 3–6 days.

4. Clinical Presentation:

   1. Low-grade fever, sore throat, malaise

   2. Painful mouth ulcers with red borders, white/gray-yellow base

   3. Maculopapular or vesicular rash on hands, feet, buttocks, arms, legs

5. Lab Testing: Usually clinical diagnosis; stool or vesicle scraping if needed.

6. Treatment: Supportive care

   1. Hydration, soft/cold foods, pain management (acetaminophen/NSAIDs

7. Nursing Interventions:

   1. Comfort measures: hydration, soft foods, analgesics

   2. Limit contact during contagious phase

   3. Avoid acidic or hot beverages

8. Prevention: Hand hygiene, clean environment; no vaccine available.

impetigo

1. Etiology:

   1. Bacterial: Group A Streptococcus or Staphylococcus aureus

   2. Primary (unbroken skin) vs Secondary (existing lesion)

2. Clinical Presentation:

   1. Nonbullous: honey-crusted lesions, face/other exposed areas

   2. Bullous: large blisters, clear/yellow → purulent fluid

   3. Fever and lymphadenopathy possible in bullous

3. Lab Testing: Clinical evaluation; bacterial culture or biopsy if needed.

4. Treatment:

   1. Nonbullous: topical mupirocin, sometimes oral antibiotics if multiple lesions

   2. Bullous: oral antibiotics (e.g., cephalexin)

5. Nursing Interventions:

   1. Education: medication adherence, hygiene, avoid spread

   2. Comfort: gentle skin care, avoid scratching

6. Prevention: Handwashing, clean clothing/linens, cover lesions, avoid contact during outbreak.

conjunctivitis

Bacterial Conjunctivitis

• Etiology: Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae

• Transmission: Close contact, contaminated surfaces

• Clinical: Redness, purulent drainage, matted eyelids

• Treatment: Topical antibiotics (ciprofloxacin drops)

• Nursing: Hygiene, apply medication, cool/warm compresses

• Viral Conjunctivitis

• Etiology: Adenovirus, HSV, enteroviruses

• Clinical: Redness, watery discharge, often bilateral, may follow URI

• Treatment: Supportive care (cool compresses, artificial tears)

• Nursing: Avoid touching eyes, hand hygiene, isolation until asymtomatic

• Allergic Conjunctivitis

  • Etiology: Allergens → IgE-mediated inflammation

  • Clinical: Redness, itching, tearing, both eyes, no discharge

  • Treatment: Antihistamine/mast-cell stabilizer drops, avoid allergens

  • Nursing: Environmental control, cool compresses

  4. Foreign Body Conjunctivitis

  • Etiology: Irritation from dust, sand, chemicals

  • Clinical: Sudden redness, tearing, gritty sensation

  • Treatment: Remove object, flush with water or saline

  • Nursing: Prevent rubbing, monitor for complications

stomatitis

1. Herpetic Gingivostomatitis

2. Etiology: HSV-1 (sometimes HSV-2)

3. Clinical: Painful vesicles/ulcers on gums, tongue, cheeks; fever, irritability, difficulty eating

4. Lab: Viral culture of ulcer

5. Treatment: Oral or topical antivirals (acyclovir)

6. Nursing: Hydration, pain management, hygiene, infection control

1. Aphthous Stomatitis (Canker Sores)

2. Etiology: Non-infectious, inflammatory, T-cell mediated

3. Clinical: Painful round/oval ulcers, white-gray/yellow center with red border; typically inner lips/cheeks/tongue

4. Lab: Clinical diagnosis

5. Treatment: Topical analgesics, corticosteroids (triamcinolone), avoid triggers

6. Nursing: Oral hygiene, soft foods, hydration, stress management, avoid spicy/acidic foods

hepatitis

Hepatitis

Definition: Inflammatory condition of the liver caused by viral infections.

Types & Transmission

• Hepatitis A: Fecal-oral (contaminated food/water)

• Hepatitis B: Bloodborne, sexual contact, body fluids

• Hepatitis C: Bloodborne (IV drug use, transfusions)

• Hepatitis D: Requires hepatitis B co-infection

• Hepatitis E: Fecal-oral, contaminated water

Pathophysiology

• Hep A & B: <1% lead to liver failure; incubation 4–12 weeks

• Hep C: Chronic infection >50% of cases; incubation ~8 weeks

Risk Factors

• Unsafe sexual practices

• Intravenous drug use

• Poor sanitation

• Exposure to infected blood/body fluids

Clinical Presentation

• Fatigue, fever, jaundice, anorexia, abdominal pain, nausea, dark urine

• Hep A: GI symptoms predominant (nausea, vomiting, diarrhea)

• Hep B:

• Prodromal phase: malaise, decreased appetite, RUQ pain

• Icteric phase: jaundice, hepatomegaly, pale stool, dark urine

• Hep C: Mostly asymptomatic; malaise, decreased appetite if symptomatic

Diagnostics

• Blood tests for viral markers and liver function

• Hep A: IgM antibodies

• Hep B: HBsAg, anti-HBs, Ig tests

• Hep C: Anti-HCV, liver biopsy

Treatment

• Hep A: Supportive care; hydration, manage complications

• Hep B:

• Acute: supportive, lamivudine if severe

• Chronic: antiretroviral therapy

• Hep C: Interferon alfa-2b, antivirals for chronic infection

• Nursing Interventions

  • Monitor vitals

  • Promote hydration & nutrition

  • Encourage rest

  • Medication adherence for chronic cases

  • Educate family about transmission and preventive measures

  Prevention

  • Hep A & B: Vaccination available

  • Hep C: Avoid blood exposure, sterile needles

  Infectious Mononucleosis (EBV)

  Definition: Viral infection caused by Epstein-Barr virus; affects B lymphocytes.

  Transmission

  • Saliva (kissing disease)

  • Close contact

  Clinical Presentation

  • Fever, pharyngitis, fatigue, lymphadenopathy, headache, malaise

  • Tonsillar exudates may be present

  • Splenomegaly (50%) or hepatosplenomegaly

  • Rare: airway obstruction, splenic rupture, encephalitis, Guillain-Barre syndrome

  Diagnostics

  • Heterophile antibody (Monospot) test

  • Increased lymphocyte count

  Treatment

  • Supportive care: rest, hydration, NSAIDs for pain/fever

  Nursing Interventions

  • Encourage rest and hydration

  • Avoid contact sports for 4–6 weeks (risk of splenic rupture)

  • Educate on manifestations of complications

  • Emotional support and monitoring

  Prevention

  • Avoid sharing utensils, cups, or saliva

  • Hand hygiene

roseola Infantum (exanthem subitum)

Definition: Viral infection, mainly by HHV-6, affecting infants 6–12 months

Transmission

• Saliva, respiratory droplets

Clinical Presentation

• Sudden high fever (up to 104°F) for 3–5 days

• Irritability, periorbital edema, otalgia, mild upper respiratory symptoms

• After fever: rose-pink, maculopapular, non-pruritic rash starting on trunk, spreading to neck, face, extremities

• Risk: febrile seizures

Treatment

• Supportive: hydration, fever management

Nursing Interventions

• Ensure hydration

• Dress child in lightweight clothing

• Educate parents about febrile seizures

• Limit contact with vulnerable individuals until 24h after fever subsides

Prevention

• Difficult due to asymptomatic contagious phase

• Immunity develops after infection

• No vaccine currently available

varicella (chickenpox)

• Pathophysiology:

• Caused by varicella-zoster virus (VZV).

• Primary infection = chickenpox; latent virus can reactivate as shingles (herpes zoster).

• Infection occurs in respiratory epithelium, spreads via bloodstream (viremia), forming vesicles.

• Transmission:

• Airborne droplets or direct contact with vesicle fluid.

• Incubation: 2–6 days to primary viremia, 10–12 days to secondary viremia.

• Clinical Manifestations:

• Pruritic vesicular rash → scabs (chest, back, face → rest of body, mouth, eyelids, genitals, scalp).

• Fever, fatigue, sore throat, headache (5–7 days).

• Diagnostics:

• Clinical evaluation; fluid from vesicles or scab scraping.

• Blood tests for acute immunologic response (IgM, IgG).

• Treatment:

• Supportive: acetaminophen for fever, analgesics for pain, calamine lotion, oatmeal baths, antihistamines (e.g., diphenhydramine).

• Avoid aspirin (risk of Reye syndrome).

• Hydration essential; monitor for secondary bacterial infection.

• Nursing Interventions:

• Comfort measures: lukewarm baths, light clothing, nail trimming.

• Airborne + contact precautions in hospital; keep at home until all lesions crusted (~1 week).

• Prevention:

• Varicella vaccine (2 doses); hand hygiene and avoiding exposure.

diphtheria

• Pathophysiology:

• Caused by Corynebacterium diphtheriae.

• Produces exotoxins → gray pseudomembrane, airway obstruction, myocarditis, neuritis.

• Transmission: Airborne droplets.

• Risk Factors:

• Non-immunized children, crowded living, travel to endemic areas (Southeast Asia, Africa).

• Clinical Manifestations:

• Flu-like symptoms: sore throat, fever, malaise, cervical lymphadenopathy.

• Gray pseudomembrane over throat/tonsils (hallmark).

• Diagnostics:

• Throat swab for culture, PCR, toxin testing.

• Treatment:

• Diphtheria antitoxin (DAT), antibiotics (penicillin G, erythromycin), supportive care.

• Nursing Interventions:

• Manage fever (acetaminophen), soft diet, fluids, calm environment.

• Infection control; isolation to prevent spread.

• Prevention:

• DTaP vaccine; immunization of close contacts if case occurs.

mumps

1. Pathophysiology:

2. Caused by Paramyxoviridae virus; replicates in upper airway mucosa → viremia → salivary glands, testes/ovaries, CNS (rare).

3. Transmission: Respiratory droplets, saliva, fomites.

4. Incubation: 7–21 days; contagious 1–2 days before symptoms, 5 days after onset.

5. Clinical Manifestations:

6. Parotitis (swelling near jawline), fever, headache, myalgia, fatigue.

7. Possible complications: orchitis, meningitis, encephalitis.

8. Diagnostics: RT-PCR (buccal swab), IgM serology.

9. Treatment:

10. Supportive care: rest, hydration, analgesics, hot/cold compresses, soft diet.

11. Prevention:

12. MMR vaccine; isolation during contagious period.

measles (rubeola)

• Pathophysiology:

• Caused by Morbillivirus; enters via nasopharyngeal/conjunctival mucosa → lymph nodes → blood → systemic spread.

• Transmission: Respiratory droplets; highly contagious.

• Incubation: 10–14 days.

• Clinical Manifestations:

• Fever, cough, rhinorrhea, conjunctivitis.

• Koplik spots: small white spots in mouth.

• Rash: hairline → body.

• Diagnostics: Clinical + serology or PCR confirmation.

• Treatment: Supportive: hydration, nutrition, vitamin A supplementation, manage fever and respiratory symptoms.

• Prevention: MMR vaccine; herd immunity important.

• Precautions: Airborne isolation if hospitalized.

poliomyelitis (polio)

• Pathophysiology:

• Caused by poliovirus (enterovirus); replicates in oropharynx and GI tract.

• Primarily affects nervous system, may cause paralysis.

• Transmission: Fecal-oral, nasopharyngeal secretions.

• Clinical Manifestations:

• Mild: flu-like (2–5 days).

• Severe: paralysis, usually legs; can involve respiratory muscles.

• Diagnostics: Throat swab, stool, CSF PCR; MRI/EMG for nerve damage.

• Treatment: Supportive: hydration, nutrition, physical therapy, respiratory support, mobility aids.

• Prevention: IPV vaccine (inactivated polio vaccine); isolation if infected.

COVID-19 (SARS-CoV-2)

1. Pathophysiology:

2. Viral infection affecting multiple systems; overactive cytokine response in severe cases.

3. Transmission: Respiratory droplets, direct contact; possible fecal-oral.

4. Clinical Manifestations in children:

5. Often mild/asymptomatic; fever, cough, respiratory symptoms.

6. Rare: MIS-C (inflammation in heart, lungs, kidneys, GI).

7. Diagnostics: PCR or rapid antigen tests; antibody testing for prior infection.

8. Treatment:

9. Supportive; severe cases may require oxygen, remdesivir (≥28 days old, ≥3 kg), ritonavir-boosted nirmatrelvir (≥12 yrs, ≥40 kg).

10. Nursing Interventions: Rest, hydration, fever management, isolation, emotional support.

11. Prevention: Vaccination ≥6 months old, mask-wearing, hand hygiene, social distancing.

different factors and extra questions

Viral Meningitis risk factors

1. Close contact with infected individuals

2. Being in crowded settings

3. Having a weakened immune system

4. Seasonality: more common in summer and fall

viral meningitis 4 month old manifestations

1. Hypothermia (in newborns/young infants)

2. Poor feeding

3. Irritability (difficult to console)

4. Lethargy

5. Full or bulging anterior fontanel

Viral meningitis- infant interventions

1. Prepare the infant for a lumbar puncture

2. Prepare to administer an antibiotic (empiric until bacterial ruled out)

3. Maintain a quiet environment for the infant

4. Monitor the infant for seizures

Bacterial meningitis adolescent manifestations

1. Fever

2. Headache

3. Nausea and vomiting

4. Photophobia

5. Nuchal rigidity

6. Irritability

7. Lethargy

8. Diplopia or blurred vision

9. Positive Brudzinski and Kernig signs

10. Petechial rash (if meningococcal infection)

• Bacterial meningitis first intervention

1. Administer empirical antibiotics (priority to prevent morbidity/mortality)

• (Lumbar puncture, corticosteroids, and prophylaxis for contacts follow as indicated.)

Bacterial Meningitis adolescent interventions

1. Administer analgesia

2. Maintain a dark environment

Hep B most likely mode of transmission

• Acquired by coming into contact with infected blood or body fluids

Hep B icteric phase manifestations

1. Yellow sclera

2. Dark urine

3. Right upper quadrant pain

Hep A preschooler complications

1. Dehydration

2. Hepatic failure (rare)

3. Electrolyte imbalances

4. Jaundice

5. Nutritional deficits

Hep B nursing interventions

1. Monitor liver function tests and vital signs

2. Encourage rest and adequate hydration

3. Provide small, frequent meals to support nutrition

4. Administer antiviral medications if prescribed

5. Educate family on preventing transmission

Mononucleosis indications

1. Spleen palpable 2–3 cm below costal margin

2. Temperature 38.6° C (101.5° F)

3. Cervical lymph nodes 2 cm

Mononucleosis Home management

• You should gargle with warm salt water

Roseola Infantum parent teaching

1. Offer the infant drinks of electrolyte solutions

2. The child can return to daycare 24 hours after the fever subsides

3. Monitor the infant for febrile seizures

4. Do not dress in warm clothing

5. there is no vaccine for roseola.

extra measures with communicable disease

• Isolation Precautions:

• Airborne + contact: Chickenpox, measles.

• Contact: Polio, COVID-19.

• Comfort Measures:

• Fever management: acetaminophen (avoid aspirin in viral infections).

• Rash/itching: calamine, antihistamines, oatmeal baths.

• Hydration and nutrition support.

• Prevention:

• Vaccination is the cornerstone: Varicella, DTaP (diphtheria), MMR (mumps, measles), IPV (polio), COVID-19.

• Family Education:

• Stay home until no longer contagious, monitor for complications, hygiene measures, and vaccine adherence.

immunotherapy terms

1. Antibody (Immunoglobulin)

• Y-shaped proteins composed of two heavy and two light chains.

• Function:

• Neutralize pathogens.

• Tag pathogens for destruction (opsonization).

• Activate complement system.

• Stimulate immune cells (ADCC).

• Types:

• IgG: Most abundant; long-term immunity.

• IgM: First antibody produced during infection.

• IgA: Found in bodily secretions; localized immunity.

• IgE: Allergic responses; defense against parasites.

• IgD: Found on B cells; function less understood.

• Role in vaccines: Stimulated to provide immunity against specific pathogens.

• Role in diagnostics: Detected to determine current or past infections.

• Role in therapy: Monoclonal antibodies target specific diseases (e.g., COVID-19, cancer).

2. Antigen

• Substance that provokes an immune response.

• Can be:

• Exogenous (from outside the body).

• Autoantigens (originating inside the body; may cause autoimmune disorders).

• Stimulates:

• Antibody production.

• T-cell activation to destroy infected cells.

• Vaccines contain harmless antigens to produce memory cells.

3. Antitoxin

• Antibody targeting toxins from bacteria, plants, or animals.

• Neutralizes toxins, preventing cell/tissue damage.

• Uses:

• Treatment of botulism, tetanus, snake bites.

• Vaccine development (toxoid vaccines).

4. Attenuate

• Process of weakening a pathogen while retaining its ability to stimulate immune response.

• Used in live attenuated vaccines (e.g., varicella, MMR).

• Careful balance: effective immunity without causing disease.

5. Cocooning

• Public health strategy protecting vulnerable individuals (e.g., newborns) by immunizing close contacts.

• Reduces disease transmission to high-risk individuals

immunity types

1. Natural Immunity (Innate)

• Present from birth.

• Rapid, nonspecific defense:

• Physical barriers: skin, mucous membranes.

• Immune cells: macrophages, neutrophils, NK cells.

• Inflammatory response.

• Does not provide long-term pathogen-specific memory.

2. Acquired Immunity (Adaptive)

• Develops after exposure to specific pathogens.

• Two forms:

• Active Immunity: Body produces antibodies (natural infection or vaccination).

• Passive Immunity: Antibodies transferred from another person (maternal antibodies, immunoglobulin therapy).

• Provides targeted defense and memory (active) or immediate temporary protection (passive).

3. Herd Immunity

• Indirect protection of non-immune individuals when a large portion of the population is immune.

• Threshold varies with disease contagiousness (e.g., 95% for measles).

• Supports community protection and disease prevention.

immunobiologics

1. Vaccines

• Contain weakened, killed, or components of pathogens.

• Stimulate antibody and memory cell production.

• Types:

• Combination: Multiple antigens in one injection.

• Conjugate: Polysaccharide antigen linked to carrier protein (e.g., Hib, pneumococcal).

• Monovalent: Targets one pathogen.

• Polyvalent: Targets multiple strains or related pathogens.

• Considerations: Contraindications vs. precautions; mild illness usually not a reason to delay.

2. Immunomodulators

• Medications that enhance or suppress immune responses.

• Used for autoimmune diseases or immunodeficiency.

3. Monoclonal Antibodies

• Lab-produced antibodies targeting specific proteins or cells.

• Treat cancer, autoimmune disorders, infectious diseases.

4. T-cell Therapy

• Uses patient’s own immune cells or genetically modified cells to target diseases (cancer, infections).

5. Immunoglobulin Therapy

• Pre-formed antibodies from donors (IVIG or injections like HBIG).

• Supports patients with immune deficiencies (e.g., SCID, Kawasaki disease).

6. Toxoids

• Inactivated bacterial toxins in vaccines (e.g., diphtheria, tetanus).

• Stimulate antibody production without causing disease.

vaccine considerations

• Contraindication: Permanent exclusion due to high risk (e.g., severe allergic reaction).

• Precaution: Elevated risk but can still vaccinate with monitoring.

• Mild illness does not delay vaccination.

• Administration:

• IM injections (vastus lateralis for infants, deltoid for older children/adults).

example vaccine Hib

• Protects against Haemophilus influenzae type B.

• Series: 2, 4, (6), and 12–15 months.

• Effective in preventing meningitis and epiglottitis in children under 5.

extra vaccine questions

Where to insert HiB vaccine for 4-week-old infant

• Administer the injection in the infant’s vastus lateralis

Hepatitis A and B teaching

• “The common reactions to the vaccine are pain at the injection site and a mild fever.”

Poliovirus vaccine for a febrile 2-month-old

• Delay the administration of the poliovirus vaccine

Pneumococcal vaccine education

• The child should be monitored for 15 minutes following administration.

Rotavirus vaccine teaching

• Common adverse effects of the vaccine include mild diarrhea and vomiting.

Varicella vaccine education

• The varicella vaccine protects against chickenpox. It is usually given in two doses: the first at 12–15 months, and the second at 4–6 years

Vaccine for an 8-year-old requiring whooping cough immunization

Tdap

8. MMR vaccine concerns

• “I understand your concerns. Extensive research shows the MMR vaccine is safe and is not linked to autism. It protects against measles, mumps, and rubella

HPV vaccine schedule for an 11-year-old

• Two doses administered 6 to 12 months apart

• Rationale: Children 9–14 years old receive 2 doses; 3 doses are for ages 15–45 or immunocompromised.

Meningococcal vaccine education for an 18-year-old

• The adolescent should receive MenACWY if not previously vaccinated. The first dose is typically given at 16–18 years if missed earlier. The vaccine is IM, commonly in the deltoid, and mild side effects may include soreness at the injection site, fatigue, or headache.

Influenza vaccine for a 9-month-old who has never had it

• Administer the vaccine and inform the parent that the child will need a second injection in 1 month.

• Refer to the manufacturer’s instructions to determine the dose of the vaccine for the child.

• Rationale: Children <9 years old receiving the flu vaccine for the first time need two doses 1 month apart. It is IM, not subcutaneous. Annual vaccination is required, not every other year, and it can be given before 12 months.

Influenza vaccine for a 6-year-old with egg allergy

• Use special precautions when administering the influenza vaccine to the child.

• Rationale: Egg allergy is not a contraindication, but monitoring is recommended.

COVID-19 vaccine for a 3-year-old moderately immunocompromised child

• “Your child should receive an annual booster once the original series is completed.”

COVID-19 vaccine teaching for a newly licensed nurse

• Monitor adolescents for 15 minutes for syncope following administration.

• There is a risk of myocarditis in children 12 years old and older following immunization.

• Avoid further immunization in children who experience pericarditis following a prior COVID-19 immunization.

parasitic disease overview

• Definition: Illnesses caused by parasites (protozoa, helminths, arthropods) that thrive at the host's expense.

• Transmission Routes:

  • Contaminated food/water

  • Insect bites

  • Contact with infected individuals

  • Contaminated soil

• Common Parasitic Diseases:

  • Malaria: Plasmodium via mosquito

  • Amoebiasis: Entamoeba histolytica via contaminated food/water

  • Giardiasis: Giardia lamblia via contaminated water

  • Helminthic infections: Pinworm, hookworm, roundworm, tapeworm via soil/food/contact

• Clinical Presentation:

  • Mild: GI discomfort, fever, skin rashes

  • Severe: Multi-organ involvement

• Diagnosis: Lab tests (blood, stool, tissue)

• Management:

  • Prevention: Sanitation, clean water, vector control, health education

  • Treatment: Antiparasitic medications, supportive care

• Nursing Role: Prevention education, hygiene promotion, proper sanitation, monitoring, and follow-up

scabies (integumentary)

• Cause: Sarcoptes scabiei mite burrowing under skin

• Transmission: Direct skin-to-skin contact or contaminated linens (~10 minutes sufficient)

• Pathophysiology:

• Mite burrows under skin (up to 10 mm)

• Eggs hatch in 2–3 weeks

• Mites survive 1–2 months

• Clinical Presentation:

• Intense itching (especially at night)

• Linear burrows, erythematous papules

• Common sites: wrists, genitals, interdigital spaces

• Complications: secondary bacterial infection (cellulitis, impetigo)

• Diagnosis: Clinical exam; skin scrapings/microscopy

• Treatment:

• Topical permethrin cream (head to toes, removed after 8–14 hrs)

• Treat close contacts

• Nursing Interventions:

• Educate on hygiene, handwashing, laundering linens in hot water, isolation if in institutions

• Comfort Measures: Cool baths/compresses, trim fingernails, avoid scratching

Lice (integumentary) (pediculosis)

• Types:

• Head lice (Pediculus humanus capitis)

• Body lice (Pediculus humanus corporis)

• Pubic lice (Pthirus pubis)

• Transmission: Close contact, sharing personal items (combs, hats, bedding)

• Clinical Presentation:

• Pruritis from hypersensitivity reaction

• Small red bumps, sores from scratching

• Visible nits (eggs) attached to hair shafts

• Diagnosis: Clinical exam, visual identification of lice/nits

• Treatment:

• Permethrin shampoo or lotion (repeat in 1 week)

• Environmental cleaning (launder clothing/bedding, vacuum furniture)

• Caution with lindane or ivermectin in children (neurotoxicity)

• Nursing Interventions:

• Hygiene education, combing to remove nits, check household contacts

• Prevention: Avoid sharing personal items; regular inspection of close contacts

Pinworms (enterobiasis) (GI system(

• Cause: Enterobius vermicularis

• Transmission: Ingestion of eggs via contaminated hands, bedding, clothing, or surfaces

• Pathophysiology:

• Eggs hatch in GI tract → adult worms migrate to anal area to lay eggs

• Lifecycle: 4–8 weeks

• Clinical Presentation:

• Nocturnal perianal itching

• Irritability, disturbed sleep, occasional abdominal discomfort

• Diagnosis: Tape test or pinworm paddle early morning

• Treatment:

• Mebendazole (repeat dose after 2 weeks)

• Treat all household members

• Nursing Interventions:

• Hand hygiene, trimming nails, morning bathing, laundering bedding/clothing in hot water

• Comfort Measures: Avoid scratching, manage irritation

• Prevention: Treat all contacts, maintain hygiene, clean living spaces

Giardiasis (GI system)

• Cause: Giardia duodenalis protozoan

• Transmission: Fecal-oral route via contaminated water or food

• Pathophysiology:

• Parasite alters intestinal epithelial cells → diarrhea, malabsorption

• Clinical Presentation:

• Diarrhea (watery), abdominal cramps, bloating, gas, fatigue, weight loss

• Pediatric: mild diarrhea, abdominal discomfort

• Diagnosis: Stool samples (3 separate samples; microscopy, DFA, EIA)

• Treatment:

• Metronidazole (may take with food to reduce stomach upset)

• Hydration and nutritional support as needed

• Nursing Interventions:

• Handwashing, proper sanitation, avoid untreated water, safe food handling

• Comfort Measures: Maintain hydration, limit dairy if sensitive

• Prevention: Ensure clean water, educate community on hygiene and safe drinking practices

communicable diseases in pediatrics

1. Children are highly susceptible to communicable diseases due to immature immune systems and close-contact environments (schools, daycares).

2. Rapid transmission in communities can lead to severe illness, hospitalization, or long-term complications.

3. Nursing role: prevention, early recognition, education, and implementation of infection control.

Assessment of communicable diseases

1. History: onset and progression of illness, fever, cough, rash, malaise, myalgia, anorexia.

2. Exposure history: contacts with similar symptoms, recent travel.

3. Immunization status: determines risk for vaccine-preventable diseases.

4. Physical exam: hydration, respiratory status, skin lesions, lymph nodes, neurological assessment.

5. Rash evaluation: characteristic appearances aid diagnosis (e.g., “slapped-cheek” for fifth disease, maculopapular for measles).

6. Diagnostic testing: throat swabs, blood samples, cultures as indicated.

Clinical example: measles

1. Clinical presentation: fever, maculopapular rash, red spots with white centers in the mouth, not itchy.

2. Important questions:

3. Recent travel

4. School/daycare attendance

5. Immunization status

6. Nutrition and hydration

7. Key concerns: unvaccinated status → high risk for measles.

8. Expected interventions: IV fluids, supportive care, infection control (airborne precautions), parent education.

9. Education points:

10. Measles is viral.

11. Primarily affects unvaccinated children.

12. Incubation ~10–14 days.

13. Public health involvement for contact tracing.

14. Vitamin A supplements and hydration support recovery.

15. Avoid NSAIDs for fever; warm mist humidifier can ease respiratory symptoms.

parasitic infestations and infections

• children are vulnerable to parasitic infections due to hygiene practices and exposure in schools.

• Common examples: scabies, pinworms, lice (pediculosis), giardiasis.

• Assessment:

• Rash, burrows, itching (worse at night for scabies).

• Vital signs, hydration, pain assessment.

• Exposure history, travel, recent outbreaks at school.

• Reporting findings: temperature, skin changes, pain, heart rate.

• Diagnosis examples:

• Scabies → linear burrows, itching

• Pinworms → nocturnal perianal itching

• Pediculosis → lice and nits visible in hair

• Giardiasis → gastrointestinal symptoms after contaminated water exposure

• Management

  • Priority interventions: infection control (contact precautions), trimming fingernails, treating infected individuals, and notifying close contacts.

  • Medications:

  • Topical permethrin cream → scabies, lice

  • Anthelmintic medication → pinworms

  • Antifungals and antivirals → as indicated

  • Parent education:

  • Wash bedding/clothing in hot water; dry on high heat.

  • Treat all family members if necessary.

  • Vacuum furniture.

  • Avoid unnecessary bathing that can interfere with topical treatments.

  • Monitor for adverse reactions (e.g., difficulty breathing).

vaccines in pediatrics

• Assessment before administration:

• Allergy history and prior vaccine reactions.

• Immunization records to identify missed doses.

• Underlying health conditions (e.g., immunocompromised status).

• Child’s fear or anxiety.

• Analysis & Prioritization:

• Consider risks vs. benefits (e.g., immunocompromised child may require postponement).

• Identify contraindications and precautions.

• Planning & Solutions:

• Follow ACIP immunization schedule.

• Use age-appropriate comfort measures:

• Infants: sucrose solution, breastfeeding

• Older children: topical anesthetics, distraction techniques (bubbles, parental involvement)

• Ensure correct vaccine storage, preparation, and aseptic technique.

• Implementation:

• Verify VIS provided to parents.

• Administer using proper technique.

• Document: date, time, route, dose, site, lot number, manufacturer, VIS acknowledgment.

• Evaluation:

• Monitor for reactions: allergic (respiratory distress, hives) or syncopal episodes.

• Observe high-risk patients for 15 minutes.

• Report significant adverse events to VAERS.

• Provide post-vaccine education for parents on supportive care and signs of delayed reactions.