WK 3 peds: vaccines + cardiac

Chicken Pox-Varicella

Contagious disease caused by varicella zoster virus

Varicella presentation

Skin rash with small itchy blisters

Spreads over other areas of the body

Fever fatigue sore throat and headache- lasts 5-7 days

Varicella treatment

Acetaminophen

Avoid aspirin

Pruritis- calamine lotion, soothing oatmeal bath, antihistamine

Hydration

Mumps

Viral infection

Mumps Presentation

Swelling of salivary glands

Parotitis-swelling of the parotid glands

Mumps Diagnostic studies

RT-PCR viral culture

Measles- Rubeola: presentation

Initial- fever cough rhinorrhea conjunctivitis

Followed- small red spots with white centers (Koplik spots) in mouth

Distinctive rash across body, starts at hairline and goes downward

Airborne precautions - if hospitalized

Rubella (German Measles) Gen Info

• caused by rubella virus

• Usually milder illness than measles

Rubella (German Measles) S/S

• low-grade fever

• Rash

• Lymphadenopathy : behind ears and neck

Prevented by MMR vaccine

Measles- more severe, highly contagious

Rubella- milder but dangerous in pregnancy

Immunizations BIRTH

B

Hep B

Immunizations 2 months

B-DR-HIP

Hep B

Dtap (for kids younger than 7 yrs)

Rotavirus

Hemophilia influenza type b

IPV Polio

PCV- pneumococcal conjugate

Immunizations 4 months

DR-HIP

D2: diphtheria, tetanus, pertussis

Rotavirus

Hemophilia Influenza type B

IPV- Polio virus

P-PCV: Pneumococcal Conjugate vaccine- streptococcus pneumonia

Immunizations- 6 Months

B-DR-HIP-IN

B- Hep b

D3: diphtheria, tetanus, pertussis

Rotavirus

Hemophilia Influenza type B

IPV- Polio virus

P-PCV: Pneumococcal Conjugate vaccine- streptococcus pneumonia

Influenza-yearly

Immunizations 1-1.5yrs

MAD-HPV

Measles, Mumps, Rubella(12-15months)

A- Hep A (1-2 years)

D4: Dtap

H-Hemophillia influenza

P- PCV pneumococcal conjugate vaccine

V-varicella

Immunizations 4-6 yrs

VERY-DIM

Very- Varicella

D5: Dtap, Diptheria-tetanus-pertussis

I-IPV polio vaccine

M-meningococcal

Immunizations 11-12 years

Tada!!

Human

Human Papilloma Virus

Men

Meningococcal

Immunizations 16-18 years

Men booster

Meningococcal booster at 16 yrs

Vaccine contraindications

Febrile

Anaphylactic reaction- hold specific vaccine

Risk vs benefit

Vaccine nursing admin considerations

OBTAIN CONSENT

If no consent, educate and document

Document date route, site, lot number, expiration date: in case of any reaction

• atraumatic care: appropriate play/ distractions

Avoid aspirin with vaccines- why?

Reye’s Syndrome

Tetanus gen info

Cause: Bacteria

Transmission: Enters body through wounds

MUSCLE RIGIDITY

Tetanus s/s

Muscle stiffness- lockjaw

Painful muscle spasms

Difficulty swallowing

Seizures-severe cases

Tetanus nursing care

Tetanus vaccine

Tetanus immune globulin

Scarlet fever cause

Group A streptococcus infection

Scarlet Fever S/S

Sandpaper Ike rash on trunk

Strawberry tongue

Fever

Scarlet Fever tx

Antibiotics required

COVID-19

Multi system inflammatory syndrome (MIS-C)

Supportive care

VACCINE

Sepsis RF

• burns

• Invasive Catheters

• Immunocompromised

• Antibiotics - long term

Early Signs of Sepsis

• fever AND hypothermia (very common in infants)

• tachycardia

• Tachypnea

• WARM extremities

• BOUNDING pulses

• BRISK cap refill

• NORMAL UOP

• ALOC

Late signs of Sepsis

• Hypotension

• PROLONGED cap refill

• Mottled COOL extremities

• WEAK pulses

• Progressive mental changes

• DECREASED UOP

• Fever or hypothermia

• SHOCK to ARREST with no interventions

Sepsis Nursing Interventions

Pan Culture: blood, sputum, urine, skin/tissue

Vitals, O2

IV fluid resuscitation=

Labs- CBC, chem, coag, glucose

Blood transfusion

IV ABX

Nutrition

MONITOR!! Hemodynamic/cardiorespiratory

Cardiac Dysfunction/Anomalies gen info

Congenital or acquired

Congenital-any defect that develops during the first 8 weeks of gestation

Makes up 30% of infant deaths related to birth defects in first year of life

Cardiac Dysfunction and Anomalies: caused by

• exposure to drugs, alcohol, smoking

• Maternal infections: rubella

KEEP WRITING

Heart Defect Main Manifestation

Murmur: Blood flow is being shunted away from normal path of flow

Patent foramen ovale

Cardiac output compensation

Elevated heart rate

Chronic desaturation s/s

<85% O2 sat

Tripod position

Clubbing nails

Pale/cyanotic

Chest retraction

Nasal flaring

Defects with increased pulmonary blood flow

HIGHER pressure on LEFT side of heart

• more blood to lungs

• Increased vascular resistance

• RIGHT ventricular HYPERtrophy

Blood is shunting from LEFT to right

• CHF can occur

INCREASED pulmonary blood flow conditions

PDA

ASD

VSD

DECREASED pulmonary blood flow conditions

TOF

Pulmonary artesia

Mixed defects conditions

TGA

Truncus Arteriosis

OBSTRUCTED systemic blood flow conditions

CoA

AS

PDA- Patent Ductus Arteriosus

Connection between pulmonary artery and aorta stays open causing mixing of blood

PDA ligation if hole does not close on its own

PDA meds

NSAIDs:

Indomethacin

IV ibuprofen

ASD- Atrial Septal Defect

Opening between right and left atria- top two chambers of the heart

Closes in 4 years

Defects with DECREASED pulmonary blood flow

Obstructed blood flow from RIGHT to left

• RIGHT TO LEFT shunting due to increased pressures if in presence of a septal defect

Decreased oxygenation →HYPOXEMIA and CYANOSIS

POLYCYTHEMIA(more RBC production) compensatory response

Hypercyanosis with change of postition, crying, feeding, activity

Pulmonary Atresia tx

TOTAL OCCLUSION of pulmonary valve

Tx- opening of PDA

Prostaglandins - PGE1

Balloon angioplasty

Tetralogy of Fallot

Overriding aorta, VSD, RVH, Pulmonary stenosis

Multiple surgeries/palliative measures

TGA-Transposition of the Great Arteries

Parallel circulation due to aorta out flue from BOTH right side of heart and pulmonary artery for left side

NEEDS SURGERY WITHIN 2 WEEKS OF LIFE

VSD-Ventricular Septal Defects

Opening between right and left ventricles - bottom two chambers of the heart

Usually closes on its own within 6 months

Cardiac Catheterization Post-Op

Check before feeding: Gag reflex + bowel movement

Check affected extremities pulse (where the PICC is), compare it to opposite extremity

Prevent bleeding: pressure and immobilize

Truncus Arteriosis

Fetal anatomy of single vessel serving for both pulmonary and systemic flow

Defects with Obstructed Systemic Blood Flow

STENOSIS leading to pressure overload in the LEFT side of the heart→ can yield DECEASED cardiac output

High pressure in ventricle can lead to DECREASED cardiac output→ shock

Aortic Artesia

OBSTRUCTION OF FLOW to systemic circulation, blood pools in left ventricle regurgitates to left atrium

PDA NECESSARY TO SUSTAIN LIFE (PEG1 to open)

Coarctation of the Aorta- CoA

Narrowing/constriction of descending aorta

CYANOSIS IN LOWER EXTREMITIES, pre/post duct saturations differ, pulse pressure narrowed in lower extremities

Tx: balloon angioplasty/stent/surgical repair

CHF

Can be due to defect INCREASING pulmonary blood flow/obstruction of systemic blood flow

Decreased contractility, edema, pulmonary congestion→ r/l heart failure can progress to bilateral

Acquired disease:

• cardiomyopathy

• Kawasaki disease

CHF- initial manifestations

• tires easily with feeds

• Weight loss

• Diaphoresis

• irritability

• Dyspnea

• Abdominal pain/distention

• Peripheral edema

• Exercise intolerance

• Frequent respiratory infections

CHF late manifestation

• Tachypnea Tachycardia

• Pallor cyanosis

• Nasal flaring, grunting, retractions, cough

• Third heart sounds

• Fluid volume overload

• Periorbita;, facial edema

• Hepatomegaly

• JVD

• Cardiomegaly- cyanosis/weak pulse/hypotension, can lead to shock

Cardiomyopathy

Heart muscle disorder effecting chamber size, wall thickness, contractions, systolic/diastolic function ]

Affects contractility → ventricles

Cardiomyopathy Dilated

Most common

• overall dilation, poor pump, blood pools

• Treatment same as CHF, need for transplant

Cardiomyopathy Hypertrophic

• ventricular hypertrophy

• Rigid walls, obstruction

Cardiomyopathy Restrictive

Not common in children

Restricted ventricular filling

Pulmonary Artery Hypertension

• Increased pressure in pulmonary arteries

• Right sided HF → CHF

• Vasodilators, diuretics, ca channel blockers, ace inhibitors, anticoagulant

• NO CURE not sustainable with life without ongoing therapies

Acquired Heart Diseases

Infective Endocarditis

Rheumatic fever

Kawasaki

Infective Endocarditis

Infectious disease of inner muscle of the heart and surrounding vessels

Common Causative bacteria:

• staphylococcus aureus

• Staphylococcus viridans

• Staphylococcus pneumoniae

Commonly seen in pt w hx of congenital or acquired disease/ indwelling prosthetic material

Infective Endocarditis Manifestation

• persistent low grade fever

• Heart murmur

• Splenomegaly

• Cutaneous signs- petechiae

Infective Endocarditis Diagnostic test

Modified Dukes Critieria

• multiple blood cultures

• Ech0

Rheumatic fever

Abnormal immune response to Group A strep- GAS- infection, usually pharyngitis

ASO titter for strep exposure

Rheumatic Fever manifestation

Fever

Large joint pain

Involuntary movement of ms

Rheumatic Fever tx

Antibiotics

Anti inflammatory therapy

HF management

Antibiotic prophylaxis-ranging from 5 years to indefinitely

Kawasaki Disease

Acute febrile

Vasculitis

Vascular inflammatory disorder of midsize and coronary arteries

Leading acquired heart disease→ ANEURYSM

Kawasaki Stages

Stages

1- Acute: 1-2 weeks of high fever, irritability

2- Subacute: 2-4 weeks fissures, joint pain, cardiac disease

3- Convalescent 6-8 weeks resolving but with signs of inflammation

Kawasaki Treatment

8 weeks

IV immunoglobulin

Aspirin

• alt- clopidogrel, dipyridamole

NO LIVE VIRUS VACCINES FOR 11 MONTHS!

Hypovolemic Showck

Inadequate perfusion due to inadequate volume

Need fluid resuscitation, transfusion

Distributive shock

Abnormal distribution of blood

• to extremities not organs

• Anaphylaxis sepsis SCI

Cardiogenic Shock

Impairment of function due to pump failure

Like hypovolemic

CHF develops, cardiorespiratory monitoring needed

Fifth Disease- Erythema Infectiosum

Droplet or contact transmission

SLAPPED CHEEK RASH

Fever, malaise, headache, myalgia, NVD

Kawasaki signs

38 C fever and antibiotics dont work

Conjunctivitis

Large cervical lymph nodes

Strawberry tongue

Peeling of skin around finger/toe nails