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pediatric NP - ANSWERhealth promotion, protection, and disease prevention Primary care NP - ANSWERwell childcare and prevention and/or management of both common pediatric acute illness and any childhood diseases. Acute care NP - ANSWERacute, chronic, or critically ill children. Unstable, experien...

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pediatric NP - ANSWERhealth promotion, protection, and disease prevention

Primary care NP - ANSWERwell childcare and prevention and/or management of both common
pediatric acute illness and any childhood diseases.

Acute care NP - ANSWERacute, chronic, or critically ill children. Unstable, experiencing life-
threatening illness, medically fragile and tech dependent.

Primary prevention - ANSWERkeep diseases from being established. Eliminate cause or increase
people's resistance. 2 types of primary prevention are health promotion and specific protection.
Health promotion includes efforts, including lifestyle changes/choices, nutrition, and maintenance of
safe environments. Specific protection involves actions targeted at specific diseases, such as
immunizations, anti-malarial prophylaxis, and environmental modifications (such as fluoride).

secondary prevention - ANSWERearly diagnosis and prompt treatment- interrupt disease process-
screening early detection and prompt treatment. Goal is to eliminate or reduce
symptoms/progression..

Tertiary care - ANSWERrequires both specialized expertise and equipment. Goal improves survival
and quality of life. There are 2 types: 1) disability limitation-early symptom management 2)
rehabilitation- late symptom management.

Quaternary care - ANSWERhighly specialized expertise and highly unusual or specialized equipment

Barriers to vaccination - ANSWERpatients feel vaccines are unsafe, may cause autism, overload or
weaken a child's immune system, or are traumatic for the child. Parents may feel there is a lack of
concern about the diseases that are being prevented. Poverty was a factor, as was a lack of
education.

How to encourage parents to get vaccines for their kids - ANSWER• Acknowledge and respect the
trusted relationship between provider and parent.

• Communicatjm0h e a strong shared commitment with the parent to the health and well-being of
their child.

• Listen to and query parents' reasons for refusing or delaying vaccines; not all vaccine-hesitant
individuals have the same concerns.

• Be familiar with misconceptions and controversies regarding vaccines and be prepared to address
them (e.g., thimerosal-free vaccines).

• Emphasize the safety of vaccines, the extensive testing before licensure, and the post-licensure
safety surveillance programs. Explain the serious consequences of not vaccinating.

• Educate the family about the safety of multiple vaccines to be given simultaneously. Mention that a
healthy infant's/child's immune system capably fights off an estimated 2000 to 6000 germs (antigens)
daily when playing, eating, and breathing. The number of antigens in any combination of vaccines on
the current schedule is much lower than the daily exposure to many substances (150 antigens for the
entire Advisory Committee on Immunization

,live vaccine - ANSWERan attenuated form of the virus that induces immunity but does not produce
disease. Broader and longer-lived immunity. Common fever and rash. This means the immune system
has responded appropriately. Do not give before 1 year of age. When you give live attenuated
vaccines, you must give both on the same day or you have to wait 4 weeks to give the second one or
neither will be effective. NOT TO BE GIVEN WHILE PREGNANT OR 28 days prior to being preg.

● Precautions- pay close attention when giving immunocompromised indv live vaccine.
Recommendations differ according to condition.

● Measles mump rubella-trivalent vaccine.MMR (2 doses, starting age 12mos)- after receiving 2
vaccines, efficacy is 98%. S/E rash, high fever 5-12 days after the vaccine. If given varicella in the quad
valiant, the chance of seizures is 2-fold. It is reduced by giving at the same time and in different
spots. NOT TO BE GIVEN WHILE PREGNANT OR 28 days prior to being preg.

Vaccines - ANSWERVaricella(2 doses)- 98% efficacy after the 2nd dose. Severe cases have become
uncommon.

● Rotavirus(2 doses)- side effect and contraindication could be intussusception. (an exception to the
rule to not give before age 1).

● Smallpox(0)- irradicated.

● Passive immunization Involves administering an exogenous antibody such as immunoglobulin

○ Immunoglobulins:

■ ***Respiratory Syncytial Virus Prophylaxis (RSV)

■ Palivizumab (Synagis) is the only product on the American market for use in infants at high risk for
adverse outcomes from respiratory syncytial virus (RSV) infection

■ Given IM, and is a humanized mouse monoclonal antibody, given in 5 monthly IM injections during
RSV season (usu Nov- march or april)

■ and effective in reducing RSV hospitalizations in high-risk infants by 39% to 82%

■ Consider RSV Prophylaxis:

● Infants born 29 wks and 0 days of gestation during RSV season until 12 months old

● Children born prematurely at or before 32 weeks and 0 days of gestation who are younger than 2
years old with chronic lung disease (CLD) and who required treatment for their CLD within 6 months
of the onset of RSV season (including oxygen therapy); prophylaxis can be given to 2-year-old
children with CLD of prematurity who continue to require medical support during the 6 months prior
to the onset of RSV season

● Infants up to 12 months old with hemodynamically significant cyanotic or complicated congenital
heart disease

● Infants up to 12 months old with neuromuscular disorder or congenital anomalies that
compromise clearing of respiratory secretions

killed (inactivated) vaccine - ANSWERKilled and inactivated vaccines provide systemic protection
(immune globulin G [IgG] antibodies). Still, they may fail to trigger local mucosal antibody (immune
globulin A [IgA]) production, resulting in local colonization or infection that can be a problem during

,an epidemic. The inactivate vaccines include diphtheria-tetanus-pertussis, polio, Hib, hepatitis A,
hepatitis B, human papillomavirus, meningococcus, and pneumococcus.

Common side effects- common side effects-mild to moderate fever and/or local swelling, pain, and
erythema, usually within the first 24 to 72 hours (e.g., to DTaP, tetanus-diphtheria [Td], or tetanus-
diphtheria-acellular pertussis [Tdap], Hib conjugate, hepatitis B virus [HBV], pneumococcal conjugate
[PCV-13]; AAP et al., 2015b). Concerned about allergic reaction.

TDAP, meningococcal and HPV- Common reaction syncope. Systemic reaction.

Common side effects of the meningococcal vaccine can also include headache and irritability.

DtAP (4 doses)-Diphtheria-Tetanus-Acellular Pertussis Vaccine - ANSWERgiven younger ages than 7.
Pertussis is not long-acting and needs to be given multiple times. TDAP is given multiple times
throughout life, even to the elderly.

● The adult version is actually recommended antenatal vaccination at 27-36 weeks (third trimester)
pregnant (Tdap),

■ Tdap is also a booster vaccine recommended to get every 10yrs as an adult.

Polio (4 doses) - ANSWERinactivated only available in the US. CDC recommendations are for
immunocompromised individuals. It used to be live, no longer.

Haemophilus influenzae Type B Vaccine(3 doses) - ANSWERcauses pneumonia, bacteremia,
meningitis, epiglottitis, septic arthritis, cellulitis, otitis media, purulent pericarditis, and other less
common infections in children under age 4. Rates significantly decreased due to immunization

Hepatitis A Virus Vaccine(1-2 doses) - ANSWERlast 14-20 years. Used in under 18mos.

Hepatitis B Virus Vaccine (3 doses) - ANSWERImmunogenicity lasts until 20 years. Routine booster
doses are not recommended. 3 dose series at age 0, 1-2, 6-18 months ( use monovalent HebB for
doses before 6 weeks.

Human Papillomavirus (HPV)(2) - ANSWERages 9-26 mild with safe effects. Pregnants should not get.
2 doses 6 months apart.

Influenza Vaccine - ANSWERyearly. 6 months and older. When enough are immunized, then we get to
herd immunity, protects those who are not immunized.

Meningococcal vaccine(2) - ANSWERthe disease is high morbidity and mortality. 11 through 21 years
with a booster at 16 years. Know when to give. Highest risk late high school/ college. Onboard before
at risk

Pneumonicoccal - ANSWERknown serotypes. PCV13 is given to children until 59 months. High-risk
should get the PCV23. (vulnerable population: infant, elderly)

VACCINE SCHEDULE - ANSWER● Birth- Hep B

● 2 months- Hep B, rotavirus, DTAP, HIB, PCV13, polio (BDRHIP)

● 4 months- rotavirus, DTAP, HIB, PCV13, polio (DRHIP)

● 6 Months- Hep B, DTAP, PCV13, polio (BDRHIP agaIN)

● 12 months- HIB, FLU, MMR, Varicella, Hep A

, ● 18 month-

● Age 4-6 MMR, VAR, polio, DTAP

● Age 11-12 TDAP, meningococcal, HPV

● Age 16 Meningococcal

Vaccines for Children (VFC) - ANSWERprogram enables PCPs to obtain ACIP-recommended vaccines
without cost. These vaccines are free to children younger than 19 years old who are Medicaid-
eligible, uninsured, or Native American, or Alaska Native. In addition, children without immunization
insurance coverage are eligible to receive vaccines at federally qualified health centers (FQHCs) and
rural health clinics. The VFC program successfully reduces disparities in vaccination rates among low-
income children.

Sudden Infant Death Syndrome (SIDS) Prevention- - ANSWERSUID- any sudden and unexplained
death in infanthood. Includes suffocation, asphyxia, entrapment, infection, ingestions, metabolic
diseases, and trauma (unintentional or nonaccidental).

SIDS - ANSWERafter thorough investigation. Typically thought suffocation and overheating.
Decreased after sleeping infants on their backs. 90% occur before age 6 months. More likely to be
premature and or growth restricted.



Recommendations- room shared without bed shared, avoidance of shared substances, avoid bumper
pads and use of bedding, avoid overheating. Breastfeeding and immunizations. Education- safe
sleeping. Alcohol and drugs use prenatal and after the child is born.

Lead Poisoning - ANSWERLead is a naturally occurring substance found throughout the environment.
Masks itself as iron deficient anemia. If lead toxic iron can't bind with hemoglobin. No matter how
much iron you give it will not correct it.



Chelation therapy is recommended for levels higher than 45. mcg/dl.



Risk factors-

● Homes- lead-based paint can be in homes built before 1972. Chipped paint on antique furniture
and toys.

● Water- plumbing soldered with lead. Fixtures not intended for drinking water (hoses, spigots, hand
washing stations.

● Soil/yard/ playgrounds- Breathing in or swallowing lead-contaminated soil while playing. Eating
fruits and vegetables grown in contaminated soil. Old playground equipment, artificial turf.
Playground surfaces with shredded rubber.

● Imported goods- glazed pottery, Asian Hispanic and Indian spices. Mexican candy with Tamarindo
and chili. Toys, Jewelry. Cosmetics that are imported.

● Hobbies- exposure through lead bullets, lead sinkers for fishing, stain glass work, and refurnishing
antique furniture.

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