VERSION 1
NR 328 FINAL EXAM STUDY GUIDE
Rubeola (measles)
A highly contagious viral disease that can lead to neurological problems and death
Direct contact with droplets from an infected person
Contagious mainly during prodromal period (Prodromal CHARATERISTICS: fever, and upper
respiratory inections)
S/S: photophobia; Koplik spots on buccal mucosa; confluent rash that beings ON THE FACE and
SPREADS DOWNWARD
Varicella (chickenpox)
Viral disease characterized by skin lesions
Lesions begin ON THE TRUNK and SPREAD to FACE and PROXIMAL EXTREMETIES
Progresses through macular, popular, vesicular, and pustular stages
Transmitted by direct contact, droplet spread, or freshly contaminated objects
Communicable prodromal period to the time all lesions have crusted
Pertussis (whooping cough)
Acute infectious respiratory disease, usually occurring in infancy
Cause by gram (-) bacillus
Begins with Upper Respiratory symptoms
Paroxysmal stage characterized by prolonged coughing and crowing or whooping UPON
INSPIRATION; lasts 4-6 weeks
Transmitted by direct contact, droplet spread or freshly contaminated objects
Treated by administering erythromycin
Complications: pneumonia, hemorrhage, and seizures
Rubella (German measles)
Common viral disease
Has teratogenic effect on fetus during first trimester
Transmitted by droplet and direct contact with infected person
Discrete red maculopapular rash that STARTS ONE THE FACE and RAPIDLY SPREADS TO
ENTIRE BODY
Rash disappears within 3 days
Parmyxovirus (mumps)
Incubatoin: 14 to 21 days
S/S: fever, headache, malaise, parotid gland swelling and tenderness; manifestations include
submaxillary and sublingual infection, orchitis, and meningoencephalitis
Transmitted via direct contact or droplet spread
Analgesics used for pain and antiseptics for fever
Bed rest maintained until swelling subsides
MMR Vaccine
Generally administered between 12-15 months and repeated at 4-6 years or by 11-12 years
In times of measles epidemic it is possible to give measles vaccine at 6 months and repeat MMR at
15 months
Measles vaccine is contraindicated in individuals with history of anaphylactic reaction to
neomycin or eggs, those with altered immunodeficiency, pregnant women
May be given to those with HIV and breastfeeding women
Administer SUB-Q at separate sites
Children may have a light, transient rash for 2 weeks after administration of vaccine
DTaP Vaccine
, Beginning at 2 months, administer 3 doses at 2 month intervals
Booster doses given at 15 to 18 months and 4 to 6 years
IM
Not given to children past 7th birthday; they would receive Td, which contains full strength
protection against tetanus and lesser strength iphtheria protection
Contraindication for pertussis vaccine: encephalopathy within 7 days of previous dose of DTaP;
history of seizures; neurological symptoms after receiving the vaccine; systemic allergic reactions
to the vaccine
Parents should be instructed to start acetaminophen administration after immunization (normal
dose 10 to 15 mg/kg)
Immediately report any side effects of immunization to PCP
HiB (Haemophilus influenzae type B) Vaccine
Offers protection against epiglottitis, bacterial meningitis, septic arthritis
IM
No contraindications
Vaccines have different series administration schedules; schedules cover children through age 5
Hepatitis B Vaccine
May be given to newborns prior to hospital discharge
All children up to 18 years should be vaccinated
Contraindicated in individuals with anaphylactic reaction to common Baker’s yeast
Varicella Vaccine
Protection from chickenpox
Usually a school requirement
Is safe for children with asymptomatic HIV
Administer at 12 to 18 months
Give MMR and varicella on same day or >30 days apart (separate site)
Nursing Care for Children with Communicable Diseases
Isolate child for period of communicability
Treat fever with NONASPIRIN products
Report occurrence to health department
Prevent child from scratching skin (cut nails, mittens, provide soothing baths, etc.)
Administer diphenhydramine HCl (Benadryl) as prescribed
WASH HANDS
Diarrhea
Increased number or decreased consistency of stool
Can be serious of fatal illness, especially in infants
Causes: bacterial, viral, parasitic; mal-absorption problems; inflammatory diseases; dietary factors
Conditions Associated with Diarrhea: dehydration; metabolic acidosis; shock
Diarrhea: Nursing Assessment
Usually occurs in infants
History of exposure to pathogens, contaminated food, dietary changes
Signs of Dehydration
Poor skin turgor
Absence of tears
Dry mucous membranes
Weight loss (5 – 15 %)
Depressed fontanels
Decreased urinary output, increased specific gravity
Lab signs of Metabolic Acidosis
Loss of bicarbonate (serum pH <7.35)
, Loss of sodium and potassium through stools
Elevated hematocrit (Hct)
Elevated BUN
Signs of Shock
Decreased blood pressure
Rapid, weak pulse
Mottled gray skin color
Changes in mental status
Diarrhea: Nursing Plan and Intervention
Assess hydration and vital signs frequently
Monitor I&Os
Do NOT take temperature rectally
Rehydrate as prescribed with fluids and electrolytes
Add potassium to IV fluids ONLY with adequate urine output
Calculate IV hydration to include maintenance and rehydration fluids
Collect specimen to aid in diagnosis of cause
Check stool pH, glucose and blood
Check urine specific gravity
Institute careful Isolation precautions; wash hands
Teach Home care for child with diarrhea
Provide child with oral rehydration solution such as Pedialyte or Lytren
Child may temporarily need lactose-free diet
Child should NOT receive anti-diarrheals (i.e. Immodium A-D)
Do not give child grape juice, orange juice, apple juice, cola or ginger ale. These solutions have
high osmolality
BURNS
Tissue injury caused by heat, electricity, chemicals, or radiation
Burns are 2nd major cause of accidental deaths in children > 15 years
Children younger than 2 years have higher mortality rate due to: greater central body
surface area, greater part of body surface area is centered in head and trunk; Greater fluid
volume (proportionate to body size); Less effective cardiovascular responses to fluid volume
shifts
In children, partial thickness burn is considered a major burn if it involves more than 25% of body
surface
Full thickness is considered major if it involves more than 10% of body surface
Rules of 9 cannot be used bc of changing proportions of children
Assessment for Children with burns: Lund-Browder Chart: which takes into account the
changing proportions of the child
Fluids need to be calculated from the time of the burn
Parkland Formula is commonly used as a guideline for calculating fluid replacement and
maintenance: it is based on the child’s body surface area and should include volume for burn
losses and maintenance
Adequacey for evaluating fluid replacement is determined by evaluating Urinary Output
(urinary output in infants and children should be 1-2mL/kg/hr)
Specific gravity should be less than 1.025
Types
1. Obstructive: Cystic fibrosis; Bronchiolitis; Asthma; Epiglottitis; Croup
2. Infective: RSV; Tonsillitis; Otitis Media
Important signs in Children
Carinal signs of Respiratory distress: restlessness; increased respiratory rate; increased pulse
rate; diaphoresis
NR 328 FINAL EXAM STUDY GUIDE
Rubeola (measles)
A highly contagious viral disease that can lead to neurological problems and death
Direct contact with droplets from an infected person
Contagious mainly during prodromal period (Prodromal CHARATERISTICS: fever, and upper
respiratory inections)
S/S: photophobia; Koplik spots on buccal mucosa; confluent rash that beings ON THE FACE and
SPREADS DOWNWARD
Varicella (chickenpox)
Viral disease characterized by skin lesions
Lesions begin ON THE TRUNK and SPREAD to FACE and PROXIMAL EXTREMETIES
Progresses through macular, popular, vesicular, and pustular stages
Transmitted by direct contact, droplet spread, or freshly contaminated objects
Communicable prodromal period to the time all lesions have crusted
Pertussis (whooping cough)
Acute infectious respiratory disease, usually occurring in infancy
Cause by gram (-) bacillus
Begins with Upper Respiratory symptoms
Paroxysmal stage characterized by prolonged coughing and crowing or whooping UPON
INSPIRATION; lasts 4-6 weeks
Transmitted by direct contact, droplet spread or freshly contaminated objects
Treated by administering erythromycin
Complications: pneumonia, hemorrhage, and seizures
Rubella (German measles)
Common viral disease
Has teratogenic effect on fetus during first trimester
Transmitted by droplet and direct contact with infected person
Discrete red maculopapular rash that STARTS ONE THE FACE and RAPIDLY SPREADS TO
ENTIRE BODY
Rash disappears within 3 days
Parmyxovirus (mumps)
Incubatoin: 14 to 21 days
S/S: fever, headache, malaise, parotid gland swelling and tenderness; manifestations include
submaxillary and sublingual infection, orchitis, and meningoencephalitis
Transmitted via direct contact or droplet spread
Analgesics used for pain and antiseptics for fever
Bed rest maintained until swelling subsides
MMR Vaccine
Generally administered between 12-15 months and repeated at 4-6 years or by 11-12 years
In times of measles epidemic it is possible to give measles vaccine at 6 months and repeat MMR at
15 months
Measles vaccine is contraindicated in individuals with history of anaphylactic reaction to
neomycin or eggs, those with altered immunodeficiency, pregnant women
May be given to those with HIV and breastfeeding women
Administer SUB-Q at separate sites
Children may have a light, transient rash for 2 weeks after administration of vaccine
DTaP Vaccine
, Beginning at 2 months, administer 3 doses at 2 month intervals
Booster doses given at 15 to 18 months and 4 to 6 years
IM
Not given to children past 7th birthday; they would receive Td, which contains full strength
protection against tetanus and lesser strength iphtheria protection
Contraindication for pertussis vaccine: encephalopathy within 7 days of previous dose of DTaP;
history of seizures; neurological symptoms after receiving the vaccine; systemic allergic reactions
to the vaccine
Parents should be instructed to start acetaminophen administration after immunization (normal
dose 10 to 15 mg/kg)
Immediately report any side effects of immunization to PCP
HiB (Haemophilus influenzae type B) Vaccine
Offers protection against epiglottitis, bacterial meningitis, septic arthritis
IM
No contraindications
Vaccines have different series administration schedules; schedules cover children through age 5
Hepatitis B Vaccine
May be given to newborns prior to hospital discharge
All children up to 18 years should be vaccinated
Contraindicated in individuals with anaphylactic reaction to common Baker’s yeast
Varicella Vaccine
Protection from chickenpox
Usually a school requirement
Is safe for children with asymptomatic HIV
Administer at 12 to 18 months
Give MMR and varicella on same day or >30 days apart (separate site)
Nursing Care for Children with Communicable Diseases
Isolate child for period of communicability
Treat fever with NONASPIRIN products
Report occurrence to health department
Prevent child from scratching skin (cut nails, mittens, provide soothing baths, etc.)
Administer diphenhydramine HCl (Benadryl) as prescribed
WASH HANDS
Diarrhea
Increased number or decreased consistency of stool
Can be serious of fatal illness, especially in infants
Causes: bacterial, viral, parasitic; mal-absorption problems; inflammatory diseases; dietary factors
Conditions Associated with Diarrhea: dehydration; metabolic acidosis; shock
Diarrhea: Nursing Assessment
Usually occurs in infants
History of exposure to pathogens, contaminated food, dietary changes
Signs of Dehydration
Poor skin turgor
Absence of tears
Dry mucous membranes
Weight loss (5 – 15 %)
Depressed fontanels
Decreased urinary output, increased specific gravity
Lab signs of Metabolic Acidosis
Loss of bicarbonate (serum pH <7.35)
, Loss of sodium and potassium through stools
Elevated hematocrit (Hct)
Elevated BUN
Signs of Shock
Decreased blood pressure
Rapid, weak pulse
Mottled gray skin color
Changes in mental status
Diarrhea: Nursing Plan and Intervention
Assess hydration and vital signs frequently
Monitor I&Os
Do NOT take temperature rectally
Rehydrate as prescribed with fluids and electrolytes
Add potassium to IV fluids ONLY with adequate urine output
Calculate IV hydration to include maintenance and rehydration fluids
Collect specimen to aid in diagnosis of cause
Check stool pH, glucose and blood
Check urine specific gravity
Institute careful Isolation precautions; wash hands
Teach Home care for child with diarrhea
Provide child with oral rehydration solution such as Pedialyte or Lytren
Child may temporarily need lactose-free diet
Child should NOT receive anti-diarrheals (i.e. Immodium A-D)
Do not give child grape juice, orange juice, apple juice, cola or ginger ale. These solutions have
high osmolality
BURNS
Tissue injury caused by heat, electricity, chemicals, or radiation
Burns are 2nd major cause of accidental deaths in children > 15 years
Children younger than 2 years have higher mortality rate due to: greater central body
surface area, greater part of body surface area is centered in head and trunk; Greater fluid
volume (proportionate to body size); Less effective cardiovascular responses to fluid volume
shifts
In children, partial thickness burn is considered a major burn if it involves more than 25% of body
surface
Full thickness is considered major if it involves more than 10% of body surface
Rules of 9 cannot be used bc of changing proportions of children
Assessment for Children with burns: Lund-Browder Chart: which takes into account the
changing proportions of the child
Fluids need to be calculated from the time of the burn
Parkland Formula is commonly used as a guideline for calculating fluid replacement and
maintenance: it is based on the child’s body surface area and should include volume for burn
losses and maintenance
Adequacey for evaluating fluid replacement is determined by evaluating Urinary Output
(urinary output in infants and children should be 1-2mL/kg/hr)
Specific gravity should be less than 1.025
Types
1. Obstructive: Cystic fibrosis; Bronchiolitis; Asthma; Epiglottitis; Croup
2. Infective: RSV; Tonsillitis; Otitis Media
Important signs in Children
Carinal signs of Respiratory distress: restlessness; increased respiratory rate; increased pulse
rate; diaphoresis
