1
602 Midterm book review/ study guide
Week 1- Chapter 14: Introduction to Health Promotion and Health Protection, pp. 161-
163, Chapter 20: Sleep, pp. 283-284, Chapter 22: Immunizations, pp. 306-317, Chapter 44:
Common Pediatric Injuries and Toxic Exposures, pp. 919-933
Nurse Practitioner Roles
• Know Diff between primary and acute NPs
Pediatric NP- health promotion, protection, and disease prevention
Primary Care NP- well childcare and prevention and/or management of both common pediatric
acute illness and any childhood diseases.
Acute Care NP- acute, chronic, or critically ill children. Unstable, experiencing life-threatening
illness, medically fragile and tech-dependent.
Primary prevention- keep 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- early diagnosis and prompt treatment- interrupt disease process-
screening early detection and prompt treatment. Goal is to eliminate or reduce
symptoms/progression
Tertiary Care- requires 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- highly specialized expertise and highly unusual or specialized equipment.
, 2
Immunizations-
Barriers to vaccination- patients 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
• Acknowledge and respect the trusted relationship between provider and parent.
• Communicating 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- an 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%.
, 3
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.
● Varicella(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- Killed 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.
, 4
Common side effects- common side effects-mild to moderate fever and/or local
swelling, pain, and erythema, usuall in y 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- given 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)- inactivated 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)-causes 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)- last 14-20 years. Used in under 18mos.
Hepatitis B Virus Vaccine (3 doses)- Immunogenicity 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) ages 9-26 mild with safe effects. Pregnants should not get. 2
doses 6 months apart.
Influenza Vaccine- yearly. 6 months and older. When enough are immunized, then we get to
herd immunity, protects those who are not immunized.
Meningococcal vaccine(2)- the 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 atrisk.
Pneumonicoccal-91 known serotypes. PCV13 is given to children until 59 months. High-risk
should get the PCV23. (vulnerable population: infant, elderly)
602 Midterm book review/ study guide
Week 1- Chapter 14: Introduction to Health Promotion and Health Protection, pp. 161-
163, Chapter 20: Sleep, pp. 283-284, Chapter 22: Immunizations, pp. 306-317, Chapter 44:
Common Pediatric Injuries and Toxic Exposures, pp. 919-933
Nurse Practitioner Roles
• Know Diff between primary and acute NPs
Pediatric NP- health promotion, protection, and disease prevention
Primary Care NP- well childcare and prevention and/or management of both common pediatric
acute illness and any childhood diseases.
Acute Care NP- acute, chronic, or critically ill children. Unstable, experiencing life-threatening
illness, medically fragile and tech-dependent.
Primary prevention- keep 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- early diagnosis and prompt treatment- interrupt disease process-
screening early detection and prompt treatment. Goal is to eliminate or reduce
symptoms/progression
Tertiary Care- requires 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- highly specialized expertise and highly unusual or specialized equipment.
, 2
Immunizations-
Barriers to vaccination- patients 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
• Acknowledge and respect the trusted relationship between provider and parent.
• Communicating 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- an 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%.
, 3
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.
● Varicella(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- Killed 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.
, 4
Common side effects- common side effects-mild to moderate fever and/or local
swelling, pain, and erythema, usuall in y 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- given 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)- inactivated 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)-causes 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)- last 14-20 years. Used in under 18mos.
Hepatitis B Virus Vaccine (3 doses)- Immunogenicity 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) ages 9-26 mild with safe effects. Pregnants should not get. 2
doses 6 months apart.
Influenza Vaccine- yearly. 6 months and older. When enough are immunized, then we get to
herd immunity, protects those who are not immunized.
Meningococcal vaccine(2)- the 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 atrisk.
Pneumonicoccal-91 known serotypes. PCV13 is given to children until 59 months. High-risk
should get the PCV23. (vulnerable population: infant, elderly)
