Note: I had this question on my OB HESI.
Toddlers (1-3 years) fear…?
Preschoolers (3-6 years) fear…?
School-age (6-12 years) children fear..?
Adolescents (12-18 years) fear…?
(Infant, toddler, preschool, school-age, adolescent)
Toddlers benefit from being taken to the hospital playroom when able, because mobility is important to their development.
Note: Reflex is difficult to elicit when infant has been fed.
(infant, toddler, preschooler, school-age, adolescent)
– Infants: after 6 months, their *cognitive* development allows them to *remember pain*
– Toddler: they fear *intrusive* procedures
– School-age children: they fear loss of control of *their bodies*
– Adolescents: their major concern is *change in body image*
2. Incubation period: 10-20 days
3. Communicable period: from 4 days before to 5 days after rash appears.
4. Source: Respiratory tract secretions, blood, or urine
5. Transmission: Airborne particles or direct contact with infectious droplets; transplacental
3. The three “C’s” – coryza, cough, conjunctivitis
4. Red, erythematous maculopapular eruption starting on face and spreading down towards feet; blanches with pressure and gradually turns brownish color (1 week)
5. Koplik’s spots: small red spots with a bluish white center and red base, located on buccal mucosa
Remember: Three “Cs” & Koplik’s spots are the key for identifying measles.
-Airborne droplet precautions
2. Incubation period: 5-15 days
3. Communicable period: unknown, but thought to be from febrile stage to time rash appears
4. Source & transmission : unknown
2. Rash appears several hours to 2 days after fever subsides and lasts 1 to 2 days.
Disease is self-limiting and treatment is supportive. Remember: fever first, then rash.
2. Incubation period: 14-21 days
3. Communicable period: Immediately before and after parotid gland swelling begins.
4. Source: Saliva of infected persons.
5. Transmission: Direct contact or droplet spread
2. Headache and malaise
4. Jaw or ear pain aggravated by chewing, followed by parotid gland swelling.
5. Orchitis (inflamed testes) may occur
Remember: Key is parotid gland swelling.
-Airborne droplet precautions
2. Incubation period: 5-21 days (usually 10)
3. Communicable period: greatest during the catarrhal stage
4. Source: Discharge from resp. tract of infected person
5. Transmission: Direct contact or droplet spread; indirect contact w freshly contaminated articles
2. Incubation period: 1 to 7 days
3. Communicable period: About 10 days during the incubation period and clinical illness; during the first 2 weeks of the carrier stage, although may persist for months.
4. Source: Nasophayngeal secretions of infected person and carriers.
5. Transmission: Direct contact or droplet spread; indirectly by contact with contaminated articles.
2. Red, fine, sandpaper-like rash develops in the axilla, groin, and neck that spreads to cover the entire body except face.
3. Rash blanches with pressure, except in areas of deep creases and folds of joints.
4. Desquamanation of skin on palms and soles appears by weeks 1-3
5. Tongue is initially coated by white, furry covering with red papillae; by fifth day, white coat sloughs off leaving red, swollen tongue (White strawberry tongue -> Red strawberry tongue)
6. Tonsils are reddened and covered with exudate.
7. Pharynx is edematous and beefy red
Remember: Key is the strawberry tongue
2. Incubation period: 4 – 14 days, may be 20 days
3. Communicable period: Uncertain, but before onset of symptoms in most children.
4. Source: Infected persons
5. Transmission: Unknown mode of transmission, possibly resp. secretions and blood.
Stage 1: Erythema on face, chiefly on cheeks. “Slapped cheek” appearance. Disappears by 1 – 4 days.
Stage 2: About 1 day after rash appears on face, maculopapular red spots appear, symmetrically distributed on the extremities; the rash progresses from proximal to distal surfaces and may last a week or more.
Stage 3: The rash subsides, but may reappear if skin becomes irritated by sun, heat, cold, exercise, or friction.
REMEMBER: Pregnant women need to avoid infected persons. Key to identification is “slapped cheek” appearance. Child is not usually hospitalized as disease is self-limiting.
2. Incubation period: 4 to 6 weeks
3. Communicable period: Unknown
4. Source: Oral secretions
5. Transmission: Direct intimate contact
2. Lymphadenopathy and hepatosplenomegaly
3. Discrete macular rash most prominent over the trunk may occur.
TEACH PARENTS TO MONITOR FOR SPLENIC RUPTURE: Marked by abdominal pain, left upper quadrant pain, referred left-shoulder pain.
2. Incubation period: 13 to 17 days
3. Communicable period: From 1 to 2 days before the onset of rash to 6 days after the first crop of vesicles, when crusts have formed.
4. Source: Respiratory tract secretions of infected persons; skin lesions.
5. Transmission: Direct contact, droplet, contaminated objects (strict contact and droplet precautions)
REMEMBER: Child is no longer contagious once lesions have dried and crusts have formed.
2. Lesions become pustules, begin to dry, and develop a crust.
3. Lesions may appear on mucous membranes of mouth, genital area, or rectum.
2. Incubation period: 14 to 21 days
3. Communicable period: From 7 days before to about 5 days after rash appears.
4. Source: Nasopharyngeal secretions; virus is also present in blood, stool, urine.
5. Transmission: Airborne or direct contact w/infectious droplets. Indirectly via articles freshly contaminated. Also transplacental.
3. Pinkish red maculopapular rash the begins on face and spreads to the entire body within 1 to 3 days.
4. Petechial, red, pinpoint spots may appear on the soft palate.
Key for identification is rash covering entire body and spots on soft palate.
REMEMBER: ISOLATE CHILD FROM PREGNANT WOMEN.
2. Incubation period: 2 to 5 days
3. Communicable period: Variable. Until virulent bacteria are no longer present (three consecutively negative cultures of pharyngeal secretions); usually 2 weeks, can be 4 weeks.
4. Source: Discharge from mucous membranes of nose and nasopharynx, skin and other lesions.
5. Transmission: Direct contact with infected person, carrier, or contaminated articles
2. Foul-smelling, mucoprurulent nasal discharge
3. Dense pseudomembrane formation of the throat that may interfere with eating, drinking and breathing.
4. Lymphadenitis, neck edema, “bull neck”
Interventions: Strict isolation for hospitalized child. Administer diphtheria antitoxin only AFTER a skin or conjunctival test rules out sensitivity to horse serum.
2. Incubation period: 2 to 14 days
3. Communicable period: NOT CONTAGIOUS
4. Source: Tick bite from mammal, usually wild rodents and dogs.
5. Transmission: Tick bite
2. Maculopapular OR petechial rash primarily on the extremities (ankles and wrists), but may spread to other areas, characteristically on the palms and soles.
Key: Rash on ankles, wrists, palms and soles. Remember it is not communicable. Provide parents teaching about preventing tick bites.
How many injections comprise the full course of vaccination and at what age should girls receive it? What age should boys receive it?
Girls can receive it around age 11 to 12.
Boys can receive it from age 9 to 18.
Guards against cervical cancer and genital warts in females and genital warts in males.
2. PREGNANT WOMEN should not receive HPV vaccine.
IICP = Decreased pulse and increased BP
– 1-11 mo … 25-35
– 1-3 years … 20-30
– 3-5 years … 20-25
– 6-10 years … 18-22
– 11-16 years …16-20