Immunizations
 Immunity: the ability to destroy and remove a specific antigen from the body
 Active immunity: acquired when a person’s OWN immune system generates the
immune response
 Passive immunity: produced from immunoglobulins transferred from one person to
another passive immunity lasts for months
 Contraindications for receiving vaccines
o Severe febrile illness
o Immunocompromised child should not receive MMR, MMRV, or Varicella
o Known allergy to vaccine or its content (MMR, influenza, yellow fever all
contains egg)
o Pregnant patients should not receive MMR
 Barriers to receiving Vaccines:
o Associated costs
o Concern about safety
o Misconceptions about vaccine link to autism and learning problems
o Multiple children in household
 VIS—Vaccine Information Sheet:
o Must be given to parent/caregiver and then consent PRIOR to vaccine
administration
o NO VIS or CONSENT= NO VACCINE!!!
o VIS associate with each type of vaccine
Skin Disorders
 Causes of skin disorders:
o Exposure to infectious microorganisms
o Hypersensitivity reactions; poison ivy
o Hormonal influences
o Injuries; burns and bites
 Bacterial infections
o Cause: staphylococci and streptococci
o At risk: children with congenital or acquired conditions
o Prevention: HANDWASHING
o TX: oral, topical, IV antibiotics
o Types of Bacterial Infections
 Impetigo (staph)
 Presents: red maculesbecome vesicular
 Rupture easily, Dries and crusts over
 CONTAGIOUS
 TX: TAO, Mupiricin, oral antibiotics
 Pyoderma (staph, Strep)
 Presents: infection to dermis
 Lymphangitis; lymph nodes near site become inflamed
 Sepsis, heart disease
 Skin to skin
 TX: soap and water cleanse, mupirocin, or antibiotics
o TX early to keep from invading lymph
 Cellulitis (step, Staph, Haemophiles, Influenzae)
 Inflammation of skin and subcutaneous tissues
 Presents: intense redness, swelling, firm infiltration, fever,
malaise, may involve lymph nodes, may progress to abscess
 TX: antibiotics and rest
o May require hospitalization
o ** Keep on bedrest so area can heal**
 Viral infections
o Virus that causes epidermal cells to become inflamed and to vesiculate as in HSV
o to form growths like wartz
o TX: antivirals and treating the cause
 Verruca or Wartz
 Cause: HPV
 Present: well-circumcised, grey or brown, firm and elevated
 Usually on hands, fingers, face, soles on exposed areas
 Tx: surgery, cryotherapy, causative solutions
 Tend to leave scars
 Fungal infections
o Caused by fungi and are superficial, live on skin (not in skin), invades the
stratum, corneum, hair and nails
o Tx: ketoconazole, Nystatinapply topically, orally, or IV
 Tinea Cruris (Jock Itch)
 Yeast in peri area
 Prevention: use own equipment, towels, fresh underwear, etc.
 Tx: clotrimazole
 Transmitted person to person
 Acne
o Classifications:
 Mild: primarily inflammatory lesions (comedones)
 Moderate: Comedones plus inflammatory lesions such as papules or
pustules (localized to face and back)
 Severe: lesions similar to moderate acne, but more widespread, and/or
presence of cysts or nodules --> scarring
 Burns
o Classification:
 Superficial ( 1st degree)epidermal injury, heals without scarring
 Partial thickness (2nd degree)epidermal and dermal involvement, heals
with minimal scarring
 Deep partial thickness (3rd degree)  causes changes in sebaceous gland
function and appearance of hair and nails; takes longer to heal, may scar,
may require surgery
 Full thickness (4th degree)  significant tissue damage, scarring through
to the hypodermis; may cause contracture and limited functions;
extensive scarring, significant healing time, requires surgery and grafting
 Cold Injury or Frostbite
o Classification:
 1st degree: superficial white layers with surrounding erythema
 2nd degree: demonstrates blistering with erythemia and edema
 3rd degree: Hemorrhagic blisters
 4th degree: progresses to tissue necrosis and sloughing
Genitourinary Disorders
 Differences in Anatomy
o Kidney: large in relation to the abdomen prone to injury
o Urethra: shorterR/F infection due to bacterin in bladder (UTI); especially in
women
o Glomerular Filtration Rate: slower in infants; R/F Dehydration
 Types of genitourinary disorders:
o Congenital: where there is an obstruction as in glomerulonephritis
o Structural: as in bladder exstrophy (bladder develops outside of body),
hypospadias (opening of penis is on the underside and not the tip), or
vesicoureteral reflux (abnormal flow of urine back up the ureters)
o Acquired: as in nephrotic syndrome (kidney disorder where the body excretes
too much protein), acute glomerulonephritis, or hemolytic-uremic syndrome
 Urinary Tract Infections:
o Lower UTI: urethra and bladder
o Upper: ureters, renal pelvis, renal cortex and renal medulla
o E.coli is the most common causative pathogen for genitourinary disorders
o Labs: renal function tests, BUN, Uremic Acid, Creatinine, MRI, Cystoscopy
 Enuresis
o s/s: common inappropriate voiding must occur at least 2 times per week for at
least 3 months in a child who is at least 5 years old *common in males*
o Types:
 Nocturnal: (at night, ages 6-8)
 Primary: bedwetting in child that has never been dry for extended
periods
 Secondary: bedwetting in children after a period of established
continence
o tx: antidiuretic, antispasmatics, tricyclic antidepressants, limiting fluids
 Phimosis:
o s/s: narrowing of the preputial opening of the foreskin, prevents retracting of the
foreskin over the glans penis which results in a dribbling stream of urine or a
ballooning of the foreskin with urine during voiding
o tx: proper hygiene of foreskin and not forcibly trying to retract the foreskin
 Hydrocele: peritoneal fluid in the scrotum
o s/s: painless swelling, nonincarcerated inguinal hernia usually resolves by age
1
o tx: surgical repair
 Cryptochidism:
o s/s: Failure of one or both of the testes to descend
o TX: surgical repositioning of the testes, hormone therapy is no longer
recommended
 Hypospadias:
o S/S: *Congenital* male urethral opening is on the underside of penis and not
on the tip
o TX: surgical correction between 6 and 12 months
 Bladder Extrophy:
o S/S: Open, inside out bladder caused by failure of abdominal wall to fuse in utero
o TX: treat to preserve renal function, attain urinary control, acceptable
appearance, prevent UTI, and preserve external genitalia 2 diapers (one on
bladder and one to cover baby bottom)
 Vesicoureteral Reflux VUR: backward flow of urine from the bladder into the kidneys
(reflux with infection is most common cause oof pyelonephritis in children)
o S/S: fever, vomiting, and chills
o TX: antibiotic therapy and surgery in cases not likely to self-resolve
 Nephrotic syndrome:
o S/S: proteinuria, hypoalbuminemia, edema, and hyperlipidemia (occurs ages 2-7
and common in males)
o TX: dietary restriction (low salt), corticosteroid TX, antibiotic TX in children with
peritonitis, cellulitis, and pneumonia.  TX aimed to reduce protein excretion,
reduce fluid retention, prevent infection, and minimize complications
 Acute Glomerulonephritis: glomeruli become edematous
o S/S: oliguria, edema, HTN, circulatory congestion, hematuria, and proteinuria
o TX: dietary restriction (sodium and fluid restriction), VS and weight assessments,
I/O, antihypertensive meds
 Hemolytic Uremic Syndrome (HUS): uncommon acute renal disease in ages 6mo-5 yrs
glomerular arterioles become swollen and occluded damaging RBCs
o S/S: acquired hemolytic anemia, thrombocytopenia, or renal injury
o TX: infusing fresh frozen plasma, plasmapheresis, hemodialysis, or peritoneal
dialysis in the anuric child (>24hrs), who presents with HTN and seizures.
 Acute Kidney Injury: kidneys become unable to regulate urine volume, caused by HUS
and glomerulonephritis poor perfusion, obstructions, and irreversible renal disease
o S/S: HTN, anemia, seizures, cardiac failure, metabolic acidosis, hyperkalemia and
uremia, high mortality rate in children, severe GFR reduction, Increased BUN,
decreased renal blood flow
o TX: strict I/O, limiting fluids, observing behavioral changes, fluid and electrolyte
imbalances
 Chronic Kidney Disease: kidneys cannot maintain normal chemical structure of body
fluids, progressive deterioration= uremic shock. caused by congenital malformations,
chronic pyelonephritis, chronic glomerulonephritis, systemic Lupus erythematous SLE
o S/S: increased BUN, increased creatinine, edema, vascular congestion (water and
sodium retention), hyperkalemia, metabolic acidosis, anemia, calcium and
phosphorus disturbance, growth disturbance
o TX: maintain F&E balance, tx systemic complications, promote active and normal
life, diet regulation, Vit D, dialysis, and kidney transplant
 Renal Failure: kidneys cannot concentrate urine, conserve electrolytes, or excrete waste
products
o S/S: can progress to end stage renal disease
o TX: dialysis and kidney transplant
 Female Reproductive Organ Disorders
o Vulvovaginitis- bacteria or yeast overgrowth
o PID: caused by STI
o Menstrual disorders
 Male Reproductive Organ Disorders
o Hydrocele: fluid around 1 or both testicles
o Testicular torsion: twisted testicles
o Epididymitis: infection with bacteria
Cardiac Disorders
 Two Groups:
o Congenital: anatomic abnormalities present at birth
 HF
 Hypoxemia
o Acquired: occurs after birth can be associated with congenital heart defect but
also seen in a normal heart can be caused by infection or environmental
tendencies
 Congenital Heart Disease (CHD):
o Cause: VSD (most common), alcohol consumption, exposure to environmental
toxins, and infection lead to heart issues for fetus
Defects with Increased Blood Flow
 Arterial Septal Defect (ASD): abnormal opening between the atria, pts may be
asymptomatic; hole may close spontaneously by 18 months
o Characteristic systolic murmur
o Pulmonary HTN or vascular obstructive disease and emboli due to increased
pulmonary blood flow
o Cyanotic baby
 Ventricular Septal Defect (VSD): abnormal opening between right and left ventricles
o Frequently associated with other conditions such as COA, PDA, and pulmonary
stenosis related to increased blood flow
o Increased risk for infective endocarditis
 Patent Ductus Arteriosus (PDA): failure of the ductus arteriosus to close within the first
weeks of life may or may not have symptoms of HF
o Machine-like murmur
o Pulmonary vascular congestion occurs causing increased pulmonary pressure
Obstructive Heart Defects
 Coarctation of the Aorta: Narrowing near the ductus arteriosus
o Pressure proximal to the defect is increased (upper extremities)
o Pressure distal to defect is decreased (lower extremities)
o Older child may experience headaches, dizziness, fainting, epistaxis from
HTN
o Risk for ruptured aorta, aortic aneurysm and stroke
 Aortic Stenosis: narrowing of aortic valve = resistance to blood flow in left
ventricle, decreased CO, left ventricle hypertrophy and pulmonary vascular
congestion.
o In infant:
 Decreased CO, hypotension and faint pulses, tachycardia,
poor feeding
o In Children:
 Exercise intolerance, chest pain, dizziness, R/F coronary
insufficiency
 Pulmonic Stenosis: narrowing at the entrance to the pulmonary artery=
resistance to blood flow, right ventricular hypertrophy and decreased pulmonary
blood flow
o Mild cyanosis
o Loud systolic ejection murmur may be present
Defects with Decreased Pulmonary Blood Flow
 Tetralogy of Fallot: comprised of four conditions including: (1)VSD, (2)pulmonary
stenosis, (3)overriding aorta, (4)right ventricular hypertrophy
o Blue spells (tet spells)
o R/F seizures
o R/F LOC
o R/F sudden death
o TX: three surgeries open heart surgery right away
 Tricuspid Atresia: tricuspid valve fails to develop leads to systemic
desaturation and decreased pulmonary blood flow
o Older children have CHRONIC HYPOXEMIA with CLUBBING
o TX: valve replacement
Mixed Cardiovascular Defects

Fully saturated blood flow mixes with desaturated pulmonary blood flow leads
to desaturation of systemic blood flow, pulmonary congestion, decreased CO, HF,
desaturation
 Transposition of the Great Valves: pulmonary artery leaves the left ventricle and aorta
exits from the right ventricle with no communication between the systemic and
pulmonary circulation; poorly oxygenated blood returns to the right atrium and right
ventricle is then pumped out to the aorta and back to the body
o Newborn presents with sever cyanosis and worsens as ductus arteriosus closes
o Deoxygenated blood is filtering through the body
 Total Anomalous Pulmonary Venous Return (TAPVR): rare defect characterized by
failure of the pulmonary veins to connect to the left atrium, instead they are connected
to the right atrium so right atrium received blood load
o Cyanotic infants
 Truncus Arteriosus: Failure of the normal separation and division of embryonic bulbar
trunk into pulmonary artery and aorta
o Most infants are asymptomatic but may have cyanosis at rest, poor growth,
activity intolerance, poor feeding
o Pressure is less in the pulmonary and higher in the systemic system leading to
increased blood flow to lungs and decreased blood flow through system
o May lead to pulmonary vascular disease over time
 Hypoplastic Left Heart Syndrome (HLHS): underdeveloped left side of the heart,
hypoplastic left ventricle, and aortic atresia
o Signs of HF until PDA closes , the heart cannot pump blood into systemic
circulation causing poor perfusion of vital organs and shock
o Progressive deterioration
o Decrease CO
o Fatal in first months of life without intervention
o TX: surgery for multistage repairs and eventually a HEART TRANSPLANT
 Risk Factors of Cardiovascular Disorders
o Family hx of heart disease or CHD (first degree relative)
o Hyperlipidemia
o DM
o Obesity
o Inactivity
o Stress
o High-cholesterol diet
 Nursing Assessments
o VS
o O2
o RR
o Cyanosis
o Mottling
o Adventitious lung sounds
o Activity intolerance
o Lethargy
o Vomiting and FTT
o Edema
o Abdominal distention
o I/O