PEDIATRIC NURSING-FINAL EXAM STUDY GUIDE
Communicating with Children (Infant through Adolescence)
Effective communication varies based on developmental stage and should be tailored
accordingly:
• Prevent overwhelming the child with excessive information at one time
• Use active listening techniques and allow pauses or silence when appropriate
• Provide encouragement and clear, simple direction
• Maintain cultural sensitivity and awareness
• Incorporate play and toys as communication tools, especially with younger children
• Be truthful in explanations to build trust
Developmental Considerations in Communication
• Infants: often display stranger anxiety
• Toddlers: commonly experience separation anxiety
• Preschool-aged children: think concretely; interpret information literally
• School-aged children: respond best to explanations and reasoning
• Adolescents: prioritize privacy and independence
Age-Specific Physical Assessment Approaches
Vital Signs (Respirations, Apical Pulse, Blood Pressure, Temperature)
• Measurements include respirations, apical heart rate, blood pressure, and axillary
temperature when appropriate
Newborn considerations:
• Respirations must be counted for a full minute due to periodic apnea
Infants:
• Apical pulse is assessed at the brachial site
• Sequence of assessment is modified to accommodate developmental needs and minimize
distress
Fontanelles and Developmental Milestones
• Posterior fontanel closes around 6–8 weeks (2–3 months)
• Anterior fontanel closes between 12–18 months
• Teething typically begins around 6 months
Growth and Development Assessment
• Birth weight typically doubles by 6 months
• Birth weight triples by 12 months
• Average birth length is approximately 20 inches
• Infants grow about 10 inches in the first year
• Recumbent length is used until 2–3 years of age
Growth Red Flags
• BMI at or above the 85th percentile
• Height below the 5th percentile
Normal Pediatric Vital Signs
Age HR RR BP
0-6 months 80-180 30-55 64-96/30-62
6-12 months 80-150 25-40 66-107/40-66
1-4 years 80-140 20-30 70-115/45-71
, 4-6 years 70-120 18-27 78-117/58-75
6-8 years 70-110 14-22 82-120/62-80
8-12 years 60-110 14-22 86-130/66-83
12 years 60-100 12-20 94-140/74-89
Communicable and Infectious Diseases
Immunization Contraindications and Precautions
• A contraindication refers to a condition that significantly increases the risk of a serious
adverse reaction (e.g., giving a live vaccine to a severely immunocompromised child)
• A precaution indicates a situation where risk may be increased or vaccine response may
be reduced, but vaccination may still proceed if benefits outweigh risks
General Vaccine Contraindications
• History of severe or life-threatening reaction to a prior vaccine or vaccine component
(e.g., anaphylaxis)
• Moderate to severe acute illness or severe febrile illness
o Mild illness (such as a cold) is not a reason to delay vaccination
• Recent receipt of blood products or IV immunoglobulin, which may reduce immune
response
Live Vaccine Contraindications
• Immunosuppression (including chemotherapy), due to risk of uncontrolled viral
replication and severe illness
DTaP vs Tdap and Cocooning Strategy
• Vaccines protect against diphtheria, tetanus, and pertussis
DTaP
• Administered to children 8 years and younger
• First three doses should come from the same manufacturer when possible; the fourth
may differ
Tdap
• Given starting at age 8 and older, typically during adolescence
• Booster (Td) recommended every 10 years
Cocooning
• Strategy to protect newborns by immunizing all close contacts and caregivers, since
infants are not fully vaccinated
Tetanus (Lockjaw)
• Caused by exotoxin from Clostridium tetani
• Preventable but potentially fatal disease
Clinical Features
• Early signs include jaw stiffness, neck rigidity, difficulty opening the mouth, and facial
spasms
• Progression may include opisthotonos, difficulty swallowing, and respiratory muscle
involvement
• Can lead to respiratory failure due to secretions, pneumonia, or airway spasm
• Patient typically remains alert and aware
• May present with tachycardia, sweating, and minimal fever
• Incubation period: 3–10 days
• Mortality rate is high, especially in newborns
,Prevention and Treatment
• Immunization with tetanus toxoid provides prevention
• Tetanus immune globulin is used for high-risk wounds in inadequately immunized
patients
• Booster recommended for contaminated, puncture, crush, burn, or frostbite injuries
• Clean, minor wounds do not require booster if immunizations are current
Live Vaccines Overview
Common live vaccines include: MMR, Varicella, Rotavirus, Intranasal influenza, Oral polio
vaccine (OPV)
General Considerations
• Side effects may appear 2–4 weeks after administration
• Mild symptoms may resemble the actual disease
Examples:
• Varicella rash may be contagious to immunocompromised individuals
• Rotavirus and OPV may be shed in stool for up to 14 days
IPV vs OPV
• IPV (inactivated polio vaccine): used in the U.S. in a 4-dose schedule
• OPV (oral polio vaccine): live vaccine, shed in stool, risk of vaccine-associated paralysis,
not used in the U.S.
MMR Vaccine
• Contraindicated in pregnancy
• Rubella virus has been detected in breast milk
• Avoid use in severe immunosuppression or recent IVIG/blood transfusion
• Not given under 12 months except during outbreaks
Vaccine Reactions
Serious (Adverse) Reactions
• Respiratory distress, wheezing, or hoarseness
• Hives
• Pallor
• Severe lethargy or dizziness
• Tachycardia
Mild Reactions
• Low-grade fever
• Local soreness or redness at injection site
• Managed with comfort measures and antipyretics
Vaccine Administration Site
• Vastus lateralis: preferred until age 3
• Deltoid: used after age 3
Major Vaccine-Preventable Diseases
Hepatitis B
• Only vaccine routinely given at birth due to maternal transmission risk
• Follow-up doses at 1–2 months and subsequent schedule
• Chronic infection may lead to cirrhosis or liver cancer later in life
MMR (Measles, Mumps, Rubella)
, • Two-dose series: 12–15 months and 4–6 years
• Maternal antibodies provide early protection in infants
• Rubella immunization primarily protects future pregnancies
• Outbreaks may require early additional dosing
Varicella
• Causes chickenpox and shingles (herpes zoster later in life)
• Two-dose series; second dose may be given before age 4 with proper interval
• Requires airborne, contact, and standard precautions when active
• Varicella exposure may require VariZIG in high-risk children
HPV
• Prevents cervical and other cancers in both sexes
• Two-dose series beginning at age 11–12 (can start at 9)
• Maximum catch-up age is 26 years
• Cervical screening still required after vaccination
Haemophilus influenzae type B (Hib)
• Prevents meningitis, pneumonia, and epiglottitis
• Not related to influenza virus
Rotavirus
• Leading cause of severe pediatric diarrhea and dehydration worldwide
• Transmitted via fecal-oral route
• Vaccine series must be completed on schedule
Transmission-Based Precautions
Standard Precautions
• Hand hygiene is essential
• Includes PPE (gloves, masks, gowns, eye protection)
• Applies to all patients regardless of diagnosis
• Includes cough etiquette and respiratory hygiene
Airborne Precautions
• For particles ≤5 micrometers that remain suspended in air
• Requires N95 respirator and negative-pressure room
• Examples: TB, measles, varicella, COVID (in some settings)
Droplet Precautions
• Spread via large respiratory droplets within ~3 feet
• Requires surgical mask, gown, and gloves
• Examples: influenza, pertussis, meningitis, pneumonia
Contact Precautions
• Spread through direct or indirect contact
• Requires gown and gloves
• Examples: C. difficile, scabies, herpes simplex, hepatitis A
Selected Pediatric Infectious Diseases
Fifth Disease
• Caused by parvovirus B19
• “Slapped cheek” rash appearance
• Most contagious before rash appears
Communicating with Children (Infant through Adolescence)
Effective communication varies based on developmental stage and should be tailored
accordingly:
• Prevent overwhelming the child with excessive information at one time
• Use active listening techniques and allow pauses or silence when appropriate
• Provide encouragement and clear, simple direction
• Maintain cultural sensitivity and awareness
• Incorporate play and toys as communication tools, especially with younger children
• Be truthful in explanations to build trust
Developmental Considerations in Communication
• Infants: often display stranger anxiety
• Toddlers: commonly experience separation anxiety
• Preschool-aged children: think concretely; interpret information literally
• School-aged children: respond best to explanations and reasoning
• Adolescents: prioritize privacy and independence
Age-Specific Physical Assessment Approaches
Vital Signs (Respirations, Apical Pulse, Blood Pressure, Temperature)
• Measurements include respirations, apical heart rate, blood pressure, and axillary
temperature when appropriate
Newborn considerations:
• Respirations must be counted for a full minute due to periodic apnea
Infants:
• Apical pulse is assessed at the brachial site
• Sequence of assessment is modified to accommodate developmental needs and minimize
distress
Fontanelles and Developmental Milestones
• Posterior fontanel closes around 6–8 weeks (2–3 months)
• Anterior fontanel closes between 12–18 months
• Teething typically begins around 6 months
Growth and Development Assessment
• Birth weight typically doubles by 6 months
• Birth weight triples by 12 months
• Average birth length is approximately 20 inches
• Infants grow about 10 inches in the first year
• Recumbent length is used until 2–3 years of age
Growth Red Flags
• BMI at or above the 85th percentile
• Height below the 5th percentile
Normal Pediatric Vital Signs
Age HR RR BP
0-6 months 80-180 30-55 64-96/30-62
6-12 months 80-150 25-40 66-107/40-66
1-4 years 80-140 20-30 70-115/45-71
, 4-6 years 70-120 18-27 78-117/58-75
6-8 years 70-110 14-22 82-120/62-80
8-12 years 60-110 14-22 86-130/66-83
12 years 60-100 12-20 94-140/74-89
Communicable and Infectious Diseases
Immunization Contraindications and Precautions
• A contraindication refers to a condition that significantly increases the risk of a serious
adverse reaction (e.g., giving a live vaccine to a severely immunocompromised child)
• A precaution indicates a situation where risk may be increased or vaccine response may
be reduced, but vaccination may still proceed if benefits outweigh risks
General Vaccine Contraindications
• History of severe or life-threatening reaction to a prior vaccine or vaccine component
(e.g., anaphylaxis)
• Moderate to severe acute illness or severe febrile illness
o Mild illness (such as a cold) is not a reason to delay vaccination
• Recent receipt of blood products or IV immunoglobulin, which may reduce immune
response
Live Vaccine Contraindications
• Immunosuppression (including chemotherapy), due to risk of uncontrolled viral
replication and severe illness
DTaP vs Tdap and Cocooning Strategy
• Vaccines protect against diphtheria, tetanus, and pertussis
DTaP
• Administered to children 8 years and younger
• First three doses should come from the same manufacturer when possible; the fourth
may differ
Tdap
• Given starting at age 8 and older, typically during adolescence
• Booster (Td) recommended every 10 years
Cocooning
• Strategy to protect newborns by immunizing all close contacts and caregivers, since
infants are not fully vaccinated
Tetanus (Lockjaw)
• Caused by exotoxin from Clostridium tetani
• Preventable but potentially fatal disease
Clinical Features
• Early signs include jaw stiffness, neck rigidity, difficulty opening the mouth, and facial
spasms
• Progression may include opisthotonos, difficulty swallowing, and respiratory muscle
involvement
• Can lead to respiratory failure due to secretions, pneumonia, or airway spasm
• Patient typically remains alert and aware
• May present with tachycardia, sweating, and minimal fever
• Incubation period: 3–10 days
• Mortality rate is high, especially in newborns
,Prevention and Treatment
• Immunization with tetanus toxoid provides prevention
• Tetanus immune globulin is used for high-risk wounds in inadequately immunized
patients
• Booster recommended for contaminated, puncture, crush, burn, or frostbite injuries
• Clean, minor wounds do not require booster if immunizations are current
Live Vaccines Overview
Common live vaccines include: MMR, Varicella, Rotavirus, Intranasal influenza, Oral polio
vaccine (OPV)
General Considerations
• Side effects may appear 2–4 weeks after administration
• Mild symptoms may resemble the actual disease
Examples:
• Varicella rash may be contagious to immunocompromised individuals
• Rotavirus and OPV may be shed in stool for up to 14 days
IPV vs OPV
• IPV (inactivated polio vaccine): used in the U.S. in a 4-dose schedule
• OPV (oral polio vaccine): live vaccine, shed in stool, risk of vaccine-associated paralysis,
not used in the U.S.
MMR Vaccine
• Contraindicated in pregnancy
• Rubella virus has been detected in breast milk
• Avoid use in severe immunosuppression or recent IVIG/blood transfusion
• Not given under 12 months except during outbreaks
Vaccine Reactions
Serious (Adverse) Reactions
• Respiratory distress, wheezing, or hoarseness
• Hives
• Pallor
• Severe lethargy or dizziness
• Tachycardia
Mild Reactions
• Low-grade fever
• Local soreness or redness at injection site
• Managed with comfort measures and antipyretics
Vaccine Administration Site
• Vastus lateralis: preferred until age 3
• Deltoid: used after age 3
Major Vaccine-Preventable Diseases
Hepatitis B
• Only vaccine routinely given at birth due to maternal transmission risk
• Follow-up doses at 1–2 months and subsequent schedule
• Chronic infection may lead to cirrhosis or liver cancer later in life
MMR (Measles, Mumps, Rubella)
, • Two-dose series: 12–15 months and 4–6 years
• Maternal antibodies provide early protection in infants
• Rubella immunization primarily protects future pregnancies
• Outbreaks may require early additional dosing
Varicella
• Causes chickenpox and shingles (herpes zoster later in life)
• Two-dose series; second dose may be given before age 4 with proper interval
• Requires airborne, contact, and standard precautions when active
• Varicella exposure may require VariZIG in high-risk children
HPV
• Prevents cervical and other cancers in both sexes
• Two-dose series beginning at age 11–12 (can start at 9)
• Maximum catch-up age is 26 years
• Cervical screening still required after vaccination
Haemophilus influenzae type B (Hib)
• Prevents meningitis, pneumonia, and epiglottitis
• Not related to influenza virus
Rotavirus
• Leading cause of severe pediatric diarrhea and dehydration worldwide
• Transmitted via fecal-oral route
• Vaccine series must be completed on schedule
Transmission-Based Precautions
Standard Precautions
• Hand hygiene is essential
• Includes PPE (gloves, masks, gowns, eye protection)
• Applies to all patients regardless of diagnosis
• Includes cough etiquette and respiratory hygiene
Airborne Precautions
• For particles ≤5 micrometers that remain suspended in air
• Requires N95 respirator and negative-pressure room
• Examples: TB, measles, varicella, COVID (in some settings)
Droplet Precautions
• Spread via large respiratory droplets within ~3 feet
• Requires surgical mask, gown, and gloves
• Examples: influenza, pertussis, meningitis, pneumonia
Contact Precautions
• Spread through direct or indirect contact
• Requires gown and gloves
• Examples: C. difficile, scabies, herpes simplex, hepatitis A
Selected Pediatric Infectious Diseases
Fifth Disease
• Caused by parvovirus B19
• “Slapped cheek” rash appearance
• Most contagious before rash appears
