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The topics covered in this NCLEX PN Study Guide section includes immunization, family education, and pain assessment.


How body develops defenses against disease

As a result of immunization, the body develops defenses against disease.

A vaccine introduces antibodies into the body to provide this defense.

Ultimately, these antibodies will prevent or ensure a milder form of the disease should the patient get it.

Vaccines introduce some of the disease’s antigens, which will cause the body to start producing its own antigens to combat it.

Ultimately, the goal is herd immunity in the general population which means the vast majority would then be immune to the disease. 

Vaccine types

Vaccines are available in many forms today, including:

  • Conjugated vaccines
  • Killed virus vaccines
  • Live virus vaccines
  • Recombinant vaccines
  • Toxoid vaccines

Your coursework will provide more information on these.

During a nurse’s daily routine, they will encounter a few specific vaccines.

Hepatitis A vaccine

In young infants, two doses of this vaccine are given to protect against Hepatitis A, which is a contagious virus that can cause liver disease.

These are administered at:

  • 12 months
  • 18 months (or a six month period following the first dose)

The vaccine can be given to older children as well.

Hepatitis B vaccine

For immunity against Hepatitis B, which is spread by blood and body fluids, three monovalent HepB injections are required.

Because Hep B can also cause liver damage and even cancer, this is a necessity.

Vaccines are administered using the following timeline:

  • At birth
  • 1-2 months thereafter
  • At 24 weeks

Adolescents who have not been vaccinated yet can receive two doses. 

Two to six months after the first has been received, the second should be administered. 

Rotavirus vaccine

This vaccine prevents severe diarrhea caused by Rotavirus.

Infants receive three doses at:

  • 2 months 
  • 4 months
  • 6 months

Inactivated Poliovirus vaccine

Poliomyelitis was a viral infection that caused 20,000 cases per year before the vaccine was introduced in 1955.

Injectable polio vaccines are administered in four doses:

  • 2 months
  • 4 months
  • 6-18 months
  • 4-6 years as a booster

MMR vaccine

Two MMR doses are required to protect against measles, mumps, and rubella:

  • 12-15 months
  • 4-6 years

Your coursework will also include the following vaccines that you can read up on:

  • Varicella  
  • DTaP and Tdap 
  • HPV 
  • PCV-7
  • PPV
  • Meningococcal
  • Hib

Summary of the schedule for infant immunization

The following schedule breaks down when infants should receive these vaccines:

  • Hep B: Administered at birth, 1-2 months, and then last dosage at 6-18 months
  • Diphtheria/pertussis/tetanus: Administered at 2, 4, and 6 months with the last dosage at 15-18 months
  • Hib: Administered at 2, 5, and 12 months but the last dosage can be later
  • Poliovirus vaccine: Administered at 2, 4, and between 6-18 months
  • MMR vaccine: Administered between the ages of 12-18 months
  • Varicella: Administered at 12 months

Children receiving immunizations should have their immunization status evaluated before receiving them.

In most states across America, children must be immunized before going to a licensed daycare center or school.

Storage of vaccines must always be done correctly.

Vaccines should be administered according to guidelines, and parental consent should be obtained.

Vaccine side effects

As a result of the administration of these vaccines, a number of side effects can occur including:

  • Fever
  • General irritability
  • Loss of appetite
  • At the site of the injection – swelling, and redness

In the event that any of these symptoms last for more than two days, parents should consult a healthcare professional.

Theories: Human development and growth

This can be used to analyze the following human development issues.

Human development issues

Theory can be used to analyze the following human development issues.

  • Universally vs context specificity: Universality says that people will develop the same way regardless of their culture while context specificity says that culture influences development
  • Assumptions regarding human nature: There are three doctrines regarding this – original sin (children need to be taught good because, by nature, they are bad), innate purity (children are, by nature, good), and tabula rasa (children are neither good nor bad when born but must be taught wrong from right)
  • Behavioral consistency: No matter what the situation is, depending on who is interacting with them, children will behave in the same way
  • Nature vs nurture: In the first, development is linked to genetic influences while the second says that development is influenced by social influences
  • Continuity vs discontinuity: Continuity says development proceeds steadily and changes have cumulative effects. Discontinuity says that later development is not influenced by the effects of early development while progress thereof is in a stair fashion
  • Passivity vs activity: With passivity, outside forces can have an impact on development. Activity is more of how a child reacts to these outside forces as well as how their development is influenced by them
  • Critical v sensitive period: The critical period is when a child will be able to pick up new behaviors and skills. The sensitive period is more flexible in terms of the time frame and here, the child is susceptible to learning new skills, regardless of the normal learning curve.

Erik Erikson: Developmental tasks

Erik Erikson proposed the developmental tasks model.

  • Trust vs mistrust: This takes place from birth to 1-year old. Here, should the needs of the child be met, they will develop faith, trust, and optimism but if not, mistrust develops
  • Autonomy vs shame/doubt: This takes place from 1 to 3 years old. Here, a child is looking for choice while becoming independent, handling tasks around basic self-care. Doubt and shame can result if this new independence (which develops willpower and self-control) is not fostered
  • Initiative vs guilt: This takes place from 3 to 6 years old. Without outside influence, a child will begin self-directed play on their own. Based on the support they receive while showing initiative, this could result in direction/purpose or guilt
  • Industry vs inferiority: This takes place from 6 to 12 years old. Pride and self-worth develop when a child feels competent and capable with a mindset that looks to do what’s right. Peer social interaction is important where feelings of inferiority or pride can result when achievements are compared
  • Identity vs role confusion: This occurs between the ages of 12-18. Youth are expected to take on certain behaviors as role models and are pressured by their ethnicity, culture, family, peers, parents, teachers, and religion. Ultimately, they have to find their own identity
  • Intimacy vs isolation: This takes place between the ages of 40 and 65. Here, roles related to work, community, and family are defined while adults carry out a number of tasks as they look to find their own niche as well as interests in the world of work
  • Integrity vs despair: The final stage is for the age group 65 and older. Here overall life experience is put into perspective while the aging process is accepted

Other theories of human development include:

  • Freud’s Stages of Psychosexual Development
  • Piaget’s Theory of Cognitive Development
  • Maslow’s Hierarchy of Needs

Make sure you review them all in your coursework.

Disease prevention and the promotion of health

Disease prevention and the promotion of health

Health promotion

The Healthy People 2030 program is run by the United States Public Health Service. 

There are five main goals of the program:

  • Achieving a healthy, thriving life for all without preventable diseases, disabilities, injuries, or premature deaths
  • Improving health literacy, eliminating health disparities, and achieving health equality
  • Promoting health through the creation of conducive environments
  • Assuring good health throughout the various life stages
  • Designing policies that improve health and well-being in collaboration with leadership and key stakeholders

There are 355 objectives total in 62 areas of this program and it is divided into 5 sections:

  • Health conditions
  • Health behaviors
  • Populations
  • Systems and settings
  • Social determinants of health

Four areas are crucial to the promotion of health:

  • Lifestyle and choices
  • Good nutrition
  • Stress
  • Physical fitness

Self-management of health

The three parts of health self-management include health maintenance, disease prevention, and health promotion.

In terms of disease prevention, there are three main components:

  • Primary prevention: Preventive measures are implemented prior to the onset of a disease
  • Secondary prevention: Preventing disease progression or other complications through screening, detection, and treatment at an early stage
  • Tertiary prevention: This involves taking proactive measures to prevent comorbid conditions or complications from occurring

Health screening

Based on various age groups, we can break this down as follows:

First, we have young adults screening (20 to 39 years).

  • Full body physical: Every 5 years
  • Blood pressure: Every 3 to 5 years if normal, more often if not 
  • Cholesterol: Every 5 years
  • Dental check-up: Annually
  • Thyroid: Every 3 years
  • Depression assessment: At every visit
  • Breast exam: Every 3 years although self-examination should be every month
  • Testicular self-assessment: Every month
  • Pap smear: Every 3 years
  • Vaccination for influenza: Every year
  • Td immunization: Every 10 years

Then there are adult screenings (40 years and older).

  • Full body physical: Every year
  • Blood pressure: Every year
  • ECG: Annually if know cardiac risks exist
  • Breast exam: Annually with a mammogram every second year
  • Colorectal cancer screening: Every year
  • Prostate-specific antigen screening:  Upon request

Illness prevention: Pediatrics 

Here we cover the Illness prevention of Pediatrics 

This section has a lot to cover, so let’s get started right away.

Disease prevention and the part that risk analysis plays in it

Both disease prevention and health promotion rely heavily on risk analysis.

It helps identify the risk of current and future diseases, especially based on family history, and

An analysis of risk could include the following areas:

  • Nutrition
  • Exercise
  • Cardiovascular
  • Diabetes
  • Hypertension
  • Cancer
  • Osteoporosis
  • Vision
  • Behavior 
  • Lifestyle

In turn, risk factors determine whether the disease has a low, medium, or high chance of developing.

Risk factors: Neonates linked with maternal disease

A number of maternal factors can contribute to an infant’s overall risk factors:

  • Diabetes mellitus: Causes hypoglycemia, macrosomia, birth defects, and even stillbirth
  • HIV/Hepatitis B: Infants are susceptible to these infectious diseases if passed on to them during pregnancy or delivery  

Fetal drug exposure and the implications thereof

It is possible for prescription drugs, as well as illicit drugs, to have a profound effect on an unborn child.

These can include:

  • Low birth weights
  • Poor sucking and dysphagia lead to them failing to thrive
  • Risk of HIV, hepatitis, and other congenital infectious diseases
  • Risk of SIDS
  • Withdrawal symptoms
  • Problems associated with development and cognition that vary with age

Fetal alcohol syndrome and the implications thereof

FAS is a condition in which babies are born with a range of birth defects because their mothers drank during pregnancy.

These include:

  • Facial abnormalities
  • Neurological defects
  • Growth retardation
  • Behavior problems 

Fetal nicotine/carbon monoxide exposure and the implications thereof

Fetuses whose mothers smoke during pregnancy are exposed to both nicotine and carbon monoxide.

This can lead to:

  • Growth retardation
  • Vasoconstriction as a result of nicotine which, along with oxygen transport interference caused by carbon monoxide, can result in fetal hypoxia. This could also lead to a chance of spontaneous abortion, premature birth as well as low weight at birth
  • High risk of SIDS and perinatal death
  • Learning disorders and cognitive deficiency
  • Cancer risk increasing

Poverty related risk factors

When children are raised in poverty, they face a number of risks.

These include:

  • No or incomplete immunizations
  • Infections that occur frequently 
  • Not enough sleep
  • Deficiencies in nutrition
  • Problems with dental care
  • Depression
  • Injuries

Overall wellness evaluation

A wellness evaluation includes a complete assessment of a child.

To do this, you need to secure the following information to create a health profile:

  • Measurements such as height and weight but also the circumference of their head
  • Vital signs
  • Temperature
  • Nutrition profile
  • Level of activity/mobility
  • Screen test results (if carried out) and why the test took place
  • Activities around health promotion and the prevention of disease

Injury prevention  

Injury prevention  

Environmental assessment

Here are a few aspects to consider:

  • Environmental health history
  • Pediatric patient’s health and the environmental influences that play a role in it
  • Environmental aspects to consider when the child patient returns home
  • General aspects of environmental safety

Social situations and recommendations for parents/children

These include;

  • Dealing with strangers
  • Dealing with violence
  • Dealing with bullying
  • Overall automobile safety

Sports and recreation recommendations

These include:

  • Risks regarding concussion
  • Using helmets in sport where necessary

Youth Risk Behavior Surveillance System (YRBSS)

A number of health-risk behaviors are monitored through this CDC program, including:

  • Violence and injury-causing behavior
  • The use of tobacco
  • The use of alcohol 
  • The use of drugs
  • High-risk sexual behavior
  • Unhealthy eating
  • Lack of physical activity

As part of the program, data obtained from participating states are combined with local surveys, which include youngsters from 9th-12th grades and resulting trends are assessed. 

STD prevention

CDC STD prevention includes five strategies:

  • Education
  • Identification of untreated infected individuals, both symptomatic and asymptomatic
  • STD diagnosis and treatment
  • Partner infection prevention
  • Pre-exposure vaccination

The 5-P approach is also used to assess risk by looking at the sexual history of a patient:

  • Partners
  • Pregnancy prevention
  • Protection
  • Practices
  • Past history when it comes to STDs

Sexually transmitted diseases can be prevented by the following methods:

  • Abstinence or a reduction in sexual partners if not
  • Pre-exposure vaccination
  • Condoms (both male and female)
  • Spermicides
  • Other non-barrier contraceptive methods

We won’t go into great detail about injury prevention for toddlers, preschoolers, school children, and adolescents since they are adequately covered in your coursework.

Take note of the various measures based on the specific age group. 

Family education 

Family education 

Our focus in this section is primarily on first-time mothers and expectant mothers.

New mothers and their educational needs

Every mother’s needs are different when it comes to their new baby. 

There are a variety of factors to consider, such as background, education, experience, expectations, and age that will all affect these needs. 

On the whole, education covers a variety of topics because it’s difficult to determine what these needs are, especially during a short hospital stay.

So, what should this education consist of?

Care of the umbilical cord

When it comes to caring for umbilical cords, mothers should know the following:

  • Moisture should be kept away from it. So, fold the diaper under the cord instead of covering it with the diaper
  • If the cord becomes dirty, wash it with mild soap and water, rinse it, and then dry it. If the cord becomes dirty, wash it with mild soap and water, rinse it, and then dry it
  • If clothing is worn over the cord stump, irritation may occur
  • Between 10 and 14 days after birth, the infant should only receive sponge baths until the cord falls off
  • Infections should be treated as soon as possible

Infants and safe positioning  

The best sleeping position for an infant is on their back in order to reduce the risks of SIDS.

  • The position of the head should be changed from side to side when a child is lying on their back. As a result, flattening is prevented
  • It is recommended that the infant is turned once a day to allow them to lie on their stomachs. As a way of preventing positional molding and strengthening both neck and head muscles, this should only be done on a firm surface 
  • It is better to hold an infant rather than leave them in their carrier
  • When additional support is provided, babies can be positioned on their sides, but this should be alternated after a time.

Fecal and urinary elimination

In the first 24 hours after birth, a baby usually passes a tarry, black stool. 

It will change as the baby consumes formula or milk.

The average baby produces five stools a day by the fifth day.

It is important to report any abnormalities in stools, including those that are watery, contain different colors, or are hard.

When cleaning up after a stool, use mild soap and water and check the skin for any signs of irritation.

A newborn will have around 6-8 wet diapers a day by day 6 following birth.

It is always a good idea to check diapers often, especially after feeding.

It is always recommended to clean the skin with baby wipes or mild soap and water. 

Diaper rash is also something to consider. 

To prevent this:

  • It is important to change diapers when necessary
  • Cleansing the skin should always be a priority
  • It is important to expose the skin to air from time to time. Changing diapers is a great time to do this
  • Diaper rash can be prevented with barrier cream

Gagging/choking in infants

The risk of choking or gagging in infants is extremely high. 

The following information should be provided to new mothers in this regard:

  • Using a propped-up bottle to feed a baby is never a good idea
  • Make sure they are not able to access any small, hazardous items
  • It is important to burp babies regularly while they are being fed. Approximately 2 to 3 ounces of milk are usually consumed after this point. Place the infant on your shoulder and gently rub or pat their back to burp them. Burp cloths should be placed under their heads. A change of shoulder can be made if they don’t burp.
  • While feeding, they should have their head elevated and kept in an upright position
  • In order for the baby to drink from the bottle properly, the nipple should never run freely, but rather provide a drip feed to the baby

Infants who choke should be placed face down on a forearm with their bodies tilted downwards. 

Then use the heel of the hand to thump them until they are dislodged from the item. 

In case of a child not breathing, CPR should be performed while emergency services are contacted. 

The procedures for performing neonatal CPR are covered in your coursework.

Infant bathing

In an infant tub, a baby can receive a full bath once the umbilical cord has fallen off.

In this regard, new mothers should be educated about the following:

  • Bathrooms should be a warm environment
  • Water should only be filled to about 3 inches in the infant tub
  • It is important to check the water temperature before placing the infant in the tub. It should be warm, not hot
  • In order to provide support to the baby, they should be held. By placing one arm under the upper back, one can support the neck and hand
  • A free hand is then used to pour water over the infant. Additionally, it is used to wash their hair and body
  • Make sure you dry the infant thoroughly when you do so
  • Infants should not be treated with lotions or creams

Car seats

It is recommended that infants be placed in a car seat during transit.

Several rules need to be followed here:

  • Always position the rear seat in the back of the car, away from any airbags, and facing backwards
  • Ensure the child is buckled in the seat at all times
  • In order to prevent the child’s head from falling forward, the seat should be reclined
  • Infants can be prevented from falling by placing padding inside the seat

Health history

There are several elements to a nursing health history.

These are:

  • Biological element: This covers details regarding the patient
  • Main complaint: The reason why they are at the medical facility
  • Present illness history: Details about the current health problem
  • Prior medical history: Details about past problems, surgeries, etc
  • Family history
  • Systems review: To obtain a full subjective symptom report from the patient, this is necessary
  • Lifestyle details: Including sleep, habits, diet, etc 
  • Social history: This includes ethnicity, family history, economic status, level of education, and more
  • Psychological status
  • Normal access to healthcare

For the exam, you should also know how to obtain a patient’s health history.

Your coursework adequately covers it, so there is no need to elaborate here too much.

The same applies to physical examination techniques including palpitation, percussion, and auscultation. 

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