IMMUNIZATION AND HEALTH PROMOTION PEDS EXAM 1.

What are the symptoms of gastroenteritis?

- fever - vomiting - DIARRHEA (most common cause) - stomach pain

What are the rare SEs of Rotarix?

- irritability - diarrhea - dermatitis - abdominal pain - flatulence - anaphylaxis

Public health laws relating to Vaccines

- laws in all 50 states require documentation that child has received immunization as condition of first entry into school - health care professionals must obtain informed consent - VAERS (Vaccine adverse event reporting system) - VFC (Vaccines for children program)

What is the function of the antibiotic in vaccines? What antibiotic is used most often in vaccines?

- to prevent bacterial growth in vaccine - Neomycin

What are toxoid vaccines, and what can it be used as?

- vaccines made from toxins that bacteria produces - can be used as adjuvant for another vaccine

When should you consider delaying vaccination?

- when immunocompromised - when moderate or severe acute illness (wait until recovering or no longer acutely ill)

Hepatitis B Vaccine

-A series of 3 injections: first at birth to 2 months, then 1 to 2 months after first, and last one at 6 to 18 months. -Is the only vaccine that prevents cancer (liver).

Meningoccus Vaccine

-Vaccinates against bacteria Neisseria meningitis. -MPSV4 given only to children over 2 years old. -Who gets it?: Children & adults without spleens, college freshman in dorms, people in contact with meningitis.

Vaccines

-Vaccines can weaken a virus/bacteria in ways that allow the individual to develop an immune response. -This refers to the production of active immunity.

Rubella (German Measles)

-Virus -Causes light mild rash of face, mild lymph node involvement, occasional swelling of joints. -Do not get pregnant three months following immunization.

Mumps

-Virus -Causes swelling of the parotid gland. -Complications: meningitis, occhitis, fetal death (in pregnant pts).

Measles

-Virus -S/s: fever, conjunctivits, red pinpoint rash (starts on face). -Complications: pneumoniae, otitis media, encephalitis.

Polio Vaccine

-Virus is highly contagious; attacks the CNS neurons that control skeletal muscle. -Vaccine is a weakened virus. -Watch for allergies to streptomycin, neomycin, or bacitracin.

list the criteria in order for a pathogen to cause a disease

1. Contact the host (transmission) 2. Colonize, adhere and grow in host 3. Infect the host 4. Evade the host's defense system 4. Damage host tissues physically or chemically.

What are some TX options for Otitis Externa?

1. Corticosporin drops (steroid and Antibiotic) 2. NSAIDS for pain

What would be the treatment for a skin lesion and systemic MRSA

1. DRAIN and INCISE lesion 2. Antimicrobial therapy with MRSA coverage such as Clindamycin and Doxycycline if pt. is hospitalized Vancomycin and Linezolid with Infectious disease consult .

What is the treatment of Kawasaki's DX? and why?

1. IV immunoglobulin 2. High dose ASA therapy decreases the incidence of coronary artery dilation and aneurysm.

What are some red flags with pharyngitis?

1. inability to swallow 2. Drooling 3. Inability to open mouth 4. Stiff neck 5. H/O HIV+

What are the "red flags" to watch for with someone with otitis media?

1. ottorhea 2. Stiff neck 3. sudden hearing loss 4. Post auricular swelling 5. TX failure in the past

What are some normal factors causing reflux in infants?

1. small stomach capicity 2. overfeed large volumes 3. short esophageal length 4. supine position 5. slow swallowing response

List some criteria why someone with a cough should be hospitalized.

1. toxic looking 2. Diaphoresis 3. Cyannosis 4. Labored respirations 5. Hemoptysis 6. Age 7. Nusing home resident 8. WBC's greater than 5000 9. TX failure

What are some examples of blocking vehicle-mediated transmission?

1. water purification 2. effective cooking 3. prevention of food contamination with infectious agents

What is the dose/regimen/route of Rotarix?

1.5ml PO X 2 doses at least 4 weeks apart

What % of pts have permanent neurological sequelae from HiB meningitis?

10-15%

What is the mortality rate of pertussis in pts <6months old?

11.8

What 2 HPV types are linked to cervical cancer?

16 and 18

HPV strains that cause malignancies

16, 18

Varicella (Varivax) Dosing for kids:

1st dose: Give at 12-15 months old. 2nd dose: give at 4-6 years old

How many doses of MMR required for 100% seroconversion?

2

When developing strategies to decrease health care disparities, the nurse working in a hospital located in a neighborhood with many Vietnamese individuals will include: a. educating the staff about Vietnamese health beliefs. b. improving public transportation. c. obtaining low-cost medications. d. updating equipment and supplies for the clinic.

ANS: A Health care disparities result from stereotyping, biases, and prejudices of health care providers. The nurse can decrease these disparities through staff education. The other strategies also may be addressed by the nurse but will not impact health disparities

Diphtheria, Tetanus, Pertussis (DTP, DTaP, Tdap); disease, type of vaccine, ages given, route

- Diphtheria; may lead to breathing problems, heart failure, paralysis - Tetanus; bacteria enters through wound - painful muscle spasms "lock-jaw" - Pertussis (Whopping cough) - coughing, choking for several weeks causing the infant to be unable to eat, drink, breathe Type: Inactivated Vaccine Route: IM Ages Given: 2m, 4m, 6m, 15-18m, 4-6 years Storage: refrigerate, irreversible loss of potency if frozen

Haemophilus Influenza Type B Vaccine (HiB)

- Hib disease is a serious disease caused by bacteria - Before Hib Vaccine, Hib was leading cause of: a) Meningitis (in children under 5 years old) b) Pneumonia c) Epiglottitis d) Death Type: Inactivated Route: IM Ages Given: 2m, 4m, 6m, 12 - 15m of age; not given to children 5 years or older

Different types of Immunity

- Immunoprophylaxis - preventing infectious disease with specific antibodies - Active Prophylaxis (Vaccines) - Immune Response to Vaccines - Passive Prophylaxis - Passive immunity *96% reduction in U.S> vaccine-preventable diseases since the pre-vaccine era**

Which type does Cervarix cover?

HPV types 16 and 18. Cervarix is INactivated, BIvalent.

Conjugated polysaccharide:

Haemophilus influenzae type B. Pneumococcal. meningococcal

The available vaccines for Hepatitis A are? Dosing interval?

Havrix and Vaqta. Given in 2 dose series at least 6 months apart Children 0.5mL IM Adults 1.0mL IM

List some side effects of Psychostimulant drugs (Concerta, Ritalin)

Headache, dysporia, loss of appetite, GI upset, Tics may occur

Small pox

Live vaccina virus vaccine. Common reaction: vaccine delivery results in weeping lesion that contains live vaccinia virus. Rare reaction: viral replication, shedding occurs at vaccination site. Unintended transmission possible immediately after vaccination until scab separates from the skin (about 2-3 weeks). Spread via infective droplets on the nasal, oral, or pharyngeal mucosal membrane. Direct and fairly prolonged face-to-face contact is required. Most contagious with the onset of rash until the last scab falls off, sometimes contagious with fever. Supportive treatment only. Vaccinate best within 3 days of exposure to prevent symptoms. Vaccinate 7 days after exposure offers some protection and might modify the disease course.

DTaP and Tdap

Protects against tetanus toxoids and acellular pertussis. Both contain Diphtheria toxoids and tetanus toxoids along with acellular pertussis. Tdap contains REDUCED diphtheria toxoid REDUCED Acellular pertussis.

Recommended gauge and needle for IM injection; Toddlers 1 to 2 years

Recommended Length of 22 -25 Gauge needles for IM immunizations and preferred injection site; Site: Anterolateral thigh** preferred IM needle size: 1 to 1 1/4 inch (25-32 mm) Can also use: Site: Deltoid muscle of arm IM needle size: 5/8 to 1 inch (16 - 25mm)

Recommended gauge and needle for IM injection; Adolescents 19 years and older

Recommended Length of 22 -25 Gauge needles for IM immunizations and preferred injection site; Site: Deltoid muscle - Weight less than 60 kg (130lb); 5/8 inch - Weight of 60 to 70kg (130 to 152lb); 1 inch - Females weighing 70 to 90kg (152 to 200 lb); 1 to 1 1/2 inch - Males weighing 60 to 118kg (152 to 260lb); 1 to 1 1/2 inch - Females weighing more than 90 kg (200 lb) and males weighing more than 118kg (260kg)l 1 1/2 inch

Recommended gauge and needle for IM injection; Children and Adolescents 3 to 18 years

Recommended Length of 22 -25 Gauge needles for IM immunizations and preferred injection site; Site: Deltoid muscle** preferred IM needle size: 5/8 to 1 inch (16 - 25mm) Can also use: Site: Anterolateral thigh IM needle size: 1 to 1 1/4 inch (25-32 mm)

Active immunity

Resistance developed in response to an antigen (infecting agent or vaccine) and usually characterized by the presence of an antibody produced by the host

A program designed to increase exercise, reduce fat in a diet, and teach low-fat cooking methods to improve the health of a large population could be best described as: a. supportive care. b. rehabilitation. c. diagnosis and treatment. d. health promotion and health protective.

ANS: D Exercise and a low-fat diet promote health and prevent illness. The nurse should engage in health protective behaviors as well as health promotion behaviors. Health protective behaviors take a person away from a dangerous situation or from a dangerous habit. Health promotion behaviors move an individual to a higher level of health, greater vigor, or energy to do more than he or she is currently capable of doing

Where does the poliovirus replicate?

in motor neurons (spinal cord and CNS)

Where is Clostridium tetani found?

in soil and animal feces

VAERS (Vaccine Adverse Event Reporting System) and Vaccine Safety Datalink Project

The Vaccine Safety Datalink project, linking the CDC with eight managed care organizations, allows monitoring regarding the adverse effects of vaccines. This data system contains data from 9 million people who did and did not get a vaccine, and did or did not experience adverse events. This system makes it possible to identify rare adverse events to vaccines. The Vaccine Safety Datalink project supplements the Vaccine Adverse Event Reporting System, which enables notification of serious vaccine adverse events from all providers. - Both systems are important for monitoring vaccine safety

Immunization Schedule

Vaccines should be administered at specific ages and intervals. The timing for the first vaccines is determined by the age at which transplacental immunity (passive immunity transferred from mother to infant) decreases or disappears, and when the immune system of the infant or child is developed enough to produce antibodies in response to the vaccine - If immunization status cannot be determined - consider susceptible and vaccinate - Lapse with immunizations does not interfere with immune response - unnecessary to repeat dose - half dose of any vaccine never acceptable

Hepatitis B vaccines

Virus is transmitted through an exchange of blood and body fluids. Contraindicated to persons who are allergic to baker's yeast. Screen all pregnant woman for HBsAg, implying protection from the virus when HBsAb is present. Booster doses of HBV is recommended in hemodialysis patients when anti-Hbs levels decline to less than 10 (annual testing). For persons who complete series but does not have post-vaccine testing, a single booster dose is given if exposed to nonoccupational known HbsAg-positive source. If exposed when not completing dose, HBIg should be given and complete the vaccine series. Unvaccinated persons should receive HBIg and vaccines ASAP after exposure, preferable within 24 hours. Should also test for HIV, hep A and hep C.

s/s of viral diarrha

Vomitting ( usually first symptom) 24 hours of a low grade temp watery diarrhea

There is increasing rate of which 2 menigococcal bacteria?

W-125 and Y

15-20% of pt who had HiB meningitis are left with what?

deafness

Smallpox vaccine:

"Variola" smallpox vaccine, made of live vaccinia cow-pox virus. NOT THE VARIOLA virus! -not pathogenic, but antigenic, giving cross immunity for variola.

Hepatitis B

* Hep B vaccine contraindicated in person with anaphylactic reaction to baker's yeast All women screen for HBsAg d/t infants infected perinatally have a 25% of carcinoma or cirrhosis. Regardless of HBV hx. 90-95% develop HBsAb (anti-HBs) after 3 doses, conferring protection. But those at high risk (HCW, IV drug users, dialysis/immunocompromised pts) should have HBsAb testing to confirm. HBIG administration after exposure, with repeat dose in 1 month is 75% effective in protecting after percutanous, sexual, mucosal exposure.

Influenza Treatment/Prevention

*Ok to give during pregnancy Amantadine/Rimantadine: 70-90% effective at preventing flu if taken during season. SE: nervousness, anxiety, lightheadedness, GI. No activity against influ B. Oseltamivir: prevent influ A/B for people who have come in contact with. SE: GI- take with food Zanamivir: treat influ A/B (with oseltamivir). Lessens by 1 day. Needs to be started within 48 hours. Inhaled. SE: bronchospasm, especially in asthma/COPD pts.

Needle size for SQ or intradermal injections

- 5/8 to 3/4 inch - 25 gauge

Active Prophylaxis (Vaccines)

- Active immunization involves administering a virus preparation that stimulates the body's immune system to produce its own specific immunity. Viral vaccines now available for use include the following types: (1) attenuated live viruses (2) killed viruses (inactivated) (3) recombinant produced antigens

Risks associated with Vaccination

- Allergy - Anaphylaxis - Guillain Barre Syndrome; peripheral neuropathy with an acute onset of rapidly developing symmetric motor weakness. Symptoms may initially present as pain, numbness, paresthesia, or weakness in all limbs. Weakness progresses bilaterally over days up to 4 weeks and can lead to respiratory distress and death if not diagnosed.

What does Quadracel contain? What is the dose/route?

- DTaP + IPV - 0.5ml IM

What does Pediacel contain? What is the dose/route?

- DTaP + IPV + HiB - 0.5ml IM

What does Infanrix contain? What is the dose/route?

- DTaP + IPV + HiB + HepB - 0.5ml IM

Administering vaccinations; General info

- Know route and dose of vaccine; check insert - Each vaccine; separate syringe and needle, Separate site for each injection - Give record to parent - Viral vaccines are kept inside refrigerator not on door (viruses are sensitive to heat) - Do NOT delay immunization for mild illness

What happens if a booster shot is given too late?

- Ok if only by a couple of months - If >1 year, then might have to restart series

What diseases can Streptococcus pneumoniae commonly cause?

- URTIs - childhood meningitis - pneumonia

Descrbe Guillain-Barre

- acute demyelination of peripheral nerves - immune mediated - progressive motor weakness, areflexia - progressess over 2-3 weeks

What are 2 benefits of Prevnar 13?

- decrease invasive pneumococcal disease by 80% - decrease recurrent otitis media by 23%

What are 3 other symptom/diseases can HiB commonly cause?

- epiglottitis - pneumonia - bacteremia

HPV vaccine is approved for use in what 2 groups?

- females 9-45 - males 9-25

Pertussis

-Aka whooping cough. -Very contagious. -Caused by Bordetella pertussis. -S/s: uncontrollable coughing, pneumonia, seizures.

DTsP Tdap dosing schedule:

-DTap: < years old. Give 1 time at each of the following ages (months): 2,4,6, 15-18 months, and 4-6 years old. -Tdap: one time booster dose of 0.5mL at ages 10-64. the booster brands are Boostrix or Adacel

Active Immunity

-Develops in response to infection or administration of a vaccine. -The result is the production of antibodies. -Takes weeks to months to develop and is long-lasting.

Protect against tetanus and diphtheria:

-Diphtheria and tetanus toxoids adsorbed (DT). -Tetanus and diphtheria toxoids adsorbed, adult (Td).

MMR: Measles, Mumps, & Rubella

-Given as a series of two doses at: 12 to 15 months and 4 to 6 years. -Given as a weakened live virus. -Life-long immunity. -Side effects: soreness at injection site, low-grade fever. -Watch for allergy to gelatin, neomycin.

Varicella (Chicken Pox) Vaccine

-Given between 1 to 12 years of age. -For adolescents or adults, it is two injections 4 to 8 weeks apart. -Made from a weakened virus. -Avoid aspirin or other salicylates for 6 weeks. -Watch for hypersensitivity to neomycin or gelatin.

Hepatitis A Vaccine

-Given in a series of 2 shots: at 12 months and then 6 to 12 months later. -Hepatis A can lead to a serious liver infection. -Contacted through: sex & contaminated water/food.

Passive Immunity

-Gives a pt. pre-formed antibodies. -Protects immediately, but only lasts as long as the antibodies remain in the body. -Specific immune globulins.

Hib Vaccine

-Haemophilus influenza type B. -Disease complications: Meningitis, sepsis, epiglottis, pneumoniae. -Side effects: Pain, soreness at injection site, fever.

Rotovirus

-Infects intestinal mucosa; is the most common diarrheal pathogen. -RotaTeq is a live oral virus. -Single 2 mL dose, times 3 doses.

Influenza Vaccine

-Is recommended for all children ages 6 to 23 months. Who gets it?: Children & adults with asthma, sickle cell, long-term heart, lung, or diabetes and members in the same household, adults over 50.

Target groups for meningococcal disease:

-Military basic training personnel. -college dormitories. -patients with asplenia (anatomic or functional) -Travelers to "Meningitis belt" of Africa or Saudi Arabia for Islamic Hajj pilgrimage. -Protection during outbreaks; work with health department

Pneumococcus Vaccine

-Pneumococcus bacterium causes infections like: pneumoniae, meningitis, and sepsis. -Vaccinate infants, children under 2, adults over 65, people with compromised immune systems. -Side affects: Fever in 21%, pain/swelling at site.

Human Papillomavirus (HPV)

-Protects against cervical cancer and genital warts. -Series of 3 shots: initial shot, one two months later, and the third six months after second. -recommended for girls between 9 to 26 years (mainly between 11 to 12 years.)

Immunizations

-Refers to the production of both active and passive immunity.

DTaP: Diptheria, Tetanus, & Pertussis

-Series of 5 shots: 2-months, 4-months, 6-months, 15 to 18 months, and 4 to 6 years. -Made from a toxin. -Side affects are rare: Soreness & pain at site, low grade fever, anaphylaxis reaction, encephalopathy. -A booster is required every 10 years.

Tetanus

-Toxin released by Clostridium tetani. -Bacteria lives in soil and enters the body via puncture. -S/s: muscle spasm, "lockjaw", can damage heart.

Diptheria

-Toxin released by corynebacterium diptheria. -S/s: SOB and difficulty salling; also effects the heart, kidney, & nervous systems.

Live ATTENUATED Vaccines

-cause loss of virulence, but the retention to replicate within host. -produces more consistent natural immunologica response. -Both cell mediated and humoral immunity. -Usually produce immunity with one dose EXCEPT ORALLY administered.

Inactivated Vaccines:

-generally can NOT replicate. -Generally not effective as live vaccines. -Less interfering from circulating antibody than live vaccines. -Generally require 3-5 doses. -Immune response mostly humoral. -Antibody titer may diminish with time.

See slide 80 referencing intervals between vaccines

...

Hepatitis B dosing schedule for adolescents:

0, 1, 6 motnhs.

Dose and route of Gardasil for boys and young men:

0.5 mL IM. 3 doses total. Give 1st dose. Give 2nd dose 1-2 months after 1st dose. Then give 3rd dose 6 months after first dose.

Dose and route of Varicella (Varivax) vaccine

0.5 mL SC

What is the dose/route for polysaccharide pneumococcal vaccine?

0.5ml IM or SC

Zostavax dose and rout of administration:

0.65mL SC

______ teens and adults are healthy carriers of meningococcus

1 in 5

What % of poliovirus infections have clinical symptoms?

1%

What are 5 signs/symptoms during the paroxysmal stage of pertussis? and why is is 'paroxysmal'?

1) Burst of coughs 2) Thick mucus 3) Long inspiratory effect (whoop) 4) Vomiting 5) Exhaustion (appears normal between attacks)

What are the 2 type of vaccines available for S. pneumoniae?

1) Conjugate (Prevnar 13) 2) Polysaccharide (Pneumovax23)

What 4 vaccines are given at 12 months of age?

1) Pneumococcal (PCV 13) 2) MMR 3) Men-C 4) Varicella

What 3 vaccines are required at age 4-6 years?

1) Quadracel (DTP + polio) 2) MMR 3) Varicella

What 3 vaccines are given orally?

1) Rotavirus 2) cholera 3) Typhoid

What are 2 sign/symptoms of diphtheria?

1) Severe pharyngitis (swollen tonsil can obstruct breathing in kids) 2) Cevical adenopathy (swelling of lymph nodes in neck)

What are 4 possible complications of chicken pox?

1) Shingles and post herpetic neuralgia 2) Pneumonitis 3) Encephalitis 4) Death

What 3 things make up the suspending fluid of vaccines?

1) Sterile water for injection 2) 0.9% NaCl 3) Complex tissue culture fluid (contains protein)

What 5 body parts does diphtheria affect?

1) Tonsils 2) Throat 3) Nose 4) Skin 5) Heart

What are 5 mild ADRs of vaccination?

1) fever 2) Malaise 3) Arthralgia 4) Chills 5) Local site tenderness

What are 3 sign/sx of chicken pox?

1) itchy rash, with up to 500 sores 2) fever 3) sore throat

Meningococcal Disease symptoms:

1) meningitis- pain, headache, neck, stiffness. 2) Bacteremia- sepsis and rash

What are 3 sequelae from measles?

1) pneumonia 2) encephalitis 3) subacute sclerosing panencephalitis

When should titres be taken for HepB?

1-2 months post last injection (to see if 4th dose is needed)

List some characteristics of Bactearia

1. Can live on their own 2. Can synthesize their own DNA and RNA 3. Prokaryotic 4. Needs host to grow and replicate 5. Have cell walls a. gram + thin cell wall b. gram - have thick cell wall

List some of the diagnostic features of Inattention in ADHD

1. Fails to give close attention to details, makes careless errors 2. Difficulty sustaining attention in work or play 3. Doesn't seem to listen 4. Cannot follow instructions, fails to complete work 5. Has difficulty organizing tasks and activities 6. Avoids tasks that require concentration (schoolwork) 7. loses things needed for tasks and activities (books, pencils) 8. Easily distracted by extraneous stimui 9. Forgetful in daily activities

What are some diagnosis criteria for Kawasaki's DX?

1. Fever for more than 5 days 2. bilateral, painless, non exudative conjunctivitis 3. Cervical lymphadenopathy 4. Polymorphus Exanthema 5. Extremity changes(redness and swelling of hands and feet). 6. Lips, tongue are red, chapped and swollen (strawberry tongue).

List some of the diagnostic features of Hyperactivity-Impulsivity in ADHD

1. Fidgets/squirms in seat 2. Leaves seat in classroom 3. Runs about or climbs wein inappropriate 4. difficulty playing quiet 5. Always on the go as if driven by a motor 6. Talks excessively 7. Blurts out answers before questions have been completed 8. has difficulty awaiting turn 9. Interrupts or intrudes on others

Types of Vaccinations (5 types)

1. Killed Virus Vaccine 2. Toxoid 3. Live virus vaccine 4. Recombinant vaccine 5. Conjugate vaccine

What are NOT causes of GERD in infants

1. Low pressures in the lower esophageal sphincter 2. developmental immaturity

What are the S/S of pyloric stenosis?

1. Non bilious projectile vomitting 2. ABD distention after feeding 3. "olive" type mass in upper quadrant on deep palpation 4. n/v wt loss and dehydration 5. prominent peristalsis waves from left to right may be seen.

Name some clinical s/s of Community acquired MRSA tissue infections.

1. Redness 2. Swelling 3. Warmth 4. Pain or tenderness 5. Complaint of "pimple" or "spider bite" that won't go away.

Give some Examples of Secondary Health promotion/prevention practices

1. Screening exams: colonoscopy, mammogram, Pap test, etc. 2. Screening for clinical conditions during an asymptomatic period such as Labs (lipid profile) or BP screen.

What are the immunizations for the adolescent child?

1. TDAP 2. Menectra (meningeococcal) 3. Gardisil (HPV)

Three reasons Infants susceptible to infection

1. The immune systems are not fully developed at birth 2. Passively acquired maternal antibodies provide limited protection 3. Disease protection through immunization is incomplete ( timing of immunization is tied to the responsiveness of the infant to specific vaccines and the waning protection from maternal antibodies

List some characteristics of E. Coli gastroenteritis or "traveler's diarrhea

1. Watery diarrhea initially followed by blood, mucous streaking or grossly bloodied stools 2. abd pain 3. may or may not have fever

List some Characteristics of Viruses

1. acellular 2. have either DNA or RNA not both 3. Have to rely on host for protein synthesis and regeneration 4. Inserts itself into host cell and injects genetic matearial.

list some characteristics of Scarlet fever

1. caused by the group B hemolytic Strep pyogene 2. Short incubation period 3. rash caused by endotoxins from Strep 4. usually occurs in kids over 3 years of age 4. spread via droplet transmission 5. DX with throat culture

Approx how many people die of chicken pox in Canada per year?

10

MCV dose and booster dose:

2 Dose: All adolescents 11-12 years old with MCV4 and booster at age 16 IM. Adolescents who receive first dose of MCV >16 years old do NOT need a booster dose. Routine vaccination after age 21 years not recommended. 2012 Update: First year college students up through age 21 years who are LIVING in residnece halls should be vaccinated if they have NOT received a dose on or after their 16th birthday.

Varicella (Varivax) schedule for susceptible adolescents and adults:

2 doses separated by at least 4 weeks.

How should the flu vaccine be give to kids <9 if first time receiving?

2 doses, 1 month apart

MMR

2 immunizations 1 mo apart for those born after 1957 (before that, consider immune d/t natural infection). Rubella causes mild 3-5 day illness but is devastating to fetus Measles: sequelae include encephalitis and pneumonia Mumps: sequelae include orchitis *Anaphylaxis to neomycin or gelatin should not receive! Ok to give with egg allergy.

what is the average age group effected by pyloric stenosis?

2 to 12 weeks of age

How many cases of meningococcal are there per year?

200-900

At least how many doses of HepB are required?

3

How many doses of eIPV required for 99-100% seroconversion?

3

How many serotypes of poliovirus are there?

3

Once reconstituted varicella vaccine is stable for ___________

30min

How many doses of eIPV required for lifelong immunity?

4

What is the mortality rate of diphtheria?

5-10%

What 2 HPV types cause genital warts, but low risk for cervical cancer?

6 & 11

What is the minimum duration of protection for varicella vaccine?

6 years (but 2nd dose now recommended)

HPV strains that cause warts

6, 11

How effective is the varicella vaccine in preventing chicken pox?

70-95%

What can occur if infected with rubella (togavirus) in the first 10 weeks of pregnancy?

85% risk of Congenital Rubella Syndrome - cataracts - deafness

How old must child be to receive MMR? Why?

>12 months - maternal antibodies neutralize vaccine, thus no effect

At what age is HiB revaccination not required? Why?

>59 months (5 years) - naturally immunity developed

How many serotypes are there of S. pneumoniae?

>90

Immune globulin

A concentrated solution of antibodies derived from pooled donated blood --> informed consent needed, not for Jehovah's witnesses

Vaccine

A product that produces immunity therefore protecting the body from diseases

MMR update; Mumps component:

A routine dose of MMR vaccine, administered a minimum of 28 days after the first dose, is recommended for adults who: -are students in postsecondary schools; -work in a healthcare facility; -or plan to travel internationally.

Toxoid

A toxin that has been treated (by heat or chemical, such as formaldehyde) to weaken its toxic effects but retain its antigenicity - Tetanus Toxoid

Conjugate Vaccine

A vaccine in which an alter organism is joined with another substance to increase the immune response - PCV13 (Pneumococcal Conjugate Vaccine) - Hib (Haemophilus influenzae type B)

Live Virus Vaccine

A vaccine that contains a microorganism in live but attenuated, or weakened, form; reduced virulence - OPV (Oral Polio Vaccine) - Var (Varicella Virus Vaccine) - MMR (Measles, Mumps, Rubella Vaccines) - LAIV (live attenuated for intranasal use Influenza vaccine - PRV, RV5 (Rotavirus Vaccine)

Inactivated Virus vaccine (Killed virus vaccine)

A vaccine that contains a microorganism that has been killed but i still capable to inducing the human body to produce antibodies; whole or partial subunits of virus or bacteria - IPV (Inactivated poliovirus vaccine) - Hep A (Hepatitis A) - Hep B (Hepatitis B) - DTaP, DTP, Tdap (Diphtheria Vaccine, Pertussis Vaccine, Tetanus Toxoid) - Hib (Haemophilus Influenzae Type B) - TIV (inactivated influenza vaccine) - MCV4 (Meningococcal Vaccine) - PPSV23 (Pneumococcal Polysaccharide vaccine

A patient has chosen to see a Family Nurse Practitioner (FNP) to assist with health promoting activities. Which of the following services provided by the FNP is the best example of a health promotion activity? a. Teaching about a low-fat diet for a patient with a blood pressure of 136/82 b. Prescribing a cholesterol-lowering medication c. Scheduling a cardiac stress test d. Prescribing an anticoagulant for a patient with atrial fibrillation

ANS: A A nurse practitioner is more likely to treat the patient from a holistic perspective and provide teaching to prevent illness or promote wellness. Although health promotion is a portion of the nurse's role, many other organizations and individuals provide primary health care. The FNP is a primary health care provider. Patients seek out FNPs and trust that their counsel will help keep them well. Writing prescriptions and scheduling stress tests are functions of an FNP and are also good health promoting activities but are not the best in terms of motivating lifestyle changes.

A nurse is developing a health promotion care plan for an otherwise healthy man who is married with four children and has a career as a public school teacher. Which of the following environmental factors could have a major effect on the patient's health promotion activities? a. Developmental b. Spiritual c. None of the above d. Both a and b

ANS: A Developmental factors describe positive or negative influences on health-seeking behaviors or compliance with a health promotion plan of care. Health promotion may be on the man's mind, but he may be caught up in self-imposed time constraints providing for his family and planning for retirement that may make it difficult to maintain a healthy lifestyle. The man may not perceive the task of self-health promotion as a priority. The spiritual environment includes a person's perception of help from a higher power and is not relevant in this scenario.

While obtaining a health history of a patient who has a large infected wound on the foot, the nurse learns that the patient has taken goldenseal to boost immune function rather than taking antibiotics for the infection. Which action by the nurse is initially most appropriate? a. Instruct the patient about the reasons for antibiotic use with infection. b. Ask the patient, "How do you feel about using both antibiotics and natural remedies?" c. Tell the patient that the doctor is likely to prescribe antibiotics. d. Tell the patient that studies of goldenseal show that it is not effective in treating infection.

ANS: B Further assessment of the patient's feelings about using Western and natural therapies is needed before further action should be taken. The patient may need instruction about antibiotics if further assessment indicates that the patient is receptive to antibiotic use. It is inappropriate for the nurse to tell the patient what another health care provider will do, and it is disrespectful to the patient's values system. Studies of goldenseal are unclear about benefit as an immune stimulant.

Which family would the nurse consider healthy? a. A family in which the parents do not allow their 10-year-old child to make basic decisions. b. A family that encourages independence while supporting each other. c. A family that does not require a specific curfew for their 16-year-old son. d. A family that does not allow their 15-year-old child to be an individual.

ANS: B Inductive reasoning explains how a family that encourages independence while supporting each other and is considered to have healthy family functioning In terms of health promotion, the nurse's role is working with people with generally good health but who are experiencing life or development changes. Health promotion efforts by nurses are educational efforts to help the individual remain an independent self-care agent

A patient has had no visitors for the 2 weeks he has been on your unit. The patient seems dejected and insists on having his few belongings in sight at all times. The nurse realizes that he may be experiencing what kind of need? a. Health-deviation need b. Developmental need c. Universal need d. Health continuum need

ANS: B Orem considers self-care as meeting one's own basic needs, including the self-care requisites of universal, developmental, and health-deviation needs. A developmental need, such as trust, love, and belonging, changes as a person moves through each life-cycle period. A health-deviation need is based on an individual's genetic or constitutional deviations from normal. A universal need is an essential requirement for everyone: food, shelter, air, water, and other basic needs. A health continuum need is not a true term

A nurse is caring for a non-English-speaking Asian patient whose cultural practices are not familiar to the nurse. The nurse is curious about practices regarding communication and eye contact. The nurse should: a. tell the patient that it is cultural practice in the United States to maintain good eye contact when communicating with someone. b. observe the behaviors and interactions between the patient and other members of the culture. c. avoid all eye contact unless the patient establishes eye contact. d. use eye contact and communication techniques that are most comfortable for the nurse.

ANS: B Telling the patient what U.S. practices are will not be helpful in assessing the patient's cultural values regarding eye contact. Avoiding eye contact may not be appropriate for interactions with some patients. The nurse should attempt to adapt communication to the patient's communication style.

A homeless patient with severe anorexia, fatigue, jaundice, and hepatomegaly is diagnosed with viral hepatitis and has just been admitted to the hospital. In planning care of the patient, the nurse assigns the highest priority to the patient outcome of: a. establishing a stable home environment. b. maintaining adequate nutrition. c. increasing activity level. d. identifying the source of exposure to hepatitis.

ANS: B The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration. Finding a home for the patient and identifying the source of the infection would be appropriate activities, but they do not have as high a priority as adequate nutrition. Although the patient's activity level will be gradually increased, rest is indicated during the acute phase of hepatitis.

To help prevent drug-drug interactions in an older adult patient taking many medications, the most appropriate instruction by the nurse is: a. "Do not take any over-the-counter (OTC) drugs with your prescription drugs." b. "Bring a list or all of your medications, supplements, and herbs that you use to every health care appointment and/or the hospital." c. "Be sure to have all your prescriptions filled at the same pharmacy." d. "Use a medication reminder system so that you won't forget to take your medications as scheduled."

ANS: B The information about drug use and possible interactions is obtained when the patient brings all prescribed medications, OTC medications, and supplements to every health care appointment. The patient should discuss the use of any OTC medications with the health care provider and obtain all prescribed medications from the same pharmacy, but these interventions alone will not prevent drug-drug interactions among prescribed drugs, OTC drugs, and any herbal supplements. Use of a medication reminder system will help the patient take medications as scheduled but will not prevent drug-drug interactions

A nurse recognizes that a homeless patient must walk great distances to obtain food. What kind of need does this patient demonstrate? a. Health-deviation need b. Developmental need c. Universal need d. Health continuum need

ANS: C A universal need is an essential requirement for everyone: food, shelter, air, water, and other basic needs. A developmental need, such as trust, love, and belonging, changes as a person moves through each life-cycle period. A health-deviation need is based on an individual's genetic or constitutional deviations from normal. A health continuum need is not a true term

Healthy People 2020 is a: a. new global action plan to prevent and treat disease. b. prevention agenda for the nation. c. national effort to improve lives of U.S. citizens. d. set of national health mandates.

ANS: C Healthy People 2020 is an example of a national effort to improve the lives and health of all Americans. For 30 years, the government has encouraged informed decisions about healthful living through collaboration across all communities of interest. Topical objectives can be found at www.healthypeople.gov. It is expected that through the help of governmental partners and their resources, states, cities, communities, and individual people will be able to achieve the objectives in each of the topic categories by 2020. The other answer choices are incorrect.

Several family members of a patient who has just been admitted to the intensive care unit (ICU) with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first? a. Take the family members to the patient's room. b. Discuss ICU visitation policies and encourage family visits. c. With the patient's approval, describe the patient's injuries and the care that is being provided. d. Invite the family to participate in a multidisciplinary care conference.

ANS: C Lack of information is a major source of anxiety for family members and should be addressed first. Family members should be prepared for the patient's appearance and the ICU environment before visiting the patient for the first time. ICU visiting should be individualized to each patient and family, rather than being dictated by rigid visitation policies. Inviting the family to participate in a multidisciplinary conference is appropriate but should not be the initial action by the nurse

A patient admitted with chest pain who is a one pack-a-day smoker tells the nurse, "I am just not ready to quit smoking yet." The most appropriate response by the nurse is: a. "This would be a really good time to quit." b. "Are you familiar with the nicotine patch?" c. "Your smoking is the cause of your chest pain." d. "What do you think keeps you from quitting?"

ANS: D Pender and Pender discuss the relationship of situational influences with regard to health promotion. The nurse's role is to assist the patient in identifying motivators to quitting. In addition, the nurse may also ask the patient about roadblocks to quitting. The responses about this being a good time to quit and naming smoking as the cause of the chest pain express judgmental feelings by the nurse and are not likely to motivate the patient. Suggesting the use of medication would be appropriate for the patient only if the patient expressed a desire to quit smoking.

The priority health promotion nursing diagnoses for an overweight, but not yet obese, patient who is learning about weight reduction may include: a. the potential for obesity. b. the potential for impaired mobility. c. alteration in nutrition. d. health-seeking behaviors or knowledge deficit.

ANS: D The priority of care for health promotion is to help a patient regain control over his or her health. The priority nursing diagnoses include health-seeking behaviors or knowledge deficit. The potential for obesity, the potential for impaired mobility, and alteration in nutrition do not address the health promotion intervention of teaching

Define Secondary Health Promotion/Prevention

Activities provided to identify and treat asymptomatic persons who have risk factors for a given disease.

Define Primary Health Promotion/Prevention

Activities provided to individuals to prevent the onset or acquisition of a given disease in order to spare individuals the suffering, burden, and cost.

Measles, Mumps, Rubella (MMR); Adverse effects

Adverse Effects: (due to measles component) Seen 7-10 days after vaccination - Fever and rash (common) - Seizure due to fever - Encephalopathy - Thrombocytopenia (due to measles and rubella component)

Pneumococcal vaccine

Against Gram + Strep. Pneumoniae. Medical indications: chronic lung, heart, liver, kidney diseases, sickle cells disease or splenectomy (if elective, vaccinate 2 weeks in advance), immunocompromised conditions-HIV, cochlear implants, and cerebrospinal fluids leak, nursing home residents, smokers, >65 older adults. One time re-vaccination after 5 years is recommended for persons with chronic renal failure, sickle cell or splenectomy, and immunocompromised. Revaccinate persons >65 years if the person was vaccinated 5 or more years previously and was younger than 65 at the time of primary vaccination.

Diptheria Tetanus (DT)

Age: Given to children less than 7 years of age if child had serious prior reaction OR if parent refuses pertussis component of DTP Route: IM Type: Inactivated For persons greater than 7 years of age: - Boosters recommended for children 11-12 years of age (if 5 years have elapsed since last dose of DTaP/DT) - DT booster every 10 years

What vaccines are given at 6 months of age?

All the same as in 4 months but not Rotavirus or Pneumococcal (Can just give Infanrix)

Anaphylaxis

An acute, life-threatening systemic reaction with varied mechanisms, clinical presentations, and severity that results from the sudden systemic release of mediators from mast cells and basophils. All vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis is available.

Menomune

Another polysaccharide meningococcal vaccineq

What else does Rotarix have in it? why?

Antacid - to prevent antigen inactivation in stomach

Inactivated vaccine is stimulated by:

Antigen load!!!! Can NOT replicate. Live attenuated vaccine must replicate to work.

Active Immunity

Antigens produce an immune response. Antibody is a protein molecule produced by lymphocytes to help eliminated and antigen. Active immunity is immunity generated by a natural immunologic response by the person's own immune system to an antigen. Usually caused by vaccines or toxoids.

What are the symptoms of hep b?

Asymptomatic or flu-like illnes

A disorder with developmentally inappropriate inattention, inpulsivity and distractibility with or without hyperactivity

Attention-Deficit/Hyperactivity Disorder

What 2 menigococcal bacteria cause most disease?

B and C

What is the cause of secondary respiratory infection/pulmonary congestion in Pertussis?

Bacteria produces toxins which paralyze respiratory cell cilia (which normally helps clear respiratory tract)

what Imagery testing should be done if you suspect pyloric stenosis?

Barium upper GI and ABD ultrasound

Polio

Before we had immunizations, 10,000 children paralyzed, 3,000 children died yearly

Rubella (German measles)

Before we had immunizations, 20,000 newborns with birth defects including developmental disability, blindness, hearing loss. Most teratogenic: congenital rubella syndrome.

Measles

Before we had immunizations, 4 million children infected, 3,000 died. If measles vaccine was discontinued, each year 2.7 million deaths worldwide will be expected.

Pertussis

Before we had immunizations, estimated at 150,000 cases per year in infants with thousands of deaths. Cause stridor, upper airway obstructions.

Cervarix

Bivalent HPV (type 16, 18)

What happens if a booster shot is given too early?

Body does not have enough time to recover to mount immune to the second shot

What was the problem with the first polio vaccine (Salk)?

Booster doses required to maintain immunity

Tdap Booster brands:

Boostrix and Adacel.

Bug that causes Pertussis (whooping cough)

Bordetella pertussis

What bacteria cause pertussis?

Bordetella pertussis

What other sign may be present with Mycoplasma Bronchitis?

Bullous Ear infection

PPD skin test and MMR vaccines

Can be given on the same day. If MMR is given on the previous day or earlier, the PPD TST should be delayed for at least one month

Which HPV vaccine is approved for prevention of cervical cancer in females?

Cervarix. It covers type 16 and 18 ONLY!

Varicella-zoster virus

Chickenpox. VZV virus lie domant in sensory nerve ganglia. Later reactivation causes shingles, about 15%. Persons without varicella immunity could contract chicken pox if comes in contact with shingles skin lesions. Shingles can't be transmitted from person to person. The second dose should be given 4-8 weeks after the first dose.

Varicella vaccine

Children > 13 and adults w/o hx varicella infection should receive 2 immunizations 4-8 wks apart. Varicell IG is a temporary, passive immunity from infection.

Target age groups for vaccination:

Children between 1-2 years old. Catch up by preschool if possible. For adolescents and adults if risk factors are present or for any person for whom immunity against hepatitis A is desired.

Age group for prevnar:

Children under 5 years old

What bacteria cause tetanus?

Clostridium tetani

Bug that causes tetanus:

Clostridium tetanus

Pediarix combo vaccine:

Combination of: DTap-HepB-IPV

Pentacel combo vaccine

Combination of: DTap-Hib-IPV (Hib is H.influenza B, IPV is Polio)

Which S. pneumoniae vaccine is effective for <2yo?

Conjugate (Prevnar13)

Which Meningococcal Vaccine is administered via IM?

Conjugate MCV4 0.5 mL IM

What is used as the antigen in HiB vaccine?

Conjugated PRP (polyribosylribital phosphate) - from organisms' capsule

Measles, Mumps, Rubella (MMR); Contraindications

Contraindications: - Anaphylactic reaction to prior dose or any vaccine component; eggs, neomycin, gelatin - Immunocompromised persons; HIV/AIDS, high dose or long term use to corticosteriods, and chemotherapy - If person received blood products within 3 - 11 months do not give MMR because possibility of no response - Can not be pregnant and must avoid becoming pregnant for 3 months

Diphtheria, Tetanus, Pertussis (DTP, DTap, Tdap); Contraindications, precautions, delay administration

Contraindications; - Precious encephalopathy within 7 days after DTaP - Progressive neurologic disorder (ex. epilepsy) Precautions; - Fever 40.5 C (105 F)or higher within 48 hours - COntinuous inconsolable crying lasing greater than 3 hours within 48 hours - Pale or limp episodes or collapse within 48 hours - Seizure within 3 days of dose Delay administration - Until moderate to severe febrile illness is resolved - Defer until a progressive neurologic problem is stable

Bug that causes Diphtheira:

Corynebacterium diphtheria.

What bacteria cause Diphtheria?

Corynebacterium diphtheriae

How can Bordetella pertussis be spread?

Cough and nasal droplets

What vaccine protects against pertussis? What dose/route is it given?

DTaP 0.5mL IM

Where should HepB vaccine be given? Why?

Deltoid muscle - immunogenicity lower in buttocks

Community (herd) immunity

Describes the state where a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not immunized (including newborns, other not vaccine not eligible and those who decline vaccines) are offered some protection because the disease has little opportunity to spread within the community

Secondary prevention

Detecting disease in early, asymptomatic or preclinical state to minimize the impac. Screening tests such as BP check, mammography, colonoscopy.

Tdap

Diphtheria (gram neg) spread by contaminated liquids (milk). Severe resp infection with psudomembranous pharyngitis Td booster (one replaced by Tdap) is recommended every 10 years. Use Td rather than tetanus toxoid to keep diphtheria immunity. Wound producing injury, tetanus IG offers temporary protection for people who have not received tetanus immunization.

Non human Immunoglobulin (antisera)

Diphtheria. Tetanus. Gas gangrene. Botulism. Rabies.

Hepatitis B vaccine dosing schedule for kidsk:

Dose 1- soon after birth. Dose 2- at age 1 or 2 months. Dose 3 No earlier than age 24 weeks.

What other possible physical findings would you expect to find if your Diagnosis is Atypical Pneumonia?

Ear and Eye Pain

Give some examples of Primary health promotion and prevention practices

Education, Diet, Immunizations, seat belts, helmet use,

Adjuvants:

Enhances immune response to vaccines or toxoids. A soluble Antigen may become particulate when combined with an adjuvant. They prolong the absorption/release, mobilize phagocytes at the site of antigen deposition.

What type of virus is the poliovirus? Where does it inhabit?

Enterovirus - inhabits GIT

Age group for pneumovax 23:

Everyone older than 65. 19-64 years old with chronic lung disease. 2-64 years old with chronic illness.

Polio viruses

Fecal-oral route. Live oral vaccines (OPV) isn't allowed in the US, only inactivated injection (IPV).

VFC (Vaccines for children program)

Federal program that provides free vaccines for qualified children and adolescents less than 19 years of age and has resolved some of the economic factors associated with vaccine coverage

Geriatrics safety concerns

Food poisoning (decreased sense of smell and taste)

Human papillomavirus Vaccine (HPV)

Gardasil, Cervarix Type: Recombinant Route: IM Ages Given: 11-26 years of age, female and male - three doses; administer the second dose 1 to 2 months after the first dose and the third dose 6 months after the first dose (at least 24 weeks after the first dose)

What is the HPV vaccines and what are their vaccine categories?

Gardasil- INACTIVATED, Quadrivalent vaccine Cervarix- INACTIVATED, BIvalent vaccine.

Which HPV vaccine covers CERVICAL cancer, VULVAR cancers, and GENITAL WARTS?

Gardasil. Gardasile is INactivated QUADrivalent Gardasil covers type 6,11, 16, 18

HPV Gardasil recommendation in young boys and young men:

Give in 3 dose series at 11 or 12 years old. Give at 13 and 21 if NOT previously vaccinated. Males 22-26 years of age may be vaccinated.

What occurs during the convalescent stage of pertussis?

Gradual recovery

Meningococcal Conjugate Vaccine and GBS:

Guillain-Barre syndrome (GBS). -A history or GBS had previously been a precaution for Menactra (MCV4) vaccine. -Findings from two studies that examined more than 2 million doses of Menactra given since 2005 showd NO EVIDENCE OF INCREASED RISK OF GBS! -ACIP voted in June 2010 to remove the precaution for use of Menactra in people with a history of GBS.

The portion of the influenza virus that sticks to the hosts cell membrane

HEMAGGLUTININ

HPV Vaccine Gardasil covers which types?

HPV 6,11,16, 18. Gardisil is Inactive, QUADrivlent vaccine

Human normal immunoglobulin:

Hepatitis A Measles Rabies Tetanus Mumps

Immunizations to avoid with Baker's yeast allergy

Hepatitis B

Hepatitis B Vaccine (Hep B)

Hepatitis B can cause liver damage (cirrhosis, liver cancer, and death. It is spread through contact with blood and body fluids of an infected person (during birth, sex, illegal drugs). Type: Inactivated Route: IM Ages Given: 3 doses required- there is variability of vaccine schedule when administering Hep B - birth-2m, 1 month and 6 months after initial vaccination - If mother is Hep B+ (HBsAg+ or unknown), give neonate Hep B vaccine within 12 hours of life and give HBIG (Hepatitis B Immune Globulin)

Human specific Immunoglobulin:

Hepatitis B. Varicella. Diphtheria.

Surface antigen recombinant vaccines:

Hepatitis V polypeptide vaccine was made by cloning hep B antigen gene in yeast cells. Hep B antigen produced, used for vaccine preparation. Efficacy and safety is high.

What disease of concern is caused by Haemophilus influezae, serotype B?

HiB Meningitis

Infections caused as a result of medical procedures which have a good potential to introduce microbes into patient tissues

IATROGENIC INFECTION

Immunizations to avoid with neomycin allergy

IPV, MMR, varicella

Immunizations to avoid with streptomycin, polymyxin B, neomycin

IPV, vaccinia (small pox)

Treatment of anaphylaxis in patient with currently patent airway

Immediate administration of epinephrine SQ or IM, antihistamine such as diphenhydramine (Benadryl) or H2 blockers, airway maintenance including supplemental O2, IV fluids, vasopressor therapy, corticosteroids. Repeat epinephrine q5 mins if symptoms persist or increase. Repeat antihistamine with H2 blocker such as ranitidine if symptoms persist. Anaphylaxis reactions often have a protracted or biphasic response. Provide instruction on avoidance of provoking agent. Give ephinephrine autiinjector (EpiPen) Rx with appropriate education about indications and safety of use (ask last time of use and where it is). Refer to allergists for life threatening allergies.

Passive immunity

Immunity conferred by an antibody produced in another host, acquired naturally by an infant from mother or artificially by administration of an antibody-containing preparation (antiserum or immune globulin IG)

Immunoprophylaxis

Immunoprophylaxis against viral illnesses includes the use of vaccines or antibody-containing preparations to provide immune protection against a specific disease.

What type of vaccine is the influenza vaccine?

Inactivated

Needle size for IM injections

Infant - 1 inch - 22-25 gauge needle Toddler and older children - 1 to 1 1/4 inch - 22 - 25 gauge need

Describe the differences in coverage between the 2 HPV vaccines:

Inform patient that the Quadrivalent vaccine (Gardasil) provides additional protection against genital warts.

If administering multiple vaccines at 1 visit, what should be done?

Inject same muscle but different sites

How would you treat Phase I GERD?

Intermittent mild lifestyle changes OTC meds.

What can occur if Rotarix is given to kids >6 months?

Intussusception - rare type of bowel obstruction - prolapse/telescoping

Give some Examples of Microcytic anemia

Iron deficiency anemia Thalsemia

Tetanus toxoid:

Is a toxoid. HCHO- inactivated toxin of Clostridium tetani. DPT- mixture with diphtheria toxoid + pertussis vaccine

Hepatitis A symptoms:

Jaundice Dark Urine N/V/D. Disease worse among adults than children

What are the target groups for varicella (Varivax) vaccination?

Kids 12-18 months old. 4-6 years old. All susceptible individuals older than 1 year old with no evidence of immunity.

Haemophilus influenza type B (Hib B)

Leading cause of meningitis, could affect 15,000 children, many with permanent disability before we had immunizations

Why are teenage girls more prone to HPV infection?

Lining of reproductive tract is still developing - easier to get HPV infection

Zostavax is what category vaccine:

Live attenuated vaccine

Varivax is what category of vaccine:

Live attenuated virus vaccine

What type of vaccines are given SC?

Live vaccines (eg. MMR, varicella)

Pneumococcal vaccine adverse reactions

Local reaction including pain, redness (30-50%), fever, myalgia (more so with Conjugates - Prevnar 13-valent: 11-40% in children, significant less in adults with adverse reaction profile similar to 23-valent polysaccharide vaccine, conjugates yields higher protection than polysaccharide), rare severe, potentially life-threatening reactions

Conjugate vaccines:

MCV4 Menactra Menveo (Novartis)

Immunizations to avoid with gelatin

MMR

Live, attenuated virus vaccine examples

MMR (measles, mumps, rubella), varicella (chickenpox), intranasal influenza virus vaccine (FluMist), Zoster (Zostavax), Rotavirus

What are 2 disease caused by the paramyxovirus?

Measles and Mumps

Give some examples of Tertiary Prevention/Promotion

Medications lifestyle modifications treatment aimed at improving or minimizing disease-related s/s

What meningococcal vaccine is for children >2y.o, teens and adults?

Menactra - N meningitidis A, C, Y and W-135 CONJUGATE vaccine

What meningoccocal vaccine is licensed for children =/>5 y.o and adults? What is the dose/route?

Mencevax AC - N meningitidis A, C, Y, and W-135 polysacchardie vaccine - 0.5ml SC

What additional vaccine is give at 2 months or age?

Meningococcal C

Meningitis Vaccine; MCV4 and MPSV4

Meningococcal Meningitis; MCV4 or MPSV4 Menactra-MCV4 (10 year efficacy) Type: Inactivated Route:MI Ages Given: 11-12 years, and second dose 5 years later - ACIP new commendation to give booster at 5 years or at College entrance Menomune-MPSV4 (5 years efficacy) Type: Inactivated Route: SQ Ages Given: 11-12 years, and second dose 5 years later - May be used at college entrance Also immunize high risk kids: asplenic , immune compromised

What is meningococcal vaccine for <2yo?

Menjugate: - meningococcus C conjugate vaccine

Tertiary prevention

Minimizing negative disease-induced outcomes. In established disease, adjusting therapy to avoid further target organ damage. Potentially viewed as a failure of primary prevention.

Give an example of a Bactearial Bronchitis

Mycoplasma Bronchitis

The toxin from C. diphtheriae can cause what 2 types of complications?

Myocardial and neurological

Diphtheria symptoms:

Myocarditis, neuritis, death

The enzymes in a virus that bore holes into the cell membrane of a host cell and allow Hemagglutnin to inject its protein inside.

NEURAMINIDASE

Bug that causes Meningococcal disease:

Neisseria meningitidis. Transmitted through respiratory droplets.

Adacel

New recommendation - Adacel; Tdap-adolescent preparation - Tetanus - Acellular Pertussis - Diphtheria Persons who should receive this; - Over 11 - 64 years of age - health care professionals - Replace one dose of DT as booster

FluMist contraindications

Not for people with airway disease or for people older than 49 years old

Oral Polio Vaccine (OPV)

OPV is no longer licensed for use in the US but may still be used in developing countries - Still given to large populations (mass vaccination) that require immediate response to vaccine to control outbreak - Optimal intestinal immunity - Do not give if cancer, immunodeficient, or someone in household has above - Given to unimmunized child traveling in less than 4 weeks to area where polio is endemic Dose at 2m, 4m, 6m, 4-6 year

Herpes Zoster (shingles) generally presents:

Often associated with advancing age or a weakened immune system. Appears as a localized rash; duration 3-5 weeks.

Vaccination

One of the most important primary prevention activities

Diphtheria

One the most common cause of death in school-aged children, killing 10,000 people annually before we had immunizations. Cause severe respiratory tract infection, including the appearance of pseudomembranous pharyngitis.

Active immunization

Onset of protection: usually within 1 month of dose. Duration of protection: usually years or lifelong. Given in anticipation of exposure to infecting agent.

Rotavirus vaccine

Oral vaccine only given to young infants. Contraindicated in infants diagnosed with severe combined immunodeficiency (SCID). Harmless virus shed from stool in first weeks post vaccine. Standard diaper hygiene and hand washing advisable. Ok for immunocompromised family members.

what are some common treatments for Scarlet Fever?

PCN Zithromax Clindamycin if recurrent

Passive Prophylaxis

Passive immunity is conferred by administering antibodies formed in another host. Human immunoglobulins remain a mainstay of passive prophylaxis (and occasionally therapy) for viral illnesses; they are usually used to protect individuals who have been exposed to a disease and cannot be protected by vaccination.

Give some examples of Macrocytic anemia

Pernicious (vit B12) anemia Folic Acid deficiency anemia

Re-vaccinateing the elderly >65 years old:

Persons who received PPSV (Pneumovax) 19-64 years old should receive another dose at 65 or older if at least 5 years have passed since their previous dose.

Polysacharride vaccine examples:

Pneumococcal. meningococcal. salmonella Typhi.

Complications of Pertussis (Whooping cough):

Pneumonia, seizures, encephalopathy, hypoxia, hospitalizations, death. Disease more severe among children < 5 years old

Pneumococcal polysacharide Vaccine 23-valent (PPSV)

Pneumovax 23

What disease does Poliovirus cause?

Poliomyelitis

Herpes Zoster can cause what kinds of complications?

Postherpatic neuralgia (PHN). This is extreme debilitating pain that can last for months. Can also cause scarring, bacterial infection, and ocular abnormalities.

Contraindications for live vaccines

Pregnancy (theoretical risks of passing virus to unborn child), Immunosuppressed individuals (with the exception of HIV patients), with HIV patients, live virus vaccines usually not given with CD4 T counts < 200.

Describe the PICR in Koch's postulates

Present in evey case of disease Isolated and grown in pure culture Causes disease when taken from pure culture & injected into host. Reisolated from host.

Primary prevention

Preventing the health problem, the most cost effective form of healthcare

Pneumococcal Conjugate Vaccine 13-valent:

Prevnar

Pneumovax coverage:

Protective against 85-90% of serotypes known to cause invasive disease. More efficacious against bacteremia than pneumonia.

Pneumococcal Vaccine

Protects agains s. pneumoniae Recommended for those > 65y or for insitiutionalized > 50, < 65 with CV or resp problems, DM or asplenic. Revaccinate 5 years after initial dose for everyone who was vaccinated before age 65, as well as those who are asplenic, immunosuppressed, organ transplants, CRF or nephrotic syndrome.

Gardasil

Quadrivalent human papillomavirus (type 6, 11, 16, 18). 3 doses series, can be given to males 9-26 to reduce the risks of genital warts.

Recommended gauge and needle for IM injection; Infants 1 to 12 months

Recommended Length of 22 -25 Gauge needles for IM immunizations and preferred injection site; Site: Anterolateral thigh IM needle size: 1 inch (25 mm)

Recommended gauge and needle for IM injection; Newborns and Preterm Infants

Recommended Length of 22 -25 Gauge needles for IM immunizations and preferred injection site; Site: Anterolateral thigh IM needle size: 5/8 inch (16mm)

Immunization principles

Remove geographic and clinical practice barriers whenever possible. When in doubt, re-immunize. Immunization deferred = immunization denied. Immunization should be deferred only in the presence of a serious or life-threatening illness.

What is the vaccine for rotavirus? What serotypes does it immunize against?

Rotarix - G1-4 and G9

Monitoring parameters and side effects of Gardasil:

SYNCOPE! May also exhibit tonic clonic(jerking) movements and seizure like activity. A person should remain seated or lying down and be closely observed by the provider for 15 minutes post vaccination. Can also cause Death, GUILLAIN-BARRE SYNDROME (GBS) and thrombolytic disorders. HOWEVER the CDC and the FDA has concluded that these potential adverse effects show no common pattern indicating that they are caused by the HPV vaccine. The continue to find the BENEFITS of the HPV vaccine outweigh the risks.

Hot water heaters temperature

Should not be set to no more than 120F (48.9C)

How should the influenza vaccine be give to kids <12yo? why?

Split virus vaccine - less reactogenic than whole virus vaccine

Although pertussis is not serious in adults and children, what can occur?

Spread to younger children

Conjugate Polysaccharide vaccine:

Stimulate T-cell dependent immunity; t helper cells. Produces immunological memory. Booster effect upon subsequent exposure. Increased immunogenicity in children under 2 years old

What adverse event can occur with the MMR vaccine?

Subclinical, noncommunicable infection - some children develop rash

Influenza Vaccine; TIV (Trivalent Inactivated Influenza vaccine)

TIV (Trivalent Inactivated Influenza vaccine) Type: Inactivated Route: IM (all ages) Ages Given: Annually beginning at 6 months of age; Vaccination recommended for: - Children as young as 6-23m - High risk children for Influenza: Asthma, Cardiac, diabetes, HIV, Sickle cell disease, immunocompromised - Healthcare workers

What is the recommended interval between a dose of Tdap and the last Td booster?

Tdap can be given if >5 years have passed since the last Td booster dose. -Intervals < 5 years may be used if protection against pertussis is necessary. -Then Td booster every 10 years

Booster dose:

Tdap one time dose <65 years old, then Td every 10 years.

Prevnar indications:

Teats prevention of invasive disease caused by 13 Steptococcus pneumoniae serotypes. Prevents otitis media cause by 7 Streptococcus pneumoniae serotypes.

Tdap

Tetanus, diphtheria, acellular pertussis (Adacel or Boostrix). Should replace a single dose of Td (tetanus, diphtheria) vaccine for most adults who have not previously received a dose of Tdap in order to provide additional protection against pertussis

Immunization or innoculation or vaccination

The process by which a person becomes protected against a disease via receiving a vaccine

Why does Tdap have a lower dose of Diphteria and acellular pertussis?

To avoid local reactions in adults.

What virus cause rubella?

Togavirus

How does tetanus work:

Toxin binds to CNS, prevents muscle relaxation.

Toxoid:

Toxoid is an Inactivated bacterial exotoxin! The retain the ability to stimulate the formation of antitoxin.

Passive Immunity:

Transfer of antibody produced by one human or animal to another; temporary. -Transplacental- important source of infancy. -Almost all blood or blood products. -Homologous pooled human antibody. -Homologous human hyperimmune globulin. -Heterologous hyperimmune serum (antitoxin).

Hepatitis A

Transmitted by fecal-contaminated drinking water and food, raw shellfish. Self-limiting. Does not contain live viruses, are given 2 times, 6-12 months apart for all children and high-risk groups.

Hepatitis A (Hep A)

Type: Inactivated Route: IM Ages given: 12-23 months or 2-18 years; first dose followed by second dose 6-12months later - Vaccinate children older than 1 year - 2 doses, 6 months apart - High risk groups; person traveling to endemic area

Immune Response to Vaccines

Vaccination evokes an antibody response and stimulates T lymphocytes. Vaccine effectiveness is assessed in terms of percentage of recipients protected and the duration and degree of protection. Most effective viral vaccines protect more than 90 percent of recipients and produce fairly durable immunity.

Immunizations to avoid with gelatin, neomycin

Varicella zoster

Varicella zoster virus vaccine is called:

Varivax.

What was the problem with the live attenuated oral polio vaccine (Sabin)?

Virus shed in stool for up to 6 weeks - people exposed to fecal matter of vaccinated infected with virus

What is Pertussis also called?

Whooping cough

Herpes Zoster (Shingles) Vaccine is called?

Zostavax

Recombinant Vaccine

a vaccine in which an organism has been genetically altered for use in vaccines; Genetically altered - Hep B (Hepatitis B) - Acellular pertussis vaccine; proteins from pertussis rather than the whole bacterial cell are used to stimulate the process of active immunity - HPV4 (Human Papillomavirus Vaccine Quadrivalent)

HIV patients should receive ____________________

all vaccines including live ones

When is the administration of the HPV vaccine reccommended?

before start of sexual acitivty

How is the poliovirus spread?

by feces and saliva

How are Corynebacterium diphtheriae spread?

by nasal droplets

Toxoid administration:

combined with Adjuvant. Adjuvant prolongs antigen absorption and exposure.

50% of patients with meningococcal septicemia _____ or have __________________

die; permanent damage

What polio vaccine is currently used today?

eIPV - enhanced potency Inactivated Polio Vaccine

Hepatitis A is transferred via:

fical oral route

What does the rotavirus cause?

gastroenteritis

BC provides free HPV vaccine for what groups?

girls in grade 6, and those born in 1994 or later

active Immunity

immunizations introduces an antigen into the body in the form of a vaccine causing the person to naturally produce antibodies and develop active immunity without becoming sick with the disease

What kind of vaccine in the HepB vaccine?

inactivated (eg. Recombinant Hep B surface antigen)

Varicella vaccine comes in what form?

lyophilized powder

What benefit is there if varicella does not prevent chicken pox?

milder disease

passive immunity

need to prevent the disease from occurring or to reduce its severity- does not give lasting immunity

What group is Menactra used for?

people at increased risk of meningoccal infection (only covered during outbreaks)

What are some "red flags" with sinusitis?

periorbital edema/ periorbital erythema 2. facial edema/ facial erythema 3. Stiff neck

In Menactra, what are polysaccharides linked to?

protein (diphtheria toxoid)

Woman has new sexual relations. Man has Hep B:

she should receive HBIG and hep B immunization series

Passive immunization

usually within hours of dose. Duration of protection: time limited, usually 6-9 months. Given post exposure to select infecting agent. IgG.

How is meningococcus spread?

via SALIVA - kissing, coughing, sneezing - sharing of cigarrets, lipsticks, drinks, toys, etc

How is HiB spread?

via nasal droplets

What type of microb cause hepatitis B?

virus

When is antiviral TX for influenza recomended?

whithin 48 hours of symptoms

What is the mortality rate of tetanus?

~10%

MMR 2012 Update Rubella component:

1) 0.5mL SC, doses within 4 weeks apart. 2) For women of childbearing age, regardless of birth year, rubella immunity should be determined: -if there is no evidence of immunity, women who are pregnant shoudl be vacciniated. -Pregnant women who do not have evidence of immunity should receive 1 dose of MMR vaccine upon completion or termination of pregnancy, and before discharge from the healthcare facility.

What 2 things vary depending on route of administration of vaccine?

1) Absorption rate 2) Processing of antigen

What are the treatments of mild ADRs from vaccines?

1) Acetaminophen 15mg/kg/dose PO q4-6H prn 2) Ibuprofen 10mg/kg/dose PO q6-8h prn

What are 7 factors that affect patient's response to vaccine?

1) Age 2) Immune status 3) Route and site of administration 4) Dose 5) Viability of antigen 6) Timing (when should booster be given) 7) Storage

What 2 things are used as adjuvants in vaccines?

1) Aluminum (less common now due to controversy regarding dementia) 2) Diptheria toxoid

What are 2 absolute contraindications to vaccines?

1) Anaphylactic allergies to any vaccine 2) Pregnancy

What are 4 serious ADRs from vaccines?

1) Anaphylaxis 2) Seizures 3) Encephalopathy 4) Guillain-Barre

What are the 5 constituents in vaccines?

1) Antigen 2) Suspending fluid 3) Stabilizers 4) Antibiotics 5) Adjuvants

What are 2 controversies regarding vaccines?

1) Autism due to Thiomerosal (antiseptic used in vaccines) and to MMR 2) Petussis vaccine cause ADRs

What are 3 complications from pertussis?

1) Bacteria pneumonia 2) Seizures 3) Encephalopathy

What are 6 risk factors for hep B?

1) Blood transfusion 2) Needle stick accidents 3) IV drug abuse 4) sexual contacts 5) Vertical transmission (mother to fetus) 6) Breastfeeding

What are the 3 stages of Pertussis, and how long does each last?

1) Catarrhal stage (1-2 weeks) 2) Paroxysmal stage (1-6 weeks) 3) Convalescent stage (2-3 weeks)

Which 6 vaccines are routinely given a 2 AND 4 months of age?

1) DTaP 2) Polio (part of Quadracel) 3) HiB (part of Pediacel) 4) Hep B (part of Infanrix) 5) Rotavirus 6) Pneumococcal (PCV 13)

What are 2 features of killed (inactivated) vaccines?

1) Decreased risk of infection 2) Boosters required to maintain adequate titres

What 3 diseases are vaccinated against in grade 9?

1) Diphtheria 2) Tetanus 3) Pertussis (DTaP)

What 5 diseases are immunized against at age 18 months?

1) Diptheria 2) Pertusis 3) Tetanus 4) Polio 5) Hib B (can just give Pediacel)

What are 4 sequelae of mumps?

1) Encephalitis 2) Orchitis or oophoritis (swelling of epididymus, fallopian tubes) 3) Infertiltiy 4) Deafness

What are 5 signs and symptoms of polio?

1) Fever 2) Headache 3) N&V 4) MUSCLE WEAKNESS 5) PARALYSIS

What are 6 signs/sx of rubella?

1) Fever 2) Headache 3) itchy eyes 4) Cervical adenopathy 5) Rash 6) Arthralgias, arthritis

What are 2 sign/symptoms of Mumps?

1) Fever 2) Parotitis (swelling of parotid glands)

What are 5 sign/Sx of measles?

1) Fever 2) Sore throat 3) Cough 4) Runny nose 5) Red rash

What 4 diseases are vaccinated against in Grade 6?

1) Hep B (if not given younger) 2) HPV (Gardisil) 3) Meningococcal C (Men-C) 4) Varicella (if not had before, or low titres)

What are 3 sequelae of hep B?

1) Hepatic failure 2) Liver cancer 3) Death

What are 2 purposes of having adjuvants in vaccines?

1) Increase immunogenicity or antigenicity 2) Prolongs antigen absorption

What are the 3 routes of vaccine administration? Which one is most common)?

1) Intramuscular (most common) 2) Subcutaneous 3) Oral

What are 3 features of live (attentuated) vaccines?

1) Long-term immunity 2) Induces immunological response 3) Organism can theoretically replicate -> very small risk of infection

What are 4 live attenuated vaccines?

1) MMR 2) Varicella 3) Rotavirus 4) Oral polio vaccine (Sabin)

What are 2 signs/symptoms of tetanus?

1) Painful muscular contractions 2) Convulsions

What are 4 symptoms during the catarrhal stage of pertussis?

1) runny nose 2) sneezing 3) low-grade fever 4) mild cough

What is the mortality rate of HiB meningitis?

5%

With treatment, what is the mortality rate of meningococcal infection?

5%

A patient is admitted to the hospital with a new diagnosis of diabetes mellitus type 1 and is scheduled for discharge on the second day after admission. In view of the patient's 2-day inpatient stay, the nurse should set realistic goals by planning to: a. teach the patient how to monitor glucose and self-administer insulin. b. include detailed information about diet and medication use in patient teaching. c. use every interaction to teach the patient about the details of glucose control. d. focus on teaching the family instead of the patient about diabetic management.

ANS: A When time is limited, the nurse should set realistic goals with the patient that will meet immediate needs. The patient and family will need further teaching about the role of diet, exercise, medications, and so forth, in controlling glucose, but these topics can be addressed through planning for appropriate referrals.

A home health nurse is going to visit a new patient for admission to the nurse's care. At the first meeting the nurse is able to meet the entire family. The nurse recognizes some unhealthy characteristics. Which statement made by the patient would lead the nurse to this conclusion? a. "We all have specific chores that we are responsible for on a daily basis." b. "We allow our 14-year-old to make all of her own decisions." c. "We like to go camping together as a family in the summertime." d. "Our children are actively involved in school-sponsored sports."

ANS: B Allowing a 14-year-old child to make her own decisions led to the nurse's conclusion that unhealthy characteristics existed within this family. The nurse should engage in health protective behaviors as well as health promotion behaviors. Health protective behaviors take a person away from a dangerous situation or from a dangerous habit. Health promotion behaviors move an individual to a higher level of health, greater vigor, or energy to do more than he or she is currently capable of doing. All the other statements imply a strong and healthy family unit.

Negative dietary influences on the health of Asian immigrants to the United States are most likely considered to be which type of environmental factor affecting health promotion? a. Spiritual b. Cultural c. Developmental d. Economic

ANS: B Cultural influences on health are most obviously observed in the form of dietary habits. For example, as a whole, Americans consume a higher degree of fat and empty calories in their diets than other cultures. The result is that a large percentage of the American population will develop negative health consequences, such as peripheral vascular disease, coronary artery disease, hypertension, obesity, and diabetes. Dietary habits have nothing to do with spiritual, developmental, and economic components of the environmental influences on health promotion.

Before discharging a patient with osteoarthritis (OA) of the left hip and lower lumbar vertebrae, the nurse teaches her about management of the condition. Which replies by the patient demonstrate proper understanding of how to manage her condition? (Select all that apply.) a. "I should try and stay active all the day to keep my joints from becoming stiff." b. "I can use a cane if I find it helpful in relieving the pressure on my back and hips." c. "A warm shower in the morning will help relieve the stiffness I have when I get up." d. "I should take no more than 1 gram of acetaminophen four times a day to control the pain." e. "Exercising daily on a stationary recumbent bicycle will lessen joint stress."

ANS: B, C, D Protection and avoidance of joint stressors are recommended for patients with OA, so this patient should use a cane to ambulate more comfortably, take warm showers to lessen joint stiffness, and should use nonsteroidal anti-inflammatory medication as directed. Staying active all day or exercising daily will likely exacerbate joint swelling and pain.

After the nurse implements diet instruction with a patient with heart disease, the patient can explain the information but fails to make the recommended dietary changes. The nurse's evaluation is that: a. learning did not occur because the patient's behavior did not change. b. the nursing responsibility for helping the patient make dietary changes has been fulfilled. c. choosing not to follow the diet is the behavior that resulted from the learning. d. the teaching methods were ineffective in helping the patient learn the dietary information.

ANS: C Orem assumes that the responsibility of primary health promotion lies with the individual. Although the patient's behavior has not changed, the patient's ability to explain the information indicates that learning has occurred and the patient is choosing at this time to continue with the previous diet. The patient may be contemplating or preparing to transition his behavior. The nurse should reinforce the need for change and continue to provide information and assistance with planning for change.

Clostridium tetani

Anaerobes, lives in soils, grows best without O2 --> higher risks with deep wounds. Decreased tetanus risks with superficial wounds. Primary series of 3 tetanus injections, a booster dose every 10 years. Using Td instead of tetanus toxoid for diphtheria. Single dose of Tdap during adulthood provides additional protection from pertussis, if unvaccinated, 2 of the 3 should be Td, and one Tdap. Early childhood vaccine has Tdap. Tetanus Ig provides temporary protection for unvaccinated persons.

What is the treatment for virus causing diarrhea?

Fluid and electrolyte replacement Supportive

What is the most frequent cause of intestinal obstruction in the first 2 years of life?

Intussusception

HPV vaccine schedule for women:

May be started as young as age 9 at discretion of provider or parent. Vaccination of females is available up to age 26.

Define Tertiary Prevention/Promotion

Measures that are part of the management of a person with an established disease to minimize disease associated complications.

Which Vaccine should Zostavax NOT be given with:

Pneumovax- Pneumococcal polysaccharide vaccine should not be given together. Clinical studies showed concomitantly reduced immunogenicity of the herpes zoster vaccine

Which Meningococcal Vaccine is administered via SC?

Polysaccharide MPSV 0.5 mL SC

meningococcal vaccine:

Polysaccharide MPSV 0.5mL SC Conjugate MCV4 0.5mL IM

Polysaccaride Vaccine

Polysaccharide is T-cell independent immunity. Stimulates B cells without assistance from helper T cells. Immunity is short lived. NO BOOSTER effect. Not consistently immunogenic in children less than 2 years old.

Symptoms of Tetanus:

Trismus-Lockjaw. Muscle rigidity and spasms. Death in 10% case fatality rate.

Pneumococcal Conjugate (PCV13)

Type: Conjugate vaccine Route: IM Ages Given: 2m, 4m, 6m, 12-15m; given at 24-59m if any dose is missing Pneumococcus; oval shaped encapsulated, non-spore forming gram positive organism that causes; - pneumonia - otitis media - meningitis Effective against Strep Pneumoniae; S. pneumoniae; - Pathogen that kills more than 1 million children world wide each year - Pneumococcal antibiotic response is increasing rapidly therefore it is better to prevent than treat

Inactivated Polio Vaccine (IPV)

Type: Inactivated Route: SQ or IM (depending on brand) Ages Given: 2m, 4m, 6-18m, 4-6 years of age- may give initial dose as early as 6 weeks of age - No documents cases of vaccine associated polio paralysis - Contraindicated if allergic to any component; may include neomycin, streptomycin, or polymixin B

Influenza Vaccine; LAIV (Live, Attenuated Influenza Vaccine)

Type: Live attenuated for intranasal use Route: intranasal (patients 2 years and older) - Recommended for ages 5-49 years - Healthy patient

Measles, Mumps, Rubella (MMR)

Type: Live, attenuated vaccine Route: SQ Ages Give: 12-15 m, 4-6 years of age (two doses) MMR may be combined with the Varicella vaccine (MMRV) - must be given on or after 1st birthday

Varicella Vaccine (Chicken pox)

Type: Live, attenuated vaccine Route: SQ Ages Given: 12-18m, 4-6 yr (two doses) Contraindications - Allergic reaction to varicella vaccine, neomycin, gelatin - Serious illness, immunocompromised: HIV/AIDS, high dose or long term use of corticosteroids, chemotherapy - If received Blood products within 3 to 11 months Can not be pregnant and must avoid becoming pregnant for 3 months

Rotavirus Vaccine; PRV, RV5

Type; Live Route: Oral Ages Given: 2m, 4m, 6m (3 doses) - do not start the series if the infant is 15 weeks of age or older Contraindications; - hypersensitivity/allergic reaction - Severe Combined Immunodeficiency Syndrome (SCID) - H/O intussusception Warnings: - no safety in immunocompromised patients; high doses corticosteroids, HIV/AIDS, blood products within 42 days

Vaccinations for diabetes patients 19-59

Unvaccinated adults with DM 1 and 2 should be vaccinated against hepatitis B as soon as possible after the diabetes diagnosis is made