immunization case week 3

Immunizations

Iriabel Nepravishta

IMMUNIZATIONS 6

Chamberlain College of Nursing

Case #1

You are rotating in the newborn nursery. Your next admission is a term newborn born at 3.5 kg, and all maternal labs are negative. The infant's exam is normal. What vaccine(s) should she receive and why? What would you do if the mother tested positive for Hepatitis B? What would you do if the mother's Hepatitis B status was unknown?

The first vaccine shot for the newborn is Hepatitis B (HepB). This should be within the first 12 hours after the infant has been born. This vaccination shot safeguards the newborn from getting the disease from individuals who do not yet know whether they are infected with Hepatitis B (Vaccines for Your Children, 2020).

If the mother tests positive for Hepatitis B, the newborn should be given additional medicine, i.e., Hepatitis B Immune Globin (HBIG). Hepatitis B Immune Globin will endow the newborn with increased immune to fight Hepatitis B virus (Vaccines for Your Children, 2020). Educate the mother on Hepatitis B information, e.g., mode of transmission, and breast feed the infant once they deliver.

If the mother’s Hepatitis B status is unknown, administer a HBsAg test. However, do not wait for the test results to give the newborn the Hepatitis B vaccine. Hepatitis B vaccine should be administered to the infant within 12 hours as you wait for the test results. Until the test result for the mother is known, she is considered to be HBsAg positive.

Case #2

Your first patient in the primary care clinic is a healthy 2-month-old. She received Hep B #1 in the nursery. She is a term infant and parents have no concerns. Her exam is normal and there are no contraindications to giving her vaccines. Which vaccines should the child receive at this visit? When should she return and which ones would you administer at the next visit? Which vaccination combinations can be used to minimize the number of needle injections, if available?

At two months, the child should receive the second dose of Hepatitis B, 1st dose of Diphtheria, tetanus, and whooping cough (DTaP), 1st dose of Haemophilus Influenzae type b disease (Hib) vaccine , 1st dose of polio (IPV) vaccine, 1st dose of Pneumococcal disease (PCV13) vaccine, and 1st dose of Rotavirus (RV) vaccine (Vaccines for Your Children 1-2 Months, 2020).

The baby should return for the next vaccinations at 4 months old. Vaccines at this visit include 2nd dose of Polio (IPV) vaccine, 2nd dose of Haemophilus influenzae type b disease (Hib) vaccine, 2nd dose of Pneumococcal disease (PCV13) vaccine, 2nd dose of Diphtheria, tetanus, and whooping cough (DTaP) vaccine, and 2nd dose of Rotavirus (RV) vaccine (Vaccines for Your Children 3-4 Months, 2020).

According to Healthcare Providers/Professionals Administer the Vaccine(s), (2020), possible combinations of vaccines include DTaP-IPV/Hib or DTaP-IPV-HepB. This will help reduce the number of injections during this vaccination visit.

Case #3

A healthy 5-year-old comes in with her mother for a well-child check in November. Her routine vaccines are up to date through 2 years old, but she has never received a vaccine for influenza. Her exam is normal. Which vaccines do you recommend at this visit? What anticipatory guidance should be given for a child receiving a flu vaccine at this age? Are there any contraindications for the vaccines that you recommended today?

At 5 years old the recommended vaccines include 5th dose of Diphtheria, tetanus, and whooping cough (DTaP) vaccine, 4th dose of Polio (IPV) vaccine, 2nd dose of Measles, mumps and rubella (MMR) vaccine, 2nd dose of Chickenpox vaccine, and 2 doses of Influenza vaccine. 2 doses are being administered because the 5-year-old had forgone previous influenza vaccinations. This will help provide the child with adequate protection from the flu. The two shots of influenza vaccine should be spaced at least 4 weeks apart (Influenza (Flu), 2020).

Anticipatory guidance for the 5-year-old receiving flu vaccination at this time should avoid hanging around people who are sick, if they get sick they should stay at home, avoid touching their mouth, nose, or eyes, parents should clean and disinfect surfaces around the home, cover their coughs when they feel like coughing, and wash their hands regularly (Influenza, 2020). There are no contraindications for the vaccines recommended today.

Case #4

An 11-year-old girl presents for a routine well-child check. Her immunizations are up to date. Her exam is normal and there are no contraindications to giving her vaccines. Which vaccine(s) do you recommend at this visit? The mother states that she only wants her daughter to have "the one required for school this year but not the others." How should the Nurse Practitioner counsel the mother and the patient? The mother is agreeable to proceed with vaccine administration today. Are additional doses needed? If yes, state which ones and when.

At 11 years old, the child should be given the recommended vaccine of 1 dose of Tetanus, diphtheria, and whooping cough (Tdap) (Vaccines for Your Children, 2020). The first dose out of 2-dose series for the human papillomavirus (HPV)vaccination, and annual IIV or LAIV and the first dose out of 2 dose series for the menningoccal ( MenACWY-D) vaccination.

The nurse practitioner should advise the mother that childhood vaccinations wear off and vaccinations at 11-12 years extend the child's protection into adolescence. The risk of exposure to diseases also increases as the young teenager grows. Hence, all vaccinations should be administered without compromise (Vaccines for Your Children, 2020).

Additional vaccination shots for the 11-year-old include 2 doses of HPV vaccine,

one dose Meningococcal disease (MenACWY) vaccine, Influenza vaccine (Vaccines for Your Children, 2020).

The first dose of tdap, fisrt dose of HPV, annual flu and first dose of meningococcal vaccination.

Then the answer B for case 4, vaccinations requirements are different based on location and to check with local health department (use cdc website)

And answer c is asking when the child should get their next vaccination:

If the mother is aggreable to to procedding with vaccine administration , I woukld recommend a second dose of the HPV vaccination within 6-12 months (CDC , 2020). I would educate the mother about the importance of receiving a flu vaccination every year. In addition, the child would need a second dose of the second dose series of the MenACWY-D vaccination at 16 years old .

The mother states that she only wants her daughter to have "the one required for school this year but not the others." How should the Nurse Practitioner counsel the mother and the patient?

According to cdc (2020) vaccinations requirement vary by location and I would recommend checking with their state health department or state immunization program for specific requirements. I would provide education that school vaccination requirements decreases the rates vaccine preventable disease (CDC 2020).

References

2020 Recommended Immunizations for Children from Birth Through 6 years old, (2020). U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf

Influenza, (2020). Health Habits to Help Prevent Flu. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/prevent/actions-prevent-flu.htm

Healthcare Providers/Professionals Administer the Vaccine(s), (2020). Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/admin/administer-vaccines.html#:~:text=Use%20combination%20vaccines%20(e.g.%2C%20DTaP,decrease%20the%20number%20of%20injections.

Influenza (Flu), (2020). Young Children. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/highrisk/children.htm

Procedures for HBsAg-Positive and Unknown Mothers and Newborns Non-Patient Specific Standing Order for the Hepatitis B Birth Dose https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_b/perinatal/docs/nps_standing_orders_pos_and_unk_moms.pdf

Vaccines for Your Children (2020). Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/parents/by-age/birth.html

Vaccines for Your Children 1-2 Months, (2020). Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/parents/by-age/months-1-html#:~:text=At%201%20to%202%20months%2C%20your%20baby%20should%20receive%20vaccines,Hib)%20(1st%20dose)

Vaccines for Your Children 3-4 Months (2020). Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/parents/by-age/months-4.html

Vaccines for Your Children (2020). Vaccines at 11 to 12 Years. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/parents/by-age/years-11-12.html#:~:text=At%2011%2D12%20years%20old,(Tdap)%20(one%20dose)