Advanced Health Assessment Nur 773 Lehman college fall 2021 PEDIATRIC IMMUNIZATION CASE 1. Identify the route of administration, dose, and the number of doses for the following immunizations scheduled for children. ANSWER 1 TABLE 1: IMMUNIZATION ROUTE OF ADMINISTRATION Time Schedule of Doses Intramuscular (IM) Hep B NUMBER OF DOSES 3 0, 1-2, 6-18 months Monovalent HepB vaccine should be used for doses given before age 6 weeks Per orem (PO) Rotavirus (RV) Rotarix: 2 and 4 months. RotaTeq: 2, 4, and 6 months. Rotarix: 2 RotaTeq: 3 Diphtheria, Tetanus, Pertussis, (DPT) Intramuscular (IM) 2, 4, 6, and 15-18 months, and 4-6 years. 5 Intramuscular (IM) Haemophilus Influenzae B (HIB) ActHIB, Hiberix, or Pentacel: 2, 4, 6, and 1215 months. ActHIB, Hiberix, or Pentacel: 4 PedvaxHIB: 2, 4, and 12-15 months. PedvaxHIB: 3 Pneumococcal Conjugate (PCV13) Intramuscular (IM) 2, 4, 6, and 12-15 months. 4 Inactivated Polio (IPV) Intramuscular (IM) 2, 4, 6-18 months, and 4-6 years. Administer 4 the final dose on or after the 4th birthday and at least 6 months after the previous dose. Measles, Mumps, and Rubella (MMR) Subcutaneous (SC) Varicella (VAR) Subcutaneous (SC) 2 12-15 months and 4-6 years. ● The 2nd dose may be given as early as 4 weeks after the 1st dose. 12-15 months and 4-6 years. 2 Influenza Intramuscular (IM) ● Administer an age-appropriate formulation and dose of influenza vaccine annually. ● Children 6 months-8 years who did not receive at least 2 doses of influenza vaccine before July 1, 2017, should receive 2 doses separated by at least 4 weeks. ● Persons 9 years and older 1 dose Annually ANSWER 2 1. How many SQ or IM injections are due today? What are strategies for administration today? ● ● ● ● IM (HIB, PCV, Hepatitis B) IPV (can be given via IM or SQ) Use combination vaccines (e.g., DTaP-IPV-HepB or DTaP-IPV/Hib) to reduce the number of injections, when appropriate. o If you will follow this then DTaP-IPV/Hib, Pneumococcal Conjugate (PCV13) and Hepatitis B - 3 IM injections are due today. Strategies for administration start first with the review of the immunization history of the patient. Next would be to assess the needed immunizations and screen for contraindications and precautions. 2. What anticipatory guidance should be provided to the parent(s) and /or caretaker(s) regarding post-immunization care? ● Some side effects are normal such as pain on the injection site, fever, and chills. ● ● ● If you think your child is having a fever, confirm it with the use of an electronic thermometer. If it is positive. then give your child plenty of water to drink, dress your child lightly and provide antipyretics. After vaccination, children may be fussy because of pain or fever. If you are worried at all about how your child looks or feels, call your healthcare provider. 3. How many doses over time are required for each immunization she receives today, and what age are the additional doses recommended for each? ● ● ● ● Rotavirus (RV)- Oral o RV1 (2-dose series) 2nd dose at 4 months DTaP-IPV/Hib -3 doses and 1 booster o Next doses at 4 months and 6 months, booster at 15 months PCV- 3 doses and 1 booster o Next doses at 4 months and 6 months, booster at 12 to 15 months Hep B- 3 doses, the booster may be given based on titers o 3rd dose at 6 months to 15 months. 4. At what age is it recommended for A.Z. to get the measles, mumps, and rubella (MMR) vaccine? Should she receive additional doses of this vaccine? If so, at what age is this recommended? ● ● Measles, mumps, and rubella (MMR) vaccine at 12 to 15 months. Yes, an additional dose of this vaccine is usually given at 4 to 6 years old. 5. At what age is it recommended for A.Z. to receive the Varicella (VAR) vaccine? Should she receive additional doses of this vaccine? If so, at what age is it recommended.? ● ● Varicella (VAR) vaccine is recommended at 12 to 15 months. Yes, an additional dose of this vaccine is usually given at 4 to 6 years old. REFERENCES: ● ● ● ● ● ● Bate's Guide to Physical Examination and History Taking 12th ed. Brunner & Suddarth Textbook of Medical-Surgical Nursing 14th ed. Fauci, J., et.al. (2018). Harrison's Principles of Internal Medicine. 20th ed. McGrawHill Education https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combinedschedule.pdf https://www.immunize.org/catg.d/p4015.pdf https://www.cdc.gov/vaccines/hcp/admin/administer-vaccines.html
