Childhood Immunizations Flashcards
Vaccination
the administration of a small amount of antigen, which is capable of stimulating an immune response but does not typically produce the disease.
traditional vaccines
inactivated (killed) microorganism
Attenuated vaccine
live, weakened (attenuated) microorganism
Toxoids
inactivated toxins stimulate formation of antitoxins that produce active immunity (tetanus toxoid)
Conjugated vaccines (newer):
require a protein or toxoid to link with disease-causing microorganism (H. influenza type B)
recombinant subunit vaccines
insertion of genetic material (DNA) of pathogen into another cell where the antigen is produced in massive quantities (HepB)
Infant primary schedule: immunization requirements
Diphtheria, Tetanus, acellular Pertussis (DTaP)
Poliovirus
Measles, Mumps, and Rubella (MMR)
Haemophilus influenza type b (Hib)
Hepatitis A virus (HAV)
Hepatitis B virus (HBV)
Pneumococcal Conjugate Vaccine (PCV)
Influenza
Varicella-zoster virus (VZV; Chickenpox).
early childhood immunizations requirements
Primary schedule is completed; with the exception of boosters
where can nurses obtain recommendations for immunization requirement schedules
Advisory Committee on Immunizations Practices (ACIP) of the Centers for Disease Control and Prevention (CDC)
uCommittee on Infectious Diseases of the American Academy of Pediatrics (AAP)
reason for Hepatitis A Virus (HepA) immunization
Daycare - diaper changes - handwashing
Children in close proximity
(Fecal-oral route, Person-to-person contact, Ingested contaminated food or water)
dosage for Hepatitis A Virus (HepA)
Two doses: 1 year old and 6 months after first dose
significance of Hepatitis B Virus (HBV)
HBV during childhood and adolescence can lead to fatality from cirrhosis of liver cancer in adulthood
newborn Hepatitis B Virus (HBV) administration
administer before discharge
dosage for Hepatitis B Virus (HBV)
Three additional doses (after newborn dose): 1, 2, and 6 months of age
Hepatitis B Virus (HBV) is safe to administer with what other immunizations
Safe to administer at a SEPARATE SITES with DTaP, MMR, and Hib vaccines
IM sites for newborns
Vastas lateralis
IM sites for toddlers and children
deltoid
Diphtheria vaccine - does not produce absolute immunity, so booster is needed…
every 10 years
Tetanus vaccine provides
antitoxin levels for about 10 years
tetanus vaccine booster is needed
every 10 years
dosage for Diphtheria, Tetanus, and Pertussis (DTaP)
Four doses: 2, 4, and 6 months of age, and fourth dose on or after four years old
Inactivated Poliovirus (IPV) significance
Exclusive use of IPV due to rare risk of vaccine-associated polio paralysis (VAPP) from oral polio vaccine (OPV)
dosage for Inactivated Poliovirus (IPV)
2 months, 4 months, 6 to 18 months, and 4 to 6 years of age
PEDIARIX
combination vaccine containing DTaP, Hep B, and IPV
Measles, Mumps, and Rubella (MMR) significance
due to recurrence of measles in older children and young adults, susceptible individuals should be immunized if 2 doses not administered previously
dosage for Measles, Mumps, and Rubella (MMR)
Two doses: 12 to 15 months of age and 4 to 6 years of age (school entry)
MMR and Varicella and ProQuad are given
sub-Q
Measles, mumps, rubella, and varicella (MMRV)
ProQuad - attenuated live virus vaccine should not be administered to children with immune deficiencies and pregnant females
ProQuad label states:
STORE FROZEN and indicates specific temperatures for the storage. This is due to the Varicella.
what develops 2-3 days after symptoms begin with Measles
Koplik spots
Pneumococcal Conjugate Vaccine (PCV 13) significance
Streptococcal pneumococci (bacterial infection) younger than 2 years who attend day care and are immuno-compromised (septicemia, meningitis, otitis media, sinusitis, pneumonia)
dosage for Pneumococcal Conjugate Vaccine (PCV 13)
2, 4, and 6 months, and 12 to 15 months of age
Haemophilus influenzae Type B (Hib) Significance
protect against serious infections (Bacterial Meningitis, Epiglottitis, Bacterial pneumonia, Septic arthritis, Sepsis)
dosage for Haemophilus influenzae Type B (Hib)
2, 4, 6, and 12 to 15 months of age
administration for Haemophilus influenzae Type B (Hib)
Administered by IM injection using separate syringe and a site separate from any concurrent vaccinations.
dosage for varicella
two doses: 12 to 15 months and 4 to 6 years of age
Varicella administration
sub-Q
Children who do contract varicella after getting the varicella immunization…
have less vesicles, lower fever, and faster recovery
antibodies for varicellla persist for
at least 8 years
varicella can be given simultaneously with…
DTaP, IPV, HepB, or Hib vaccine
if varicella is NOT given with MMR, how long must you wait between vaccines
1 month
Influenza significance
especially to children with asthma, cardiac disease, HIV, diabetes, sickle cell disease that place them at risk for influenza-related complications
when is the influenza vaccine recommended
annually (usually in the Fall) starting at 6 months of age
dosage for first time recipients of influenza vaccine
2 separate doses 4 weeks apart
what allergy assessment must be done before the influenza vaccine
egg allergies
influenza vaccine can be given at the same time as other vaccinations if…
Use separate syringe
Use separate injection site
Meningococcal Infections vaccine significance
highest fatalities occur in adolescents and college freshmen living in residence halls; morbidities include limb or digit amputation, skin scarring, hearing loss and neurologic disability
dosage for Meningococcal vaccine
Two doses: first at 11 to 12 years of age with second at 16 to 18 years of age
Rotavirus significance
Acute gastroenteritis; contagious and may be particularly severe in infants and young children
How are the rotavirus vaccines administered
administered orally, by putting drops in the infant’s mouth. Each requires multiple doses:
-RotaTeq® (RV5) is given in three doses at 2 months, 4 months, and 6 months of age.
-Rotarix® (RV1) is given in two doses at 2 months and 4 months of age.
Human Papillomavirus (HPV) significance
Sexually transmitted and seen as cervical, vaginal, anal, and oropharyngeal cancers and genital warts
when does the HPV administration begin
Beginning at 11 or 12 years old (can start as early as age 9)
Number of doses dependent on age at initial vaccination: Age 9-14 years at initiation: for HPV
2-dose series at 0 and 6-12 months.
Number of doses dependent on age at initial vaccination: Age 15+ years at initiation: for HPV
3 doses at 0, 1-2 months, and 6 month
reactions that can occur with vaccination within a few hours to days
-Local tenderness
-Erythema
-Swelling at the injection site - cold compress; administer acetaminophen
-Low grade fever - administer acetaminophen
-Behavioral changes: drowsiness, eating less, prolonged or unusual cry
general contraindication for all immunizations is
a severe febrile illness (Minor illness such as common cold is not a contraindication)
Live virus vaccines such as Varicella and MMR should not be administered to child who is…
severely immunocompromised
patient education when child is getting a vaccine
Teach parent about administering acetaminophen 45 minutes before the immunizations
Application of EMLA cream to the injection site before administration is…
ordered by HCP
needle length for anterolateral thigh with infants
5/8 inch, 22-25G
needle length for toddlers
5/8 - 1 inch, 22-25G
needle length for older children (3-18y)
< 60 kg: 5/8 to 1 inch, 22–25G in the deltoid
> 60 kg: 1 to 1½ inch, 22–25G in the deltoid
When multiple injections to be given, two may be given into the thigh at least ____ apart
2.5 cm (1 inch
what site of injection should be avoided at all times for pediatric patients
dorsogluteal (because possibility of damaging sciatic nerve)
site of injection for infants (not walking)
anterolateral thigh
site of injection for children older than 1 year
deltoid
Ventrogluteal site can be used for
any age
nursing interventions for varicella vaccine
-Strictly adhere to vaccine storage requirements
-Upon reconstitution, administer within time limits stated in package insert
-Administer at separate sites
-Do not mix vaccines in the same syringe
-Document completely
-Observe for adverse reactions
-Keep epinephrine available for use in the case of anaphylactic reaction
-Provide patient with record of immunizations received
patient teaching for varicella vaccine
-Discuss vaccine-preventable diseases
-Answer questions clearly
-Advise females to avoid pregnancy for 1 month
-Avoid contact with immunocompromised persons
-Provide VIS before administering the vaccine
-Patient or patient’s family to maintain vaccine record
-Provide return date for next immunizations
-Advise to contact health care provider if signs of reaction occur
Birth vaccines
Hep B
4 mo vaccines
“DR HIP”
DTaP
RV
Hib
IPV
PCV
2 mo vaccines
“B DR HIP”
Hep B
DTaP
RV
Hib
IPV
PCV
6 mo. vaccines
“B DR HIP”
Hep B
DTaP
RV
Hib
IPV
PCV
& annual flu
toddler vaccines 6-18 mo.
“IM HPV”
IVP (if not already given at 6 mo)
MMR
Hib
PCV
Varicella
12 - 23 months vaccines
Hep A (2 dose 6 mo, apart)
15-18 mo vaccines
DTaP
4-6 y/o vaccine
“DIM”
DTap
IPV
MMR
11-12 y/o vaccine
Tdap HPV Meningitis
16-18 y/o vaccine
meningitis booster
