Exam 3: Immunizations and Infectious Diseases Flashcards
Active Immunity
Stimulates the immune system and gives long-lasting immunity
~Can be from actually getting the disease (natural infection) or from getting vaccinated
Passive Immunity
Protection transferred from another human or animal that is temporary and wanes with time
~When you get antibodies from the disease, rather than producing them in the body
~Immune Globulin
Live Vaccines: Precautions and Contraindications (4)
- Altered immune system (immunocompromised)
- Recent steroid use
- Recent acquisition of passive immunity
- Blood transfusion
- Immunoglobulin
- Admin of MMR and Varicella should be postponed for a minimum of 3 months after passive immunity***** - Can give 2 live vaccines on the same day, but can’t give them one day after the other –> MUST HAVE 28 DAYS BETWEEN DOSES ***
Recombinant Vaccines
Are produced by genetic engineering
- HPV
- Hepatitis B (should be given w/i 2 weeks of birth)
Herd Immunity
If 80-90% of people in the community are vaccinated, it reduces the spread of contagious diseases
*Leaning towards 90% nowadays since fewer people are getting vaccines and it has increased the amount of communicable diseases
Vaccine Administration (4)
- Rotate vaccines in stock so that the oldest vaccines are used first, and never use a vaccine past the expiration date
- Administer vaccines w/i the prescribed time periods following reconstitution
- Wait to draw vaccines into syringe until immediately prior to admin (at bedside)
- Never mix vaccines in the same syringe unless FDA approves it
Vaccine Administration Documentation (6)
Document:
- Lot number
- Expiration date
- Who gave it
- When it was given
- Injection site
- Patient’s record
Pain control during vaccine administration
- EMLA cream
- Age appropriate distractions
For infants:
- They can breastfeed while getting the vaccine or use pacifier
- Give sugar water
Vaccine information statements
- Must give VISs (CDC informative packets) to parents BEFORE vaccination is given
- Must obtain informed consent separately
Vaccine Adverse Event Reporting System (VAERS)
A national vaccine safety surveillance program, which requires healthcare providers to report selected events occurring after vaccination such as symptoms
Most common age and season for Pertussis
Age: Under age 4 with no hx of vaccination
Season: spring and summer
Pertussis Priority
AIRWAY
Equipment to have at bedside: suction, airway materials, and know where intubation materials are kept
*Bacteria attach to the cilia of the epithelial cells and produce toxins that paralyze the cilia and cause inflammation to the respiratory tract which interferes with the clearing of pulmonary secretions
Pertussis Source and Transmission (3)
- Discharge from respiratory tract of the infected person
- Direct contact or droplet
- Indirect contact with freshly contaminated articles
Pertussis Incubation and Communicability
6-20 days, but usually 7-10 days
Communicability is greatest during the first phase (catarrhal stage)
Pertussis Catarrhal Stage Clinical Manifestations (3)
- URI symptoms
- Low grade fever
- Hacking cough which worsens
Pertussis Paroxysmal Stage Clinical Manifestations (5)
–Occurs with they develop the “whoop” at the end of the cough
- Short, rapid cough followed by short respirations and a high-pitched “whoop”
- Redness
- Post-tussis emesis
- Runny nose
- Cough can last 4-6 weeks
Pertussis Convalescent Stage Clinical Manifestations (3)
- Lasts 2-3 weeks
- Susceptible to other respiratory infections
- cough will wean, but there can still be episodes
Pertussis Dx (2)
- Nasopharyngeal swab or aspiration
2. Culture and polymerase chain reaction (PCR)
Pertussis Therapeutic Management: Antibiotics
- Erythromycin
- Clarithromycin
- Azithromycin
*Antibiotics are used to control symptoms
Pertussis Therapeutic Management: Supprotive
CPAP (continous positive air pressure)
Pertussis Complications (6)
- Pneumonia
- Hemorrhage
- Rib fractures
- Hernias
- Prolapsed rectum
- Weight loss
Pertussis Prevention
- DTap
- Tdap
* Immunity of pertussis weans over time
Contraindications and Precautions for Immunization with DTaP (5)
- Moderate to severe illness
- Life threatening allergic or previous reaction to a dose of DTaP
- Brain or nervous system disease w/i 7 days after receiving DTaP
- Cried for more than 3 hours after previous shot
- Temp > 105
When should expectant mothers receive Tdap during pregnancy?
Between 27 through 36 weeks
Varicella Source and Transmission
VARICELLA= CHICKEN POX
Source: to a lesser degree skin lesions (scabs are not infected)
Transmission:
- Primary secretions of respiratory tract of infected person
- Direct contact, droplet spread and contaminated objects
- People with breakthrough varicella after vaccination are contagious
- Adult that has shingles can give a child chicken pox
Varicella Incubation and Communicability
Incubation: usually 14-16 days but has a range of 10-20 days
Communicability: during prodromal phase, which is 1-2 days before eruption of lesions and until lesions have crusted over
*People with breakthrough varicella after vaccination are contagious
Varicella Clinical Manifestations: Prodromal stage (4)
- Low grade fever
- Malaise
- Anorexia
- Pruritic rash
Varicella Prodromal Stage Rash
- Begins as macules, rapdily progresses to papules, and then breaks and crusts over
Papule –> vesicle –> crust - Distribution is centripetal: STARTS ON ABDOMEN, then progresses to face and proximal extremities
Varicella Constitutional Stage Signs and Symptoms (3)
- Elevated temperature
- Can get lymphadenopathy
- Irritability
Breakthrough varicella (with 4 signs and symptoms)
Defined as infection with wild-type varicella disease occurring >42 days after vaccination
- Usually has milder clinical presentation than varicella in unvaccinated patients
1. Usually low or no fever
2. Develop
Varicella Dx
Physical assessment is main diagnosis, PCR may confirm it but is not necessary
Varicella Therapeutic Management (3)
- Acyclovir (anti-viral)
- Varicella-zoster immune globulin (VariZIG) for immunocompromised patients only
- AVOID USE OF ASPIRIN
Varicella-zoster immune globulin (VariZIG)
For immunocompromised patients who don’t have a history of the disease but have been exposed and have a risk of developing complications as a result
- Will not eliminate chance of getting varicella, but will decrease the symptoms
- An intravenous immunoglobulin
Varicella Complications (5)
- Rye Syndrome
- Dehydration (b/c lesions could be on mucous membranes and cause decreased drinking)
- Abscesses
- Cellulitis
- Pneumonia
Varicella Prevention
Vaccination, 2 doses
Varicella Vaccination Contraindications and Precautions (7)
- Life threatening allergic reaction to the vaccine
- Previous dose of varicella vaccine
- Contains gelatin and neomycin, so if someone has an allergy to those then consider it before giving
- Moderate or severe illness at the time of admin
- Pregnant women
- *Wait until after birth
- *Can get it 1 month before getting pregnant
- HIV/AIDS, Cancer, steroids, radiation, recent blood transfusion consult provider
- Varicella is a live vaccine, so must wait 28 days before giving it if you gave a live vaccine the day before
Fifth Disease Erythema Infectiosum
Mild rash illness that can increase the incidence of hydrops fetalis in fetus and potentially miscarriage
- Cause by parvovirus B19
- CAUTION IN PREGNANCY!
Parvovirus Source and Transmission
- Infected person
- Respiratory secretions
- Blood and blood products
Parvovirus Incubation and Communicability
Incubation: 4-14 days, but can be as long as 21 days
Communicability: unknown
Parvovirus Clinical Manifestions
- First symptoms are URI
2. Rash appears in 3 stages
Parvovirus Rash Stage I (4)
- Slapped cheeks (bright ride), which disappear in 1-4 days
- Mild fever
- Runny nose
- Headache
Parvovirus Rash Stage II
1 day after slapped cheeks, patient will develop maculopapular rash on extremities
Symmetrically distributed rash, progresses from proximal to distal
Parvovirus Rash Stage III (2)
- Rash subsides
2. Joint pain in hands and feet (Polyantropathy syndrome)
Parvovirus Therapeutic Management (5)
- Geared towards treating the symptoms
- Antipyretics
- Analgesics
- Anti-inflammatory drugs
- Possible blood transfusion for aplastic anemia
~Aplastic anemia: cessation of RBC production
Measles source of Transmission (5)
- Resp tract secretions
- Blood
- Urine
- Direct contact with droplets of infected person
* Droplet isolation - Primarily in the winter
*Can remain in the air for up to 2 hours after the infected person leaves the areas
Measles Incubation and communicability
Incubation: 7-21 days
Communicability: From 4 days before and 5 days after the rash appears
*Mainly during prodromal stages
Measles and Pregnancy
CAUTION DURING PREGNANCY
Can lead to miscarriage, prematurity, low birth weight
Measles Prodromal (Catarrhal) Signs and Symptoms (7)
- Fever
- Malaise
Followed in 24 hour..
- Coryza (cold symptoms)
- Cough
- Conjunctivitis
- KOPLICK SPOTS
- symptoms increase in severity until 2nd day after rash
Measles 3 C’s
- Coryza (cold symptoms)
- Cough
- Conjunctivitis
Measles Koplik Spots
Small, irregular red spots with a minute-bluish with center first seen on the buccal mucosa opposite morals 2 days before the rash
Once rash appears, koplik spots subside
Measles rash
- Appears 3-4 days after onset of prodromal stage
- Erythematous maculopapular eruption on face
- Spreads downward
- After 3-4 days red or red-brown appearance
Measles Constitutional Signs and Symptoms (4)
- Anorexia
- Abd pain
- Malaise
- General lymphadenopathy
Measles Nursing Care (6)
- Maintain isolation until 5th day of rash
- N95 respirator
- Comfort measures to relieve symptoms
- Antipyretics
- Eye care
* Because conjunctivitis is a risk factor
* Clean eye from in to out - Skin Care
* Tepid baths, keep skin clean
Measles Complications (5)
- Otitis Media (most common under 5 years old and above 20 years old)
- Pneumonia (often the cause of death in young children)
- Diarrhea (most common under 5 years old and above 20 years old)
- Obstructive laryngitis and laryngotracheitis
- Encephalitis (rare, but high mortality)
Measles Prevention
MMR or MMRV
*MMRV contains varicella, not used as often because it may cause seizures
Contraindications and Precautions of MMR Vaccine (5)
- Life threatening previous dose or reaction to neomycin or other component of MMR
- Illness at the time of scheduled vaccine
- Pregnancy
* Avoid pregnancy for 4 weeks after admin of vaccine - HIV/AIDS, cancer, blood disorders, blood transfusion, another vaccine within 4 weeks should consult with provider before getting vaccine
* *Because it’s a live vaccine - Discuss risks and benefits with immunocompromised patients
Mono (EBV) Source and Transmission
Direct contact with oral secretions, blood transfusions, or transplantation
Mono (EBV) Incubation and Communicability
Incubation: 30-50 days
Communicability: unknown due to general symptoms
EBV Clinical Manifestations (10)
- Symptoms appear 10 days to 6 weeks after exposure***
- Generalized complaint of fatigue***
- Malaise
- Sore Throat
- Fever
- General lymphadenopathy
- Difficulty maintaining level of activity***
- Spleenomegaly***
- Limit contact activity for up to 6 weeks or until spleen is normal size - Hepatomegaly and jaundice***
- Skin rash
* Recovery shorter in younger people
EBV and Beta-lactam antibiotics
EBV may present as strep, and if prescribed beta-lactam antibiotics, an EBV patient will develop a rash 7-10 days after taking the medication
EBV Prevention
Limit contact with infected body fluid
Bacterial Meningitis (with 5 pathogens)
An acute inflammation of the of the meninges and CSF
Pathogens:
1. Haemophilus influenza type B
- Streptococcus pneumoniae (pneumococcus)
- Streptococcus group B
- Neisseria meningitides
* *Leading cause in ages 10-19 - Listeria
Bacterial Meningitis Risk Factors (4)
- Age (Infants/elderly)
- Community setting
- Certain medical conditions
- Travel
Bacterial Meningitis Source and Transmission
Droplet infection with nasopharyngeal secretions
*Symptoms usually occur 3-7 days after exposure
Bacterial Meningitis Clinical Manifestions: Infant
- Fever or hypothermia
- Poor feeding, vomiting
- Marked irritability
* *High pitched cry (neuro cry)
* *Not consolable - Restlessness
- Seizures
- Bulging or tense fontanel
- High pitched cry
Bacterial Meningitis Clinical Manifestions: Children and Adolescents (7)
- Sudden onset of fever, headache, and nuchal rigidity
* Nuchal rigidity= stiff neck
* How to assess nuchal rigidity: ask them to touch chin to chest - Nausea
- Vomiting
- Photophobia
* Hallmark
* Ask patient to look into the light and they won’t do it (too afraid) - Alerted mental status
- Positive Kerning and Brudzinski sign
- Petechial or purpuric rashes (meningoccal infection)
Positive Kernings
Stiffness in hamstrings and inability to straighten leg when hip is flexed at a 90 degree angle
Brudzinski
Neck stiffness - if patient is lying flat, and you bend the neck, it will force them to bend knees as well
Bacterial Meningitis Dx
- Blood
- CSF
*The sooner you dx, the sooner you treat = the better prognosis
Bacterial Meningitis Therapeutic Management (8)
- Isolation precautions and notify anyone that was exposed so they can start prophylactic antibiotics
- Initiation of antimicrobial therapy
* Antibiotics can work for some strains - Hydration
- Ventilation
- Reduction of ICP
- Management of systemic shock
- Control of seizures, temperature and pain/comfort
- Keep room dark due to photophobia
Bacterial Meningitis Prevention: Meningococcus (2)
- Meningococcal polysaccharide vaccine (MPSV4)
* *The only one licensed for older than 55 years old - Meningococcal conjugate vaccine (MCV4)
* Routine one
Bacteria that can cause Meningitis (3)
- Nesisseria meningitidis (meningococcus)
- Streptococcus pneumoniae (pneumococcus)
- Haemophilus influenza type b (Hib)
Considerations and Precautions for Miningococcus Vaccine
- Severe life threatening allergic reaction to previous dose
- Moderate or severe illness
- Can be given to pregnant women
- Can be given at the same time as other vaccines
* *Except children with sickle cell disease or without a working spleen
Bacterial Meningitis Prevention: Pneumococcus (2)
- Pneumoccal conjugate vaccine (PCV13)
* The routine vaccine - Pneumococcal polysaccharide vaccine (PPSV)
* For children older than 24 months with chronic lung disease, cardiac disease, or sickle cell, and for adults over 65 years old
–Can be given at the same time as other vaccines
Bacterial Meningitis Prevention: Hib Contraindications (3)
- Life threatening reaction to previous dose
2. Children
Bacterial Meningitis Prevention: Hib Mild Reactions (2)
- Redness, warmth, or swelling at injection site (1 out of 4)
- Fever of over 101 (1 out of 20)
*These are not an indication to not get the subsequent doses
Hepatitis B Vaccine
- Hep B can lead to cirrhosis or liver cancer
- Newborns should receive first dose before leaving hospital
- Anyone through 18 yrs of age who was not vaccinated should be
Hepatitis B Vaccine Contraindications and Precautions (4)
- Life-threating allergy to yeast or other component of vaccine
- Previous reaction to Hep B
- Moderate to severe illness
- Many will be asked to wait 28 days before donating blood after getting hep B vaccine
* means it’s a live vaccine
Rotavirus
Diarrhea, vomiting, fever –> can lead to dehydration
Rotavirus Vaccine
1st dose can be given as early as 6 weeks of age and should be given by 14 weeks 6 days.
**If you don’t get the patient during this time period, then they can’t be vaccinated
The last dose should be given by 8 moths of age
Contraindications and Precautions of Rotavirus Vaccine
- Life-threatening allergic reaction to previous dose or latex
- SCID severe combined immunodeficiency
- Moderate or severe illness
- HIV/AIDS, Cancer or other weakened immune system causes
- Studies have shown a small increase in cases of intussusception**
*intussuscpetion: telescoping of the intestines
SandS → gelly-like stool and waxing and weaning pain
*Usually would occur 1 week after first dose
**Tell parents to report s/s abd pain, bloody stool, weakness and irritability
HPV Vaccine Info (5)
- Can be given to both males and females
- Recommended ages: 11-12 and as early as 9
- Females can have it as late as 26
- May be given to men 22-26 years old who have not completed the 3 doses
* Recommended for males through age 26 who have sex with men or have a weakened immune system - HPV can be given at the same time as other vaccines
HPV Vaccine Contraindications (4)
- Life-threatening allergic reaction to previous dose or component of HPV yeast
- Pregnancy
- Moderate to severe illness
- Brief fainting spells and jerking movements after vaccination has been reported
Intradermal flu vaccine
Approved for ages 6 months and older
- The high dose vaccine
- Inactivated vaccine
Nasal-spray flu vaccine
LAIV
Live, weakened flu virus
Who should not be vaccinated against the seasonal flu? (4)
- People with severe allergy to chicken eggs
- Severe reaction to influenza in the past
- Children younger than 6 months of age
- Moderate to severe illness with fever should wait to get vaccinated until their symptoms lessen
Contraindications of LAIV (7)
- Persons who have experienced severe allergic reactions to LAIV, to any of its components, or to a previous dose of any other influenza vaccine
- Children 2 through 17 years receiving aspirin or aspirin-containing products
- Persons who are allergic to eggs
- Pregnant women
- Immunosuppressed persons;
- Children 2 through 4 years of age with asthma or who had wheezing in the past 12 months
- Persons who have taken influenza antiviral medications in the previous 48 hours
