Immunizations/Infectious Diseases Flashcards
1
Q
Vaccines stimulate
A
immune system to produce antigens
- same antigens as disease (killed or weakened)
2
Q
What happens to the antibodies after destroying the antigens of the vaccine?
A
memory cells formed
3
Q
Who decides what vaccines are needed?
A
CDC - pink book
American Academy of Pedi - red book
4
Q
What are the best ways to prevent infectious diseases?
A
immunizations
handwashing
isolations (reduce cross-transmissions)
infection control
sneeze and cough etiquette
5
Q
What is the best way to prevent complications of individuals at high risk? (steroids, immunodeficiency, hemolytic disease -sickle cell)
A
vaccinate
6
Q
Why should a society vaccinate?
A
decrease/eliminate the infectious disease
7
Q
Herd Immunity
A
85% majority with vaccine
8
Q
If not enough people are vaccinated, what could potentially happen?
A
reemergence
example) measles, mumps, polio
9
Q
Active Immunity
A
endogenous production of antibodies
long-lasting
months to develop
10
Q
Natural Active Immunity
A
survive infection
11
Q
Acquired Active Immunity
A
vaccination
12
Q
Passive immunity
A
antibodies given to a person
immediate and short-lived
13
Q
What is the most common passive immunity?
A
last 1-2 months of pregnancy mother passes gamma globulin to the baby and lasts up to a year
14
Q
Antibody sources
A
blood products
immune globulins (diff. people in one)
hyperimmune globulins (specific antibody)
Antitoxins (horses)
15
Q
What is a complication of antitoxin?
A
serum sickness from horses
16
Q
Live Attenuated Vaccines
A
a weakened form of live
same as the infection itself
must replicate (can get the disease)
17
Q
Live attenuated vaccines have how many doses?
A
1-2
18
Q
Live attenuated vaccine effectiveness issues
A
circulating antibody (blood transfusion)
damage to organ (extreme temps and sunlight)
19
Q
What vaccines are live attenuated?
A
MMR
Varicella
Rotavirus
Intranasal Influenza
20
Q
How many doses do inactivated vaccines have to gain immunity?
A
2-3
21
Q
Inactivated Vaccines are produced in
A
culture media
22
Q
Inactivated Vaccines replication
A
cannot replicate ( does not cause disease)
23
Q
Inactivated Vaccines is less affected by
A
circulating antibodies
24
Q
Antibody titer
A
antibody levels in the blood
25
Which vaccine is most likely needed for a "booster"?
inactivated vaccine
26
Inactivated Vaccines types
Polio,
Hepatitis A and B
Rabies,
Influenza,
Acellular pertussis,
Human papillomavirus,
Diphtheria,
Tetanus,
Pneumococcal,
Meningococcal
27
Haemophilus influenzae type b (Hib)
BEFORE INTRODUCTION OF THE VACCINE
the leading cause of bacterial meningitis
invasive bacterial disease among children younger than 5 years
epiglottis
28
The Hib vaccine prevents against
epiglottitis
29
Haemophilus influenzae type b (Hib) has how many doses?
multiple no number
99% decrease with vaccine
30
Vaccine Factor for failure
**Age/maternal antibody**
Dose
Route
Storage and handling – lose potency or contaminated
Nutritional status – malnutrition low
Coexisting disease
Genetics
31
What is prepared for administering vaccines?
Immunization **history** every visit
Recommended **schedule**
Screening
Discuss benefits/risks - **VIS**
After-care instructions
Appropriate **doses of ibuprofen and tylenol**
32
National Childhood Vaccine Injury Act of 1986 (NCVIA)
includes
Injury compensation
adverse event reporting (DATE GIVEN and EDITION)
- any effect even if unsure it caused the event
VIS
33
Nursing Considerations for Vaccines
accurate user friendly
parent concern (empathy and participate with them)
avoid judgment
**Give VIS before vaccination and answer questions**
Tylenol and EMLA to minimize adverse effects
**respect ultimate wishes**
flexibility for different vaccines
34
Documentation for Vaccinations
Date
Manufacturer
Lot #
Who administered the vaccine with the address
VIS received date and edition
Route, Dose, Site
Informed Consent or Refusal
35
If vaccines are given too close together, what increases
adverse effects, spacing is important
36
Timing of antibody-containing blood products (Ig) should be scheduled appropriately for what vaccines?
live
37
Screening helps
identify contraindications and precautions
increases the risk of adverse effects
38
Live doses of vaccines should only be given after
1 year (MMR, Varicella)
39
Hib Vaccine
contraindications
severe allergic reaction after a previous dose or to a vaccine component
**less than 6 weeks**
40
Hib Vaccines allergic reaction to what
dry natural latex
41
Hib Vaccine
Precautions
moderate to severe acute illness with or without fever
42
MMR vaccine
contraindications
severe allergic reaction to the previous dose
**severe immunodeficiency (chemo, sickle cell, HIV infection, immunocompromised)
pregnancy**
43
MMR vaccine
precautions
**recent (<11 months) receipt of antibody-containing blood product**
moderate to severe acute illness with/without fever
44
Rotavirus
contraindications
severe allergic reaction after the previous dose
**severe combined immunodeficiency
Hx of intussusception**
45
Rotavirus
precautions
moderate to severe acute illness with or without fever
- chronic GI disease
46
Varicella
contraindications
Severe allergic reaction after previous doses
**severe immunodeficiency and pregnancy**
47
When a contraindication is present in vaccines, a vaccine should ________ administered
NOT be administered
48
When a vaccine precaution is present, vaccinations should generally be
deferred but if the risks outweigh the benefits
49
Varicella
precautions
recent (<11 months) receipt of antibody-containing blood product
moderate to severe acute illness with or without fever
50
Live attenuated Vaccine vs. inactivated Vaccine
Is it contraindicated, vaccinated, or precautioned for an Allergy to vaccine or component?
contraindicated; contraindicated
51
Live attenuated Vaccine vs. inactivated Vaccine
Is it contraindicated, vaccinated, or precautioned for an encephalopathy?
Not known in live; contraindicated in inactivated
52
Live attenuated Vaccine vs. inactivated Vaccine
Is it contraindicated, vaccinated, or precautioned for pregnancy?
Live= contraindicated
Inactived = Vaccinate (some exceptions)
53
Live attenuated Vaccine vs. inactivated Vaccine
Is it contraindicated, vaccinated, or precautioned for immunosuppression?
Live= contraindicated
Inactived = Vaccinate (some exceptions)
54
Live attenuated Vaccine vs. inactivated Vaccine
Is it contraindicated, vaccinated, or precautioned for moderate to severe illness?
precaution on both
55
Live attenuated Vaccine vs. inactivated Vaccine
Is it contraindicated, vaccinated, or precautioned for recent blood products?
Live: precaution till after 3-4 months
Inactivated = vaccinate
56
Invalid "contraindications" for vaccines
Mild illness
Antimicrobial/antibiotics therapy
Pregnant or immunosuppressed person in the household
Breastfeeding except small-pox
Preterm birth once to 2 kg
Allergy to products not in vaccine
Multiple vaccines
57
Local Adverse Events
Mild/self-limited
Pain/swelling/redness at the injection site
Within hours of injection
58
Local adverse reactions are common with
inactivated vaccines
59
Systemic reactions to vaccine
Fever/malaise/headache/myalgia/loss of appetite
Reactions following live vaccines may be similar to mild form of disease
60
Systemic reactions can occur how many days after administration
7-21
61
Which adverse reactions can be life-threatening?
allergic (anaphalaxis)
s/s and preparations are needed
62
How long should you observe the patient after vaccination for allergic reactions?
15 minutes
63
What s/s should be watched out for after vaccinations?
Respiratory distress, wheezing, shock like, hives, swelling in mouth and throat
64
What treatment is needed for allergic reactions?
IM Epipen
65
What vaccines are given SubQ?
MMR
Varicella
-live-
66
What vaccines could be IM or SubQ?
IPV (Inactivated Polio Vaccine)
PCV (Pneumococcal Vaccine)
MCV (Meningococcal Vaccine)
67
What vaccines are given IM?
DTaP/Tdap (Diphtheria, Tetanus, Acellular Pertussis)
Hepatitis A
Hepatitis B
Hib (Haemophilus Influenzae type B)
HPV (Human Papillomavirus)
68
Do you aspirate on a vaccine?
not required
- experience less pain when given rapidly without aspiration
69
Why are vaccines not given IVP?
veins and arteries are too small
70
If a child has a bleeding disorder, what could happen during the IM injection and how can it be prevented?
hematoma; 23 g or finer and firm pressure for 2 minutes (NO RUBBING)
71
Hemophilia needs what after receiving a vaccine IM.
factor replacement on last dose
recent the better
72
Atraumatic Care during vaccinations
Distraction (developmentally appropriate)
Parent cuddling/holding, pacifiers
Sweet-tasting solutions (oral sucrose)
Breastfeeding
Injection technique
Order of injections – painful last
Tactile stimulation (rub/stroke near injection site; buzzy)
Topical anesthetic
73
Macule
flat discoloration of the skin
74
Papule
solid raised lesion of the skin
75
Vesicular
small fluid-filled sac
76
Pertussis means
whooping cough
77
Pertussis transmission
Respiratory secretions (direct/indirect)
Most contagious during catarrhal stage (before harsh coughing)
78
S/S of Pertussis
- Catarrhal stage
Respiratory symptoms –
Mild occasional cough
Low-grade fever
Lasts 1-2 weeks
79
The pertussis catarrhal stage lasts how long
1-2 weeks
80
S/S of Pertussis
- Paroxysmal stage
Bursts of numerous, rapid coughs
**Sudden inspiration creates high pitched “whoop”**
Might not occur in younger babies
Cheeks become **flushed or cyanotic**
Eyes may bulge/tongue protrude
May continue **until thick mucous plug dislodged**
Vomiting
**Exhaustion**
More common at **night**
81
What are the stages of pertussis?
catarrhal
paroxysmal
convalescent
82
How long does the paroxysmal stage last in pertussis?
4-6 weeks
83
S/S of Pertussis
- Convalescent stage
Coughing gradually stops
Single cough may continue
Paroxysmal cough may return it cold or respiratory illness occurs
84
How long does the convalescent stage last
2-3 weeks
85
Complications of pertussis
Pneumonia
Apnea - give O2
Neurological - seizures
Pressure effects of paroxysms
86
Complications of pertussis in adolescents
Syncope, sleep disturbances, rib fractures, incontinence
87
Interventions for Pertussis
Continuous assessment of respiratory status
**Remain with child during coughing spells**
Ensure **adequate oxygenation - blowby**
**Suction** prn
Reduce factors that promote cough–**calmness**
Small, frequent meals (maybe NG Tube)
**Refeed a few minutes for recovery after emesis**
**Droplet precautions
5-7 days after antibiotics start**
88
What isolation do pertussis need to have and for how long?
Droplet
5-7 days after antibiotics start
89
Pertussis vaccinate
5 doses
DTaP - 5 doses
2 months
4 months
6 months
15-18 months
4-6 years
Tdap
11-12 years
90
DTaP gives the individual an
active immunity against pertussis
91
Varicella
chickenpox
92
Varicella-Zoster Virus
primary - chickenpox
reactivation of latent - shingles
93
Shingles
herpes zoster
94
Transmission of varicella
respiratory secretions
contact
95
Varicella is what level of contagious
HIGHLY
- away from immunocompromised
1-2 days before rash appears
96
How long is an individual contagious with varicella
1-2 days before rash
until all lesions have crusted over
97
Varicella in the hospital
Airborne and Contact
assignments need to not be high risk
98
Children the 1st sign of chickenpox
rash
99
In adults the 1st sign of chickenpox
1-2 days of fever
malaise
100
The chickenpox rash looks like starts and transforms into
Macule → Papule → Vesicle → Crust
101
The chickenpox rash starts where
Head → Trunk → Extremities
Most lesions on trunk
Can occur on mucous membranes
102
The rash occurs in
crops
- 200-500 lesions in 2-4 crops
103
The rash causes the patient to
itch = pruritis
104
S/S of varicella
healthy children
mild
Malaise
Temperature up to 102°F for 2-3 days
Vesicular rash on skin and mucous membranes
Itching!!
105
Complications of varicella
Secondary bacterial infection FROM ITCHING
Pneumonia
CNS Manifestations = meningitis and
106
Varicella on an immunosuppressed patient
high risk for disseminated disease
- multisystem involvement
- hemorrhagic
107
Varicella on an immunosuppressed patient
Frequent complications
pneumonia
encephalitis
108
Varicella Children with HIV infection have an increased risk for
morbidity
109
Acyclovir (Zovirax)
Decreased number of lesions
Shortens duration of fever
Decreased itching, lethargy, and anorexia
110
Post-exposure Prophylaxis for Varicella
Varicella vaccine
- within 5 days of exposure for pts w/o immunity
C**ontrol outbreaks in child facilities and schools**
111
Chickenpox Interventions
Skin Care – **Luke-warm bath without soap
- Aveno, oatmeal**
Apply pressure (no scratching)
Topical **calamine**
Distraction
**Fingernails short (or mittens, etc.)**
Keep cool
**No aspirin** associated with Rene’s syndrome
112
Why do you not give aspirin to a child?
Rene's syndrome
113
Prevention of Chickenpox
maternal up to 1 year
2 doses of VAR or MMRV vaccine
- 12-15 months, 4-6 years
114
Chickenpox is what type of immunity after the infection
active
115
If a healthcare personnel is looking after a Chickenpox and MMR pt then they need?
documented immunity
116
Rubeola
measles
117
Transmission of rubeola
respiratory (droplet)
118
Communicability of measles
HIGHLY
High-risk populations (colleges, healthcare providers, travelers)
119
S/S of measles before the rash
fever peak ar 103-105
120
s/s of rubeola
Fever **103-105**
**3 C's (cough, coryza, and conjunctivitis)
Koplik spots**
Photophobia
**red maculopapular rash**
121
Coryza
runny nose
122
Koplik spots
bluish-white spots (mouth)
123
Rash of Rubeola
red maculopapular rash (raised discolored)
124
The rash start and ends where
Hairline→Downward→Outward
- fades in order of appearance
125
The rash becomes
confluent
126
Associated s/s of Rubeola
Anorexia
Malaise
Diarrhea – infants
Generalized lymphadenopathy
127
Rubeola occurs in
less than 5 y/o and 20 y/o
128
Rubeola complications
Otitis Media
Pneumonia
Encephalitis in adults
More severe in malnourished
Vitamin A deficiency
129
Rubeola complications are more severe in deficiency of what Vitamin causing malnutrition
A
130
Rubeola Interventions
**Vitamin A for severe measles – decreases morbidity and morality **
**- High doses - may experience vomiting & headache**
Antipyretics
**Cool Mist Vaporizer**
Eye Care
Dim lights
**Clean eyelids with warm saline solution if drainage**
Skin Care
**Airborne** Precautions – hangs out for 2 hours after exposure
131
What precautions are taken for Measles?
airborne
- hangs in the air 2 hours after exposure
132
Post-exposure Prophylaxis for Measles
Immune globulin after exposure for
- Immunocompromised persons
- Susceptible household contacts
133
Vaccination of Rubeola
maternal immunization up to 1 year
MMR - 2 doses (12-15 months and 4-6 years)
134
Mumps transmission
respiratory (direct or indirect)
135
Early s/s of Mumps
non-specific (muscle aches, low fever)
136
s/s Mumps
“Earache” within 24 hours
- Jaw line in front of ear lobe (Parotid gland)
- Swell the chin and jaw line
137
Complications of Mumps
Orchitis – testicular inflammation
Oophoritis/Mastitis – inflammation of breast or ovaries
Pancreatitis
Encephalitis
Meningitis
Deafness
138
Mumps asymptomatic percentage
20-30
139
Mumps Interventions
Analgesics
Antipyretics
supportive care
**Soft or liquid foods
Warm or cool** compresses
**Droplet** Precautions
140
Mumps Preventions
maternal immunity up to 1 year
MMR - 2 dose (12-15 months, 4-6 years)
141
If the patient has an MMR vaccine, the s/s of mumps is
milder
142
Rubella
German measles
143
Rubella means
little red
144
Rubella transmission
Direct contact
Respiratory (primary)
-Blood
-Stool
-Urine
Mom if pregnant passes to baby
145
S/S Children rubella
rash 1st
146
S/S before rash for older children/adults rubella
Low-grade fever
Headache
Malaise
Mild conjunctivitis
Lymphadenopathy
Sore throat
Upper respiratory symptoms
147
Rash for Rubella
**Pinkish-red maculopapular** rash
Begins on face then head to foot
- more prominent in hot shower
Lasts 3 days
Occasionally pruritic
148
Rubella rash lasts for
3 days
149
Rubella Complications
Arthritis/arthralgia
Thrombocytopenic purpura (rare)
Encephalitis (rare)
150
Rubella Pregnancy Complications and greatest reason for vaccinations
Miscarriages
Fetal death/stillbirth
Birth defects (congenital rubella syndrome)
151
Rubella Interventions
**Avoid contact with pregnant women**
Antipyretics
Comfort measures
**Droplet precautions**
152
Precaution for Rubella
droplet
153
Prevention of Rubella
maternal immunity for 1 year
MMR - 2 dose
12-15 months, 4-6 years
154
Scarlet Fever Transmission
Direct or indirect contact with nasopharyngeal secretions
155
Scarlet fever is most common in
school-aged children
156
Initial s/s of Scarlet Fever
High fever/chills
Sore throat
Headache
Malaise
Abdominal pain/vomiting
157
s/s after the rash appears of Scarlet Fever
Enanthema – internal
Exanthema - outward
**avoids the face**
158
Enanthema
Tonsils red, swollen, and covered with exudate
throat red/swollen
white (1-2 days) to red (4-5 days) strawberry tongue
palate - pinpoint red lesions
159
Exanthema
Flushed face with **circumoral pallor**
Red **pinpoint rash**
Absent on face
Feels like **sandpaper**
More intense **in folds of joints bends**
Desquamation begins by end of first week
**Pealing of the skin**
160
Complications of scarlet fever
Retropharyngeal abscess
Sinusitis
Otitis media
Acute and/or long-term
- Glomerulonephritis
- Rheumatic fever
161
Scarlet Fever Interventions
**Antibiotics – PCN,**
Bedrest – FEBRILE STAGE
Encourage fluids – FEBRILE STAGE
Relieve discomfort of sore throat
Prevent spread
Handwashing, discard toothbrush, avoid sharing food/drinks
**Droplet Precautions
Until 24 hours after starting antibiotic**
162
Scarlet Fever in Febrile stage
bedrest
encourage fluids
163
Scarlet Fever precautions
Droplet until after 24 hours of ANTIBIOTICS
164
COVID-19 Transmission
respiratory (direct and indirect)
165
COVID-19 Communicability
Highly contagious even if asymptomatic
166
COVID-19 s/s
Asymptomatic (no s/s, normal CXR) = 4%
Mild (fever, fatigue, myalgia, cough) = 5%
**Moderate (symptomatic pneumonia/abnormal CXR) = 39%**
Severe (dyspnea, central cyanosis, hypoxia) = 5%
Critical (ARDS, Resp. failure, shock, MOD) = 0.6%
167
COVID-19 Complications
Short-term and long-term
**Underlying medical conditions = ↑ risk for severe illness** – duh!
**Post-COVID Multisystem Inflammatory Syndrome in Children (MIS-C)**
168
COVID-19 in Children's Complication
Post-COVID Multisystem Inflammatory Syndrome in Children (MIS-C)
169
COVID-19 Interventions
Airborne precautions + gown, gloves & goggles/faceshield
Supportive Care
Rest
Adequate hydration
Analgesics
Antipyretics
Source Control – mask, distancing, hand hygiene, etc.
170
COVID-19 Precautions
Airborne precautions + gown, gloves & goggles/faceshield
171
COVID-19 Vaccination
6 months and older can get it
172
Isolation Precautions for Airborne/Contact
Varicella (Chickenpox)
Rubeola (Measles)
Coronavirus (COVID-19)
173
Airborne/Contact PPE
N95
gloves
gown
174
Isolation Precautions for Droplet
Rubella (German Measles)
Pertussis (Whooping Cough)
Mumps
Scarlet Fever
175
Droplet Precaution PPE
MASK
176
Nursing Priorities of Infectious Diseases
Prevent spread
Provide comfort
Ear, nose, and throat symptoms
Urticaria -
Fever
Pain
Irritability
Family support
177
Urticaria
itchy welts
