Immunizations/Infectious Diseases Flashcards
Vaccines stimulate
immune system to produce antigens
- same antigens as disease (killed or weakened)
What happens to the antibodies after destroying the antigens of the vaccine?
memory cells formed
Who decides what vaccines are needed?
CDC - pink book
American Academy of Pedi - red book
What are the best ways to prevent infectious diseases?
immunizations
handwashing
isolations (reduce cross-transmissions)
infection control
sneeze and cough etiquette
What is the best way to prevent complications of individuals at high risk? (steroids, immunodeficiency, hemolytic disease -sickle cell)
vaccinate
Why should a society vaccinate?
decrease/eliminate the infectious disease
Herd Immunity
85% majority with vaccine
If not enough people are vaccinated, what could potentially happen?
reemergence
example) measles, mumps, polio
Active Immunity
endogenous production of antibodies
long-lasting
months to develop
Natural Active Immunity
survive infection
Acquired Active Immunity
vaccination
Passive immunity
antibodies given to a person
immediate and short-lived
What is the most common passive immunity?
last 1-2 months of pregnancy mother passes gamma globulin to the baby and lasts up to a year
Antibody sources
blood products
immune globulins (diff. people in one)
hyperimmune globulins (specific antibody)
Antitoxins (horses)
What is a complication of antitoxin?
serum sickness from horses
Live Attenuated Vaccines
a weakened form of live
same as the infection itself
must replicate (can get the disease)
Live attenuated vaccines have how many doses?
1-2
Live attenuated vaccine effectiveness issues
circulating antibody (blood transfusion)
damage to organ (extreme temps and sunlight)
What vaccines are live attenuated?
MMR
Varicella
Rotavirus
Intranasal Influenza
How many doses do inactivated vaccines have to gain immunity?
2-3
Inactivated Vaccines are produced in
culture media
Inactivated Vaccines replication
cannot replicate ( does not cause disease)
Inactivated Vaccines is less affected by
circulating antibodies
Antibody titer
antibody levels in the blood
Which vaccine is most likely needed for a “booster”?
inactivated vaccine
Inactivated Vaccines types
Polio,
Hepatitis A and B
Rabies,
Influenza,
Acellular pertussis,
Human papillomavirus,
Diphtheria,
Tetanus,
Pneumococcal,
Meningococcal
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
The Hib vaccine prevents against
epiglottitis
Haemophilus influenzae type b (Hib) has how many doses?
multiple no number
99% decrease with vaccine
Vaccine Factor for failure
Age/maternal antibody
Dose
Route
Storage and handling – lose potency or contaminated
Nutritional status – malnutrition low
Coexisting disease
Genetics
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
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
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
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
If vaccines are given too close together, what increases
adverse effects, spacing is important
Timing of antibody-containing blood products (Ig) should be scheduled appropriately for what vaccines?
live
Screening helps
identify contraindications and precautions
increases the risk of adverse effects
Live doses of vaccines should only be given after
1 year (MMR, Varicella)
Hib Vaccine
contraindications
severe allergic reaction after a previous dose or to a vaccine component
less than 6 weeks
Hib Vaccines allergic reaction to what
dry natural latex
Hib Vaccine
Precautions
moderate to severe acute illness with or without fever
MMR vaccine
contraindications
severe allergic reaction to the previous dose
severe immunodeficiency (chemo, sickle cell, HIV infection, immunocompromised)
pregnancy
MMR vaccine
precautions
recent (<11 months) receipt of antibody-containing blood product
moderate to severe acute illness with/without fever
Rotavirus
contraindications
severe allergic reaction after the previous dose
severe combined immunodeficiency
Hx of intussusception
Rotavirus
precautions
moderate to severe acute illness with or without fever
- chronic GI disease
Varicella
contraindications
Severe allergic reaction after previous doses
severe immunodeficiency and pregnancy
When a contraindication is present in vaccines, a vaccine should ________ administered
NOT be administered
When a vaccine precaution is present, vaccinations should generally be
deferred but if the risks outweigh the benefits
Varicella
precautions
recent (<11 months) receipt of antibody-containing blood product
moderate to severe acute illness with or without fever
Live attenuated Vaccine vs. inactivated Vaccine
Is it contraindicated, vaccinated, or precautioned for an Allergy to vaccine or component?
contraindicated; contraindicated
Live attenuated Vaccine vs. inactivated Vaccine
Is it contraindicated, vaccinated, or precautioned for an encephalopathy?
Not known in live; contraindicated in inactivated
Live attenuated Vaccine vs. inactivated Vaccine
Is it contraindicated, vaccinated, or precautioned for pregnancy?
Live= contraindicated
Inactived = Vaccinate (some exceptions)
Live attenuated Vaccine vs. inactivated Vaccine
Is it contraindicated, vaccinated, or precautioned for immunosuppression?
Live= contraindicated
Inactived = Vaccinate (some exceptions)
Live attenuated Vaccine vs. inactivated Vaccine
Is it contraindicated, vaccinated, or precautioned for moderate to severe illness?
precaution on both
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
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
Local Adverse Events
Mild/self-limited
Pain/swelling/redness at the injection site
Within hours of injection
Local adverse reactions are common with
inactivated vaccines
Systemic reactions to vaccine
Fever/malaise/headache/myalgia/loss of appetite
Reactions following live vaccines may be similar to mild form of disease
Systemic reactions can occur how many days after administration
7-21
Which adverse reactions can be life-threatening?
allergic (anaphalaxis)
s/s and preparations are needed
How long should you observe the patient after vaccination for allergic reactions?
15 minutes
What s/s should be watched out for after vaccinations?
Respiratory distress, wheezing, shock like, hives, swelling in mouth and throat
What treatment is needed for allergic reactions?
IM Epipen
What vaccines are given SubQ?
MMR
Varicella
-live-
What vaccines could be IM or SubQ?
IPV (Inactivated Polio Vaccine)
PCV (Pneumococcal Vaccine)
MCV (Meningococcal Vaccine)
What vaccines are given IM?
DTaP/Tdap (Diphtheria, Tetanus, Acellular Pertussis)
Hepatitis A
Hepatitis B
Hib (Haemophilus Influenzae type B)
HPV (Human Papillomavirus)
Do you aspirate on a vaccine?
not required
- experience less pain when given rapidly without aspiration
Why are vaccines not given IVP?
veins and arteries are too small
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)
Hemophilia needs what after receiving a vaccine IM.
factor replacement on last dose
recent the better
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
Macule
flat discoloration of the skin
Papule
solid raised lesion of the skin
Vesicular
small fluid-filled sac
Pertussis means
whooping cough
Pertussis transmission
Respiratory secretions (direct/indirect)
Most contagious during catarrhal stage (before harsh coughing)
S/S of Pertussis
- Catarrhal stage
Respiratory symptoms –
Mild occasional cough
Low-grade fever
Lasts 1-2 weeks
The pertussis catarrhal stage lasts how long
1-2 weeks
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
What are the stages of pertussis?
catarrhal
paroxysmal
convalescent
How long does the paroxysmal stage last in pertussis?
4-6 weeks
S/S of Pertussis
- Convalescent stage
Coughing gradually stops
Single cough may continue
Paroxysmal cough may return it cold or respiratory illness occurs
How long does the convalescent stage last
2-3 weeks
Complications of pertussis
Pneumonia
Apnea - give O2
Neurological - seizures
Pressure effects of paroxysms
Complications of pertussis in adolescents
Syncope, sleep disturbances, rib fractures, incontinence
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
What isolation do pertussis need to have and for how long?
Droplet
5-7 days after antibiotics start
Pertussis vaccinate
5 doses
DTaP - 5 doses
2 months
4 months
6 months
15-18 months
4-6 years
Tdap
11-12 years
DTaP gives the individual an
active immunity against pertussis
Varicella
chickenpox
Varicella-Zoster Virus
primary - chickenpox
reactivation of latent - shingles
Shingles
herpes zoster
Transmission of varicella
respiratory secretions
contact
Varicella is what level of contagious
HIGHLY
- away from immunocompromised
1-2 days before rash appears
How long is an individual contagious with varicella
1-2 days before rash
until all lesions have crusted over
Varicella in the hospital
Airborne and Contact
assignments need to not be high risk
Children the 1st sign of chickenpox
rash
In adults the 1st sign of chickenpox
1-2 days of fever
malaise
The chickenpox rash looks like starts and transforms into
Macule → Papule → Vesicle → Crust
The chickenpox rash starts where
Head → Trunk → Extremities
Most lesions on trunk
Can occur on mucous membranes
The rash occurs in
crops
- 200-500 lesions in 2-4 crops
The rash causes the patient to
itch = pruritis
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!!
Complications of varicella
Secondary bacterial infection FROM ITCHING
Pneumonia
CNS Manifestations = meningitis and
Varicella on an immunosuppressed patient
high risk for disseminated disease
- multisystem involvement
- hemorrhagic
Varicella on an immunosuppressed patient
Frequent complications
pneumonia
encephalitis
Varicella Children with HIV infection have an increased risk for
morbidity
Acyclovir (Zovirax)
Decreased number of lesions
Shortens duration of fever
Decreased itching, lethargy, and anorexia
Post-exposure Prophylaxis for Varicella
Varicella vaccine
- within 5 days of exposure for pts w/o immunity
Control outbreaks in child facilities and schools
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
Why do you not give aspirin to a child?
Rene’s syndrome
Prevention of Chickenpox
maternal up to 1 year
2 doses of VAR or MMRV vaccine
- 12-15 months, 4-6 years
Chickenpox is what type of immunity after the infection
active
If a healthcare personnel is looking after a Chickenpox and MMR pt then they need?
documented immunity
Rubeola
measles
Transmission of rubeola
respiratory (droplet)
Communicability of measles
HIGHLY
High-risk populations (colleges, healthcare providers, travelers)
S/S of measles before the rash
fever peak ar 103-105
s/s of rubeola
Fever 103-105
3 C’s (cough, coryza, and conjunctivitis)
Koplik spots
Photophobia
red maculopapular rash
Coryza
runny nose
Koplik spots
bluish-white spots (mouth)
Rash of Rubeola
red maculopapular rash (raised discolored)
The rash start and ends where
Hairline→Downward→Outward
- fades in order of appearance
The rash becomes
confluent
Associated s/s of Rubeola
Anorexia
Malaise
Diarrhea – infants
Generalized lymphadenopathy
Rubeola occurs in
less than 5 y/o and 20 y/o
Rubeola complications
Otitis Media
Pneumonia
Encephalitis in adults
More severe in malnourished
Vitamin A deficiency
Rubeola complications are more severe in deficiency of what Vitamin causing malnutrition
A
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
What precautions are taken for Measles?
airborne
- hangs in the air 2 hours after exposure
Post-exposure Prophylaxis for Measles
Immune globulin after exposure for
- Immunocompromised persons
- Susceptible household contacts
Vaccination of Rubeola
maternal immunization up to 1 year
MMR - 2 doses (12-15 months and 4-6 years)
Mumps transmission
respiratory (direct or indirect)
Early s/s of Mumps
non-specific (muscle aches, low fever)
s/s Mumps
“Earache” within 24 hours
- Jaw line in front of ear lobe (Parotid gland)
- Swell the chin and jaw line
Complications of Mumps
Orchitis – testicular inflammation
Oophoritis/Mastitis – inflammation of breast or ovaries
Pancreatitis
Encephalitis
Meningitis
Deafness
Mumps asymptomatic percentage
20-30
Mumps Interventions
Analgesics
Antipyretics
supportive care
Soft or liquid foods
Warm or cool compresses
Droplet Precautions
Mumps Preventions
maternal immunity up to 1 year
MMR - 2 dose (12-15 months, 4-6 years)
If the patient has an MMR vaccine, the s/s of mumps is
milder
Rubella
German measles
Rubella means
little red
Rubella transmission
Direct contact
Respiratory (primary)
-Blood
-Stool
-Urine
Mom if pregnant passes to baby
S/S Children rubella
rash 1st
S/S before rash for older children/adults rubella
Low-grade fever
Headache
Malaise
Mild conjunctivitis
Lymphadenopathy
Sore throat
Upper respiratory symptoms
Rash for Rubella
Pinkish-red maculopapular rash
Begins on face then head to foot
- more prominent in hot shower
Lasts 3 days
Occasionally pruritic
Rubella rash lasts for
3 days
Rubella Complications
Arthritis/arthralgia
Thrombocytopenic purpura (rare)
Encephalitis (rare)
Rubella Pregnancy Complications and greatest reason for vaccinations
Miscarriages
Fetal death/stillbirth
Birth defects (congenital rubella syndrome)
Rubella Interventions
Avoid contact with pregnant women
Antipyretics
Comfort measures
Droplet precautions
Precaution for Rubella
droplet
Prevention of Rubella
maternal immunity for 1 year
MMR - 2 dose
12-15 months, 4-6 years
Scarlet Fever Transmission
Direct or indirect contact with nasopharyngeal secretions
Scarlet fever is most common in
school-aged children
Initial s/s of Scarlet Fever
High fever/chills
Sore throat
Headache
Malaise
Abdominal pain/vomiting
s/s after the rash appears of Scarlet Fever
Enanthema – internal
Exanthema - outward
avoids the face
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
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
Complications of scarlet fever
Retropharyngeal abscess
Sinusitis
Otitis media
Acute and/or long-term
- Glomerulonephritis
- Rheumatic fever
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
Scarlet Fever in Febrile stage
bedrest
encourage fluids
Scarlet Fever precautions
Droplet until after 24 hours of ANTIBIOTICS
COVID-19 Transmission
respiratory (direct and indirect)
COVID-19 Communicability
Highly contagious even if asymptomatic
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%
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)
COVID-19 in Children’s Complication
Post-COVID Multisystem Inflammatory Syndrome in Children (MIS-C)
COVID-19 Interventions
Airborne precautions + gown, gloves & goggles/faceshield
Supportive Care
Rest
Adequate hydration
Analgesics
Antipyretics
Source Control – mask, distancing, hand hygiene, etc.
COVID-19 Precautions
Airborne precautions + gown, gloves & goggles/faceshield
COVID-19 Vaccination
6 months and older can get it
Isolation Precautions for Airborne/Contact
Varicella (Chickenpox)
Rubeola (Measles)
Coronavirus (COVID-19)
Airborne/Contact PPE
N95
gloves
gown
Isolation Precautions for Droplet
Rubella (German Measles)
Pertussis (Whooping Cough)
Mumps
Scarlet Fever
Droplet Precaution PPE
MASK
Nursing Priorities of Infectious Diseases
Prevent spread
Provide comfort
Ear, nose, and throat symptoms
Urticaria -
Fever
Pain
Irritability
Family support
Urticaria
itchy welts
