Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2). INSTRUCTIONS: "In your reply to each of your peers, discuss content that you learned while explorin
POST # 1 JENNIFER
The Center for Disease Control and Prevention (CDC) has set guidelines for vaccination schedules. These guidelines have been established to decrease the spread of preventable diseases. The purpose of this discussion post is to educate the reader on a case study in which one child requires a catch-up vaccination schedule and one requires the standard vaccination schedule. As five-year-old children, different preventive guidelines related to vaccinations will be discussed to ensure both patients are up to date on their vaccinations.
One of the patients is a five-year-old girl that is in foster care. Her foster parent states that this patient has only received immunizations up to one year old. The foster parent can tell the provider that all of the recommended immunizations up to one year old has been completed. As a future Advanced Practice Nurse Practitioner, reviewing the CDC immunization guidelines would be a priority. As listed on the Immunization schedules on the CDC website (2020), it would be imperative to ask if this patient received the 3rd dose of the Hepatitis B vaccine. This vaccine can be given from 9 months old to 15 months old on the standard immunization guidelines (“Immunization Schedule,” 2020). If the patient did not receive the 3rd dose of Hepatitis B vaccine, this will be the first vaccine that would be needed. Also, per the CDC website (2020), it is not unsafe to receive an extra dose of the Hepatitis B vaccine. If the foster parent is unsure if this patient received the hepatitis vaccine, the patient can safely receive the third dose of the Hepatitis B vaccine series. Also, if the series is interrupted, the first one or two doses do not need to be repeated (“Hepatitis B Questions and Answers for the Public,” 2020). The next vaccine to be discussed will be the Diptheria, Tetanus and Acellular Pertussis. The 4th dose of this vaccine is recommended between 15 months and 6 years old. This vaccine will need to be administered. This patient will not need a 5th dose since the 4th dose was given after the age of 4 years old (“Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States,” 2020). Next, the Haemophilus Influenzae B vaccine’s 3rd dose is recommended between 12-15 months old. Again, as a provider, asking the foster parent if the patient received the 3rd dose will be a necessity. If the patient did not receive the 3rd dose, then this patient can receive the 3rd dose. Per the CDC website (2020), patients that are 5 years old and have not completed the series, can receive one more dose. However, the CDC also says, if the patient is not at high risk then and over 5 years of age then this patient does not need to receive any more doses of this vaccine (Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States”, 2020). Next, the pneumococcal conjugate vaccine will need to be discussed. Per the CDC website (2020), if the patient is over 59 months old and has received at least one dose was given before 12 months old, then the patient will not need to receive any more doses. Inactivated polio vaccine is next on the list to discuss with the patient’s foster parent. Since it has been more than 6 months since the last inactivated polio vaccine, the next and final dose can be given (“Catch-Up Guidance for Children 4 Months through 17 Years of Age Inactivated Polio Vaccine (IPV),” 2020). Measles, mumps and rubella (MMR) vaccine and the Varicella vaccines, are the two vaccines that are recommended for the 5 year old patient. The MMR vaccine requires two doses. This patient missed the first dose at the first recommended age of 12-15 months old. The CDC (2020) recommends that the two doses be given 4 weeks apart. The varicella vaccine was also missed at this patient’s first birthday. It is recommended for the 2 doses of varicella to be given 3 months apart (“Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States,” 2020).
Administering vaccines together can be safe. However, the CDC has guidelines on which vaccines can be given at the same time however in different syringes. The CDC also has guidelines on which vaccines can not be given at the same time as other vaccines. Per the CDC guidelines (2020), “DTap (diphtheria-tetanus-pertussis), trivalent IPV (three strains of inactivated polio vaccine), MMR (measles-mumps-rubella), DTap-Hib, and Hib-Hep B” are examples of the vaccines that can be combined in the same syringe for administration (“Multiple Vaccines and Immune System,” 2020). This patient will need to receive the MMR, Varicella, Inactivated Polio, Hib, DTap and Hepatitis B vaccines. This patient can receive the combination vaccine, DTap-Hib. At this visit, the patient can receive DTap-Hib vaccine, Inactivated Polio vaccine, Hepatitis B vaccine (“Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States,” 2020). Per the CDC (2020), all vaccines can be given at the same time without adverse reactions. This will increase the chances that the patient becomes vaccinated and protected against preventive diseases (“Immunology and Vaccine-Preventable Diseases – Pink Book –General Recommendations,” 2020). The MMR and Varicella vaccine is also a combined vaccine called MMRV. This combination vaccine can be given for patients 12 months to 12 years old (“MMRV (Measles, Mumps, Rubella & Varicella) VIS,” 2019). At this appointment, the patient can receive the DTap-Hib vaccine, MMRV vaccine, Inactivated Polio vaccine and the Hepatitis B vaccine.
The next patient is a five year old girl that is up to date on her vaccinations. Per the CDC’s (2020) guidelines, between the ages of 4 and 6 years of age, a patient should receive the MMRV vaccine, the Inactivated Polio vaccine and the DTap vaccine. However, if the foster parent is unsure if the patient has been vaccinated at 4 years of age, titers can be ordered to ensure the patient has immunity to the preventable diseases. There is another option as well. Per the CDC (2020), if a patient does not have records of up to date vaccinations, it is safe to administer the vaccines that are recommended for their age (“Vaccine Administration,” 2019). If the foster parent is unaware of these vaccinations, this patient will receive the MMRV vaccine, the DTap vaccine and Inactivated Polio vaccine.
Before administering any vaccines, the provider must ensure the patient has never had a reaction to any vaccines as well as no allergies to neomycin. Patients with a neomycin allergy have an increased risk of an adverse reaction to certain vaccines that have traces of neomycin in them. Also, the provider should not give the MMR vaccine if the patient has an allergy to gelatin. A severe adverse reaction could occur. The provider must ensure the patients are not immunocompromised. This is a contraindication for administration of live vaccines (“Immunology and Vaccine-Preventable Diseases – Pink Book –General Recommendations,” 2020).
As a future Advanced Practice Registered Nurse (APRN), continuing to be educated on the standard immunization guidelines and the catch up schedule will be a priority in my practice. Ensuring the caregivers and patients are educated on the importance of vaccines, the information on the vaccines administered and the risks with and without vaccines will be a priority. As a future APRN, I will handle every appointment as a learning moment, take every opportunity to vaccinate as long as it is safe for the patient. Increasing vaccination rates will increase patients’ health promotion and disease prevention.
References
Birth-18 Years Immunization Schedule. (2019). https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html#birth-15
CDC/NCIRD. (2015). Immunology and Vaccine-Preventable Diseases – Pink Book –General Recommendations. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/genrec.pdf
Hepatitis B Questions and Answers for the Public. (2019). https://www.cdc.gov/hepatitis/hbv/bfaq.htm
Multiple Vaccines and the Immune System. (2019). https://www.cdc.gov/vaccinesafety/concerns/multiple-vaccines-immunity.html
Pinkbook. (2019). https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html
Vaccine Information Statement. (2019). https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hib.html
