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Nursing Management in Childhood Immunization (PowerPoint)

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Nursing Management in Childhood Immunization and communicable disease.

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 Childhood and Adolescent
      Pediatric Nursing
       What Immunization Is
 Immunization is the process by which a
  subject is rendered immune or resistant to
  a specific disease
 Natural exposure – contact with the agent
 Artificial exposure – parts of the infectious
  agent or inactivated version is given for
  the purpose of becoming immune to the
  disease agent it causes.
       Childhood Immunization
   Childhood immunization schedule
    American Academy of Pediatrics

    – http://www.cispimmunize.org/
    – Download children age 0 - 6
    – Download children age 7 - 18
    Hepatitis B (HepB) Vaccine
 All infants should receive the first dose soon
  after birth or before hospital discharge.
 Second dose should be given at least 4 weeks
  after the first
 Third dose 16 weeks after the first dose and at
  least 8 weeks after the second dose
 Infants born of HBsAg-postive mothers should
  receive first immunization within 12 hours of
  birth as well as HBIG.
    Diphtheria, Tetanus, Acellular Pertussis

 DTaP
 Given at 2, 4 and 6 months
    – 4th dose between 15 and 18 months
    – Last DTaP at the 4-6 year pre-K check up
 1stTdap at age 11-12 years or at least 5
  years from last DTap
 Every 10 years after that
 Injection form at 2 months, 4 months
  after 6 months and at kindergarten check-
 Oral not given due to shedding in stool.
    Haemophilus Influenza Type b
 Hib
 Given at ages 2 and 4 months
 Last dose at 12 months
    – Any child entering child care or pre-
      kindergarten under age 5 years would be
      required to have Hib.
    – Not a standard immunization for children born
      outside the USA
       Measles, Mumps, Rubella
 Two doses:
    – 1st 12 months or older
    – 2nd dose kindergarten visit
    – If no record of second dose it should be given at 11
      to 12 year old visit
    – May develop a rash a week to ten days after
    – Not immunized against wild strain – exposure would
      bring milder case
 Chicken pox – recommended at 12
  months and second dose at 4-6 years or
  kindergarden visit
 Susceptible children over 13 years would
  receive two doses at least 4 weeks apart
         Pneumococcal Vaccine
 PCV - Prevnar
 Recommended for all children 2 to 23 months
  and certain populations up to 59 months
 Asthma
    – Sickle cell anemia
    – Cystic fibrosis
   2, 4, 6 and 4th dose after 12 months of age
      Human Papillomavirus
 HPV is the most common sexually
  transmitted virus
 40 types of HPV
 Spread through sexual contact
 Can cause cervical cancer
 Can also cause genital warts
         Human Papillomavirus
 HPV series
 Recommended for all girls 11-12 years
 Can be given as young as 9 years
 Get HPV before first sexual contact
    – 1st dose
    – 2nd dose 2 months after 1st dose
    – 3rd dose 6 months after dose one
   Contraindications:
    – Allergy to yeast or reaction to first
    – HPV will not help if already infected
 Meningococcal disease is a serious illness
 Leading cause of bacterial meningitis in 2
  – 28 year old in USA
    Meningococcal polysaccharide Vaccine

 Prevents 4 types of meningococcal
  diseases – 2 out of 3 of the most common
  strains seen in the US
 MCV4 recommended for all children at
  their routine preadolescent visit (11 – 12
 College freshmen living in dorms
 U.S. military recruits
 Traveling to Africa
 Persons exposed to meningitis outbreak
        Influenza (Flu) Vaccine
   “Flu shot”: Inactivated vaccine containing
    the virus
    – Approved for infants older than 6 months
   Nasal spray flu vaccine: live, weakened flu
    – Approved for children over 5 years to 49
    When to get Flu Vaccination?
   October or November yearly
Contraindications to Flu Vaccine
   Children with severe allergy to chicken eggs.
   Severe reaction to influenza vaccination in the
   Less than 6 months of age.
   Children who have developed Guillain-Barre
    syndrome after previous immunization.
   Do not give if child has moderate to severe
    illness with fever until a later date.
           Premature Infants
 AAP currently recommends that all premature
  infants receive full dose immunizations at the
  same chronologic age as term infants even if
 Contraindications include: significant febrile
  seizure, active seizure disorders, encephalopathy
 Infants with BPD or RAD should receive
  influenza immunizations
 Infants with congenital heart and premature
  infants immunization against RSV.
       Premature continued
 Hepatitis B may be deferred until
  discharge unless mother is Hep B positive
 OPV should not be given in NICU
 Do NOT dilute dosages
 Usually given when they reach at least 2
  kg or 4.4 pounds
    To Immunize or Not to Immunize
 Children on antibiotics
 Children with minor illness – otitis, cough,
  diarrhea, sore throat, low grade fever
 Children with mild allergies
 Breast feeding infants
 Children with pregnant household contacts
         True Contraindications
   True allergic response
    – Rash or hives after previous vaccination
    – Allergy to eggs or egg products should not be
      given influenza vaccination
    – Allergic to streptomycin should not be given
      IPV or influenza vaccination
    Reactions to Immunizations
 Fever greater than 103, shock or collapse,
  or inconsolable crying for greater than 3
  hours. (DTaP)
 Low grade fever, fussiness, and soreness
  at injection site are not reasons to prevent
  further vaccinations
 Mild rash or fever may occur 10 days to 2
  weeks after MMR or Varicella
 Tylenol every 4 hours for fussiness or low
  grade fever
 Warm bath
 NO Motrin for infants under 6 months of
 AAP recommends Tylenol for all ages due
  to confusion in dosing.
   Hepatitis A (recommended only)
   Pneumococcal if they have any chronic disease: heart,
    sickle cell disease, cystic fibrosis, diabetes, or organ
    transplant or receiving chemotherapy
   Hepatitis B
   MMR: second booster
   D Tap
   Varicella if no reliable history or negative titers
   Meningococcemia for all college freshman and all military
   Influenza yearly
               Hepatitis A
 Recommended for children and
  adolescents living in selected states or
  regions and for certain high risk groups
 This would include California, Texas, and
 2 doses 6 months apart
               Live Vaccines
   MMR and Varicella
    – Pregnancy
    – HIV +
    – Immunodeficiency
    – Chemotherapy: not given until 6 months after
      treatment is completed.
    L.A. Unified Recommendations
 Complete health and immunization record
 All new students must have written results of a
  PPD test for tuberculosis within 12 months
 If Manoux test is positive a chest x-ray is
 Treatment is recommended unless the child has
  some immune suppressed condition.
                 PPD Waiver
   I hear by request exemption of the child
    from the tuberculosis assessment
    requirement for school / childcare entry
    because this is contrary to my beliefs. I
    understand that should there be cause to
    believe that my child is infected with
    active TB or should there be a tuberculosis
    outbreak, my child may be temporarily
    excluded from school.
    Pre-school and Child Care
 Pre-kindergarteners must be immunized
  against Haemophilus influenza type B or
 This is not a standard immunization for
  children born outside the United States
 Hib would not be required for a child over
  5 years of age.
 Second MMR: Measles, Mumps, Rubella
 Hepatitis B
 Hepatitis A in high risk areas
 D Tap: tetanus, diphtheria, pertussis
     Communicable Diseases
 Chicken pox (varicella)
 Measles (Rubeola)
 Pertussis (Whooping Cough)
 Rubella (German Measles)
 Scarlet Fever
 Mumps
   Agent: varicella zoster virus
   Incubation: 10 – 14 days
   Transmission: respiratory
   Period of communicability: 2 days before
    eruption of vesicles until lesions crusted.
   Prodromal phase: slight fever, malaise, pruritic
    rash; macular to papular to vesicular.
   Communicability: children who have
    “chicken-pox” are infectious for two days
    before the vesicles erupt until all vesicles
    are crusted over.
     Management of Varicella
 Isolation
 Skin care: tepid bath, calamine lotion, clip
  finger nails.
 Keep from scratching
 Antihistamines for itching - Benadryl
 No ASA – acetaminophen only.
 Varicella vaccine now available.
         Measles or Rubeola
 Agent: Virus
 Transmission: respiratory, blood and urine
 Incubation period: 10 to 20 days
 Period of Communicability: 4 days before
  and 5 days after rash appears.
 Prodromal stage: fever, cough,
  conjunctivitis, Koplik spots.
    Rubella or German Measles
 Agent: Rubella virus
 Source: nasopharyngeal secretions;
  secretions in blood, stool, and urine.
 Transmission: direct contact.
 Incubation period: 14 to 21 days
 Period of communicability: 7 days before
  to 5 days after appearance of rash.
 Rash first appears on face and rapidly
  spreads downward
 Isolate from pregnant women
 TORCH – affects fetus

  In mumps the parotid
  glands swell and obscure
  the angle of the jaw.
 Disease caused by a virus that spreads through
  saliva and infects many parts of the body
  especially the parotid salivary gland.
 Incidence has decreased to about 1,000 per
 Two potential complications: encephalitis and
  orchitis (inflammation of testicle)
    Pertussis (Whooping Cough)
 Agent: Bordetella Pertussis
 Source: Respiratory
 Transmission: droplet spread or contact
  with contaminated article.
 Incubation period: 10 days
 Period of communicability: before onset of
  paroxysms to 4 weeks after onset.
 Erythromycin for the child and all contacts
 Very dangerous for the neonate – most
  often the contact is an adult with a chronic
 May led to hospital admission – ventilator
                  Scarlet Fever
   Caused by group A Streptococcus
   Rash is usually seen in children under age 18 years.
   Rash appears on chest and abdomen – feels rough like a
    piece of sandpaper
   Redder in the arm pits and groin area.
   Rash lasts 2-5 days
   After rash disappears fingers and toes begin to peel
   Face is flushed with a pale area around the lips.
Scarlet Fever
    Management of Scarlet Fever
 Respiratory precautions for 24 hours.
 Oral antibiotic for 10 days.
 Treat sore throat with analgesics, gargles,
  lozenges, and antiseptic throat spray.
 Encourage fluids.
 See health care provider if fever persists.
                 Fifth Disease
   Fifth disease is a mild childhood illness caused
    by the human parvovirus B19 that causes flu-like
    symptoms and a rash. It is called fifth disease
    because it was fifth on a list of common
    childhood illnesses that are accompanied by a
    rash, including measles, rubella (or German
    measles), scarlet fever (or scarlatina), and
    scarlatinella, a variant of scarlet fever.
              Fifth Disease

 Primarily seen in school-age children
  between ages 5 and 14 years.
 Causes a reddish rash on the child’s face
  that looks as if the child has been slapped.
     Fifth Disease Symptoms
 Starts as a vague illness.
 Fever, nasal congestion, sore throat,
  fatigue, muscle aches and headache.
 7-10 days later the facial rash appears
  (slapped cheeks rash).
 Light pink rash on arms and spreads to
  the trunk in a lacelike pattern.
Fifths Disease

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