hello this is professor o'hanley we're talking about vaccinations and communicable diseases in pediatric nursing so what you need to know is there's a lot of people that go into making the schedule for children and adults but we're going to talk about babies from birth to 18 years and you know you need to know the yellow in here which is the recommendations decided upon by the academy of pediatric nursing the academy of pediatric physicians the aap they call it american academy of pediatric doctors the nurse practitioners have some input the academy of immunization practice and the family doctors and then the federal government has employees that do nothing but run the trials before the research trials before they are allowed to go through the fda they test these vaccines on animals and then humans there's a lot of things that go into it then they test the vaccines after they're approved and we have to record everything and report everything which you will hear in this lecture so what they come up with is the recommended time and it's not carved in stone because doctors and parents don't get together usually on a given day it's when the baby's sick or it fits the mom's schedule or so it can be recommended from birth saving hepatitis b from birth to two months and then after it's given it's supposed to be given within four months and then a third shot is given after that now the tricky thing is these are not all carved in stone i'm not expecting you to know everything just know that the yellow are the recommended times for these vaccines here the green is the range of recommendations for catch-ups so somebody comes in from russia and has no vaccines and they're four years old we have to decide what what we're going to give them because we don't know if they've had anything you do not need to know that when you get in a clinic you'll you'll learn it it'll take you probably a couple weeks and then you'll still be checking the schedule like all of us but you do not need to know this right now the greek the purple is for high risk and that means kids that have cystic fibrosis or sickle cell anemia those children if a new vaccine comes out and there's a shortage we give it to the high-risk kids because we know if they get the disease they're going to be sicker than the healthy supposedly the healthy non-at-risk children now the blue you don't need to know either and that's the range recommended ages for non-high-risk groups that may be that may receive the vaccine subject to specific clinical decisions so worry about the yellow and worry about the dates that i tell you in the notes to try to keep it straight one more thing about that schedule it comes out every year in february and it doesn't come to print until probably very late february so you'll have a copy of the most recent one and in in while we're lecturing it'll be under investigation and review now i volunteered in a immunization clinic when i was in grad school because i had been an icu nurse and i'm very comfortable with codes and all the skills and action and the er but when i came into primary care it was a whole new world and so i volunteered actually to learn the immunization schedule and what health promotion health guidance it was it was a lot of fun but when we do give immunizations which was greek to me at the time there's a lot of documentation now here for example hepatitis b and you usually don't give one vaccine you usually give a baby three or four so you put down the vaccine how much you gave it's usually 0.5 mls the date who who funded it if it was private or insurance um the route where you gave it the vaccine lot the vaccine manufacturer so all those things are on a little vial bottle and then the date that there's that the vaccine education was given you always give the parents a sheet and tell them what to expect and then the date that um that you gave it so there's a lot of documentation for each vaccine and um you won't have any trouble uh figuring that out at the end is usually a little section over here that says whether the vaccine is given i am or sub-cute because the people that come new in the clinic are not going to know that right off so in the beginning i did a lot of checking for that so we're going to go on to the next slide and important concepts this you have to know so prodromal is the time that they're contagious before they get the symptoms chickenpox you're going to get a lecture on that but those kids are very contagious before they ever get any symptoms they might just have a little cold and no no rash no no vesicles they're contagious and they're contagious so that's the pro-dermal stage incubation is the time that say you sent your child over to a house where the kids ended up getting chicken pox the day that you had your kids exposed we know that 10 to 21 days somewhere in there 14 days depending on the book is the incubation period which means the time they're exposed from the time they can start to get the symptoms of the disease transmission is very important that's how it's spread airborne skin to skin secretions and you you students really have to think on this because it's kind of automatic that you'll say contact airborne and then i ask you um what you're going to wear for this disease and i get different answers so i'm going to focus on that and i want you to think not to put you on the spot but to think because nclex is asking a lot of questions about this with a different a lot of different terms and communicability is the time the person is contagious so that little guy with chickenpox is contagious from the time he has the cold but nobody knows what's wrong until the pox are healed and scabbed and not draining side effects so this question comes up all the time we expect that with this antigen redness sworn us to site a knot which i didn't know but it's sloughing at the subcutaneous tissue and sometimes the knots will last six or eight months but they still still get the vaccine this just comes with the my kids are real chunky and they had a lot of knots but they still get the absorption and they get the protection if they get a knot you can just tell the parents that the the vaccine was given correctly it just is when they go through all that sub-cute tissue sometimes there's a little knot formed and fever fever is a good thing fever is a reaction to an antigen no we always tell them if it gets too high afterwards uh we're 101 they give tylenol not before because before they get the vaccine the town affects the buildup of the immunity so these these are important these are things we expect now if some baby you can't wake them up and they call the office and they say i can't get my baby awake it's just it won't i pat it i was not hungry that baby goes the er that we don't know what that is there's other things that can happen besides reactions or if the kid is vomiting and vomiting mommy that's not usually from a vaccine these are side effects that are expected so i'm going to talk about these in class but these are questions so that you can think if you learn the first part of the voiceover and we'll stop there and continue with part two later hello again the first vaccine we're going to talk about is hepatitis b vaccine this protects against a virus there's hepatitis a which is oral fecal and there is a vaccine out for that and you should all get it because the physicians often don't expect hepatitis a which comes from like i said oral fecal bad water there's hepatitis b which is from sex and drugs and that's a very uh very serious illness it's a wonderful vaccine all healthcare providers have to have this and then there's cnd and c is also from uh drugs i'm not gonna talk about c and d the the b vaccine is the one i'm gonna talk about right now now i have review questions in here that i'm going to cover in a different voiceover but these are good thought uh questions for you to review they'll help you with the exam okay hepatitis b vaccine is given at birth and then a month later and then four months after that now the truth is it can be given at birth a month later in four months but if if somebody doesn't come back after the second immunization or the first they can get it a year later so this is the recommended this is what you need to know but my children didn't get this at first because it wasn't as a recommendation then so i would take them in as teenagers and they get the first one at 15 and i wouldn't go back with them for a year and they'd get the second one at 16 and that's fine and actually they're very protected after one shot but what you need to know is what i'm telling you for the recommended for babies and children because parents will ask you we're going for the two-month checkup what are we going to get the side effects are very minimal one nursing consideration is if the mom is hepatitis b surface antigen when they do the prenatal care then they they give immune globulin hepatitis b immune globulin which is an antibody to protect the body the baby and hopefully that they won't get the hepatitis b during the delivery and then they check the lab work they also give the vaccine so they get hbig and the vaccine and also this is if they're allergic to baker's yeast they do not give this vaccine hepatitis b is a very serious virus causes melee jaundice appetite decreased and this is exactly how you get it this is the most problem pure needle transmission is the big problem and so that's why we do prenatal screening to see if anybody is a carrier or if they've been in contact with people so that we protect the babies if you get this disease you can be a chronic carrier and you can also get liver cancer and diet this is i've seen people die of this before they had the vaccine healthcare workers this is the one we worry about not hiv it's very very very very rare that any health care provider is stuck with a needle and gets hiv this on the other hand is a huge problem and easily transmitted by any secretions or fluids so that's why healthcare providers need to be protected i am not going to take the time to show you these wonderful links but i will post this as a large open full screen powerpoint and the links do work and i may not give you a review of this in class since you're supposed to watch the voiceovers i may show you the links and just tell you some important things rather than follow this rat to touch tat since you learn better if you participate and get some information ahead so the second vaccine is rotavirus this is also protecting against a virus and this one is not like most of the vaccines that are killed and inactivated this this one happens to be still alive weakened but alive attenuating this is oral it depends on the manufacturer whether it's two doses or three doses uh there's two companies that make it and one gives two longest three this virus rotavirus is a gastroenteritis where children die all over the world and when this came about people were very very happy because they don't have the water they don't have the gatorade and pedialyte then these kids get this virus they get dehydrated and they die so this was a wonderful vaccine the problem was they do trials from these vaccines before they do them in animals they do them in children then they fda goes through all kinds of hoops and approves it and then they follow the children that are getting the vaccine well a small group got anticipation anticipation is a telescoping of the bowel it's a bowel obstruction and you can get this without the vaccine some kids present around under under usually under a year with abdominal distension and peeing and ends up being this telescoping but the number of children that got this was something like very very small zero zero zero point eight enough that the vaccine study studiers and researchers and developers decided to take it off the market and people were very very upset when they took this off the market so i always tell the story about people that don't believe in vaccines about rotavirus rotaviruses on the market and they took it off for eight months i think i believe it was in around 2006 and the whole world was really upset but they did not want to take a chance on sending children to surgery due to having a side effect of a vaccine so they they took some of the valence which are components to make the vaccine work out and did more studies and now we do not have the incidence of interception inception a rotavirus is a very very safe effective vaccine good morning this section is on bacterial protection and the first vaccine is pneumococcus you might remember this from geriatrics or medical surgical because they've been giving this protection to adults older adults for many years but now they have broken the 27 valence into 13 and it's safe for children so the pneumococcals as you can see is two four six uh and then at a year it can't be given 11 months in three weeks it has to be a year because then they're chronologically developmentally able to absorb and build up the immunity simple local reactions and again this is the same to protect against pneumococcus pneumococcal disease is a very serious disease you may hear in the exams streptococcal pneumonia streptococcal meningitis it's all the pneumococcal bacterial om is otitis media that's the middle ear infection it can also get in the blood it can pass the blood-brain barrier and cause meningitis and bacterial pneumonia one year we had many many children with just tubes normal healthy kids before this vaccine sinusitis it can go into the tiny sinuses up by the brain and even get into brain absence this is a great vaccine and it's spread by droplets and a treatment is penicillin the hemophilus influenza type b vaccine is another bacteria and circle this because people think it's the flu especially students because of the word influenza but it's a very potent bacteria and it affects the population under six years of age so they only give it up until six years of age there are simple regular reactions all the ones i said on the very first slide redness soreness knots uh possible fever and this is also given two four to four and 15 months after a year and then if they come in later like it's seven or eight they don't get this one we all get can get hemophilus influenza type b you me elderly teenagers but the population that gets it the worst and most seriously is under six years of age and that's who they choose to put on the recommendation again this is uh causes a lot of serious things circle epiglottitis because that is a respiratory condition where the flap over the trachea gets very swollen and you're going to get a lecture on it but we know that since we've given this vaccine the incidence of hypoglotitis has decreased at least 40 percent in presentations now this epiglottitis can be due to many things but largely uh often it's this bacteria so this is a great vaccine and again spread person to person and treated with antibiotics the dtap the diphtheria tetanus acellular that means they broke the wall of the pertussis valent and made it less potent protects against the bacteria and you can see they give this 2 4 6 15 18 months four to six years before kindergarten is when they do this and then before junior high and they get a booster every 12 years so they ask a lot about this and partly because we have had pertussis outbreaks occasionally we've had some tetanus no diphtheria respiratory diphtheria we have not seen so in the past before it was the acellular there were some bad reactions and since they broke it down about 10 15 years ago to the acellular it is very has been very safe a few reactions the big one here is history of seizures three days after the vaccine know that so if somebody comes in and gives a history of a seizure after the last set of vaccines then that's a contraindication uncontrollable crying up to three hours that's a hard one for new pediatric students because babies cry a lot and uncontrollable crying is very rare where it goes on and on and on and there's nothing that will stop it so this is the big one they ask and if they do have this that they can't stop them totally with every trick in the book then it's usually um some kind of inflammation and makes them an injuries irritable so they cry that's the main thing about the dtap so what are these diseases the corny bacterium diphtheria one thing about that we haven't seen it for years but children back in the 50s 60s were dying of a severe severe respiratory condition that went into uh quickly bacterial left sent out a toxin and they couldn't breathe and one clinical thing they always want you to know is about the pseudo membrane on the back the throat which we haven't seen fortunately in the united states but you might in the future it doesn't look like strep it doesn't look like pharyngitis i'll show you a picture and then contact respiratory or skin the treatment is an anti-toxin and the complications are severe death kids kids would die very quickly after they got this so this vaccine has been great and well received there's that pseudo-membrane clostridium tetanus to protect against clostridium tetani which you we know if you're in an mba they'll always ask you if you had your tetanus booster and if you blink and you don't say yes right away you get it which is a good thing because we have had a couple cases of this uh outbreak the treatment is it is the um penicillin and then if they're if they do have this they get the immune globulin the passive immunity and the booster if they have an open wound or anything but they can't have paralysis and death little neonatal tetanus kids don't do well at all there's a thirty percent mortality and then border dela pertussis uh that's the dtap part we protect against whooping cough which has been around and and it still exists i had it a couple nurses up on one of the units had a couple residents it's droplets so always if there's anybody coughing and you're close contact put a mask on because sometimes they haven't diagnosed it yet um they don't always look for pertussis parents they'll say they're vomiting and yeah they are vomiting because they're coughing so you can get exposed to this always get your tenure booster and the treatment for this is erythromycin so we used to time the cough that's what the doctors would want to know how long they coughed and how often an hour and then that before they had the nasal swab that's how they would diagnose it so meningococcal is your population it's young 15 to 25 30. it's recommended for all kids in colleges and there's two doses but now for high risk it's also on the schedule for babies it's a very good injection this disease really is serious and as you know the people die quickly so the word the bacterial meningitis range of coxemia meningitis it can cause sepsis or it can go across the blood-brain barrier and cause meningitis and it's often misdiagnosed as the flu so um one thing if they are on antibiotics they're not contagious after 24 hours which is always amazing how wonderful the antibiotics are but the studies show that they take the isolation off after 24 hours and this is how it's transmitted and it's treated with penicillin i suggest you get your booster because my my daughter's friend died over in spain and it was very quick my kids were not vaccinated they are now all the pediatricians get them vaccinated because they know that how potent this bacteria is so these are the little petechiae if you ever see these when you're doing an assessment on somebody that's concerning and then it goes into this and then we pretty much know it's meningococcemia one year we had five little kids i could remember have amputations from back from meningococcemia good morning okay this last uh section is on viruses that are pretty well discussed in the united states because we've had outbreaks measles mumps and rubella the mmr is a little bit different than the inactivated killed vaccines it's live attenuated and it's also different in that it's not given until the child is 12 months of age not 11 months and 6 days but 12 months chronologically and then it's repeated before they go to junior kindergarten or junior high they miss him in kindergarten we have had measles outbreak so you'll hear about this and the side effects of this are usually nothing but um these are things that something like maybe under five percent might might have this is given sub q and i can tell you it burns this is the injection this and miracel i would give last there with live attenuated i'll say this again but they are not allowed to have had a recent blood transfusion within 11 months three to 11 months they shouldn't be pregnant or be getting pregnant and they shouldn't be allergic to neomeister and gelatin specifically for mmr and the reason for the transfusion and the pregnancy is it's stratogenic possibly but also they can't build up the immunity if they have a history of a immunoglobulins or blood transfusions so they always check that the rabiola virus is a paramyxavirus and i'll show you some pictures but it's confluent it affects the conjunctiva systemic they are very sick it's airborne respiratory transmission and we have had outbreaks of this recently and there's studies going on it is not a good disease to get because you can get measles pneumonia you can get horrendous diarrhea and dehydration in other countries children die otitis media they're very sick so this was a good virus one thing you need to know is the complex spots the white specks on the oral mucosa is the clinical diagnosis and that's always on a test this is a confluent rash it runs together it's not just macular and not just popular but there's very little skin in between the complex spots you need to know those on the oral because the conjunctiva is involved and here again there's very little skin that's not raised or involved with the rash and then mumps is the product land is inflamed with with a virus and this is we haven't had too many outbreaks of this in the united states but we have had a lot of people in the deaf school and stereo sterile males especially so this was a great vaccine we we've eliminated some complications rubella listen up because this is one that crosses over to ob and this is a mild mild virus three days that we didn't even know existed except that pregnant women got in the first trimester and had a teratogenic effect on the babies which had intrauterine growth retardation extra digits and they identified these these symptoms in the babies and then they studied the moms and found out that they'd had this mild rash in the first trimester and they gave it a name rubella so same thing as mmr this also can be given uh separately to mothers who are discharged uh from having babies if their titers low and then this actually is what i was talking about with the virus know the difference between rubella and rubiola rubella we it's really hard to diagnose because there's so many mild rashes the only way we found this out was by the turret of genesee the virabx this is an interesting one is the name of the vaccine for chickenpox again it's not given until one year not seven months and three days i can't have it it's given sub q it burns and chickenpox is the varicella virus the symptoms can be uri burning itching little papules and then they get the vesicles they'll show you some pictures of it and at first they get an upper respiratory disease fever melee itching the incubation is 10 to 21 days in most books the communicability is they're contagious a few days before the onset i believe ati says three or four some books is a little different but before the onset of the rash until the lesions are crested or scabbed over complications we saw a lot of complications so this is a good thing so what is shingles shingles is a reactivation of the chickenpox uh varicella that gets down into the dermatomes in the nerve endings when you have the disease since we've had the varicella vaccine those people who are vaccinated who don't get the disease usually don't get shingles and that's important now the shingles vaccine the herpes zoster is uh only recommended for people over 55 right now people would like to get it because it's not just elderly people that get shingles so there's a little papule that's health starts out after the uri then they get a vesicle and then it eventually this little guy actually is not contagious because he's not draining so he's scabbed over and the polio we have eradicated polio in the united states knock on wood this is not a live attenuated the live attenuated i've mentioned so far are rotavirus mmr and varivax this one again is like the rest of them inactivated poliovir vaccine it's due right here very few side effects now i want to mention the opv the oral polio vaccine is given all over the world and when we first got that little liquid it was in a cup or a plastic tube that they scored on the side of the child's face mouth everybody ran and got it because nobody wanted to be paralyzed and everybody saw the kids on crutches and things so everybody got vaccinated but then the studies we still had polio outbreaks and what could they do they studied it down cincinnati dr saban salko invented it and they found out that the oral polio was a live attenuated and it was going in the gi tract and grandma who was immunosuppressed was changing the diaper and contracting polio so we told dr steven insult cincinnati children's to please come up with a better immunization and they did so the united states now uses the inactivated shot and not the oral polio and since 1979 we have not seen knock on wood uh polio disease other countries they still use this because it's cheaper this was just what it says if i don't mention the communicability and the um incubation period it's probably not real important no chickenpox and no measles that's a hot one pertussis is important in other countries you'll see these little guys all over the streets because they just don't have the money to take care of children that are disabled mononucleosis is viral but it's the epstein-barr virus and it affects your population it's in the saliva and the important thing is it's very inflammatory i saw a child get so swollen they admitted her and she died on the way to the picu because of her uh lymphadenopathy and her tonsils are stolen the spleen is very important because if it's systemic and they um they have in large spleen we worry that it would rupture so sometimes they come in and they do strep culture and they diagnose it as pharyngitis and the mom would say this child is really really sick and the doctor would lay them down and check this plane so know this because this is the concern when you hear that kids can't go to school when they have to be on bed rest usually the spleen is enlarged otherwise it runs its course some are very sick as you know some of you probably had it and there's no vaccine and there's no real treatment because it's a virus but it can be confused with strep and so uh when they do think the monospot is sometimes negative in little kids but sometimes they'll give erythromycin instead of amoxicillin if that's because it can be strep and mono but the rashform amoxicillin looks like a rash they sometimes get with mono so that's just a side note for the fact that children do get it and sometimes this diagnosis is is missed so always teach health promotion there's no vaccine watch the spleen if you get a child admitted teenager or someone with mono you have great respect that their airway can be very very inflamed so do a good assessment of that the flu vaccine how many times have you heard oh i i'm not getting the flu vaccine because i always get the flu when i get the flu vaccine well that's true because there's 20 strains of flu out there but the cdc and the acip study every year the two most dangerous flus that are predicted to outbreak and they come up with that and you have to decide what you feel about vaccines but i i definitely believe that it's better to get it now they're not a hundred percent you can still get the flu uh this last year it was not as good as it is some years the thing about this is they do make if you're allergic to eggs there's another way that they do break it down and not in eggs but you should know that that that's the allergy that you have to check for are they safe that's up to you uh hopefully we'll have time to discuss because i'm not going to go over this lecture in class since you can listen to it as many times as you want and maybe we'll have time to discuss if you believe in vaccines but the cdc the academy of pediatrics family practice and immunization practice all study these pre-trials post-trials during administration they do it in animals before they do it in humans and they've taken it off the market when they found problems like for example the rotavirus vaccine that i talked about so yes i believe in vaccines i've seen children die of most of these conditions that people sometimes are hesitant to get vaccinated our rate in a lot of areas is eighty percent not a hundred we still have people that refuse so as a bsn you need to be able to say why you believe in vaccines or why you don't because people listen to you so the one thing be careful with this if somebody has a seizure it has to be reported if somebody uh has a gillian beret reaction with ascending paralysis weakness they have to report it and if they do have a grand mal or tony clonic seizure and they vomit and aspirate their brain damage guess what they're going to sue everybody in the vicinity the office but they do not get money from the doctors and the nurses because you guys are going to know how to do vaccines correctly in document but it does happen and so it goes through the national vaccine injury compensation program and that's where they get their settlement from otherwise doctors would not get vaccines because they make no money they just do it because they don't want childhood diseases in their practice i'm going to go over these in class but all these except vomiting as you know and which protect against viral diseases well i happen to know that this is a bacteria so that's not the answer but i do know that these c would be the answer here because i happen to know that those are all viral and as far as protecting against bacterial diseases that would be dtap meningococcal and hemophilus influenza that's a bad bacteria so that's a good way to start learning these so a contraindication as i said would be a seizure within three days after the dtap or any vaccine i call the cdc on that one i'm like why why would they stop vaccines and they said well there's a chance that it could have been to something so that they made that decision that when you get vaccines you have to ask what happened at last set of vaccinations so this is a contraindication this is a distractor this is a distractor and this is a distractor so learn to pick out those things that don't make any sense and trust yourself this would be lethargy now children will do this they're scared if you give it in the vastus lateralis or that area it's they're not going to have any nerves so but they might not move it if it hurts they might be afraid they might not move their other leg either so you have to talk to kids and find out what they're thinking but lethargy or non-responsive those things we send kids to the er for we don't even have them come to the office they the kids should have head leg like hold her head up when you pull a little baby up if their head's back and they're floppy and they can't you can't wake them up they need to get to the er and then these are expected so these are just a few um we we do give vaccines if somebody's got a temperature of 101 and they're playing and they're eating we give the shot because they're probably healthy enough to build up the immunity and they may not come back they may not come back for six or eight months and then they might get the disease so we don't want to miss an opportunity but if they're very ill then we don't because they can't build up the immunity and premature infants we get vaccines on the same chronological schedule so if they're born at 38 weeks they can get their hepatitis b at 38 weeks they don't have to wait until 40 weeks and that is pretty much the end of the vaccination communicable disease that's a lot of information and i hope you listen to this because i'm going to do some creative things when you come to class to reinforce it please email me any questions