Immunity/Vaccines

● Types of Immunity
○ Active: a state where immune bodies are actively formed against specific antigens, either
naturally by having has the disease or artificially by introducing the antigen into the
individual.
○ Passive: temporary immunity obtained by transfusing immunoglobulins or antitoxins
either artificially from another human or an animal that has been actively immunized
against an antigen or naturally from mother to fetus via placenta.
● Types of Vaccines
○ Killed Virus: inactivated virus consisting of the virus particles or bacteria
■ IPV, Hep B, Hep A
○ Toxoid: a toxin that has been made harmless, but elicits an immune response against the
poison.
■ Diphtheria, Tetanus, Botulism
○ Live Virus: weakened form of the virus
■ MMR, Varicella
■ Oral: rotavirus
○ Recombinant: inserting an antigen that stimulates an immune response from the body to
create memory cells
■ HPV, Pertussis
○ Conjugate: a weak antigen is attached to a strong antigen to elicit a stronger immune
response
■ HIB, Meningococcal, Pneumococcal
● Contraindications
○ Do not administer live virus to immunocompromised children.
● Requirements
○ Administer IM in the vastus lateralis or ventrogluteal in infants and young children
○ Administer IM in deltoid for older children and adolescents
● Consent
● TB Screening
○ Begins at 12 months
○ Who? High risk (known exposure, traveled out of country, homeless shelters and nursing
homes)
Immunization Schedule
● Hepatitis B (Hep B)
○ Age: Birth
○ Doses: 3
○ Schedule
■ Birth
■ 1-2 months
■ 6-18 months
○ Considerations
■ Final dose no earlier than 24 weeks of age and at least 16 weeks after the first
dose.
 ■ Withheld for prematurely born infants weighing less than 2000 grams.
■ Administration
● Newborns: IM in vastus lateralis
● Older infants/children: IM in deltoid
● AVOID: dorsogluteal - associated with low antibody conversion rate
indicating reduced immune response
○ Adverse Effects
■ Redness, swelling, warmth at injection site / low grade fever
○ Contraindications
■ Allergy to yeast
● Rotavirus (RV)
○ Age: 6 weeks
○ Doses: 2
○ Schedule
■ 2 months
■ 4 months
○ Considerations
■ First dose given before 14 weeks
■ Last dose given before 8 months
○ Adverse Effects
■ Irritability
■ Mild diarrhea / vomiting
○ Precaution
■ Chronic GI diseases
■ Spina Bifida
■ Immunocompromised
● Diphtheria, Tetanus and Acellular Pertussis (DTaP)
○ Age: 6 weeks
○ Doses: 5
○ Schedule
■ 2 months
■ 4 months
■ 6 months
■ 15 - 18 months
■ 4 - 6 years
○ Considerations
■ Minimum of 6 months between doses three and four.
○ Adverse Effects
■ Mild: redness, swelling and tenderness at injection site / low grade fever
■ Moderate: seizures / shock like state
○ Contraindication
■ Occurrence of encephalopathy within 7 days of prior doses
○ Precaution: progressive neurological disorders and uncontrolled seizures
● Tetanus, Diphtheria and Acellular Pertussis (Tdap)
 ○ Age: 10 years
○ Doses: 1
○ Schedule
■ 11 - 12 years
■ Booster every 10 years
○ Considerations
■ Booster Tdap every 10 years after administration of DTaP
● Haemophilus Influenzae Type B (Hib)
○ Age: 6 weeks
■ Hiberix: 12 months
○ Doses: 3 - 4
○ Schedule
■ 2 months
■ 4 months
■ 6 months (if 4 dose series)
■ 12 - 15 months (booster dose with any Hib - containing vaccine)
○ Considerations
■ Administer Hiberix as a booster dose at 12 months to 4 years of age only if a
prior dose of Hib was received
■ First dose not given to any age younger than 6 weeks
■ For? Reduce risk of bacterial meningitis and bacterial pneumonia
● Pneumococcal Conjugate (PCV13)
○ Age: 6 weeks
○ Doses: 4
○ Schedule
■ 2 months
■ 4 months
■ 6 months
■ 12-15 months
○ Considerations
■ Administer one time dose of PCV12 to children who are 14 to 59 months of age
■ For? Protection against otitis media, sinusitis, and pneumonia
○ Contraindication
■ Anaphylactic reaction to any vaccine containing diphtheria toxoid
● Inactivated Poliovirus (IPV)
○ Age: 6 weeks
○ Doses: 4
○ Schedule
■ 2 months
■ 4 months
■ 6-18 months
■ 4-6 years
○ Considerations
■ Final dose administered on or after the age of 4 years and at least 6 months from
 the previous dose.
○ Contraindication: neomycin allergy
● Measles, Mumps, Rubella (MMR)
○ Doses: 2
○ Age
■ 12 to 15 months
■ 4 - 6 years
○ Adverse Effects
■ Mild: local reactions
■ Moderate: joint pain, febrile seizure, low platelet
■ Severe: deafness, brain damage, thrombocytopenia
○ Contraindication: Pregnant; immunocompromised (corticosteroids)
● Varicella (VAR)
○ Doses: 2
○ Age
■ 12 to 15 months
■ 4 - 6 years
○ Adverse Effects
■ Mild
● Injection site tenderness
● Rash
■ Moderate
● Seizures
■ Severe
● Pneumonia
● Low blood count
○ Contraindication: neomycin allergy, pregnant, immunocompromised (corticosteroids)
● Hepatitis A (Hep A)
○ Dose: 2
○ Age
■ 12 - 23 months
■ 6 - 18 months
○ Adverse Effects
■ Tenderness at injection site
■ Headache
○ Contraindication: latex allergy
● Human Papillomavirus (HPV)
○ Dose: 3
○ Age
■ 11 - 12 years
■ 1 - 2 months after first dose
■ 24 weeks after first dose
○ Contraindication: yeast allergy
Rashes
 ● Transmission: Standard Precautions
● Pediatric Rashes
○ Childrens skin is thinner and more sensitive → heat aggravates most skin rashes and
will cause itching.
● Describing a rash
○ Size - Location
○ Shape - Warmth
○ Type - Color
○ Distribution (linear, circular, general)
○ Dry/oozing
● Nursing Interventions
Infectious Diseases
● Chicken Pox (Varicella)
○ What? A viral disease which is most contagious 1-2 days before the rash and continues
until all lesions are crusted over.
○ Transmission: direct contact with lesions / airborne secretions
○ Clinical Manifestations
■ Pre rash
● Fever / fatigue / headache
■ Rash
● Macules start in center of trunk and spread to face and proximal
extremities
● Progresses from macules → papules → vesicles → crust formation
● Scabs appear within 1 week
○ Nursing Care
■ Symptomatic Tx
● Antipyretic for fever (no aspirin = reye’s syndrome)
● Analgesic for pain
● Antipruritic for itching
■ Skin Care
● Calamine for topical relief
● Keep skin clean and dry
● Baths in tepid water
● Loose clothing
● Change linens daily
● Coxsackievirus
○ What? A viral disease.
○ Transmission: fecal-oral / respiratory (droplet)
○ Clinical Manifestations
■ Hand-Foot-Mouth Disease → lesions on cheeks, gums, sides of tongue, hands
and feet for 7 -10 days.
■ Herpangina → acute sudden onset of fever, sore throat, and small discrete
grayish papulo-vesicular ulcerative pharyngeal lesions.
● Measles/Rubeola
○ What? A childhood infection caused by a virus.
○ Transmission
■ Direct contact
■ Droplet
○ Clinical Manifestations
■ 3 - 4 days pre-rash
● Photophobia
● Mild to moderate fever
● Conjunctivitis
● Fatigue
● Cough, runny nose, red eyes, sore throat
■ Rash
● Koplik spots (tiny white spots) on buccal mucosa two days pre rash
● Confluent rash (dark red to purple / blotchy maculo-papular) that begins
on the face and spreads downward
● Spike in fever with the rash
○ Nursing Care
■ Symptomatic Tx
● Antipyretic for fever (no aspirin = reye’s syndrome)
● Analgesic for pain
● Antipruritic for itching
■ Skin Care
● Calamine for topical relief
● Keep skin clean and dry
● Baths in tepid water
● Loose clothing
● Change linens daily
● Mumps
○ What? A viral infection that affects the salivary glands located near your ears.
○ Transmission
■ direct contact
■ droplet
○ Clinical Manifestations
■ Painful, swollen parotid gland
■ Earache made worse by chewing
■ Fatigue and loss of appetite
■ Fever and muscle aches
○ Prevention
○ Nursing Care
■ Symptomatic Tx
● Antipyretic for fever (no aspirin = reye’s syndrome)
● Analgesic for pain
● Antipruritic for itching
 ■ Skin Care
● Calamine for topical relief
● Keep skin clean and dry
● Baths in tepid water
● Loose clothing
● Change linens daily
● Pertussis “whooping cough”
○ What? Highly contagious respiratory disease caused by gram negative bacteria
Bordetella Pertussis.
○ Transmission
■ Direct contact
■ Droplet
■ Indirect contact with freshly contaminated articles
○ Clinical Manifestations
■ Begins as an upper respiratory disease then worsens with a prolonged coughing
(in 1-2 weeks)
● Crowing or whooping upon inspiration.
■ Lasts 4-6 weeks / contagious until 5-7 days after antibiotics begin
■ Coughing can induce → cyanosis, emesis, secretions…
○ Complications
■ Pneumonia
■ Hemorrhage
■ Seizures
○ Nursing Care
■ Symptomatic Tx
● Antipyretic for fever (no aspirin = reye’s syndrome)
● Analgesic for pain
● Antipruritic for itching
● Antibiotics (erythromycin)
■ Skin Care
● Calamine for topical relief
● Keep skin clean and dry
● Baths in tepid water
● Loose clothing
● Change linens daily

● Rotavirus
○ What? A contagious virus that can cause gastroenteritis (inflammation of stomach and
intestines)
○ Transmission
■ Contact via particles
■ Spread through feces
○ Clinical Manifestations
 ■ Severe watery diarrhea (3 - 8 days)
■ Vomiting
■ Fever
■ Abdominal pain
○ Nursing Care
■ For dehydration
■ Handwashing
● Rubella
○ What? Three day measle infection caused by rubella virus where a rash may start around
two weeks after exposure and lasts for three days.
○ Transmission:
■ Direct contact
■ Droplet
○ Clinical Manifestations
■ Low grade fever / sore throat
■ Headache / malaise / Lymphadenopathy
■ Enlarged tender lymph nodes at the base of the skull and behind the ears
■ Red rash that begins on face and spreads to rest of the body, lasting 2-3 days
○ Nursing Care
■ Symptomatic Tx
● Antipyretic for fever (no aspirin = reye’s syndrome)
● Analgesic for pain
● Antipruritic for itching
■ Skin Care
● Calamine for topical relief
● Keep skin clean and dry
● Baths in tepid water
● Loose clothing
● Change linens daily
● Contact Dermatitis
○ What? An inflammatory reaction of the skin caused by contact with chemicals or irritants.
■ Caused by? Clothing dye, laundry detergent, body soap, tight clothes, rough
clothing and irritation from soiled diaper.
○ Clinical Manifestations
■ Contact Dermatitis
● Red bumps that can form moist, weeping blisters.
● Oozing, drainage or crusts.
● Raw, thick skin.
■ Diaper dermatitis
● Bright red rash that extends / small red patches that blend together
○ Tx
■ Antihistamines
■ Antifungals
● Poison Ivy
 ○ What? A plant leaf that has a poisonous oil which causes a delayed hypersensitivity
response.
○ S/S → begins as itching with a mild rash and gradually worsens, developing into a red
raised rash.
■ Bumps turn into blisters
○ Tx
■ OTC corticosteroid cream
■ Oral antihistamines
■ Calamine lotion
● Impetigo
○ What? A highly contagious superficial infection of the skin, which is seen most often on
the face and extremities.
○ Transmission: direct contact
○ Clinical Manifestations
■ Macular rash that progresses to a papular/vesicular rash
■ Erupts and forms a moist, honey colored crust.
○ Tx: topical bactericidal or triple antibiotic ointment
● Eczema
○ What? A condition of redness, scaling vesicles and crusting which presents as an allergic
response or reaction to stress.
○ Common sites: warmer, wetter areas of the body.
○ Nursing Interventions
■ Reduce itching and scratching
■ Avoid irritating fabrics
■ Apply steroidal topical creams or antihistamines
● Tinea (infection with fungus)
○ Tinea capitis (hair)
■ S/S: scaly, circumscribed lesion with alopecia on the scalp.
■ Tx: oral antifungal agents (griseofulvin, terbinafine, fluconazole)
○ Tinea corporis (ringworm) → affects the trunk extremities and groin area
■ S/S: round erythematous scaling patch which spreads peripherally and clears
centrally
■ Tx: topical antifungal medication over two weeks
○ Tinea cruris (jock itch)
■ S/S: medical and proximal aspects of the thigh and crural folds; rounds
erythematous scaling patch
■ Tx: topical antifungal medication over two weeks
○ Tinea pedis (athlete's foot)
■ S/S: between toes or on the plantar surface of the feet
■ Tx: topical antifungal medication over two weeks
● Candidiasis/Thrush
○ What? A yeast like fungus that is most often found in the GI tract, skin and vagina which
grows most often in moist warm areas.
○ Cause: oral antibiotic therapy and hyperglycemia
 ○ Clinical Manifestations
■ Complaints of itching, burning and irritation
■ Mouth: white plaque with a bright red surface underneath
■ Skin lesions: red and moist
○ Interventions
■ Oral: administer oral antifungal suspension
■ Skin: keep dry and wear loose clothing
● Scabies
○ What? A contagious mite infection which is usually contracted by close body contact
with infected individuals.
■ The mite will burrow into the skin and deposit eggs which hatch over 30 days
and travel to the skin (incubation 1-2 months)
○ Transmission: close body contact with infected individuals
○ Clinical Manifestations
■ Presence of itching that worsens at night
■ Presence of rash between fingers, wrists, genitals, waist, buttocks, knees and
elbows.
■ Observe skin for burrows that may be linear, curved or S shaped.
○ Nursing Interventions
■ 5% permethrin cream to remain on skin for 8-14 hours, repeat in 1-2 weeks.
■ Treat those who came in contact with infected persons
■ Itching → calamine
○ Tx: scabicide on skin for 8 to 14 hours; repeated in 1-2 weeks
● Pediculosis Lice
○ What? Caused by a blood obligate parasite that must feed every day and lives close to the
scalp.
○ Transmission: contact
○ Clinical Manifestations
■ Egg shells (nits)
■ Intense pruritus of the scalp
■ Secondary infections from scratching
○ Nursing Interventions
■ 1% permethrin OTC medications → follow directions
■ Wash hair → remove nits with comb → wash all linens and clothes
● Acne
○ What? Bacteria associated with inflammation or hormonal stimulation causes an increase
in sebaceous gland activity.
○ Clinical Manifestations
■ Lesions which are open (blackheads) or closed (whiteheads)
■ P. acnes can lead to inflammation manifesting as papules, pustules, nodules or
cysts.
○ Tx
■ Tretinoin
■ Antibiotic - Benzoyl peroxide
■ Isotretinoin
■ Oral contraceptives