CASE STUDY #1

Group 1: Manalili, Manata, Mangaoang, Marcaida

A 12-month-old patient presents for a routine well-child care visit. This patient is
new to your practice and has no immunization records. What do you do?

STEP-BY-STEP CARE:

a. Introduce self and greet clients appropriately

b. Perform hand hygiene and ensure cleanliness
c. Take patient’s vital signs
d. Explain how important are the vaccines to the client’s mother and what vaccines
can the client take

BACKGROUND OF THE STUDY:

The Expanded Program on Immunization (EPI) was established in 1976 under

PD 996 to ensure that infants/children and mothers have access to routinely
recommended infant/childhood vaccines. Six vaccine-preventable diseases were initially
included in the EPI: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis, and
measles. Furthermore, by 2011 it was amended which created RA 10152 that mandates
basic immunization for all infants and children that covers vaccine-preventable
diseases: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis, and measles,
mumps, rubella, hepatitis B, and influenza type B. In relation to the case of the patient,
the immunization for measles, mumps, rubella is not yet given since the schedule for
MMR vaccine is given for 12 months of age. Since the patient has no immunization
record, it is our duty to ask the mother of the patient for a history of vaccination and plan
a catch-up vaccination; assuming that the vaccines have not been given.
 DRUG STUDY:

Vaccine Dosage Frequency Purpose Route Nursing Responsibility

Measles-Mumps- 0.5mL Given at the The MMR vaccine Subcutaneous ● Withhold vaccine and notify the physician if
Rubella (MMR) age of 12 is a vaccine against the patient has a history of hypersensitivity
months measles, mumps, to eggs or current febrile infection
and rubella
(German measles) ● Assess for signs and symptoms of
anaphylaxis and have epinephrine available

● Do not administer MMR Vaccine to

individuals with an active febrile illness with
fever >38.5°C

Varicella 0.5mL A single dose Vaccination against Subcutaneous ● Withhold vaccine and notify the physician if
is given to varicella in the patient has a history of hypersensitivity
patients 12 individuals 12 to neomycin or current febrile infection
months of age months; A live
to 12 years attenuated vaccine ● Monitor for signs and symptoms of
that acts against hypersensitivity and administer epinephrine
both chickenpox if an anaphylactic reaction occurs
and shingles in
healthy children
and adults

Hep A 0.5mL 2 doses given Active Intramuscular ● Assess for signs and symptoms of
to 12 months of immunization anaphylaxis and have epinephrine available
age with a 1- against hepatitis A;
month interval Antibody levels are ● Do not administer during a febrile illness
50- to 300-fold
Booster dose higher with ● Monitor for anaphylaxis and syncope for 15
(0.5 mL) may inactivated hepatitis minutes following administration; If seizure-
be given at 6– A vaccine than with like activity associated with syncope occurs,
12 mo after passive immunity maintain the patient in supine or
primary doses with human Trendelenburg position to reestablish
 immune globulin adequate cerebral perfusion

Pneumococcal 0.5mL Give three Pneumococcal Intramuscular ● Assess for signs and symptoms of
Conjugate (PCV) doses at the Conjugate Vaccine anaphylaxis and have epinephrine available
age of 6, 10, (PCV) is for the
and 14 weeks. Prevention of
If the invasive infections,
vaccination pneumonia, and
history is 0 or acute otitis media
unknown, due to
giving two Streptococcus
doses. Give pneumoniae, in
dose on the children from 6
visit then weeks of age
followed by the
second dose at
least 8 weeks
apart.
(CDC,2021)

DTaP-IPV-HiB 0.5mL Give one dose This vaccine is Intramuscular ● Assess for signs and symptoms of
for booster for indicated for active anaphylaxis and have epinephrine available
age 12-23 immunization
months against diphtheria,
(WHO,2020) tetanus, pertussis,
poliomyelitis and
invasive disease
due to
Haemophilus
influenzae type b

Hepatitis B 0.5mL Give one dose To promote active Intramuscular ● Assess for signs and symptoms of
for booster immunity in anaphylaxis and have epinephrine available
individuals at high
risk of potential
exposure to
 hepatitis B virus or
HBsAg-positive
materials

Nursing Care Plan:

Assessment Nursing Outcome Nursing Interventions Rationale Evaluation

Diagnosis

Subjective Risk for anxiety Short Term Goal: 1. Familiarize the 1. Awareness of Goal met.
Cues: related to patient with the the environment
unfamiliarity After 4 hours of environment and promotes Short Term Goal:
The mother towards nursing intervention
new experiences comfort and
stated, environment, the patient will be After 4 hours of
“Natatakot siya staff, and able to: or people as may decrease nursing intervention
kapag knowledge & needed. anxiety the patient was able
nakakakita ng di practice of ● Appear experienced by to:
kilalang tao” immunizations Relaxed and the patient.
report Anxiety may ● Appear
anxiety is intensify to a Relaxed and
reduced to a report anxiety
panic level if the
manageable is reduced to a
level patient feels manageable
threatened and level
● Verbalize unable to
readiness for control ● Verbalize
immunization environmental readiness for
stimuli. immunization

2. Converse using a 2. When

simple language experiencing
and brief moderate to
 statements. severe anxiety,
patients may be
unable to
understand
anything more
than simple,
clear, and brief
instruction.

3. Assess client’s 3. Helps to clarify

concerns plans or and
regarding deal with
immunizations. misconception
or myths.

4. Explain all 4. With pre

activities, admission
procedures, and patient
issues that involve education,
the patient; use patients
nonmedical terms experience less
and calm, slow anxiety and
speech. Do this in emotional
advance of distress and
procedures when have increased
possible, and coping skills
validate the because they
patient's know what to
understanding. expect.
Uncertainty and
lack of
predictability
 contribute to
anxiety

5. Introduce 5. To divert patient

diversional attention to non-
activities such as less fearful
playing with toys situations
or instruments.

Assessment Nursing Outcome Nursing Interventions Rationale Evaluation

Diagnosis

Objective Risk for infection Short Term Goal: Short Term Goal:
Cues: related to 1. Identify all due 1. Many vaccines
incomplete After 1 hour of vaccines that can can be given at After 1 hour of
No immunization nursing intervention be provided the same visit to nursing intervention
immunization series the patient’s mother simultaneously. more adequately the patient’s mother
records will be able to: protect the child. was able to:

● Demonstrate 2. Identify potential 2. Reduces the risk ● Demonstrate

hygienic contradictions to for the child and hygienic
measures needed vaccines. other caretakers measures like
like oral care to have adverse oral care and
and reactions to the handwashing
handwashin vaccines.
g
3. Monitor for signs 3. Signs and
● Verbalize and symptoms of symptoms may ● Verbalize
which infection. vary according which
infections to to which body infections to
watch out for parts are watch out for
involved.
 ● Show ● Show
capability to 4. Wash hands or 4. Friction and capability to
recognize perform hand running water recognize
signs of hygiene before effectively signs of
infections having contact with remove infections
the patient; Also microorganisms
impart these duties from hands.
to the patient and Washing
their significant between
others. procedures
reduces the risk
of transmitting
pathogens from
one area of the
body to another.

5. Discuss 5. To help the

management of guardian
common side understand that
effects. the client may
feel side effects
because of the
medication such
as muscle pain,
rash, fever, site
swelling, etc.

HEALTH TEACHING

Health Education
Purpose: To educate the family regarding the importance of immunization and its recommended schedule
Goal: To reduce the morbidity and mortality of vaccine-preventable diseases
Objectives Content Outline Method(s) of Time Resources Methods of
Teaching Allotted (Instructional Evaluation
 Materials)
Following a 20-
minute teaching
session, the family
will be able to:

Identify - Immunizations, also Discussion 3 minutes Poster Question and Answer

immunization and known as vaccinations,
its importance and help protect you from
purpose getting an infectious
disease. When you get
vaccinated, you help
protect others as well.
Vaccines are very safe. It
is much safer to get the
vaccine than an
infectious disease.

Learn the different At birth: Discussion 5 minutes Checklist Question and Answer
vaccines needed in a. Bacillus Calmette–Guérin
the previous years (BCG) Vaccine
b. Hepatitis B Vaccine

6th, 10th week:

a. Rotavirus Vaccine

6th, 10th, 14th week:

a. Pentavalent Vaccine
b. Oral Polio Vaccine
c. Pneumococcal
Conjugate Vaccine
 14th week:
a. Inactivated Polio Vaccine

9th month:
a. Measles-Rubella (MR)
Vaccine

Identify the needed 12th month: Discussion 5 minutes Checklist Question and Answer
vaccinations of a a. Measles-Mumps-Rubella
12-month-old and Vaccine (MMR)
its purposes b. Varicella Vaccine
c. Hepatitis A Vaccine

*Catch-up Vaccines:
d. Pneumococcal
Conjugate Vaccine
(PCV)
e. DTaP-IPV-HiB Vaccine
f. Hepatitis B Vaccine

Discuss the things - The child may Discussion 3 minutes Poster Question and Answer
to know and experience mild and
remember after temporary reactions as
immunization part of the body’s normal
response. These may
include temporary
discomfort, redness,
soreness, and/or swelling
at the injection site; or
low-grade fever. If
reactions persist or if
there are any other
 reactions observed,
consult the nearest
health center or hospital.

Express outlook, - Let the patient and Interactive 4 minutes Pamphlet Open Forum
concerns regarding guardian raise their Discussion
immunization questions for clarification
and other queries
towards immunization

CASE STUDY #2
Group 2: Malones, Malves, Manalad

2 month-old patient presents for routine well child care visit. This patient is new to your practice. Brings
immunization records. Patient is up to date with the exemption of the 12 month-old shots. No record of birth Hepa B. What
do you do?

Since the patient is up for a well-child visit, as a nurse we would have to do a physical
assessment.

1. Weigh the child

2. Measure their head, chest circumference as well as their length.
3. Take the child’s vital signs; temperature, respiratory rate, pulse rate.

Nursing Care Plan:

Assessment Nursing Outcome Nursing Interventions Rationale Evaluation

 Diagnosis

Subjective: Risk for disease After 1 hour of 1. Vaccinate the child with - This will immunize the Child is complete with
related to nursing intervention pentavalent vaccine. child to hepa b virus as their age-required
Immunization incomplete the patient will be pentavalent contains vaccines.
record: immunization able to: hepa b and become
Hepa B vaccine series  Be protected as the child Child is immune to
not given at adequately was not given at birth. Hepa B virus.
birth, protected
from vaccine- - Many vaccines can be
preventable 2. Identify all due vaccines given at the same visit
illnesses. that can be provided to more adequately
simultaneously protect the child. This
also saves health care
trips for families.

- Identify potential
3. Identify potential
contraindications to
contraindications to
needed vaccines.
needed vaccines. Review
Review past reactions
past reactions to
to vaccines.
vaccines.

Assessment Nursing Outcome Nursing Interventions Rationale Evaluation

Diagnosis

Subjective: Knowledge After 1 hour of 1. Educate the parents - It is important for Parents could report
deficit related to nursing intervention about the need for specific parents to be aware of all side effects to the
Immunization potential side the parents will be vaccines and the risk if how crucial it is for their health care provider.
record: effects of not able to: not given and obtain child to be completely
Hepa B vaccine having the signed consent before vaccinated in order to The child is given
not given at vaccine.  Learn about giving the vaccine. be protected from comfort measures
birth, the vaccine diseases and informed after vaccine
and will sign consent is required for administration.
consent for giving vaccinations.
 the vaccine
to be given. 2. Describe - Parents
serious side effects that need to be prepared for
 State the should be reported to potential side effects so
side effects health care providers. they can obtain care
of vaccines immediately.
given. 3. Describe common - Parents should expect
potential reactions and common reactions and
 Manage the why they occur. know they indicate the
common side child’s body is building
effects of protection to the illness.
vaccines.