02.09 Immunizations (Vaccinations)

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Overview

  1. Immunizations
    1. Primary prevention
    2. Types of immunizations
    3. Immunization safety

Nursing Points

General

  1. Prevention
    1. Stimulates immune system
    2. Required for school and hospital
  2. Types of immunizations
    1. Live (attenuated)
      1. Ex: MMR, Varicella
    2. Killed
      1. Protein
      2. Ex: Pertussis
    3. Toxoid
      1. Contains toxin
      2. Ex: diphtheria, tetanus
    4. Biosynthetic
      1. Manmade
      2. Ex: hepatitis B
  3. Safety
    1. Recommendations
      1. CDC (Centers for Disease Control)
      2. AAP (American Academy of Pediatrics)
    2. Immunizations carry some risk
      1. Benefits far outweigh risk
    3. Contraindications
      1. Disease contraindications
      2. Pregnancy
    4. Defer to provider
  4. Administration
    1. Patient education
      1. Common side effects
      2. Serious side effects
    2. Consent
    3. 6 patient rights
    4. Appropriate site
    5. Watch for reactions

Nursing Concepts

  1. Safety
  2. Immunity

Patient Education

  1. Educate patients on the vaccines they need or are required to have by an organization.
  2. Attempt to dispel myths associated with vaccines with evidence to patients via education.

Reference Links

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Video Transcript

In this lesson, we’re going to take a look at immunizations.

I’m sure you’ve got a solid understanding of what immunizations are, but in this lesson we are going to focus on how immunizations play into how we care for our patients. But why is this a safety issue? Well, it’s a generalized community safety issue. If we protect the general public from illness by using vaccines appropriately, we can help those who can’t get vaccines or those who are really susceptible to getting sick.

First off, vaccines are a primary prevention. There’s a great lesson on levels of prevention, so check that out.

Remember the way immunizations work. You’re triggering the immune system to build a defense against an invader. The vaccines carry little bits of either viruses or bacteria to “force” the immune system to build a response. By doing this, it works as a protective mechanism, so that if a patient is exposed to an infection, the body can protect itself.

For the most part, states and schools follow guidelines set up by the CDC and AAP (American Academy of Pediatrics) (we’ll talk more on that later). But they’re required to protect the general public from disease. This works in a couple of ways. First, it offers a protection against the actual illness through active immunity. The second is called herd immunity. Herd immunity is when a person or small group of people, who can’t get vaccines safely (as with leukemia or other immune diseases), require the general public to be immunized. By keeping everybody else healthy, those people stay healthy too.

Now that we’ve hit some high points on vaccines, let’s take a look at different types.

Vaccines fall into four general categories.

The first is live viruses. There are live snippets of the virus or bacteria in the vaccine so that the body creates antibodies against them. An example of this is MMR (measles, mumps and rubella) or varicella, which is chickenpox.

The second type is killed vaccines, or inactivated vaccines. It contains snippets of the virus or bacteria that has been killed off during the manufacturing process. But it will still create an immune response. An example of this one is pertussis.

Toxoid vaccines are immunizations created with the toxin from a bacteria. Tetanus and diphtheria are examples of toxoid vaccines.

Since science is so awesome, biosynthetic vaccines have been manmade to provide another avenue for making immunizations available. A biosynthetic vaccine is something like hepatitis B.

Now let’s look at immunization safety.

The general consensus with vaccines is that they are generally well tolerated and the benefits of getting them far outweigh any risks. But there are risks to consider like age and any other medical issues with the patients.

The Centers for Disease Control (the CDC) and the American Academy of Pediatrics (AAP) both have national guidelines for vaccines. They also help to influence state and school vaccine schedules.

All immunizations carry some risk, but overall, the benefits far outweigh any risk in most cases.

There are some contraindications, such as immune mediated diseases like AIDS or leukemia, and also not all vaccines can be given to pregnant women.

The best thing to do for those patients is to look up each immunization, check out any recommendations and defer them to their provider to make sure that it’s safe.

When we give immunizations, we need to make sure that we educate the patient. For the most part, vaccines are well tolerated, but you need to educate your patient on common and serious side effects. You’ll also need to provide them with educational information, in the form of pamphlets.

Also, make sure they agree to the immunization, and explain what you’re doing.

Follow the patient 6 patient rights when you’re giving an immunization. Right patient, right drug, right dose, right route, right time, right documentation.

One other thing you’ll want to be sure to do is to make sure that you’re giving it in the right spot. One time I was supposed to get the flu shot in my deltoid, and the nurse gave it in my tricep. Not only was it the wrong spot, that thing hurt for days. .

Also, watch for your patient reactions after you give them, and intervene when necessary. Like I said, most people do extremely well, but just be mindful that some patients have reactions.

Remember, this lesson is about general safety to the community, so our nursing concepts are focused around that.
Ok, for our recap, focus on education first. Make sure your patient knows what immunizations they need, they’re getting, what they’ll need in the future and what to expect in terms of side effects. Also be sure to tell them what serious side effects to watch for.

Know the different types of immunizations you’re giving. Is it live, killed, toxoid or biosynthetic? That plays into other aspects of care.

Watch your patient for reactions and know which ones are severe and those that are mild.

Remember that vaccines are form of primary prevention.

When in doubt, always defer to your provider so that they can have a solid discussion with your patient.

That’s our lesson on immunizations. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

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  • Question 1 of 8

A healthcare office provides immunizations for children and adults in the community. The nurse is preparing vaccine information sheets (VIS) to give to clients about the vaccines. Another nurse says, “Those forms are optional. You do not have to give those out if you do not want to.” Which response from the nurse is accurate?

  • Question 2 of 8

The parents of a 6-month old infant have brought the child in for a routine well-child check. The parents want to know what immunizations their child should get at this visit. According to the Centers for Disease Control and Prevention recommendations, which vaccines should the child get at this age? Select all that apply.

  • Question 3 of 8

The nurse is administering a pneumococcal conjugate vaccine to a client. Which of the following is true regarding this type of vaccine? Select all that apply.

  • Question 4 of 8

A mother has brought her 5-year-old son into the healthcare clinic for a physical to prepare for kindergarten. The nurse is reviewing the child’s immunization history and notes that the child has had one prior MMR vaccine. Which response of the nurse is most appropriate?

  • Question 5 of 8

The nurse is caring for a client who stepped on a rusty nail. The client does not want to receive medications if possible. The nurse educates the client on which of the following important medications to receive?

  • Question 6 of 8

The nurse is preparing to administer medications to clients. Which client will need to receive a tetanus shot?

  • Question 7 of 8

According to the Centers for Disease Control and Prevention, which of the following best describes the recommended ages to administer the measles, mumps, and rubella vaccine?

  • Question 8 of 8

The parents of a 4-year-old child have brought the child in to the pediatric care clinic for a routine physical exam. The parents tell the nurse that their child has never had immunizations as a baby, but they would like to start giving the vaccines now. Which response from the nurse is accurate?

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