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Vaccines: Nursing Pharmacology

Notes

Notes

VACCINES, PART 1
DRUG NAME
measles, mumps, rubella (MMR: MMR-II); varicella zoster (Varivax, MMR-V: ProQuad); herpes zoster (Shingrix), rotavirus (RotaTeq, Rotarix); yellow fever (YF-Vax); smallpox (ACAM2000); influenza
hepatitis A (Havrix, Vaqta); inactivated polio (IPOL); rabies (Imovax, RabAvert); influenza (Afluria Quadrivalent, Fluad Quadrivalent, FluLaval Quadrivalent, Fluzone Quadrivalent)
HiB (PedvaxHIB, Hiberix, ActHIB); hepatitis B (Engerix-B, Recombivax HB); HPV; pneumococcal (Pneumovax 23, Prevnar); meningococcal (Menactra, Menveo, Bexsero); varicella-zoster (Varzig); SARS-CoV-2 (Janssen)
CLASS
Live attenuated vaccines
Inactivated vaccines
Subunit, recombinant, polysaccharide, and conjugated vaccines
MECHANISM OF ACTION
Trigger a specialized immune response against pathogens, building up immunological memory to fight the infectious disease if and when exposed to the pathogen in the future
INDICATIONS
  • Primary prevention against infectious diseases
  • Primary prevention of cervical and anal cancer (HPV vaccine)
ROUTE(S) OF ADMIN.
  • MMR-V, varicella, yellow fever: SUBQ
  • Rotavirus: PO
  • Smallpox: ID
  • Live influenza: NAS
  • IM
SIDE EFFECTS
  • Local injection site reactions
  • Systemic flu-like symptoms
  • Rare, but severe adverse reactions - seizures, high fever, Guillain-Barré syndrome, thrombocytopenia, anaphylaxis
CONTRA-INDICATIONS & CAUTIONS
  • Allergic reaction to previous dose of vaccine or any vaccine ingredient
  • Moderate or severe active infections (wait until infection is resolved)
  • Immunodeficient and pregnant individuals
  • Rotavirus: contraindicated in clients with history of intussusception
  • MMR-V: caution in clients with history of seizures or thrombocytopenia
  • None
  • HPV: contraindicated during pregnancy
VACCINES, PART 2
DRUG NAME
diphtheria, tetanus, pertussis (DTaP: Daptacel, Infanrix); tetanus, diphtheria, pertussis (Tdap: Boostrix, Adacel); tetanus, diphtheria (DT: Generic, Td: Tenivac)
SARS-CoV-2 (Pfizer-BioNTech, Moderna)
CLASS
Toxoid vaccines
mRNA vaccines
MECHANISM OF ACTION
Trigger a specialized immune response against pathogens, building up immunological memory to fight the infectious disease if and when exposed to the pathogen in the future
INDICATIONS
  • Primary prevention against infectious diseases
  • Primary prevention of cervical and anal cancer (HPV vaccine)
ROUTE(S) OF ADMINISTRATION
  • IM
SIDE EFFECTS
  • Local injection site reactions
  • Systemic flu-like symptoms
  • Rare, but severe adverse reactions - seizures, high fever, Guillain-Barré syndrome, thrombocytopenia, anaphylaxis
CONTRA-INDICATIONS & CAUTIONS
  • DTaP, TdaP: contraindicated if signs of encephalopathy have occurred with a prior dose of vaccine (e.g., coma, seizures, altered level of consciousness)
  • None
NURSING CONSIDERATIONS: VACCINES
ASSESSMENT AND MONITORING
Assessment, intervention, and monitoring
  • Review the child’s immunization record
  • Determine vaccine to be administered; cautions or contraindications to receiving the vaccine
  • Select the correct needle length and injection site
  • Use age-appropriate interventions to reduce pain
  • Explain the procedure in age-appropriate language
  • Record: month, day, and year of administration; the site of administration; the type of vaccine given, along with the name of the manufacturer, lot number, and expiration date
  • Monitor: observe for at least 15 minutes for severe reaction
CLIENT EDUCATION
  • Purpose of vaccine: to help prevent infection and disease
  • Review symptoms and complications of each disease
  • Include older children in the conversation
  • Review common side effects and management
  • Review risk of the disease versus risk of side effects
  • For rare severe allergic reactions: call emergency services immediately for itchy rash, swelling of the face or throat, or difficulty breathing
  • Listen to concerns, answer their questions, clarify any misconceptions
  • Provide vaccine information statement
  • Verify informed consent
  • Remind them about the next scheduled vaccination
Transcript

Vaccines are biological products designed to protect humans from potentially serious infections caused by various kinds of pathogens.

Most vaccines are routinely administered to clients as part of a vaccination schedule; while other vaccines are only given to certain populations, such as chronically ill clients or those travelling to foreign countries.

Now, there are five main types of vaccines: live attenuated, inactivated, subunit, toxoid vaccines, and mRNA vaccines.

Live attenuated vaccines contain pathogens that have been weakened in the laboratory. As a result, these weakened pathogens are no longer able to cause infection, but are still able to trigger a protective immune response.

These vaccines are used to protect against influenza with the live attenuated influenza vaccine or LAIV for short; as well as measles, mumps, and rubella, called the MMR vaccine, and can also include varicella zoster, also known as the MMRV vaccine; other live attenuated viruses include vaccines for rotavirus, smallpox, and yellow fever.

On the other hand, inactivated vaccines use a pathogen that has been killed in the laboratory, so it is no longer able to replicate or cause infection, but is still able to trigger a protective immune response.

These include vaccines against Hepatitis A, or HAV vaccine, as well as against polio, called the Salk vaccine or inactivated polio vaccine or IPV, and against rabies, or the rabies vaccine.

Another important inactivated vaccine is again for influenza with the inactivated influenza vaccine or IIV for short.

Next, subunit, recombinant, and polysaccharide vaccines contain just the portion of the pathogen that stimulates the immune response, such as a viral protein, DNA, or sugar.

Some of these vaccines are combined with proteins to form conjugated vaccines, which elicit a much stronger and longer lasting immune response.

These vaccines are used to protect clients against Haemophilus influenzae type B, or HiB vaccine; Hepatitis B, or HBV vaccine; Human papillomavirus, or HPV vaccine; Streptococcus pneumoniae, with the pneumococcal conjugate vaccine or PCV13, and the pneumococcal polysaccharide vaccine or PPSV23; and Neisseria meningitidis with the meningococcal conjugate or MenACWY vaccine and the serogroup B meningococcal or MenB vaccine.

Another important vaccine is again for influenza, with the recombinant influenza vaccine or RIV for short; as well as the recombinant zoster vaccine, or RZV, to prevent the reactivation of varicella zoster and development of shingles; as well as the adenovirus vector SARS-CoV-vaccine to protect against COVID-19.

Then, toxoid vaccines contain inactivated toxins produced by pathogens, and are used to protect against tetanus and diphtheria. Sometimes, toxoid vaccines are combined with subunit vaccines to make a more immunogenic, or strong, vaccine.

This is the case of the DTaP and TDaP vaccines, which provide immunity against tetanus, diphtheria, and pertussis.

Finally, the most recent vaccine technology involves messenger RNA or mRNA vaccines, such as the Pfizer-BioNTech and the Moderna vaccines for SARS-CoV-2, the virus that causes COVID-19.

These vaccines contain a piece of genetic material or mRNA that codes for a harmless viral protein that’s unable to cause the disease, but it’s capable of triggering an immune response.

Now, vaccines can be administered in one of four ways: intramuscularly, intradermally, subcutaneously, or orally. Once administered, they stimulate the immune system’s response against a specific pathogen, just like it would occur after being exposed to an infectious disease.

As a result, the body is left with a supply of memory immune cells that will remember how to fight the pathogen in the future. One thing to keep in mind with inactivated, subunit, and toxoid vaccines is that the immune response generated is not as strong as that from natural infections or live attenuated vaccines, so clients may require “booster shots,” or additional vaccinations to help bring immunity levels back up over time.

Alright now, vaccines can sometimes cause mild side effects. For intramuscular, intradermal, or subcutaneous injections, there may be pain, swelling, or redness at the injection site.

In addition, vaccines can sometimes cause systemic flu-like symptoms, such as fever, malaise, headache, and anorexia, that usually last for a day or two.

In rare situations, however, there can be more serious reactions, including prolonged irritability, seizures, high fever, thrombocytopenia, and anaphylaxis, as well as rare autoimmune conditions like Guillain-Barré syndrome.

However, it’s important to mention that the low risk of developing these side effects from a vaccine outweigh the risks of getting the actual disease.

Still, there are some of the general contraindications and precautions for vaccines. First, clients who have a moderate or severe infection should wait until they recover before getting a vaccine.

Next, clients who have had a previous allergic reaction to a vaccine or any vaccine ingredient should avoid getting additional doses or boosters for that particular vaccine.

In addition, immunocompromised clients should not receive live attenuated vaccines because of the small risk of developing the infection even from the weakened pathogen.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. "Flu Vaccine and People with Egg Allergies"  (Sept 2020)
  6. "Vaccine Recommendations and Guidelines of the ACIP"  (Aug 2021)
  7. "Shingles (Herpes Zoster) Vaccines"  (Sept 2020)
  8. " Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger"  (2021)
  9. "MMR Vaccine (Measles, Mumps, and Rubella): What You Need to Know"  (6 Aug 2021)
  10. "Influenza (Flu) Vaccine (Inactivated or Recombinant): What you need to know"  (6 Aug 2021)
  11. "Lehne's Pharmacology for Nursing Care" Elsevier Health Sciences (2014)
  12. "Wong's Essentials of Pediatric Nursing" Mosby (2016)