Vaccines: Nursing pharmacology

Definitions & Key takeaways

Vaccinations, also known as immunizations, are a way to protect individuals from infectious diseases. Vaccines work by stimulating the immune system to recognize and fight specific pathogens, such as viruses or bacteria. They allow us to develop active immunity where a protective adaptive immune response is made to pathogens without causing disease in the patient. There are four main types of vaccines: Live attenuated, inactivated, subunit, and toxoid vaccines. Live attenuated and inactivated vaccines are whole-cell vaccines, which means that the whole virus or bacteria is used to create the vaccine. Subunit and toxoid vaccines are considered fractionated vaccines because only one part of the pathogen is used to create the vaccine.

Vaccines are typically given through injections, nasal sprays, or oral doses, and are usually recommended for infants and young children, as well as for adults who may be at risk for certain infectious diseases. Vaccines can sometimes cause mild side effects. There may be pain and swelling at the injection site, flu-like symptoms like fever, malaise, headache, and anorexia, that usually last for a day or two. In rare situations, there can be more serious reactions, including prolonged irritability, seizures, high fever, thrombocytopenia, and anaphylaxis, as well as rare autoimmune conditions like Guillain-Barre syndrome. Nursing considerations when administering vaccines include screening for contraindications or cautions to vaccine administration, administering the vaccine, and monitoring for adverse reactions, as well as providing education about vaccine side effects and how to manage them.

Chapters:

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Introduction0:00–0:23

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.

Live attenuated vaccines0:23–1:11

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.

Inactivated vaccines1:11–1:46

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.

Subunit, recombinant, polysaccharide, and conjugated vaccines1:46–3:00

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.

Toxoids3:00–3:24

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.

mRNA vaccines3:24–3:49

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.

Mechanism of action3:49–4:31

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.

Side effects4:31–5:16

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.

Contraindications and cautions5:16–6:54

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.
Likewise, live vaccines are not recommended during pregnancy, as the weakened pathogens could potentially cross the placenta and affect the fetus.
In addition to these general recommendations, some vaccines have specific contraindications. For instance, pertussis-containing vaccines, like DTaP and TdaP, should not be given to clients who have experienced signs of encephalopathy with the administration of a previous dose of the vaccine.
The rotavirus vaccine carries a small risk of intussusception, so it is contraindicated in children with a history of this disorder.
The MMRV vaccine should be used with caution in clients with a history of seizures or thrombocytopenia because it carries a small risk of developing these complications.
In addition, if a client has received antibody-containing blood products, such as intravenous immunoglobulin or IVIG for short, whole blood, or frozen plasma, it’s recommended to wait for at least 3 months to get a vaccine, since the antibodies from the blood product could interfere with the vaccine and prevent the client from developing an immune response.Now, when preparing to administer a vaccine to a pediatric client, first review the child’s immunization record to determine which vaccine they will need, and assess them for any contraindications or cautions to receiving the vaccine.

Nursing considerations & client education6:54–9:46

Talk to the child’s parents or caregivers about the vaccine, explain how it will help prevent infection and disease, and review the symptoms and complications of each disease.
When administering a vaccine to an older child, be sure to include them in the conversation, ask them what they know about vaccines, and talk about any concerns they may have, such as fear of needles and pain.
Then, review common side effects, such as soreness, redness, and swelling at the injection site, as well as muscle aches, feeling tired, fussiness, fever, and chills, and remind them that these are usually mild and go away within a few days.
Let them know they can manage these side effects by placing ice packs at the injection site, taking a pain reliever like children’s acetaminophen, and drinking plenty of fluids.
Reassure them that these are signs that the body is building protection against disease, and that the risk of the disease is much greater than the risk of vaccine side effects.
Also, explain that, even though severe reactions to a vaccine are rare, they should call emergency services immediately if they develop a serious allergic reaction, such as an itchy rash, swelling of the face or throat, and difficulty breathing.
Be sure to listen to their concerns, answer their questions, clarify any misconceptions they may have, and provide them with the most current vaccine information statement.
Lastly, verify that informed consent has been signed by the parent or caregiver.During administration, select the correct needle length and injection site, and take age-appropriate steps to reduce pain associated with the injection.
For infants, suggest the parent or caregiver hold the baby during administration. Assist them to hold the infant skin-to-skin or breastfeed during vaccine administration if they desire, or offer a pacifier dipped in 24% sucrose water.
For toddlers, have them sit on their caregiver’s lap and give them an object to distract them while you administer the vaccine.
For older children, explain the procedure using age-appropriate language and let them select the arm to be vaccinated. Finally, after administering the vaccine, record the month, day, and year of administration; the site of administration; and the type of vaccine given, along with the name of the manufacturer, lot number, and expiration date.
In addition, be sure to monitor the client for at least 15 minutes for any signs of a severe adverse reaction. Then, give the parent or caregiver a copy of the child’s updated vaccination record and remind them about the next scheduled vaccination.Alright, as a quick recap… Vaccines are biological products that protect humans from potentially serious infections, and act by stimulating the immune system to make antibodies against a specific pathogen.

Review9:46–10:29

Side effects are generally mild and include soreness, redness, and swelling at the injection site, as well as fever, headache, and muscle aches.
Rare but more serious side effects include anaphylaxis and Guillain-Barré syndrome. Nursing considerations when administering vaccines include screening for contraindications or cautions to vaccine administration, administering the vaccine, and monitoring for adverse reactions, as well as providing education about vaccine side effects and how to manage them.