Reference no: EM132406853 , Length: word count:1750

AHS 2470 - Fundamentals of Pharmacology - Immunization Assignment, Community College of Vermont, USA

Instructions: Please answer the following cases in detail. You may utilize any and all resources to accurately answer the questions. Resources available to you include the current immunization schedule published by the CDC and ACIP, and the Pink Book, which should be available in all offices that administer vaccines, and your CDC immunization cards.

Cases Overview:

Xiomara

Randall

Anya

Javier

Genevieve

Antwan

Henrietta

Taro

Immunization Cases -

Case 1 - Xiomara's mother has brought her in to the office for a re-check of an upper respiratory infection and otitis media. Xiomara's mom asks you when she will finally be able to get her immunizations. She tells you she has cancelled the last 3 appointments for vaccines due to nasal stuffiness and congestion. You review the state immunization registry and discover that Xiomara has only received her 2-month-old vaccines, and she is not 9 months old.

1. How do you counsel Xiomara's mom regarding vaccine delays?

2. What will be your action plan for today?

3. How will you catch Xiomara up on her vaccines?

4. How long will it take?

5. Write out an appropriate catch-up vaccine schedule for Xiomara that will maximize vaccine combinations.

Case 2 - 4-year-old Randall comes to your office with his mom. He is new to your practice. His mother states that his last vaccines were just after his 1st birthday. You obtain his immunization record and review it. You note that Randall has received the following vaccines:

- 3 doses of DTaP

- 4 doses of Hib

- 1 dose of MMR

- 2 doses of IPV

- 3 doses of PCV13

- 1 dose of Hepatitis A

- 3 doses of Hepatitis B

- 1 dose of Varicella vaccine

1. What vaccines does Randall need today?

2. Will he need any future catch-up doses of other vaccines?

3. If yes, which vaccines and when? If no, why not?

Case 3 - Anya is a 32-year-old female nursing student. She has been referred to your office before starting nursing school to verify her vaccines and sign off on her immunization status. She tells you she had vaccines as a child, but she does not have her immunization record anymore. She knows she has not had any vaccines since she was in high school. On further questioning, she doesn't know if she had the chicken pox vaccine or not, but she is sure she has never had the disease.

1. How do you confirm her immunity?

2. Do you advise vaccines?

3. If yes, what? If no, why not?

Case 4 - Javier a 45-year-old homosexual patient that is new to your practice. He tells you he was recently diagnosed with HIV at a public health screening. He did have his CD4 count tested and it is >700. He will be seeing the local infectious disease specialist to manage his HIV disease, but he was advised to seek a primary care physician to manage his well-health issues. He states the specialist told him there were vaccines he should receive because of his HIV diagnosis, but he doesn't recall which vaccines. He does know that his last Td was 10 years ago. He remembers having chicken pox when he was in elementary school. He states that all of his immunizations were given as a child but has not had any other adult vaccines.

1. What vaccines do you advise Javier to receive and why?

2. Are there any vaccines you would not give? Why or why not?

Case 5 - 12-year-old Genevieve comes into your office for a sports physical. As part of your office protocol, all adolescents receiving sports physicals have their immunization record downloaded and reviewed. As you review the form with her, you notice that Genevieve's last vaccines were when she was 4 years old. You recognize that she has had 1 varicella vaccine given at the same time as her MMR when she was 13 months old. When she was 4 years old, she received her fifth dose of DTaP, fourth dose of IPV, and second dose of MMR. She has had no other vaccines. She reports that she is very healthy and hasn't missed a day of school since kindergarten.

1. What vaccines do you advise the parents (and Genevieve) to receive?

Case 6 - Antwan is a 15-month-old infant you are seeing for an upper respiratory infection. He is afebrile and non-toxic appearing. While reviewing his immunization record, you notice his last well child exam was 2 weeks prior to his 1st birthday. At that visit, he received his MMR and varicella vaccines. No other vaccines were given at that time. The remainder of his vaccines are up to date through age 6 months.

1. How do you counsel Antwan's parents regarding the MMR and varicella vaccine? Are the doses valid? If not, what needs to be done?

2. Are there any additional vaccines indicated?

3. If yes, what are they and when should they be administered?

Case 7 - Henrietta is a 19-year-old G1P0 who presents to your office for her 1st OB visit in December. On review of her history, she has received all her immunizations, including 1 varicella vaccine and her last Td at age 14. As part of your OB assessment, you discover that her blood type is O negative and she is rubella non-immune. Her hepatitis B surface antigen is negative.

Side note: In obstetrics, you may see women labeled with G, T, P, A, and L. G represents how many times a woman has been pregnant in total, T represents how many Term births (>37 weeks) she has had, P represents how many Premature births (<37 weeks) she has had, A represents fetal deaths in utero (Abortions), and L stands for how many living children she has. For example, a woman who has been pregnant 4 times, had 1 term birth, 1 premature birth, 2 abortions, and 2 living children would have an obstetric history of G4T1P1A2L2.

1. What vaccines do you recommend for Henrietta?

2. When do you recommend them to be administered? Pre or Postpartum? 

Case 8 - Taro 62-year-old gentleman who has come to your office for a well-health exam in November. He is married, monogamous, and has no plans for future travel. He does not drink alcohol, quit smoking 5 years ago, and denies drug use. His medical problems include COPD for which he rarely uses a rescue inhaler. Otherwise, he considers himself healthy. He works as a tax preparation specialist for H&R Block. He received his pneumovax vaccine 7 years ago. He has not had his influenza vaccine yet this year. He states he had all his childhood immunizations and childhood illnesses, and no vaccines since his pneumovax 7 years ago.

1. How do you counsel Taro regarding his immunization status?

2. What vaccines are recommended? Why?

Attachment:- Immunization Assignment File.rar