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CMN 571 Final Exam/374 Questions with Answers 2024
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CMN 571 Final Exam/374 Questions withAnswers 2024
Laws related to administering vaccines: VIS - -All vaccine providers, public or
private, are required by the National Vaccine Childhood Injury Act to give the
appropriate VIS to the patient (or parent or legal representative) prior to
every dose of specific vaccines.
The appropriate VIS must be given prior to the vaccination, and must be
given prior to each dose of a multi-dose series. It must be given regardless of
the age of the recipient.
- What is required to be recorded in the medical record? - -The edition date
of the VIS (found on the back at the right bottom corner).
The date the VIS is provided (i.e., the date of the visit when the vaccine is
administered).
The office address and name and title of the person who administers the
vaccine.
The date the vaccine is administered.
The vaccine manufacturer and lot number.
- Vaccines at birth - -Hep B
- Vaccines at 4 months - -D - Dtap
R - Rotovirus
H - HIB
I - IPV
P - PCV
- Vaccines at 2 months - -B - Hep B
D - Dtap
R - Rotovirus
H - HIB
I - IPV
P - PCV
- Vaccines at 6 months - -B - Hep B
D - Dtap
R - Rotovirus
H - HIB
I - IPV
P - PCV
- Vaccines at 12-15 months - -M - MMR
,A - HepA
D - Dtap
H - HIB
P - PCV
V- Varicella
- Vaccines at 4-6 years - -VERY - Varicella
D - DTAP
I - IPV
M - MMR
- Active immunity - -Resistance developed in response to infection with an
agent resulting in antibody production. Active immunity is usually
permanent. Can be either naturally acquired through exposure and infection
with the disease or artificially acquired through immunization. Onset is 2-4
weeks and duration is years to lifetime.
- Passive Immunity - -A person is given antibodies to a disease rather than
producing them through his or her own immune system. This is short term
immunity through introduction of antibodies to a disease. Can occur
naturally as in the passage of antibodies from the mother to the fetus during
pregnancy or artificially acquired through injection of antibodies such as
gamma globulin. Onset is within 24 hours of the dose and duration is about
4-6 months.
- Herd Immunity - -This occurs when a significant portion of the population
is vaccinated and that provides a portion of immunity for those that have not
developed immunity. The population (herd) helps prevent disease in the
unprotected population. The herd protects those who can not safely get
vaccinations. Generally 90 -95% of the population should be to be vaccinated
to have effective Herd immunity.
- Hep B Vaccine - -3 dose schedule: 1st Should be given within 24 hours of
birth (12 hours if mother + or unknown HBsAg status). 2nd at 2 months and
3rd at 6 months.
Low rate of adverse events.
Contraindications: Do not give to anyone with serious allergic reaction to
yeast.
Can be solo vaccine (engerix-B/Recombivax HB) or combined with Dtap & IPV
(pediarix)
- Rotavirus Vaccine - -Rotavirus is the most common cause of severe
gastroenteritis among young children.
Two vaccines available - RV5 (Rotateq) and RV1 (Rotarix).
RV5 is 3 dose schedule at 2, 4, 6 months. RV1 is 2 dose schedule at 2 & 4
months.
,Risks and contraindications: Risk of intussusception, should not be given to
infants with history. RV1 should not be given to infants with severe latex
allergy (package is latex). Both vaccines are contraindicated in SCID. Should
be deferred in infants with acute moderate to sever gastroenteritis.
- DTaP Vaccine - -For prevention of diphtheria, tetanus, and pertussis
(whooping cough)
Can be in combo with IPV & HepB, combo with IPV & HIB, or combo with IPV.
Should be deferred in individuals with progressive neuromuscular disorders
until neuro status is clarified and stabilized.
Moderate to severe systemic effects: fever, inconsolable crying, hypotonic-
hyporesponsive episodes.
- HIB Vaccine - -Haemophilus influenzae type B - causes a wide spectrum of
serious infections bacterial illnesses, particularly in young children, including
meningitis, epiglottitis, pneumonia, septic arthritis, and cellulitis. Can be solo
vaccine or combo with Dtap and IPV. Given as series of 3 or 4 doses
(depending on formula) OMP is 3 - T is 4.
Not recommended in children over 5 yrs
Should not be given to infants under 6 weeks
Adverse effects are uncommon.
- Pneumococcal vaccine - -Streptococcus pneumoniae - leading cause of
invasive bacterial disease in children, causes febrile bacteremia, bacterial
sepsis, meningitis, and pneumonia. Also a common cause of otitis media and
sinusitis. Two vaccines in use: PCV13 and PCV23 (only 2yrs and older).
PCV13 given in 4 doses.
Both vaccines should be deferred during moderate or severe acute illness
with or without fever.
Adverse effects: fever, injection site reactions, irritabilit, and increased or
decreased sleep.
Not proven - when given in conjunction with flu vaccine increased risk of
febrile seizures.
- Poliomyelitis - -Polioviruses cause acute flaccid paralysis via destruction of
the motor neurons.
IPV only vaccine available in the US, CANNOT cause polio.
Can be combined wth Dtap, Hep B, or HIB.
4 Dose series
Contraindications/Precautions: Should be deferred during moderate to severe
illnesses with or without fever. Pregnancy is a precaution.
No serious adverse reactions described.
- Influenza - -Occurs each winter-early spring, often associated with
significant morbidity and mortality in certain high risk groups.
Annual vaccination is recommended for all persons over 6 months.
, Fluzone for over 6 months. (fluvirin >4yrs and fluarix >3yrs, and afluria
>9yrs)
Intranasal not currently recommened
Optimal time to vaccinate is as soon as the vaccine is available in early fall.
Two doses are recommended for children under 9yrs who did not recieve two
doses in the past.
Non type 1 egg allergies can still recieve the vaccine, type 1 egg allergies
may be eligible after allergist assessment.
Adverse affects - few have fever, malaise, and myalgia.
- MMR vaccine - -Given in two doses.
Can cause febrile seizures.
Two vaccines available: MMR II and MMRV(MMR and varicella combo). MMRV
only for > 1 year old, has higher occurrence of febrile seizures.
Ig interfere with immune response - vaccination should be deferred for 3-11
moths after Ig administration.
Contraindicated in pregnant women or women intending to become pregnant
within 28 days, immunocompromised.
Contraindicated in children receiving high dose corticosteroid therapy
(except replacement therapy).
Adverse effects: fever. febrile seizures, transient thrombocytopenia,
arthalgia, measles inclusion body encephalitis.
- Varicella vaccine - -Prevention or decreased severity of Varicella
(chickenpox)
Given in two doses - alone or with MMR
Live virus vaccines - contraindicated in children who have acquired
treatment related cellular immunodeficiencies or congenital T cell
abnormalities. (can be given to HIV infected children who are not severely
immunosuppresed)
Should not be given to pregnant women, however a pregnant family member
is not a reason to withhold vaccine in a child.
Personal or family Febrile seizure history is a precaution
Adverse effects- minor site reactions.
- Hepatitis A vaccine - -Two dose schedule between 12 and 23 months, 6
months apart.
Formulas - Havrix, Vaqta. Combo with Heb B- Twinrix.
Precaution to vaccination include pregnancy and moderate to severe acute
illness.
Adverse effects - uncommon and mild. Pain, swelling, and induration at
injection site, headache and loss of appetite.
- Development 1-2 Months - -Observed:
Holds head erect/lifts head
Turns side to back
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