NU 629 Discussion 1: Immunization Case Scenarios

Sample Answer for NU 629 Discussion 1: Immunization Case Scenarios Included After Question

Initial Post

This discussion will allow you to examine several different preventive guidelines related to vaccinations. Please read the following four scenarios and choose ONE for your initial post; be sure to address all the questions posed by the scenario and include at least three scholarly sources within your initial post.

Note: As you are choosing a topic, please try to make sure that all topics are chosen at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads

Immunizations

  1. Patient #1: Two five-year-old girls are on your schedule for a kindergarten physical. The foster parent of one of the children indicates she received all her immunization from birth to one year of age, but after that the child has not had any further vaccines. The second child appears to have been vaccinated per the CDC schedule.
    • Is there a difference in the immunization plan you will initiate today for these two patients? Why or why not?
    • What immunizations will you be ordering for each of these two patients today?
  2. Patient #2: Today you have two patients on your schedule for the HPV vaccine. One is a 27-year-old female. In taking her health history, you find that she is sexually active and that she had a splenectomy when she was 17. The second patient is an eleven-year-old female whose mother is concerned and wants to discuss the vaccine further before consenting. She feels that by giving the child the vaccine she is giving her permission to be sexually active.
    • What type of immunizations will you recommend and why for each of these patients?
    • What type of counseling will you provide in each of these scenarios related to their immunization needs?
  3. Patient #3: The following two patients present for their yearly physicals before going to spend the holidays with their grandchildren, who are two months, 18 months, and seven years of age. The 72-year-old male states he “doesn’t want a flu shot” because he’s afraid he will just get sick like his neighbor who got her shot last week; however, his 67-year-old wife (who you are also seeing for a follow-up related to shingles she had a month ago) states, “I want the flu vaccine, but I don’t need the shingles vaccine now since I’ve already had it.”
    • How will you counsel these individuals? Are there risks related to the children from either party?
    • What adult immunization should be recommended for these patients?
    • Should you discuss COVID vaccines? Why or why not?
  4. Patient #4: Your final patient of the day is a three-month-old baby. The nurse states that the mom is refusing vaccinations today even though the baby’s records show she is up to date on her immunizations. Mom explains that she feels like her baby is getting “too many” shots and since everyone else is being vaccinated, they can skip a few of the vaccines and her baby will be just fine.
    • What is herd immunity and how can this help protect individuals who are not vaccinated? What are the rates for your state related to immunizations, and how could this affect herd immunity?
    • What immunizations should this patient receive today, and is there any leeway in the schedule to help alleviate some of the mom’s concerns?

Reply Post

Reply to two of your peers who chose two different topics. Provide your own examples of situations in which you have had to discuss immunizations/vaccines. What suggestions might you provide your peers in terms of dealing with misinformation related to this topic? Replies to your peers must be on two separate days (minimum) and must utilize at least two scholarly references per peer post.

Please refer to the Grading Rubric for details on how this activity will be graded.

A Sample Answer For the Assignment: NU 629 Discussion 1: Immunization Case Scenarios

Title: NU 629 Discussion 1: Immunization Case Scenarios

What is herd immunity and how can this help protect individuals who are not vaccinated?


Herd immunity or population immunity helps protect individuals who are vaccinated and those who are not. Herd immunity is when immunity within the population is high enough that regardless of vaccination status, transmission becomes unlikely (Kadkhoda, 2021). If the transmission rate is very low, then individuals who have not gained immunity by direct infection or vaccination are more protected.


What are the rates for your state related to immunizations, and how could this affect herd immunity?


There was a lot of information regarding vaccinations and children. To narrow down my search I looked specifically at vaccination rates among children who are 3 months old, like the child in this case study. I found that data collected for children 3 months old, born in 2018, had vaccination coverage rates the highest for both polio (92%) and hep b vaccines (93.6%) (cdc.gov). The CDC  reported that in 2018 children aged 24 months old 96.8% of children were covered against MMR and less than 80% were vaccinated against influenza. Gathering this information, I would say that most children in Massachusetts are protected against diseases such as MMR, Hib, hep b, varicella, and DTAP regardless of vaccination status. For some of these diseases greater than 95% of children are reported to be vaccinated making herd immunity possible. Vaccines that are 95% effective require at least 60% immunity to reduce the risk of transmission (Kadkhoda, 2021).

What immunizations should this patient receive today, and is there any leeway in the schedule to help alleviate some of the mom’s concerns?


The babies’ records show that she is up to date with her vaccinations. Therefore, she does not need to receive any vaccines today. However, if she was not up to date it would indicate she could have missed vaccines delivered at birth and the recommended 2 months. These vaccines include hep b (birth, 1 month, 2 months), RV1, DTaP, Hib, PCV13, and IPV (cdc.gov) The CDC provides a vaccination schedule with recommendations for catchup vaccination for any child whose vaccination record is not up to date. The American Academy of Pediatrics recommends sticking to the recommended vaccination schedule. The recommended ages for vaccination on the chart are based upon evidence-based research, to provide the best efficacy for disease prevention (Edwards and Hackell, 2016).

To alleviate some of the mother’s concerns, I would begin by asking her what her concerns are so that I can better answer her questions. Perhaps the baby had a fever or was fussy after her last round of vaccines and this concerned mom. I could then explain to her that fever and fussiness are a natural immune response, and we could go over treatment measures to help alleviate the child’s symptoms with her next scheduled vaccination. Mom may not know the purpose of each vaccine or what disease they help prevent. As the APRN, I should be providing a vaccine information statement before each vaccination, help clarify any misconceptions, and educate my patients and their families to help create a helpful safe, and non-judgmental environment.

References

Centers for Disease Control and Prevention. (2020, September 28). ChildVaxView interactive child vaccination coverage. Centers for Disease Control and Prevention. Retrieved November 9, 2021, from https://www.cdc.gov/vaccines/imz-managers/coverage/childvaxview/interactive-reports/index.html.

Edwards, K. M., & Hackell, J. M. (2016). Countering vaccine hesitancy. PEDIATRICS, 138(3). https://doi.org/10.1542/peds.2016-2146

Kadkhoda, K. (2021). Herd immunity to covid-19. American Journal of Clinical Pathology, 155(4), 471–472. https://doi.org/10.1093/ajcp/aqaa272

A Sample Answer 2 For the Assignment: NU 629 Discussion 1: Immunization Case Scenarios

Title: NU 629 Discussion 1: Immunization Case Scenarios

Patient #4: Your final patient of the day is a three-month-old baby. The nurse states that the mom is refusing vaccinations today even though the baby’s records show she is up to date on her immunizations. Mom explains that she feels like her baby is getting “too many” shots and since everyone else is being vaccinated, they can skip a few of the vaccines and her baby will be just fine. 

Jesenia thank you for your informative post.  As an acute care geriatric nurse practitioner, it would not be likely that I would have an experience with a three-month-old baby.  You provided useful information regarding catch up vaccinations that would be extremely helpful for parents.  I would have the experience of educating people about herd immunity especially during the COVID-19 pandemic.   

Herd immunity occurs when most of the community becomes immune to a disease.  This makes the spread of disease from person to person less likely (Mayo Clinic, 2021a).  The result of herd immunity is the who community becomes protected against the disease not just the persons who are immune (May Clinic, 2021a).  The Mayo Clinic reports that the percentage of community members who need to be immune to achieve herd immunity depends on how contagious the disease is (Mayo Clinic, 2021). An example is measles are highly contagious, according to the Mayo Clinic 94% of the population must be immune to the measles to accomplish herd immunity (May Clinic 2021a). 

A recent study shows that COVID-19 is very contagious, but not as easily contagious as the measles, but the COVID-19 affects a more generalized population which increases the spread (Smith, 2021). There is no determination at this time what percentage of the population would need to be vaccinated to achieve herd immunity. As of November 11, 2021 only 58% of the US population has been fully vaccinated against COVID-19 (May Clinic 2021b) There have been many cases called breakthrough cases, where fully vaccinated people have still become ill with COVID-19.   As an APRN I would advise all patient to become fully vaccinated and not to rely on the rest of the community to develop herd immunity because herd immunity from COVID-19 will not be achieved at any time soon.   

References 

Mayo Clinic (2021, Oct 1) Herd Immunity and What You Need to Know?     https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/herd-immunity-and- coronavirus/art-20486808 

Mayo Clinic (2021b, Nov 11) US COVID-19 Vaccine Tracker:  See Your States Progress.      https://www.mayoclinic.org/coronavirus-covid-19/vaccine-tracker 

Wilder-Smith, A. (2021) COVID-19 In Comparison with Other Emerging Viral Diseases: Risk of Geographic Spread via Travel.     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847598/