Nurse Immuniser Program Assessment Two

Two weeks after her initial visit to you with her son Elijah,  Skye presents again with her partner Rocky. They think they will proceed with the immunisations for Elijah but have some concerns and questions

1. Skye and Rocky agree to have Elijah vaccinated, as part of the pre-vaccination procedures it is required that you obtain consent.
   1. Define valid consent 2 marks
   2. What elements must be present for consent to be legally valid? 4 marks

2. Skye and Rocky wondered what side effects occur with vaccines.

What are the common side affects you would discuss with them and how would you treat these side effects? 6 marks

3. Skye is extremely concerned as she says that Elijah has anaphylaxis to egg so she doesn’t think that he should  have either MMR or the influenza vaccine.

How would you respond? 3 marks

4. Before vaccinating Elijah you will need to perform pre-vaccination screening, why should immunisation providers do this? 6 marks
5. Before vaccinating Elijah you check the vaccine fridge and note the min-max thermometer states the maximum temperature was 19 degrees. Further investigation reveals from the data logger shows  the temperature rising to 19 degrees over 2 hours and returning to 8 degrees over the next 2 hours.
   1. For this breach what guidelines do you follow and what action do you take? 5 marks
   2. Can you use vaccines from this fridge to vaccinate Elijah? 1 mark

6. Why would you ask Skye to remain with Elijah for 15 minutes post vaccination? 2 marks
7. You find out that Skye is currently 25 weeks pregnant, she is planning a homebirth and that she has not ever been vaccinated. She agrees to a screening blood test and this shows she is  not immune to measles. 
   1. What would you discuss with her regarding immunisations for her while she is pregnant? 3 marks
   2. Skye doesn’t think that Elijah should be given MMR as it is a live vaccine and she is pregnant and not immune. What is your explanation to Skye? 2 marks
   3. Skye wants to protect Elijah as soon as possible against varicella so requests that Elijah be given the MMR-V vaccine instead of the MMR today in his first catch up vaccines, what do you say to Skye and why? 3 marks

8. Elijah presents for his next immunisations with his father Rocky, Skye is in hospital with their new baby Verity who was born prematurely at 27 weeks weighing 1.3 kilos she has no other apparent medical issue apart from her prematurity

Rocky  says that he was told apart from the normal scheduled vaccines on the NIP that Verity would require some additional vaccines because she was born early. What additional vaccinations would be required when and why?  5 marks

9. The acronym for diphtheria, tetanus, pertussis can be written as DTPa or dTpa what if any difference is there? 2 marks

Skye and Rocky are now embracing vaccination and have recommended family and friends check their vaccination status and catch up their immunisations prior to visiting Verity. Please develop catch up programs as stated.

All catch ups must clearly identify the antigens and the name of the vaccine that would be used e.g.  DTPa - IPV, Infanrix-IPV. If 2 brands are available you only need to put in one e.g. MMR, Priorix

You must put in the age of the person when the vaccines will be given

10. Plan the catch up for Elijah who presents having never received a vaccination, include vaccinations up to and including 4 years of age. Before commencing his catch up using his date of birth you find out his exact age is 2 years 7 months 5 marks
11. Verity who was born at 27 weeks gestation, weighing 1.3 kgs is now 6 months of age (in calculating her age in weeks you find this is actually 26 weeks). Whilst in hospital, at 2 months of age, she was given DTPa-hepB-IPV-Hib (Infanrix-hexa®) vaccine, 13vPCV (Prevenar 13®) vaccine and rotavirus (Rotarix®) vaccine.

There were no serious adverse events from the previous vaccinations and there are no current contraindications.  Note she has had an intracranial shunt inserted.

1. What catch-up schedule would you advise for Verity, according to the NIP? 4 marks
2. What is the immunisation program for Verity to the age of 13 years (inclusive). 7 marks
3. Skye’s nephew Dakshi is 13 months old and was born overseas and immunised according to the schedule in India. In India, he received the following vaccines;

6 weeks of age            DTP-Hib-Hep B, OPV

10 weeks of age          DTP-Hib-Hep B, OPV

14 weeks of age          DTP-Hib-Hep B, OPV

9 months of age          Measles vaccine

3 weeks ago (prior to arriving back in Australia) BCG vaccine was administered

Develop a catch up program for Dakshi, according to the NIP and his ongoing vaccination requirements up to and including 4 years of age (5.5 marks)

13. Rocky’s nephew is 16 years old, four years ago he was treated for a tetanus prone wound, where the treating hospital administered an ADT.  He attends your clinic and you ascertain this is the only vaccine he has ever received, complete a catch-up immunisation program, for him . 7 marks
14. Skye’s next door neighbour Yindi has offered to assist with babysitting. She is 58 years old and identifies as Aboriginal, she spent her childhood in a remote area of the Far North Queensland but now lives permanently in Victoria.  She remembers having injections as a child but has no written records. She is healthy with no medical conditions.

1. Describe the principle you will use to assist in working out what vaccines should be offered to Yindi as an adult 4 marks
2. Design a catch up plan for Yindi stating what vaccines will you recommend and why. 11 marks