final blue print

Prevention & Professionalism-  vitamin supplementation  Colon cancer screen immunization guidance Types live vaccine- replicate in the host and generates the response that mimic immunity caused by the illness  may not be able to be used in all patients Inactivated vaccine: inactivated microbial agents or components that are made through physical chemical and molecular means Passive immunity is passed on in antibodies  IGG transfers is the synthesized version  (from mom to baby is passive  Short term protection from disease by administration of antibodies Herd immunity- immune members prevent the spread of infection for susceptible members.  Depends on how contagious the disease is, mode of transmission, interaction in the community, and endemic vs epidemic disease Small pox, measles, polio, and rubella have been eliminated in the US because of immunization. MMR has resurged because of people hesitation to get vaccines Dr.Wakefield is U.K. physician that published an article saying vaccines cause autism. This is a myth.  Children 6-59 months are at risk for severe illnesses and complications Barriers to vaccination  Product recall  Misinformation  Vaccine storage  Parental refusal  Vaccine hesitancy Vaccines for children- almost every state provides vaccines for children. This is free in most states. There are resources in the U.S. an in PA for those that are not insured. Adverse reactions- acute emergency after vaccines are rare  Observe the pt for 15 minutes after vaccine  Common reactions o Redness achiness  Synscope- vasovagal reaction is common in adolexcents and young adult females  Anaphylaxis- sings and symptoms are flushing warmth urticaria erythema soft tissue edema pruritis dry mouth swelling of lips, tongue, throat, sneezing, congestion, stridor cough, dyspnea chest tightness wheezing and cyanosis tachycardia hypotension dizziness shock cardiovascular collapse o Tx with epinephrine 0.01ml/kg  0.3 ml max dose for child  0.5max dose for adolescents 10 rules of vaccines 1) Any vaccine can be given together except varicella and small pox! Mcv4 and pcv13 can’t be given together in a functional or anatomically asplenic child because it decrease response to pneumococcal

2) Live vaccines can not be given together and should be 28 days apart 3) Different inactivated vaccines can be given at any time a. Can have simultaneous administration to improve compliance 4) Doses of the same vaccine must be separated by minimal intervals. Proper spacing of doses given within 5) Most vaccines have a minimum age except for hep b and rabies 6) Do not restart a vaccine series if theres been a lapse in administration 7) Similar vaccines made by different manufacturers are interchangeable 8) No harm in vaccinating a person who has already had the disease or vaccine 9) Defer MMR and Varicella after administration of antibody containing blood products 10) Live vaccines can not be used in households with pregnant or immunocompromised person Contraindications  Mild illness is NOT A CONTRAINDICATION  Immune deficient and pregnant people can not be For vaccine hesistancy talk to them early, have a plan, be consistent, understand and listen Vaccine refusal  Discharging pt from the patient is not recommended o Request alternative schedule o See if they will agree to certain vaccines o See what your facility policy is Managing pain  Infants: oral sucrose or breastfeeding during immunization  Children” breathing exercises, distraction, stroking, rocking, or blowing  Pharamoloical o Topical anethethics applied 30-60 minutes before injection o Oral analgesics before or after immunization o Tylenol has not been decided if you can give it before the vaccination or after Diphtheria Pertussis Tetanus DTAP or TDAP  Children younger than 7 get DTAP  Children older than 7 and adults get TDAP  Diptheria can cause infection on the membranes of the upper respiratory or skin and gives exotoxins causing paralysis of the palate and hypopharynx with effects on the kidney heart and nervous system o Requires intimate contact with respiratory exotoxins excreted  Tetanus- creates a neuro toxin and transmitted by an open wound like a rusty nail. Anything that is an open wound that can be dirty. Spreads to the blood stream and lymphatic. Anytime you have an open wound GIVE THEM A BOOSTER TETANUS. TDAP o Causes spasms and rigidity o If you have tetanus it is hard to treat  Pertussis excretes toxin that causes problems with the respiratory system o inspiratory whoop

o post tussive emesis o rib fractures o carotic artery dissection o seizure pneumonia and encephalopathy o spreads respiratory secretions  ANY ONE PREGNANT GETS A TDAP Haemoephilus Influenza Type B  Causes respiratory disease processes and MENINGITIS o Mengingitis o Otitis media o Periorbital cellulitis Hepatitis A- least concerning hepatitis. Sourced from contaminated water and under cooked food  Fecal oral spread  Causes diarrhea and high liver enzymes, jaundice  Does not manifest into chronic problem  Has two vaccines Hepatitis B- has 3 vaccines. Virus affects the hepatocytes causing low grade chronic hepatitis and hepatocellular cancer.  If mom has hepatitis b while pregnant give hep b shot and hep b immunoglobulins  All babies get hep b when they are born. Birth is bloody.  Phases o Prodromal- starting to get sick. Malaise, anorexia, nausa o Icteric- clay colored stools jaundize elevated liver enzymes o Convalescence phase- for months malaise and fatigue  Spread by contaminated blood, semen, vaginal secretion, saliva  Don’t give if allergy to baker’s yeast Human papillomavirus- original vaccine protected against only 4  Gardasil 9 covers 9 different strains of HPV that cause precancer  Can do 2 doses before 14  If after 14 do 3 doses  Contraindications is allergy to bakers yeast and pregnancy  Virus must be present for cancer to develop Measles, Mumps, and Rubella : rash that progresses to pneumonia Measles- affects nasopharyngeal epithelium and spreads to lymph nodes  Immune suppression gives bacterial and viral infection  Spreads by respiratory droplets  KOPLIK SPOTS- white lesions with moist red background Mumps- affects the nasopharyngeal epithelium and spreads to regional lymph nodes  Replicates leads to plasma viremia  Enlarged parotid glands, fever, malaise, uri, and rash  Spreads through respiratory droplet or direct contact with saliva  Salivary glands, pancreas, ovaries, testes affected Rubella- infection in the nasopharyngeal epithelium and spread to lymph nodes to respiratory tract, skin, body fluids, and in pregnant women the placenta  Causes vasculitis affecting organ development

 Spreads via airborne droplet shed from respiratory tract  CONGENITAL RUBELLS SYNDROME o Birth defect deafness, cataracts, microopthalmia, cardiac defects, and cns abnormalities Pneumococcal  Strep pneumoniae bacteria  Can lead to meningitis, blood and ear infection, brain damage death  Starts as fever chills cough and chest pain  Spread by direct contact and respiratory droplets PCV13- Prevnar, 4 injections, and starts at 2 mo, 4mo, 6mo, 12mo PPSV23- children 2-18 years at high risk for penomocccoal. 2 doses. Given to older adults, immunosuppress Polio- contagious and starts like a cold and causes paralysis of muscles and death  Spread by fecal oral route  Do not give IPV (inactivated polio vaccine) to those that are allergic to neomycin, streptomycin, or polymyxin B Varicella- causes chicken pox (varicella) and shingles (herpes zoster)  Typical rash is made of small itch blisters around inflamed skin  Rash starts on the face, scalp, or chest  Incubation 10-21 days  Vesicles crust over  Contagious to two days before vesicles and contagious until last lesion crusted  Live vaccine- 12 months  Avoid given salicylates (aspirin) in kids.  Allergy to gelatin or neomycin in contradindication Meningitis Vaccine-  Give to children 11-12 or 13-18  Give those living in dorm or close conditions  Second dose at 16  Bacterial meningitis inflames the membrane of the brane and is highly contagious o Fever, vomiting, tenderness on the spinal column  Meningococcal serogroup ACWY vaccine o Regular meningitis vaccine o Covers 4 strains  MCV4for 2-55  MPSV4 for 2 or older than 55  Meningococcal serogroup B vaccine o Minimum age 10 o Type b meningitis o Should get both types of vaccines Rotovirus- first live vaccine given Common cause of diarrhea and rotavirus gastroenteritis causes dehydration  Fever, vomiting, diarrhea  Spread through fecal oral route and airborne droplets in fomites  Vaccine liquid given by mouth 2 mo, 4 mo, 6 mo  Start series before 12 weeks of age and complete by 32 weeks

o Minimum age 6 weeks Influenza- virus of the respiratory tract  Prevalent winter and spring  Infants under 6 months can’t get it  Kids under 9 with seasonal flu vaccine for the first time have to get influenza and H1N1 shots apart  Do not give if allergy to eggs, had guillian barre syndrome  Regular is inactivated and high dose is several strains and the live flu NP role and professionalism CT Scan- Computed Tomography  Pros of availability speed and decreased cost  Cons is ionizing radiation, iv contrast for renally impaired  Used often for head ct in tbi, stroke, bleed, abdomen, c-spine, pelvic and facial fractures XRAY Pros is inexpensive, portable, fast, and effective for most tissues Cons is it can miss soft tissue abnormalities Order in 2-3 views Frequent orders: Chest pa and lateral- chest pain, kub for abdomen. nephrolithiasis, abdominal, extremity Ultrasound- least invasive and rapid Use in trauma, cardiac for pericardial fluid, AAA, 1 st trimester of pregnancy, vascular access, gallbladder disease, renal colic. Good for looking for fluid collections MRI- imaging of choice for spinal cord compression, occult femoral neck fracture, posterior cranial fossa  Most expensive  Most detailed  Will require preauthorization and step wise approach for health insurance to cover so start xray, ct, then mri highest level of service billing CPT code  992 is outpatient visit and NEW PATIENT  99205 is the highest compensated outpatient visit  Usually worsening condition  With an ascending level of care  Level of acuity matters the most  Some providers bill on amount of time(outdated practice) but certain medicare assess notes for level of acuity  Pg23 talks about how your not supports billing  99203 is level three visi t  99204 is level four visit