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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Develop a plan for administering any needed vaccines, when given a patient’s age, immunization history, and medical history.

  • Describe appropriate use of pediatric vaccines.

  • Educate a child’s parents on the risks associated with pediatric vaccines and ways to minimize adverse effects.

  • Recognize inappropriate reasons for deferring immunization.

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PATIENT PRESENTATION

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Chief Complaint

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“My daughter is here for the ‘Back to School’ program.”

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HPI

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Allison Showalter is a 4-year-old girl who is generally healthy. She presents today (August 30, 2015) to the pharmacy with her mother for evaluation and to receive any needed immunizations. Allison will be entering junior kindergarten in the fall, and she needs to have an updated immunization record.

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PMH

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Some prenatal care, delivered at 42 weeks’ gestation via uncomplicated vaginal delivery; birth weight 7 lb, 4 oz. Mother states that her child has had a couple of ear infections and three or four “colds,” no other illnesses.

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FH

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Mother is 4 months pregnant

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SH

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Lives with mother, age 30, and father, age 32. No siblings. Mother works part-time. Father works as an electrician.

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Meds

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  • Amoxicillin suspension 540 mg PO Q 8 H

  • No recent OTC medication use

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All

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NKDA

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ROS

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Negative

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Physical Examination

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Gen
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Alert, happy, appropriately developed 4-year-old child in NAD. Wt 18 kg (75th percentile), height 40 in (50th percentile).

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VS
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BP 105/65 mm Hg, P 110 bpm, RR 28, T 36.7°C (axillary)

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HEENT
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AF open, flat; PERRL; funduscopic exam not performed; ears slightly red; normal looking TMs, landmarks visualized, no effusion present; nose clear; throat normal

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Lungs
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Clear bilaterally

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CV
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RRR, no murmurs

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Abd
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Soft, nontender, no masses or organomegaly; normal bowel sounds

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Genit/Rect
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Normal external genitalia; rectal exam deferred, no fissures noted

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Ext
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Normal

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Neuro
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Alert; normal DTRs bilaterally

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Labs

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See Table 145-1. Immunization Record Card

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Table Graphic Jump Location
TABLE 145-1Immunization Record Card

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