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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.

  • Recognize appropriate precautions and contraindications for vaccination, including inappropriate reasons for deferring vaccination.

  • Explain appropriate administration of vaccines, including timing and spacing of both inactive and live attenuated vaccines.

  • Recognize the differences in vaccines for young adults currently in use in the United States.

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PATIENT PRESENTATION

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Chief Complaint

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“I’m here to get my new prescription filled.”

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HPI

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Sandra Williams is a 23-year-old woman who presents to your pharmacy in January with a new prescription for prednisone 40 mg PO BID for 10 days. She has had a moderate asthma exacerbation. She just started her new job as an elementary school teacher. She is a new patient to your pharmacy. She inquires about your “One less” signs which refers to a national HPV vaccination campaign.

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PMH

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  • Moderate persistent asthma

  • Chickenpox at age 5 per patient

  • Splenectomy secondary to car accident 3 months ago

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FH

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  • One sister—healthy

  • Mother—healthy

  • Father with type 2 diabetes

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SH

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  • Does not smoke

  • Drinks alcohol socially

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Meds

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  • Albuterol MDI two inhalations PRN

  • Pulmicort DPI two inhalations once daily

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All

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NKDA

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Immunization Record

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No vaccines since kindergarten except:

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  • Meningococcal vaccine before she started her freshman year in college

  • One dose of hepatitis B vaccine before she started her freshman year in college

  • MMR vaccine before she started her freshman year in college, Td 10 years ago at her adolescent well check-up

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ROS

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WDWN African-American woman in NAD

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VS

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BP 120/72 mm Hg (left arm, large cuff, seated), P 76 bpm; Wt 54 kg, Ht 5′5″

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Physical Examination

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Deferred

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Assessment

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A 23-year-old woman recently treated for a moderate asthma exacerbation. She is in need of immunizations today.

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QUESTIONS

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Problem Identification

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1.a. Create a list of the patient’s immunization-related problems, including any contraindications or precautions for vaccination.

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1.b. Create a list of this patient’s drug-related problems.

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Desired Outcome

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2.a. What immediate immunization goals are reasonable in this case?

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2.b. Provide the rationale for administering each of the recommended vaccines to this patient.

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