Skip to Main Content

Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services (userservices@mhprofessional.com) for more information.

LEARNING OBJECTIVES

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

  • 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.

PATIENT PRESENTATION

Chief Complaint

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

HPI

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.

PMH

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.

FH

Mother is 4 months pregnant

SH

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

Meds

  • Amoxicillin suspension 540 mg PO Q 8 H

  • No recent OTC medication use

All

NKDA

ROS

Negative

Physical Examination

Gen

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

VS

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

HEENT

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

Lungs

Clear bilaterally

CV

RRR, no murmurs

Abd

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

Genit/Rect

Normal external genitalia; rectal exam deferred, no fissures noted

Ext

Normal

Neuro

Alert; normal DTRs bilaterally

Labs

See Table 145-1. Immunization Record Card

TABLE 145-1Immunization Record Card

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.