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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.

  • 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.

PATIENT PRESENTATION

Chief Complaint

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

HPI

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.

PMH

  • Moderate persistent asthma

  • Chickenpox at age 5 per patient

  • Splenectomy secondary to car accident 3 months ago

FH

  • One sister—healthy

  • Mother—healthy

  • Father with type 2 diabetes

SH

  • Does not smoke

  • Drinks alcohol socially

Meds

  • Albuterol MDI two inhalations PRN

  • Pulmicort DPI two inhalations once daily

All

NKDA

Immunization Record

No vaccines since kindergarten except:

  • 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

ROS

WDWN African-American woman in NAD

VS

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

Physical Examination

Deferred

Assessment

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

QUESTIONS

Problem Identification

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

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

Desired Outcome

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

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