Chapter 146: Adult Immunization: Immunizations: Not Just Kid Stuff Level II

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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 who is healthy; mother is healthy; father has type 2 diabetes.

SH

Does not smoke; drinks alcohol socially; has healthcare coverage through her employer; religious affiliation is Baptist.

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 checkup.

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

Collect Information

1.a. What subjective and objective information indicates needs, precautions, or contraindications to immunization?