Exam 4, Level 3 Nursing SCF
Pharmacology for TB - Isoniazid (INH), Rifampin (RIF) turn body fluids red/orange, tears, urine, etc.
Ethambutol (EMB), Pyrazinamide (PZA), Rifapentine (RPT). Multi-drug for 8 wks., then still continue to
take meds 4-7 months
Hepatitis B Vaccine - Is highly effective vaccine that provides active immunity for 99-100% of
patients. Prepared using yeast. (do not give if allergic to yeast). All infants at birth 3 doses are given 1st
dose (IM vastus, 1 month & 6 months. Recommended: All children younger than age 19 who have not
been vaccinated, HC workers, caregivers, those working in facilities for developmentally disabled. High
risk Sex, hetero, homo w/multiple partners, prostitution, bisexual, share needles, correctional facilities,
end-stage renal disease, liver disease, HIV or diabetes. living or traveling in regions w/high Hep B
common
B & T Lymphocytes - Produced in the bone marrow. B mature in bone marrow. T mature in the
thymus gland. As person is challenged by specific antigens in life, lymphocytes to specific antigens
emerge. If re-exposed body will have a more rapid response. A memory capacity for the immune system.
Active Acquired immunity
Antibody Production - Secreted by B lymphocytes
Antibodies/immunoglobulins formed after B engulfs antigen and interacts with helper T's
B makes identical copies of specific antibody
Active Immunity - A form of acquired immunity in which the body produces its own antibodies
against disease-causing antigens. Natural: Infection, exposed & body makes antibodies. Artificial:
Vaccination given, then body makes antibodies.
Passive Immunity - Natural: Maternal antibodies from Mother to child, (breastmilk), Artificial:
infusion of monoclonal antibodies. This does not last forever 3-5 months
Types of Antibodies - IgG: gone (feel better, but body has the memory of it), IgM: miserable
(actively sick) immunoglobulins & antibodies are the same thing.
,Herd Immunity - Protecting the people that cannot get vaccinated... by giving vaccine to those
who can get it. Most people will be immune, then chance of unvaccinated getting sick is LOW
Vaccine program goals - Use widespread efforts to prevent specific infectious diseases from
occurring in a population. Risk & benefits for the person & the community, Morbidity, mortality, financial
cost & benefit. No vaccine is safe for all need to follow recommendations. Based on evidence based
science CDC sets optimal schedules
Live attenuated vaccines - Live pathogen, but weakened. May cause minor illness in rare cases
cannot produce disease unless the person is immunocompromised. Ex: MMR & Varicella, Pregnant &
immunosuppressed cannot get this type. Flu nasal spray is attenuated-no pregnant women
Inactivated Vaccines - Inactivated or killed by heat or chemicals, unable to produce the disease.
Some may only include a sub-unit of the microbe like a piece of protein from this. Boosters may be
necessary to prolong immunity. Ex: Flu & Hep A. CANNOT infect the pt. w/a disease. May be
symptomatic: fever. These are okay to give immunocompromised pt.
Toxoid Vaccines - contain bacterial toxins that have been chemically modified to be incapable of
causing disease. Spores can withstand high heat (c. diff. clostridium, etc) produce toxins. These vaccines
induce the formation of antibodies can neutralize the real toxins. Ex. Tetanus & Diphtheria. Even if you
have a break in the cornea this is a break in the skin Tetanus will be recommended.
Immunity - Commonly defined as a physiological process that provides an individual with
protection or defense of disease. Latin word: immunis-which means exempt.
Recombinant Technology Vaccines - Contain partial viral subunits or proteins that are generated in
the lab via biotechnology. Do not contain viral material-you cannot become infected/sick. Ex. Hep B &
HPV Vaccines.
COVID-19 Vaccine - mRNA gives instructions for our cell to make a harmless piece of what is called
the "spike protein". The "spike protein" is found on the surface of the virus that causes COVID. mRNA
degrades very quickly; that why the storage at extreme cold temp.
Hepatitis B Symptoms - preventable liver function, spread by blood, semen, or other body fluids.
May be asymptomatic. Symptoms: fatigue, poor appetite, stomach pain, nausea, & jaundice. Can be
,acute or chronic. Chronic leads to cirrhosis or liver cancer or failure. 90% infants w/this go onto develop
chronic infections, where as 2-6% adults who get hep B as adults become chronically infected.
Hepatitis B Vaccine how to give - Three IM injections, 1st given at birth, 1 month, & then 6 months
after 1st dose. 90% effective. In adults use deltoid, infants vastus laterals. There are catch up schedules if
you don't get the dose early. Need a written consent for vax
Hepatitis B Vaccine Adverse Effects - pain at injection site, mild to moderate fever, chills, approx
15% of pt will experience minor symptoms: fatigue, dizziness, fever, H/A, hypersensitivity reactions such
as urticaria or anaphylaxis are possible. Do not give if allergic to yeast
Rotavirus - is oral vaccine, many vaccines are in a combo which will decrease the amount of
injection
Pediarix Combination Vaccine covers - DTap, hepatitis B, & inactivated poliovirus vaccine
When all 3 systems are wrong in ABG - Partially compensated
Pentacel - DTap, inactivated poliovirus, & Haemophilus influenzae type B vaccine
ProQuad - MMRV - Measles, Mumps, Rubella, AND Varicella (SQ) (live virus vaccine) no
pregnancy, immunocompromised
VAERS Vaccine Adverse Event Reporting System - to report any adverse reactions after
administration of any vaccine. Vaccine information statements must be given to parents before
administration of given vaccines, provide updated information for parent/guardian of child being
vaccinated
Barriers to Vaccines - Parents: feel not safe ingredients, false belief cause Autism, not adequately
tested. Too many shot at one time. Perceived contraindications, distrust government regulation, religious
beliefs. Geographic, language, socioeconomic barriers. Higher education levels & living in poverty
associated w/lower vaccination rules.
, Measles Symptoms - Initial symptoms: fever, cough, conjunctivitis, nasal discharge, general
malaise. Late Symptoms: Kolpik Spots (white spots in the mouth) & Rash
Why are measles such a concern? - 90% susceptible to the disease will contract it when exposed,
virus remains present in the environment for up to 2 h. after the infectious person leaves, contagious 4
days prior to the rash presenting & 4 days following it's eruption, by the time you realized you have
measles & take measures to avoid infecting others, you've already infected others. 1 in 20 child develop
pneumonia & can die, encephalitis-brain swelling can cause intellectual disability, respiratory &
neurological complications. Pregnant mom can have premature birth if infected while pregnant. 1 in 5
chances of being hospitalized.
TB pathophysiology - Slow growing acid-fast bacteria, mycobacterium tuberculosis bacillus,
airborne transmission. primarily in lungs, can travel to other parts of the body: brain-meninges, kidney,
bone, lymph, spine, disparity, poverty, overcrowding, inadequate healthcare. 1/3 of the world
population, remains the leading cause of death from an infectious disease in the world. Curable and
preventable.
Active TB disease - Able to transmit via airborne. Most common places in lungs, coughing
(productive or nonproductive), difficulty breathing, chest pain, low grade late afternoon fever, night
sweats and weight loss, weakness, coughing up blood. Older adults have fewer symptoms. If you receive
chemo/immunocompromised it will become active. Pt will be placed in a negative airflow hospital room
(w/6 air exchanges per hour exhausted to the outside. When patient leaves hospital keep door closed 3
h. before admitting new patient in that room. Nurses need to be fitted with an N-95 mask.
Latent TB infection (LTBI) - infected but no active disease, encasement of the TB because their
immune systems has it contained. You are not contagious during this period
TB Risk Factors - Close contact to active TB, Health conditions, socio-economic, poverty,
malnutrition, overcrowding, inadequate healthcare, Immunocompromised: HIV, Chemo, Transplant,
prolonged high dose corticosteroid therapy, IV users, alcoholics, diabetes, CKD, malnourishment,
hemodialysis, prisons, dorms, psychiatric institutes, overcrowding, HC worker, intubation, suctioning,
immigration, travel
TB Testing - Mantoux Test, Sputum AFB Stain, Sputum culture, Chest X-ray-presence of lesions in
the upper lung fields, QuantiFeron Gold
