Title NCM 113 RLE SEMI FI ✅

NCM 113 RLE Semi Fi BY TONS and MADS IMMUNIZATION Videos: ● IMMUNIZATION (transcribed) ● NCM 104 RLE EP IMMUNIZATION (transcribed) ● WHO_EPI 40th anniversary Check Child’s Immunization Status, Check Immunization Status for ALL sick children (recommended for age, and check if need any immunizations during the visit) ● Use the DOH recommended immunization schedule ● Give mother tetanus toxoid as required Immunization Schedule ★ Only intended for <59 months (Ideally, children receive all recommended immunizations for <5y.o before first birthday but allowance for MMR - w/in 12 -15 months) ★ If child does not come for immunization at recommended age, give necessary immunizations at time after child reaches that age, give remaining doses at least 4 weeks apart. No need to repeat the whole schedule ➢ Birth: BCG; Hep B1 ➢ 6 weeks: Pentavalent 1; OPV 1; PCV 1; Rotavirus 1 ➢ 10 weeks: Pentavalent 2; OPV 2; PCV 2; Rotavirus 2 ➢ 14 weeks: Pentavalent 3; OPV 3; PCV 3; IPV ➢ 9-11 months: MMR1 (previously Measles) ➢ 12-15 month: MMR2 ➢ School entrants (Grade 1) BCG ➢ 9 y.o: HPV Contraindications to Immunization ➔ In general: no contraindications of sick child if well enough to go home. ➔ Almost no contraindication; mild illness should be immunized unless needs to be hospitalized. ➔ Children with malnutrition immunize them as usual because they are more likely than other children to die ➔ Conditions considered false contraindications: ◆ Malnutrition (instead an indication) ◆ Low-grade fever ◆ Mild respiratory infection ◆ Diarrhea ➔ Children w/ diarrhea, should receive OPV during visit. However, dose is not counted. Child should return when the next dose of OPV is due. ➔ Do not give: ◆ Pentavalent to children <5 yrs of age or w/ recurrent convulsions or another active neurological disease of CNS ◆ Pentavalent 2 or 3 to child who has had convulsions/shock w/in 3 days of most recent dose ● Pertussis: causes convulsion because of its effect to CNS. ● Instead of penta, give individual dose ◆ Rotavirus when a child has a hx of hypersensitivity to previous dose, intussusceptions or intestinal malformation or acute gastroenteritis. ◆ BCG (and other Live Attenuated) to child who has s/s of AIDS, immune deficiency, immunosuppressed (drug treatment or illness) ● Live attenuated: OPV, MMR, tetravalent vaccine, MervV (varicella) chickenpox, rotavirus Check Child’s Immunization Status To decide if child receives an immunization today 1. Look at the child's age on clinical record - or ask 2. Ask mother if child has immunization card - compare child immunization record w/ recommended immunization schedule, and decide whether child has had all immunizations recommended for child's age. 3. On the recording form, check all immunizations the child already reserved. Circle any immunization that child needs to receive today. If child is not being referred, explain to mother that child needs to receive immunization/s 4. If mother says that she does not have an immunization card w/ her, ask the mother to tell you what immunization the child has received. a.Use judgment to decide if the mother has given a reliable report. b.If you have doubts, immunize the child 5. Give immunizations according to the child's age, give an immunization card to mother, and ask her to bring it w/ her when she brings the child to the Health Center. Check Vitamin A status of ALL Sick children Vitamin A ➔ plays a vital role in growth and development of children. ➔ helps prevent invasion of infectious organisms ➔ maintains tissue in skin, respiratory tract and intestinal tract, and cornea of the eye. ➔ Use Recommended Vitamin A Schedule: ◆ All children 6 months should receive 100,000 IU ◆ 200,000 IU q6months after up to age of 59 months. ➔ Two colors of vitamin A: ◆ BLUE - 100,000 IU, for children 6 - 11 months ◆ RED - 200,000 IU 12 months to 5 years old ➔ Observe administration precautions (overdosage=problem) ◆ Before giving vitamin, ask 2 questions: ● Is child >6 months. If yes, ask 2nd question. ● Has child had dose of vit A in the past 6 months? ◆ Check clinical record date when vit A was last given. If child is >6 months and has not had a dose of vitamin A in past six months, give single dose, ◆ Child may develop vomiting, Headaches, nausea after. Reassure symptoms will disappear w/in 24hrs Assess Other Problems: Identify and treat any other problems according to Health Center policy. Refer child for any problem you cannot manage in the Health Center Expanded Program on Immunization (EPI) ➢ established in 1976 to ensure infants/children and mothers have access to routinely recommended infant/childhood vaccines ➢ Vaccines under the EPI are: ○ BCG and Hepatitis B birth dose ○ Oral Poliovirus Vaccine ○ Pentavalent Vaccine ○ Measles Containing Vaccines (Anti-measles, MMR) ○ Tetanus Toxoid ○ Pneumococcal Conjugate Vaccine 13 (2014) 1

NCM 113 RLE Semi Fi BY TONS and MADS D. At 9 months, and booster in 18 months E. 0.5ml, powdered, left deltoid, subq F. Generally no Side effect G. Measles - live vaccine 1. Highly infectious viral illness manifested by cold like symptoms, fever, small grayish spots; rashes starts from head neck and will spread throughout the body. spread through droplet infection H. Mumps 1. contagious viral disease manifested by a painful swelling at side of neck or under ears, hamster face of appearance, fever, headache, joint pains. I. Rubella (German measles) 1. Red pinkish petirash (2-3 weeks to appear) 2. fever, sore throat, sore red eyes, rashes appear starting behind the ears and spread through the neck, head and body. Keep Potency of Vaccines ➔ vaccines confirm immunity only when they are potent by properly stored, handled, and transported ➔ Vaccines are very sensitive to heat and freezing, and must be kept at the correct temperature. ➔ Vaccine potency cannot be retained once it is lost. ➔ The system used for keeping and distributing vaccines in good conditions is called “cold chain”. ➔ Cold chain - system for ensuring potency of a vaccine from the time of manufacturer to the time it is given ➔ Person responsible for cold chain management ◆ Each level of RHU has a cold chain officer ◆ Health Center level - PHN (cold chain officer) -nurse in charge of maintaining cold chain equipment and supplies (freezer/refrigerator, transport box, vaccine bags, and carriers) ◆ monitors ice packs, thermometers, and cold box ◆ The nurse implements an emergency plan in the event of an electrical breakdown, or Power failure. ➔ Oral polio vaccine ◆ Stored in freezer 15 to 25C ◆ If transported: vaccine bag in contact with cold packs ➔ MMR and other vaccines: stored in refrigerator 2-8 C ◆ Should be stacked neatly on shelves of refrigerator. ◆ Do not stack vaccines on refrigerator door shelves. ➔ Hepatitis B and pentavalent vaccine are damaged by freezing, should not be stored in the freezer. ◆ Wrap containers with paper before putting them in vaccine bag With cold packs, if ever transported, ◆ Keep diluents cold by storing them in the refrigerator in the lower or door shelves. ➔ Maintain potency: first expiry first out policy EPI RECORDING AND REPORTING ● Accomplished using FHSIS (Field Health Services Information System) - major component of information networks developed by DOH designed to assess performance of the health programs. ○ All immunized children in every health centers are recorded and these are reported monthly through the FHSIS ● Fully Immunized Child (FIC) given BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of Pentavalent and 1 dose of anti Measles vaccine before 1 year of age ● Completely Immunized Children - completed immunization schedule at the age of 12-23 months ● PHN - responsible in recording and reporting immunization activity in respective health centers. Send to Central office, service monitoring and evaluation division DDST (DENVER DEVELOPMENTAL SCREENING TEST) Video: https://youtu.be/BXcOQa03b48 (transcribed) DDST ➔ tool or early detection model for determining developmental delays in ages 1-6 years old (Children 6 1⁄2 years and below) ➔ Screening - presumptive identification of unrecognized disease or defect (Not a diagnosis but detection/basis/reference) ➔ Facilitates early referral and treatment (Simple and clinically useful tool) ➔ Important Consideration: Age is crucial; initial step in test administration ➔ manual and sample test forms used by nurses and psychologists in determining developmental delays ➔ discovered by WILLIAM FRANKENBERG ➔ Purposes ◆ Measures developmental delays ◆ Evaluates 4 aspects of development ➔ DDST Kit: Manual, Sample test form, Test materials, DDST bag (CHN Bag) ◆ A bright red yarn pom-pom ◆ A rattle with narrow handle ◆ Eight 1-inch colored wooden blocks (red, yellow, blue green) plastic or wood (most preferable) ◆ A small clear glass/bottle with 5/8 inch opening 350ml mineral water bottle or 500ml ◆ A small bell with 2 1⁄2 inch-diameter mouth ◆ A rubber ball 12 1⁄2 inches in circumference ◆ A pencil ◆ Cheese curls - can be eaten, not expired 3