1 JMJ Marist Brothers Notre Dame of Dadiangas University College of Nursing ________________________________________________ A Ward Class Lesson Plan On Immunization

________________________________________________ Presented to: Ms. Claire Espiritu, RN Ms. Eleanor Caballero, RN CLINICAL INSTRUCTOR

In Partial Fulfillment of the Requirements in Nursing Care Management 102-B

Presented by: Jeande Lee Sasam, SN Joanna Paula Songcayauon, SN Level III Section B MEIN BENENNEN 2010 January 19, 2009 2nd Semester S.Y. 2008-2009

2 IMMUNIZATION (VACCINATION) Overview At birth, infants have protection against certain diseases because antibodies have passed through the placenta from the mother to the unborn child. After birth, breastfed babies get the continued benefits of additional antibodies in breast milk. But in both cases, the protection is temporary. Immunization (vaccination) is the process by which vaccines are introduced into the body before infection sets in. Vaccines are administered to induce immunity thereby causing the recipient’s immune system to react to the vaccine that produces antibodies to fight infection. Vaccinations promote health and protect children from disease-causing agents. Infants and newborns need to be vaccinated at early age since they belong to the vulnerable age group. They are susceptible to childhood diseases. TARGET DISEASES 1. tuberculosis 2. diphtheria 3. pertussis 4. tetanus 5. poliomyelitis 6. measles 7. hepatitis A child is “Fully Immunized Child” when a child receives one dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of Hepa B and one dose of measles before a child’s birthday.


TETANUS VACCINE Description: The tetanus vaccine is an inactivated toxin (poison) called a toxoid. It is made by growing the bacteria in a liquid medium and purifying and inactivating the toxin. Because it is not a live vaccine, a person's immunity tends to decline with time, which is why booster doses are recommended. Indication: To actively immunize all children from the age of 6 weeks onwards.

To protect infants against the risks of tetanus neonatorum by immunizing pregnant mothers. To actively immunize civil population particularly those who are exposed to occupational risks such as road workers, athletes, agricultural workers, industrial workers etc.

To actively immunize civil and defense personnel, home guards and police personnel.

Dosage: The full basic course of immunization against tetanus toxoid consists of three primary doses of 0.5ml at least four weeks apart, followed by booster doses at 18 months, 5 years, 10 years and 16 years and then every 10 years. Protection of the newborn against tetanus: For prevention of neonatal tetanus, tetanus toxoid is recommended for immunization of women of childbearing age, and especially pregnant women. Tetanus toxoid may be safely administered during pregnancy and should be given to the mother at first contact or as early as possible in pregnancy. Administration: The vaccine should be administered by deep intramuscular injection. Tetanus toxoid should be injected intramuscularly into the deltoid muscle in women and older children. If there are indications for the use of tetanus toxoid in

4 younger children the preferred site for intramuscular injection is the anterolateral aspect of the upper thigh since it provides the largest muscular area. Only sterile needles and syringes should be used for each injection. The vaccine should be well shaken before use. Each injection of the primary immunization series should be made into a different site. Adverse Reactions: Mild local reactions consisting of pain, erythema, tenderness and induration at the injection site are common and may be associated with systemic reactions including mild to moderate transient fever and irritability.

BCG VACCINE BCG, or bacille Calmette-Guérin, is a vaccine for tuberculosis (TB) disease. Many foreign-born persons have been BCG-vaccinated. BCG is used in many countries with a high prevalence of TB to prevent childhood tuberculous meningitis and miliary disease. However, BCG is not generally recommended for use in the United States because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine’s potential interference with tuberculin skin test reactivity. The BCG vaccine should be considered only for very select persons who meet specific criteria and in consultation with a TB expert. Contraindications Immunosuppression BCG vaccination should not be given to persons who are immunosuppressed (e.g., persons who are HIV infected) or who are likely to

5 become immunocompromised (e.g., persons who are candidates for organ transplant). Pregnancy BCG vaccination should not be given during pregnancy. Even though no harmful effects of BCG vaccination on the fetus have been observed, further studies are needed to prove its safety. Recommendations Children  BCG vaccination should only be considered for children who have a negative tuberculin skin test and who are continually exposed, and cannot be separated from, adults who  Are untreated or ineffectively treated for TB disease (if the child cannot be given longterm treatment for infection); or  Have TB caused by strains resistant to isoniazid and rifampin. Health Care Workers BCG vaccination of health care workers should be considered on an individual basis in settings in which  A high percentage of TB patients are infected with M. tuberculosis strains resistant to both isoniazid and rifampin;  There is ongoing transmission of such drugresistant M. tuberculosis strains to health care workers and subsequent infection is likely; or  Comprehensive TB infection-control precautions have been implemented, but have not been successful.

Specific Objectives


Time Allotted

Classroom/Clinical Skills Lab

Reference/ Instructional Materials


After 45 minutes of lecture, the student nurse will be able to: Define Immunization The process by which vaccines are introduced into the body before infection sets in. 1.tuberculosis 2.diphtheria 3.pertussis 4.tetanus 5.poliomyelitis 6.measles 7.hepatitis Description, Indication, Dosage, Protection of the newborn against tetanus, Administration, Adverse Reactions

5 mins RT Building Room 201

Fundamentals of Nursing 7th Edition, Barbara Kozier et. Al Brunner and Suddarth’s textbook of MedicalSurgical Nursing Volume 1, 10th Edition, Nursing Care Plans Guidelines for individualizing patient care, edition 6, Marilynn E. Doenges LCD


Enumerate diseases that commonly require immunization

10 mins

Discuss the description, indication and nature of the Tetanus Toxoid Vaccine

10 mins

Discuss the description, indication and nature of the BCG Vaccine

Description, Contraindications (Immunosuppression, Pregnancy), Recommendations (Children, Health Care Workers)

10 mins