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Respond to the 2 following posts separately with separate reference lists.
Length: A minimum of 150 words per post, not including references.
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
1. [Julia Russell] Q1. The child will need her second Hep B, RV, DtaP, Hib, PCV13, IPV – combination vaccines are available for this baby and can be given. Pediarix covers DTaP + Hep B + IPV5 diseases (Diphtheria, tetanus, pertussis, hepatitis B, and polio)(Immunization Schedules, 2022)Click and drag to move
Q2. At 12 months old the child will now receive Hib, PCV13, IPV, Annual influenza, MMR, varicella and HepA. Again a combination is available in our clinic and she will be given an injection of Proquad this covers MMR plus Varicella.
Q3. Pneumococcal polysaccharide vaccine (PPSV23)is given for children at risk for
1.alcoholism, 2.chronic liver disease, including cirrhosis 3.chronic heart disease (e.g., congestive heart failure, cardiomyopathies), excluding hypertension 4.chronic lung disease (including COPD and emphysema) 5.diabetes mellitus 6.candidate for or recipient of cochlear implant 7.cerebrospinal fluid (CSF) leak 8.functional or anatomic asplenia (e.g., splenectomy or congenital asplenia) 9.sickle cell disease and other hemoglobinopathies 10.congenital or acquired immunodeficiencies (e.g., B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4), and phagocytic disorders (excluding chronic granulomatous disease) 11.generalized malignancy 12.HIV infection 13.Hodgkin disease, leukemia, lymphoma, and multiple myeloma 14.immunosuppression due to treatment with medication, including long-term systemic corticosteroids, and radiation therapy 15.solid organ transplantation; for bone marrow transplantation, 16.chronic renal failure or nephrotic syndrome(Pneumococcal Vaccines, 2022, Recommendations for children section)Click and drag to move
A review of 35 studies of over 6900 individuals showed that “The available evidence suggests that SJW extracts are effective in treating patients with mild and moderate major depressive disorder, compared to placebo and comparable to antidepressants. Observed adverse events were fewer than compared to antidepressants(Apaydin et al., 2016, p. 21)Click and drag to move.”
Q4. St Johns wort can and does interfere with the efficacy of birth control pills and the patient should be advised to use a back-up method starting immediately. Otherwise, a discussion about taking a different anti-depressant can occur. A large concern would be serotonin syndrome. Patient teaching would need to include this potentially lethal side effect.
Echinacea is not known to lessen the length of a cold.
Q5. There are nine known species of echinacea, all of which are native to North America. They were used by Native Americans of the Great Plains region as traditional medicines. It has been used as a supplement for diseases such as the common cold, and is believed to boost the immune system, It comes in both oral and topical forms.
Echinacea is promoted as a dietary supplement for the common cold and other infections, based on the idea that it might stimulate the immune system to more effectively fight infection. Echinacea preparations have been promoted for topical use (application to the skin) for wounds and skin problems.
Q6. The studies about the use of Echinacea in children are inconclusive. The supplement is found in all major drug stores in a form for children. I would suggest that if she wants to give this to her child to follow the directions and not give adult dosages also that if the child gets worse to come into the clinic to be seen. As the child is only 4 years old, taking this unregulated and invalidated medication would not be in my treatment plan.
Apaydin, E. A., Maher, A. R., Shanman, R., Booth, M. S., Miles, J. V., Sorbero, M. E., & Hempel, S. (2016). A systematic review of st. john’s wort for major depressive disorder. Systematic Reviews, 5(1). https://doi.org/10.1186/s13643-016-0325-2
Echinacea. (2020, July). National Institutes for health, complementary and integrative health. Retrieved April 21, 2022, from https://www.nccih.nih.gov/health/echinacea?msclkid=ed33e246c1d511ec8bd835a9883b13d8
Immunization schedules. (2022). Centers for disease control. Retrieved April 21, 2022, from https://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html?msclkid=60179294c1ce11ec8ed96f2f4d627a32
Pneumococcal vaccines. (2022, March 22). Immunize.org. A cooperative effort with the National Center for Immunization and Respiratory Diseases. Retrieved April 21, 2022, from https://www.immunize.org/askexperts/experts_pneumococcal_vaccines.asp
2. [Janeeh Marie Miranda] A healthy 2-month-old child was brought to your clinic by her parents. The child is a full-term infant with no concerns. Her exam is normal, and she had received her Hep B #1 in the nursery.
Q1. What vaccines does she get? What combinations are available at your clinic?
According to CDC (2022), she can get her second dose of hepatitis B, the first dose of rotavirus, Diptheria pertussis and acellular pertussis (DTaP), Haemophilus influenzae type B (Hib), pneumococcal conjugate vaccine, and inactivated poliovirus. I can recommend giving her multiple shots at the same time. It is safe and better in increasing the 2-month old baby’s immunity (CDC, 2022).
Q2. The child comes back at 12 months after completing her primary series of vaccines at 2, 4, and 6 months. Her vaccines are right on schedule, and her parents have no concerns. She is developing normally, and her exam is normal. What vaccines can she get today?
Suppose she has not gotten her third dose of the Hepatitis B vaccine. In that case, she can receive the third dose of Haemophilus influenzae type B (Hib). Also, the fourth dose of the pneumococcal conjugate vaccine and the third dose of inactivated poliovirus can be administered (CDC, 2022).
She can also receive the first dose of measles mumps and rubella (MMR) and the first of the Varicella vaccine(CDC, 2022).
Q3. Which groups of patients are at higher risk for pneumococcal disease, and need PPSV23 early, starting at 2-years old?
According to Rosenthal & Burchum (2021), children with sickle cell anemia, injury to the spleen, cochlear implants, chronic heart or lung disease, or immunosuppression of any cause (e.g., diabetes, cancer, liver disease, HIV infection, use of immunosuppressive drugs) are at high risk for severe pneumococcal disease. They are recommended to take the vaccine.
A 25-year-old woman comes to your office asking for oral contraceptive refills. She stated that she was feeling depressed and heard about St. John’s wort used in depression which she started taking a week ago.
Q4. How might concomitant administration of St. John’s wort affect the efficacy of drugs this patient is taking such as the oral contraceptives? Discuss another example of a possible drug interaction that might occur with St. John’s wort?
It is not recommended to combine oral contraceptive pill with St, John’s wort because the Induction of 3A4 isoenzymes of cytochrome P450 can accelerate the metabolism of many drugs. Therefore it can cause bleeding and unplanned pregnancy (Rosenthal & Burchum, 2021).
The 25-year-old woman stated that her 4-year-old child has been coughing and sounds congested. She wants to know if echinacea might help her child.
Q5. What is echinacea used for and how is it taken?
Echinacea stimulates immune function, suppresses inflammation, and treats viral infections, including influenza and the common cold. It can be taken orally or topically (Rosenthal & Burchum, 2021).
Q6. Is it safe for this mother to give her child echinacea?
There are few side effects and adverse reactions. However, the taste may hinder this from the child taking it. Although the study shows it is safe and effective, especially in upper respiratory tract infection, recovery time is faster (Weishaupt et al., 2020). Therefore, I will tell the mother it is safe just as long the patient is not on immunosuppressant drugs, drug therapy of tuberculosis, cancer, and HIV infection (Rosenthal & Burchum, 2021).
CDC. (2022). Child and adolescent immunization schedule. Retrieved on April 23, 2022. DOI: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. Elsevier.
Weishaupt R, Bächler A, Feldhaus S, Lang G, Klein P, Schoop R. (2020). Safety and dose-dependent effects of echinacea for the treatment of acute cold episodes in children: A multicenter, randomized, open-label clinical trial. Children. 7(12):292. https://doi.org/10.3390/children7120292
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