First time vaccinating 11 yr old, help?

Nurses General Nursing

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I graduated from LPN school in March and started my job in a peds office 3 weeks ago. I have an 11 yr old who is coming into the office tomorrow to get Tdap, Menactra, Hep A, and Gardasil. This will be my first time giving so many shots to an older child. The CMA who works there was going to handle this appointment because she didn't want to overwhelm me but she's out sick. So here's my question: where should I give the shots? I spent the afternoon researching if it would be ok to administer them all in the deltoids (2 in the left, 2 in the right). I read that Gardasil can be given in the upper anterolateral thigh. I am not good with locating the ventrogluteal and would like to avoid it because I'd rather give it at a landmark I'm more familiar with. I was thinking the Menactra could be given in the Left, and the Tdap and Hep A in the right, and the Gardasil in the thigh. Would this be a problem as far as receiving the optimal level of protection?

P.S We really weren't taught much about vaccines in school. They prepared us for working in the hospital and always skipped over anything related to office work so all of this is a bit new to me.

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I've always found thigh shots to really hurt. She might also have to pull down pants for that depending on what she is wearing and that age can be very shy. Every Gardasil shot I've known to have been given has always been in deltoid so I'd opt for that instead. Ideally the Gardasil should be given alone. If you think you'd be best off having someone there to aide you this early in your career see if you can re-schedule for the next day. There is no shame in that.

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I would start with checking the info/insert from each vaccine. Sometimes there will be info on what you can give in combo. If you want to verify, try calling your state DPW that handles your state vaccines. Even if the child is not a medicaide pt, they are a good info source. You might want to hold the Gardasil for another time- in my experience sometimes girls get light-headed, so we always gave it on its own. Not sure if that's much help, but it mightbe a place to start :)

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Thank you guys. I was going to suggest to the mom that she bring her back another time for the HPV because I know it's very painful. The package insert was where I read about giving it in the thigh but I've also never known anyone to get Gardasil anywhere but the deltoid.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Hang in there. TALK to her - 11yo's, unless they have learning disabilities, have an amazing capacity for logic and reason.

My 13yo son just got Gardasil (first male at our clinic to receive it - the MA argued with me at first that he could get it), and it wasn't particularly painful to him.

I agree that doing two in each arm would be better than the thigh or glutes. And I think it would be better for her if you just got it over with in one visit, rather than her having to come back to the clinic another time.

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Are the parents insisting on doing all at once? If I were getting that many I'd split them up and I'm alot bigger than most 11yo.

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I don't know if this particular parent would refuse them or if she'd insist on having them all at once. She seems like she's just going with the flow.

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Before I went back to school for my RN I worked as an MA. I would give 2 in each deltoid, whatever two you want to give in either delt. Just make sure you document which was in the Right Upper and the Right Lower and the Left Upper and the Left Lower, that way if there is any type of reaction you will know what vaccine caused it. It won't be that bad I promise. You really only need to worry about the number of ml that each region (deltoid, dorsogluet, ect. can hold) Giving 2 vaccines in each is not going to overload the muscle.

I am sure you will do great!

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Specializes in Ambulatory Care, Case Manager.

This child seems to be behind on her vaccinations already. Unless the schedule has changed, Tdap is given at 7 years old and Hep A at 1 year old and they can be given together. Tdap is more painful, so it's better to give it in the non- dominant side

For Hep A: 2 doses are given at least six months apart. (IM deltoid)

Gardasil: is given in three doses. Second dose is given 2 months after first one and third dose is given 6 months after first dose. Make sure that you monitor your patient for a vaso vagal reaction. We had several teenage girls who almost fainted after receiving Gardasil (IM deltoid). Just FYI.

Give them all in one sitting. My concern is that the mother will not bring the child and she will be behind on her vaccinations once again. Better to keep her schedule up to date. Just follow the protocol if the child has fever or if the site of the injections swells up. Hope this helps.

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Based on the schedule posted in our office, Tdap is given at 11. She was born before 2006 so Hep A wasn't routinely given when she was 1. So yea, she's behind with that and the first dose was given years ago. We have the Gardasil girls lay down for 15 minutes in our offfice. I'm just worried about giving her so many painful shots now. Thanks everyone for the advice, I appreciate it all!!

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
This child seems to be behind on her vaccinations already. Unless the schedule has changed, Tdap is given at 7 years old and Hep A at 1 year old and they can be given together.

I believe TDaP is not recommended before the age of 12. Prior to that, either DTaP or DT is recommended.

Many people delay vaxes for their children.

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My tips:

Label all syringes before hand, do your most uncomfortable vac last, tdap/dtap in non dominant arm.

Explain what you're going to do briefly, then get her talking : school, hobbies, music etc.

Act confidant!! You are going to do a great job, show it with a smile, be kind and no nonsense.

Have her take a deep breath, them work quickly.

Tell her what a great job she did.

Review the CDC protocols online before hand...they are newly revised and super helpful!

Make sure to give aftercare tips (ibuprofen prn, move those arms etc...)

You got this! You are going to do great!!! (don't forget to give the vaccine information sheets to mom)

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