Need an answer to this situation

Nursing Students NCLEX

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i read this question to Saunders Comprehensive.Chapter 45 page 505.

5. A 9-year-old child ith leukemia is in remission and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. The most appropriate response by the clinic nurse to the mother is

1. "Monitor the child for an elevated temperature, and call the clinic if a temperature occurs."

2. "Keep the child out of school for a 2-week period."

3. " There is no need to be concerned."

4. "Bring the child into the clinic for a vaccine."

The answer to this question is 4 accdg to the book.

My question is, is it ok to administer varicella vaccine to an immunocompromised child in this situation? because the book say so.

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Specializes in Pediatrics Only.

Yes, the child is already immunocompromised, but you do not want him to get the chicken pox. Therefore, he needs to get the vaccine. Yes, there is a chance he might get the chicken pox but with the vaccine the chances lessen greatly.

You want to keep this child from getting sick, so he needs the vaccine.

Does that help?

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The vaccine given to the child in the question will not be varicella vaccine. This child would be administered VZIG (varicella-zoster immune globulin). VZIG would be administered to this non-varicella immune immunocompromised to child to hopefully prevent them from developing varicella.

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Specializes in OB, M/S, HH, Medical Imaging RN.

Hey MeghanRN... we haven't crossed paths in quite a while! How ya doing girlie? Smart as ever!

I am assuming the vaccine is a killed virus? If so, #4 would be my choice as well. My Grandson got a mild case of the measles from his MMR which is a live virus. Pediatrician said it only happens less than 10% of the time.

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Specializes in Pediatrics Only.

Hey DutchGirlRN!

I've been here and there, reading lots of posts. I'm the shy one though, dont respond unless I know the answer or have a strong opinion!

I was going on the basis that it wasnt a live vaccine either, as DutchGirl mentioned. I still think its #4 :)

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Specializes in Critical Care: Cardiac, VAD, Transplant.

I am assuming the vaccine is a killed virus? If so, #4 would be my choice as well. My Grandson got a mild case of the measles from his MMR which is a live virus. Pediatrician said it only happens less than 10% of the time.

The immunoglobulin is the antibody, not the antigen, so this would be a passive immunity. Immunocompromised patients should avoid attenuated or live vaccines unless doc decides that the risk is small enough. Does that help any?

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Specializes in ER.

I think it's A, just because if the child HAS caught chicken pox you wouldn't want to give a vaccine on top of it. My answer would be to moniter for 21 days (the maximum incubation time) and then bring the child in for a vaccine. I would also question why the vaccine wasn't already given- perhaps there is a reason (ongoing chemo?), and does the doc want to start prophylactic antivirals, or immunoglobulin (I'm guessing probably not).

Can't miss school though, when I was a kid you had to be half dead, or likely to cause clean up issues for the teacher before you got out of going to school.

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Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.

Not all that you read in a book as the 'correct' answer, is correct...

Not all situations are the same....not all patients are the same....not all nurses are the same...

Maybe the beginning of wisdom in nursing is recognizing this one thing...

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thanks for the replies.giving a immunoglobulin is the best choice(vzig) but the given choice only states "vaccine" is it proper to think that in this kind of question (situation) the "vaccine "is a immunoglobulin(vzig) not a varicella vaccine? since the choice is not specific...

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"thanks for the replies.giving a immunoglobulin is the best choice(vzig) but the given choice only states "vaccine" is it proper to think that in this kind of question (situation) the "vaccine "is a immunoglobulin(vzig) not a varicella vaccine? since the choice is not specific..."

Yes this is the concept that the question is testing.

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ah. ok. very tricky ^^ tnx a lot.

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I work on a transplant unit. These patients are immunosuppressed and are generally not given vaccines fresh post transplant. I questioned one of the immunologist about that just out of curiosity. She told me that a vaccine wouldn't hurt an immunosuppressed patient. It would just be a waste though because they wouldn't build up antibodies like a normal person would do. They could get a small amount of protection if their body isn't extremely immunosuppressed. Basically I just wanted to know if it would hurt a patient to get a vaccine post transplant and she said no it just probably wouldn't work as well if at all.:smilecoffeecup:

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