Vaccination Training for Health Care Providers

Betsy Hubbard RN MNImmunization Clinical Practice Supervisor

Colleen Woolsey PhD ARNP MSNH1N1 Flu Training Coordinator

Agenda--1

Overview amp Introductions Flu Disease amp Flu Vaccine Intramuscular Injection ldquoImmunization Techniquesrdquo Video Skills practice 1 Drawing up vaccines amp

using safety syringes Locating IM injection landmarks Skills Practice 2 Locating IM injection

sites

Agenda--2 Skills Practice 3 FluMist administration Giving Vaccines in a Medication Center Adverse Reactions Skills Practice 4 Positioning amp

comforting restraint Skills Practice 5 Locating IM injection

sites on adult and child arm and leg Skills Practice 6 Use of Triage Algorithm QampA and Evaluation

What is the flu Highly infectious viral illness Characterized by abrupt

onset of fever dry coughmuscle aches and malaise

Cough and malaise may persist up to two weeks

Transmitted by respiratory droplets Seasonal flu season typically occurs

late fall through spring

Flu can complicate underlying medical conditions causinghellip

Bacterial infections Pneumonia Sinus and ear infections

in children Increased risk of stroke MI and heart

failure Increased blood sugar in diabetics Death

How is influenza transmitted Large-particle

respiratory droplets (infected person coughs or sneezes near a susceptible person)

Requires close contact (lt6 feet)

Novel A H1N1 probably spread in ways similar to other flu viruses

Transmission of Influenza Other possible sources of transmission

Contact with contaminated surfaces Via droplet nuclei--also called

ldquoairbornerdquo transmission (particles stay suspended in the air)

All respiratory secretions and bodily fluids (diarrheal stool) of novel influenza A (H1N1) cases should be considered potentially infectious

Distribution by Age Group of Cases Hospitalized with Pandemic H1N1

July 2009

0

5

10

15

20

25

30

35

40

45

50

lt 6 mo 6mo-4 yrs 5-9 yrs 10-17 yrs 18-29 yrs 30-49 yrs 50-64 yrs 65+ yrs

Age group

Perc

ent

Seasonal 2007-08 Pandemic 2009

April 12ndashJune 30

ED Visits for I LI by Age Group

King County WA 2009

0

50

100

150

200

250

300

03-J

an-0

9

10-J

an-0

9

17-J

an-0

9

24-J

an-0

9

31-J

an-0

9

07-F

eb-0

9

14-F

eb-0

9

21-F

eb-0

9

28-F

eb-0

9

07-M

ar-09

14-M

ar-09

21-M

ar-09

28-M

ar-09

04-A

pr-09

11-A

pr-09

18-A

pr-09

25-A

pr-09

02-M

ay-

09

09-M

ay-

09

16-M

ay-

09

23-M

ay-

09

30-M

ay-

09

06-J

un-0

9

13-J

un-0

9

20-J

un-0

9

27-J

un-0

9

04-J

ul-09

11-J

ul-09

18-J

ul-09

25-J

ul-09

Week ending

Num

ber of E

D v

isits for IL

I

under 2

2 to 4

5 to 17

18 to 44

45 to 64

65 and over

Health Care Workers Protect Yourself Protect Your Clients Individuals are contagious for 1 to 4

days before the onset of symptoms and about5 days after the first symptom

About 50 of infected people do not have any symptoms but are still contagious

Health care workers are frequently the source of influenza transmission in health care settings

Influenza Vaccine

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

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Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Agenda--1

Overview amp Introductions Flu Disease amp Flu Vaccine Intramuscular Injection ldquoImmunization Techniquesrdquo Video Skills practice 1 Drawing up vaccines amp

using safety syringes Locating IM injection landmarks Skills Practice 2 Locating IM injection

sites

Agenda--2 Skills Practice 3 FluMist administration Giving Vaccines in a Medication Center Adverse Reactions Skills Practice 4 Positioning amp

comforting restraint Skills Practice 5 Locating IM injection

sites on adult and child arm and leg Skills Practice 6 Use of Triage Algorithm QampA and Evaluation

What is the flu Highly infectious viral illness Characterized by abrupt

onset of fever dry coughmuscle aches and malaise

Cough and malaise may persist up to two weeks

Transmitted by respiratory droplets Seasonal flu season typically occurs

late fall through spring

Flu can complicate underlying medical conditions causinghellip

Bacterial infections Pneumonia Sinus and ear infections

in children Increased risk of stroke MI and heart

failure Increased blood sugar in diabetics Death

How is influenza transmitted Large-particle

respiratory droplets (infected person coughs or sneezes near a susceptible person)

Requires close contact (lt6 feet)

Novel A H1N1 probably spread in ways similar to other flu viruses

Transmission of Influenza Other possible sources of transmission

Contact with contaminated surfaces Via droplet nuclei--also called

ldquoairbornerdquo transmission (particles stay suspended in the air)

All respiratory secretions and bodily fluids (diarrheal stool) of novel influenza A (H1N1) cases should be considered potentially infectious

Distribution by Age Group of Cases Hospitalized with Pandemic H1N1

July 2009

0

5

10

15

20

25

30

35

40

45

50

lt 6 mo 6mo-4 yrs 5-9 yrs 10-17 yrs 18-29 yrs 30-49 yrs 50-64 yrs 65+ yrs

Age group

Perc

ent

Seasonal 2007-08 Pandemic 2009

April 12ndashJune 30

ED Visits for I LI by Age Group

King County WA 2009

0

50

100

150

200

250

300

03-J

an-0

9

10-J

an-0

9

17-J

an-0

9

24-J

an-0

9

31-J

an-0

9

07-F

eb-0

9

14-F

eb-0

9

21-F

eb-0

9

28-F

eb-0

9

07-M

ar-09

14-M

ar-09

21-M

ar-09

28-M

ar-09

04-A

pr-09

11-A

pr-09

18-A

pr-09

25-A

pr-09

02-M

ay-

09

09-M

ay-

09

16-M

ay-

09

23-M

ay-

09

30-M

ay-

09

06-J

un-0

9

13-J

un-0

9

20-J

un-0

9

27-J

un-0

9

04-J

ul-09

11-J

ul-09

18-J

ul-09

25-J

ul-09

Week ending

Num

ber of E

D v

isits for IL

I

under 2

2 to 4

5 to 17

18 to 44

45 to 64

65 and over

Health Care Workers Protect Yourself Protect Your Clients Individuals are contagious for 1 to 4

days before the onset of symptoms and about5 days after the first symptom

About 50 of infected people do not have any symptoms but are still contagious

Health care workers are frequently the source of influenza transmission in health care settings

Influenza Vaccine

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Agenda--2 Skills Practice 3 FluMist administration Giving Vaccines in a Medication Center Adverse Reactions Skills Practice 4 Positioning amp

comforting restraint Skills Practice 5 Locating IM injection

sites on adult and child arm and leg Skills Practice 6 Use of Triage Algorithm QampA and Evaluation

What is the flu Highly infectious viral illness Characterized by abrupt

onset of fever dry coughmuscle aches and malaise

Cough and malaise may persist up to two weeks

Transmitted by respiratory droplets Seasonal flu season typically occurs

late fall through spring

Flu can complicate underlying medical conditions causinghellip

Bacterial infections Pneumonia Sinus and ear infections

in children Increased risk of stroke MI and heart

failure Increased blood sugar in diabetics Death

How is influenza transmitted Large-particle

respiratory droplets (infected person coughs or sneezes near a susceptible person)

Requires close contact (lt6 feet)

Novel A H1N1 probably spread in ways similar to other flu viruses

Transmission of Influenza Other possible sources of transmission

Contact with contaminated surfaces Via droplet nuclei--also called

ldquoairbornerdquo transmission (particles stay suspended in the air)

All respiratory secretions and bodily fluids (diarrheal stool) of novel influenza A (H1N1) cases should be considered potentially infectious

Distribution by Age Group of Cases Hospitalized with Pandemic H1N1

July 2009

0

5

10

15

20

25

30

35

40

45

50

lt 6 mo 6mo-4 yrs 5-9 yrs 10-17 yrs 18-29 yrs 30-49 yrs 50-64 yrs 65+ yrs

Age group

Perc

ent

Seasonal 2007-08 Pandemic 2009

April 12ndashJune 30

ED Visits for I LI by Age Group

King County WA 2009

0

50

100

150

200

250

300

03-J

an-0

9

10-J

an-0

9

17-J

an-0

9

24-J

an-0

9

31-J

an-0

9

07-F

eb-0

9

14-F

eb-0

9

21-F

eb-0

9

28-F

eb-0

9

07-M

ar-09

14-M

ar-09

21-M

ar-09

28-M

ar-09

04-A

pr-09

11-A

pr-09

18-A

pr-09

25-A

pr-09

02-M

ay-

09

09-M

ay-

09

16-M

ay-

09

23-M

ay-

09

30-M

ay-

09

06-J

un-0

9

13-J

un-0

9

20-J

un-0

9

27-J

un-0

9

04-J

ul-09

11-J

ul-09

18-J

ul-09

25-J

ul-09

Week ending

Num

ber of E

D v

isits for IL

I

under 2

2 to 4

5 to 17

18 to 44

45 to 64

65 and over

Health Care Workers Protect Yourself Protect Your Clients Individuals are contagious for 1 to 4

days before the onset of symptoms and about5 days after the first symptom

About 50 of infected people do not have any symptoms but are still contagious

Health care workers are frequently the source of influenza transmission in health care settings

Influenza Vaccine

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

What is the flu Highly infectious viral illness Characterized by abrupt

onset of fever dry coughmuscle aches and malaise

Cough and malaise may persist up to two weeks

Transmitted by respiratory droplets Seasonal flu season typically occurs

late fall through spring

Flu can complicate underlying medical conditions causinghellip

Bacterial infections Pneumonia Sinus and ear infections

in children Increased risk of stroke MI and heart

failure Increased blood sugar in diabetics Death

How is influenza transmitted Large-particle

respiratory droplets (infected person coughs or sneezes near a susceptible person)

Requires close contact (lt6 feet)

Novel A H1N1 probably spread in ways similar to other flu viruses

Transmission of Influenza Other possible sources of transmission

Contact with contaminated surfaces Via droplet nuclei--also called

ldquoairbornerdquo transmission (particles stay suspended in the air)

All respiratory secretions and bodily fluids (diarrheal stool) of novel influenza A (H1N1) cases should be considered potentially infectious

Distribution by Age Group of Cases Hospitalized with Pandemic H1N1

July 2009

0

5

10

15

20

25

30

35

40

45

50

lt 6 mo 6mo-4 yrs 5-9 yrs 10-17 yrs 18-29 yrs 30-49 yrs 50-64 yrs 65+ yrs

Age group

Perc

ent

Seasonal 2007-08 Pandemic 2009

April 12ndashJune 30

ED Visits for I LI by Age Group

King County WA 2009

0

50

100

150

200

250

300

03-J

an-0

9

10-J

an-0

9

17-J

an-0

9

24-J

an-0

9

31-J

an-0

9

07-F

eb-0

9

14-F

eb-0

9

21-F

eb-0

9

28-F

eb-0

9

07-M

ar-09

14-M

ar-09

21-M

ar-09

28-M

ar-09

04-A

pr-09

11-A

pr-09

18-A

pr-09

25-A

pr-09

02-M

ay-

09

09-M

ay-

09

16-M

ay-

09

23-M

ay-

09

30-M

ay-

09

06-J

un-0

9

13-J

un-0

9

20-J

un-0

9

27-J

un-0

9

04-J

ul-09

11-J

ul-09

18-J

ul-09

25-J

ul-09

Week ending

Num

ber of E

D v

isits for IL

I

under 2

2 to 4

5 to 17

18 to 44

45 to 64

65 and over

Health Care Workers Protect Yourself Protect Your Clients Individuals are contagious for 1 to 4

days before the onset of symptoms and about5 days after the first symptom

About 50 of infected people do not have any symptoms but are still contagious

Health care workers are frequently the source of influenza transmission in health care settings

Influenza Vaccine

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Flu can complicate underlying medical conditions causinghellip

Bacterial infections Pneumonia Sinus and ear infections

in children Increased risk of stroke MI and heart

failure Increased blood sugar in diabetics Death

How is influenza transmitted Large-particle

respiratory droplets (infected person coughs or sneezes near a susceptible person)

Requires close contact (lt6 feet)

Novel A H1N1 probably spread in ways similar to other flu viruses

Transmission of Influenza Other possible sources of transmission

Contact with contaminated surfaces Via droplet nuclei--also called

ldquoairbornerdquo transmission (particles stay suspended in the air)

All respiratory secretions and bodily fluids (diarrheal stool) of novel influenza A (H1N1) cases should be considered potentially infectious

Distribution by Age Group of Cases Hospitalized with Pandemic H1N1

July 2009

0

5

10

15

20

25

30

35

40

45

50

lt 6 mo 6mo-4 yrs 5-9 yrs 10-17 yrs 18-29 yrs 30-49 yrs 50-64 yrs 65+ yrs

Age group

Perc

ent

Seasonal 2007-08 Pandemic 2009

April 12ndashJune 30

ED Visits for I LI by Age Group

King County WA 2009

0

50

100

150

200

250

300

03-J

an-0

9

10-J

an-0

9

17-J

an-0

9

24-J

an-0

9

31-J

an-0

9

07-F

eb-0

9

14-F

eb-0

9

21-F

eb-0

9

28-F

eb-0

9

07-M

ar-09

14-M

ar-09

21-M

ar-09

28-M

ar-09

04-A

pr-09

11-A

pr-09

18-A

pr-09

25-A

pr-09

02-M

ay-

09

09-M

ay-

09

16-M

ay-

09

23-M

ay-

09

30-M

ay-

09

06-J

un-0

9

13-J

un-0

9

20-J

un-0

9

27-J

un-0

9

04-J

ul-09

11-J

ul-09

18-J

ul-09

25-J

ul-09

Week ending

Num

ber of E

D v

isits for IL

I

under 2

2 to 4

5 to 17

18 to 44

45 to 64

65 and over

Health Care Workers Protect Yourself Protect Your Clients Individuals are contagious for 1 to 4

days before the onset of symptoms and about5 days after the first symptom

About 50 of infected people do not have any symptoms but are still contagious

Health care workers are frequently the source of influenza transmission in health care settings

Influenza Vaccine

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

How is influenza transmitted Large-particle

respiratory droplets (infected person coughs or sneezes near a susceptible person)

Requires close contact (lt6 feet)

Novel A H1N1 probably spread in ways similar to other flu viruses

Transmission of Influenza Other possible sources of transmission

Contact with contaminated surfaces Via droplet nuclei--also called

ldquoairbornerdquo transmission (particles stay suspended in the air)

All respiratory secretions and bodily fluids (diarrheal stool) of novel influenza A (H1N1) cases should be considered potentially infectious

Distribution by Age Group of Cases Hospitalized with Pandemic H1N1

July 2009

0

5

10

15

20

25

30

35

40

45

50

lt 6 mo 6mo-4 yrs 5-9 yrs 10-17 yrs 18-29 yrs 30-49 yrs 50-64 yrs 65+ yrs

Age group

Perc

ent

Seasonal 2007-08 Pandemic 2009

April 12ndashJune 30

ED Visits for I LI by Age Group

King County WA 2009

0

50

100

150

200

250

300

03-J

an-0

9

10-J

an-0

9

17-J

an-0

9

24-J

an-0

9

31-J

an-0

9

07-F

eb-0

9

14-F

eb-0

9

21-F

eb-0

9

28-F

eb-0

9

07-M

ar-09

14-M

ar-09

21-M

ar-09

28-M

ar-09

04-A

pr-09

11-A

pr-09

18-A

pr-09

25-A

pr-09

02-M

ay-

09

09-M

ay-

09

16-M

ay-

09

23-M

ay-

09

30-M

ay-

09

06-J

un-0

9

13-J

un-0

9

20-J

un-0

9

27-J

un-0

9

04-J

ul-09

11-J

ul-09

18-J

ul-09

25-J

ul-09

Week ending

Num

ber of E

D v

isits for IL

I

under 2

2 to 4

5 to 17

18 to 44

45 to 64

65 and over

Health Care Workers Protect Yourself Protect Your Clients Individuals are contagious for 1 to 4

days before the onset of symptoms and about5 days after the first symptom

About 50 of infected people do not have any symptoms but are still contagious

Health care workers are frequently the source of influenza transmission in health care settings

Influenza Vaccine

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Transmission of Influenza Other possible sources of transmission

Contact with contaminated surfaces Via droplet nuclei--also called

ldquoairbornerdquo transmission (particles stay suspended in the air)

All respiratory secretions and bodily fluids (diarrheal stool) of novel influenza A (H1N1) cases should be considered potentially infectious

Distribution by Age Group of Cases Hospitalized with Pandemic H1N1

July 2009

0

5

10

15

20

25

30

35

40

45

50

lt 6 mo 6mo-4 yrs 5-9 yrs 10-17 yrs 18-29 yrs 30-49 yrs 50-64 yrs 65+ yrs

Age group

Perc

ent

Seasonal 2007-08 Pandemic 2009

April 12ndashJune 30

ED Visits for I LI by Age Group

King County WA 2009

0

50

100

150

200

250

300

03-J

an-0

9

10-J

an-0

9

17-J

an-0

9

24-J

an-0

9

31-J

an-0

9

07-F

eb-0

9

14-F

eb-0

9

21-F

eb-0

9

28-F

eb-0

9

07-M

ar-09

14-M

ar-09

21-M

ar-09

28-M

ar-09

04-A

pr-09

11-A

pr-09

18-A

pr-09

25-A

pr-09

02-M

ay-

09

09-M

ay-

09

16-M

ay-

09

23-M

ay-

09

30-M

ay-

09

06-J

un-0

9

13-J

un-0

9

20-J

un-0

9

27-J

un-0

9

04-J

ul-09

11-J

ul-09

18-J

ul-09

25-J

ul-09

Week ending

Num

ber of E

D v

isits for IL

I

under 2

2 to 4

5 to 17

18 to 44

45 to 64

65 and over

Health Care Workers Protect Yourself Protect Your Clients Individuals are contagious for 1 to 4

days before the onset of symptoms and about5 days after the first symptom

About 50 of infected people do not have any symptoms but are still contagious

Health care workers are frequently the source of influenza transmission in health care settings

Influenza Vaccine

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Distribution by Age Group of Cases Hospitalized with Pandemic H1N1

July 2009

0

5

10

15

20

25

30

35

40

45

50

lt 6 mo 6mo-4 yrs 5-9 yrs 10-17 yrs 18-29 yrs 30-49 yrs 50-64 yrs 65+ yrs

Age group

Perc

ent

Seasonal 2007-08 Pandemic 2009

April 12ndashJune 30

ED Visits for I LI by Age Group

King County WA 2009

0

50

100

150

200

250

300

03-J

an-0

9

10-J

an-0

9

17-J

an-0

9

24-J

an-0

9

31-J

an-0

9

07-F

eb-0

9

14-F

eb-0

9

21-F

eb-0

9

28-F

eb-0

9

07-M

ar-09

14-M

ar-09

21-M

ar-09

28-M

ar-09

04-A

pr-09

11-A

pr-09

18-A

pr-09

25-A

pr-09

02-M

ay-

09

09-M

ay-

09

16-M

ay-

09

23-M

ay-

09

30-M

ay-

09

06-J

un-0

9

13-J

un-0

9

20-J

un-0

9

27-J

un-0

9

04-J

ul-09

11-J

ul-09

18-J

ul-09

25-J

ul-09

Week ending

Num

ber of E

D v

isits for IL

I

under 2

2 to 4

5 to 17

18 to 44

45 to 64

65 and over

Health Care Workers Protect Yourself Protect Your Clients Individuals are contagious for 1 to 4

days before the onset of symptoms and about5 days after the first symptom

About 50 of infected people do not have any symptoms but are still contagious

Health care workers are frequently the source of influenza transmission in health care settings

Influenza Vaccine

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

ED Visits for I LI by Age Group

King County WA 2009

0

50

100

150

200

250

300

03-J

an-0

9

10-J

an-0

9

17-J

an-0

9

24-J

an-0

9

31-J

an-0

9

07-F

eb-0

9

14-F

eb-0

9

21-F

eb-0

9

28-F

eb-0

9

07-M

ar-09

14-M

ar-09

21-M

ar-09

28-M

ar-09

04-A

pr-09

11-A

pr-09

18-A

pr-09

25-A

pr-09

02-M

ay-

09

09-M

ay-

09

16-M

ay-

09

23-M

ay-

09

30-M

ay-

09

06-J

un-0

9

13-J

un-0

9

20-J

un-0

9

27-J

un-0

9

04-J

ul-09

11-J

ul-09

18-J

ul-09

25-J

ul-09

Week ending

Num

ber of E

D v

isits for IL

I

under 2

2 to 4

5 to 17

18 to 44

45 to 64

65 and over

Health Care Workers Protect Yourself Protect Your Clients Individuals are contagious for 1 to 4

days before the onset of symptoms and about5 days after the first symptom

About 50 of infected people do not have any symptoms but are still contagious

Health care workers are frequently the source of influenza transmission in health care settings

Influenza Vaccine

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Health Care Workers Protect Yourself Protect Your Clients Individuals are contagious for 1 to 4

days before the onset of symptoms and about5 days after the first symptom

About 50 of infected people do not have any symptoms but are still contagious

Health care workers are frequently the source of influenza transmission in health care settings

Influenza Vaccine

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Influenza Vaccine

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Why immunize

Flu is a serious illness thecause of 36000 deaths eachyear in the US

Immunizations are first lineof defense 70-90 effective in lt65 yrs30-40 in frail elderly

Immunizations prevent serious illness hospitalization and death

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Groups at Increased Risk for Seasonal Flu Complications

Children less than 5 years old Persons aged 65 years or older People age lt18 years who are on long-term

aspirin therapy (risk of Reye syndrome) Pregnant women Adults and children with chronic medical conditions Adults and children who have immunosuppression

(caused by medications or by HIV) Residents of nursing homes and other chronic-care

facilities

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

H1N1 vaccinemdashTarget groups for vaccination

All pregnant women People who live with or care for children

age lt 6 months Healthcare and emergency services

personnel All people ages 6 months through 24

years Persons ages 25 through 64 years with

chronic medical conditions

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Who Should Not Be Immunized

Anyone with Severe (anaphylactic) allergy

to eggs gentamycin or a previous dose of influenza vaccine

Moderate to severe illness with or without fever

History of GBS within 6 weeks after a previous flu shot

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Flu Vaccine Formulations Seasonal flu vaccine

Trivalent inactivated influenza vaccine (TIV) Ten-dose vial Prefilled syringe 025 ml and 05 ml

Live attenuated influenza vaccine (LAIV) Novel H1N1 ndashmonovalent versions of the

same formulations Age range for vaccines and formulations

differs by manufacturer

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Flu Vaccine Strains

Seasonal flu vaccine components usually change every year 2009-10 vaccine has ABrisbane

(H1N1) ABrisbane (H3N2) and BBrisbane

Novel H1N1 vaccine (ACalifornia) licensed as ldquochange of strainrdquomdashwould have been in seasonal flu vaccine if outbreak had started earlier in the spring

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Flu Vaccine Dosage TIV and Novel H1N1

05 ml--Children 3 years through adult 025 ml--Infantstoddlers age 6-35 months

LAIV (seasonal and novel H1N1) 02 ml (intranasal)

Two doses of vaccine 4 weeks apart are needed the first year they get it for children under age 9 years for seasonal flu children under age 10 years for novel H1N1

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Thimerosal Free Influenza Vaccine--1

Thimerosal is a preservative containing ethyl mercury used in vaccines since 1930rsquos

No conclusive scientific evidence of harm from exposure to thimerosal Studies of risk were of methyl mercury

In 1999 USPHS recommended eliminating thimerosal in vaccines for infants as a precaution and to retain trust in vaccine supply

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Thimerosal Free Influenza Vaccine--2

Influenza vaccine in multi-dose vial contains 25mcgdose

Manufacturers make a limited amount of thimerosal-free (lt1mcg dose) flu vaccine

Benefits of flu vaccine outweigh any theoretical risk from thimerosal

Washington law requires that children lt3 years and pregnant women be given thimerosal-free vaccine as of 712007

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Thimerosal Free Influenza Vaccine--3

Emergency suspension of thimerosal law for H1N1 vaccine only as of 92409

Can give thimerosal-containing vaccine to children lt3 years and pregnant women BUT must give notice of the suspension to Everyone lt 18 years Pregnant and breastfeeding women

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

10 minute break

Break out Health Educators

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Use the correct needle length for IM injections

1rdquo minimum needle recommended 1frac12rdquo to 2rdquo needle for larger arm Longer needles

Hurt less Cause fewer local reactions1

Assures proper route and a valid dose of vaccine

Diggle L Deeks J BMJ 2000321(7266)931-33

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Needle gauge

Determine appropriate needle gauge IM 22 - 25 gauge

Lower gauge number = bigger needle Use for more viscous medications

Usual needle lengthgauge for IM vaccines is 25 G 1rdquo

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Syringes

Use 3 cc syringes for vaccine Vanish Point safety syringes have

needle attachedmdashvarious sizes and gauges

Manufacturer-prefilled syringesmdashneed to attach a separate needle

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Intramuscular (IM) injection

Insert the needle at a 90ordm angle to the skin

IM injection sites Deltoid (arm) Vastus Lateralis (thigh)

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Intramuscular (IM) injection

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Vaccine Administration

Video Clip from ldquoImmunization Techniques

mdashSafe Effective Caringrdquo

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Skills PracticemdashPart 2Measuring amp administering doses

Draw up 05 ml dose of sterile water into a 3 cc safety syringe

Show the 05 ml dose Administer 05 ml dose

into an orange Activate the syringersquos safety

device Repeat with the Smith syringe

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Locating injection landmarks

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Landmarks 2-3 finger widths down from the acromion process bottom edge is at an imaginary line drawn from the axilla

Deltoid

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

The deltoid site may be used on a child that is one year old and walking depending on the childrsquos muscle mass

Assess the deltoid muscle of the child to determine if it has sufficient mass for the injection

Bunching of the muscle may be needed with smaller muscle mass

Deltoid

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Vastus Lateralis

Landmarks Place one hand below the greater trochanter and one hand above the lateral femoral condyle mid-lateral thigh

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

The muscle of choice for IM injections in a child less than 12 months of age

Vastus Lateralis in Infants

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Injection Site Assessment

Do not use a site with any of the following Muscle atrophy Inflammation Edema Scarring tattoo mole or lesion IV port access Surgery in the limblymph node

problems

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Skills PracticemdashPart 3 Locating Injection Sites

Locate the appropriate site for a deltoid injection on your partner

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Intranasal Vaccine (LAIV)

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Skills PracticemdashPart 4 FluMist Administration

Dispense the first half of the FluMist dose into the air (NOT INTO YOUR NOSE)

Remove the dose-divider clip Dispense the second half of the FluMist

dose

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Getting ready to give vaccines in a Medication Center

Assessment and client education is done by others in Step 1

RegistrationConsent form Risk vs benefit of vaccine (Vaccine

Information Statement) Thimerosol Information Sheet After care instructions

Emergency Situations call 911 and use PH CHS Emergency Response Procedures (see Handouts for Vaso-vagul and Emergency Response)

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Getting Ready--2 Identify antigenformulation to be

administered Patient documentation Washsanitize hands

Draw upprepare the vaccine Have bandage and supplies ready

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Giving the injection

Ensure client is seated Gloves are not required unless there is

a break in the skin on the nursersquos hand(s)

Clean the injection site with alcohol and let it dry before injecting

Suggest client take slow deep breath relax arm muscle during injection

Aspiration not necessary

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

After the immunization--1 Engage syringersquos safety device Have the patient hold the cotton on their

injection site No need to massage the injection site

Used needles and syringes go into sharps container

Place empty vials into biohazard bags

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

After the immunizaton--2 Partial vials and unused

manufacturer pre-filled syringes go back into the cooler or refrigerator (35-46deg F)

If you attach a needle to a manufacturer pre-filled syringe you must use it in the same clinic day or discard it

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Immediate Adverse Reactions Be Prepared

Monitor if possible for 15-20 minutes Anaphylaxis rare but may be life-threatening Symptoms

Dyspnea rapid breathing wheezing Flushed face perspiration anxiety Hives itching swelling at injection site Itchypuffy eyes swelling of mouth or throat Hypotension coldclammy skin syncope

Summon help from paramedics

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Additional Considerations

Bloodborne Pathogen Exposure Vaccine Adverse Event Reporting

System (VAERS)

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Positioning the Patient

Adults and adolescents should sit down Parents should use ldquocomforting

restraintrdquo technique Parent embraces the child and

controls all four limbs Avoids ldquoholding downrdquo or

overpowering the child but helps you steady and control the limb of the injection site

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Comforting Restraint for Infants amp Toddlers

Hold the child on parentrsquos lap1 One of childrsquos arms embraces

parentrsquos back and is held under parentrsquos arm

2 Other arm controlled by parentrsquos arm and hand--for infants parents can control both arms with one hand

3 Both legs anchored with the childrsquos feet held firmly between parentrsquos thighs and controlled by parentrsquos other arm

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Comforting Restraint for Kindergarten amp Older Kids

Hold the child on parentrsquos lap or have the child stand in front of the seated parent

1 Parentrsquos arms embrace the child

2 Both legs are firmly between parentrsquos legs

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Skills PracticemdashPart 5

Positioning an infant and child to receive vaccine

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Skills Practice

Locating landmarks and giving IM injections

Locate IM injection sites on adult arm

Locate IM injection sites on baby leg

Practice giving IM injections

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Triage

Why Assure safe disposition of patients Present patient information

consistently Expansion of skill set for potential

public health response

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Triage A piece of the pie Screening clients

assists in

determining those who may need vaccination

prophylaxis or

urgent medical attention

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Triage

How Using the algorithms Pediatric Algorithm Adult Algorithm Home Care Instructions Triage Note

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Pediatric Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Fast breathing or trouble breathingmiddot Bluish skin colormiddot Not drinking enough fluidsmiddot Severe or persistent vomitingmiddot Not waking up or not interactingmiddot Infants with no wet diapers for 6 hours and not taking fluids

irritable or screaming with painmiddot Flu-like symptoms improve then return with fever and

worse coughmiddot Irritability where the child doesnrsquot want to be held

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot Fever Newborns with fever over 1004 F 3 months ndash 2 year with fever gt 102 F Any age ndash fever gt 1005 F x 3 days Any age ndash fever gt 105 Fmiddot Fever with rashmiddot Not drinking enough fluidsmiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Diseasemiddot Coronary Vascular Disease or Congestive Heart Failuremiddot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Sickle cell or other hemolytic anemiasmiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive andor Neuromuscular Diseasemiddot On chronic aspirin therapymiddot Live with someone 65 years or older

Other household contacts with an underlying condition (listed above)who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Pediatrics lt 18 yearsSick with a fever gt100F and a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Adult Triage Algorithm Patient Presents With Influenza Like Illness (ILI)

middot Difficulty breathing or shortness of breath middot Constant pain or pressure in the chest or abdomenmiddot Less responsive than normal or becoming confusedmiddot Severe or persistent vomitingmiddot Unable to keep liquids downmiddot Exhibiting signs of dehydration such as dizziness when

standing or absence of urinationmiddot Seizuresmiddot Flu-like symptoms improve but then return with fever and

worse cough

Answers yes to one or more of the

indicators of severe illness

Elevated RiskAdvise to seek medical care

immediately

Assess for Co-morbid Conditions

middot 65 years or oldermiddot Asthma Cystic Fibrosis or Chronic Obstructive Pulmonary Disease

(COPD)middot Coronary Vascular Disease (CVD) or Congestive Heart Failure (CHF)middot Diabetesmiddot Pregnancy If PHSKC patient refer triage to provider for treatmentmiddot Morbidly Obese (BMI gt40)middot Organ transplant recipient or immune compromisedmiddot AIDSmiddot Renal Dialysismiddot Receiving or completed chemotherapy in the past 30 daysmiddot Neurocognitive and or Neuromuscular Diseasemiddot Sickle Cell or other hemolytic anemiasmiddot Live with a child less than 19 years old on chronic aspirin therapy

Check in with caller to see if there is any other close household contact that is showing possible ldquoflurdquo like symptoms that may affect patient with above conditions

Other household contacts with an underlying condition who are at risk

Does the patient have one or more co-morbid factors

Low RiskOkay for self-care at home Repeat

self assessment if condition worsens

Any positive answer

No positive answers

Yes

No positive answers

Adults gt18 yearsSick with a fever gt1000 F with a cough or sore throat

Intermediate Risk ConditionsRecommend person contact at their primary care provider or seek care in

clinic

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Home Care Home Care Recommendations for ILI Keep away from others as much as possible This is to keep from making others sick

Get plenty of rest

Drink clear fluids (such as water broth sports drinks and electrolyte beverages for infants) to keep from being dehydrated You will probably be sick for several days with fever cough and stuffy nose

Cover your cough and sneezes

Frequent hand washing

Donrsquot share drinking glasses or eating utensils Dishes can be done in dishwasher or with hot soapy water

Throw away tissues and other disposable items used by the sick person in the trash Wash your hands after touching used tissues and similar waste

Have everyone in the household wash hands often with soap and water especially after coughing or sneezing Alcohol-based hand cleansers are also effective

Avoid touching your eyes nose and mouth

Take medications for symptom relief as needed for fever and pain such as acetaminophen (Tylenolreg) and ibuprofen (Advilreg Motrinreg Nuprinreg) and cough medicine These medicines do not need to be taken regularly if your symptoms improve

Stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (Your fever should be gone without the use of fever-reducing medicine)

Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (eg bismuth subsalicylate ndash Pepto Bismol) to children or teenagers 18 years old or younger

Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider

1048766 If you develop any of the following seek medical care immediately o Difficulty breathing o Purple or blue discoloration of lips o vomiting or unable to keep liquids down o Dizziness no urination lack of tears in infants (signs of dehydration) o Seizures uncontrolled convulsions o Confusion less responsive than normal

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Triage Note

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Skills Practice- Part 6Using the tools

Use pediatric and adult algorithms Demonstrate when to advise home

care vs office visit

Preview triage note and use in conjunction with the home care sheet

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Questions

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as a member for a noble cause we nursing and attendants staff please contact us

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin

Contact us- 011-25464531 9818569476

E-mail- nursingnursingyahooin