Shoot Me with Immunizations

Ugh.  Immunizations.  I don't know why they make us memorize this when every freaking pediatrician's office has charts in every checkup room.  But ok.  Here's the ones that ALWAYS pop up on exams.

@Birth
The only vaccine you give at birth is Hep B with a 5/8" needle.  Hep B requires 3 immunization rounds--you have to give it 2 more times, at 1 month, and 6 months.

@2, 4, 6 (mos) with 1" needles:
Rotavirus (RV)
diptheria-tetanus-pertussis (DTaP)
haemophilus influenza B (HiB)
pneumococcal conjugate vaccine (PCV)
inactivated polio virus (IPV)
**remember HepB @ 1 & 6 months too
**annual influenza as early as 6 months

@1 year, the motherload with 5/8" (deltoid) - 11/4" (anterolateral thigh) needles--these needle lengths remain the same from year 1 on:
haemophilus influenza B
pneumococcal conjugate vaccine
inactivated polio
measles, mumps, rubella***
varicella***
hepA


***Rubella (from the MMR) and Chickenpox (Varicella) are live viruses. You can't give it until 12 months because the baby's immune system isn't strong enough to fight off the live virus.  Also, egg derivative, so watch out for allergies.

@15 months
diptheria-tetanus-pertussis

@4 years
diptheria-tetanus-pertussis
inactivated polio virus
measles-mumps, rubella
varicella

According to the Lippincott-RN 2015 edition, simultaneous injections of vaccines is preferred to serial injections because the anticipation of the next injection can cause heightened "trauma" (I think they mean, anxiety).  Also, (and this really surprised me considering every instructor I've ever known harped on aspirating for blood return with IM injections) "aspirating for blood return does not confirm needle placement and is no longer recommended by the American Council on Immunization Practices for vaccine administration." (page 196)  Apparently, the Public Health Agency of Canada doesn't recommend it either.  I'm not sure the NCLEX has caught up to that, yet.  If it pops up on a multiple answer question, I guess, go with your gut and accept that you will get some answers wrong on the test.  *shrug*  Eh.  Just keep it in your back pocket for when you practice.