4.7 Immunization Schedules

NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

4.7 Immunization Schedules

Key Takeaways Explain This Topic AI

Hepatitis B vaccine is given at birth, with a 3-dose series completed by 6-18 months; this is often the first vaccine a newborn receives

DTaP (Diphtheria, Tetanus, Pertussis) requires a 5-dose series at 2, 4, 6, 15-18 months, and 4-6 years; adults receive Tdap booster then Td every 10 years

MMR (Measles, Mumps, Rubella) and Varicella vaccines are live vaccines given at 12-15 months and 4-6 years; contraindicated in pregnancy and severe immunocompromise

Annual influenza vaccination is recommended for everyone 6 months and older; high-dose or adjuvanted formulations available for adults 65+

Shingles vaccine (Shingrix) is recommended for adults 50+ as a 2-dose series; pneumococcal vaccines (PCV15/PCV20 and PPSV23) recommended at 65+

Last updated: January 2026

Immunization Fundamentals

Vaccines prevent serious diseases by stimulating the immune system to develop protection without causing the disease itself. Nurses play a crucial role in administering vaccines, educating patients, and addressing vaccine hesitancy.

Types of Vaccines

• Type Description Examples
• Live attenuated Weakened live organism MMR, Varicella, Rotavirus, Nasal flu
• Inactivated Killed organism Injectable flu, Hepatitis A
• Subunit/conjugate Parts of organism Hep B, HPV, Pertussis component
• Toxoid Inactivated toxin Diphtheria, Tetanus
• mRNA Genetic instructions COVID-19 (Pfizer, Moderna)
• Live Vaccine Considerations

Live vaccines are contraindicated in:

• Pregnancy
• Severe immunocompromise
• Recent blood product transfusion (varies by vaccine)

Key Point : Live vaccines can be given on the same day; if not given simultaneously, wait 4 weeks between live vaccines.

• Childhood Immunization Schedule (Birth to 6 Years)
• Birth
• Hepatitis B (first dose) - Given before hospital discharge
• 2 Months

• Vaccine Disease Protected
• DTaP Diphtheria, Tetanus, Pertussis
• IPV Polio
• Hib Haemophilus influenzae type b
• PCV15/PCV20 Pneumococcal disease
• Rotavirus Rotavirus gastroenteritis
• Hepatitis B Hepatitis B (if not given earlier)
• 4 Months
• DTaP, IPV, Hib, PCV, Rotavirus
• 6 Months
• DTaP, Hib, PCV, Rotavirus (final dose)
• Hepatitis B (if 3rd dose due)
• Influenza (begin annual vaccination; 2 doses first season if <9 years)
• 12-15 Months

• Vaccine Notes
• MMR Live vaccine
• Varicella Live vaccine
• Hepatitis A 2-dose series starts
• Hib Final dose
• PCV Final dose
• DTaP 4th dose (15-18 months)
• 4-6 Years
• DTaP (5th dose)
• IPV (4th dose)
• MMR (2nd dose)
• Varicella (2nd dose)
• Childhood Schedule Summary Table

• Vaccine Birth 2 mo 4 mo 6 mo 12-15 mo 4-6 yr
• Hep B 1st 2nd-3rd
• DTaP 1st 2nd 3rd 4th 5th
• IPV 1st 2nd 3rd 4th
• Hib 1st 2nd 3rd 4th
• PCV 1st 2nd 3rd 4th
• Rotavirus 1st 2nd 3rd
• MMR 1st 2nd
• Varicella 1st 2nd
• Hep A 1st-2nd
• Influenza Annual (begins at 6 mo)
• Adolescent Immunizations (11-18 Years)
• 11-12 Years

• Vaccine Schedule
• Tdap Single dose (replaces Td booster)
• HPV 2-dose series (if starting before age 15)
• Meningococcal ACWY First dose
• Annual Influenza Every year
• 16 Years
• Meningococcal ACWY (booster)
• Meningococcal B (based on risk/shared decision)
• HPV Vaccine Details
• Protects against cervical, anal, oropharyngeal, and other HPV-related cancers
• Ages 9-14: 2-dose series (0 and 6-12 months)
• Ages 15-26: 3-dose series (0, 1-2, and 6 months)
• Catch-up available through age 45 (shared decision)
• Adult Immunization Schedule
• All Adults

• Vaccine Recommendation
• Influenza Annual
• Td/Tdap Tdap once if not given in adolescence; Td every 10 years
• COVID-19 Per current recommendations
• Based on Age

• Age Vaccine
• 50+ Shingrix (2-dose series)
• 65+ Pneumococcal (PCV15/PCV20, may add PPSV23)
• 65+ RSV vaccine (single dose)
• Based on Risk Factors

• Condition Vaccines
• Asplenia Pneumococcal, Meningococcal, Hib
• Immunocompromise Inactivated vaccines (avoid live)
• Chronic liver disease Hepatitis A, Hepatitis B
• Healthcare workers Hepatitis B, annual flu
• Special Populations
• Pregnancy

Recommended during pregnancy :

• Tdap (each pregnancy, preferably 27-36 weeks)
• Influenza (inactivated)
• COVID-19
• RSV (32-36 weeks, during RSV season)

Contraindicated during pregnancy :

• Live vaccines (MMR, Varicella, Live attenuated influenza)
• Immunocompromised
• Avoid live vaccines
• May need higher doses or additional doses
• Household contacts should receive indicated vaccines
• Consider timing relative to immunosuppressive therapy
• Common Vaccine Reactions
• Expected Reactions
• Injection site pain, redness, swelling
• Low-grade fever
• Fussiness (infants)
• Fatigue, headache

Management : Acetaminophen or ibuprofen as appropriate; cold compress to site.

Concerning Reactions

• Reaction Action
• High fever (>104°F/40°C) Notify provider
• Severe local reaction Document; may affect future doses
• Anaphylaxis Emergency treatment; document contraindication
• Encephalopathy within 7 days (DTaP) Contraindication to pertussis component
• Contraindications and Precautions
• True Contraindications
• Severe allergic reaction (anaphylaxis) to previous dose or vaccine component
• Encephalopathy within 7 days of pertussis vaccine (for DTaP/Tdap)
• Severe immunodeficiency (for live vaccines)
• Pregnancy (for live vaccines)
• NOT Contraindications

These are NOT reasons to delay vaccination:

• Mild illness without fever
• Current antibiotic therapy
• Premature birth (vaccinate per chronological age)
• Breastfeeding
• Family history of vaccine reactions
• Allergies to products not in the vaccine
• Addressing Vaccine Hesitancy
• Communication Strategies
• Listen to concerns without judgment
• Acknowledge emotions and provide empathy
• Provide information in clear, simple terms
• Use trusted sources (CDC, AAP, WHO)
• Give strong recommendation - provider recommendation is most influential
• Common Concerns and Responses

• Concern Response
• "Too many vaccines" Immune system handles thousands of antigens daily; vaccines add minimal burden
• "Vaccines cause autism" Thoroughly disproven; original study was fraudulent
• "Natural immunity is better" Disease risks far outweigh vaccine risks
• "Ingredients are harmful" Components are in safe amounts; strictly tested
• Exam Tips
• Know the childhood schedule - especially timing of first doses
• Hep B is given at birth (before hospital discharge)
• Live vaccines : MMR, Varicella, Rotavirus - avoid in pregnancy/immunocompromise
• Tdap in every pregnancy (27-36 weeks)
• Annual influenza for everyone 6 months and older
• Shingrix at age 50+ (not the old Zostavax)
• True contraindications are RARE - mild illness is not a reason to delay