TUBERCULOSIS (TB) SCREENING FORM
-240030-233045Emergency Procedure - Child/Adult***All clients should sit in clinic room or waiting area for at least 15 minutes after immunization to assure safetyReactionSymptomsManagementLocalizedSoreness, redness, itching, or swelling at the injection siteApply a cold compress to the injection site. Suggest an analgesic such as Tylenol or Ibuprofen to parent.Slight bleedingApply an bandaid over the injection siteContinuous bleedingPlace a thick layer of gauze pads over the site. Maintain direct and firm pressure; raise the bleeding injection site (e.g., arm) above the level of the patient’s heart.Vasovagal (Psychological fright and syncope) Fear before injection is givenHave patient sit or lie down for the vaccination. Enlist help of family or another staff to help assure patient does not fall and injure him/herself.Extreme paleness, sweating, bradycardia, hypotension, coldness of the hands and feet, nausea, light-headedness, dizziness, weakness, or visual disturbances.Have patient lie flat or sit with head between knees for several minutes. Loosen any tight clothing and maintain an open airway. Apply a cool, damp cloth to patient’s face and neck. Enlist help of family or another staff to help assure patient does not fall and injure him/herselfFall, without loss of consciousnessExamine the patient to determine if injury is present before attempting to move the patient. Place patient flat on back with feet elevated.Loss of consciousnessCheck the patient to determine if injury is present before attempting to move the patient. Place patient flat on back with feet elevated. Call 911 if patient does not recover immediately.AnaphylaxisSudden or gradual onset of generalized itching, erythema, or urticaria, angioedema (swelling of the lips, face or throat); severe bronchospasm (wheezing); shortness of breath; shock; abdominal cramping, or cardiovascular collapse.CALL 911 See page 2 for “emergency management of anaphylactic reaction”The signs and symptoms of anaphylaxis can be confused with vasovagal reaction-- Vasovagal reaction is most often evoked by stress associated with fear or painSkin changes (itching) and respiratory difficulty DO NOT occur with vasovagal reaction Emergency Medical Management of Anaphylactic ReactionsSigns and Symptoms of Anaphylactic Reaction:Sudden or gradual onset of generalized itching, erythema, urticaria, angioedema swelling of the lips, face or throat); severe bronchospasm (wheezing); shortness of breath; shock; abdominal cramping, or cardiovascular collapse Treatment of children and adults: If itching and swelling are confined to the injection site where the vaccination was given, observe the patient closely for the development of generalized symptoms for at least 15 minutes. If symptoms are generalized call 911/ EMS. The primary nurse should assess the airway, breathing, circulation, and level of consciousness of the patient. Take blood pressure and pulse. Request 2nd nurse and clinic aide to consult, assist with family, call supervisor, consult about cancelling clinic, send other clients home and assist 911 arrival. A. Primary treatment option: Administer the epinephrine intramuscularly, as instructed on chart below. Other staff should notify a supervisor whenever time allows. (see table 1 for dosing) B. Secondary treatment option: In addition to epinephrine treatment, for hives or itching, you may also administer diphenhydramine orally if client has no problems with airway/breathing/throat swelling; the standard dose is 1–2 mg/kg body weight, up to 30 mg maximum dose in children and 50 mg maximum dose in adolescents and adults. (see table 2 for dosing)Monitor patient closely until EMS arrives. Perform CPR if necessary, and maintain airway. Keep patient flat on back unless he or she is having breathing difficulty. If breathing is difficult, patient’s head may be elevated, provided blood pressure is adequate to prevent loss of consciousness. If blood pressure is low, elevate legs. Monitor blood pressure and pulse every five minutes. (see tables 3 and 4)If EMS has not arrived and symptoms are still present, repeat dose of epinephrine every 5-15 minutes for up to 3 doses, depending upon patient’s response. Record all vital signs, medications administered to patient, including the time, dosage, response, and the name of the medical personnel who administered the medication, and other relevant clinical information. Notify patient’s primary care physician.Table 1--Primary Treatment Option: Epinephrine7745795588Epinephrine dose chart – To be given IMAge Group Dose Weight (lbs) Epinephrine Dose (1:1000 dilution) 1 mg/mL Intramuscular injection REPEAT 2nd DOSE IF NEEDED0- 8 yrs 62 lbs and under 0.15 mg (0.15 ml) > 8 yrs Over 62 lbs 0.3 mg (0.3 ml) 00Epinephrine dose chart – To be given IMAge Group Dose Weight (lbs) Epinephrine Dose (1:1000 dilution) 1 mg/mL Intramuscular injection REPEAT 2nd DOSE IF NEEDED0- 8 yrs 62 lbs and under 0.15 mg (0.15 ml) > 8 yrs Over 62 lbs 0.3 mg (0.3 ml) ***REPEAT Epinephrine dose AS NEEDED For up to three dosesHow to use Snap-V Table 2- Secondary Treatment Option, in addition to epinephrine use, when indicated: Diphenhydramine (Benadryl) dosing 1-2 mg/kg body weightAge GroupRange of Weight (pounds)Range of weight (kilograms)Diphenhydramine dose12.5 mg/5 mL liquid, 25 or 50 mg tabletsInfants and children7-36 months20-32 lb9-14.5 kg10 mg- 20 mg37-59 months33-39 lb15-17.5 kg15 mg-30 mg5-7 years40-56 lb18-25.5 kg20 mg -30 mg8-12 years57-99 lb26-45 kg30 mgTeens and Adults>13 years> 100 lb> 46 kg50 mgNote: if body weight is known, then dosing by weight is preferred. If weight is not known or not readily available, dosing by age is appropriate. *30 mg is the maximum dose for children. *50 mg is the maximum dose for adults.Table 3- Adult Blood Pressure Guidelines (American Heart Association) Table 4- Pediatric Blood pressure guidelines Retrieved from: ................
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