A nurse is caring for a child who has hemophilia. While reviewing this child's immunization records, the nurse notes that the child needs the tetanus and reduced diphtheria toxoids and acel-lular pertussis (Tdap) vaccine and the hepatitis A vaccine
. The nurse should notify the provider and obtain an order to give: a. both vaccines intramuscularly.
b. both vaccines subcutaneously.
c. the hepatitis A vaccine only subcuta-neously.
d. the Tdap vaccine only intramuscularly.
A
To minimize the risk of hepatitis, all patients with hemophilia should be fully vaccinated, and all newly diagnosed patients should receive both the hepatitis A and hepatitis B vaccines to minim-ize the risk of hepatitis from infusions. Clinicians should inject vaccines intramuscularly, taking precautions to prevent excessive bleeding, because subcutaneous administration does not guar-antee efficacy. There is no reason to withhold any vaccine in children with hemophilia.
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