McKenna's Pharmacology for Nursing, 2e

268

P A R T 3  Drugs acting on the immune system

■ ■ Monitor the results of laboratory tests such as FBC to identify changes in bone marrow function . Implementation with rationale ■ ■ Arrange for laboratory tests before and periodically during therapy, including FBC, differential and liver and renal function tests, to monitor for drug effects and adverse effects . ■ ■ Administer the drug as indicated; instruct the person and a significant other if injections are required to ensure proper administration of the drug . ■ ■ Protect the person from exposure to infections and maintain strict aseptic technique for any invasive procedures to prevent infections during immunosuppression . ■ ■ Arrange for supportive care and comfort measures for flulike symptoms (rest, environmental control, paracetamol) to decrease discomfort and increase therapeutic compliance . ■ ■ Monitor nutritional status during therapy; provide small frequent meals, mouth care and nutritional consultation as necessary to ensure adequate nutrition . ■ ■ Instruct women in the use of barrier contraceptives to avoid pregnancy during therapy because of the risk of adverse effects to the fetus . ■ ■ Offer support and encouragement to help the person deal with the diagnosis and the drug regimen . ■ ■ Provide thorough teaching, including measures to avoid adverse effects, warning signs of problems and proper administration, to increase knowledge

■■ Immune suppressants are used to depress the immune system when needed to prevent transplant rejection or severe tissue damage associated with autoimmune disease. Research is ongoing to extend the use of various immune suppressants to other situations, including various autoimmune disorders. ■■ Increased susceptibility to infection and increased risk of neoplasm are potentially dangerous effects associated with the use of immune suppressants. People need to be protected from infection, injury and invasive procedures. about drug therapy and to increase compliance with the drug regimen . Evaluation ■ ■ Monitor response to the drug (prevention of transplant rejection; improvement in autoimmune disease or cancer; prevention of RSV disease; improvement in signs and symptoms of Crohn’s disease or rheumatoid arthritis). ■ ■ Monitor for adverse effects (flu-like symptoms, GI upset, increased infections, neoplasms, fluid overload). ■ ■ Evaluate the effectiveness of the teaching plan (person can name drug, dosage, adverse effects to watch for, specific measures to avoid adverse effects, proper administration technique). ■ ■ Monitor the effectiveness of comfort measures and compliance to the regimen (see Critical thinking scenario).

KEY POINTS

CRITICAL THINKING SCENARIO Holistic care for a person with a transplant

THE SITUATION After waiting on a transplant list for 4 years, T.B. received a human heart transplant to replace his heart, which had been severely damaged by cardiomyopathy. Before getting the transplant, T.B. was bedridden, on oxygen, and near death. The transplant has given T.B. a “new lease on life”, and he is determined to do everything possible to stay healthy and improve his activity and lifestyle. Currently, he is being maintained on cyclosporin, mycophenolate and corticosteroids.

CRITICAL THINKING What important teaching facts would help T.B. to achieve his goal? Think about the psychological impact of the heart transplant and the “new lease on life”. What activity, dietary and supportive guidelines should be outlined for T.B.? What impact will T.B.’s drug regimen have on his plans? How can all of the aspects of his condition and medical care be coordinated to give T.B. the best possible advantages for the future?