McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 8  Vaccines and sera

Contraindications and cautions The use of vaccines is contraindicated in the presence of immune deficiency because the vaccine could cause disease, and the body would not be able to respond as anticipated if it is in an immunodeficient state ; during pregnancy because of potential effects on the fetus and on the success of the pregnancy ; in individuals with known allergies to any of the components of the vaccine (refer to each individual vaccine for specifics, sometimes including eggs, where some pathogens are cultured); or in people who are receiving immune globulin or have received blood or blood products within the last 3 months because a serious immune reaction could occur. Caution should be used whenever a vaccine is given to a child with a history of febrile convulsions or cerebral injury, or in any condition in which a potential fever would be dangerous. Caution also should be used in the presence of any acute infection. Adverse effects Adverse effects of vaccines are associated with the immune or inflammatory reaction that is being stimu- lated: moderate fever, rash, malaise, chills, fretfulness, drowsiness, anorexia, vomiting and irritability. Pain, redness, swelling and even nodule formation at the injection site are also common. In rare instances, severe hypersensitivity reactions have been reported. Clinically important drug–drug interactions Vaccines should not be given with any immunosuppres- sant drugs, including corticosteroids, which could alter the body’s response to the vaccine.

hypersensitivity reactions ; check temperature to monitor for possible infection ; monitor pulse, respirations and blood pressure; auscultate lungs for adventitious sounds; and assess level of orientation and affect to monitor for hypersensitivity reactions to the vaccine . ■ ■ Evaluate the range of motion of the extremity to be used for vaccine administration to assure adequate blood flow to deal with the antigen and inflammatory reaction . ■ ■ Assess tissue perfusion to establish a baseline to monitor for potential hypersensitivity reactions . Implementation with rationale ■ ■ Do not use to treat acute infection; a vaccine is used to prevent infection with future exposures . ■ ■ Do not administer if the person exhibits signs of acute infection or immune deficiency because the vaccine can cause a mild infection and can exacerbate acute infections . ■ ■ Do not administer if the individual has received blood, blood products or immune globulin within the last 3 months because a severe immune reaction could occur . ■ ■ Arrange for proper preparation and administration of the vaccine; check on the timing and dose of each injection because dose, preparation and timing vary with individual vaccines . ■ ■ Maintain emergency equipment on standby, including adrenaline, in case of severe hypersensitivity reaction . ■ ■ Arrange for supportive care and comfort measures for flu-like symptoms (rest, environmental control, paracetamol) and for injection discomfort (local heat application, anti-inflammatories, resting arm) to promote comfort . ■ ■ Do not administer aspirin to children to treat discomforts associated with immunisation. Aspirin can mask warning signs of Reye’s syndrome, a potentially serious disease . ■ ■ Provide thorough teaching, including measures to avoid adverse effects, warning signs of problems and the need to keep a written record of immunisations, to increase knowledge about drug therapy and to increase compliance with the drug regimen . ■ ■ Provide a written record of the immunisation, including the need to return for booster immunisations and timing of the boosters, if necessary, to increase compliance with medical regimens . Evaluation ■ ■ Monitor response to the drug (prevention of disease, appropriate antibody titre levels).

Care considerations for people receiving vaccines

Assessment: History and examination

■ ■ Assess for contraindications or cautions: known allergies to any vaccines or to the components of the one being used to prevent hypersensitivity reactions ; current status related to pregnancy, which is a contraindication to the use of vaccines ; recent administration of immune globulin or blood products, which could alter the response to the vaccine ; history of immune deficiency, which could alter immune reactions ; and evidence of acute infection, which could be exacerbated by the introduction of other antigens . ■ ■ Perform a physical assessment to determine baseline status before beginning therapy and for any potential adverse effects : Inspect for the presence of any skin lesions to monitor for