McKenna's Pharmacology for Nursing, 2e

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P A R T 3  Drugs acting on the immune system

■■ Immunity is a state of relative resistance to a disease that develops only after exposure to the specific disease-causing agent. ■■ Vaccines provide active immunity by stimulating the production of antibodies to a specific protein, which may produce the signs and symptoms of a mild immune reaction but protects the person from the more devastating effects of disease. ■ ■ Monitor for adverse effects (flu-like symptoms; GI upset; local pain, swelling, nodule formation at the injection site). ■ ■ Evaluate the effectiveness of the teaching plan (person can name drug, dosage, adverse effects to watch for; has written record of immunisations; can state when to return for the next immunisation or booster if needed). ■ ■ Monitor the effectiveness of comfort measures and adherence to the regimen. See Critical thinking scenario for additional information on educating a parent about vaccines. THE SITUATION S.D. is a 25-year-old, first-time mother who has brought her 2-month-old daughter to the maternal and child health centre for a routine evaluation. The baby is found to be healthy, growing well and within normal parameters for her age. At the end of the visit, the nurse prepares to give the baby the first of her routine immunisations. S.D. becomes concerned and expresses fears about paralysis and infant deaths associated with immunisations. What care interventions would be appropriate at this time? Think of ways to explain the importance of immunisations to S.D. while supporting her concerns for the welfare of her baby. How can this experience be incorporated into a teaching plan for S.D. and her baby? DISCUSSION S.D. should be reassured before the baby is immunised. The nurse can tell her that in the past, paralysis and infant CRITICAL THINKING What information should S.D. be given about immunisations?

Prototype summary: Measles, mumps and rubella vaccine Indications: Active immunisation against measles, mumps, and rubella in children older than 15 months and adults. Actions: Attenuated measles, mumps and rubella viruses produce a modified infection and stimulate an active immune reaction with the production of antibodies to these viruses. Pharmacokinetics: Route Onset Peak IM Rapid 3–12 hours T 1/2 : Unknown; metabolised in the tissues, excretion is unknown. Adverse effects: Moderate fever, rash, or burning or stinging wheal or flare at the site of injection; rarely, febrile convulsions and high fever; Guillain- Barré syndrome, ocular palsies.

KEY POINTS

CRITICAL THINKING SCENARIO Educating a parent about vaccines

deaths were reported, but that efforts continue to make the vaccines pure. Careful monitoring of the child and the child’s response to each immunisation can help avoid such problems. Reassure S.D. that the immunisations will prevent her daughter from contracting many, sometimes deadly, diseases. Praise S.D.’s efforts for researching information that might affect her baby and for asking questions that could have an impact on her child and her understanding of her care. The recommended schedule of immunisations should be given to S.D. so that she is aware of what is planned and how the various vaccines are spaced and combined. She should be encouraged to monitor the baby after each injection for fever, chills and flu-like reactions. When she gets home, she can medicate the baby with paracetamol to avert many of these symptoms before they happen. (S.D. should be advised not to give the baby aspirin, which could cover up Reye’s syndrome, a potentially serious disorder.) S.D. also should be told that the injection site might be sore, swollen and red, but that this will pass in a couple of days. S.D. can ease the baby’s discomfort by applying warm soaks to the area for about 10 to 15 minutes every 2 hours. S.D. should be encouraged to write down all of the immunisations that the baby has had and to keep this