McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 8  Vaccines and sera

IMMUNE SERA As explained earlier, passive immunity can be achieved by providing preformed antibodies to a specific antigen. These antibodies are found in immune sera, which may contain antibodies to toxins, venins, bacteria, viruses or even red blood cell antigenic factors. The term immune sera , or immunoglobulin, is usually used to refer to sera that contain antibodies to specific bacteria or viruses. The term antitoxin refers to immune sera that have anti- bodies to very specific toxins that might be released by invading pathogens. The term antivenin is used to refer to immune sera that have antibodies to venom that might be injected through spider or snake bites. These drugs are used to provide early treatment following exposure to known antigens. They are very specific for antigens to which they can respond (see Table 18.2). information handy for easy reference. She should also be encouraged to record any adverse effects that occur after each immunisation. If reactions are uncomfortable, it is possible to split doses of future immunisations. The nurse should give S.D. a chance to vent her concerns and fears. First-time parents may be more anxious than experienced ones when dealing with issues involving a new baby. To alleviate S.D.’s anxiety, the nurse should provide a telephone number that S.D. can call if the baby seems to be having a severe reaction or if S.D. wants to discuss any questions or concerns. She should feel that support is available for any concern that she may have. Because this interaction is likely to form the basis for future interactions with S.D., it is important to establish a sense of respect and trust. CARE GUIDE FOR S.D.’S BABY: VACCINES Assessment: History and examination Allergies to the serum base, acute infection, immunosuppression General: temperature CV: pulse, cardiac auscultation, blood pressure, oedema, perfusion Respiratory: respirations, adventitious sounds Skin: lesions Joints: range of motion Implementation Ensure proper preparation and administration of vaccine within appropriate time frame. Provide supportive and comfort measures to deal with adverse effects: anti-inflammatory/antipyretic, local heat application, small meals, rest and a quiet environment. Provide parent teaching regarding drug name, adverse effects and precautions, and warning signs to report.

Therapeutic actions and indications Immune sera are used to provide passive immunity to a specific antigen, which could be a pathogen, venom or toxin. They may also be used as prophylaxis against specific diseases after exposure in individuals who are immunosuppressed. In addition, immune sera may be used to lessen the severity of a disease after known or suspected exposure (see Figure 18.3 for sites of action of immune sera and antitoxins). Table 18.2 lists the various available immune sera, antitoxins and antivenins, as well as usual indications. Pharmacokinetics No pharmacokinetic data are available for these biologicals. • Booster immunisations are required for this immunisation. Your baby should receive a booster immunisation at your next scheduled checkup. Keep a written record of this immunisation. • Please contact your healthcare provider if you have any questions or concerns. Provide emergency life support if needed for acute reaction. Evaluation Evaluate drug effects: serum titres reflecting immunisation (if appropriate). Monitor for adverse effects: pain, flu-like symptoms, local discomfort. Evaluate effectiveness of parent teaching program. Evaluate effectiveness of comfort and safety measures. Evaluate effectiveness of emergency measures if needed. TEACHING FOR S.D. • This immunisation will help your baby to develop antibodies to protect her against diphtheria, tetanus and pertussis. The baby will develop antibodies to these diseases, and this will prevent the baby from contracting one of these potentially deadly diseases in the future. • The injection site might be sore and painful. Heat applied to the area may help this discomfort and speed the baby’s recovery. • Adverse effects that the baby might experience include fever, muscle aches, joint aches, fatigue, malaise, crying and fretfulness. Paracetamol may help these discomforts; check with your healthcare provider for the correct dose to use for the baby. Rest, small meals and a quiet environment may also help the baby to feel better. • The adverse effects should pass within 2 to 3 days. If they seem to be causing undue discomfort or persist longer than a few days, notify your healthcare provider.