Chapter 49 Immunizing Drugs and Biochemical Terrorism Copyright © 2014 by Mosby, an imprint of...

Chapter 49

Immunizing Drugs and Biochemical Terrorism

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Immune response Antigens Antibodies

Active immunization Passive immunization

Immunity

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

The body is exposed to a relatively harmless form of an antigen

The immune system is stimulated and “remembers” this antigen if subsequent exposures occur

Does not cause a full-blown infection

Artificial Active Immunization


Person acquires immunity by surviving the disease itself and producing antibodies to the disease-causing organism

Natural Active Immunization


Also called biologicals Antitoxins Antisera Toxoids and vaccines (immunizing biologicals) Used to prevent, treat, or cure infectious

diseases

Biological Antimicrobial Drugs


Antigenic (foreign) preparations of bacterial exotoxins

Detoxified with chemicals or heat Weakened or “attenuated”

Cannot revert back to a toxic form

Toxoids


Stimulate one’s immune system to produce a specific antibody Artificial active immune response

These antibodies protect against future exposures

Toxoids (cont’d)


Suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms

These slight alterations in the bacteria and viruses prevent the person injected from contracting the disease

Vaccines


Also stimulate the production of antigens against a specific antibody

Vaccinations with live bacteria or virus provide lifelong immunity

Vaccinations with killed bacteria or virus provide partial immunity, and booster shots are needed periodically

Vaccines (cont’d)


BCG vaccine (tuberculosis) Diphtheria, tetanus, and pertussis toxoids,

several forms Haemophilus influenzae type B conjugate

vaccine Hepatitis A and B virus vaccines

Active Immunizing Drugs: Examples


Measles, mumps, and rubella virus vaccine, live—several forms

Pneumococcal bacterial vaccines Human papilloma virus vaccine (Gardasil) Poliovirus vaccine; several forms Rabies virus vaccine

Active Immunizing Drugs: Examples (cont’d)


Smallpox virus vaccine Tetanus toxoid Varicella virus vaccine (chickenpox) Yellow fever virus vaccine Many others

Active Immunizing Drugs: Examples (cont’d)


Classroom Response Question

A patient has an order for the varicella vaccine. It is most important for the nurse to assess the patient for

A.use of high dose systemic steroids in the past month.

B.allergy to aspirin.

C.allergy to eggs.

D.history of hypertension.


Serum or concentrated immunoglobulins from humans or animals are injected into a person

The substances needed to fight off invading microorganisms are given directly to a person

The immune system is bypassed Short-lived compared with active immunization,

but works faster

Passive Immunization


Administration of serum or concentrated immunoglobulins

Provides the inoculated person the substance needed to fight off the invading microorganism

Bypasses the host’s immune system

Artificial Passive Immunization


Antibodies are transferred From mother to fetus through the placenta From mother to infant through breast milk

Natural Passive Immunization


Antitoxins Immunoglobulins Snake and spider antivenins (antivenom)

Passive Immunizing Drugs


Antivenins Pit viper, coral snake Black widow spider

Hepatitis B immune globulin Immunoglobulin, various forms Rabies immunoglobulin (human)

Passive Immunizing Drugs: Examples


Rho(D) immune globulin (RhoGAM) Tetanus immunoglobulin Varicella-zoster immunoglobulin

Passive Immunizing Drugs: Examples (cont’d)



A patient with AIDS was cut by a rusty piece of metal while walking outside. He recalls that his last tetanus booster was over 20 years ago. Which immunization therapy will he receive at this time?

A.He cannot receive any type of immunization therapy.

B.Tetanus immunoglobulin

C.Tetanus toxoid, adsorbed

D.Tetanus and diphtheria toxoid (Td) booster


Active immunization Prevents infection caused by bacterial toxins or

viruses Provides long-lasting or permanent immunity “Herd immunity”

Indications


Passive immunization Antitoxins, antivenins, immunoglobulins Minimizes effects of poisoning by the venoms of

spiders and certain snakes Provides quick immunity before a person’s own

immune system has a chance to make antibodies (such as in cases of exposure to hepatitis B or rabies viruses)

Indications (cont’d)


CDC/Department of Health and Human Services recommendations for adult and pediatric immunizations (U.S.) Provide specific dosages and intervals for

immunizations Refer to the CDC website for current

recommendations

Indications (cont’d)



The zoster vaccine (Zostavax) is used in which situation?A.To prevent chickenpox in childrenB.To prevent chickenpox in children who have been exposed to herpes zosterC.To prevent postherpetic neuralgia in patients who have shinglesD.To prevent reactivation of the zoster virus that causes shingles in patients age 60 or older


Range from mild and transient to very serious or life threatening

Minor effects Fever, minor rash, soreness at injection site, itching,

adenopathy Severe effects

Fever higher than 103° F, encephalitis, convulsions, anaphylactic reaction, dyspnea, others

Adverse Effects


Minor reactions Treated with acetaminophen and rest

Serious or unusual reactions Serum sickness Report serious or unusual reactions to the Vaccine

Adverse Event Reporting System (VAERS)

Adverse Effects (cont’d)



After immunizations at a well-baby check-up, a mother notes that her infant has redness and swelling at the injection site, is irritable, and has a fever of 99.9° F. She calls the clinic and is worried about her baby. Which action by the nurse is appropriate?

A.Tell the mother there’s nothing to worry about and that these symptoms are normal and will go away

B.Tell the mother that she should bring her baby in to the office for an examination

C.Tell the mother that acetaminophen and rest should help to alleviate these symptoms, which are not unusual after immunizations.

D.Complete a Vaccine Adverse Event Reporting System form (VAERS).


Assess patient’s health history, medication history, allergies, pregnancy status

Assess previous reactions and responses to immunizations

Assess for contraindications, including immunosuppression

Nursing Implications


Before giving any drug, recheck the specific protocols for administration and schedules for administration

Follow manufacturer’s guidelines for drug storage, administration, routes, and site of administration

Nursing Implications (cont’d)


Encourage parents of young children to keep a journal of the child’s immunization status, with dates of immunizations and reactions, if any



If discomfort occurs at the injection site, apply warm compresses and give acetaminophen

Do not give aspirin to children Monitor for therapeutic responses and adverse

reactions



Anthrax Smallpox Botulism Tularemia Viral hemorrhagic fever Plague

Illnesses Caused by Possible Bioterrorism Agents


Sarin (nerve gas) Mustard (blistering agent) Cyanide (blood agent) Chlorine (choking agent) Radioactive elements Ricin

Possible Bioterrorism Agents



A patient is admitted to the emergency department with cyanide toxicity. Which antidote drugs does the nurse expect to administer?

A.atropine

B.pralidoxime

C.pyridostigmine

D.sodium nitrite



Which statement regarding possible bioterrorism agents does the nurse identify as being true?

A.Gentamicin and tetracycline are useful in the treatment of botulism.

B.Tetracycline and ciprofloxacin are indicated in the treatment of tularemia.

C.Vaccination for plague is recommended for public defense personnel in the United States.

D.Antibiotics are useful in the treatment of smallpox.


Chapter 49 Immunizing Drugs and Biochemical Terrorism Copyright © 2014 by Mosby, an imprint of...

Documents

Transcript of Chapter 49 Immunizing Drugs and Biochemical Terrorism Copyright © 2014 by Mosby, an imprint of...