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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 3
Person acquires immunity by surviving the disease itself and producing antibodies to the disease-causing organism
Natural Active Immunization
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 4
Also called biologicals Antitoxins Antisera Toxoids and vaccines (immunizing biologicals) Used to prevent, treat, or cure infectious
diseases
Biological Antimicrobial Drugs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 5
Antigenic (foreign) preparations of bacterial exotoxins
Detoxified with chemicals or heat Weakened or “attenuated”
Cannot revert back to a toxic form
Toxoids
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 6
Stimulate one’s immune system to produce a specific antibody Artificial active immune response
These antibodies protect against future exposures
Toxoids (cont’d)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 7
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 8
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)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 9
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 10
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)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 11
Smallpox virus vaccine Tetanus toxoid Varicella virus vaccine (chickenpox) Yellow fever virus vaccine Many others
Active Immunizing Drugs: Examples (cont’d)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 12
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.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 13
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 14
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 15
Antibodies are transferred From mother to fetus through the placenta From mother to infant through breast milk
Natural Passive Immunization
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 16
Antitoxins Immunoglobulins Snake and spider antivenins (antivenom)
Passive Immunizing Drugs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 17
Antivenins Pit viper, coral snake Black widow spider
Hepatitis B immune globulin Immunoglobulin, various forms Rabies immunoglobulin (human)
Passive Immunizing Drugs: Examples
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 18
Rho(D) immune globulin (RhoGAM) Tetanus immunoglobulin Varicella-zoster immunoglobulin
Passive Immunizing Drugs: Examples (cont’d)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 19
Classroom Response Question
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 20
Active immunization Prevents infection caused by bacterial toxins or
viruses Provides long-lasting or permanent immunity “Herd immunity”
Indications
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 21
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)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 22
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)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 23
Classroom Response Question
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 24
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 25
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)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 26
Classroom Response Question
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).
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 27
Assess patient’s health history, medication history, allergies, pregnancy status
Assess previous reactions and responses to immunizations
Assess for contraindications, including immunosuppression
Nursing Implications
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 28
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)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 29
Encourage parents of young children to keep a journal of the child’s immunization status, with dates of immunizations and reactions, if any
Nursing Implications (cont’d)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 30
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
Nursing Implications (cont’d)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 31
Anthrax Smallpox Botulism Tularemia Viral hemorrhagic fever Plague
Illnesses Caused by Possible Bioterrorism Agents
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 32
Sarin (nerve gas) Mustard (blistering agent) Cyanide (blood agent) Chlorine (choking agent) Radioactive elements Ricin
Possible Bioterrorism Agents
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 33
Classroom Response Question
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 34
Classroom Response Question
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.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 35