268
P A R T 3
Drugs acting on the immune system
■■
Immune suppressants are used to depress the immune
system when needed to prevent transplant rejection
or severe tissue damage associated with autoimmune
disease. Research is ongoing to extend the use of
various immune suppressants to other situations,
including various autoimmune disorders.
■■
Increased susceptibility to infection and increased
risk of neoplasm are potentially dangerous effects
associated with the use of immune suppressants.
People need to be protected from infection, injury
and invasive procedures.
KEY POINTS
■
■
Monitor the results of laboratory tests such as FBC
to identify changes in bone marrow function
.
Implementation with rationale
■
■
Arrange for laboratory tests before and periodically
during therapy, including FBC, differential and
liver and renal function tests,
to monitor for drug
effects and adverse effects
.
■
■
Administer the drug as indicated; instruct the
person and a significant other if injections are
required
to ensure proper administration of the
drug
.
■
■
Protect the person from exposure to infections
and maintain strict aseptic technique for any
invasive procedures
to prevent infections during
immunosuppression
.
■
■
Arrange for supportive care and comfort measures
for flulike symptoms (rest, environmental control,
paracetamol)
to decrease discomfort and increase
therapeutic compliance
.
■
■
Monitor nutritional status during therapy; provide
small frequent meals, mouth care and nutritional
consultation as necessary
to ensure adequate
nutrition
.
■
■
Instruct women in the use of barrier contraceptives
to avoid pregnancy during therapy because of the
risk of adverse effects to the fetus
.
■
■
Offer support and encouragement
to help the
person deal with the diagnosis and the drug
regimen
.
■
■
Provide thorough teaching, including measures to
avoid adverse effects, warning signs of problems
and proper administration,
to increase knowledge
about drug therapy and to increase compliance
with the drug regimen
.
Evaluation
■
■
Monitor response to the drug (prevention of
transplant rejection; improvement in autoimmune
disease or cancer; prevention of RSV disease;
improvement in signs and symptoms of Crohn’s
disease or rheumatoid arthritis).
■
■
Monitor for adverse effects (flu-like symptoms,
GI upset, increased infections, neoplasms, fluid
overload).
■
■
Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects
to watch for, specific measures to avoid adverse
effects, proper administration technique).
■
■
Monitor the effectiveness of comfort measures and
compliance to the regimen (see Critical thinking
scenario).
CRITICAL THINKING SCENARIO
Holistic care for a person with a transplant
THE SITUATION
After waiting on a transplant list for 4 years, T.B. received
a human heart transplant to replace his heart, which had
been severely damaged by cardiomyopathy. Before getting
the transplant, T.B. was bedridden, on oxygen, and near
death. The transplant has given T.B. a “new lease on life”,
and he is determined to do everything possible to stay
healthy and improve his activity and lifestyle. Currently, he
is being maintained on cyclosporin, mycophenolate and
corticosteroids.
CRITICAL THINKING
What important teaching facts would help T.B. to achieve
his goal?
Think about the psychological impact of the heart
transplant and the “new lease on life”.
What activity, dietary and supportive guidelines should be
outlined for T.B.?
What impact will T.B.’s drug regimen have on his plans?
How can all of the aspects of his condition and medical
care be coordinated to give T.B. the best possible
advantages for the future?
