C H A P T E R 1 8
Vaccines and sera
283
Contraindications and cautions
The use of vaccines is contraindicated in the presence
of immune deficiency
because the vaccine could cause
disease, and the body would not be able to respond as
anticipated if it is in an immunodeficient state
; during
pregnancy
because of potential effects on the fetus and
on the success of the pregnancy
; in individuals with
known allergies to any of the components of the vaccine
(refer to each individual vaccine for specifics, sometimes
including eggs, where some pathogens are cultured); or
in people who are receiving immune globulin or have
received blood or blood products within the last 3 months
because a serious immune reaction could occur.
Caution should be used whenever a vaccine is
given to a child with a history of febrile convulsions or
cerebral injury, or in any condition in which a potential
fever would be dangerous. Caution also should be used
in the presence of any acute infection.
Adverse effects
Adverse effects of vaccines are associated with the
immune or inflammatory reaction that is being stimu-
lated: moderate fever, rash, malaise, chills, fretfulness,
drowsiness, anorexia, vomiting and irritability. Pain,
redness, swelling and even nodule formation at the
injection site are also common. In rare instances, severe
hypersensitivity reactions have been reported.
Clinically important drug–drug interactions
Vaccines should not be given with any immunosuppres-
sant drugs, including corticosteroids, which could alter
the body’s response to the vaccine.
Care considerations for
people receiving vaccines
Assessment: History and examination
■
■
Assess for contraindications or cautions: known
allergies to any vaccines or to the components of
the one being used
to prevent hypersensitivity
reactions
; current status related to pregnancy,
which is a contraindication to the use of vaccines
;
recent administration of immune globulin or
blood products,
which could alter the response to
the vaccine
; history of immune deficiency,
which
could alter immune reactions
; and evidence of
acute infection,
which could be exacerbated by the
introduction of other antigens
.
■
■
Perform a physical assessment
to determine
baseline status before beginning therapy and
for any potential adverse effects
: Inspect for
the presence of any skin lesions
to monitor for
hypersensitivity reactions
; check temperature
to monitor for possible infection
; monitor pulse,
respirations and blood pressure; auscultate
lungs for adventitious sounds; and assess
level of orientation and affect
to monitor for
hypersensitivity reactions to the vaccine
.
■
■
Evaluate the range of motion of the extremity
to be used for vaccine administration
to assure
adequate blood flow to deal with the antigen and
inflammatory reaction
.
■
■
Assess tissue perfusion to establish a baseline
to
monitor for potential hypersensitivity reactions
.
Implementation with rationale
■
■
Do not use to treat acute infection;
a vaccine is
used to prevent infection with future exposures
.
■
■
Do not administer if the person exhibits signs
of acute infection or immune deficiency
because
the vaccine can cause a mild infection and can
exacerbate acute infections
.
■
■
Do not administer if the individual has received
blood, blood products or immune globulin within
the last 3 months
because a severe immune
reaction could occur
.
■
■
Arrange for proper preparation and administration
of the vaccine; check on the timing and dose of
each injection
because dose, preparation and
timing vary with individual vaccines
.
■
■
Maintain emergency equipment on standby,
including adrenaline,
in case of severe
hypersensitivity reaction
.
■
■
Arrange for supportive care and comfort measures
for flu-like symptoms (rest, environmental control,
paracetamol) and for injection discomfort (local
heat application, anti-inflammatories, resting arm)
to promote comfort
.
■
■
Do not administer aspirin to children to treat
discomforts associated with immunisation.
Aspirin can mask warning signs of Reye’s
syndrome, a potentially serious disease
.
■
■
Provide thorough teaching, including measures to
avoid adverse effects, warning signs of problems and
the need to keep a written record of immunisations,
to increase knowledge about drug therapy and to
increase compliance with the drug regimen
.
■
■
Provide a written record of the immunisation,
including the need to return for booster
immunisations and timing of the boosters, if
necessary,
to increase compliance with medical
regimens
.
Evaluation
■
■
Monitor response to the drug (prevention of
disease, appropriate antibody titre levels).
