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P A R T 3
Drugs acting on the immune system
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Immunity is a state of relative resistance to a disease
that develops only after exposure to the specific
disease-causing agent.
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Vaccines provide active immunity by stimulating
the production of antibodies to a specific protein,
which may produce the signs and symptoms of a mild
immune reaction but protects the person from the
more devastating effects of disease.
KEY POINTS
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Monitor for adverse effects (flu-like symptoms;
GI upset; local pain, swelling, nodule formation at
the injection site).
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Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects to
watch for; has written record of immunisations;
can state when to return for the next immunisation
or booster if needed).
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Monitor the effectiveness of comfort measures and
adherence to the regimen.
See Critical thinking scenario for additional
information on educating a parent about vaccines.
Prototype summary: Measles, mumps and
rubella vaccine
Indications:
Active immunisation against measles,
mumps, and rubella in children older than
15 months and adults.
Actions:
Attenuated measles, mumps and rubella
viruses produce a modified infection and stimulate
an active immune reaction with the production of
antibodies to these viruses.
Pharmacokinetics:
Route
Onset
Peak
IM
Rapid
3–12 hours
T
1/2
:
Unknown; metabolised in the tissues, excretion
is unknown.
Adverse effects:
Moderate fever, rash, or burning
or stinging wheal or flare at the site of injection;
rarely, febrile convulsions and high fever; Guillain-
Barré syndrome, ocular palsies.
CRITICAL THINKING SCENARIO
Educating a parent about vaccines
THE SITUATION
S.D. is a 25-year-old, first-time mother who has brought her
2-month-old daughter to the maternal and child health
centre for a routine evaluation. The baby is found to be
healthy, growing well and within normal parameters for her
age. At the end of the visit, the nurse prepares to give the
baby the first of her routine immunisations. S.D. becomes
concerned and expresses fears about paralysis and infant
deaths associated with immunisations.
CRITICAL THINKING
What information should S.D. be given about
immunisations?
What care interventions would be appropriate at this time?
Think of ways to explain the importance of immunisations
to S.D. while supporting her concerns for the welfare of her
baby.
How can this experience be incorporated into a teaching
plan for S.D. and her baby?
DISCUSSION
S.D. should be reassured before the baby is immunised.
The nurse can tell her that in the past, paralysis and infant
deaths were reported, but that efforts continue to make
the vaccines pure. Careful monitoring of the child and the
child’s response to each immunisation can help avoid such
problems. Reassure S.D. that the immunisations will prevent
her daughter from contracting many, sometimes deadly,
diseases. Praise S.D.’s efforts for researching information that
might affect her baby and for asking questions that could
have an impact on her child and her understanding of her
care.
The recommended schedule of immunisations should
be given to S.D. so that she is aware of what is planned
and how the various vaccines are spaced and combined.
She should be encouraged to monitor the baby after each
injection for fever, chills and flu-like reactions. When she
gets home, she can medicate the baby with paracetamol
to avert many of these symptoms before they happen. (S.D.
should be advised not to give the baby aspirin, which could
cover up Reye’s syndrome, a potentially serious disorder.)
S.D. also should be told that the injection site might be sore,
swollen and red, but that this will pass in a couple of days.
S.D. can ease the baby’s discomfort by applying warm soaks
to the area for about 10 to 15 minutes every 2 hours.
S.D. should be encouraged to write down all of the
immunisations that the baby has had and to keep this
