Chapter 3
This allergy involves an antibody that reacts with specific sites in the body to cause the release of chemicals, including histamine, that produce immediate reactions (mucous membrane swelling and constricting bronchi) that can lead to respiratory distress and even respiratory arrest.
anaphylactic reaction
What are the types of allergic reactions?
anaphylactic cytotoxic serum sickness delayed allergic
Examples of adverse drug reactions
-The drug may have other effects on the body besides the therapeutic effect. -The patient is sensitive to the drug being given. -The drug's action on the body causes other responses that are undesired or unpleasant. -The patient may be taking/given too much or too little of the drug.
Assessment Findings: Dry mouth, urinary retention, blurred vision Interventions: Sugarless lozenges to keep mouth moist; have the patient void before administration of the medication
Atropine-like (Anticholinergic) Effects
How would we intervene for stomatitis?
Frequent mouth care diet accommodations local anesthetic
Assessment Finding: Low serum blood glucose level Intervention: Restore glucose to the body
Hypoglycemia
Assessment Findings: Extrapyramidal symptoms Interventions: Discontinue medication as appropriate
Neuroleptic Malignant Syndrome
Assessment Findings: Muscle tremors, changes in gait Interventions: Discontinue medication as appropriate
Parkinson-like Syndrome
occurs when an overdose of a drug damages multiple body systems Damage to multiple systems can lead to a fatal reaction. Treatment varies accordingly with drug
Poisoning
How would we intervene for superinfections?
Supportive care (mouth and skin care) administer antifungal medications as needed may also need to stop drug responsible for the superinfection
Any drug that causes harm to the developing fetus or embryo
Teratogenicity
How would we intervene for blood dyscrasia?
monitor blood counts protective isolation
Undesired effects that may be unpleasant or even dangerous
adverse drug reactions
Assessment Findings: Dizziness, ringing in the ears (tinnitus), loss of balance, and loss of hearing Interventions: Monitor for hearing loss; discontinue medication as appropriate if a decrease in hearing is noted on assessment.
auditory damage
Bone marrow suppression Assessment: Fever, chills, weakness; low WBC, platelet count, hematocrit
blood dyscrasia
This allergy involves antibodies that circulate in the blood and attack antigens (the drug) on cell sites, causing death of that cell. This reaction is not immediate but may be seen over a few days
cytotoxic reaction
This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells
delayed allergic reaction
How would we intervene for rash/hives?
discontinue medication administer antihistamine and/or corticosteroid
How would we intervene for liver injury?
discontinue medication supportive measures
Occurs when the body forms antibodies, resulting in an immune response
drug allergies
Assessment Findings: Altered level of consciousness Interventions: Prevent injury
general CNS effects
Assessment Finding: High serum glucose level Intervention: Administer medications to decrease glucose level
hyperglycemia
Assessment Finding: Increase in serum potassium level Interventions: Decrease the serum potassium concentration (Sodium Polystyrene Sulfonate, IV glucose and insulin, IV calcium), monitor serum levels of potassium, and monitor cardiac rhythm
hyperkalemia
Types of Adverse Reaction: Excessive or exaggerated response to primary or secondary effect of drug usually from an underlying condition Examples: drug induced blood dyscrasia, organ injury or allergy
hypersensitivity
What are examples altered glucose metabolism?
hypoglycemia hyperglycemia
Assessment Finding: Decrease in serum potassium levels Interventions: Replace serum potassium (IV or oral supplement) and monitor serum levels of potassium
hypokalemia
toxicity: Change in urinary pattern, elevated BUN and creatinine and/or electrolyte imbalance
kidney/renal injury
toxicity: Fever, malaise, nausea, jaundice, change in color of urine or stool, elevated liver enzymes
liver injury
What are examples of toxicity?
liver injury kidney/renal injury
How would we intervene for kidney/renal injury?
notify physician may need to stop medication or decrease the dosage diet and fluid modifications
Assessment Findings: Visual changes Interventions: Monitor for any visual changes when giving any medication that is known to cause ocular damage; discontinue medication as appropriate.
ocular toxicity
Types of Adverse Reaction: Overdose; extension of the desired effect Examples: Anticoagulants, Diabetic agents
primary
What are the types of adverse reactions?
primary secondary hypersensitivity
Types of Adverse Reaction: Undesired effects produced in addition to the pharmacologic effect Examples: drowsiness, n/v, constipation
secondary
Dermatological Reaction: Abnormalities in the skin, red area, blisters
rash/hives
What are the dermatological reactions?
rash/hives, stomatitis
This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 week or more after exposure to the drug
serum sickness reaction
Dermatological Reaction: Inflammation of the mucous membranes
stomatitis
Destruction of the body's normal flora Assessment: Fever, diarrhea, vaginal discharge
superinfection
What are examples of drug-induced tissue and organ damage?
superinfections blood dyscrasia
A noxious or toxic affect from prescribed drug
toxicity