Nursing Considerations for Patients Receiving Immune Stimulants 使用免疫刺激剂患者的护理考虑
Assessment: History and Examination
评估：病史和检查
• Assess for contraindications and cautions: known allergies to any of these drugs or their components to prevent hypersensitivity reactions; current status related to pregnancy or lactation to avoid serious adverse effects on the fetus or baby; history of hepatic, renal, or cardiac disease, bone marrow depression, and CNS disorders, including seizures, all of which could be exacerbated by the effects of these drugs.
• 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 detect early dermatological effects; obtain weight to monitor for fluid retention; monitor temperature to detect any infection; check heart rate and rhythm and blood pressure to monitor for any cardiac effects of the drug; assess level of orientation and reflexes to evaluate CNS effects of the drug.
• Obtain a baseline electrocardiogram (ECG) to evaluate cardiac function and monitor adverse effects of the drugs.
获得基线心电图数据，评价心脏功能，监测药物的不良效应。
• Assess patient’s renal and liver function, including renal and liver function tests, to determine the appropriateness of therapy and to determine the need for possible dose adjustment and toxic drug effects.
• Monitor the results of laboratory tests such as complete blood count (CBC) to identify changes in bone marrow function.
监测实验室试验结果，如完全血细胞计数（CBC），鉴定骨髓功能变化。
Nursing Diagnoses 护理诊断
Nursing diagnoses related to drug therapy might include the following:
药物疗法相关护理诊断可能包括：
• Acute Pain related to CNS, GI, and flu-like effects
急性痛，与CNS、GI和流感样效应相关
• Imbalanced Nutrition: Less Than Body Requirements related to flu-like effects
营养失调：低于身体需求，与流感样效应相关
• Anxiety related to diagnosis and drug therapy
焦虑，与诊断和药物疗法相关
• Deficient Knowledge regarding drug therapy
药物疗法知识缺乏
Implementation With Rationale
实施及说明
• Arrange for laboratory tests before and periodically during therapy, including CBC and differential, to monitor for drug effects and adverse effects.
治疗前和治疗期间定期安排实验室试验，包括CBC和分化结果。
• Administer drug as indicated; instruct the patient and a significant other if injections are required to ensure that the drug will be given even if the patient is not able to administer it.
根据需要用药；一旦患者需要，应指导患者及亲属，确保患者无法自己给药时也能得到药物治疗。
• Monitor for severe reactions, such as severe hypersensitivity reactions, and arrange to discontinue the drug immediately if they occur.
监测有无严重反应，如严重的过敏反应，一旦出现，立即安排停药。
• Arrange for supportive care and comfort measures for flu-like symptoms (e.g., rest, environmental control, acetaminophen) to help the patient cope with the drug effects. Ensure that the patient is well hydrated during therapy to prevent severe adverse effects.
为流感样症状提供支持性护理和舒适措施（如，休息、环境控制、醋氨酚），帮助患者应对药物效应。确保患者治疗期间水合充分，预防严重的不良效应。
• Instruct female patients in the use of barrier contraceptives to avoid pregnancy during therapy because of the potential for adverse effects on the fetus.
指导女性患者使用屏障性避孕措施，避免治疗期间怀孕，因为药物对胎儿存在潜在的不良效应。
• Offer support and encouragement to deal with the diagnosis and the drug regimen.
提供支持和鼓励，应对诊断和药物治疗。
• Provide patient teaching about measures to avoid adverse effects; warning signs of problems; and proper administration technique.
教育患者如何避免不良效应、识别问题警示信号及正确给药。
Evaluation 评价
• Monitor patient response to the drug (improvement in condition being treated).
监测患者对药物的反应（所治疾病的得到改善）
• Monitor for adverse effects (flu-like symptoms, GI upset, CNS changes, bone marrow depression).
监测有无不良效应（流感样症状、GI不适、CNS变化、骨髓抑制）。
• Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, specific measures to avoid adverse effects).
评价宣教计划的效果（患者可能说出药名、剂量、需要留意的不良效应、避免不良效应的具体措施）
• Monitor the effectiveness of comfort measures and compliance with the regimen.
监测舒适措施的效果和治疗方案依从性。
★Vocabulary for Today ★
immune stimulants – 免疫刺激剂
bone marrow depression – 骨髓抑制
exacerbate – v. 加剧，加重
significant other – 亲属，有关系者
discontinue – v. 停止
regimen – n. 计划，制度，养生法
1. A 42-year-old woman with a 1-year history of rheumatoid arthritis comes to see her primary care physician complaining of worsening symptoms. She has been taking leflunomide. IL-1 and TNF-a are two key cytokines involved in the negative sequelae of rheumatoid arthritis. Which of the following drugs is a recombinant form of an endogenous IL-1 antagonist?
A) Abatacept
B) Anakinra
C) Methotrexate
D) Hydroxychloroquine
2.A 42-year-old woman with a 1-year history of rheumatoid arthritis comes to see you complaining of worsening symptoms. She has been taking leflunomide. You know that IL-1 and TNF-a are two key cytokines involved in the negative sequelae of rheumatoid arthritis. You decide to give her anakinra to interfere with IL-1 signaling. Which of the following is the most common side effect of anakinra administration?
A) Blurry vision
B) Diarrhea
C) Headache
D) Injection site reaction
1. B: Anakinra.
IL-1ra (interleukin-1 receptor antagonist) is a natural blocker of the IL-1 receptor. As an antagonist, IL-1ra blocks the effects of IL-1. In rheumatoid arthritis, these effects include bone and cartilage destruction in the joints. Anakinra is a recombinant form of IL-1ra. It must be administered daily and mimics the effects of IL-1ra, blocking IL-1 signaling. It is not very effective when used alone. 2. D: Injection site reaction.
The IL-1ra (interleukin-1 receptor antagonist) is a natural blocker of the IL-1 receptor. As an antagonist, IL-1ra blocks the effects of IL-1. In rheumatoid arthritis, these effects include bone and cartilage destruction in the joints. Anakinra is a recombinant form of IL-1ra. It must be administered daily and mimics the effects of IL-1ra, blocking IL-1 signaling. The most common adverse effect of anakinra administration is an injection site reaction (inflammation and ecchymosis), occurring in about 70% of patients.
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