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2 Minute EBP Challenge

Monday, March 08, 2010
Restoring Hemoglobin
One of the goals for a patient who has a large blood loss is the restoration of normal hemoglobin levels.  This is partially done by blood transfusions, usually to a hemoglobin level of about 10g/dL.  A hemoglobin level that low will leave the patient feeling fatigued, but should be high enough to protect the heart from anemic ischemia.

Sunday, February 28, 2010
Renal Dysfunction
Mrs. Mersa is admitted with sepsis and hypotension.  Her labs indicate:
BUN 58 mg/dl
Serum creatinine 2.1 mg/dl
Urine sodium 70 mEq/L
Urine specific gravity 1.010, with cellular casts and RBCs in the urine.
Based on these findings you would consider:

Friday, February 12, 2010
Which action first?
Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse?

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Home > 2 Minute EBP Challenge > Acetaminophen and vaccinations

Acetaminophen and vaccinations

Monday, November 02, 2009
 

Stay up-to-date the easy way!

How would you answer this question?

Administering acetaminophen (Tylenol) at the time of pneumococcal or influenza vaccination may decrease fever and discomfort associated with vaccination, but is also associated with:

a. Fever greater than 38 degrees C
b. Swelling at the injection site
c. Irritability in infants
d. Decreased antibody responses

The correct answer is "d," decreased antibody response.

Acetaminophen (Tylenol) is often classified as a non-steroidal anti-inflammatory (NSAID) medication due to its action on cyclooxygenase 3 (COX3), which is very similar to COX1 that is blocked by other traditional NSAIDs.  The main effects of acetaminophen are the relief of fever and pain.  Acetaminophen is often prescribed for the relief of discomfort of vaccination injections.  In a recent study, the authors found a significant reduction in fever, pain, and irritability after vaccination in children who were premedicated with acetaminophen.

Acetaminophen is not thought to reduce inflammation though, so theoretically it should not interfere with immunogenicity of vaccinations.  However, in their study, Prymula, et al. found a significant reduction in antibody responses to vaccination in the pretreated group.  Given the long history of administration of acetaminophen with vaccinations, it is likely that the magnitude of immune suppression caused by acetaminophen is primarily found in laboratory testing and not in clinical expression of disease.

The authors recommend avoiding the prophylactic use of acetaminophen for vaccinations, unless the patient has moderate to severe complications from vaccinations.

From: Prymula, R. et al. (2009).  Effect of prophylactic paractamol administration at the time of vaccination on febrile reactions and antibody response in children: Two open-label randomised controlled trials.  Lancet, 374:1339.

Congratulations to Susan Weiss who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Susan!     

Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

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