Clinical Experience

Posted: May 5th, 2020

Clinical Experience

Several years ago a flu shot clinic was being held for employees of the facility. It had been going on for several hours without any issues. If any issues did arise, the team would call for the non-patient rapid response team. In that case, the ER would respond. A RRT was called over head to the flu shot clinic. I responded and found a female patient lying on the floor in mild respiratory distress. She was anxious, diaphoretic, and stating like she felt like her throat was swelling, We quickly assessed her and did a set of vitals and felt it was safe to transport her to the ER down the hall.

In the ER, the patient was placed on the cardiac monitor and vital signs were obtained. The provider ordered for an IV to be placed and medication given. Some of the meds first included Benadryl, Pepcid, and a steroid. IV fluids were started as well and the patient was placed on oxygen. After a short period, the patient symptoms had not improved. The provider ordered for epinephrine to be given. The patient was observed for some time after to make sure they did not rebound.

Pharmacokinetics and Pharmacodynamics

Pharmacokinetics is the movement of drugs in the body. Pharmacodynamics is the affects of the drug on the body and mechanism of action “Dose, indications, adverse effects, interactions… from PDR.net,” n.d.).

The influenza vaccine works by causing the body to produce its own antibodies against the virus. Several medications can interfere with the flu vaccine. In total, 268 medications can cause a severe reaction (“Influenza virus vaccine, inactivated interactions,” n.d.).

A questionnaire should have been done prior to giving the vaccine. This is to make sure there has not been a previous reaction to the vaccine, eggs, or any ingredient to the vaccine. An anaphylaxis reaction would have to be caused by the virus or a component of the vaccine.

Personalized Plan of Care

I’m not sure of the patient’s prior health history before the event but I do know there was not a previous anaphylaxis event to a flu shot prior. The patient was being seen to rule out Lupus but no official diagnosis was given yet. As far as a plan, no further flu shots will be received. The patient should follow up with an allergist to see where the sensitivity lies. If any vaccine is approved, the patient should be pre-treated with Benadryl, Pepcid, and a Zyrtec prior to administration.

References

Dose, indications, adverse effects, interactions… from PDR.net. (n.d.). PDR.Net. https://www.pdr.net/drug-summary/Fluvirin-influenza-virus-vaccineLinks to an external site.

Influenza virus vaccine, inactivated interactions. (n.d.). Drugs.com. https://www.drugs.com/drug-interactions/influenza-virus-vaccine-inactivated.htmlLinks to an external site.

Kinman, T. (n.d.). What are the side effects of a flu shot? Healthline. https://www.healthline.com/health/flu-shot-side-effectsLinks to an external site.

Clinical Experience

A few years ago, we organized a flu shot clinic for facility employees, which had been running smoothly for several hours. In the event of any issues, we had a non-patient rapid response team available to call, and the emergency room (ER) would respond accordingly. During the clinic, a rapid response team (RRT) was summoned to the flu shot clinic through the overhead announcement. I promptly responded and found a female patient lying on the floor, experiencing mild respiratory distress. She appeared anxious, diaphoretic, and expressed a sensation of throat swelling. We promptly assessed her condition, conducted vital sign measurements, and determined it was safe to transport her to the ER located down the hall.

Upon arrival at the ER, the patient was connected to a cardiac monitor, and vital signs were monitored. The healthcare provider ordered an intravenous (IV) line placement and administration of several medications, including Benadryl, Pepcid, and a steroid. IV fluids were initiated, and the patient received oxygen therapy. However, despite these interventions, the patient’s symptoms did not improve significantly. As a result, the provider decided to administer epinephrine. The patient was then closely observed to ensure there were no adverse reactions following the administration of epinephrine.

Pharmacokinetics and Pharmacodynamics

Pharmacokinetics refers to the movement of drugs within the body, while pharmacodynamics pertains to the effects of the drug on the body and its mechanism of action (PDR.net, n.d.).

The influenza vaccine stimulates the body to produce its own antibodies against the virus. It is worth noting that several medications can potentially interfere with the flu vaccine, with a total of 268 medications identified as causing severe reactions (Drugs.com, n.d.).

Prior to administering the vaccine, it is essential to conduct a thorough questionnaire to ascertain the absence of any previous reactions to the vaccine, eggs, or its constituents. Anaphylactic reactions can occur due to the virus itself or components of the vaccine.

Personalized Plan of Care

Although the patient’s complete prior health history is unknown, it was confirmed that she had not experienced anaphylaxis in response to a flu shot before. She had been undergoing evaluation to rule out a Lupus diagnosis, but no official diagnosis had been made yet. Going forward, it is advised that the patient abstains from receiving any further flu shots. Additionally, it is recommended that she follows up with an allergist to determine the specific source of her sensitivity. If any future vaccines are deemed appropriate, the patient should be pre-treated with Benadryl, Pepcid, and Zyrtec prior to administration.

References

Dose, indications, adverse effects, interactions… from PDR.net. (n.d.). PDR.Net.