All medications are chemicals and when we put those into our bodies they are
potentially dangerous and so we need to be aware of the adverse events that can
happen with any medication that we take. In this video we'll be looking at the
different classifications of adverse events and what that means to you as a
healthcare provider, right after this.
Welcome back my name is Tammy and this is NurseMinder and on this channel we
do everything nursing so if you're new here consider subscribing below so that
you get the next video when it's released. Welcome back. Before we get started be
sure to LIKE, subscribe, and comment below at the end of this video to let me know
if this has been helpful for you, and if you have ideas for future videos please
send those in. Now an adverse event is an undesirable outcome and it can range
from just a slight unpleasant taste in your mouth or a little nausea in your
stomach to a life-threatening condition. So we're first gonna take a look at the
primary adverse event category. In a primary action what's happening here is
we actually have an extension of the desired effect, so for example if you
take a blood pressure medication to lower your blood pressure and it works
so well that it lowers it too far - that would be considered an extension of the
desired outcome and that can cause a patient some concern. Now there are
reasons why this might happen, we consider this sometimes to be a simple
overdose in the sense that the drugs dosing is correct for your condition and
your situation and your person in your age and all those things, but your body's
response is more sensitive than we would have anticipated. Now the effects on the
individual can be different for a variety of reasons. Sometimes it is the
patient's age, happens to deal with the patient's weight, maybe underlying
conditions that affect how that drug works in your body. When it comes to
secondary effects these are considered in addition to the desired effects. So
when we do hear a patient education, example for that blood pressure medication,
we let them know that they're getting this particular medication because it
acts on this site and the end result is to lower your blood pressure.
We also need to tell them that there are other side effects with this medication
for example if my blood pressure gets too low I might be tired and dizzy,
confused, but there's also the fact I'm taking this pill orally and my stomach
may not like that so I can have nausea with that, and if my heart slows down or
my blood pressure lowers enough I may end up having some edema. So these are
considered in addition to effects. This is not the desired intention but they
may be things that happen as a result of getting the desired intention. We may be
able to manage some of these undesirable adverse events by adjusting the dose
here. Unlikely that we can eliminate all risk, so education and letting our
patients know what they might expect and when to come back is important for you
to know as a nurse caring for your patients. In hypersensitivity reactions
what we're seeing is a heightened response to either the primary or the
secondary reactions that we're seeing now present in our patients who have a
hypersensitivity to the medication. There are some things that we need to consider
that will put our patients at risk. What is the underlying pathology of that
patient? There may be a condition and that is impacting how that medication
can work. If you recall back in a previous video when we talked about
pharmacodynamics and pharmacokinetics, if a patient has a proton pump inhibitor it
is impacting how a medication can be absorbed. With age sometimes those
receptors are known to become more sensitive to drugs and even though we
may have a desired outcome of the lower blood pressure in giving a blood
pressure medication, we may find that there's an opposite reaction. This happens
a lot with narcotics and medications that are used to decrease the awakeness
and alertness of our patients to lower their anxiety, sometimes they become more
anxious. So age we see that often in our geriatric population. Liver and kidney
functio; we know that the liver is a huge organ for metabolism as
the lungs. Kidney is a major place where we excrete our medication so if there's
any pathology there we may end up having a toxic buildup and then we'll end up
having a hypersensitivity reaction in our patient. Drug allergies is the fourth
classification of adverse events I want to stay a little bit more time on this
because this is where our body is actually launching an immune response
and forming antibodies to the medication that we've just ingested or infused. Many
times our patients will say they have an allergy to a drug in particular and we need
to actually determine if it's a true allergy. So for example we're giving that
ACE inhibitor and the blood pressure is so low that they get when they wake up
in the morning and sit up they feel confused and they faint. They may think
that's an allergy but really that's education about side effects; primary and
secondary, and then how to manage that and treat that. So not to give up so
quickly, to just sit for a while, let the dizziness go away things like that.
If it's a true allergy and there are some rare allergies for example like ACE
inhibitors - angioedema can be a life-threatening allergy that patients
experience; swelling of the face, numbness and tingling, and about twenty to forty
percent of ER visits related to angioedema are traced back to ACE
inhibitors, so understanding the definition of a true allergy versus an
adverse event is important in terms of caring for your patient holistically. So
there's four classifications of allergies: anaphylactic, cytotoxic, serum
sickness, and delayed allergy reaction. Now it's important to note that a
patient cannot be allergic to a medication they have never taken; however
there can be cross sensitivity so if you have a particular class of antibiotics
and they've reacted to one medication in that classification it is likely they
will react to the others or you would expect to see a potential reaction. So
let's start with anaphylactic, this is a life-threatening reaction where the
airway becomes swollen and they cannot swallow. The first type we are going to look at is
anaphylactic because it's the most serious. This is a life-threatening reaction
to a stimulus like bee stings. Histamine and other chemicals are released at the
site and cause immediate swelling. You may also notice itching, rashes, lower
blood pressure. These need to be treated right away and this is where you often
hear those public service announcements and commercials about epinephrine for
those who have life-threatening allergies to peanuts and shellfish, things
like that. So epi pens are something you will see
carried by those who have known reactions to specific antigens that are
life-threatening in nature. In cytotoxic allergic reactions what's happening here
is that their cell death occurring because it's kind of a mistaken identity.
So we have taken this medication and it's bound to the cell, let me get rid of
this here, this is our cell and its receptor site and here's the medication
we want to change, so say it's an antibiotic, it is bound to the cell that
we want it to work with. IgG, one of our immunoglobulins, comes along and it
mistakenly identified this as a foreign body and then it destroys it. So
cytotoxic antibodies are circulating and they mistakenly identify the good guys
as bad guys and then they destroyed them. We often see this show up in blood work. Now
when our our system is not working to its capacity and we end up having a lot of
antigen antibody complexes in the body, they're not able to be cleared
effectively because the system is overrun. So what happens is that these
tend to clump together then in serum sickness syndrome and they end up
depositing in the vasculature and in the joints of patients. So we end up having
several days two weeks later a patient will present with polyarthralgia, so
multiple joints that are painful and swollen, there may be rashes. So in this
case as with all of these cases, we would stop the medication, symptomatic control
and wait for further instructions. A delayed allergic reaction, again it is
not happening immediately, there's some time that goes from the insult to the
reaction and we're going to see a delay. There maybe a rash, pain, and swelling
such as your first bee-sting, you may be due to react right away but
the next day you wake up and you notice there's a bit of swelling and redness at
the site. That will be considered a delayed reaction. So that's a quick
overview of the different types of adverse events that we can plan and
prepare for when we give our patients medications. Having this knowledge will
help you anticipate potential danger in the upcoming days to weeks after we
give treatment to our patients. As always, make sure you like, subscribe and comment
below. Let me know if this video was helpful and until next time make it a
great day :)