Nursing care

Table 8.8 gives guidelines for a nursing assessment for patients about to undergo biologic therapies. It is modified from an article by Jackson et al. (2007).

Table 8.8 Nursing assessment guide for those about to be prescribed biologics.   Question   Rationale   Are you currently or have you in the past 2 weeks experienced any of the following: Fever Night sweats Sore throat Runny nose Face pain Ear ache Toothache Cough Breathing problems Painful urination Blood in urine Antibiotic use Headache Wound complication Severe fatigue   Any of these could indicate infection   Have you had any recent surgery? If so were there any complications? Did you experience any drainage from your incision?   Surgery poses an infection risk which usually requires biologic therapy to be postponed   Have you had a recent flu vaccination or other vaccination?   Live vaccines are contraindicated in people receiving biologic therapy because of the infection risk   Are you taking any other medication?   Possible drug interactions should be considered   Do you have any of the following medical conditions: heart failure, haematological or neurological disease or any malignancies?   These conditions may affect the ability to safely use biologic drugs and must be carefully assessed   Could you be pregnant?   Biologics should be avoided in women who are pregnant, trying to conceive or are breast feeding   Have you gained or lost weight since your previous treatment?   Weight may affect dosing, so changes may need to be made   Did you have any hypersensitivity last time you received your biologic medication?       What was your response to your previous treatment?

It is also important that the patient receives full information about the implications of using biologics prior to commencement of treatment. Not only should patients be aware of the potential side effects (see Table 8.9), but they also need to know about the commitment to therapy. All treatments except for etanercept are considered ongoing treatments that will require injections or infusions on a long-term basis.

Table 8.9 Potential side effects of biologic drugs.   Name of drug Very common symptom (≥1/10) Common symptom (≥1/100 <1/10)   Etanercept Bacterial infections (including upper respiratory tract, bronchitis, cystitis and skin infections) Injection site reaction Allergic reactions Pruritus Fever   Infliximab   Viral infection Serum sickness-like reaction Headache, vertigo, dizziness Flushing Lower respiratory tract infection, upper respiratory tract infection, sinusitis, dyspnoea Abdominal pain, diarrhoea, nausea, dyspepsia Increased liver enzymes Urticaria, rash, pruritus, hyperhidrosis, dry skin Infusion related (including injection site reaction, chills, oedema, pain)   Adalimumab Injection site reaction (including pain, swelling, redness and pruritus) Lower and upper respiratory tract infections, viral infections, candidiasis, bacterial infections Dizziness, vertigo, headache, neurologic sensation disorders Cough, nasopharangeal pain Diarrhoea, abdominal pain, stomatitis, mouth ulceration, nausea Increased hepatic enzymes Rash, dermatitis, hair loss Musculoskeletal pain Pyrexia Fatigue