Why would a patient take cyclosporine?
Cyclosporine is a steroid used to suppress the immune system. It can be given while you're getting chemo to quiet the immune response so the chemo kills the cancer cells.
Patient education for cyclosporine.
Don't take with grapefruit juice, it can raise the levels by 50-200%
Watch for urine output (can cause renal problems)
Watch GFR, higher risk for an infection
Monitor vital signs and watch for fever (SEPSIS). Check CBC (WBC, RBC, Platelets, ANC)
What's the rationale for using two chemo agents instead of one?
We put most patients on two, three, or four drugs and then depending on where the cell is in its growth in the end of mitosis stage 0123, we try to make the cancer treatment attack the cell at a different point in growth
Why do you need to give vincristine through a large IV line/large vessel?
You have more dilution in a larger vein, a smaller vein you have more of a chance of damaging the vein.
What drug should a patient not take if they are taking methotrexate?
Concurrent use with NSAIDs may lead to severe methotrexate toxicity
What does aspirin do?
It's an anti-platelet aggregation medication.Don't give to anyone under the age of 21 risk for REYE'S SYNDROME Reduces inflammation, fever & pain
What side effect would you have with aspirin?
- Asthma- Dont give if has asthma; can cause asthma
- Salicylism- overdose on aspirin, ringing of ears, bleeding, bruising.
- Peptic ulcer disease (don't give if pt has)
- Intestinal blood loss
- Reye's syndrome
- Idiosyncratic reactions
- Noise;tinnitus-ringing of the ears
Side effects of Cyclophosphamide (cytoxan)
Cytoxan can cause Hemorrhagic cystitis means once the chemotherapy goes through the body and sits in the bladder it makes the bladder bleed the patient can hemorrhage in their bladder.
- Feel like they have the flu
- Their muscles ache
- They're extremely fatigued feeling
- Low RBC, WBC & platelets
Patient education of cytoxan (cyclophosphamide)
- Avoid crowds and avoid people with respiratory infections.
- Make sure the patient takes their temperature at home
- Tell patients they may feel fatigued
Nursing intervention for a patient getting cytoxan
To prevent hemorrhagic cystitis we give it first thing in the morning, and we give it with a ton of Iv fluids to flush it out and make the patient urinate, urinate, and urinate so it's not sitting in the bladder making it BLEED
Who would you not give morphine to?
Hypersensitivity and respiratory condition (COPD, asthma) or low BP because it's a vasodilator
What would you see if you saw a patient having an anaphylactic reaction?
- Hypotension due to low B/P
- Difficulty breathing
- Skin Rash
Side effects of doxorubicin aka Adriamycin
- Bone marrow suppression
- A Fib (treat with anticoagulant)
Adverse effects of interferon alpha.
- Flu Like symptom
- Severe Depression
Why would we give cyclosporine?
Prevention of organ rejection in transplant patients, ulcerative colitis, rheumatoid arthritis. It is to quiet the immune system
Why would they limit your chemotherapy? (general)
Chemotherapy is limited if the patient's blood counts are low that put them at risk because they are already immuno-compromised
Harsh on the body and they need to lower it because it a toxin
Nursing priority for a patient receiving narcotics.
Ask for pain level first. Check RR and BP (vitals) monitor for adverse effects.
When to withhold a narcotic from a patient.
We withhold narcotic if RR is below 10 breath per min
Why you wouldn't let a patient crush an extended release pill.
Crushing an extended release pill can come on too rapidly and must be swallowed whole for slow release.
Half life of narcan and other narcotics and why it's so important
The half life is short and requires 3-4 doses until the patient can metabolize however it depends on the dose given.
Half life 30-90 minutes (per drug book)
Half life 2- 4 hours Morphine (per drug book)
Nursing assessment for a patient getting a narcotic.
Monitor pain level, vital signs,respiratory status.
Before administering Narcotics check RR & BP; recheck RR in 30 minutes, Recheck BP & pain scale in 1 hour.
How to prevent a GI bleed if a patient is getting aspirin
Give it with milk or food.
Adverse effects of chronic tylenol use
Hepatotoxicity (liver damage).
*The total daily dose in a day for adults is 3000mg in 24hrs due to chronic use and liver damage. It used to be 4000.
Treat acute gout & a presurgical prophylaxis to prevent exacerbation (worsening) of gout
Nursing education for a patient getting colchicine
stay away from fructose sweetened drinks, meat, and seafood because it can cause more uric acid
N/V/D, abdominal pain, paralytic ileus
What would cause toxicity for a patient getting colchicine
Radiation therapy and drugs that depress bone marrow function.
-Also a patient with cardiac disease, renal disease, and hepatic disease.
Assessment for patient taking allopurinol
Assess medical history, CBC, uric acid base level, LFT, CMP, assess ROM (big toe).
Assess for Stevens-Johnson syndrome (Severe rash & blisters RARE)
Injection products are used to treat anemia, in people with chronic kidney failure
stimulates the bone marrow to make reticulocytes
Hemoglobin < 12 at risk for stroke & MI
If over 12 give ALOT of fluids to thin the blood & then phlebotomy to take excess blood out to prevent thrombus
Low iron or folate can NOT take Epoetin alfa
Contraindiciated with Iron deficiency anemia
Oprelvekin what labs would you need to monitor?
Monitor platelet counts! We give this drug anytime the platelets are below 50,000.
What to monitor when your patient is getting epoetin alfa
RBC count, hematocrit, hemoglobin (we want to keep hemoglobin under 12, or the patient could be at risk for hypertension or a thrombus formation, MI or stroke)
Who could get epoetin alfa?
-patients with anemia.
-A patient who needs adequate iron levels
-pre-op patients with large expected blood loss in the OR.
***make sure it is preservative free for infants and babies because the preservatives can cause death!
Joahovah witness because it's not a blood product
Who should not get epoetin alfa?
-patients with uncontrolled hypertension.
-patients with a folate deficiency
-patients with an iron deficiency
-patients with GI bleeds
Patient education for filgrastim
Return frequently for follow-up lab work.
-report any severe bone pain not relieved by nonnarcotic analgesics.
-immediately report any palpitations, dizziness, angina, or dyspnea.
Nursing action with reporting lab work with a patient getting epoetin alfa
Notfiy HCP if Hgb is over 12
Reticulocyte below 20% increase notify HCP (normal person is 2-3-4%)
Folate levels can be masked by large dose of Epoetin alfa
What would you tell a patient about the response of epoetin alfa
You will give it 2 to 3 times a week SQ at home
Do NOT shake
Do NOT save residual
Return to hospital in 2-6 weeks for blood work
Refrigerate multidose vials
Know cell cycle specific treatment
Cell cycle specific agents act on the cells in a specific phase. They are most effective against tumors that have a large proportion of cells actively moving through the cell cycle and cycling at a fast rate.
- fluorouracil(5-FU, Adrucil, Carac, Efudex)
Know cell cycle non-specific treatment
they kill the cell in various and multiple phases of the cell cycle.
Alkylating agents, antitumor antibiotics, hormones, and hormone inhibitors
Nursing action if a patient has an infiltration of a chemo agent
Stop IV if signs of redness or stinging.
Adverse effects of Oprelvekin (Numega)?
fluid retention and if a patient has too many platelets from this drug, they will be at risk for CHF & dependent edema.
Know anti-angiogenic drugs (thalidomide) Mode of action
-Stimulates t-cells, decreases TNF (tissue necrosis factor).
Gold standard for treating rheumatoid arthritis
Assessment of your patient getting the gold standard drug to see if they are getting better.
Evaluate nutrition, malnourished patients will have a decrease in RBC, WBC
Assess for infection
Bone mineral density (BMD)
Check CBC, CRP, ESR look at inflammation markers
Diet instruction for gout patient
Stay well hydrated and drink plenty of water
-Stay away from fructose sweetened drinks, organ meats, red meats, and seafood.
-Increase dairy and folic acid foods
Ibuprofen side effects
-GI upset & bleeding, hepatotoxicity, and acute renal failure. Increase risk of CVA or MI with prolonged use.
Religious considerations with anemia patients
Jehovah witnesses cannot receive blood
Assessment of the patient taking vincristine
Assess the IV site for redness or swelling or any extravasation.
-Assess pt. For neurotoxicity.
-Assess patient for allergies to plants or flowers.
-Assess patient’s lungs because this drug can cause pulmonary problems or bronchospasms.
Patient assessment methotrexate
Monitor for photosensitivity and idiosyncratic pneumonitis
-Monitor IV site frequently for extravasation .
-Assess for mucosal damage (mouth). As well as stomatitis of the mouth and throat.
How to administer iron injections
Giving liquid iron patient education
Liquid iron can stain the teeth and skin, so educate the patient to take their liquid iron with a straw or to brush their teeth right afterwards.
Patient education for immunosuppressants like humera.
They should NOT be around people who are infected or sick
They should wash their hands A LOT
patient has no relief by 4 month with concurrent treatment with methotrexate they need to go back to see the HCP
Teach them how to give a proper SQ injection
Assess for ROM
Which drugs decrease inflammation, decrease in fever,and decrease in pain and which ones do not.
-Aspirin and ibuprofen decrease inflammation, fever & pain
-Tylenol is NOT an anti inflammatory but is used for pain & fever
-Corticosteroids (glucocorticoids) are great for decreasing severe inflammation.
Raloxifene for osteoporosis, know lab values and patient education
Check calcium levels 8.6-10.3 is normal
Know SERMS Selective Estrogen Receptor Modulator drugs, Side effects risk factors
S/E: hot flashes, leg cramps, weight gain, flu like symptoms.
Why would some patients be anemic? (ages)
Most common in infants and children, adolescents, pregnancy, poor, elderly.
-Inadequate food (iron) intake (especially 9-24 months of age if milk is primary food) , also people on vegetarian diets, alcoholics
Rapid growth (pregnancy and adolescents whose demand is increased)
Kids with hypothyroidism.
In hyperthyroidism, eyes can appear very large and stick out.
Side effects of all steroids?
- skin thins
- necrosis of the hip/shoulder
- dependent edema