Immune System ATI- posttest & drills – Flashcards

*a. Infuse 1 to 2 L of IV fluid.* *c. Administer an antiemetic.* *d. ​Evaluate the patient's hearing.* *e. Determine the patient's weight.* Cisplatin, a platinum compound, can cause *renal toxicity*. Prior to therapy, you should *hydrate the patient with 1 to 2 L of IV fluid and continue for 24 hr following therapy* to help prevent renal impairment. Monitor *serum creatinine, BUN, fluid I&O, and weight*. Cisplatin can cause severe nausea and vomiting. Administer an *antiemetic 30 min before* starting the infusion. This drug can cause *ototoxicity*, so make sure to evaluate the patient's hearing *prior to therapy and periodically thereafter*, and to tell the patient to report tinnitus, vertigo, or hearing loss. Cisplatin is unlikely to affect peripheral circulation, but it can cause *peripheral neuropathy*.

*a. Bruising* Mercaptopurine, a purine analog, can cause *bone marrow suppression*, so you should instruct the pt to report easy or unexplained bruising or bleeding, sore throat, or fever. Monitor CBC throughout treatment and advise the pt to avoid activities that can cause injury. Mercaptopurine can also cause *liver toxicity* and gastrointestinal symptoms, including *stomatitis (mouth sores)*, *esophagitis*, and *anorexia*.

*c. 24 hr after the topotecan infusion* Filgrastim, a colony stimulating factor, stimulates neutrophil proliferation for patients with neutropenia due to bone marrow suppression. The combination of filgrastim and topotecan, a topoisomerase 1 inhibitor, *can worsen bone marrow suppression*. To avoid this interaction, administer filgrastim 24 hr after the topotecan infusion, *not before or during the infusion*.

1. Tamoxifen (Soltamox) --- estrogen-receptor-positive breast cancer 2. Enfuvirtide (Fuzeon) --- advanced or resistant HIV disease 3. Delavirdine (Rescriptor) --- HIV-1 infection 4. Flutamide --- prostate cancer

*d. Crackles at lung bases* Imatinib, a targeted antineoplastic drug, can cause *fluid retention and pulmonary edema*. You should monitor the patient's weight and *report weight gain*. Assess for *peripheral edema* by listening to breath sounds and monitoring for shortness of breath. Report crackles in the lung bases as they might indicate pulmonary edema. Imatinib can also cause muscle pain and cramping.

*b. Epinephrine* Trastuzumab, a monoclonal antibody, can cause an *allergic reaction*. You should have epinephrine available to *treat anaphylaxis*. Monitor the patient for hives, wheezing, or hypotension.

*b. Zidovudine (Retrovir)* The patient should take the drug *orally five times daily from 14 weeks of gestation until delivery*. During delivery, the patient should receive the drug via *IV infusion until the birth attendant clamps the newborn's cord*.

*a. Expect periodic blood glucose testing.* *c. Watch for and report jaundice.* *d. Increase weight-bearing activity.* *e. Expect periodic cholesterol testing.* Ritonavir, a protease inhibitor, can cause *hyperglycemia and diabetes mellitus*. Tell the patient to expect periodic blood glucose checks. Patients who already have diabetes should check their blood glucose levels frequently and report elevations as well as increased hunger, thirst, or urination. Tell the patient to *take the drug with food to maximize absorption and minimize gastrointestinal upset*. Ritonavir can cause *liver toxicity*, so tell the patient to watch for and report indications of liver toxicity, such as yellowed sclera and skin. Ritonavir can *reduce bone density*, so instruct the patient to *increase weight-bearing activity and calcium and vitamin D intake*. Tell the patient to *expect periodic cholesterol checks*.

1. Paclitaxel (Taxol) --- Kaposi's sarcoma, ovarian and breast cancer, and non-small cell lung cancer 2. Cytarabine (Cytosar-U) --- acute myelocytic leukemia & non-Hodgkin's lymphoma 3. Cyclophosphamide --- multiple myeloma; leukemia; lymphomas; and head, ovary, breast, and lung cancer 4. Carmustine (BiCNU, Gliadel) --- gastrointestinal adenocarcinoma, brain tumors, lymphomas, multiple myeloma, melanoma, hepatoma

*a. Abnormal menstrual bleeding* Tamoxifen, an estrogen receptor blocker, can cause *uterine cancer*. Instruct the patient to watch for and report *abnormal uterine bleeding, pelvic pain, or pressure* and make sure she has *regular gynecologic examinations*.

*c. Influenza* All adults should receive the seasonal influenza immunization once per year. All children 6 mo. and older adults should also receive this immunization once per year. Adults who have no demonstrated immunity to varicella should receive this immunization in a two-dose series 28 days apart. It is not repeated each year. Adults should receive a tetanus toxoid immunization every 10 years as a booster, along with diphtheria toxoid. Adults at risk for acquiring Hep B should receive this immunization in a 3-dose series. It is not repeated each year.

*Prevent drug resistance* Combo tx to reduce the risk for drug resistance and to increase drug effectiveness

*Cataracts* can cause retinopathy, cataracts, and decreased visual acuity

*Trastuzumab (Herceptin)*

*Fever* can cause a flu-like reaction, manifesting as fever, myalgia, and fatigue. for this effect, the HCP should give acetaminophen (Tylenol)

*Gynecomastia* can cause gynecomastia, decreased libido, and impotence

*1. Administer the drug subcutaneously* *2. Roll the vial gently to reconstitute the solution* *3. Inject the solution at room temperature* Admin SC BID. To reconstitute, roll gently in palms after adding sterile water; should be clear. Refrigerate unused portion for up to 24 hr; must warm solution to room temp before giving next dose out of the vial.

*1. Paresthesias* *2. Sore throat* *3. Flank pain* *4. Tinnitus* *Bone marrow suppression:* report fever, sore throat, bruising, fatigue. *Kidney toxicity:* hydrate with 1-2 L IV fluid before tx, continue for 24 hr after to flush kidneys (flank pain) *Ototoxicity:* monitor hearing; report tinnitus, hearing loss, or vertigo Can also cause blurred vision, papilledema, and optic neuritis

*1. Paresthesias* *2. Cough* *3. Jaundice* *4. Fever* *Neuromuscular:* paresthesias, dizziness, and musculoskeletal pain *Infections:* cough and upper respiratory infection. fever and sinus infection. *Liver damage:* report allergic reaction (rash) bc it can precede liver damage (jaundice or abd pain)

*Non-chemokine receptor 5 (CCR5)-tropic HIV-1*

*Resistant HIV disease*

*1. Give the patient an antihistamine* *2. Administer the drug through non-PVC tubing* *3. Use an in-line filter* Before admin, give an *antihistamine* (diphenhydramine), a *proton-pump inhibitor* (cimetidine), and a *glucocorticoid* (dexamethasone) to prevent a hypersensitivity reaction Infuse over 3 hr.

*Increase fiber intake* can cause severe constipation and upper colon fecal impaction. monitor bowel fxn and palpate abd for distention. increase fluid and fiber intake, and take stool softeners

*1. Clean fruits and vegetables thoroughly* *2. Weigh yourself daily* *3. Perform hand hygiene frequently* *4. Avoid herbal supplements* can cause bone marrow suppression (infection precautions). can cause fluid retention and weight gain. St. John's wort can decrease levels. can also cause hypokalemia.

*Advanced HIV disease*

*Premenopausal*

*Ibuprofen (Advil)* NSAIDS, anticoags, and antiplatelet drugs increase risk for bleeding

*1. Wheezing* *2. Dysrhythmias* *3. Hypotension* *4. Fever* *Anaphylaxis:* have Epi ready. hives, bronchospasm, dyspnea, wheezing, hypoxia, hypotension. *Cardiotoxic:* ventricular dysfunction, HF, and dysrhythmias. monitor ECG. *Flu-like Rxn:* fever, chills, nausea, headache. monitor temp.

*Dehydration*

*Rash* rash can occur 1-3 wk after therapy. can develop into SJS.

*Dexamethasone* w/ the intrathecal form, they should also receive dexamethasone (glucocorticoid) to help decrease the inflammation of the arachnoid that the drug can cause. IV dexamethasone reduces the risk of neurotoxicity

*4 to 6 weeks* delayed bone marrow suppression

*Use a soft-bristled toothbrush* can cause severe bone marrow suppression (decreased thrombocyte counts & oral and GI ulcerations)

*1. Use contraception is pregnancy is a risk* *2. Perform oral hygiene frequency* *3. Perform hand hygiene frequently* *4. Avoid activities that can cause injury* Preg Category D Can cause stomatitis, neutropenia, thrombocytopenia

*Weak hand grasps* Peripheral neuropathy: monitor DTRs, strength and movement of hands and feet. Report paresthesias or reduced sensations in hands or feet.