*Monitor for significant side effects, especially symptoms of neurological or cardiovascular events.

Transcription

1 Assessment Prior to administration: Obtain complete health history including allergies, drug history, and possible drug reactions Assess reason for drug administration such as presence/history of anemia secondary to chronic renal failure, malignancy, chemotherapy, autologous blood donation & HIV infected patients treated with Zidovudine Check vital signs, especially blood pressure (contraindicated for patients with uncontrolled hypertension). Assess complete blood count, specifically hematocrit and hemoglobin levels. (Establish a baseline to compare values). Nursing Process Focus: Patients Receiving Epoetin Alfa Potential Nursing Diagnoses Ineffective Tissue Perfusion, related to ineffective response to drug Risk for Injury, related to anemia Risk for Injury, related to seizure activity secondary to drug Activity Intolerance, related to RBC deficiency Deficient Knowledge Planning: Patient Goals & Expected Outcomes The patient will: exhibit an increase in hematocrit level and improvement in anemia related symptoms. immediately report effects such as severe headache, chest pain, confusion, numbness or loss of movement in an extremity. demonstrate understanding of the drug s action by accurately describing drug side effects and precautions. Implementation Interventions and (Rationales) *Monitor vital signs (especially blood pressure). (The rate of hypertension is directly related to the rate of rise of the hematocrit. Patients who have existing hypertension are at higher risk for stroke and seizures. Hypertension is also much more likely in patients with chronic renal failure). *Monitor for significant side effects, especially symptoms of neurological or cardiovascular events. *Monitor patient s ability to self-administer Patient Education/Discharge Planning in the importance of periodic blood pressure monitoring. on the proper use of home blood pressure monitoring equipment. of reportable blood pressure ranges ( call health care provider when blood pressure is greater than ) to report side effects such as nausea, vomiting, constipation, redness/pain at injection site, confusion, numbness, chest pain, and difficulty breathing. in the technique for SC injection if patient is to self administer the

2 *Monitor laboratory values such as hematocrit and hemoglobin *Monitor patient for any signs of seizure activity. (Seizures result in a rapid rise in the hematocrit- especially during first 90 days of treatment). *Monitor patient for any signs of blood clot such as swelling, warmth, and pain in an extremity. (As the hematocrit rises, there is an increased chance of thrombus formation particularly for patients with chronic renal failure.) *Monitor dietary intake. Ensure adequate intake of all essential nutrients. (Response to this medication is minimal if blood levels of iron, folic acid, and vitamin B 12 are deficient) proper disposal of needles and syringes. on the need for initial and continuing lab work to keep all appointments for lab work. of latest hematocrit value so that physical activities may be adjusted accordingly. *Instruct patient to avoid driving or operating heavy machinery until the response to the medication is known. to report any increase in size, pain, and/or warmth in an extremity on signs and symptoms of blood clots. not to rub or massage calves and to notify the health care provider of leg discomfort. Instruct patient to: maintain adequate dietary intake of essential vitamins and nutrients. continue to follow necessary dietary restrictions if receiving renal dialysis. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

3 Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug reactions. Assess reason for drug administration such as presence/history of severe bacterial or fungal infections, chemotherapy induce neutropenia, or AIDS related immunosuppression. Assess vital signs. Assess complete blood count specifically WBCs with differential, to establish a baseline. Nursing Process Focus: Patients Receiving Filgrastim (Neupogen) Potential Nursing Diagnoses Risk for Infection, related to impaired immune defense (low WBC) Risk for Injury, related to side effects of drug regimen Deficient Knowledge Planning: Patient Goals and Expected Outcomes The patient will: exhibit an increase in leukocyte levels and experience a decrease in the incidence of infection. demonstrate an understanding of the drug s action by accurately describing drug side effects and precautions immediately report significant adverse effects from the drug such as nausea, vomiting, fever, chills, malaise and skeletal pain, and allergic type responses such as rash, urticaria, wheezing, and dyspnea. Implementation Interventions and (Rationales) *Monitor vital signs. (Myocardial infarction and dysrhythmias have occurred in a small number of patients because filgrastim has been known to cause abnormal ST segment depression.) *Monitor for signs and symptoms of infection. Limit the patient s exposure to pathogenic microorganism until WBC response is achieved. Patient Education/Discharge Planning *Instruct patient to report any chest pain or palpitations. Instruct the patient to: wash hands frequently as a defense against infection. avoid crowds and other people with colds, flu, and other infections. cook all foods completely and thoroughly clean surfaces touched by raw foods. avoid fresh fruits, vegetables, plants until WBC level is within normal limits. limit exposure to children and animals. increase fluid intake and empty bladder

4 *Monitor complete blood count with differential until white blood count is at an acceptable level. *Monitor hepatic status during treatment. (Filgrastim may cause an elevation in liver enzymes) *Assess for bone pain. (This medication works by stimulating bone marrow cells.) *Monitor for significant side effects and allergic type reactions. (Patient may be hypersensitive to E-coli.) frequently. cough and deep breathe several times per day. *Inform patients of WBC status during the course of the treatment so they may take necessary precautions to avoid infection. Inform patient about the need for initial and intermittent laboratory blood monitoring. Advise patient to keep all laboratory appointments. *Instruct patient to report any pain not relieved by OTC analgesics. Instruct patient to immediately report: side effects such as nausea, vomiting, fever, chills, and malaise. Symptoms of allergic reaction such as rash, urticaria, wheezing, and dyspnea *Monitor patient s ability to self-administer Instruct patient about: self-injection technique proper disposal of needles and syringes. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

5 Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug reactions. Assess vital signs. Assess for other causes of anemia Nursing Process Focus: Patients Receiving Cyanocobalamin (Cyanabin) Potential Nursing Diagnoses Risk for Injury (weakness, dizziness, syncope), related to anemia Ineffective Tissue Perfusion, related to adverse effects of drug Deficient Knowledge, related to therapeutic regimen Planning: Patient Goals and Expected Outcomes The patient will report a decrease in symptoms of vitamin B 12 deficiency. immediately report significant side effects such as dyspnea, palpitations, fatigue, muscle weakness, and dysrhythmias. Demonstrate understanding of the drug s action by accurately describing drug side effects and precautions. Implementation Interventions and (Rationales) *Monitor vital signs. (Altered potassium levels and overexertion may produce cardiovascular complications especially irregular rhythm). *Monitor potassium levels during first 48 hours of therapy. (Alterations in potassium level occur because conversion to normal red blood cell production increases the need for potassium.) *Monitor respiratory pattern. (Pulmonary edema may occur early in therapy related to a possible sensitivity to the Reactions may take up to 8 days to occur.) *Monitor serum Vitamin B 12, RBCs and hemoglobin levels to determine effectiveness of (Initial doses of B 12 stimulate rapid RBC regeneration and should return to near normal within 2 weeks.) *Assist patient to plan activities and allow for periods of rest to conserve energy. *Encourage patient to maintain adequate dietary intake of essential nutrients and vitamins. Patient Education/Discharge Planning *Instruct patient to monitor pulse rate and report irregularities and changes in rhythm. Inform patient about the need for initial and intermittent laboratory blood monitoring. Advise patient to keep all laboratory appointments. *Instruct patient to immediately report any respiratory difficulty. *Advise patient that treatment for pernicious anemia (usually IM injection) must be continued throughout life to prevent neurological damage. Instruct patient to: rest when they begin to feel tired avoid strenuous activities. that dietary management is not possible in

6 treating pernicious anemia. to consume adequate dietary intake of essential nutrients and vitamins. *Monitor for side effects such as palpitations, *Teach patients to immediately report side fatigue, muscle weakness, and dysrhythmias. effects to their healthcare provider. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

7 Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug reactions. Assess reason for drug administration such as presence/history of anemia, or prophylaxis during infancy, childhood, and pregnancy. Assess complete blood count- Hematocrit and Hemoglobin levels. (Establish a baseline to compare values). Assess baseline vital signs. Nursing Process Focus: Patients Receiving Ferrous Sulfate (Ferralyn) Potential Nursing Diagnoses Imbalanced Nutrition, related to inadequate iron intake Impaired Gas Exchange, related to decreased red cell count resulting in decreased oxygenation Risk for Injury (dizziness, syncope), related to anemia Deficient Knowledge, related to therapeutic regimen Planning: Patient Goals and Expected Outcomes The patient will: exhibit an increase in hematocrit level and improvement in anemia related symptoms. demonstrate an understanding of the drug s action by accurately describing drug side effects and precautions. immediately report significant side effects such gastrointestinal distress. Implementation Interventions and (Rationales) *Monitor vital signs especially pulse. (Increased pulse is an indicator of decreased oxygen content in the blood.) *Monitor complete blood count to evaluate effectiveness of treatment. *Monitor changes in stool. (May cause constipation, change stool color, and cause false positives when stool tested for occult blood) *Plan activities and allow for periods of rest in order to help patient conserve energy. (Diminished iron levels result in decreased formation of hemoglobin leading to weakness). *Administer medication on an empty stomach (if tolerated) at least 1 hour before bedtime. (Maximizes absorption; taking closer to Patient Education/Discharge Planning *Instruct patient to monitor pulse rate and report irregularities and changes in rhythm Inform patient about the need for initial and intermittent laboratory blood monitoring Advise patient to keep all laboratory appointments. that stool color may change (dark green or black) and is not cause for alarm. on measures to relieve constipation, such as including fruits, fruit juices in diet and increasing fluid intake and exercise. Instruct patient to: rest when they begin to feel tired and not to overexert. Plan activities to avoid fatigue not to crush or chew sustained release preparations.

8 bedtime may increase the chance of GI distress.) *Administer liquid iron preparations through a straw or placed on the back of the tongue (To avoid staining the teeth.) *Monitor dietary intake to ensure adequate intake of foods high in iron. *Monitor for potential for child access to (Iron poisoning can be fatal to young children.) that medication may cause GI upset. take medication with food if GI upset becomes a problem. to take at least one hour before bedtime Instruct patient to dilute liquid medication before using and to use a straw to take medication to help prevent staining of teeth. rinse the mouth after swallowing to decrease the chance of staining the teeth. *Instruct patient to increase intake of iron-rich foods such as liver, egg yolks, brewer s yeast, wheat germ, and muscle meats. *Advise parents to store iron-containing vitamins out of reach of children and in childproof containers. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).