Interactive Patient Case - Oncology & Hematinics

 At the Cancer Center you are an infusion Nurse. Your first patient of the day is a 26 y/o female with a history of systemic lupus erythematosus (SLE) induced nephropathy s/p kidney transplant in 2011 on immunosuppression, hypertension, and a newly diagnosed non-Hodgkin's Lymphoma. She here to be treated with the following chemotherapy: Rituximab, Cyclophosphamide, Vincristine, Doxorubicin, Prednisone (RCHOP). No one has educated her on her chemo yet, so she asks you to explain how each of the above medications work 1).________.

 During her 8 hour infusion, your patient tells you her right arm (where the peripheral IV line is located) is starting to feel painful. Upon examination, you notice it is red, swelling, and feels warm to the touch. Since this occurred right after you administered doxorubicin, you suspect it is 2)______; and go grab the reversal agent _______.

 In the next month, your patient returns for her 2nd cycle, but you notice that her laboratory values are out of range. Her white blood cell count is 2480 cells/uL, absolute neutrophil count is 410 cells/uL. This is an adverse effect of her cytotoxic chemotherapy and called 3)._______. Your patient will not be treated with chemo today, but you discharge her with this agent 4)______, to improve her white blood cell count. Because her toxicity would put her at risk of infections, you counsel her to perform the following preventative measures 5).________.

 1). Drug mechanism of each of the above chemotherapy

2). Definition/name of toxicity __________; Reversal agent ______________

3). Name of toxicity

4).

5). Counseling points (3 separate counseling points)"

IMT 517: Computer Applications in Health Professions Interactive Patient Case Oncology & Hematinics

 1. Essential Action of Every Chemotherapy Agent

 Rituximab: This is a monospecific antibody that binds to the CD20 cell surface antigen of B-cells. Rituximab works by attaching itself to a ‘marker’ known as CD20 on the surface of these faulty cells and assists the body’s defense mechanisms in eliminating these cancerous cells and stopping them from multiplying.

 Cyclophosphamide: It is an alkylating agent that is formed from a cross-link between the two strands of DNA thus inhibiting DNA replication and transcription. This eventually results in cell death especially in fast growing cancer cells as the research shows.

 Vincristine: This is a vinca alkaloid that stops the formation of microtubules in the course of cell division. That causes the suppression of formation of mitotic spindle and which stops the division and leads to death of cancer cells.

 Doxorubicin: This is an anthracycline antibiotic that inserts into the DNA and in the process interferes with the activity of the DNA and inhibits topoisomerase II. This leads to the passive suicidal death of the cancer cells, which is termed as apoptosis or programmed cell death.

 Prednisone: It is a corticosteroid that helps in the reduction of inflammation and also has the ability to suppress the immune system. It does so by binding to complexes that transcribe genes that code for pro-inflammatory cytokines and in so doing minimizes the proliferation of tumor cells as well as the symptoms associated with cancer.

 2. Toxicity and Reversal Agent

 Name of Toxicity: This patient presented symptoms of Doxorubicin extravasation, which is a common adverse effect in which the drug escapes the targeted vein and disperse to adjacent tissues leading to finding redness, swelling as well as warmth at the IV site.

 Reversal Agent: Totect is the reversal agent of extravasation of Doxorubicin This reversal agent is Dexrazoxane. It is applied as a burn dressing and to minimize the damage in cases of extravasation injury.

 3. Name of Toxicity

 Name of Toxicity: The patient’s laboratory values demonstrate Neutropenia is a decrease in the absolute neutrophil count (ANC) and can predispose the patient to have more risks of acquiring an infection.

 4. Agent To Increase The Count Of The White Blood Cells

 Agent: To increase the number of white blood cells especially neutrophils, an agent is can be used which is Filgrastim trade name Neupogen or Pegfilgrastim trade name Neulasta. These are G-CSFs that enhance the production of neutrophils will be used in this study upon meeting the requirements of this protocol.

 5. Counseling Points

 Avoid Crowded Places and People with Infections: Indeed, because of neutropenia, your immune system is weak, so it is advisable to avoid any setting that may expose you to infections. This include staying away from crowded places and people be affected with diseases such as flu.

 Maintain Good Hygiene: Maintain cleanliness of hands wash it regularly with soap and water in order to avoid the spread of the virus. This serves to minimize the infections from germs and bacteria in the human body.

 Monitor for Signs of Infection: These are signs that indicate that the body is fighting off infection, as it should: fever, chills, sores, etc. You should consult your doctor if you have any of these signs because quick treatment is vital.

 Thus, with the knowledge of these factors of chemotherapy administration, the nurse can guarantee that a patient will receive safe and effective treatment avoiding possible complications.