Common Drugs
at least two antibiotics ordered for first time fevers;
cefepime, vancomycin, merrem, rocephin
bonus: why would you one med over the other?
neutropenic food precautions (name at least 3)
no buffets, thoroughly wash all fruits/veggies; fully cook meat; do not leave food out for more than 1 hour
most common reasons for admission in PHOT patients
scheduled chemotherapy; fever/neutropenia
how long to document a post pain medication assessment
within 1 hour
Lab ordered every admission and Q Mondays
VRE
At least three antiemetics
Zofran, kytril, Benadryl, Ativan, reglan, phenergan, zyprexa, etc.
Steps to take for a patient who has a first time fever
use teamwork and delegate: contact physician; notify pharmacy; give Tylenol; draw blood cultures from all central lines (access port if not accessed); reconstitute cefepime if ordered and give within 30 minutes of fever spike
how often do you change central line dressings?
Q 7 days or as needed (i.e. dressing wet, no longer occlusive, upon admission, no bio patch, etc)
When to document a withdrawal assessment
between 7-9 am/pm daily on pain medications and within 2 hours of a wean
temperature spike instructions
draw blood cultures q24h PRN
Common premeds for blood transfusions
Tylenol, Benadryl, steroids
define count recovery
the time it takes for a patient's bone marrow to recover following chemotherapy; usually the ANC rises to at least 500
Two best ways to prevent CLABSIs
following central line bundle and oral hygiene
You get a call from lab with a critical value of Hgb 6.4 but have standing transfusion criteria to transfuse blood if Hgb is </= 7.0
Manage/refer/notify - document that you didn't contact MD due to standing orders
platelet criteria for procedures
typically greater than 30K for LPs; may be higher for line placements, always check your orders
name at least 2 chemo supportive care medications
leucovorin, mesna, mannitol, eye drops, electrolytes, hyper-hydration
ideal air pressure/filtration for a neutropenic patients
positive pressure with heppa filtration
lab trends in Tumor lysis syndrome
elevated potassium, uric acid, phosphorus; decreased calcium
What documentation is needed if your patient has a fall (3 things)
post fall assessment, post fall debrief, occurrence report
What multidiscipline orders do you expect PHOT patients to have (name at least 3)
The medication used to treat ITP
IVIG
how do you teach/perform a CHG wipe down
name at least 3 things to expect when your patient is taking induction steroids
no dextrose in IVF; no concentrated sugar diet/carb control; accuchecks; insulin as needed; "roid rage"; increased appetite
Your patient/family is non English speaking
Language assist with interpreter ID number or decline assist paperwork
What medication do you expect your patient to be on prophylactically if they are 18+
lovenox