WHAT ARE THOOOSEE...
Orders & Policies?
Orders & Policies?
If gauze is used or visualized under a central line dressing, the dressing must be changed within this time frame.
48 hours
This chemotherapy requires Q4 hour urine pH's along with maintenance IV Sodium Bicarbonate fluids in order to alkalize the urine and excrete this chemo properly.
Methotrexate
Mesna is administered as a preventative treatment in patients receiving certain chemos (i.e. Cyclophosphamide, Busulfan, Ifosfamide, Thiotepa) that are at high risk for this oncologic emergency.
Hemorrhagic Cystitis
Chemotherapies, Radiation, prophylactic anti-bacterial agents, and even graft-versus host disease (GVHD) after transplant can cause this symptom characterized by increase of frequent, loose or watery bowel movements in our oncology population.
Diarrhea
WBC 5.2
HGB 7.2
PLT 179
HGB 7.2
According to Atrium's Alcohol Port Protector Policy, an alcohol port protector (Curos Cap) must be in place for this long so that no additional “scrubbing the hub” with alcohol to be required.
For 1 minute
This chemotherapy is high risk for neurotoxic effects & this chemo must not be flushed.
blinatumomab/Blincyto
Patients that are admitted to the hospital in "blast crisis" or as a newly diagnosed acute leukemic patient often have to get leukapheresis and/or Hydroxyurea to reduce the risk of this oncologic emergency.
If left untreated, this syndrome can cause thrombus formation, end-organ damage, possible stroke, and/or CHF due to increased viscosity of the blood from the elevated white blood cell count.
Leukocytosis (WBC > 100)
This is a typical finding approximately 2-10 weeks following chemotherapy when a patient's hair falls out. Some specific chemos known for causing this are 5-FU, Cyclophosphamide, Platins, Rubicins, Ifosfamide, Vincristine, and Paclitaxel. Hair typically begins to regrow about 1-3 months following treatment.
Alopecia
K 4.1
Mg 2.2
Phos 6.7
Phos 6.7
This typical standing order is vital for knowing parameters for replacement of blood and platelets for patients following chemotherapy and/or transplant.
Give 2-units of PRBCs for HGB </= 8.0 and/or 1-unit of platelets for PLT count </= 10 or </= 20 if patient is febrile.
Acetaminophen / Tylenol must be held for patients receiving this chemotherapy.
Busulfan
This life-threatening situation requires frequent labs and can manifest itself in a variety of ways including:
Urinary symptoms, lethargy, fluid overload, cardiac dysrhythmias, and more
Blood chemistry changes (elevated potassium, phosphorus, and uric acid / low calcium)
Tumor Lysis Syndrome (TLS)
Various chemotherapies that affect the function of the heart, lungs, & kidneys in addition to maintenance IV fluids, poor nutrition (low protein), and steroids can contribute to a patient's development of this abnormal fluid buildup and swelling in the body.
This symptom is most often seen in the extremities & abdomen, but can be problematic if the fluid begins to encroach upon heart & lungs.
Edema
WBC 17.8
HGB 15.2
PLT 222
WBC 17.8
This procedure must be ordered prior to every dose of High-Dose Cyclophosphamide or Arsenic & Atra in order to verify heart function, QTc, arrythmias, etc.
Daily EKG
We check vital signs every 30 minutes when titrating this biotherapy infusion.
Rituximab (Rituxan)
This syndrome is characterized by signs & symptoms such as fever, nausea, headache, rash, rapid heartbeat, low blood pressure, and trouble breathing and is typically seen as a reaction to some types of immunotherapy (i.e. CAR-T Cell Therapy).
Cytokine Release Syndrome (CRS)
Chemotherapy and Radiation place our patients at risk for this finding when the treatment affects the lining of the patient's GI tract. This finding is displayed as painful sores and ulcerations of the mucosal lining of the GI tract.
Mucositis
Alk Phos 47
ALT 8
AST 78
AST 78
Nurses are unable to change the dressing for this type of line, administer chemotherapy or TPN through, or heparin-lock this type of line. IV Team is responsible for line maintenance & checks this line at least once each week. To have this type of line placed, a patient’s kidney function labs must be acceptable and approved by a provider beforehand.
Midline
Dexamethasone eye drops are required to be given 4 times a day in order to prevent conjunctivitis and frequent neurological checks are imperative when a patient is receiving this chemotherapy.
High-Dose Cytarabine
This oncologic emergency is characterized by shortness of breath, rapid HR, low BP, extreme pain/discomfort, clammy skin, fevers, shivering, and confusion/disorientation.
Our patients are at risk for this after receiving chemo due to their immunosuppression/neutropenia.
Sepsis
This side effect is seen after certain chemotherapies and is characterized by numbness, pain, and/or tingling of the extremities (typically the hands & feet).
Common symptomatic relief medications include gabapentin/Neurontin, pregabalin/Lyrica, etc.
Peripheral Neuropathy
Na 138
Creat 2.01
BUN 28
Creat 2.01