Infusion of an Outpatient in Nursing

NURSING

Nursing: Outpatient Infusion

Question 1

Lung Cancer: It is considered one of the deadliest forms of cancer within the United States. It is caused by cell origination in the bronchi or lung. The term encompasses all four types of cells, naming adenocarcinoma, squamous cell (epidermoid) carcinoma, large cell (anaplastic) cancer, and small cell (oat cell) cancer.

Osteoporosis is a disease in which loss of bone mass is observed throughout the skeleton, predisposing the patient to fractures.

Multiple Sclerosis (MS): This illness targets the central nervous system (CNS), in which damage to myelin and numerous regions of the brain and spinal cord is witnessed. The results could be seen in the form of momentary, recurrent, or sustained disturbances in nerve impulse conduction, leading to symptoms like muscular feebleness, absence of coordination, numbness, visual impairment, lacking control of bowel, bladder and sexual functions. The extent of demyelination forms the foundation of the clinical picture of MS.

Question 2

Lung Cancer: Gas exchange, acid-base balance, comfort, mental health, infection

Osteoporosis: Safety, functional ability

Multiple Sclerosis (MS): Cognition, communication, sensory perception

Question 3

· The responsibilities of the infusion nurse in the first given video link are knowing different diseases, having an awareness of different medications, and ensuring that infusions are made according to the doctor’s orders accompanied by another nurse. Three of the procedures performed in the infusion center are managing patients and making trust relationships with those who have a chronic condition as they have to be treated over a long period, working interdisciplinary teams involving advanced practitioners, doctors, and staff management, etc., and knowing about medications that might have side effects and informing patients about them.

· The responsibilities of the infusion nurse in the second given video link are taking blood samples; if the condition requires, the nurses will proceed with giving intravenous catheter and work as a patient coordinator. Three of the procedures performed in the infusion center are taking blood samples, sharing the reports with doctors, and making recommendations for medications for the day.

· The responsibilities of the infusion nurse in the third given video link are constant evaluations and interactions for medications, specifically for the chemotherapy patients who come to the infusion centers for chemo infusion, providing information to the patients for taking home, and taking care of their individual needs who suffer from distinct medical conditions. Three of the procedures performed in the infusion center are giving a comfortable environment to the patients who are there for long hours, treating the patients with a smile all day, and remaining in continuous touch with the doctors and the patients simultaneously.

Question 4

The three new things after having watched the NCLEX review blood administration video are:

i. Verifying about the patient’s cultural and religious beliefs about the transfusion of blood in terms of nay prohibition possibilities.

ii. Taking the vital signs before the process and disseminating information to the patient is important, especially about adverse effects, mainly referred to as patient education.

iii. No drugs should be given via IV line except normal saline solution.

Question 5

Ferrlecit

Patient diagnosis for which the medicine would be ordered: IDA, Osteoporosis

Mechanism of action: It is an important mineral found in hemoglobin, myoglobin, and numerous enzymes (Nursing Central, n.a.). It penetrates the bloodstream and is carried to the organs like the liver, spleen, and bone marrow when it becomes part of iron stores.

Side effects: Dizziness, headaches, vomiting, diarrhea, nausea, hypotension, hypertension, chest pain, flushing, urticarial, arthralgia, myalgia, and pain or erythema when injected (Nursing Central, n.a.).

Important assessment data to consider and trend: The patients should be educated for its need and make dietary history assessments to determine the likely cause of anemia, bowel function for constipation or diarrhea, monitor blood pressure level and heart rate for IV until they are stable. Checking signs and symptoms of anaphylaxis for 30 minutes at least after the administration is done (Nursing Central, n.a.).

Information to teach patient: Explaining the reason for iron therapy and instructing the patient to inform healthcare professionals about symptoms of hypersensitivity reaction instantaneously (Nursing Central, n.a.).

Immune Globulin (IV)

Patient diagnosis for which the medicine would be ordered: IDA, MS

Mechanism of action: It is a human serum that contains gamma globulin antibodies (IgG). Its therapeutic effects include passive immunity against various infections, alleviation of magnitudes of idiopathic thrombotypenic purpura, reduction in damage to a coronary artery in Kawasaki syndrome, and improvement in indications of chronic inflammatory demyelinating polyneuropathy (Nursing Central, n.a.).

Side effects: Wheezing, dyspnea, aseptic meningitis, headache, dizziness, urticarial, cyanosis, renal failure, arthralgia, backache, hip pain, fever, sweating, chills, local inflammation, and phlebitis (Nursing Central, n.a.).

Important assessment data to consider and trend: The date of exposure should be noted for passive immunity. It is recommended that administration of immune globin should be done after two weeks of exposure to hepatitis A and within six days after measles exposure. Monitoring of vital signs constantly after the infusion of immune globin IV and assessing patient’s signs after one hour for anaphylaxis, monitoring the patient for signs of aseptic meningitis syndrome and any infection signs of leukemia during the therapy are included in assessment strategies (Nursing Central, n.a.).

Information to teach patient: Patient should be taught about avoidance against infectious diseases, increment in platelets levels when idiopathic thrombocytopenic purpura is observed, prevention strategies for bacterial infection, and bringing improvement in muscle function during chronic inflammatory demyelinating polyneuropathy (Nursing Central, n.a.).

Filgrastim

Patient diagnosis for which the medicine would be ordered: Lung cancer and chronic lymphocytic leukemia

Mechanism of action: A glycoprotein filgrastim supports binding and stimulating immature neutrophils for division and differentiation. There is a decrease of infection observed in neutropenic patients due to chemotherapy and other similar causes, improvement in the harvest of progenitor cells for transplantation of bone marrow, and better survival when exposed to myelosuppresive doses of radiation (Nursing Central, n.a.).

Side effects: Pain at the injection site, acute respiratory syndrome, hypersensitive reactions, glomerulonephritism hemotysis, artists, vasculitis, and splenic rupture (Nursing Central, n.a.).

Important assessment data to consider and trend: Monitoring heart rate, blood pressure levels, and status of respiration before and occasionally during therapy, making assessments of pain in bone throughout the therapy, monitoring for detection of allergic reactions, acute respiratory distress syndrome, splenic enlargement or rupture (Nursing Central, n.a.).

Information to teach patient: The patient should be educated about the purpose of filgrastim and taught about the correct technique for injection, its care, and removal of equipment afterward. Teaching the patient to tell his healthcare expert about hypersensitivity signs immediately and any Rx or OTC medications he takes before is mandatory. Females should take special care for reproductive concerns or breastfeeding (Nursing Central, n.a.).

Epoetin

Patient diagnosis for which the medicine would be ordered: Lung cancer and chronic lymphocytic leukemia

Mechanism of action: Creates stimulation in the production of red blood cells (erythropoiesis) and helps maintain RBCs and decrease transfusion needs (Nursing Central, n.a).

Side effects: Headaches, thromboembolic events, stroke, Stevens-Johnson syndrome, passing rashes, reinstated fertility, the continuation of menses and capitals that are lethal (Nursing Central, n.a.).

Important assessment data to consider and trend: Monitoring blood pressure before and throughout the therapy and informing healthcare experts of hypertension signs are experienced. Assessments are to be made for anemia and monitoring dialysis shunts (Nursing Central, n.a.).

Information to teach patients: Patients should be taught to read the Medication Guide before initiating the therapy. After making satisfactory prior assessments about the patient’s condition regarding red blood cell production in iron therapy, the healthcare expert should acknowledge. Informing the patient about shortened overall survival rate and discussions about self-injury ways for patients at risk of seizures should be ensured (Nursing Central, n.a.).

Influximab

Patient diagnosis for which the medicine would be ordered: Rheumatoid arthritis, Crohn’s disease, plaque psoriasis, ulcerative colitis

Mechanism of action: It helps neutralize tumor activity, specifically for necrosis factor-alpha (TNF-alpha), resulting in anti-inflammatory and antiproliferative activity (Nursing Central, n.a.).

Side effects: The side effects include fatigue, depression, lightheadedness, insomnia, hypotension, hypertension, edema, pain in the chest, hot flashes, rash, sweating, urticarial, dry skin, eczema, loss of vision, urinary tract infection, backache, involuntary muscle contractions and other hypersensitive reactions along with respiratory problems (Nursing Central, n.a.).

Important assessment data to consider and trend: Making assessments for infusion-related reactions during or after two hours after the infusion, monitoring the patients for any development of new infection or hypersensitivity signs, detecting for signs of weight loss, testing for skin irritabilities, and rheumatoid arthritis, Crohn’s disease, and Psoriasis (Nursing Central, n.a.).

Information to teach patient: Explaining to the patient the purpose of infliximab, telling him about its adverse reactions, asking him to notify healthcare professional immediately if any such signs occur, constant examination of the skin for any side effects, not receiving live vaccines during therapy and instructing females for continually checking PAP smears for cervical cancer screening (Nursing Central, n.a.).

Methylprednisolone

Patient diagnosis for which the medicine would be ordered: Lung cancer, and Chronic lymphocytic leukemia

Mechanism of action: Suppression of inflammation and normalizing the immune response, intense metabolic impacts, suppresses the adrenal functioning in chronic doses of 4mg per day, and insignificant mineralocorticoid activity (Nursing Central, n.a.).

Side effects: Hypertension, acne, fragility, adrenal suppression, hyperglycemia, muscle wasting, weight gain or loss, osteoporosis, muscle pain, depression, fluid retention, cataracts, headaches, changes in personality, restlessness, and capitals that are life-threatening (Nursing Central, n.a.).

Important assessment data to consider and trend: The assessment should include before and after therapy monitoring, signs of adrenal insufficiency before and after in periodic assessments, children should be evaluated for growth assessments periodically, and checking for intake and output ratios for daily weights (Nursing Central, n.a.).

Information to teach patient: Correct technique of medication should be taught to the patient, review for side effects cautions for avoiding vaccinations without consultation, notifying healthcare professionals for any signs of symptoms for worsening the condition, females should specifically take care for reproductive potential, and periodic lab tests along with eye tests should be conducted (Nursing Central, n.a.).

Ocrelizumab

Patient diagnosis for which the medicine would be ordered: MS

Mechanism of action: It helps tie CD20 antigen on pre-B and mature-B lymphocytes ensuing in antibody-dependent and complement-mediated cell lysis (Nursing Central, n.a.).

Side effects: Depression, progressive multifocal leukoencephalopathy, reactivation of hepatitis B virus, diarrhea, peripheral edema, cough, backache, neutropenia, malignancy, and capitals that are lethal (Nursing Central, n.a.).

Important assessment data to consider and trend: Assessments to be made for active infections, monitoring for signs of infusion reaction, checking for signs of progressive multifocal leukoencephalopathy, and determining for any current indications of HBV infection (Nursing Central, n.a.).

Information to teach patient: Advising the patient for informing the healthcare professional immediately for any signs of reaction during 24 hours, identifying the importance of infusion and schedule maintenance, indicating the healthcare expert about Rx or TC medications, avoiding live vaccines during therapy, informing female patients about increased perils of malignancy and reproductive complications (Nursing Central, n.a.).

Question 6

Three important actions that would have prevented the medication error are:

i. Special vigilance should have been ensured in the transition of care when one pharmacist was to administer the IV treatment and the second pharmacist was to prepare it for another pharmacy. The first and second nurses should also have double-checked the information.

ii. Presence of a standardized and transparent treatment plan for which review and approval by a multidisciplinary team should have been carried out.

iii. The entire staff’s simultaneous access to the standardized electronic health record (EHR) should have been guaranteed for the new and old users to re-check the treatment and chart documentation.

Question 7

The three self-protection actions the nurses should take when discontinuing chemotherapy after watching the given video are:

i. Putting on the face and eye mask to avoid any splash or vapors.

ii. Putting on inner hand gloves that should be long enough to reach under the gown or sleeves to avoid skin contact with hazardous liquids.

iii. Putting on an impermeable gown and then putting on the outer gloves over the cuffs of the gown.

Question 8

· Lung Cancer: Patients diagnosed with lung cancer should be referred to the emergency department (ED) if signs of stridor, massive hemoptysis, superior vena cava obstruction, and new neurologic symptoms suggest brain metastases or cord compression (Giudice et al., 2014). Moreover, they should be referred to a specialist if they have persistent signs of hemoptysis, chest X-ray indicating a nodule or mass, multiple pulmonary nodules, slowly evolving pneumonia, unexplained elevation in the diaphragm, etc.

· Osteoporosis: Patients diagnosed with osteoporosis should be referred to a specialist when they have conditions like resistance to oral treatment, poor renal functioning, young patients having intricate comorbidities, or eating difficulties (Royal United Hospitals, 2020).

· Multiple Sclerosis (MS): The patients showing signs of demyelination should be referred to the neuroinflammation clinic since some delays are often experienced due to differences between young and old patients showing onset signs of MS for months or years (Kelly et al., 2011). Hence, the delay should be avoided as it might relate to greater disability.

Question 9

The online support group that would be helpful for patients with lung cancer is Cancer Care.org (https://www.cancercare.org/diagnosis/lung_cancer). The site is patient-friendly since it provides various links for searching online support such as caregiver support, patient support group, community programs, connection for education programs, etc. (Cancer Care.org, n.a.). I want to change and make it more supportive for lung cancer patients by adding a section catering to ethnic minorities in the online group support programs. Their cultural and linguistic barriers do not hinder them from searching for such support.