Chemotherapeutic Drugs Biologic and Immune Modifiers Flashcards
Block hormone receptors on hormone-sensitive tumors to stop or slow cancer growth rate - specific cancers r/t some type of hormone
Used in treatment of breast cancer, prostate cancer, etc.
Cancers hormonal related
Cancer treatments: hormonal manipulation
Competes with estrogen binding sites in target tissue; antiestrogen - help growth cancer because r/t estrogen activty
MoA: - Hormone Modulators: Prototype: Tamoxifen
breast cancer; prophylactic breast cancer - certain breast cancers r/t hormonal activity: block hormones thus reduce cancer growth; specific cancer
Indications: - Hormone Modulators: Prototype: Tamoxifen
oral (may take for sev years) - may go through antineoplastic and may be on this drug for long-period time for number yrs after
Route: - Hormone Modulators: Prototype: Tamoxifen
r/t antiestrogen effects [blocking receptor sites] (menopausal like symps: needs much edu and if not gone through it: hot flashes, menstrual irregularities); Masculinizing effects in women; risk DVT
AE: - Hormone Modulators: Prototype: Tamoxifen
pregnancy; breastfeeding, anticoagulants; hx blood clots
Contraindications: - Hormone Modulators: Prototype: Tamoxifen
comfort measures to help client cope with menopausal signs and symptoms such as hygiene measures, temperature control, and stress reduction
Nursing: - Hormone Modulators: Prototype: Tamoxifen
Aka chemotherapy drugs
General
Goals of treatment
Caution
Routes
Antineoplastic agents
Harmful to all rapidly growing cells
Narrow therapeutic index/window:
Fine line between toxic & therapeutic levels - little margin of room; monitored closely; frequent lab monitoring
General
Limit cancer cells to degree that immune system can then eliminate without causing too much toxicity to the host - kill cells; prob not specifically rapidly growing cancer cells; affect all rapidly growing cells of body - numerous AE to numerous sys in body; kill enough cells that immune sys can finish up killing up rest
Goals of treatment
Pregnancy / lactation - killing rapidly growing cells: fetus rapidly trying to grow: complicates treatment if pregnant
Bone marrow suppression: antineoplastic sig suppression and decrease cell count; giving if already suppression problematic
Hepatic or renal impairment - toxic to all sys
CNS disorders
Caution
Variety routes: Oral, SQ, IM, IV, Topically, Intracavity, Intrathecal
Frequent and prolonged admin: Central vascular access devices are common: PICC line/port placed: easy access and last longer period of time; often caustic to veins to central access imp
Nurse require certification to administer chemotherapy - lot for safety
Routes
Monitor and intervene AE, hydration/nutritional/labs
Complicates growth and development if frequently hospitalized - high risk for infection: tricky to interact with kids appropriately: figure out good ways to assist fam so learn and play and explore appropriately for age and development
Needs support, comfort, to explore and learn like other children
Body image, lack of energy, parental need to protect child-isolate
Risk for infection diff; body image diff if lose hair; challenge for variety reasons
Children - Antineoplastics across the lifespan
Monitor and intervene AE, hydration/nutritional/labs/status
Body image (hair loss - some shave head); fear of diagnosis, treatment, job (not able work because too ill can be financial strain - very expensive so depending on insurance is financial strain; trying deal with diagnosis and other social things), financial strains, social issues
Need networking support systems, teaching, reassurance, and comfort
Adults - Antineoplastics across the lifespan
Monitor and intervene AE, hydration/nutrition/labs
More susceptible to the CNS, GI, renal, liver effects – may need reduced dose - toxicities of drugs - might need lower dose
Older adults - Antineoplastics across the lifespan
Diff classifications because affecting cancer in diff ways; target cell in diff ways
EX of antineoplastic drugs: classifications/prototypes
kills cancer cells
MoA: - Alkylating Agents: Prototype: Cyclophosphamide (Cytoxan)
antineoplastic; treats cancer
Indication: - Alkylating Agents: Prototype: Cyclophosphamide (Cytoxan)
toxic increase in uric acid level, CNS toxicity, hemorrhagic cystitis - bleeding in the urine - imp encourage adequate hydration to prevent it
AE: - Alkylating Agents: Prototype: Cyclophosphamide (Cytoxan)
Encourage hydration to prevent cystitis; see general
Nursing: - Alkylating Agents: Prototype: Cyclophosphamide (Cytoxan)
kills cancer cells; some autoimmune disease
MoA: - Antimetabolites: Prototype: Methotrexate (Rheumatrex)
antineoplastic; treats cancer
Indication: - Antimetabolites: Prototype: Methotrexate (Rheumatrex)
Gastrointestinal ulceration, bone marrow suppression
AE: - Antimetabolites: Prototype: Methotrexate (Rheumatrex)
See general
Nursing: - Antimetabolites: Prototype: Methotrexate (Rheumatrex)
kills cancer cells
MoA: - Antitumor Antibiotics: Prototype: Doxorubicin (Adriamycin)
antineoplastic; treats cancer
Indication: - Antitumor Antibiotics: Prototype: Doxorubicin (Adriamycin)
injection site extravasation (vasocostic: monitor IV site closely - cause localized tissue necrosis if not careful); cardiotoxic (montior cardiac func closely)
AE: - Antitumor Antibiotics: Prototype: Doxorubicin (Adriamycin)
see general
Nursing: - Antitumor Antibiotics: Prototype: Doxorubicin (Adriamycin)
Affecting all rapidly growing cells
Alopecia – hair loss
CNS/PNS: neuropathy/cognitive dysfunction, headache, dizziness
CV/Pulmonary – risk toxicity
Myelosuppression – leukopenia, anemia, thrombocytopenia
GI: N/V, anorexia, diarrhea/constipation; mucous membrane deterioration (stomatitis)
Liver/renal – risk toxicity
Skin reactions: rashes; blisters; photosensitivity
GU/reproductive risks – cystitis; dysfunction
Gen antineoplastic AE
Assessment
Nursing Diagnosis
Outcomes: what achieve: The client will receive:
Nursing: antineoplastic assessment/diagnosis/outcome
H&P, Contraindications (pregnancy/ lactation, etc.), monitor labs: CBC (imp - weekly), renal/liver functions regular basis - see if decline - see if getting toxic; respiratory or cardiac disease (status of these)
Head to toe - note any AE happening for pat
Assessment - Nursing: antineoplastic assessment/diagnosis/outcome
Fatigue R/T drug effects (anemia) disease effects
Disturbed body image related to alopecia, skin effects …
Risk for injury
Risk for infection - HUGE; neutropenic
Nursing Diagnosis - Nursing: antineoplastic assessment/diagnosis/outcome
Best therapeutic effect - killing the cancer; cancer cells die and tumor shrink; hope to remission; take antineoplastic drugs, surgery, and radiation
Limited adverse effects - hard goal; most become pretty ill at some point because nature drugs; try intervene to lessen severity AE
Understanding or drug therapy, AE, comfort measures
Outcomes: what achieve: The client will receive: - Nursing: antineoplastic assessment/diagnosis/outcome
Do for all pats receiving antineoplastic drugs
Schedule blood tests to monitor bone marrow function, liver, renal
Monitor AE, pt. response
Adm. meds (anti-nausea, antidiarrheal, etc.)- intervene as appropriate to AE and meds to treat AE
Ensure hydration to decrease risk of renal toxicity - sometimes hydration can be hard
Provide small freq. meals instead larger (harder digest and provoke nausea), good mouth care imperative to prevent effects, dietary consult to maintain nutrition - visit with dietician on good path to maintain nutrition
Arrange for proper head covering for alopecia-temp. control; esp if really cold; hair does a lot insulation
Avoid exposure to infection - measures take to avoid infection; imp to avoid
Observe for signs of bleeding - suffer from thrombocytopenia; report so intervene
Energy conservation - suffer from fatigue from antineoplastics and/or cancer and/or anemia; discuss this
Barrier contraception - utilized for pats getting antineoplastic drugs and having sex protect partner from from agents, excreted in bodily fluids up to 48 hours; neeed best protect partner from agents; child-bearing age: cogniscent to prevent pregancy because hinders growth of fetus
Nursing: antineoplastic: gen implementation
Alopecia
Skin probs/effects
Nursing management: alopecia/skin
Begins 2 to 3 weeks after start of tx with antineoplastic drugs
Obtain wig/scarves/caps/hats
Avoid vigorous brushing hair
Shave head once hair loss begins and get covering
Re-growth begins 2 to 3 month after treatment ends; May be different thickness and texture than old hair
Alopecia - Nursing management: alopecia/skin
Diff types of rashes/blisters
Protective clothing
sun-burn easily - protection from sun; reduce impact to skin as best can
Skin probs/effects - Nursing management: alopecia/skin
Sig role in preventing nausea
Goal: prevent with very first treatment; then have anticipatory and feel it coming and more likely experience it again - want to stay ahead of it
Chemotherapy pattern of nausea
Prevention
Nursing management GI effects: treatment induced nausea
Early: first 12 hours
Delayed: 2 to 5 days
Anticipatory (goal: no nausea from first dose)
Chemotherapy pattern of nausea - Nursing management GI effects: treatment induced nausea
Bland diet before and after chemo (not spicy, heartburn, upset stomach, easily digestable); adequately hydrate before chemo - less likely experience dehydration after if vomit after
Pre-medication 30 min prior to chemo: ondansetron
Around the clock dosing of antiemetics for 48 hours after admin of antineoplastic
Prevention - Nursing management GI effects: treatment induced nausea
Causes (varies): N/V/D/constipation/fatigue/pain
Individualize plan to address all contributing factors - figure out exact cause - if cannot use gen measures to ensure getting nutrition needed
Nursing management GI effects: anorexia
Control N&V
Good oral care
Pain meds prior to eating
Conserve energy so not too tired to eat
Small, freq. meals high in calories and protein - real dense
Avoid noxious stimuli (odors/visual/conversations)
Nutritional Supplements-Ensure; high protein/calorie milkshakes
Treat constipation/diarrhea
Appetite stimulants - stimulate wanting to eat; more severe cases anorexia
Last resort- PEG tube/NG tube enteral feedings/TPN (ABSOLUTE LAST RESORT: not great source nutrition) - diff kinds feeding
Individualize plan to address all contributing factors - figure out exact cause - if cannot use gen measures to ensure getting nutrition needed
Stomatitis
Mucositis
Ulcers diff - painful; hard eat and drink; maintaining hydration imp; imp assess and find ulcers early on
Teach pt. to report early signs of dryness of mouth, tenderness of mouth/with eating, lesions
Pain medication needed!
Good oral hygiene - good thing do to prevent them
Maintain hydration
Mouth rinses – Magic mouthwash - not want alcohol mouthwashes; lidocaine in there, provider tells what to be included
No smoking/alcohol/spicy or acidic foods - avoid irritation: burn and pain
Liquid supplements for nutrition - best intake to deal with mouth sores so can heal
Nursing management: GI effects: stomatitis/mucositis
Ulceration of oral mucous membranes
Stomatitis - Nursing management: GI effects: stomatitis/mucositis
Ulceration of any part of GI system from mouth to anus - GI tract
Mucositis - Nursing management: GI effects: stomatitis/mucositis
Typ have with antineoplastic
Damage to mucosal lining
Low fiber diets, limit fried foods, spicy/gas food - damage to lining avoid as much lining eat low fiber not have process all fiber; limit spicy food and GI distress
Treat rectal irritation with lot diarrhea: keep rectal area clean and dry/ointments used PRN
Hydration (3 L day) - losing excess fluids; push excess fluids; not have electrolyte imbalances
Antidiarrheal meds (Imodium/codeine - cancer pat meds)
Diarrhea - Nursing management GI effects: diarrhea/constipation
Nerves affected/damaged in GI tract - not have same peristalsis and slows down movement through GI tract
Hydration - not having to strain/drier stools
Exercise - movement up sev times a day to help peristalsis as much as can talk
Enemas – last resort; more invasive; at risk for infection and bleeding
Laxatives
Constipation - Nursing management GI effects: diarrhea/constipation
Neutropenia
Nadir:
Teach precautions risk/signs of infection/prevention
Weekly CBC
Hand hygiene/good personal hygiene/mouth care
Avoid crowd/ill people/wear mask
Avoid constipation/shaving with blade/No invasive procedures
No fresh flowers or plants/No gardening/No fresh fruits or veggies - pesticides and pathogens
Who to notify of inf. & when (report temp > 100.5 degree F - concerned with low temp)
Minor infection can be fatal - immunosuppressed; not norm WBC count
Nursing management myelosuppression: neutropenic precautions
low level of type WBC; why monitor CBC weekly - high risk for infection
Neutropenia -
Predictable point in time that WBC lowest point after treatment
Treat with granulocyte colony stimulating factor: Filgrastim (Neupogen) - raise WBC and stimulate production
Nadir:
Stimulates production, maturation, and activation of neutrophils to reduce incidence of infection; stimulates bone marrow to produce more neutrophils since killing more
MoA: - Immunostimulants: Colony Stimulating Factors: Prototype: Filgrastim (Neupogen)
myelosuppression conditions (Antineoplastic drugs, bone marrow transplant, HIV)
Indications: - Immunostimulants: Colony Stimulating Factors: Prototype: Filgrastim (Neupogen)
SQ - taught - sent home
Route: - Immunostimulants: Colony Stimulating Factors: Prototype: Filgrastim (Neupogen)
fatigue, bone pain - driving bone marrow work overtime to produce more and bone marrow in bone so get pain, fever, N/V, peripheral edema, GI
AE: - Immunostimulants: Colony Stimulating Factors: Prototype: Filgrastim (Neupogen)
Frequent LAB MONITORING (CBC before treatment & twice weekly if diagnosed with neutropenia because want it to rise; monitor it if when get to acceptable place for next round of treatment because is chance too low for next round treatment delayed); teach self-administration
Nursing: - Immunostimulants: Colony Stimulating Factors: Prototype: Filgrastim (Neupogen)
Platelet count less than 50,000/mm3: Danger/concerned about/of minor or major bleed
Platelet transfusion if < 10,000mm3
Weekly CBC
Low platelet count: risk for bleeding
Thrombocytopenic Precautions - specific bleeding precautions; protect from unecessary bleeding
Nursing management myelosuppression
Avoid IM/SQ/IV or invasive procedures
No aspirin/NSAID - drugs participate more bleeding
Soft toothbrush/no flossing/dental procedures
No razor blades (use electric)
Avoid hard stools (stool softeners/laxatives)
Teach signs of bleeding: bruises/nose/gums/urine/stool/severe HA
Avoid falls/trauma
Thrombocytopenic Precautions - specific bleeding precautions; protect from unecessary bleeding - Nursing management myelosuppression
Can affect development of RBCs
Drop in RBC due to destruction by tx.-poor tissue perfusion
Signs and symptoms
Anemia management
Nursing management myelosuppression: anemia
Fatigue, decreased endurance, headache, tachycardia, angina, dizziness, dyspnea at rest, pallor, feel colder than usual
Signs and symptoms - Nursing management myelosuppression: anemia
Injection with epoetin-alfa SQ weekly
Weekly CBC - track RBC; monitor Hgb and Hct
Energy conservation techniques
RBC transfusion (hemoglobin < 7.5)
Anemia management - Nursing management myelosuppression: anemia
Erythropoietin factor controlling rate of RBC production
MoA: - Immunostimulants: Colony Stimulating Factors: Epoetin-Alfa (Epogen)
Treat disorders of RBC formation to decrease need for blood transfusions; renal failure, antineoplastic treatments
Indications: - Immunostimulants: Colony Stimulating Factors: Epoetin-Alfa (Epogen)
Angina, anticoagulant therapy, caution in CHF/Renal
Contraindications: - Immunostimulants: Colony Stimulating Factors: Epoetin-Alfa (Epogen)
Fatigue, bone pain, edema, hypertension (HTN), headache, fever, (DVTs CVAs and MI’s have occurred with tx)
AE: - Immunostimulants: Colony Stimulating Factors: Epoetin-Alfa (Epogen)
Monitor CBC weekly (dose depends on Hgb & indication), check VS (risk for HTN); analgesia for bone pain; goal above 10; hold or dose reduction if hold if Hgb >12; SQ - taught to admin at home while getting antineoplastic drugs
Nursing: - Immunostimulants: Colony Stimulating Factors: Epoetin-Alfa (Epogen)
Convo between pt with cancer and if childbearing age
Females
Males
Reproductive effects: risk for infertility
Age important predictor of future fertility
Women < 30 more likely to regain ovarian function after cancer treatment than > 30; more fertility when younger
Premenopausal will stop periods
No periods with treatment in chemo and is norm
Advise no pregnancy first year post tx - allow regain ovarian func and body rest; consider chances of relapse
Females - Reproductive effects: risk for infertility
Testes more sensitive (constant mitosis)
Sperm banking advised if wants try to have baby after cancer treatment
Males - Reproductive effects: risk for infertility
Will prepare/hang drugs
Oncology nurse - Safety for med-surg nurse
Monitor client during and after infusion
Intervene as appropriate to manage adverse effects
Wear PPE when handling (gown and gloves at min, splash: mask and face shield) to prevent accidental exposure to hazardous drugs
Call the oncology nurse if questions arise during monitoring or before taking down the IV bag and tubing and if something happens
Unit nurse - Safety for med-surg nurse
Wear correct PPE designated for chemotherapy
Prevention of
Contamination by body fluid for long period time;
Safe disposal
Safe handling of chemotherapeutic drugs/waste
Ingestion
Inhalation of aerosols
Absorption through skin
Antineoplastic agents
Prevention of - Safe handling of chemotherapeutic drugs/waste
Discard in cytotoxic waste in leak proof, puncture proof sealable containers marked cytotoxic waste
Safe disposal - Safe handling of chemotherapeutic drugs/waste
Take antiemetics - prescribed and know when take them; diet/fluids; when to call; next CBC
Manage n/v/d
Know when call: presence infectionl fever >100.5
When lab schedule and how often come in after with current condition rn
Check with provider on need for growth factors
Prevent contamination by body fluids at home - person living with needs be protected as well; educate them on this
Discharge instructions: client and fam edu
Wear gloves when handling body fluids-wash hands
Avoid splashing when use toilet, close lid, flush 2-3 times to ensure body fluids down and not exposing others
Place soiled linen in separate, washable pillowcase and wash twice, separate from other laundry
Drug waste; placed in sealed receptacle and transported in a non-passenger area to home agency for disposable
Prevent contamination by body fluids at home - person living with needs be protected as well; educate them on this - Discharge instructions: client and fam edu
Assists immune system to fight cancer
Types of immunotherapy:
Emerging cancer treatment: immunotherapy
Immune checkpoint inhibitors
T-cell transfer therapy
Monoclonal antibodies
Treatment vaccines
Immune system modulators
Types of immunotherapy: - Emerging cancer treatment: immunotherapy
Modify the actions of immune system
Umbrella term; affecting immune sys in one-way or another
Immune modulators - Immune modifying drugs
Energize immune system when it needs help fighting a specific pathogen
Filgrastim - stimulating bone marrow to build up WBCs
Immune stimulants - Immune modifying drugs
Block normal effects of the immune system in organ transplantation and autoimmune disorders
Some implications
Immune suppressants - Immune modifying drugs
Inhibits action of helper T-cell; block antibody production of B cells - all Ig; suppressing immune sys so not try attack new organ and reject it since seen as foreign; farther out transplant lower dose need organ been in body longer less likely be rejected
MoA: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine
anti-rejection organ transplant; psoriasis, rheumatoid arthritis
Indications: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine
Hypersensitivity, pregnancy or lactation, renal/liver dysfunction, infection, malignancies
Contraindications: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine
grapefruit juice -increase levels by 50-200% - sig; big piece of edu
Drug/Food: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine
infection risk (suppressing immune sys - big piece edu; immunosuppressant drug forever), kidney/liver damage
AE: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine
monitor lab: CBC, renal/liver function (highly nephrotoxic), drug level; Teach – avoid infection, no grapefruit juice, s/s kidney/liver toxicity
Nursing: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine
Body recognizes a foreign protein and begins producing antibodies to react with it
Active - Types of Immunity - Review immunity and immunization
Occurs when preformed antibodies are injected and react with a specific antigen
Passive - Types of Immunity - Review immunity and immunization
Process of artificially stimulating active immunity by exposing body to weakened disease causing organisms - introduce disease in some fashion to body in some amount and enough for immune sys to see and recongize it so next time exposed amount more quicker and stronger response
Immunization (Vaccines) - Review immunity and immunization
Routine immunization for children is standard of care; routine prac
Provide parents written records of immunizations (assure continuity of care); how adequately keep track is hard
Educate parents to report common adverse reactions to any immunization
Warm soaks for injection site, acetaminophen to reduce fever or aches
Children - Vaccines across the lifespan
Immunize if traveling to areas with high risk for specific disease
See list for recommendations
Adults - Vaccines across the lifespan
Greater risk for severe illness prevent disease, no age limit to any vaccination
Older adult - Vaccines across the lifespan
Lab test -evaluates level of antibodies from prior vaccine or infection; antibodies are present at high enough level to provide protection
Still immune to certain disease
+ want: proves immunity
-: not have immunity and need booster
Titers: - Childhood vaccinations (Birth-18)
repeat injections of vaccine after time has passed to strengthen immune response and maintain protection
Regain immunity
Boosters: - Childhood vaccinations (Birth-18)
Influenza (yearly)
Tetanus: Tdap or TD (every 10 years; exposure; pregnancy)
Varicella
Zoster
Pneumococcal
Adult vaccinations (19+)
Alive but weakened – could produce disease if immune compromised
Example: MMR, varicella
Imp for pat’s status to receive vaccines
Attenuated (LIVE) - Types of vaccines
Introduces inactive cells; Initiates B cell response (antibodies) and destruction of pathogen if exposed
MoA: - Biological Agents: Vaccines
disease preventionIndications: immunosuppressant drugs - not give any vaccines on if on these drugs not get good response so vaccine not helpful - esp if live vaccines: risk for developing disease, including corticosteroids
Drug/Drug(person): - Biological Agents: Vaccines
Common: redness and discomfort at injection site, fever, minor aches/muscle pain (acetaminophen and muscle soaks), arthralgia
Rare: anaphylactic reaction
AE: - Biological Agents: Vaccines
Moderate to severe acute illness with or without fever: already sick immune sys working not want hinder more; wait till feeling better
Severe allergic reaction to vaccine or component
Immunosuppression
History of Gillain-Barre syndrome following vaccination - rare
Pregnancy
Vaccine contraindications
Influenza injectable: eggs used in development of vaccine
Severe allergic reaction to vaccine or component - Vaccine contraindications
MMR and varicella (live, attenuated) - susceptible to getting diseases
Immunosuppression - Vaccine contraindications
Influenza, Tdap, TD
History of Gillain-Barre syndrome following vaccination - rare - Vaccine contraindications
Influenza (nasal), MMR, varicella, Meningococcal B
Pregnancy - Vaccine contraindications
Actual disease and vaccination history - immunosuppressed; more vaccinations needed
Previous allergic responses, allergies to components (eggs)
Contraindications
Physical assessment with VS to determine baseline status (free of infection) - well enough get vaccine
Evaluate ROM of the extremity to be used for vaccine administration
Route: Intramuscular (deltoid)
Medication contraindication: immunosuppressants
Gen nursing: vaccines: History / Examination
Do not admin if s/s of illness
Arrange for proper preparation and administration-varies on vaccinations
Emergency equipment standby - in case have allergic rxn so appropriately respond
Written record of immunization
Evaluation
Teach:
Nursing: gen vaccines: interventions/eval
Consider immune status for some vaccines
Do not admin if s/s of illness
Correct Timing of boosters
Written record of immunization
Serum titers reflecting immunization (if appropriate)
Evaluation
Importance of compliance with schedule
Common AE and symptomatic care (No aspirin)
Warning signs of problems (anaphylaxis): tachycardia, muscle weakness, rashes, dyspnea, LOC
Teach:
Vaccination would be contraindicated in which client?
A.A client receiving an immunostimulant
B.A client who is 90 years old
C.A client prescribed high dose prednisone
D.A client with allergic rhinitis
Answer: C
Rationale: The use of vaccines is contraindicated in the presence of immune deficiency because the vaccine could cause disease and the body would not be able to respond as anticipated if in an immunodeficient state; or in clients who are receiving immune globulin or who have received blood or blood products within the last 3 months because a serious immune reaction could occur.
Prednisone compromise immune systems action; no age limit on vaccinations; allergic rhinitis is okay; immunostimulant enhances rxn of immune sys
The nurse is caring for a client receiving an immunosuppressant. The nurse should monitor the client for which adverse effects? Select all that apply.
A.Cancer
B.Infection
C.Cardiac standstill
D.Increased bleeding
E.Hepatomegaly
Answer: A, B
Rationale: Immunosuppressants decrease the immune system’s function putting clients at risk for certain cancers and infections.
Immunocompromised: more at risk for cancer; immunosuppressants one long term helps body from developing cancers
