Treatment Administration Flashcards
Antineoplastic therapy is a collective term that describes
the types of therapies used to treat cancer. In many references, the term antineoplastic therapy is used interchangeably with the term chemotherapy.
The nursing role as it relates to informed consent (regardless of what the consent is for) includes the following:
Ensuring that patients and family members understand the purpose of what they are consenting for and what it entails
Answering questions related to treatment and its side effects or referring patients and family members to the appropriate resources for answers
Ensuring that patients and family members receive enough time to make a thoughtful, informed decision
Providing educational resources, if needed, to assist patients and families in making an informed decision
Documenting any conversations that you have with patients or family members related to the informed consent process
Several steps can be taken to help minimize the risk of medication errors when working with antineoplastic therapies.
These steps are:
Have up-to-date drug information and other resources readily available.
Have policies in place to support standardized ordering, storage, preparation, and administration.
Verify pertinent clinical information, including the patient’s measured height and weight, laboratory results, and body surface area (BSA) prior to ordering.
Review orders in an environment with minimal distractions. A “timeout” has been employed by many institutions during dose verification.
Use preprinted, standardized forms or computerized order entry for antineoplastic therapies when possible. Avoid the use of abbreviations, acronyms, coined names, and other ambiguous methods of communicating drug information. Review any look-alike, and/or soundalike medications.
Support institutional policy that prohibits verbal orders for antineoplastic therapy.
Use specialized labels and alerts.
Incorporate a systematic method of dose verification, including schedule and dose calculations. Use patient identifiers approved by the institution. Verify the six “rights” of medication administration: drug, patient, dose, route, time, and documentation.
Provide ongoing education to patients about their medications and encourage them to ask questions and seek clarification before their drugs are administered. Enlist patients’ help by educating them on admission.
Is there a history of drug, allergic, or transfusion reaction?
Many antineoplastic therapy agents can lead to a hypersensitivity reaction or infusion reaction during administration. A history of past reactions will alert the nurse to watch the patient closely.
Is there a history of heart failure?
If the patient was receiving antineoplastic therapy and had heart failure, nurses may need to check a MUGA scan and evaluate the ejection fraction of the heart, as well as monitor the infusion of fluids associated with antineoplastic therapy. Certain antineoplastic therapy agents require heart function to be monitored prior to administration.
Is there a history of renal failure?
Many antineoplastic therapy agents are excreted primarily by the kidneys. Impaired renal function can lead to an alteration in pharmacokinetics, elevated blood levels of drugs, and increased toxicities.
Does the patient have comorbid conditions?
Many people with cancer have at least one other chronic condition that can affect how they will respond to treatment.
Review what patient data before giving antineoplastic therapy?
Obtain vital signs, as well as measured height and weight. Always measure height and weight for antineoplastic therapy dosing. Do not accept stated height and weight. Compare weight to previous measurement to ensure weight has not significantly changed.
Complete a comprehensive physical assessment.
Obtain relevant laboratory and testing results. Needed laboratory values and tests are often drug-specific.
Assess psychosocial status, including patient perception, mental health state, coping style, relationships, support systems, accommodations, finances, employment status, ethnic background, and spiritual health.
Provide all patients with written documentation to support the teaching, including information about the following:
Diagnosis
Goals of therapy
Treatment plan, including the drugs to be given and the schedule; include procedures related to drug administration
Short- and long-term side effects and how they should be managed (including fertility risk, as appropriate)
Issues that should prompt a call to the healthcare team, with instructions on who to call at different times of the day
Plan for monitoring and follow-up; provide information on laboratory draws or follow-up testing that will be needed
Procedures for safe handling of body fluids and waste in the home
Can you take a verbal order for antineoplastic therapy?
NO
Rechecking and recalculating the drug dose and comparing it to the current antineoplastic therapy order are part of the safety steps needed to prevent harm to a patient. Several methods of calculating a dose are used:
Fixed dose: Does not require dose calculation, often used with oral antineoplastic therapy
Weight-based dosing (mg/kg): Requires accurately measured weight
AUC (area under the curve): Used with specific drugs, such as carboplatin, and based on renal function
BSA (mg/m2): Most common method to calculate antineoplastic therapy dosing
Institutional policies may allow for a variance in dose. What is this variance?
A 5% variance is often permitted to “round” the dose of chemotherapy.
What can influence the dose and how the dose is calculated?
Why a drug is being given can influence the dose and how the dose is calculated. For example, a drug administered with the goal of cure may be given in a different amount than one given in a palliative setting. The nurse administering antineoplastic therapy must take this information into account when verifying the dose and regimen.
