Podcast
Questions and Answers
A client undergoing chemotherapy develops anemia. Which medication would the nurse anticipate being prescribed to stimulate red blood cell production?
A client undergoing chemotherapy develops anemia. Which medication would the nurse anticipate being prescribed to stimulate red blood cell production?
- Filgrastim
- Sargramostim
- Oprelvekin
- Epoetin alfa (correct)
A client with chronic kidney disease is prescribed epoetin alfa. What laboratory value should the nurse monitor to assess for adverse effects of this medication?
A client with chronic kidney disease is prescribed epoetin alfa. What laboratory value should the nurse monitor to assess for adverse effects of this medication?
- Platelet count
- Potassium level
- Hemoglobin level (correct)
- White blood cell count
A preoperative client is receiving epoetin alfa to increase erythrocyte counts. What nursing intervention is crucial to prevent a potential complication associated with this medication?
A preoperative client is receiving epoetin alfa to increase erythrocyte counts. What nursing intervention is crucial to prevent a potential complication associated with this medication?
- Monitoring liver function tests
- Administering prophylactic anticoagulants (correct)
- Providing potassium supplements
- Encouraging increased fluid intake
A client's hemoglobin level increases rapidly while on epoetin alfa therapy. Which nursing intervention is most important?
A client's hemoglobin level increases rapidly while on epoetin alfa therapy. Which nursing intervention is most important?
A client receiving darbepoetin alfa reports frequent, severe headaches. What is the nurse's priority action?
A client receiving darbepoetin alfa reports frequent, severe headaches. What is the nurse's priority action?
A client with anemia secondary to chronic kidney disease is prescribed epoetin alfa. The client's blood pressure has increased significantly since starting the medication. Which action should the nurse take first?
A client with anemia secondary to chronic kidney disease is prescribed epoetin alfa. The client's blood pressure has increased significantly since starting the medication. Which action should the nurse take first?
A nurse is caring for a client receiving epoetin alfa. What assessment finding would warrant immediate intervention due to a potential adverse effect of the medication?
A nurse is caring for a client receiving epoetin alfa. What assessment finding would warrant immediate intervention due to a potential adverse effect of the medication?
A client with HIV/AIDS is taking zidovudine and develops anemia. Which medication is most likely to be prescribed to manage this specific type of anemia?
A client with HIV/AIDS is taking zidovudine and develops anemia. Which medication is most likely to be prescribed to manage this specific type of anemia?
A nurse is preparing to administer sargramostim to a client post-chemotherapy. Which assessment finding would warrant withholding the medication and contacting the provider?
A nurse is preparing to administer sargramostim to a client post-chemotherapy. Which assessment finding would warrant withholding the medication and contacting the provider?
The nurse is caring for a client receiving sargramostim. Which laboratory value requires immediate intervention?
The nurse is caring for a client receiving sargramostim. Which laboratory value requires immediate intervention?
A client with a history of heart failure is prescribed sargramostim. What nursing intervention is most important to implement?
A client with a history of heart failure is prescribed sargramostim. What nursing intervention is most important to implement?
A nurse is teaching a client about potential adverse effects of sargramostim. Which of the following should the nurse include in the teaching?
A nurse is teaching a client about potential adverse effects of sargramostim. Which of the following should the nurse include in the teaching?
The nurse is preparing to administer epoetin alfa to a client with chronic kidney disease. Prior to administration, it is most important for the nurse to assess which laboratory result?
The nurse is preparing to administer epoetin alfa to a client with chronic kidney disease. Prior to administration, it is most important for the nurse to assess which laboratory result?
A client receiving epoetin alfa reports a severe headache. Which action should the nurse take first?
A client receiving epoetin alfa reports a severe headache. Which action should the nurse take first?
A client with chronic kidney disease is prescribed epoetin alfa. The nurse understands that this medication is effective because it performs which action?
A client with chronic kidney disease is prescribed epoetin alfa. The nurse understands that this medication is effective because it performs which action?
The nurse is preparing to administer epoetin alfa subcutaneously. Which action is correct?
The nurse is preparing to administer epoetin alfa subcutaneously. Which action is correct?
A client receiving epoetin alfa reports experiencing muscle aches. The nurse should:
A client receiving epoetin alfa reports experiencing muscle aches. The nurse should:
A nurse is monitoring a client receiving epoetin alfa. Which finding suggests a potential thrombotic event requiring immediate intervention?
A nurse is monitoring a client receiving epoetin alfa. Which finding suggests a potential thrombotic event requiring immediate intervention?
A client receiving epoetin alfa is being monitored for adverse effects. Which of the following findings should the nurse identify as a potential adverse effect of this medication?
A client receiving epoetin alfa is being monitored for adverse effects. Which of the following findings should the nurse identify as a potential adverse effect of this medication?
A nurse is preparing to administer epoetin alfa to a client with chronic kidney disease. What is the priority nursing action before initiating treatment?
A nurse is preparing to administer epoetin alfa to a client with chronic kidney disease. What is the priority nursing action before initiating treatment?
When teaching a client about epoetin alfa, which statement indicates the need for further education?
When teaching a client about epoetin alfa, which statement indicates the need for further education?
A nurse is monitoring a client receiving filgrastim for neutropenia. Which of the following findings indicates a potential adverse effect that should be reported to the provider?
A nurse is monitoring a client receiving filgrastim for neutropenia. Which of the following findings indicates a potential adverse effect that should be reported to the provider?
A client receiving filgrastim reports experiencing bone pain. Which of the following interventions is most appropriate for the nurse to implement?
A client receiving filgrastim reports experiencing bone pain. Which of the following interventions is most appropriate for the nurse to implement?
A nurse is reviewing the laboratory results of a client receiving filgrastim. Which of the following WBC values would warrant a dosage adjustment or interruption of treatment?
A nurse is reviewing the laboratory results of a client receiving filgrastim. Which of the following WBC values would warrant a dosage adjustment or interruption of treatment?
A nurse is preparing to administer filgrastim to a client. Which of the following actions is essential for safe administration?
A nurse is preparing to administer filgrastim to a client. Which of the following actions is essential for safe administration?
A nurse is providing discharge instructions to a client who will be self-administering filgrastim at home. Which instruction is most important to emphasize?
A nurse is providing discharge instructions to a client who will be self-administering filgrastim at home. Which instruction is most important to emphasize?
A nurse is caring for a client receiving sargramostim after a bone marrow transplant. What therapeutic effect should the nurse monitor for to determine the medication's effectiveness?
A nurse is caring for a client receiving sargramostim after a bone marrow transplant. What therapeutic effect should the nurse monitor for to determine the medication's effectiveness?
A client with a history of uncontrolled hypertension is prescribed epoetin alfa. Which action should the nurse take?
A client with a history of uncontrolled hypertension is prescribed epoetin alfa. Which action should the nurse take?
What laboratory value is most important for the nurse to monitor in a client receiving epoetin alfa to ensure its effectiveness?
What laboratory value is most important for the nurse to monitor in a client receiving epoetin alfa to ensure its effectiveness?
A nurse is evaluating a client who has been receiving filgrastim. Which assessment finding suggests the medication has been effective?
A nurse is evaluating a client who has been receiving filgrastim. Which assessment finding suggests the medication has been effective?
A client is scheduled to receive pegfilgrastim following a round of chemotherapy. The nurse knows to administer this medication:
A client is scheduled to receive pegfilgrastim following a round of chemotherapy. The nurse knows to administer this medication:
Which of the following conditions warrants cautious use of filgrastim?
Which of the following conditions warrants cautious use of filgrastim?
A nurse is caring for a client receiving epoetin alfa. What should the nurse teach the client regarding diet?
A nurse is caring for a client receiving epoetin alfa. What should the nurse teach the client regarding diet?
Flashcards
Hematopoiesis
Hematopoiesis
The biological process in which blood cells and platelets are produced.
Hematopoietic Growth Factors
Hematopoietic Growth Factors
Hormones that control hematopoiesis, the production of blood cells.
Erythropoietic Growth Factors
Erythropoietic Growth Factors
Stimulates red blood cell production.
Leukopoietic Growth Factors
Leukopoietic Growth Factors
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Epoetin Alfa
Epoetin Alfa
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Epoetin Alfa: Therapeutic uses
Epoetin Alfa: Therapeutic uses
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Epoetin Alfa: Nursing Actions for Hypertension
Epoetin Alfa: Nursing Actions for Hypertension
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Epoetin Alfa: Nursing Actions for Thrombotic Risk
Epoetin Alfa: Nursing Actions for Thrombotic Risk
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Epoetin alfa: Hypertension
Epoetin alfa: Hypertension
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Epoetin alfa contraindication
Epoetin alfa contraindication
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Epoetin alfa monitoring: Hypertension
Epoetin alfa monitoring: Hypertension
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Epoetin Alfa: Desired Hemoglobin
Epoetin Alfa: Desired Hemoglobin
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Filgrastim Use
Filgrastim Use
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Filgrastim: Bone Pain
Filgrastim: Bone Pain
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Filgrastim Monitoring: Leukocytosis
Filgrastim Monitoring: Leukocytosis
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Filgrastim: Splenomegaly
Filgrastim: Splenomegaly
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Filgrastim contraindication
Filgrastim contraindication
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Filgrastim vial use
Filgrastim vial use
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Filgrastim Effectiveness
Filgrastim Effectiveness
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Sargramostim Action
Sargramostim Action
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Sargramostim Use
Sargramostim Use
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Sargramostim: Failed Transplant
Sargramostim: Failed Transplant
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Sargramostim Complications
Sargramostim Complications
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Sargramostim Monitoring
Sargramostim Monitoring
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Sargramostim Contraindications
Sargramostim Contraindications
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Sargramostim Administration
Sargramostim Administration
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Sargramostim Effectiveness
Sargramostim Effectiveness
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Leukocytosis & Body Aches
Leukocytosis & Body Aches
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Epoetin alfa Use
Epoetin alfa Use
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Epoetin alfa Complications
Epoetin alfa Complications
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Epoetin alfa Monitoring
Epoetin alfa Monitoring
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Study Notes
- Hematopoiesis is the biological process by which the body produces blood cells and platelets.
- Hematopoietic growth factors, also known as hormones, naturally control hematopoiesis.
- Genetically engineered products are available for therapeutic purposes.
- These products replace neutrophils and platelets after chemotherapy and hasten bone marrow function after a bone marrow transplant.
- They increase red blood cell production for clients who have chronic kidney disease
Hematopoietic Growth Factors
- Three groups of hematopoietic growth factors are erythropoietic growth factors, leukopoietic growth factors, and granulocyte-macrophage colony-stimulating factor.
- Erythropoietic growth factors are also known as erythropoiesis-stimulating agents (ESAs).
- The biological name for erythropoietic growth factors is erythropoietin.
- The biological names for leukopoietic growth factors are granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor.
Erythropoietic Growth Factors
- Prototype medication: Epoetin alfa (erythropoietin)
- Other medication: Darbepoetin alfa (long-acting erythropoietin)
- Act on the bone marrow to increase red blood cell production.
- Epoetin alfa is used for anemia related to chronic kidney disease, anemia caused by chemotherapy (nonmyeloid cancers), to increase erythrocyte counts in clients undergoing elective surgery, and anemia caused by taking zidovudine for HIV/AIDS.
- Darbepoetin alfa is used for chronic kidney disease and anemia caused by chemotherapy (nonmyeloid cancer).
Complications of Erythropoietic Growth Factors
- Hypertension secondary to elevations in hematocrit level requires monitoring of Hgb levels and blood pressure and possible administration of antihypertensive medications.
- A thrombotic event, such as myocardial infarction or stroke, is a risk if the client has an Hgb of 11 g/dL or higher or an increase of more than 1 g/dL in 2 weeks, and seizures may occur with a too-rapid rise in blood counts
- Deep-vein thrombosis is an increased risk in preoperative clients, who might need prophylactic anticoagulants.
- Headaches and body aches require reporting frequent or severe headaches, as hypertension can be the cause.
Contraindications/Precautions for Erythropoietic Growth Factors
- Use epoetin alfa/erythropoietin during pregnancy only if the benefit to the client outweighs the risks to the fetus.
- Epoetin alfa/erythropoietin is safe for use while lactating.
- Uncontrolled hypertension is a contraindication.
- Contraindicated in clients who have some cancers due to possible increases in tumor growth.
Nursing Administration for Erythropoietic Growth Factors
- Obtain baseline blood pressure and control hypertension before treatment in clients who have chronic kidney disease.
- Monitor blood pressure frequently and adjust antihypertensive medication as treatment progresses.
- Administer medications by subcutaneous or IV bolus injection based on the client’s weight.
- Do not agitate the vial, use each vial for one dose, and do not mix with other medications in the syringe.
- Dosing is usually three times per week but can be once per week with certain chemotherapies.
- Monitor iron levels and ensure adequate levels of iron, folic acid, and vitamin B12.
- Monitor Hgb and Hct once weekly (darbepoetin) and twice per week (epoetin) until they reach the target range.
- Ensure that clients receive the FDA’s Risk Evaluation and Mitigation Strategy medication guide.
Nursing Evaluation of Medication Effectiveness for Erythropoietic Growth Factors
- Effectiveness is indicated by Hgb level 10 to 11 g/dL and a maximum Hct of 33%.
Leukopoietic Growth Factors
- Prototype medication: Filgrastim
- Other medication: Pegfilgrastim
- Stimulate the bone marrow to increase neutrophil production.
- Decreases the risk of infection in clients who have neutropenia, from cancer, and other conditions.
- Used to build up numbers of hematopoietic stem cells before harvesting for autologous transplant.
Complications of Leukopoietic Growth Factors
- Elevation of plasma uric acid, lactate dehydrogenase, and alkaline phosphatase, which are usually moderate and reverse spontaneously.
- Bone pain requires monitoring and administration of acetaminophen or opioid analgesics.
- Leukocytosis requires monitoring WBC two times per week during treatment and decreasing the dose or interrupting treatment if WBC is too high.
- Splenomegaly and risk of splenic rupture with long-term use require evaluation of reports of left upper quadrant abdominal pain or shoulder tip pain.
Contraindications/Precautions for Leukopoietic Growth Factors
- Use filgrastim during pregnancy only if the benefit to the client outweighs the risks to the fetus, and use filgrastim with caution during lactation.
- Contraindicated in clients who are sensitive to Escherichia coli protein.
- Use cautiously in clients who have cancer of the bone marrow, sickle cell disease, or respiratory disease, and in children.
Nursing Administration for Leukopoietic Growth Factors
- Administer filgrastim via intermittent IV bolus, continuous IV, subcutaneous infusion, or subcutaneous injection.
- Do not agitate the vial, use each vial for one dose, and do not combine with other medications.
- Monitor CBC two times per week.
- Reinforce instructions on self-administration procedures for clients administering subcutaneous filgrastim at home.
- Pegfilgrastim is administered by subcutaneous injection 24 hr after each round of chemotherapy, with at least 14 days before the next round.
Nursing Evaluation of Medication Effectiveness for Leukopoietic Growth Factors
- Effectiveness can be evidenced by the absence of infection and WBC count and differential within expected reference ranges.
Granulocyte-Macrophage Colony-Stimulating Factor
- Select Prototype Medication: Sargramostim
- Acts on the bone marrow to increase production of WBCs (neutrophils, monocytes, macrophages, eosinophils).
- Hastens bone marrow function after bone marrow transplant.
- Used in the treatment of failed bone marrow transplant.
- Given to older adult clients who have acute myelogenous leukemia after induction of chemotherapy to accelerate neutrophil recovery and decrease incidence of life-threatening infections.
Complications of Granulocyte-Macrophage Colony-Stimulating Factor
- Diarrhea, weakness, rash, malaise, and bone pain require monitoring for adverse effects and administration of acetaminophen.
- Leukocytosis and thrombocytosis require monitoring CBC two times per week during the treatment and reducing the dose or interrupting treatment if counts are too high.
Contraindications/Precautions of Granulocyte-Macrophage Colony-Stimulating Factor
- Sargramostim safety has not been established during pregnancy, and caution is advised during lactation.
- Contraindicated in clients allergic to yeast and certain other products.
- Use cautiously in clients who have lung, cardiac, kidney, or hepatic disease; hypoxia; peripheral edema; or pleural or pericardial effusion.
- Use cautiously in clients who have cancer of the bone marrow.
Nursing Administration of Granulocyte-Macrophage Colony-Stimulating Factor
- Check for a documented baseline CBC, differential, and platelet count and monitor periodically during treatment.
- When administered subcutaneously, reconstitute with sterile water and mix contents gently, but do not shake vial.
- Sargramostim is administered by an RN via IV infusion, diluted, and without an in-line membrane filter, and infusion is slowed or discontinued if a client experiences increased dyspnea.
Nursing Evaluation of Medication Effectiveness of Granulocyte-Macrophage Colony-Stimulating Factor
- Effectiveness can be evidenced by the absence of infection and WBC and differential within expected reference ranges.
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Description
An overview of hematopoietic growth factors, hormones that control the production of blood cells and platelets. Includes erythropoietic growth factors, leukopoietic growth factors, and granulocyte-macrophage colony-stimulating factor. These factors are used to replace neutrophils and platelets after chemotherapy and hasten bone marrow function after a bone marrow transplant.
