C H A P T E R 4 9
Drugs used to treat anaemias
781
Care considerations for people receiving
erythropoiesis-stimulating agents
Assessment: History and examination
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Assess for contraindications or cautions: any
known allergies to any component of the drug
to avoid hypersensitivity reactions
; severe
hypertension,
which could be exacerbated
; and
breastfeeding
because of potential adverse effects
on the neonate.
These drugs should be used with
caution in people with anaemia and normal renal
function
to prevent rebound decrease in normal
erythropoietin production
and in people with
cancer receiving the drugs to increase haematocrit
after antineoplastic chemotherapy
because of the
risk of rapid tumour progression if haemoglobin
levels exceed guidelines.
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Perform a physical assessment to establish a
baseline before beginning therapy and during
therapy to determine drug effectiveness and
evaluate any potential adverse effects.
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■
Assess neurological status, including affect,
orientation and muscle strength,
to identify
possible adverse CNS effects.
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■
Monitor vital signs, including pulse and blood
pressure,
for changes
, and assess cardiovascular
status,
to identify possible cardiovascular effects
;
and inspect lower extremities
for evidence
of oedema, which could indicate a change in
cardiovascular function.
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■
Assess respirations and auscultate lungs for
adventitious breath sounds
for early detection of
changes in cardiovascular function.
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■
Monitor the results of laboratory tests, including
renal function tests, full blood count (FBC),
haematocrit, iron concentration, transferrin and
electrolyte levels,
to evaluate the effectiveness of
therapy.
Be aware of variations in haematological
test results due to race (see Box 49.2).
Implementation with rationale
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■
Confirm the chronic, renal nature of the person’s
anaemia before administering the drug to treat
renal failure anaemia
to ensure proper use of
the drug.
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Give epoetin alfa three times per week, either
intravenously or subcutaneously,
to achieve
appropriate therapeutic drug levels.
Administer
darbepoetin alfa once per week, subcutaneously or
intravenously. Administer methoxy polyethylene
glycol-epoetin beta once every 2 weeks, and then
once a month when the person is stabilised, by
subcutaneous injection
to achieve appropriate
therapeutic drug levels.
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■
Provide the person with a calendar of marked
days
to aid in remembering dates for injection
and promote increased compliance with the drug
regimen.
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■
Do not mix with any other drug solution
to avoid
potential incompatibilities
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■
Monitor access lines for clotting and
arrange to
clear line as needed.
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Ensure that prescribed laboratory testing, such
as haematocrit levels, is completed before drug
administration
to determine correct dose.
If
the person does not respond within 8 weeks,
re-evaluate the cause of anaemia. Anticipate a
target haemoglobin range between 10 and 12 g/dL.
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■
Evaluate iron stores before and periodically during
therapy
because supplemental iron may be needed
as the person makes more RBCs.
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■
Maintain seizure precautions on standby
in case
seizures occur as a reaction to the drug.
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Provide comfort measures
to help the person
tolerate the drug effects.
These include small,
frequent meals to help minimise nausea and
vomiting; readily available access to bathroom
facilities should diarrhoea occur; and analgesia
for headache or arthralgia.
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■
Offer support and encouragement
to help the
person deal with the diagnosis and the drug
regimen.
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■
Provide thorough teaching, including the name
of the drug, dosage prescribed, administration
technique and frequency of administration,
measures to avoid adverse effects, warning signs of
problems and need to notify healthcare provider,
and the need for follow-up laboratory testing,
to enhance knowledge about drug therapy and to
promote compliance.
Evaluation
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■
Monitor response to the drug (alleviation of
anaemia, target haemoglobin level a maximum
of 12 g/dL).
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Monitor for adverse effects (headache,
hypertension, nausea, vomiting, seizures,
dizziness).
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Monitor the effectiveness of comfort measures and
compliance with the regimen.
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Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects
to watch for and specific measures to avoid them;
person understands the importance of continued
follow-up).
