Nursing Process Applied to Drug Therapy

Drug Information
Drug Name : Epoetin-alfa (Epogen® , Procrit® , Eprex®)
Drug Class/Therapeutic Use: Recombinant Human Erythropoietin/A natural
glycoprotein produce in the kidneys, which stimulates red blood cell production in the
bone marrow. It is used to treat anemia in people with chronic renal failure, cancer
patients undergoing chemotherapy and it decreases the need for blood transfusion in
patients who do not have other reversible anemias such as iron or folate
deficiencies.
Mechanism of Action: Erythropoietin is a protein that normally is made in the body by
the kidney. It causes the bone marrow to produce oxygen-carrying red blood cells.
Under normal conditions, when the body senses a decrease in red blood cells or a
deficiency in the supply of oxygen, more erythropoietin is produced, and this
increases the number of red blood cells. When this natural mechanism is not
working, it may become necessary to stimulate the bone marrow to produce red
blood cells. The erythropoietin that is used for therapy, called epoetin alfa, is man-
made. It is a product of the genetic engineering of ovarian cells of the Chinese
hamster and is produced through recombinant DNA technology in bacteria. It does
not cure the underlying cause of the anemia, and unless the underlying cause can
be reversed, treatment with epoetin alfa must be continued indefinitely.
Common Side Effects:
• Dizziness, Headache, Seizures
• Fatigue, Joint pain
• Nausea and vomiting
• Diarrhea, Stomach pain, Indigestion
• Pain, burning, numbness or tingling sensation on hands and feet
• Redness, swelling, pain, or itching at the injection site
Drug-to-Drug Interactions: No evidence exists that indicates that treatment with
epoetin alters the metabolism of other drugs
Nursing Process:
Assessment
• Obtain complete health history including allergies, drug history, and possible
drug reactions.
• Assess reason for drug administration such as presence/history of anemia
secondary to chronic renal failure, malignancy, chemotherapy, autologous
blood donation, and HIV-infected clients treated with zidovudine.
• Assess vital signs, especially blood pressure.
• Assess complete blood count, specifically hematocrit and hemoglobin levels,
to establish baseline values.
Nursing Diagnoses
• Impaired Tissue Oxygenation related to anemia
• Risk for injury related to adverse effect of Epoetin-alfa
• Knowledge deficit related to drug therapy
Planning
Exhibit an increase in hematocrit level and improvement in anemia-related
symptoms.
Immediately report severe headache, chest pain, confusion, numbness, or
loss of movement in an extremity.
Demonstrate an understanding of the drug’s action by accurately
describing drug side effects and precautions.
Implementation
• Monitor vital signs, especially blood pressure. (The rate of hypertension is
directly related to the rate of rise of the hematocrit. Clients who have
existing hypertension are at higher risk for stroke and seizures.
Hypertension is also much more likely in clients with chronic renal failure.)
• Monitor for side effects, especially symptoms of neurological or
cardiovascular events. (Headache, seizures, and hypertension have been
related to drug usage.)
• Monitor client’s ability to self-administer medication. (Inability to self
administer medication requires the nurse to arrange for someone else to
administer the medication.)
• Monitor laboratory values such as hematocrit and hemoglobin to evaluate
effectiveness of treatment. (Increases in hematocrit and hemoglobin
values indicate increased RBC production.)
• Monitor client for signs of seizure activity. (Seizures result in a rapid rise in
the hematocrit—especially during first 90 days of treatment.)
 • Monitor client for signs of thrombus such as swelling, warmth, and pain in
an extremity. (As hematocrit rises, there is an increased chance of
thrombus formation, particularly for clients with chronic renal failure.)
• Monitor dietary intake. Ensure adequate intake of all essential nutrients.
(Response to this medication is minimal if blood levels of iron, folic acid, and Vit.
B12 are deficient.
Client Education/Discharge Planning
• Instruct client to periodically monitor blood pressure using proper
monitoring equipment. Consistent increases in blood pressure should be
reported immediately.
• Instruct client to report side effects such as nausea, vomiting, constipation,
redness/pain at injection site, confusion, numbness, chest pain, and
difficulty breathing.
• Instruct client in the technique for subcutaneous injection if client is to self
administer the medication, and on the proper disposal of needles and
syringes.
• Instruct client to keep all laboratory appointments for testing and to adjust
activities according to the latest hematocrit value.
• Instruct client to avoid driving or performing hazardous activities until the
effects of the drug are known.
• Instruct client to:
• Report any increase in size, pain, and/or warmth in an extremity.
• Monitor for signs and symptoms of blood clots.
• Avoid rubbing or massaging calves and to report leg discomfort.
• Instruct client to:
• Maintain adequate dietary intake of essential vitamins and nutrients.
• Continue to follow necessary dietary restrictions if receiving renal dialysis.
Evaluation
• The client exhibits an increase in hematocrit level and improvement in
anemia-related symptoms.
• The client reports severe headache, chest pain, confusion, numbness, or
loss of movement in an extremity.
• The client demonstrates an understanding of the drug’s action by
accurately describing drug side effects and precautions.
Sources:
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a692034.html#brand-name-1
2011 Lippincotts Nursing Drug Guide pg. 457
Roach’s Introductory Clinical Pharmacology By Susan M. Ford, Sally S. Roach
Drug Therapy in Nursing By Diane S. Aschenbrenner, Samantha J. Venable
http://wps.prenhall.com/wps/media/objects/3775/3866436/npf_charts/ch28