Question

A patient with CD20 POSITIVE , non -Hodgkin lymphoma is scheduled to begin rituximab. The nurse knows

Answer 1

What is CD20?

CD2o is membrain-emdded surface mole cule which place a role in development and diffrenciation of B cells in to plasma cells CD20 is expressed in a vast majority of mature B- cells neoplasmas and some cases of B lymphoblastic.luekemia /lymphomus, plasma cells myelomas , T - cells neoplasms and AMLs.

CD20 positive is a T cell lymphoma , a rare condition charectorized by the coexpression of CD20 and T markers such as CD3, CD5, or UHCL_1. Positivity for CD20 in any type of T cell lymphoma represents an aberrant immunophenotype, despite presence of various indicators of T cell lymphoma

The patiant diagnosis is non- Hodgkin lymphoma

cancer that starts in the lymphatic system

the condition occures when the body produces too many abnormal lymphocytes, a type of WBC.

Symptoms include swollen lymph nodes, fever, stomach ache, night sweats, weight loss, chest pain and loss of apipetite.

the patient is scheduled to began Rituximab

Rituximab is a chimeric monoclonal antibody against the protien CD20 , which is primarity found on the surface of immune system B cells.

The nurse shoild know the following

Rituximab may in addition cause immunosupression through several other mechanisms such as delayed on set cytopenia, particularly neutropenia and hypogammaglobulinema. Clinical trials have shown conflicting results regarding the association of rituximab with infections.

Side effects

• Hives ( red itchy welts) or rash
• Itching
• Swelling of your lips , tongue,throught, or face
• Sudden cough
• Shortness of breath, difficulty breathing or wheezing
• weakness
• Dizziness or feel faint

Contraindications

hypersensitivity to murain protiens, rituximab , or abciximab, angina, cardiac arrythmias ,cardiac diseases, plmonary disesse, chronic lymphatic leaukemia,lymhoma,severe hypotension, oliguria,rising serum creatinine, viral hepatitis B, vaccination, pregnancy and lactation,children.

Cautions use

Prior exposure to murain based monoclonal antibodies , history of allergies asthma and other pulmonary disease,respiratory insufficiancy, CAD, thrombocytopenia, h/o cardiac arrythmias, hypertension, renal impairment.

safty and efficiancy in children are not established.

Preparation of medication shoud be in closed chamber with all PPE worn

Administration of medication

Dose must be follwed by the physcians order.

Counter check with other staff before administration,

NURSING IMPLICATIONS ASSESSMENT & DRUG EFFECTS

• Lab tests: CBC with diffrential , peripheral CD20+ B lymphocytes.
• Monitor carefully BP and ECG status during infusion and immediately report signs and symptoms of hypersensitivity.( eg fever, chills, urticaria,pruritis,hypotension,bronchospasms,)

Patiant and Family education

• Do not take antihypertensives medications with in 12 hour of rituximab infusions.
• USe effective contraceptives during and for up to 12 months following rituximab therapy
• Report any of the following experienced during infusion, itching, difficulty breathing . tightness in throat, dizziness , head ache,nausea.
• Do not breast feed while taking this drug

Record and report data of medication administration , patient education, take cosent before administering High Risk medications.