Question

Case 2: 4 year old girl is about to start the chemotherapy drug vincristine for leukemia. You need to give this drug safely.

Q1: What information does a nurse need to gather about this pediatric patient during assessment before safely dosing this medication?

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Case 3: Parents took 6 month-old Jared on a long car ride. It was a hot day and they had all the windows partially rolled down. Jared has a mild sunburn on his forehead and part of his scalp (he doesn’t have a lot of hair). The parents want to apply some Solarcaine spray.

Q1: What are some important considerations regarding the use of topical medications in general, and this medication in particular in infants?

Answer 1

1) vincristine is belongs to a class of chemotherapy drugs called plant alkaloids.The nurse is responsible for the safe and appropriate adminstration of drugs

Information including,

* The nurse should provide all the information about the medications including it's pros and cons

* Family ,carers or other are adequately informed about the treatment and administration process.

*. Patient education and consent is important.if the patient is a child we have to take the consent from the parents.

* The planned treatment is verified with patient and understood by them .

* Medications should be stored appropriately prior to administration.

* The therapy and associated treatments are administrated to the patient in a safe and timely manner.

* Any immediate and longer term effects are appropriately managed.

* All professional and legal responsibilities with respect to administration of medication are met.

* Instruct the patient and family members to team the patient information sheet prior to starting vincristine liposome and before each infusion in case of change.

* Immediatly report of the nurse notice any redness , swelling, burning or pain at the site of injection.

* Instruct the patient family that after administration, it may cause fatigue and mental impairement .

* Patient should inform the nurse if severe constipation, abdominal pain, bloating, diarrhoea, nausea or vomiting occur,as this may be a sign of neuropathy.

* Advise the Patient family members that to report if the patient has fever,chil,sorethroat bleeding gums , blood in urine,stool emesis,mouthsore .

* Discuss the family about the possibility of hair loss and explore coping strategies.

* Instruct the Patient to receive any vaccination without advice of health care professional.

* During drug administration if extravasation occur, infusion must be stopped and restarted elsewhere to avoid damage to subcutaneous tissue.

* Do not mix with other drugs.

*During the treatment there may be many side effects.Being able to anticipate the side effects can help you and your child prepare and in some cases, prevent these symptoms from occuring.

2 )Topical medications are medication that is directly applied to the skin .it is used to nourish the skin and protect from harm.it is in the forms of oinment ,oils, paste ,creams,gels, solutions,lotions,etc

Important consideration are

* An increased does of medication is applied where it is needed

* There are reduced side effects and toxicity to other organs compared to systemic medications.

* This can be time consuming to apply

* Topical formulation are made up in a base which may be optimised for a particular site of the body or type of skin condition.

* Topical steroids and emollient are more effective if the skin slightly wet.so the most effective time to apply is within 3 minutes after a bath or shower.

* Topical skin medicines should not be applied near the eyes or mouth.

* Topical medications are not meant to be taken orally.

* Before applying Topical medications,the nurse should wash his or her hands and put on a glove

* The medicine label should be checked each time to avoid medications errors.

* Before administrating be sure ,it's the right medicine,the right dose ,the right time ,the right person and the right method.

* Look the expiration on the label ,do not use outdated medicine.

* Applying excessive amount can cause adverse skin reaction such as redness, itching,and inflammation.

* Most Topical medicine when applies properly,will produce the desired results within a few days .

Topical administration in infants

* In infants,Topical medications can be given

* There is particularly a problem in newborn and premature infants,who also have a higher rates of percutaneous absorption because the barrier functions of the skin is relatively immature.

* Compared with adults ,infants have an increased ratio of skin surface area to body weight,which enhance the danger of accumulating significant serum drug levels.

* The amount is used for administration is based on the child age because young children are at increased risk of side effects from Topical medications

* When used a prescribed amount of Topical corticosteroids rarely cause permanent skin changes in the colour of the skin.

* If Topical sheets are used for long period,they can occur usually cause a temporary