Final answer:
Major nursing considerations for a perimenopausal patient prescribed lenalidomide include teaching them to report symptoms of infection due to risk of myelosuppression, monitoring blood levels like ANC, and also advising on thrombosis prophylaxis. This drug should also be avoided in pregnant women due to its teratogenic effects.
Step-by-step explanation:
A patient who is perimenopausal and has been prescribed lenalidomide, a medication often used in cancer therapy, especially for multiple myeloma, should heed certain important nursing considerations due to the drug's potential side effects. One major nursing consideration is to teach the patient to report symptoms of infection. This is crucial because lenalidomide can cause myelosuppression, leading to neutropenia (a decrease in neutrophils, which are a type of white blood cell that fights infection). A low neutrophil count puts a patient at greater risk of infections. Before starting and during the use of lenalidomide, patients will typically undergo periodic blood tests, like the absolute neutrophil count (ANC), to monitor their neutrophil levels. An ANC higher than 1500 cells per microliter is generally considered safe for proceeding with cancer chemotherapy, although protocols can differ based on individual patient factors and treatment regimens. If a patient's ANC is significantly lower, the healthcare team might decide to delay treatment and take measures to increase the neutrophil count to prevent infections.
Another reason for close monitoring is that lenalidomide has been associated with venous thromboembolism, so prophylaxis against blood clots may also be indicated. Furthermore, because lenalidomide is classified as a teratogen, it is extremely important that women who are pregnant or could become pregnant avoid exposure to the drug. The Risk Evaluation and Mitigation Strategy (REMS) program is often required for female patients to prevent fetal exposure to lenalidomide.
Lastly, due to potential side effects, including blood clots and other cardiovascular issues, it's important for healthcare providers to assess the patient's overall health status regularly. Patients should be educated on the importance of reporting any new or worsening symptoms, particularly those that could indicate blood clots, such as swelling, pain, or redness in the limbs.