Question

The physician has ordered filgrastim (Neupogen) intravenously for the client. What is a priority plan by the nurse prior to administering this drug?

1. Plan to monitor the client's ECG readings.
2. Plan to insert a Foley catheter and monitor urine output.
3. Plan to administer 10% oxygen during the infusion.
4. Plan to have a white blood cell (WBC) count drawn every 30 minutes.

Answer 1

Before administering filgrastim, a nurse should check the patient's most recent WBC count to establish a baseline, not draw a count every 30 minutes. Continuously monitoring ECG, inserting a Foley catheter, or administering supplemental oxygen, as suggested in the other options, are not standard preparatory actions for filgrastim infusion.

Step-by-step explanation:

Filgrastim, a synthetic form of granulocyte colony-stimulating factor (G-CSF), is administered intravenously to patients who have low white blood cell (WBC) counts, often as a result of chemotherapy. The healthcare professional must monitor the patient's response to treatment by assessing WBC counts. However, drawing a WBC count every 30 minutes, as suggested in option 4, is not practical or necessary.

A priority for the nurse before administering filgrastim would be to ensure that a baseline WBC count is known; this would allow for monitoring the effectiveness of the medication and the patient's response. Continuously monitoring through frequent WBC count testing would not be a standard procedure and is more invasive and stressful for the patient than necessary.

Therefore, the appropriate nursing action before starting filgrastim infusion would typically involve checking the most recent WBC count to have a baseline for comparison post-administration. Options 1, 2, and 3 listed in the question do not directly relate to the primary concern with filgrastim administration, which is the effect on WBC levels.