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Immune Effector Cell therapy
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During the 2200 telehealth visit the patient experiences a seizure witnessed by the nurse. What action should the nurse take?
 
Stay on the call. Ask caregiver to call 911. RN call MD.
 
End the call promptly and wake the attending.
 
Tell the patient to take more Keppra.
 
Panic.
The nurse is conducting a telehealth visit with a patient that has received CAR T therapy. The ICE score is 10. The VS are: T 100.6, P 102, BP 108/62. What should the nurse do next?
 
Instruct the patient to come to the hospital. Call the MD.
 
Tell the patient to take Tylenol and call back in 8 hours.
 
Tell the patient to go to the ED immediately.
 
Document the call and hang up.
The nurse asks the patient to write the standard sentence on the CAR T writing log. How should the nurse assist the patient?
 
Sit the pt upright. Turn lights on. Hard writing surface.
 
Hold their hand while writing.
 
Tap and shout what to write on the paper.
 
The patient is on their own for this.
The nurse asks the patient to write the standard sentence on the CAR T writing log. Upon viewing the writing log what should the nurse do NEXT?
 
Score as 0 on the ICE assessment, complete ICANS, call MD.
 
Congratulate the patient on a job well done.
 
Scold the patient for doing it wrong.
 
Score as -1 on the ICE assessment, complete the EWS.
A patient that has received CAR T-cell therapy today asks the nurse when they can drive again. Which answer by the nurse is correct?
 
"At least 8 weeks"
 
"Never"
 
"As soon as the benadryl wears off"
 
"At least 4 months"
A patient that has received CAR T therapy has a CRS grade of 2 (temp 100.9*F, BP 88/48) and is not responding to the 2nd 1000 mL fluid bolus. Which orders would the nurse anticipate?
 
Give tylenol & tocilizumab, transfer to ICU for vasopressors
 
Continue to monitor the patient.
 
Give a 3rd bolus and ibuprofen.
 
Give steroids and turn down the infusion.
Prior to the administration of CAR T therapy, the facility must have at LEAST ___ doses of Tocilizumab available.
 
2
 
1
 
4
 
12
The nurse completes the ICE assessment and the patient scores 3. The patient awakens to light sternal rub and has no seizures or other notable neurologic deficits. What grade is their ICANS?
 
Grade 3
 
Grade 2
 
Grade 10
 
Grade 4
The nurse completes the ICE assessment and the patient scores 7. The patient awakens spontaneously and has no seizures or other notable neurologic deficits. What grade is their ICANS?
 
Grade 1
 
Grade 0
 
Grade 2
 
Grade 3
The nurse is completing the ICE assessment on a patient that has received IEC therapy. The patient does not get a perfect score. What does the nurse do NEXT?
 
Complete the ICANS assessment by assigning a grade.
 
Wait 6 hours and rescreen the patient.
 
Ask the medical student to round on this patient 1st.
 
Reorient the patient and reassess after coaching them.
The nurse is completing the ICE assessment on a patient that has received IEC therapy. Abnormals: patient states the year is 2016, they identify 2 out of 3 objects correctly and they can't count backwards from 100. What is their ICE score?
 
7
 
10
 
3
 
1
The nurse is completing the ICE assessment on a patient that has received IEC therapy. What is a "perfect" ICE score?
 
10
 
100
 
50
 
1
A patient completed IEC therapy 4 days ago. Their VS are T - 101*F, P 112, BP 100/56, O2 Sat 93% on 2L via NC. Grade the CRS
 
Grade 2
 
Grade 1
 
Grade 0
 
Grade 4
A patient has completed IEC therapy. Their VS are: T - 99.1*F, P 96, BP 104/70, O2 sat 98% on RA. Grade the CRS.
 
Grade 0
 
Grade 2
 
Grade 4
 
Grade 6
What is the BEST thing a nurse can do to recognize and intervene for IEC related adverse effects?
 
Frequent assessments with CRS & ICE/ICANS screening tools.
 
Infrequent assessments with CRP and ICAN'T screening tools.
 
Remind the attending physician every hour to assess the pt.
 
Facebook thoughts and prayers.
Patients that receive immune effector cell therapy are most at risk for which 2 serious side effects?
 
Cytokine Release Syndrome & neurologic toxicities
 
Cytokine Restraint Sickness & nephrotoxicity
 
Sickle cell conversion & myeloablation
 
There are NO side effects.
Where do the T-cells come from that are engaged in BiTE therapy?
 
The patient's own T-cells
 
A donor's T-cells
 
A friend of a friend's T-cells
 
They are harvested from actual bite wounds
Which of the following conditions are NOT treated with CAR T-cell therapy?
 
Aplastic anemia
 
Lymphoma
 
Multiple Myeloma
 
Acute Lymphoblastic Leukemia
Which statement about CAR T-cell therapy is FALSE?
 
It creates immediate graft versus host disease
 
CAR T-cells can be directed to specific antigens
 
Useful in treating chemo refractory disease
 
Can be used independent of or in addition to a BMT
What therapy uses autologous T-cells engineered to express a specific T-cell receptor that makes the T cells recognize tumor cells and destroy them?
 
CAR T-cell therapy
 
CAR B-cell therapy
 
CAR battery therapy
 
T-cell battering therapy
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