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 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.
Score as -1 on the ICE assessment, complete the EWS.
Scold the patient for doing it wrong.
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 3
Grade 2
Grade 0
Grade 1
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 6
Grade 2
Grade 0
Grade 4
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?
Tell the patient to take Tylenol and call back in 8 hours.
Tell the patient to go to the ED immediately.
Instruct the patient to come to the hospital. Call the MD.
Document the call and hang up.
The nurse is completing the ICE assessment on a patient that has received IEC therapy. What is a "perfect" ICE score?
50
10
100
1
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 battery therapy
T-cell battering therapy
CAR T-cell therapy
CAR B-cell therapy
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 10
Grade 4
Grade 3
Grade 2
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
Give a 3rd bolus and ibuprofen.
Give steroids and turn down the infusion.
Continue to monitor the patient.
What is the BEST thing a nurse can do to recognize and intervene for IEC related adverse effects?
Infrequent assessments with CRP and ICAN'T screening tools.
Remind the attending physician every hour to assess the pt.
Facebook thoughts and prayers.
Frequent assessments with CRS & ICE/ICANS screening tools.
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
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?
Ask the medical student to round on this patient 1st.
Wait 6 hours and rescreen the patient.
Complete the ICANS assessment by assigning a grade.
Reorient the patient and reassess after coaching them.
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.
The patient is on their own for this.
Tap and shout what to write on the paper.
Which of the following conditions are NOT treated with CAR T-cell therapy?
Aplastic anemia
Multiple Myeloma
Acute Lymphoblastic Leukemia
Lymphoma
Prior to the administration of CAR T therapy, the facility must have at LEAST ___ doses of Tocilizumab available.
12
1
4
2
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
1
3
10
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?
"Never"
"At least 4 months"
"At least 8 weeks"
"As soon as the benadryl wears off"
Patients that receive immune effector cell therapy are most at risk for which 2 serious side effects?
Cytokine Restraint Sickness & nephrotoxicity
Sickle cell conversion & myeloablation
There are NO side effects.
Cytokine Release Syndrome & neurologic toxicities
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 4
Grade 1
Grade 0
Which statement about CAR T-cell therapy is FALSE?
Can be used independent of or in addition to a BMT
It creates immediate graft versus host disease
CAR T-cells can be directed to specific antigens
Useful in treating chemo refractory disease