Prophylactic antiemetic therapy

  1. Hi, hoping someone can help me with a question - I am currently working on an orthopaedic ward. Recently one of the patients I was allocated was admitted with sciatic pain which turned out to be melanoma. He was immediately commenced on a prophylactic regime of antiemetics pre-commencement of radiotherapy. The orthpaedic house surgeon charted the dexamethasone, cyclizine and a couple of other drugs on the front of the chart and dated it as commencing that day and then did a conseqential drug administration regime of altered dosages of the dexamethasone on the stat/standing order section of the drug chart for subsequent days. Flipping back and forth I made an error and started the Dexamethasone a day early, being the day of original charting. This was a total error on my part and I accept responsibility for it totally. However I have decided to exemplar my mistake for future learning. My CNL explained to me how important it was not to give the Dex on the first day of the regime, however I still dont "get it". Can anyone enlighten me on this process. The patient started his radiotherapy on day two of the regime.
  2. Visit jojoENZED profile page

    About jojoENZED

    Joined: May '05; Posts: 11
    Senior Staff Nurse
    Specialty: 4 year(s) of experience in orthopaedics/Medical/Oncology/Haematolog

    4 Comments

  3. by   globalRN
    don't understand the question?

    If the patient has melanoma and that was the cause of sciatica:
    would assume spread of melanoma.
    In oncology, steroids are often given to 'decompress' impingement
    as in spinal cord compression or pain related to tumor invasion

    since the dose of steroid is often =or more than what you might give for
    antiemetic....you wouldn't need additional steroid for nausea

    get extra bang for your tx buck
  4. by   globalRN
    Quote from globalRN
    don't understand the question?

    If the patient has melanoma and that was the cause of sciatica:
    would assume spread of melanoma.
    In oncology, steroids are often given to 'decompress' impingement
    as in spinal cord compression or pain related to tumor invasion

    since the dose of steroid is often =or more than what you might give for
    antiemetic....you wouldn't need additional steroid for nausea

    get extra bang for your tx buck
    or are you talking about a steroid taper?

    if the steroid course is given for cancer pain
    managemt...usually give the same dose for several days-2 weeks
    before beginning a taper.

    if pain comes back,....reintroduce at a higher dose than the one patient
    was on while on taper
  5. by   heamoRN
    I have seen dex use as a antiemetic but it's normally with haloperidol and in pal care. the best antiemetic that covers emotional and phyiscal neasea is ativan(lorazepam) s/l
  6. by   augigi
    What rationale did your CNL give you for not giving dexamethasone on Day 1 of the regime?

    What regime were they planning - radiation on Day 2... when was the first dex dose due?

close