A nurse is initiating the first dose of rituximab for non-Ho… | MyMerci
Adverse Effects/Contraindications/InteractionsPPT
Question
A nurse is initiating the first dose of rituximab for non-Hodgkin lymphoma. Thirty minutes into the infusion the client develops fever, chills, dyspnea, and hypotension. Which is the priority action?
1Wait 30 minutes and reassess
2Increase the infusion rate to complete the dose faster
3Stop the infusion, maintain IV access with saline, notify the provider, administer additional antihistamine/steroid/epinephrine per protocol, and monitor for tumor lysis syndrome✓ Correct answer
4Encourage oral fluids
Explanation
Correct (2): Rituximab carries an FDA boxed warning for severe infusion reactions (cytokine release syndrome) — most common within 30-120 min of first dose. STOP infusion, maintain IV with NS, provider notification, additional antihistamine/steroid/epinephrine per severity. After resolution, restart at 50% rate. Monitor for tumor lysis syndrome in high tumor burden. (1,3,4) Dangerous.
In-depth explanation
Memory Tip Rituximab = "Rit-uxi-DROP" — first infusion drops blood pressure. Slow rate + pre-meds (APAP·diphenhydramine·steroid) reduce reactions. Hep B screening required (reactivation).
Clinical scenario
Scenario 58-year-old male with NHL receiving first rituximab infusion. Premedicated with acetaminophen + diphenhydramine + steroid. 30 min in: fever 38.5°C, chills, dyspnea, BP 88/52.