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《ISPN学习》总第554期
日期：2019-11-23 19:05:14
《ISPN学习》2019年11月04日总第554期
阳光总在风雨后
★ From the Programs ★
（From the Programs [课程选粹]栏目摘登奥医及国外NCLEX-RN（ISPN）课程视频讲座，旨在帮助读者了解NCLEX-RN（ISPN）考试内容，指导考生复习，加深考生对考试相关内容的学习、掌握[进一步了解请点击底部阅读原文]。您的需要就是我们的努力方向。
Chest Tube Notes
| 想提高专业英语听力吗？想边练听力边增加护理专业知识吗？《Listening -- Elementary》(专业英语听力 – 初级)可助你一臂之力。 |
★ ISPN Review ★
Antiemetics and Cancer Chemotherapy
止吐药和癌症化疗
Antineoplastic drugs can directly stimulate the chemoreceptor trigger zone (CTZ) in the medulla to induce nausea and vomiting. These drugs also cause cell death, which releases many toxins into the system, which in turn stimulate the CTZ. Because patients expect nausea and vomiting with the administration of antineoplastic agents, the higher cortical centers of the brain can stimulate the CTZ to induce vomiting just at the thought of the chemotherapy.
抗肿瘤药可直接刺激髓质化学感受器触发区（CTZ），诱发恶心和呕吐。这些药物也可引起细胞死亡，从而将很多毒素释放进入身体系统，反过来又会刺激CTZ。因为病人预期使用抗肿瘤药时会伴恶心和呕吐，一想到化疗，大脑皮质中枢就会兴奋CTZ，诱发呕吐。
A variety of antiemetic agents have been used in the course of antineoplastic therapy. Sometimes a combination of drugs is most helpful. It should also be remembered that an accepting environment, plenty of comfort measures (e.g., environmental control, mouth care, ice chips), and support for the patient can help to decrease the discomfort associated with the emetic effects of these drugs. Antihistamines to decrease secretions and corticosteroids to relieve inflammation are useful as adjunctive therapies.
在抗肿瘤治疗期间会使用多种止吐药。有时，联合疗法是最有助益的。另外也应建议提供一个可以接受的环境、一些安慰措施（如环境控制、口腔护理、冰条等），及病人支持，这些都有助于减少与这些药物呕吐效应相关的不适。作为辅助疗法，减少分泌物的抗组胺药和减轻炎症的皮质甾类也是有用的。
Drugs that are known to help in treating antineoplastic chemotherapy–induced nausea and vomiting include the following:
已知的有助于治疗抗肿瘤药化疗诱发性恶心和呕吐的药物包括以下这些：
• Dronabinol (Marinol) and nabilone (Cesamet) are synthetic derivatives of delta-9- tetrahydrocannabinol, the active ingredient in marijuana; this is not usually a first-line drug because of associated CNS effects. The usual dosage for dronabinol is 5 mg/m2 PO 1 to 3 hours before chemotherapy and repeated every 2 to 4 hours after chemotherapy. Nabilone is given orally as 1 to 2 mg PO twice daily initially, then daily during the cycle and for 48 hours after the last dose of chemotherapy.
屈大麻酚（Marinol）和大麻隆（纳麻隆）是大麻活性成分delta-9-四氢大麻酚的合成衍生物，通常不属于一线药物，原因是其CNS效应。屈大麻酚的日常药量是5 mg/m2 PO，化疗前1-3小时使用，并在化疗后2-4小时重复一交次。纳比隆口服，1-2 mg PO，开始时一天2次，接着，在疗程内，每天一次，在末次化疗后48小时内服用。
• Ondansetron (Zofran), granisetron (Kytril), and palonosetron (Aloxi) block serotonin receptors in the CTZ and are among the most effective antiemetics, especially if combined with a corticosteroid such as dexamethasone. The usual dosage is three 0.15-mg/kg doses IV or 8 mg PO three times a day starting 30 minutes before chemotherapy (ondansetron) or 10 mg/kg IV or 1 mg PO twice a day (granisetron), or 0.25 mg IV over 30 seconds, starting 30 minutes before chemotherapy (palonosetron).
昂丹司琼（枢复宁）、格拉司琼（凯特瑞）和帕洛诺司琼（阿罗西）阻断CTZ血清素受体，属于最有效的止吐药之一，特别是也地塞米松之类的皮持甾类一起联用时。日常剂量是IV 0.15-mg/kg三剂，或8 mg口服，一天3次，化疗30分钟前（昂丹司琼）开始使用，或10 mg/kg IV，或1 mg PO一天2次（格拉司琼），或0.25 mg IV 30秒钟，化疗30分钟前开始（帕洛诺司琼）。
• Aprepitant (Emend) blocks human substance P/neurokinin 1 receptors in the CNS, blocking the nausea and vomiting caused by severely emetogenic antineoplastic drugs without effects on dopamine, serotonin, or norepinephrine. The usual dosage is 125 mg PO 1 hour before chemotherapy (day 1) and 80 mg PO once daily in the morning on days 2 and 3; given in combination with 12 mg dexamethasone PO on day 1 and 8 mg dexamethasone PO on days 2 to 4, and 32 mg ondansetron IV on day 1 only.
阿瑞吡坦（意美）阻断CNS人P物质/神经激肽1受体，阻断极高致吐性抗肿瘤药物引起的恶心呕吐，但对多巴胺、血清素或去甲肾上腺素无影响。常规剂量是，第1天125 mg PO化疗前1小时用，第2、3天一天一次，80 mg，早晨使用；第1天与12 mg地塞米松PO联用，第2-4天地塞米松8 mg PO；只在第1天IV 32 mg 昂丹司琼。
• Two benzodiazepines—alprazolam (Xanax), 0.5 mg PO four times a day, and lorazepam (Ativan), 2 to 6 mg/day PO— seem to be effective in directly blocking the CTZ to relieve nausea and vomiting caused by cancer chemotherapy; they are especially effective when combined with a corticosteroid.
两种苯二氮卓类 – 阿普唑仑（安宁神）0.5 mg PO，一天四次；劳拉西泮（氯羟安定），2-6 mg/天 PO；可有效直接阻断CTZ，缓解癌症化疗引起的恶心呕吐；与皮质甾类联用时特别有效。
• Haloperidol (Haldol), 0.5 to 2.0 mg PO four times a day, or 2 to 25 mg intramuscularly (IM) or IV, is a dopaminergic blocker that also is believed to have direct CTZ effects.
氟哌啶醇（卤吡醇），0.5 – 2.0 mg PO，1天4次，或2 – 25 mg IM 或IV，该药为多巴胺能阻断剂，据信还有直接的CTZ效应。
• Metoclopramide (Reglan), 2 mg/kg IV over at least 30 minutes, calms the activity of the GI tract; it is especially effective if combined with a corticosteroid, an antihistamine, and a centrally acting blocker such as haloperidol or lorazepam.
甲氧氯普胺（灭吐灵），2 mg/kg IV，至少30分钟，平静胃肠道活性，也皮质甾类、抗组胺药及氟哌啶醇或劳拉西泮类中枢阻断药联用时特别有效。
• Prochlorperazine (Compazine), 5 to 10 mg PO three to four times a day, or 5 to 10 mg IM, is a phenothiazine that has been found to have strong antiemetic action in the CNS; it can be given by a variety of routes.
丙氯拉嗪（甲哌氯丙嗪）5 – 10 mg PO，一天3-4次，或5 – 10 mg IV。该药为吩噻嗪类药，具有强烈的CNS止吐作用，可多途径给药。
Nausea and vomiting are unavoidable aspects of many chemotherapeutic regimens. However, treating the patient as the chemotherapy begins, using combination regimens, and providing plenty of supportive and comforting nursing care can help to alleviate some of the distress associated with these adverse effects.
对很化疗药物而言，呕心呕吐是无法避免的，不过，随着化疗开始，患者接受治疗，使用联合疗法，提供支持性和安慰性护理可以帮助缓解与这些不良效应相关的痛苦。
★ Vocabulary for Today ★
antiemetic – n. 止吐的，止吐药
CTZ -- 化学感受器触发区
（chemoreceptor trigger zone）
medulla – n. 骨髓，髓质
cortical centers – n. 大脑皮质中枢
emetic effects – n. 催吐效应，催吐药
antihistamine – n. 抗组胺药
adjunctive therapies – 辅助疗法
dronabinol – n. 屈大麻酚
Marinol – n. 屈大麻酚商标名
nabilone – n. 大麻隆
Cesamet – n. 纳比隆
delta-9- tetrahydrocannabinol -- δ-9-四氢大麻酚
ondansetron – n. 昂丹司琼
Zofran – n. 枢复宁
granisetron – n. 格拉司琼
Kytril – n. 凯特瑞
palonosetron – n. 帕洛诺司琼
Aloxi – n. 阿罗西
serotonin – n. 血清素
substance P receptor – n. P物质受体
mechlorethamine – n. 氮芥
Mustargen – n. 氮芥商标名
melphalan – n. 美法仑
Alkeran – n. 爱克兰
Oxaliplatin – n. 奥沙利铂
Eloxatin – n. 乐沙定
procarbazine – n. 丙卡巴肼
Matulane – n. 盐酸丙卡巴肼
Streptozocin – n. 链佐星
Zanosar – n. 链脲菌素
temozolomide – n. 替莫唑胺
Temodar – n. 替莫唑胺商标名
thiotepa – n. 塞替派
Thioplex – n. 塞替派粉针剂
| 尽快地从茫然中理清复习思路，准确地抓住复习重点，这是每一个考试复习者的一大愿望。“ISPN考试复习要点提示”即是帮您实现这一愿望的利器！该教程已在www.omedin.com陆续上线。 |
★ Video ★
Antiemetics
★ NCLEX-RN Experience ★
考试从来不易，前行者的经验可以使后来者少走不少弯路！
有的说自己记忆力不好，有的说自己年龄太大了…..看看这位考生，年龄似乎并不是什么问题。至少，就我所知，我们群里的考试都比她年轻得多。
NCLEX Study Review. Old RN but still a goodie!
by tamyo
Hi all
I am a foreign graduate (Australia) who graduated in 1990. [Yep...just turned 50] Sat NCLEX in 1993 when only offered twice a year (no stress?!?!?) and passed.
As an oldie (but still a goodie!) feel like I need to take full course review. Initially tried Hurst when I thought I could take the test within 3-4 months which I loved, along with the Kaplan question program but after waiting and waiting and constant discouragement I stopped studying as I had no idea when I could retest.
Tried to reconnect with Hurst re being able to 'subsidize' my initial investment at $50 a month. No response. Looked at other options...Blah, blah, found www.NRSNG.com which I think provides a more basic and totally comprehensive and interactive experience for core course review if that is what you think you need. They provide 6 and 12 week + study review programs, which I have used generally as a guideline, but I am looking at EVERY single review as I wanted to start from the beginning and cover all that they have to offer - so will obviously take longer. I do prefer the short and integrative lectures and synopsis review for me. I feel Hurst primarily lectures, and maybe assumes more recent academic knowledge and practical background. Also NRSNG only $30/12. I think the question base/review with NRSNG for NCLEX prep is lacking but have also incorporated UWorld v's Kaplan as I think the rationales are more informative with uWorld which is working well for me in combination right now.
Hope this helps someone? Will see what transpires on my end. If I do not pass it won’t be for lack of trying or commitment.
Age will not define me, my worth or employability. My mum is 75 and still working per diem in the NICU and giving lectures as a NICU clinical consultant to medical and nursing staff on a monthly basis at one of the largest hospitals in Sydney - she is my primary motivation!
★ Test ★
1. Which instructions should the nurse teach the client receiving oprelvekin (Neumega), a hematopoietic growth factor?
A. Report any edema of arms, legs, or both.
B. Take the pill with food to prevent gastric distress.
C. Monitor the blood glucose levels daily.
D. See the ophthalmologist if vision becomes blurred.
2. The client receiving intravenous chemotherapy was nauseated and vomited twice the day before. Which action should the nurse implement?
A. Ask the dietary department to provide full liquids.
B. Hold all meal trays until the client is not nauseated.
C. Premedicate the client before each meal.
D. Have the client suck on ice chips frequently.
（答案见页底）
答案
Key to Questions
1. A. Neumega is a biologic response modifier that acts on the bone marrow to increase the production of platelets. It can also cause cardiovascular stimulation, tachycardia, vasodilation, palpitations, dysrhythmias, and edema. The client should report any of these symptoms and shortness of breath or blurred vision immediately.
2. C. The client may be able to tolerate meals if the client receives an antiemetic medication 30 minutes before each meal. The nurse can administer a PRN medication prior to each meal or request a routine medication order from the HCP.
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