“A real people-person who never met a stranger.” That is how family and friends have always described Carl Guenther. His positive and outgoing personality is well known in the community. When Carl was...

“A real people-person who never met a stranger.” That is how family and friends have always described Carl Guenther. His positive and outgoing personality is well known in the community. When Carl was informed about his prostate cancer, he handled the diagnosis well and with his usual optimism. He was confident that the chemotherapy would be successful. His mantra for years had been to “Live every day as if it were your last.” However, the treatment for the cancer had adverse effects that he did not expect and his enthusiasm diminished. Carl is a 72-year-old retired sales representative for a chain of department stores. His entire career was centred on interacting of people. When he retired, his outgoing nature was an asset for the many community agencies at which he volunteered to help. He was active in the local Lions Club, his church’s outreach ministry, and at the children’s hospital. He had even considered working as a greeter at his neighbourhood department store. As he went through chemotherapy, the associated nausea and vomiting were well managed with antiemetic agents. His physical appearance did not change much since Carl had minimal hair loss due to the chemotherapy. Now he faces an exceedingly low white blood cell count and has been advised to avoid potential sources of infection, including people. By far this is the worst adverse effect of the chemotherapy for Carl. He feels socially.

1. The health care provider orders filgrastim (Neupogen) 10 mcg/kg daily for 4 days. Carl asks you, his nurse, “How does this drug work?” What is your response?

2. List interventions that should be followed during this period of chemotherapy-induced neutropenia to protect Carl from infection.

3. What adverse effects would you monitor in patients receiving Neupogen?