Question

A 33 year old female is being treated for rheumatoid arthritis with Methotrexate, a Disease-Modifying Antirheumatic arthritis drug (DMARD). She has a history of DVT, but no other significant medical history. The physician currently increased her dose from 10 mg/week to 25 mg/week and also added Leucovorin to her treatment regimen. Bone marrow suppression is a common adverse effect of methotrexate treatment.

1) What 2 labs would the nurse expect to be ordered to monitor for bone marrow suppression? If the patient is experiencing bone marrow suppression what signs and symptoms would the nurse look for on assessment?

2)What are contraindications for treatment with a DMARD?

3) What therapeutic effects should the patient experience from treatment with a DMARD?

4) Why has the physician ordered Leucovorin (See Chapter 45-Methotrexate)? Explain your answer.

Answer 1

1. 2 LAB TESTS TO DETERMINE BONE MARROW SUPPRESSION

• Bone marrow aspiration : which removes a small amount of bone marrow fluid.
• Bone marrow biopsy:which removes a small amount of bone marrow tissue.

Bone marrow makes different types of blood cells like RBC, WBC and platelets. When bone marrow is suppressed there can be alterations in the amount of production of these cells.

SIGNS AND SYMPTOMS OF BONE MARROW SUPRESSION

Signs and Symptoms of low platelet cells (thrombocytopenia)

• Bleeding from nose, gums or mouth.
• Easy bruising
• Blood in urine
• Dark bowel movement

Signs and Symptoms of low WBC (Neutropenia)

• Rash
• Mouth soars
• Diarrhea
• Fever
• Chills
• Cough
• Shortness of breath

Signs and Symptoms of low RBC (anemia)

• Pale skin and lips
• Weakness
• Dizziness
• Tiredness
• Pale nails

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