Jackie is administering six units of pooled random donor platelets to Stuart, a patient with myelodysplastic syndrome. The transfusion was started at 120 ml per hour, per hospital policy. When Jackie rechecked Stuart’s vital signs at 15 minutes, she noted that his temperature had increased from 37.1°C to 38.1°C. In addition, Stuart was chilling. What would you do?

Hal is a 73-year-old patient with refractory multiple myeloma. Florence, his wife, calls the hematologist’s office and asks to speak with the triage nurse. She says she is worried about her husband and that “he’s just not himself.” What would you do?

As oncology care continues to move toward delivery in the outpatient setting, the number of patients reporting symptoms by telephone also continues to increase. Unlike face-to-face symptom reporting, telephone reports are initiated by patients or caregivers.

Gina is filling in for the triage nurse at her facility’s outpatient solid tumor department. She receives a call from a patient who reports severe swelling in her left arm after returning from a trip on the opposite side of the United States. She says the skin in her arm and hand is quite tight, and that her hand was throbbing when she woke up this morning. What would you do?

Erin arrives in your injection clinic for her monthly injection of fulvestrant. She tells you that her regular nurse always warms the drug before the injection by wrapping it in a warm pack because it lessens the discomfort during the injection. She says her nurse also told her it makes the medication easier to administer. What would you do?

Although use of hospice services continues to increase across the United States, with more than 1.5 million Americans receiving services in 2010, only 9% of hospice recipients are African American.

William calls your office complaining of painful redness and blisters on his chest. He admits that during the recent warm weather, he hadn’t been wearing a shirt while working in the yard. He initially thought it was a sunburn, but the symptoms continued to worsen and were unrelieved by typical sunburn remedies. Upon reviewing William’s chart, you see that he recently received radiation and chemotherapy therapy for Hodgkin disease. What would you do?

Bob, a 61-year-old man with multiple myeloma, calls his hematologist’s office complaining of worsening constipation despite increasing his fiber and liquid intake. Yesterday, he stopped taking his ondansetron because he remembered that it can cause constipation, but now he’s nauseated in addition to being constipated. What would you do?

April is car­ing for a patient with bil­iary can­cer. She receives a new chemother­apy order for cis­platin fol­lowed by gem­c­itabine on days 1 and 8 every three weeks. The stan­dard sequence in April’s hos­pi­tal is to admin­is­ter plat­inum agents last. How­ever, the order clearly states to admin­is­ter the cis­platin first. What would you do?

Louise arrives in your office for her chemotherapy treatment with doxorubicin and paclitaxel.

Symp­toms of lung can­cer rarely occur in iso­la­tion