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Chemotherapy

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This type of cancer treatment is trained to recognize rapidly dividing cells. (This includes hair follicles and GI cells, which are also rapidly dividing.) It is systemic and effects all body tissues. It can kill metastatic cells.

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Risk for Infection

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This is the PRIMARY risk for patients on chemotherapy.

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Reasons for using Chemotherapy

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These include: - A Cure - Increased Survival Time - Decreased life threatening complications

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Chemotherapy Types: Antimetabolites

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This is a type of chemotherapy that is considered renal and hepatotoxic Ex: Methotrexate

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Chemotherapy Types: Antitumor Antibiotics

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This is a type of chemotherapy that is considered cardio-toxic. It can cause a patient to go into heart failure. Ex: Adriamycin (This is Ototoxic and Nephrotoxic)

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Chemotherapy Types: Alkylating Agents

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This is a type of chemotherapy that is considered Renal and Ototoxic. It can cause seizures. Have the patient drink and void frequently. - Be concerned with Cystitis / pinkish urine

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Chemotherapy Types: Antimiotic Agents/Plant Alkaloids

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This is a type of chemotherapy that is considered Neurotoxic and can cause parastesia. Ex: Vincristine. This can cause bowel hyper-motility, but usually hypo-motility

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Chemotherapy Types: Hormones

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This is a type of chemotherapy that is an Anti-Estrogen agent, used for breast cancer. Ex: Tamoxifen

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Chemotherapy Types: Miscellaneous Agents

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Examples of these are Matulane and Procarbazine, which are used to treat nausea and vomiting.

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Nadir

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This is the time when bone marrow activity and blood counts are the lowest. Usually 7-28 days for most drugs. Combination Chemotherapy is the most effective because each medication kills cells at varying times.

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Routes of Chemotherapy Administration

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These include - Intravenous (Systemic and Rapid delivery) - CVAD - Central Venus Access Device * When going for placement of this: Prep vitals, etc. It should be 1st patient of the day to deal with unless there is an emergency.

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Types of Catheters

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These include: - PICC Line - Portacath

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PICC Line Catheter

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This catheter for chemotherapy has 2 ports. A certifyed RN can insert this. Things to observe for: - Any cyanosis or change in VS, call Dr. Stat - If there is a break or rupture in the line - Clamp between the break and the patient. This line can stay in place for years.

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Portacath Catheter

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This catheter for chemotherapy that has an implanted port which looks like a pacemaker. With this: Palpate, locate the center of septum, aspirate and discard 5 mL Once the incision is healed, patients can go back to normal activity.

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Extravasation

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This is a complication that can occur during chemotherapy. Chemo is a tissue irritant, and if it leaks into the surrounding area or becomes infiltrated, Erthema and Edema can occur. - less than .5 mL heals itself. Anything greater is a large problem.

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Extravasation Actions

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With this, first FILE INCIDENT REPORT. Then: - Discontinue - Follow facilities policy - Call MD - Follow MD's orders - Monitor S&S - Monitor Patient for the remainder of the shift - Give a report to the next nurse about what occurred.

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Side Effects of Chemotherapy: Alopecia

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This usually happens 2-4 weeks after treatment begins. Hair regrows 1-2 months after chemotherapy is done. It may become a different texture though.

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Side Effects of Chemotherapy: Nausea and Vomiting

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Chemo is considered emitogenic (vomit inducing) This lasts 1-2 days after chemo is stopped. If a patient gets nauseous the first time, they may get anticipatory nausea before future treatment. They shouldn't eat or drink 4 - 6 hours before.

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Antiemetics

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Examples of these include: Reglan, Compazine, and Zofran.

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Non-Pharmacological Anti-Nausea Treatments

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Here, try to distract the patient: use music, tv, convo, guided imagery or massage.

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Side Effects of Chemotherapy: Mucositis/Stomatitis

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This is a side effect of chemotherapy that causes sores on the mucus membrane, due to the rapid uptake of chemotherapy.

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Stomatitis/Mucositis Treatment

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With this, assess every 4 hours. Have the patient use a soft bristle toothbrush, disposable gauze - several times daily. - For Pain Relief * Hurricane - swish and spit (lidocaine based) * Nistatin - swish and swallow for fungal Avoid spicy foods, citrus, hard foods. Give ice chips and popsicles

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Side Effects of Chemotherapy: Bone Marrow Supression

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This is the most life threatening effect of chemotherapy. This can cause: - Leukopenia - Anemia - Thrombcytopenia - Pancytopenia

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Leukopenia

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This occurs in Bone Marrow Suppression, resulting in a decrease in WBC, and decreased Neutrophils. With this, infection is a major concern, as well as sepsis (band shift to the left)

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The Treatment For Leukopenia

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This is Neuprogen (Filgrastim) It has a side effect of chills or fever. If this occurs, give the patient Tylenol.

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Nursing Care for the Immuno-suppressed Patient

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Here, give the patient a private room. If the WBC count is below 1000, establish reverse isolation. Limit the number of people entering the room. No flowers or plants.

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Prevention of Infection in the Immuno-suppressed patient

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Here, even if the WBCs are back to normal - the cells are immature and can't fight infection. Avoid crowds Hand washing Clean toothbrush inside the dish washer. Don't change a litter box. Record temperature daily and report any temperature above 100, any persistent cough, any drainage from an open area, and any foul smelling urine.

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Anemia

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This occurs in bone marrow supression where a patients RBC, Hgb, and Hct are decreased. With this, you are worried about Hypoxia. - Patient will be weak, cold, pale, with an increased RR

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The Treatment for Anemia

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This is Epogen/Procrit. Side effects of this include joint pain, fever, headache, myalgia, and seizures.

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Nursing care for the Anemic Patient

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With this, the patient needs adequate rest periods. - Vital signs need to be done - You must monitor labs - Call the MD if the Oxygen saturation is low.

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Thrombocytopenia

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This occurs in bone marrow suppression, where the patients platelets are decreased. Here, you are concerned with bleeding and a risk for injury.

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The Treatment for Thrombocytopenia

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This is Neumega. Side effects of this are Nausea and Vomiting. Sometimes, fresh frozen plasma can be used to replace blood volume. *Hang platelet transfusion before the blood transfusion. *Before Fresh Frozen Plasma, give Benadryl and Tylenol

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Nursing care for the Thrombocytopenic Patient

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With this, assess level of consciousness for a brain bleed. - Assess VS, hematuria, hemptisis, stool for blood, abdominal girth - Handle them gently, always use a lift sheet. - Avoid IM injections and venipuncture. - Use a small gauge needle and apply pressure for 10 minutes. - Monitor new IV site site for 2 hours. - Trauma to any area - apply ice - Test all stool and urine for blood - no rectal temp, and if the patient needs a suppository, use lubrication - Don't pick nose, brush teeth, and use an electric razor - Avoid anal intercourse - No tight fitting cloths - advise against contact sports - wear shoes with firm soles - give a stool softener - don't take asprin

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Pancytopenia

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This is the occurance of all three bone marrow issues; Leukpenia, Anemia, and Thrombocytopenia. With this, monitor VS ver carefully for any change. You want to keep them as close to their baseline as possible.

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Renal System Effects of Chemotherapy

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Here, chemo can cause kidney damage and increase uric acit (Normally 3 - 8) This is cause by: - Platinol or Cytoxan - Adriamycin (CAUSE RED DISCOLORATION IN URINE, it is Ototoxic and Nephrotoxic)

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Renal System Care

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With this, check BUN and creatinine. Here, you want to increase voiding so therefore increase fluid to 3 - 5 liters per day. - You would give Alopurinol to prevent uric acid formation and decrease uric acid level.

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Chemotherapy Reproductive System Effects

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This causes infertility. Patients should be encouraged to due egg retrieval and place sperm in a bank. Also, encourage reliable contraception.

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Chemotherapy Neurological System Effects

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These effects are usually the result of the medication Vincristine (Plant Alkaloid)

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Hormonal Manipulation

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This treatment keeps cancer cells from getting the hormones it needs to survive. Some need Estrogen. - Example: AntiEstrogen = Tamoxifen

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Biological Response Modifiers (BRM)

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This treatment modifies patients biological response to tumor cells. It is used to boost or restore the ability of immune system to fight cancer and other infections.

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Targeted Therapy

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This is an experimental treatment, not considered a cure. An example of this is moAB - Monoclonal Antibodies, which are used to prevent the growth of tumors and extend life.

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Gleevec

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This is an oral Monoclonal antibody, used for treatment of CML. With this medication: - AVOID TYLENOL as it increases the absorption and can cause liver cancer. - AVOID GRAPEFRUIT JUICE as it also increases the absorption of the medication.

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Herceptin

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This is a Monoclonal antibody used in the treatment of breast cancer.

Nursing 22: Oncology – Exam 1 (Chemotherapy) – Flashcards

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