Download Chemotherapy

Chemotherapy
Cancer Therapy
Patient Receiving Chemotherapy
Today’s Class:
Chapter 16 Pg. 381-386
 Goals of chemotherapy
 Agents & drug classifications
 Methods of administration
 Side effects (assessment/management)
 Nursing care, management &
interventions
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Chemotherapy Class Objectives:
Discuss the goals of chemotherapy.
 Describe the agents used in
chemotherapy, including classification,
methods of administration and side
effects.
 Describe the nursing assessment and
management of side effects of
chemotherapy
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Chemotherapy
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Is the use of drugs (antineoplastic
agents) to kill tumor cells by interfering
with cellular functions and reproduction.
Systemic treatment rather than a
localized therapy such as surgery and
radiation therapy.
Goals of Chemotherapy:
1) Cure: tumor or cancer disappears and
doesn’t return.
2) Control: stop the cancer from growing
and spreading.
3)Palliation: when cure and control are
not possible the goal is to relieve
symptoms caused by cancer, improve
QoL.
Goals of Chemotherapy
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Must be realistic because they will define the
meds to be used & aggressiveness of
treatment.
The primary focus of chemotherapy is
preventing cancer cells from multiplying,
invading adjacent tissue or developing
metastasis.
Objective of chemo : Destroy all malignant
cells without excessive destruction of normal
cells
Potential Patient Responses
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Complete response (CR)
– complete disappearance of the disease. No disease is
evident on examination, scans or other tests.
Partial response (PR)
– some disease remaining in body, but there has a been a
decrease in size or number of the lesions by 30% or more.
Stable disease (SD)
– disease has remained virtually unchanged in size and
number of lesions. Generally, a less than 50% decrease or a
slight increase in size would be described as stable disease.
Progressive disease (PD)
– Disease has increased in size or number on treatment.
Chemotherapeutic Agents :
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Cell Cycle Specific: mostly affect the S phase
& some the M phase. Administered in minimal
concentrations by continuous dosing routes.
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Cell Cycle Non-Specific: affects dividing and
resting cells in all phases of the cell cycle.
Administered in single bolus injection.
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Combination: agents that differ in both cell
cycle specificity & their toxicities are
combined to maximize tumor cell kill with
minimal toxicity.Administered in repeated courses.
Major Chemo Classifications
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Cell Cycle Specific:
Antimetabolitesinterfere DNA
synthesis, S Phase
(5FU, MTX ,folic acid)
Vinca Alkaloidsinhibits spindle
formation during
mitosis
(Vincristine)
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Cell cycle Non Specific:
Alkyating- alter DNA
(nitrogen mustard,
busulfan)
Antitumor Antibodies
DNA & RNA distort
( Bleomycin)
Hormonal Agentsbind to receptor sites
that promote growth
(Tomoxifen)
Factors to consider when choosing
patient’s chemo. treatment
Type of cancer
 Stage of Cancer (TNM System)
 Patient’s Age
 General State of Health
 Other health problems (liver, renal )
 Types of anticancer treatments in the
past
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Methods to Administer Chemo:
Oral
 Topical
 IV
 IM
 SC
 Intra-arterial
 Intrathecal
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Intrapleural
Intraperitoneal
Intravesical
Intralesional
Chemotherapeutic Agents
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Chemotherapeutic agents are apt to impair or damage
cells in the marrow than other normal cells in the body
(myelosuppression).
myelosuppression is the depression of bone marrow
function; decreased production of blood cells
Only actively dividing cells in the bone
marrow are affected (i.e. stem cells). Cells
with shorter life span are more affected
(white vs. red blood cell)
The damage to the bone marrow is
directly porportional to the drug dosage.
Thus, the damage to these tissues is dose
limiting. (Monitor CBC regularly)
What would happen if the nurse didn’t
know what the acceptable limit was???
Chemotherapeutic Agents
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The resulting reduction in the body’s
RBC, WBC and platelets limits the next
dose of chemotherapy that may be
safely given or causes postponement of
further drug treatment of cancer until
the patient recovers from the toxic
effects. (Recovery)
Chemotherapy: Side Effects
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Normal Cells
Affected:
– bone marrow
– mouth
– stomach
– intestine
– hair follicles
– reproductive
system
Side Effects of Chemo: RBC Decrease
RBC Decrease :
Anemia
Fatigue
SOB
Cold
Pale
Irritable
Dizzy
Weakness
Tingling
Anemia
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RBC’s transport oxygen to all parts of the
body are produced in the bone marrow.
Sometimes chemo can reduce the bone
marrow’s ability to produce these cells,
resulting in too few RBC’s to carry
oxygen to other body tissues.
 Without enough oxygen, other tissues
are unable to perform their functions.
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Female 120-160 g/L & Male 140-180 g/L
Anemia Nursing Interventions
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Assist pt. to conserve energy
sit on bedside prior to ambulating
oxygen administered as ordered
small frequent meals nutritional meals
communicate feelings of frustration & anger
are normal when fatigued
obtain order to administer blood when
hgb.<80
Side Effects of Chemo.
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Platelets Decrease:
bruises
petechiae
bleeding gums
blood urine/stool
Thrombocytopenia
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Platelet count in healthy individual ranges
150,000-350,000 per micro liter of blood.
Thrombocytopenia occurs when the plt.
Count <100,000
b/t 50,000-74,000 the condition is considered
moderate.
<50,000 risk bruising and bleeding increases
<20,000 plt. transfussion
Symptoms of Thrombocytopenia
Small red or purple spots on the skin
 unexplained bruising
 blood in stools(black) or emesis (coffee)
 usually heavy menstrual bleeding
 red to pink urine
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Nursing Interventions:
Thrombocytopenia
Avoid use straight-edged razor
 Avoid aspirin & NSAID’s
 Avoid IM’s
 avoid rectal temps. and suppositories
 Use lotions and lubricants on skin & lips
 Ensure BM’s soft
 Soft toothbrush
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Nursing Interventions:
Thrombocytopenia
Notify/educate for signs of bleeding
 Notify physician of hypertension
 Apply pressure to injection site,
venipuncture, biopsy site for 4-5
minutes post-procedure
 Avoid indwelling catheters
 May use birth control pill temporarily to
prevent/arrest menses
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Side effects of Chemo:
Neutropenia
Neutropenia: abnormally low WBC’s which
increases risk of infection.
WBC decrease therefore increase susceptiability to
INFECTIONS
 Symptoms:
 Fever, sore throat, cough, SOB,Nasal
congestion, burning urination, shaking
 chills, redness, swelling and warmth of an injury
Nursing Interventions:
Decreased WBC
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good handwashing b/t pts.
monitor v/s (esp.T)
monitor lab values
monitor signs inf.(resp,urinary
oral,skin)
maintain good patient hygiene
no mouthwashes (drying)
avoid people with colds
balanced diet
Managing Mucositis
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Through buccal cavity assessment
oral hygiene: soft toothbrush, freq. Rinses,
keep moist
no commercial mouthwashes or
lemon/glycerine swabs
use saline, club soda or saline & baking soda
meds as chlorhexidine rinses (may discolor
teeth)
Radioprotector
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Pilocarpine
administered orally
decreases the
chance of mucositis,
fungi, infections and
ulcers of the mouth.
Managing Peri-rectal
Complications
Scrupluous peri-care
 Clean front to back(F)
 Sitz baths
 Stool softners
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Alopecia
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Unavoidable side effect of some chemo which
is individual.
The life cycle of the cell that produces a hair
shaft is ~ one day.
Rapid rate of cell growth & reproduction
makes hair follicles sensitive to effects of
chemo.
B/t 7 &14 days post chemo hair thinning &
loss begin (not permanent)
hair may grow back a new color or texture
Caring for Scalp & Hair during Chemo
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Do not use hair coloring/permanent
treatments
Do not use brush type rollers
use mild shampoos
avoid blow drying
use soft brushes
use a sun block with most or all hair loss
to protect scalp from sun use hat, scarf or
turban
Safe handling of Chemo
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Three routes of accidental exposure:
1). Absorption through skin
2). Inhalation
3). Ingestion (food, gum)
Cytotoxic Precautions: protective practices
whereby all excreta from pt. on chemo. may
contain metabolized or cytotoxins. (urine &
feces highest concentration)
begin:prior to chemo & end ~ 48hrs. Post
completion chemo
Cytotoxic Precautions: Protective
Equiptment
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Gown: protective, non absorbent,
disposable
Gloves: Non-powdered latex made for
chemo
Goggles: not regular glasses
Masks: potential risk of droplet (topical
chemo)
Cytotoxic Caution Signs: foot of bed
Spill Kits: commercially developed
Sharps Container: needles, IV’s, blades
Chemo. Administration
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Remember:
to always spike chemo. bag at waste
level
to water proof tape at all connections
to remove protective equipment prior to leaving pt’s
room
know signs & symptoms of side effects chemo
adhere to hospital policies & procedures regarding
chemo. Be certified to give chemo
Two RN’s always check chemo
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Chapter 13 Pain Next Class