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Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

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Oncologic Nursing: Chemotherapy

the oncology nurse administering IV chemotherapy
Definition
  • Chemotherapy involves the use of powerful chemical to kill cancer cells
  • Different chemotherapeutic drugs attack cancer cells and interfere with cell growth in different stages of the cell cycle.
  • Chemotherapy works by killing rapidly dividing cells, meaning, it affects cancer cells and healthy cells of the bone marrow, gastrointestinal tract, reproductive system and hair follicles; healthy cells, however, recover after treatment is complete.
  • In some cases, chemotherapy may be the only treatment needed by cancer patients. More often, it's used in conjunction with surgery, radiation or a bone marrow transplant, to improve results. For instance, patients may receive:

      • neoadjuvant chemotherapy-->chemotherapy before other treatments; reduces the size of a tumor prior to surgery or radiation
      • adjuvant therapy-->given after surgery or radiation; eliminates cancer cells not removed by previous treatments
Purposes of Chemotherapy
  • Chemotherapy can be used to eliminate cancer cells in the body, control the spread of cancer to other parts of the body, and relieve symptoms of cancer.
How Chemotherapy is Administered
  • The most common ways to administer chemotherapy are:
    • oral
    • intravenous (IV)
    • intramuscular (IM)
    • subcutaneous (SC)
  • Chemotherapy may also be administered to using the following techniques:
    • Intrathecal: directly to the CNS-->brain, spinal cord
    • Intra-arterial: arteries are used to deliver chemotherapy directly to the organs
    • Intraperitoneal:directly into the abdomen
    • Intravesical: directly in the bladder
Major Side Effects and Nursing Interventions
  • nausea and vomiting
    • administer antiemetics (e.g. Plasil) routinely every 4-6 hours after as well as before chemotherapy is started
    • withhold food and fluids 4-6 hours before chemotherapy-->a light, dry snack may be allowed
    • improve patient's appetite and minimize food aversion by:
      • providing 5-6 small meals per day
      • provide bland, non-greasy foods-->crackers, toast
      • serving foods at room temperature or slightly cooler-->less odor
  • diarrhea
    • administer antidiarrheals as ordered
    • maintain perineal care-->to prevent infection and minimize discomfort; medicated creams may be prescribed
    • give clear liquids as tolerated-->apple juice, ginger ale, jello, broth
    • instruct patient to avoid milk products, spicy foods, and hard to digest foods temporarily-->to rest the bowel
    • monitor potassium, sodium, and chloride levels
    • measure I&O regularly
  • stomatitis
    • provide and instruct patient on good oral hygiene-->inspect mouth regularly, use non-alcoholic mouthwash (e.g.)diluted hydrogen peroxide),removal of ill-fitting dentures, use of soft-brsitled toothbrush
    • provide health teachings on the importance of:
      • keeping mucous membranes moist-->let patients suck on popsicle
      • avoidance of hot and spicy foods-->pasta and tacos
      • avoidance of acidic and/or carbonated food and drinks-->cola, orange juice, grapefruit juice
      • keeping food at room temperature or slightly cool
    • apply water-soluble lubricant such as KY jelly to dry, cracked lips
    • offer viscous lidocaine before meals to minimize discomfort
  • thrombocytopenia (low platelet count)
    • monitor blood count
    • observe for epistaxis, petechiae, and ecchymosis
    • protect clients from injury-->no flossing, use of razor
    • instruct clients to avoid bumping or bruising the skin
    • avoid giving IM injections
  • leukopenia (decrease in number of circulating WBCs)
    • implement careful handwashing technique
    • maintain reverse isolation as ordered
    • monitor for signs of respiratory and other infections
    • instruct patient to avoid crowds/person with infections
    • provide patient teachings on the early signs of infection:
      • Fever above 100.4°F (37.8°C)
      • Chills
      • New cough or production of sputum
      • Sore throat
      • More than three loose stools in a day
      • Pain or burning upon urination
  • anemia
    • monitor hemoglobin and hematocrit
    • encourage adequate rest and sleep periods
    • administer oxygen as needed
    • provide health teachings on symptoms of anemia:
      • Fatigue, dizziness, lightheadedness
      • Shortness of breath
      • Difficulty staying warm
      • Chest pains
  • alopecia
    • inform patient that hair loss is not permanent
    • encourage the patient to obtain bandana or wig before starting treatment
    • administer scalp tourniquet or scalp hypothermia using ice pack as ordered-->to minimize hair loss
    • offer support and encouragement
    • provide health teachings on the importance of:
      • maintaining skin and scalp moisture-->limit shampooing to 3x a week with a mild shampoo and conditioner
      • preventing damage to hair follicles-->avoid using hair dryers, irons, and dyes
      • avoid tangling hair-->wide-toothed comb; use of silk pillowcase when sleeping
  • kidney damage
    • encourage increased fluid intake and frequent voiding to prevent accumulation of metabolites in the bladder
    • administer Allopurinol (Zyloprim) as ordered-->prevents uric acid formation which is common among patients on chemotherapy
  • reproductive organ damage
    • sperm banking is encouraged for men-->chemotherapy may cause infertility
    • advise clients and partners to use reliable methods of contraception-->chemotherapy can cause mutagenic damage to chromosomes leading to birth defect
  • neurologic damage
    • peripheral neuropathies and hearing losses may occur
    • protect patient from injury


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