Chemotherapy nsg

8/13/2019 Chemotherapy nsg

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What

You Need to Knowabout

Chemotherapy?

__________________Jessie T. Orao, RN, RM

eacher


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Objectives

Define common terms regardingchemotherapy and radiation.

Identify the principles of chemotherapy andradiation therapy.

Discuss the purposes of chemotherapy andradiation to cancer patient.

Prioritize safety of the patient, self, and othersin preparation, administration, and the after

care procedure for chemotherapy andradiation.

List safety measures regarding chemotherapyadministration and radiation therapy.


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Definition

It is the use of antineoplastic drugs to

promote tumor cell destruction byinterfering with cellular function and

reproduction. It includes the use of

chemotherapeutic agents and hormones


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Personal Safety toMinimize Exposure via

Inhalation

Chemotherapeutic agents shouldbe prepared in a class II biologicsafety cabinet (vertical laminar flowhood)

Vent vials with filter needle toequalize the internal pressure or usenegative pressure techniques.

Wrap gauze or alcohol padsaround the neck of ampules whenopening to decrease dropletcontamination.

Wrap gauze or alcohol padsaround injection sites whenremoving syringes or needles from

IV injection ports. Do not dispose materials by

clipping or removing needles fromsyringes.

Use puncture-and leak-proofcontainers for non-capped, non-clipped needles

Do not eat, drink, chew gum, orsmoke while preparing orhandling chemotherapeuticagents.

Keep all food and drink awayfrom preparation area.

Wash hands before and afterhandling chemotherapy. Avoid hand-to-mouth or hand-to-

eye contact while handlingchemotherapeutic agents orbody fluids of the personreceiving chemotherapy.

Personal Safety toMinimize Exposure via

Ingestion


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PERSON L S FETY TO MINIMIZE EXPOSUREVI SKIN CONT CT

1. Wear powder-free latex gloves with at least .007 thickness at alltimes when preparing or working with chemotherapeutic agents.

2. Wash hands before putting on and after removing gloves.3. Change latex gloves after each use, tear, puncture or medication

spill or after every 30 minutes of wear.4. Wear a long-sleeve, non-absorbent gown with elastic at the wrists

and back closure.5. Eye and face shields should be worn if splashes are likely to occur.6. Use syringes and IV tubing with Luer locks.7. Label all syringes and IV tubing containing chemotherapeutic

agents as hazardous material.8. Place an absorbent pad directly under the injection site to absorb

any accidental spillage.9. If any contact with the skin occurs, immediately wash the area

thoroughly with soap and water.10. If contact is made with the eye, immediately flush the eye with

water and seek medical attention.11. Spill kits should be available in all areas where chemotherapy is

stored, prepared, and administered.


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Safe Handling

Chemotherapeutic Agents

Chemotherapeutic Drugs are hazardous drugs.

a hazardous drug is defined as an agent that

presents a danger to healthcare personnel due toits inherent toxicity.

They are carcinogenic

They are genotoxic

They are teratogenic

There is evidence of toxicity at low doses


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SAFE DISPOSAL OF ANTINEOPLASTIC AGENTS,BODY FLUIDS, AND EXCRETA

Discard gloves and gown into a leak-proofcontainer which should be marked as

contaminated or hazardous waste. Use puncture-and-leak-proof containers for

needles and other sharp or breakable objects. Linens contaminated with chemotherapy or

excreta from patients who have receivedchemotherapy within 48 hours should bemarked hazardous waste bags.

Wear latex gloves in disposal. In the home, wear gloves when handling

contaminated linen, clothing or even excreta ofthe patient receiving chemotherapy.


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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSING

INTERVENTIONS

Alopecia

Hair loss that occurs as chemotherapeutic drugs

destroy the rapidly growing cells of hair follicles This is dependent on the dose, half-life of drug,

and duration of therapy.

Begins 2-3 weeks after administration of

chemotherapy Regrowth takes about 3-5 months.


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INTERVENTIONS

Interventions:

Goal:Strengthening Coping with Altered Body Image

1. Reassure patient that hair usually grow back.

2. Suggest wearing of turban, wig or headscarf

3. Encourage patient to stay on therapeutic program.

4. Emphasize to the patient the need for appropriate headprotection against sunburn

5. Inform the patient that his scalp will become sore at

times due to follicles swelling


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Nursing Diagnosis:

Altered Body Image related to alopecia


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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSINGINTERVENTIONS

Anorexia Chemotherapy changes

the reproduction of tastebuds.

Altered taste can lead to

decrease food intake. Renal or hepatic disease

can lead to anorexia.

Interventions:

Goal: Promoting nutrition

1. Encourage small, frequentmeals, appealing topatient preference.

2. Encourage to eat a diethigh in calories andproteins.

3. Discourage smoking andalcoholic beverages ,which may irritate mucousmembranes.

4. Discuss the importance ofincreasing fluid intake


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Nursing Diagnosis

Altered Nutrition: Less Than Body

Requirements related to side-effects oftherapy


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INTERVENTIONS

Fatigue

The cause is unknownbut can be related toanemia, weight loss,altered sleep patternsand coping.

Interventions:Goal: Minimizing fatigue1. Monitor blood counts

(Hgb. and Hct.)2. Administer blood products

as prescribed.3. Caution the patient about

overexertion4. Plan frequent rest periods

between daily activities.5. Explain that BT may begiven.

6. Observe skin color.7. Monitor nutritional status


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Nursing Diagnosis

Fatigue related to anemia


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INTERVENTIONS

Nausea and Vomiting

Caused bystimulation of thevagus nerve.

Incidence dependson the particularchemo- therapeuticagent.

3 Patternsa. Anticipatory

b. Acutec. Delayed

Interventions:Goal:Promoting Nutrition

1) Administer antiemetics prior tochemotherapy and on routineschedule.

2) For highly emetogenic regimens:Zofran & Decadron3) For Moderately emetogenic

regimens: Droperidol, Decadron,4) Metoclopramide, plus Benadryl5) For low emetogenic regimens: OTC

antiemetic drugs.

6) For delayed vomiting, continuetreatment for 24 to 48 hours.7) Consider measures for anticipatory

vomiting8) Encourage small, frequent meals.9) High protein diet, increase fluid

intake.

10) Monitor I & O.


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ACUTE NAUSEA and VOMITING

Signs and symptomsNausea and vomiting occurring within

the first 24 hours of treatment

Nursing InterventionsTreat the patient with acute nausea and

vomiting with antiemetic drugsDexamethasoneGranisetron

LorazepamMetoclopramideOndansetron


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DELAYED NAUSEAand VOMITING

Signs and SymtomsNausea or vomiting starting or continuingbeyond 24 hours after chemo has begun

Nursing InterventionsThe administration of serotonin

antagoninsts, corticosteroids, variousantihistamines, benzodiapines, and andmetoclopramide is usually effective intreating patients

Prevention Measures

Administer antiemetic before chemobeginsSome patients with delayed nause and

vomiting are treated with an antiemetic for3 days or longer


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Nursing Diagnosis

Risk for Fluid Volume Deficit related to side-

effects of chemotherapy


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Nursing Diagnosis

Altered Oral Mucous Membrane related to

stomatitis


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Anemia

Occurs as chemo drugsdestroy healthy cells andcancer cells

RBCs are destroyed andcant be replaced by the

bone marrow It require RBC transfusion or

erythropoietin injection

Signs and symptomsDizziness, fatigue,

pallor, andshortness of breathafter minimalexertion

Low hemoglobinlevel andhematocrit

May developslowly over severalcourses oftreatment


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Interventions:

Goal: Minimizing anemia

Nursing Interventions

Monitor hemoglobin level, hematocrit, RBC count; reportdropping values

Be prepared to administer a blood transfusion or erythropoietin

Prevention Measures

Instruct the patient to take frequent rests, increase his intake ofiron-rich foods, and take a multivitamin with iron as prescribed

If the patient has been prescribed a drug such as epoetin,make sure he understands how to take the drug and whatadverse effects he should watch for and report


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Neutropenia

Absolute neutrophilcount 1,500/mm orless.

Occurs 7-14 daysafterchemotherapy.

Risk of infection isincreased.

Caused bysuppression of stemcell.

Interventions:Goal:Preventing Infection1. Monitor V/S q4h. Report

occurrence of fever.

2. Reinforce good personalhygiene habits.3. Avoid contact with persons

who have transmissible illness.Practice reverse isolation.Wear mask.

4. Encourage coughing anddeep-breathing.5. Follow-up monitoring of WBC

count.6. Administer prophylactic

antibiotics as prescribed.


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LEUKOPENIAReduced leukocytes or WBCsOccurs as WBCs and cancer cells are destroyed bychemo drugs

Signs and SymptomsSusceptibility to InfectionsNeutropenia

Nursing InterventionsWatch for the nadir, the point of lowest blood cellcountBe prepared to administer colony-stimulating factorsInstitute neutropenic precautions


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Nursing Diagnosis

Risk for Infection related to neutropenia


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Thrombocytopenia

Caused by suppression

of megakaryocytes. Risk of bleeding is

present when plateletcount falls below50,000/mm.

May require platelettransfusion if count dropsbelow 20,000/mm.

Interventions:Goal:Minimizing Bleeding1. Avoid invasive procedure

when platelet count is less

than 50,000/mm.2. Apply pressure on injectionsites fro 5 minutes.

3. Monitor platelet count.4. Abstain from the following:

a. Use of sharp objects.

b. Sexual intercourse.c. Dental workd. Use of NSAIDs, aspirin,and aspirin-containingproducts.


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Nursing Diagnosis

Risk for Bleeding related to

thrombocytopenia


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DIARRHEA

Occurs because the rapidly dividing cells of the intestinal

mucosa are killed

Complications include weight loss, F&E imbalance, and

malnutrition

Signs and symptoms

An increase in the volume of stool compared with the

patients normal bowel habits


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DIARRHEA

Nursing InterventionsAssess frequency, color, and consistency of stool

Encourage fluids, give IV fluids and potassium supplements

as ordered

Prevention measuresUse dietary adjustments and antidiarrheal meds

Provide good perianal skin care


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EXTRAVASATIONThe inadvertent leakage of a vesicant

solution into the surrounding tissue

Signs and Symptoms Initial signs and symptoms may resemble

those of infiltrationblanching, pain,swelling

Symptoms possibly progressing to blisters; toskin, muscle, tissue and fat necrosis; and totissue sloughing

Blood return is an INCONCLUSIVE test andshouldnt be used to determine if IVcatheter is correctly seated in theperipheral vein. To assess peripheral IVplacement, flush the vein with NSS andobserve site for swelling.


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Extravasation of Doxorubicin


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INFILTRATION

The inadvertent leakage of a nonvesicantsolution or medication into the surroundingtissue

Infusion-site related

Signs and symptoms

BlanchingChange in IV flow rateNumbness and tingling in swollen area due

to nerve compression injury leading tocompartment syndrome

Swelling around IV site (the swollen areawill be cool to touch)


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Nursing Interventions

Remove the IV catheter

Insert a new IV catheter in a different location

Prevention Measures

Check for infiltration before, during, and after theinfusion by flushing the vein with normal saline

solution


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The art of being a nurse

lies in the power of giving what is best for ourpatients in some ways.

Life does not force us to be the best, it onlyasks constant care and love

Dr. Gregory House


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THE END!!!

Thank YouVery Much!!!

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Chemotherapy nsg