Nursing Interventions in the Client with Cancer: Chemotherapy

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Nursing Interventions in the Client with
CancerChemotherapy Radiation

• Developed for Adult Health II by
• Leslie S. Lorette, RN, MSN

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Goals of Chemotherapy

• Cure
• Adjunct to other therapy
• Induce remission
• Prolong life
• Palliate symptoms

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Mechanism of Action

• Selective destruction of cancer cells
• Systemic Administration
• Cytotoxic effects
• Normal cells affected
• Frequent cell division
• Skin
• Hair
• GI tract
• Spermatocyte
• Hematopoietic cells

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Antimetabolites

• Chemicals similar to normal metabolites,
  disrupting DNA
• Cofactors
• Vitamins
• Nucleotides
• Methotrexate
• Acute Leukemia
• Sarcoma
• Breast
• Colon
• Lung

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Antitumor Antibiotics

• Cause major damage to the cells DNA and
  interrupting DNA or RNA synthesis
• Bleomycin
• Squamous cell
• Lung
• Testicular
• Lymphoma

• Adriamycin
• Breast
• Ovarian
• Lung
• Lymphoma
• Hodgkins

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Alkylating Agents

• Tightly binds the double strands of DNA
  preventing DNA RNA synthesis, inhibiting cell
  division
• Cytoxan
• Leukoran
• Treat
• Hodgkins disease
• Adult acute leukemia
• Multiple myeloma
• Breast

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Antimitotic Agents

• Made from plant sources
• Interfere with the proper formation of
  microtubules so cells cannot complete mitosis
  during cell division. The result is cellular
  death or creation of two daughter cells incapable
  of mitosis.
• Taxol
• Ovarian
• Breast
• Lung

• Vincristine
• ALL
• Breast
• Wilms tumor
• Hodgkins
• Lymphoma

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Topoisomerase Inhibitors

• Inhibits DNA synthesis causing DNA breakage and
  cell death using Topoisomerase inhibition, an
  enzyme needed for DNA synthesis and cellular
  division.
• Camptosar
• 1st line therapy w/ 5FU leucovorin for
  metastatic colon rectal cancer

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Combination Chemotherapy

• Use of more than one drug results in synergy ( 1
  1 3).
• Damage to normal tissues and cells also
  increased.
• Oncologist must incorporate Nadir into the
  treatment plant when combining agents.

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Drug Dosing Schedule

• Usually based on a formula of mg/TBSA
• Schedule Timed to maximize malignant cell death
  and minimize death of normal cells (usually q3-4
  weeks) for a set number of deliveries.
• Course Entire planned schedule
• Rounds Individual day of administration.

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Routes of Administration

• Oral
• Hodgkins Lymphoma
• Leukemia
• Small cell lung CA
• Intravenous
• Solid tumors
• Lymphoma
• Intra-arterial
• Head neck
• Hepatic

• Isolated limb perfusion
• Intra-cavity
• Ovarian
• Brain
• Bladder

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Intravenous Administration

• Therapeutic effects rapid
• Tissue damage (vesicants)
• Complications
• Extravasation
• Pain, swelling, redness
• Infection
• Tissue loss
• Prevent tissue damage
• Cold compresses
• Warm compresses
• Antidote injection at extravasation site

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Cytoxic-Hazardous Drug Handling

• Powder free, thick, latex glove
• Protective gown, goggles, mask
• Supplies disposed in non-permeable container
• Spill kit on unit
• Wear gloves gown with patient toileting
• WASH HANDS
• Visit http//www.nih.gov/od/ors/ds/pubs/cyto/

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Intravenous Accesses

• Implantable
• Port-A-cath, Mediport
• Access with non-coring needles (Huber)
• Advantages
• Flush every 4 weeks
• No daily site care
• Completely internal
• No patient restrictions
• Disadvantages
• Surgical procedure to insert
• Requires skin puncture with each use
• Needle can become dislodged

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• Peripherally Inserted Central Cath
• (PICC)
• Advantages
• Inserted peripherally
• Appropriate for thrombocytopenic patients
• Disadvantages
• Daily care requirements
• Adequate vessel access
• Phlebitis (20)
• Only temporary line

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• Tunneled Central Venous Catheter
• Hickman, Groshong
• Single or double lumens
• Advantages/Disadvantages
• Long term use
• ? infection rate
• Require daily site care must be meticulous with
  care because of risk for infection.
• Inserted by minor surgical procedure
• Effects body image
• Visit
• http//um-jmh.org/HealthLibrary/homecare/VACathete
  r.html

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Side Effects of Chemotherapy

• Alopecia
• N V
• Mucositis
• Hemopoietic
• Immunosppression
• Anemia
• Thrombocytopenia
• Pancytopenia
• Cardiac toxicity
• Pulmonary toxicity
• Nephrotoxicity
• Fatigue

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Nursing Care

• Alopecia
• Hair loss within 2-3 weeks
• Patchy hair loss may occur
• Other parts may not be affected
• Minimize hair manipulation
• Reassurance that hair will grow back

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Side Effects- Gastrointestinal

• Anorexia
• Eat even when not hungry
• Avoid fluids with meals
• Small feedings
• Provide high calorie, high protein foods
• Increase activity level
• Appetite stimulants
• Megace
• Marinol
• Steroid compounds

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Gastrointestinal Side Effects

• Nausea vomiting
• Induced during and 1-2 days post
• Causes
• Direct GI mucosal irritation
• Chemoreceptor Trigger Zone
• Labyrinth disturbances
• Cerebral cortex

• Antiemetics
• Given prior to chemo cont. for 12-24 hrs
• Serotonin Antagonist
• (Zofranvery expensive)
• Relaxation
• Guided Imagery
• Music
• Acupuncture

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Mucositis

• Entire GI tract, esp. mouth
• Results from added effect of mucosal cell death
  from chemotherapy.
• Occurs 3-8 days post
• last 5-14 days
• Good, frequent oral hygiene
• Soft toothbrush or tooth spongettes
• No dental floss
• Rinse every hour with H2O or NS
• (Avoid commercial products)
• Swish and spit
• Viscous xylocaine prior to meals

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Bone Marrow Suppression

• ? leukocytes, RBC platelets
• Neutropenia (? in circulating neutrophils
  tissue macrophages) count lt 1000
• Absolute neutrophil count (ANC)
• Total WBC X ( neutrophils bands)
  100 ANC
• Thrombocytopenia (Platelet count)
• lt 50 (prolonged bleeding w/ small trauma)
• lt 20 (spontaneous uncontrollable bleeding)
• Anemia
• ? circulating erythrocytes
• Fatigue, hypoxia

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Protection from Infection

• STRICT HANDWASHING!!!!!!!!
• Strict Asepsis
• Private room
• Daily housekeeping
• Limit visitors
• Inspect mouth, skin, IV sites
• Monitor vital signs Q4h
• Keep BP cuff, thermometer, stethoscope in room
• Avoid indwelling catheters
• No fresh flowers or plants in room
• Eat a low bacteria diet
• No raw vegetables or fruits, salads, undercooked
  meat, yogurt, cheese, pepper and paprika

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Clients with Thrombocytopenia

• Avoid IM injections or venipunctures
• Hold puncture sites for at least 10 minutes
• PICC for Medication
• Avoid invasive procedures
• Guaiac stools and urine
• No rectal temps or enemas
• Use stool softeners to avoid straining
• Gentle oral care
• Avoid hard foods
• Reposition in bed using pad or sheet
• No ASA or anticoagulants
• Use electric razor
• Avoid blowing nose
• Platelet infusion for count lt 20,000

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Teaching for Home

• Avoid crowds
• Do not share toiletry items
• Do not reuse dishes without washing
• No contact sports
• Wear shoes
• Avoid dental work
• Do not change pet litter boxes

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Radiation Therapy

• Purpose
• Destroy cancer cells with minimal exposure of
  normal cells
• Mechanism of action
• Ionizing radiation
• Gamma
• Beta
• Alpha
• Exposure
• Dose

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Radiation Therapy

• Teletherapy
• Brachytherapy
• Sealed Radiation
• Nursing Care
• Private room
• Dosimeter badge
• Limit time
• No pregnant women or children
• Handling radioactive source

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Nursing Care

• Education
• Skin care
• Avoid sun exposure
• Long term effects