10.5 Basics of Chemotherapy

Question 1

Chemotherapy

Answer 1

• Use of cytotoxic agents to inhibit growth, development, and proliferation of malignant cells.

Types
- Alkylating agents
- Antimetabolites
- Anti-tumor antibiotics
- Topoisomerase inhibitors
- Mitotic inhibitors
- Corticosteroids
- L-asparaginase (Velcade)

Others
- Targeted therapies
- Differentiating agents
- Hormone therapy
- Immunotherapy

Question 2

Chemotherapy

Answer 2

• Affect cells that are actively growing and dividing (healthy or malignant) such as bone-marrow, cells lining mouth, GI tract, or hair follicles.

Question 3

Adverse Effects of Chemotherapy

Answer 3

Low Blood Cell Counts
- Usually reach their lowest point 7-14 days after chemotherapy
- Due to effects on bone marrow
- MOST SERIOUS SIDE EFFECT OF CHEMOTHERAPY
- Neutropenia, thrombocytopenia, anemia

N/V - Within 24 hours

Diarrhea - Due to affecting the GI tract (worse when combination of drugs are given)

Lose interest in sex, fertility, can induce menopause.

Loss of appetite due to buildup of waste as cancer cells die. Can also cause changes in taste/smell

Stomatitis and Sore Mouth - Happens 5-10 days into treatment and often gets better few weeks after treatment.

Alopecia - Loss of hair due to damaged hair follicles

Question 4

Chemotherapy Administration

Answer 4

• IV is most common (also oral can be used)

Handling/Proper Disposal
- Can be absorbed through skin, mucous membranes, and inhalation.
- Manage spills and measure accidental exposure.

Question 5

Nursing Management

Answer 5

• Assess fluid/electrolytes
• Assess cognitive status
• Risk of infection
• Prevent N/V
• Manage fatigue
• Protect caregivers
• Administer the chemotherapy

Question 6

Chemotherapy at home

Answer 6

• Have a spill kit
• Put all hazardous waste in leakproof bags that can be sealed
• Use puncture proof containers for needles/breakables.
• Place containers away from the kitchen or areas where kids and pets can get them
• Make arrangements for proper disposal
• Clean linen with chemotherapy solutions immediately (wear gloves to handle these and do not wash with other clothes)
• FLUSH TOILET TWICE AFTER USE
• Clean areas that urine or stool gets on IMMEDIATELY
• Wash hands after handling chemo products.

Question 7

N/V

Answer 7

• Treat with distraction, relaxation and possibly acupuncture
• Serve meals at room temperature with clear liquids
• Control unpleasant smells
• Encourage slow eating and avoid high bulky meals. Include fluids while eating
• Administer antiemetics as ordered (usually given before chemotherapy treatment)

Question 8

Bone Marrow Suppression

Answer 8

• Infection
• Bleeding (monitor for hemorrhage, HgB/Hct, ENCOURAGE FOODS HIGH IN VITAMIN K, avoid IM injections, monitor occult bleeding)

Question 9

Hypersensitivity

Answer 9

• Paclitaxel, Asparaginase, Murine Monoclonal Antibodies are increased risk for hypersensitivity reactions.
• Previous exposure to metal is also increase risk
• Give antihistamines/steroids as ordered
• Ensure emergency equipment is available
• Scratch test if history of reactions or is their first dose
• Stay with client for 15 minutes
• Vitals q15 if localized reaction
• Stop infusion and maintain airway if anaphylaxis occurs

Question 10

Chemotherapy

Answer 10

PPE
- Special gowns and gloves

Linen
- Double bagged with impervious bag (substances cannot leak through)

• Double flush toilets and splash guard before flushing

Brachytherapy (internal radiation)
- Keep the patient door closed
- Warning sign of radiation
- Limit visitors to 30 minutes and they need to stay 6 feet away from the patient
- Nurses must wear lead aprons and decameter film badge which can track how much radiation exposure you are getting. Also FACE THE PATIENT SO LEAD APRON CAN PROTECT YOU

Education for EXTERNAL RADIATION
- Area undergoing radiation will be marked (patient must not wash off these markings)
- Must be gentle with skin receiving radiation (gentle soap and padded dry)
- Do not apply lotions or ointments over the area unless specifically prescribed.
- Advise patient to wear loose and soft clothing (because of sensitivity) and avoid sun/heat exposure to area of radiation

Common Complications

Malnutrition (n/v)
- Provide antiemetics 30 minutes prior to chemotherapy
- Give patient appetite stimulant (megestrol)

Education
- Avoid drinking liquids with meals because we do not want them to fill up on liquid, we want them on high calorie nutrient dense diet.
- Room temperature or cooler foods are easier to get down when feeling nauseas.

Mucositis (inflamed mucous membranes)
- Provide METICULOUS ORAL CARE
- Teach patient to avoid any mouth wash that contains glycerin or alcohol
- Mouth should be rinsed with saline twice a day
- Soft toothbrush
- Avoid foods that can cause more pain and damage to mucosa (like chips with sharp edges)