13.4 Chemotherapy

Question 1

General Cancer Treatment

Answer 1

• Surgery
• Chemotherapy
• Immunotherapy
• Bone marrow transplant
• Integrative medication and complementary therapies are common

Goal - Curative, supportive, palliative

• Radiation Therapy (proton beam) - Radiation therapy for children who are still growing or developing can cause cognitive and neurological delays. Growth and development issues

Question 2

Side Effects of Chemotherapy

Answer 2

• Chemotherapy interferes with the production and function of nucleic acids, DNA and RNA. This destroys cells that rapidly proliferate.
• Only chemo-certified nurses can give chemotherapy.
• Chemotherapy can only be given via central venous access because it can damage tissue if given through peripheral IV (vesicant)
• Nurses must wear a chemo-gown to protect themselves, special chemo gloves, and all material are disposed into a special yellow bin.

Side Effects
- N/V is the most common (must be pre-treated)
- Mucosal ulcerations (mouth ulcers) - ORAL HYGIENE AND PAIN MANAGEMENT
- Skin Breakdown (ASSESS DAILY)
- Neuropathy (constipation, jaw pain, foot drop, risk for falls)
- Anorexia (nutrition supplements)
- Hemorrhagic Cystitis (blood that leaks into urine) - Provide frequent fluid and voids and MESNA is a protective med
- Alopecia (plan for head coverage like a wig)

Question 3

Abnormal Side Effects to Chemotherapy

Answer 3

Allergic Reaction
- STOP CHEMOTHERAPY IMMEDIATELY

Question 4

Nursing Management Chemotherapy

Answer 4

What to Monitor?
- Organ systems
- I&O and Specific Gravity
- Daily weight
- Labs
- Side effects of medications

• Coordination with pharmacy
• Safety and chemo precautions
• Psychosocial aspects (child’s view of themselves, body image, prepare parents for symptoms and changes they will notice as a result of chemotherapy)

Chemotherapy attacks the blood, GI, and integumentary system the most.

Question 5

Mucositis/Stomatitis

Answer 5

• Very common side effect of chemo (mouth ulcers)
• PROVIDE FREQUENT ORAL CARE
• Use soft bristled brush
• Lubricate lips frequently
• Prevent Dehydration and Optimize Nutrition Status with BLAND AND SOFT FOOD (to prevent pain)
• Salt Water and Baking Soda Mix Mouthwash will provide soothing to ulcers

Medications
- Local anesthetics
- Antifungal/Antibacterial mouth wash

EXAMINE MOUTH EVERYDAY

AVOID
- Viscous lidocaine (depresses gag reflex)
- Hydrogen peroxide (delays healing)
- Milk of Magnesia (dries mucous membranes)
- Lemon Glycerin Swabs (can cause tooth decay and erosion of tissue)