Adverse Effects of Antineoplastic Medications and Nursing Implications Flashcards
Common Adverse Effects of Antineoplastic Medications
- Alopecia
- Myelosuppression
- Nausea/Vomiting
- Hemorrhagic Cystitis
- Oral Mucositis
- Hypersensitivity
- Infertility
- Diarrhea
- Skin toxicities
- Cardiotoxicity
- Hepatic (Liver) toxicity
- Pulmonary fibrosis
- Clotting abnormalities
- Peripheral neuropathy
- Capillary permeability syndrome
- Menopausal Symptoms
Alopecia
- loss of hair begins soon after therapy begins
- variable
- hair begins to grow back several weeks after completion of therapy; when growing back, hair comes back differently: curly, thicker, or different color
> Nursing Implications
- loss of hair may cause a self-image disturbance, especially in women
- be encouraged to investigate wigs or other head coverings to use during therapy
- cover their heads while outside to protect against sun damage
Myelosuppression
(bone marrow suppression)
is the decrease in production of cells responsible for providing immunity, carrying oxygen, and/or those responsible for normal blood clotting.
> Nursing:
- inform patients that a complete blood count (CBC) will be assessed frequently
- call provider immediately if a fever presents; patients with myelosuppression and fever may be managed aggressively to prevent severe sepsis or shock
Nausea/ Vomiting
Nursing:
- administer prophylactic antiemetic therapy as ordered
- assess fluid and nutritional status
Hemorrhagic Cystitis
Nursing:
- administer IV hydration before and after chemotherapy
- prophylactic bladder protectant medication mesna (chemoprotectant medication to help prevent bladder toxicities) may be used
Oral Mucositis
inflammation and ulceration of the mucosal lining of the mouth, causing pain and difficulty with eating
> Nursing:
- encourage frequent oral rinsing (every 2-4 hours) with toothbrushing to reduce severity of mucositis
- encourage use of 2% viscous lidocaine mouth rinse if ordered to help control pain
- oral saliva substitute may be recommended for comfort or to reduce severity of symptoms
Hypersensititvity
administer premedication for hypersensitivity as ordered
-emergency equipment should be readily available
Infertility
encourage patient to consider sperm or egg banking prior to therapy if desired
Diarrhea
- administer antimotility agents for diarrhea as ordered
- assess fluid and nutritional status frequently
Skin toxicities
(palmar-plantar erythema)
- encourage use of emollients to reduce skin toxicities
- teach patient to report severity of skin toxicities b/c it may require therapy break
Cardiotoxicity
- cardiac function will be monitored with echocardiograms or multi-gated acquisition scans (MUGAs)
- many medications are held if decreased ejection fraction is found
- serum troponin levels may be drawn during curative therapy with Doxorubicin (type of chemotherapy) to identify patients who may receive prohpylatic treatment with cardioprotectant agents
- maintain fluid and electrolyte balance to reduce risk of dysrhythmias
Hepatic (liver) toxicity
hepatic function tests will be assessed regularly
albumin, ALP, AST, ALT, bilirubin
Pulmonary Fibrosis
pulmonary function tests will be assessed periodically
Clotting abnormalities
thromboses and/or bleeding
- some antineoplastic medications are never given within 6-8 weeks of major surgery b/c of bleeding risk
- prophylactic anticoagulation is common to prevent thromboses
- assess frequently for bleeding
- bleeding precautions; avoid falls or trauma, so no aggressive sports
- avoid sharps such as razors, scissors, nail clippers
- use stool softeners to avoid straining
Peripheral neuropathy
weakness, numbness, and pain in hands or feet
- teach fall precautions
- remove scatter rugs from home
- use nonslip mats in your bathtub or shower
