chemo and radiation and pain Flashcards
1
Q
chemo
A
Cytotoxic medications that damage a cell’s DNA or destroy rapidly dividing cells.
2
Q
adverse effects of chemo- related to
A
related to the unintentional harm done to normal rapidly proliferating cells, such as those found in the mucous membranes of the gastrointestinal (GI) tract, hair follicles, and bone marrow.
3
Q
Agents that protect healthy cells (cytoprotectants or chemoprotectants) are given before or with chemotherapy to decrease the effect on normal tissues are:
A
amifostine and mesna
zofran
gut proflaxis
special mouthwash
4
Q
preparing chemo
A
- Most chemotherapy medications, including oral, are absorbed through the skin and mucous membranes.
- Anyone preparing, giving or disposing of these medications must wear proper personal protective equipment.
- cytotoxic: can cause birth defects, special gloves, urine and stool disposed in chemo bin
5
Q
routes of chemo
A
- Topical
- Oral: Oral medications should not be crushed, split, broken or chewed.
- IV
- Intra abdominal, intrathecal (spine), intrapleural (pleural space),
Intra ventricular, intra bladder
6
Q
lines for chemo
A
- A central catheter is usually placed for chemotherapy or laboratory blood testing.
- Chemo can cause serious damage to the skin and muscle tissue if it infiltrates.
- Two of the more commonly used included PICC lines and implanted port.
- The implanted port is used when therapy is intended to be given on a long-term basis.
- needs blood checked constantly
- more people die from sepsis than cancer
7
Q
complication: Immunosuppression/neutropenia due to
A
- Due to bone marrow suppression by cytotoxic medications
- The most significant adverse effect of chemotherapy
- serious
8
Q
Immunosuppression/neutropenia nursing considerations body wise
A
- Monitor temperature, white blood cell (WBC) count, and absolute neutrophil count (ANC).
- A fever greater than 37.8° C (100° F) should be reported to the provider immediately.
9
Q
Neutropenia nursing actions
A
- Monitor skin and mucous membranes for infection (breakdown, fissures, and abscess).
- Cultures should be obtained prior to initiating antimicrobial therapy.
- The risk of serious infection increases as the ANC falls.
- The nurse should implement neutropenic precautions, including placing the client in a private room.
10
Q
An ANC less than 1,000/mm3 indicates a
A
weak immune system
11
Q
Neutropenic Precautions
A
- Protect the client from possible sources of infection (plants, change water in equipment daily).
- Have client, staff, and visitors perform frequent hand hygiene. Restrict visitors who are ill.
- Avoid invasive procedures that could cause a break in tissue (rectal temperatures, injections, indwelling urinary catheters) unless necessary.
- Keep dedicated equipment (blood pressure machine, thermometer, stethoscope) in the client’s room.
- negative airflow
- toothbrush in dishwasher
12
Q
Client Education for neutropenic
A
- Encourage the client to avoid crowds while undergoing chemotherapy.
- Take temperature daily. Report fever greater than 37.8° C (100° F) or other manifestations of bacterial or viral infections immediately to the provider.
- Avoid food sources that could contain bacteria (fresh fruits and vegetables; undercooked meat, fish, and eggs; pepper and paprika).
- Wash all dishes in hot, soapy water or a dishwasher. Wash glasses and cups after each use.
- Wash toothbrush daily in the dishwasher or rinse in a bleach solution.
13
Q
complications: anemia
A
- Monitor for fatigue, pallor, dizziness, and shortness of breath.
- Help the client manage anemia-related fatigue
- Administer darbepoetin alfa, epoetin, and ferrous sulfate as prescribed.
- Monitor Hgb values to determine response to medications. Be prepared to administer blood if prescribed.
14
Q
complication: Thrombocytopenia
A
Monitor for petechiae, ecchymosis, bleeding of the gums, nosebleeds, and occult or frank blood in stools, urine, or vomitus.
15
Q
thrombocytopenia Institute bleeding precautions.
A
- Avoid IVs and injections.
- Apply pressure for approximately 10 min after blood is obtained.
- Monitor platelet count, and be prepared to administer platelets if the count falls below 10,000/mm3.
16
Q
thrombocytopenia client education
A
- Instruct the client and family how to manage active bleeding.
- Instruct the client to use electric razor and soft-bristled toothbrush, avoid blowing nose vigorously, ensure that dentures fit appropriately.
- Avoid the use of NSAIDs.
- Wear closed-toes shoes
- Remove tripping hazards in the home
17
Q
complication: nausea, vomiting, anorexia meds
A
- Serotonin blockers, such as ondansetron, have been found to be effective and are often administered with corticosteroids, phenothiazines, and antihistamines. (always give before)
- Corticosteroids (dexamethasone, methylprednisolone) helps with inflammation
- Histamine blockers and proton pump inhibitors (omeprazole, ranitidine)
- Metoclopramide
- Lorazepam: keeps them calm
- Cannabinoids (dronabinol, nabilone): helps with eating
***All used for chemotherapy-induced nausea and vomiting, and should be given BEFORE treatment
18
Q
side effects from zofran
A
- diarrhea
- headache: most common
- fever
- lightheadedness: not enough hemoglobin
- weakness
- constipation
- rash
- blurred vision
- muscle spasm
19
Q
nausea and food
A
- Encourage the client to eat several small meals a day if better tolerated.
- Suggest that the client select foods that are served cold and do not require cooking. Cooking food can emit odors that stimulate nausea. cold foods and bland
- Encourage consumption of high-protein, high-calorie, nutrient-dense foods and avoidance of low- or empty-calorie foods. (continuous feeds, tpn, g/jtube)
20
Q
complications: alopecia
A
- Discuss the effect of alopecia on self-image.
- Discuss options such as hats, turbans, and wigs to deal with hair loss.
- Inform clients that hair loss occurs 7 to 10 days after treatment begins (for some agents). Encourage the client to select hairpiece before treatment starts.
- Reinforce that alopecia is temporary, and hair should return about 1 month after chemotherapy is discontinued.
- The new hair can differ from the original hair in color, texture, and thickness.
21
Q
complications: Mucositis and Stomatitis nursing actions
A
- inflammation, swelling, soares
- Examine the client’s mouth several times a day, and inquire about the presence of oral lesions.
- Avoid using glycerin-based mouthwashes or mouth swabs.
- Nonalcoholic, anesthetic mouthwashes are recommended.
- Administer a topical anesthetic prior to meals.
Discourage consumption of salty, acidic, or spicy foods. - Offer oral hygiene before and after each meal.
- ensure and boost: increase proteins
22
Q
complications: Chemotherapy‑induced peripheral neuropathy nursing actions
A
- Loss of sensory or motor function of peripheral nerves
- Monitor in hands and feet, loss of taste, and constipation.
- Monitor for orthostatic hypotension.
- Teach the client how to prevent injury, including falls, and that loss of sensation makes the client unaware of heat, cold, or pressure.
- Inform regarding risk of erectile dysfunction and treatment options.
23
Q
radiation
A
- One of the oldest nonsurgical methods of cancer treatment
- 50% of all cancer patients will receive radiation therapy at some point in their treatment
- Cells damaged by radiation either die or become unable to divide.
- Gamma rays are used most commonly because of their ability to penetrate tissues and damage cells.
24
Q
radiation: teletherapy
A
distance treatment, the radiation source is external to the patient.
25
radiation: Brachytherapy
internal radiation that is placed close to the target tissue.
- This is done via placement in a body orifice (vagina) or body cavity (abdomen) or delivered via IV such as with radionuclide iodine, which is absorbed by the thyroid
26
nursing actions brachytherapy
- Place the client in a private room away from other clients when possible.
- Place a sign on the door warning of the radiation source.
- Wear a dosimeter film badge that records personal amount of radiation exposure.
- Limit visitors to 30-min visits, and have visitors maintain a distance of 6 feet from the source.
- Visitors and health care personnel who are pregnant or under the age of 18 should not come into contact with the client or radiation source.
- flush urine 3 times
- lien dispose of
- Wear a lead apron while providing care keeping the front of the apron facing the source of radiation.
- Follow protocol for proper removal of dressings and bed linens from the room.
- Inform the client of the need to remain in an indicated position to prevent dislodgement of the radiation implant.
- Instruct the client to call the nurse for assistance with elimination.
- Instruct the client and family about radiation precautions needed in health care and home environments.
27
External Radiation (Teletherapy)
- Delivered in small doses over several weeks and aimed at the body from an external source.
- Unlike internal radiation, the client is not radioactive and is not hazardous to others.
- Monitor for radiation injury to skin and mucous membranes and implement a skin care regimen.( keep skin moist)
- Radiation will affect only the area getting treatment
28
Radiation will affect only the area getting treatment: skin mouth neck
- Skin: blanching ( takes a long time), erythema, desquamation (flaking), sloughing, hemorrhage
- Mouth: mucositis, dry mouth
- Neck: difficulty swallowing, (dysphagia)
- Abdomen: gastroenteritis, Diarrhea, dyspnea
- Gently wash the skin over the irradiated area with mild soap and water.
- Dry the area thoroughly using patting motions.(no towels)
29
external radiation: nursing actions
- Do not remove or wash off radiation tattoos (markings) used to guide therapy.
- Do not apply powders, ointments, lotions, deodorants, or perfumes to the irradiated skin.
- Wear soft clothing. Avoid tight or constricting clothes.
- Do not expose the irradiated skin to sun or a heat source.
- Inspect skin for evidence of damage and report to the provider.
30
pain
- Management of cancer pain is necessary to optimize quality of life for a client who has cancer.
- Not all clients who have cancer have pain.
- Either the tumor or the treatment can cause cancer pain.
- Tumor pressure or cell invasion can cause direct tissue, bone, and nerve pain.
- Surgery, radiation, chemotherapy, and inactivity can also cause cancer pain.
31
qualities of pain
- Pain is subjective and can indicate tissue injury or impending tissue injury.
- Pain can have physical and emotional components.
- Pain can be acute or chronic.
- Chronic pain results from nerve changes and lasts longer than 3 months.
- Tumor growth and the effects on surrounding tissue (destruction or pressure) cause chronic cancer pain.
- become tolerant to meds= up dose
32
neuropathic
Due to nerve damage
Numb, tingling, shooting, burning, or radiating
33
Visceral/Deep
Occurs in internal organs
Can be difficult to identify
Deep, sharp pain
34
Somatic
Occurs in bone or connective tissues
Throbbing or dull
35
Palliative Management of Pain
- Provides comfort and reduce pains rather than to curing the cancer.
- The goal is to reduce pain to improve quality of life while maintaining dignity and mental clarity.
36
METHODS OF PAIN MANAGEMENT:
- Surgery
- Chemotherapy
radiation therapy
- can reduce pain by removing the tumor or reducing its size, which can alter pressure on adjacent tissues or organs.
37
medications for pain
NSAIDs
Opioids
Antidepressants
Anticonvulsants
Corticosteroids
Local anesthetics
Some clients who have cancer pain require regular use of analgesics for pain control.
38
Opioids
Morphine
Meperidine
Hydromorphone
Oxycodone
Fentanyl
Combinations, such hydrocodone with acetaminophen, for breakthrough pain
39
routes for opioids
- The parenteral route is best for immediate, short-term relief of acute pain.
- The oral route is better for chronic, non-fluctuating pain.
40
Monitor and intervene for adverse effects of opioid use:
- constipation, orthostatic hypotension, urinary retention, nausea, vomiting, and sedation
- Monitor for respiratory depression.
- Have naloxone available to reverse effects.
- Administer stimulant laxatives to prevent opioid-induced constipation.
- The patient may build up a tolerance to pain medications and require increased dosages
41
Supportive Therapy
- In addition to cancer treatment, the client can require assistance for altered body function or to meet emotional and spiritual needs.
- Provide alternate means of communication for clients who have cancer affecting the mouth, throat, larynx, or vocal cords.
- Consult physical therapy, and genetic or other counseling services as indicated.
- Administer nutritional supplements or substitutes as prescribed.
- Monitor feeding tube or central line as appropriate
- Follow patient’s Albumin for chronic malnutrition
- Encourage cancer support groups/therapy
