pt with cancer modalities Flashcards
what are the 4 major types of tx for cancer
- surgical removal (debulking) of a tumor
- chemo
- radiation
- biological therapy
what is the goal of sx for cancer
- remove the cancer
- spare as much normal tissue as possible
what types of sx are done with cancer
- biopsies- definitive diagnosis
- rehabilitation/reconstructive
- supportive care- catheters feeding tubes
- preventional - removal of nonvital organs
- liative- Palliative- reduce the sxs without curing
- exploritory laparotomy - “surgical staging”
what is surgical staging
when the pt has pain or other problems and the md cannot figure out what is causing it. an exploratory laparotomy may be done to get a visual of what is going on
what does chemo therapy offer
cure
control
palliative care
what is chemo used to treat
- liquid tumors- such as leukemia, lymph cancers.
- solid tumors
what is the goal of chemo
to destroy majority of cancer cells and micrometastasis leaving remainder to be destroyed with normal immune processes
how does chemo work
damages the DNA and interferes with cell division
what is the mitotic index
the actual # of cells in the M phase (the phase when the cell divides into 2 daughter cells)
when is chemo most effective
when the greatest number of cells are dividing
when the mitotic index is high
what are the 2 major categories of chemo
cell cycle non specific
and
cell cycle specific
what is the cell cycle non specific
cyotoxic in ANY phase of cell growth
effective with large slow growing tumors
what is the cell cycle speicific
destroys cells that are actively dividing.
effective with rapidly growing tumors
what are we going for when combining cell cycle specific and non specific
to get a synergistic effect
to be more effective than a single agent
hoping to get rid of as many cancer cells as possible in the shortest amount of time
what does chemo success depend on
-general health of the pt.
(comorbidities, bad habits, overweight, etc. )
types and stage of breast cancer
growth rate of cancer
development of drug resistance
what is methotrexate
a cell cycle specific med.
an antimetabolite
works in the S phase(inhibits DNA synthesis)
used for sarcoidosis
what is cytoxin
a cell cycle non specific
an alkylating agent (most beneficial in the resting phase)
it is used to prevent rejection of organs.
what is the nurses role in chemotherapy
- educating the patient and reinforcing the info the dr has given to the pt
- what to expect
- educate about chemo meds
- IV access- watch for extravation
- know the potential toxicity to the pt and the RN
- teach the pt to know the signs of reaction to chemo and to alert if they experience those sxs
what do we want to do prior to administering chemo
give anti nausea meds
analgesics for discomfort
IV hydration to prevent kidneys becoming damaged
how are chemo agents absorbed
- inhalation and skin contact.
- body fluids also carry risk
- cover toilet when flushing
what do you need to do when drawing up chemo meds
be under a laminar hood
how do you handle a chemo spill
hazardous waste spill protocol
-special kits and specific personnel to clean up
how do you dispose chemo products
- sealed special chemo bags
- discard into chemo receptacles
- wear the gloves in the chemo kit- usually are thicker - or you can double glove.
- wash hands after disposal.
what does hormonal manipulation and what is the med
Tamoxifen
it blocks the hormones that regulate tumor growth
how does anti tumor abx work and what is the med
Bleomycin
it interferes with DNA of a tumor
good for squamous cell ca
how do corticosteroids work in cancer
disrupt cell membranes of tumors
dexamethasone
good for leukemia
what is the most distressing side effect of chemo
fatigue
what can exercise do when pts are on chemo
it can decrease fatigue and improve coping skills
what are the toxic effects of chemo
hair follicles
GI cells
Bone marrow cells
heart
liver
kidneys
lungs
neuropathy
hearing loss
all are effected
what is Nadir
the point in which bone marrow cells reach their lowest level after admin of chemo (about 7-10 days)
what cell is the most abundantly loss
WBCs because they are being suppressed but also are being used up to fight infection
what should you do to manage nausea with chemo
keep pt well hydrated
encourage small frequent meals
avoid noxious stimuli
premeditate prior to tx with anti emetics
what happens to the immune system while on chemo
infection- leukopenia d/t myelosupression
when is someone on neutropenic precautions
if the WBC is <2000
what stimulates WBC production
neupogen
what is mucositis
a toxic inflammatory condition
involves the mucus membranes of GI tract
what is stomatitis
a form of mucositis
it causes painful sores in the mouth
how to you mangage mucositis
treat diarrhea or constipation with anti diarrhea’s or stool softness / high fiber diet
provide oral care-
what is tumor lysis syndrome
cellular contents of tumor cells released during chemo
can cause electrolyte imbalance-
ex: hyperkalemia/hyperphosphatemia
how do you treat tumor lysis syndrome
hydration
allopurinol - to decrease uric acid concentrations and to protect kidney function
what are methods of administration for chemo drugs
Oral and IV routes-most common
long term central line may be used for IV access
what is extravastion
infiltration of chemo
can result in permanent damage to nerves, tendons, muscle and skin
how do you treat extravasation
STOP the infusion
- do NOT d/c the iv catheter- there may be an antidote that can be put in that catheter
- if extravasation occurs- aspirate the remaining drug
- instill specific antedote
- apply warm or cold compress as indictated by agent used
why is chemo on a certain schedule
to allow the body to rest between drug administrations
allow normal body cells to proliferate and repair damaged tissues
what is the chemo dose based on
the pts body surface area
previous response to chemo
and major organ function
how long does chemo tx last
about 3 months or longer
what is palliative radiation therapy used for
to relieve pain and symptoms
what does radiation do
destroys highly mitotic cells
it damages their DNA resulting in cell death
what is external Beam RT
the pt is exposed to a certain amount of radiation for a certain amount of time over a certain duration
(pt not radioactive)
what is brachytherapy
a radioisotope is placed into or near the tumor or in systemic circulation
it emits a certain amount of radiation towards the tumor
(pt and excretions are radioactive)
what is a sealed source of brachytherpay
an implant, seeds, ribbons inserted into the pt
pt is radioactive
what is an unsealed source of brachytherapy
given systemically IV PO or into body cavitity
the pts excretions are radioactive
what are the radiation safety standards
keep distance from radiation source
minimize time of exposure
<30 min per 8 hr shift
shielding- lead aprons
what is the distance recommendation for pts with radiation
6 ft away from the pt
depending on the source of radiation
what are adverse effects of radiation
skin reactions-dequamation (sunburn type area where getting radiation) can be either dry or moist
fatigue- daily exercise program can help the fatigue
why is a pt “tattooed” with radiation
done prior to radiation therapy to align the radiation beam in specific patterns to get the cancer source
what is the pt to do after radiation
- keep area of radiation dry
- do not wash treatment area until told by md
- wear loose fitting clothing
- shave with electric razor
- protect from direct sunlight, chemicals and extreme temps
what is the late effects of radiation and chemo
secondary malignancies- usually more resistant to therapy,
may occur months or year after therapy
what is biologic response modifiers
a tx in adjacent to chemo/radiation
colony stimulating factors, interferons, interleukins, and monoclonal antibodies
used to boost the immune system
has anti tumor effects
- restores, modifies, stimulates, augments natural immune defenses
- can be used alone or in combo with other therapy
what are the hematopoietic drugs and what do they do
neupogen- restore WBCs
epogen- Restore RBCs
Neumega- restore platelets
what are interferons do and how are they given
they are an anti-viral and anti-tumor properties
they prevent cancer cells from dividing and replicating
given IM or Sub Q
what do interleukins do
they are cytokines released from activated lymphocytes
it activates the immune system:
- has an anti tumor action- recognizes cancer cells and destroys them
- proliferation and activation of NK cells
- Proliferation of T cells
- Increased production of B cells
what do monoclonal antibodies do
enhances the effects of the immune response on tumor cells
angiogenesis inhibitor- inhibits blood supply to the tumor
what are side effects of interferons, monoclonal antibodies, and interleukins
Flu- like syndrome
fatigue
autoimmune sxs (inflammation of organs) capillary leak syndrome orthostatic hypotension tachy neurologic effects(confusion, memory loss, sleep disorders)
what are side effects of chemo
FATIGUE GI- mucositis N&V anorexia diarrhea constipation hepatotoxicity
Hematologic-all d/t bone marrow suppression
anemia
leukopenia
thrombocytopenia
integumentary-
alopecia- all over body
hyperpigmentation
photosensitivity
sore throat extravasation fear/anxiety depression fluid and electrolyte imbalance possible sterility allergies pain renal damage (from nephrotoxic agents)
what are nursing managements for low hgb and hematocrit
Epogen for RBC production
neumega for platelet production after chemo is done
bood transfusions may be indicated for a symptomatic anemic patient
what are long term effects of chemo
cataracts arthralgias endocrine alterations renal insufficiency hepatitis osteoporosis neurocognitive dysfunction
secondary malignancies
what diet should a person on chemo therapy have
high protein, high carb
small and frequent meals
decrease noxious stimuli
keep hydrated
what complications are related to chemo
myelosuppression
toxic damage to organs
toxic damage to neurologic system- neuropathies and hearing loss
what med is an example of an interferon
Roferon
How do you prevent nephrotoxicity in someone receiving chemotherapy
hydrate prior during and after therapy
what are some adjuvant therapies with chemo
- hormonal manipulation: blocks hormones that facilitate tumor growth (tamoxifen)
- antitumor abx– interferes with DNA of tumor (bleomycin)
- Corticosteroids– disrupt cell membranes of tumor (dexamethasone)
what are the colony stimulating factor drugs
-hematopoetic drugs
neupogen- to restore WBC
epogen- restore RBCs
nuem ego- restore platelets
what are the types of radiation therapy
external beam RT(most common)
Brachytherapy/ internal RT
-sealed source
unsealed source
what are adverse effects of radiation
- fatigue
- skin reactions (dry desquamation/wet desquamation)
- possibility of dental caries if radiation in the head area
