Symptom Management Flashcards

1
Q

hemorrhagic cystitis

Complication of
Symptoms

Prevention is the key

A
Complication:
Cyclophoshamide
ifofamide
Busulfan
Rad (occur 10-14d)

Inflammation of bladder defined by lower urinary tract symptoms
Symptom: dysuria, hematuria, hemorrhage

Prevention

  • Mensa IV as uroprotectant if taking ifofamide or high-dose cyclophosphamide
  • AMIfosine as cytoprotectant for cisplatin
  • avoid alkalizing agents
  • Avoid caffeine, spicy food, alco
  • hydration
  • po cyclophosphamide early AM to allow for increased hydration and diuresis of metabolites prior to evening
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2
Q

Anemia

Complication of
Symptoms

A

Hb <10

Ferritin - no change or decrease (<30)

Reticulocyte count:
Low- in hypoproliferative disease
High (LDH, Bili)- hemolysis because of increase erythropoiesis and Tx response anemia

Tx with:

  • Transfusion to Stable Hb 7-8
  • Erythropoietic therapy (Epoetin, darbepoetin)

_____________

  • Cancer exacerbate anemia – by suppression of hematopoiesis
  • by cytokine production that kills RBC prematurely
  • Chemo/Rad causes myelosuppressive effects

Symptoms:
Flank bleeding
RENAL insufficiency
hemolysis

____________
severe Anemia can cause:

Cardio: as RBC decreases, blood flow more aggressively with less viscosity. Bruits, murmur, tachy, postural hypo

Pulmo: Dyspnea @ rest, hypoxia, tachypnea, pulmonary edema

GU: water retention, proteinuria

CNS: headache, dizziness

GI: decrease motility/constipation, hepatospenomegaly

MS: bone pain

Other: brittle nails

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3
Q

Neutropenia

Symptoms

A

ANC = %neutrophils xWBC

%neutrophils = segment%+bands%

ANC<500
ANC <1000 (risk of infection)
-______

Neutrophils - takes 10-14 days to produce in BM they only live 4-8 hours once release into the circulation. Continual production in BM

_____
Symptoms:

Fever: >100.4, maybe the only sign (risk >65yrold)
Fever with chills, rigors
Vascular access device tenderness or erythema
Cough
Dysuria
Mucositis
Diarrhea
perirectal pain
changes in Mental staus

___
Patient education:
-Report fever >100.4
-Good hygiene
-avoid uncooked and unwashed fruits and veg
-avoid barn animals, reptiles, birds and litter
-avoid construction areas
-avoid contact with peple who recently vaccinated with a live virus
-avoid undercooked meats, seafood, and eggs

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4
Q

Tx for chemo induced Neutropenia

SE

A

Treatment

  • GCSF (white blood cells stimulants) for chemo induced neutropenia
  • Filgrastim (neulasta-act fast)
  • Pegfilgrastim (neupogen)
  • tbo-filgrastim
  • Sargramostim

Mechanism of action: Trigger stem cells in BM to produce more of a particular WBC. Stimulate hematopoietic development of GRNULOCYTES, reducing the duration of neutropenic episodes

SE:
Pain to long bones

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5
Q

Tx for chemo induced Anemia

SE

A

RBC stimulants for chemo induced ANEMIA

POIETIN

  • Erythropoietin
  • Epoetin-alfa
  • Darbepoetin

Mechanism of action: Stimulate stem cells to develop into RBC

SE:

  • HPT
  • increased risk of venous thromboembolic (Particularly in MM)
  • diarrhea
  • fluid retention
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6
Q

Platelet stimulants for chemo induced thrombocytopenia

SE

A
  • Oprelvekin
  • ProMEGApoietin (can affect all blood cells but primarily PLT)

Mechanism of action: stimulate thrombopoietin, a hormone that stimulates development of stem cell MEGAkaryocytes (immature precursors of PLT) to produce PLT faster than normal

SE:

  • ventricular arrhythmia
  • visual/opthalmologic defect
  • FLuid retention
  • anaphylaxis
  • pulmonary edema
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7
Q

Nursing Consideration - Prevention of infection

A
  • CSFs for high-risk patient
  • influenza vaccine annually
  • 23-valent pneumococcal polysaccharide vaccine for cancer aged >5
  • 7-valent pneumococcal polysaccharide protein-conjugate vaccine for cncer aged <5yr
  • Prevention of Pneumoncystic carnii pneumonia
  • give AntiFungals to prevent oral candidiasis if pat is receiving chemo

High risk pt

  • antifungal prophy
  • antibacterial prophy
  • HEPA filters/masks for those with prolonged neutropenia
  • clean of oxygen humidifier andnebulizers
  • use automatic ice machines rather than ice bins. Do not handle ice
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8
Q

Thrombocytopenia

PLT <150k

Normal 150-400k

\_\_\_\_
CAUSE:
s/s:
Mgt:
info:
A

Cause:

  • BM infiltrated y malignancy
  • DIC or thrombotic thromboytopenic purpura can cause destruction
  • Splenomegaly
  • occur 8-14D after chemo
  • Meds: NSAIDs, aspirin, thiazide diuretics, tricyclic antidepressants, abx (piperacillin, ampicillin), HEPARIN

s/s:

  • bleeding 9any orifice_
  • mucosa or skin (petechiae, ecchymosis)
  • Menorrhagia
  • change in mental or neurologic status
  • epitaxis

Mgt:
MESNA: given to pt receiving ifosfamide, high dose cyclophoshamide to decrease pos of hemorrhagic cystitis

Nurs intervention:

  • soft toothbrush, no flossing
  • avoid invasic procdure (enemas, rectal temp, IM injection)
  • observe for dark, tarry stools, easy brusing or petechiae
  • avoid electric razor, dental
  • avoid tampons
  • avoid constipation
  • immediatly report sudden onset of headache.

____________

  • healthy adult: 1/3 store in spleen
  • PLT circulate abt 708 days and are then removed by the normal body macrophage system.
  • no reserve in BM
  • myelosuppressive therapy puts pt at increased risk for thrombocytopenia
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9
Q
Lymphedema:
Definition
Cause
Management
complete decongestive therapy (CDT)
A

-greater than 1.5cm difference in circumference of affected limb to unaffected lumb
-Caused by diseases w/invasion into lymphatics ( lymphoma, breast, melanoma, H/N), scarring of radiation, metastasis
Mgt of Lymphedema
-manual lymph drainage
-skin care
- compression
-exercise/movement therapy
-PT massage
-Elevate
-AVOID bp and iv start only if LN was removed on that side

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10
Q

Mucositis

s/s

cause (med)

A

inflammation of mucosal lining

Stomatitis (oral)**
Esophagitis (esophagus)
Gastroenteritis (intestine)

Stomatitis is so painful and disruptive that pt may d/c Tx prematurely.

  • 100% in HN rad
  • 80% HSCT
  • 40% in chemo

___

s/s

  • Mucosal: pallor, WHITE patches, erythema
  • Foul odor, cracks, fissures in mucosa
  • changes in voice quality

Cause:

  • BusulFAN
  • Capacitabine
  • Cyclo
  • DOxil
  • 5-FU
  • Mechlorethamine

___

Tx
Ice chips are placed in the mouth, beginning 5 minutes before administration of chemotherapy and replenished as needed for up to 30 minutes.

diphenhydramine-lidocaine-antacid mouthwash (so-called magic mouthwash)

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11
Q

Mucositis

Patho ( 5 phases)

A

2: Primary damage response

Indirect Tox:

  • myelosuppression
  • loss of immune cells in the mucosal tissue
  • loss of protective saliva
  • FIVE phases of pathology occur in the development and resolution mucositis

#1 (soon after chem or rad)
- DNA and non-DNA damange, causing basal and epithelial damange in submucosa
-Mucosa appears normal

  • DNA damage and cell death in epithelium of mucosa
  • Pt may still not feel that any damage has occurred
  • mutitude of GENES are activated, ncluding proinflammtory cytokines, tumor necrosis factor-alpha, interleukin-beta and interleukin-6 causing more cell injury and death
  • cytokines amplify the acceleration and amplify the original injury
  • Tissue is biologically altered but still may appear NORMAL
  • fibrous exudates may thinly cover oral ulcer, which then can fill with bacteria
  • Pain, dysphagia, decreased intake, diffifult talking, INCREASED risk of bleeding
#5 Healing
-when d/c chemo/rad, new molecules direct the epithelium to heal and increase WBC production to fight local mucosal infection
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12
Q

Refractory to random PLT and reports bleeding gum

What’s next

A

Admin Human Leukocyte antigen-matched PLT

May be considered to manage patients who have developed refractory responses to standard PLT transfusion

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13
Q

DoxeTAXOL

Combo with Dex

Why?

A

Docetaxol is associated with

fluid retention and associated
alveolar permeability and
Pulmonary infiltration

Which can be prevented with
Corticosteroids as pre-med

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14
Q

palonosetron

Aloxci

Common side effect?

A

Constipation

Headache

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15
Q

Infusion of cryopreserved stem cells

Common experience for patients

A

DMSO, the preservative used to stored collected stem cells, cause a strong garlic like taste during infusion

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16
Q

Repeated thoracenteses

Usually for pulmonary Mets

A

Repeated thoracenthesis may result in the development of unexpected or tapped lung

Trapped lung- inability to expand and fill due to restricted fibrous visceral pleural peel

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17
Q

5-FU

Melphalan

Fluorouracil

To do-
Side effect-

A

Oral mucositis

  • help swish ice chip or cold water around your month for the first half hour of the treatment
18
Q

Acute toxicities
Persistent toxicities
Long term effects

A
  • Acute: onset w/in days/weeks of treatment, once drug is out of the system, toxicity goes away (Ex: N/V/D, mucositis, myelosuppresion)
  • Persistent: occurs during and beyond completion of tx (ex: peripheral neuropathy, fatigue, cognative impairment, dry mouth, ocular)
  • Long term effects: toxic effexts on the organ causing damage that can come up later, months to years (Ex: pulmonary, cardiac, neuropathy, fertility, secondary cancers)
19
Q
Late effects of therapy:
Brain tumor
Hodgkin disease
H/N
Testicular
Breast
ALL
Cervical
Lung
Abdomen/Pelvis
A
  • Brain tumor: memory/cognitive
  • Hodgkin disease: cardiac, pulm, xerostomia (dry mouth), thyroid and breast ca
  • H/N: xerostomia, thyroid
  • Testicular: fertility, pulmonary
  • Breast: cardio if rad was on L side
  • ALL: neuropathy and 2nd ca, CNS
  • Cervical: cystitis, fistulas
  • Lung: fibrosis, arm edema, pericarditis, CAD, pneumonitis
  • Abdomen/Pelvis: colon perf, fistulas, bladder fibrosis, leg/scrotal edema, impotency, fertility
20
Q
Dyspnea:
Disease related
Treatment related
Other causes
Assessment
Testing
Treatment
A
  • Lung cancer
  • Bleomycin
  • other causes: asthma, anemia, COPD, PE, poor physical status
  • Assess: wheezing
  • CXR,PFT,CT
  • Tx: morphine, breathing tx, cool air
21
Q

Mucositis

Tx

Grade
Symptom

A
  • Cryotherapy (ice)
  • PALIfermin for pt receiving HSCT
Grade:
1 - erythema
2- patcy
3- ulcerations, bleeding
4- tissue necrosis

Symptom - pain
Due to tissue damage

22
Q

Xerostomia

Management

A

subjective feeling of dryness in mouth

Parotid gland produces 60% of saliva

____
Management
-Dental examination prior to initiation of thearpy
-Meticulous teeth brushing and flossing (if hematologically stable)
-avoid SPICY, rough foods and harsh chemicals
-limit SUGAR intake
-pain management
-saliva substitutes/increase fluid intake

  • prophy abx
  • SIAlagogues (drug increase saliva producation)
  • AmiFOStine (cytoprotectant, HN pt receiving rad, IV)
23
Q

N/V

Type of chemo induced

Mgt

A

Acute CINV

  • occur 24hrs after chemo
  • highly emetogenic drugs (CISplaTIN)

Delayed CINV

  • after 24hrs and last upto 6D
  • women
  • high dose Cisplatin
  • Carbopltin
  • Cyclophosphamide
  • anthraCyclines

Anticipatory nausea

  • trigger by tasts, odors, sights, thoughts, or anxiety associate with chemo
  • Tx: Benzodiazepine

_______
Patho:
-chemo causes release of serotonin (5-HT3) thr GI tract

Management

  • Prevention: begin antiemetic therapy prior to chemo and then for the first 24hr. Prevention is a best weapon for anticipatory N/V
  • Postchemo: prophylactic dex and aprepitant two to four days after chemo

Break through emesis Tx:

  • challenging to Tx because once it is present, it can be difficult to reverse
  • corticosteroids, haloperidol, metoclopramide, scopolamine are sometimes used for breakthrough emesis
24
Q

N/V Tx

A

N/V Tx

Neuroleptics
Motility agents
antihistamines
Benzo
steroids
cannabinoids
anticholinergics
5-HT3 antagonist
substance P antagonist

Best to treat:
Acute N/V (5-HT3 anta, steroid, antihis)

Delay N/V: Substance P antagonist, neuroleptics, anticholinergics, motility agents)

Anticipatory N/V:
-benzo

25
Q

Dysphagia

Types

A

difficulty swallowing

  1. Transfer dysphagia
    alteration in the oral-pharyngeal passage of food
  2. Transit dysphagia
    absence of esophageal peristalsis
  3. Obstructive dysphagia
    mechanical obstruction dt stenosis or tumor involvement
26
Q

Anorexia and Cachexia

Labs

Tx

A

Anorexia: involuntary. 80% pt

Cachexia: wasting syndrome that combines weight loss w/ loss of muscle+proteins and includes anorexia, N & weakness. Often in end stage of disease.

Labs
Na, K, Alb, Glu decreased

BUN/creatinine ration - increased in cachexia

Folate: decreased (indicates malnutrition)

Both:
Tx: Corticosterids, Progestins

In addition - Cachexia: Metoclopramide, cannabinoid derivates, Enteral or parenteral feeding
Tx underlying etiology (obstruction)

27
Q

Constipation

unusual-
cause:
Tx:

A

cause:
hypercalcemia
Autonomic neuropathy
Spinal cord lesion

Tx:

  • polyETHYlene glycol w or w/out electrolytes
  • polyPHYlactic if taking opioids
  • teach diaphragmatic breathing and abd muscle exercis

Pharm:

  • Osmotic agents: Lactulose, polyETHYlene glycol 3350
  • opioid receptor antagonist: methylnatreXONE
  • Prokinetic agents: METOclopromide
28
Q

CTID

cancer treatment induced diarrhea

Tx

Prevention

A

Patho:
Osmotic: from consumption of food or drughs that increase osmotic activity of the intestine, drawing more water into the colon

Risk Factors:
Female
>10% weight Loss
Colectomy 
Inflammation 

Treatment:

Chemo induced diarrhea

  • Loperamide
  • high dose loperamide if tx w/ IRInotecan
  • Somatostatin analog or OCTerotide/IM loge acting if refractory to loperamide

Rad induced diarrhea
-oral opiates

Prevention rad induced diarrhea

  • Probiotic
  • Psyllium fiber
  • Octeotide if G2 or 3
29
Q

Mgt of Sexual Dysfunction

communication tools
PLISSIT
ALARM

Intervention

A
P LI SS IT
Permission, 
limited information, 
specific suggestions,
Intensive therapy
ALARM
Activity
libido
arousal
resolution 
Med Hx

Intervention for men

  • po erectogenic Sildenafil,
  • prostaglandin injections
  • Psy support

Intervention for women
-Kegel exercise

30
Q

UI

ICIQ-SF

consequence of what -tomy

Mgt

A

Urinary Incontinence (UI)

ICIQ-SF

  • screening for UI
  • assess freq, severity and impact of UI

UI consequence of (below)

  • Prostatectomy
  • Hysterectomy
  • colectomy
  • abd-perineal resection
  • Rad (external to pelvis or brachy)

Mgt of UI

  • Pelvic floor muscle exercise
  • FLuid
  • avoid caffeine and alco
  • Mgt constipation, which can exacerbate sym
31
Q

Hand foot syndrome

A
SE
Taxane
antiangiogenic agent
toPOISisomerease inhibitor
Sunitinib 
Sorafinib
32
Q

Retrograde Pyelography

A

form of x-ray used to get detailed pic of the

ureters and kidneys

with contrast agent

33
Q

Tumor lysis syndrome

A
Temp
HR
BP
RR
Hct
PLT
34
Q

TTP - Lab

Thrombotic thrombocytopenia purpura

A

Lab findings

CBC/PLT: decrease (RBC burst)
ADAMst13: decrease
adam street on TTP

Smear: schistocyte
Combs: -
LDH: increase
Bil: increase

35
Q

Stereotactic radiosurgery (SRS)

A

non-surgical, radiatin therapy to treat small tumors of the brain

deliver precisely-targeted radiation in fewer higer dose

36
Q

Stereotactic radiosurgery (SRS)

A

non-surgical, radiation therapy to treat small tumors of the brain

deliver precisely-targeted radiation in fewer higer dose

37
Q

Radiation pneumonitis

A

inflammation of the lung caused by radiation therapy to the chest. It most commonly develops 1 to 3 months after treatment is over, but it can happen up to 6 months after treatment. Chronic pneumonitis can lead to permanent scarring of the lungs-pulmonary fibrosis.

38
Q

Posaconazole

Anti-f

Adverse reaction

A

Life threatening AE
-Torsades de Pointes
-hepatocellular damage
-

39
Q

Thx

Opioid related conatipation

A

Bowel stimulant laxatives

40
Q

Cyclophosphamide

No no .. allopurinol

Why?

A

Cyclophosphamide is an alkali ting agent that disturbs the synthesis of PROTEIN as a cancer treatment.

The concomitant use of alopurinol can

  • increase the toxicity of agent, particularly
  • BONE MARROW SUPPRESSION by
  • decrease renal excretion
41
Q

Hypercalcema

Up..up.. s/s

A

Delay dc of hypercalemia often occurs d/t no specificity of symptoms

  • constipation
  • lethargy
  • CONFUSION

-bradycardia
Down down d/t depression of conduction system

42
Q

Increased ICP

S/s
Thx

A

Increased ICP s/s

  • drowsiness
  • fatigue
  • headache
  • changes in BP - high

Steroid tx to decrease surrounding edema from the tumor