test 3 Flashcards
Chemotherapy complications
N/V/anorexia
Immunosuppression/neutropenia
Alopecia
Oral effects- Mucositis and stomatitis
Anemia and thrombocytopenia
Neutropenic precautions
Private room
* Client in mask if they leave
the room
* Protect from sources of
infection
* Frequent hand hygiene
* No ill visitors
* Avoid invasive procedures
* Dedicated equipment in
room
Immunosuppression/neutropenia education
Avoid crowds
* Daily temp
* Avoid food that could
contain bacteria
* Avoid yard work
* Avoid cleaning pet’s litter
box
* Discard beverage sitting
at room temp >1 hour
* Wash dishes in hot,
soapy water or
dishwasher
* Do not share toiletry or
personal hygiene items
w/others
when should you report a fever during chemo?
Report temp > 37.8 C (100 F) immediately
what kind of catheter do you use for chemo?
central catheter
Nursing considerations for Nausea and vomiting
Give antiemetics before chemo and when
CINV present
» Administer for several days afterwards
– Non-pharmacological methods to reduce
nausea
– Remove vomiting cues
– Calorie counts to ensure adequate intake
» Liquid nutritional supplement PRN
– Megesterol to increase appetite
– Mouth care prior to meals – enhance appetite
oral effects complications for chemo nursing considerations
Education
– Rinse mouth w/0.9% NaCL, room-temp
tap water, salt/soda water
» Frequency depends on mucositis
– Gentle flossing/brushing
– Rinse mouth before/after meals
– Meds to prevent infection as prescribed
– Soft, bland foods/supplements high in
calories
– Avoid alcohol/smoking
– At least 2L water/day
adverse effects of cytotoxic chemo
unintentional harm to normal cells
* i.e. – mucous membranes in GI tract, hair follicles,
bone marrow
Alopecia education
Avoid using damaging hair care measures
– Consider cutting short before treatment
– After hair loss – protect from sun exposure
when does alopecia normally begin?
7-10 days after treatment and hair should return about 1 month after treatment
Anemia/thrombocytopenia nursing considerations
Nursing (thrombocytopenia)
– Monitor for petechiae, bleeding (gums,
nosebleeds), frank blood in stool, urine, vomit
– Bleeding precautions
» Avoid IV’s/injections
» If necessary – smallest needle
possible
» Pressure for 10 minutes
» Handle gently/avoid trauma
– Admin thromopoietic meds to stimulate platelet
production
– Prepare to admin platelets if count
<10,000/mm3
what is brachytherapy
internal – body fluids contaminated, body waste
disposed of appropriately
Radiation placed close to target tissue
* Tumor and limited amount of surrounding
tissues
* Clients remain in facility until therapy complete
– Seed implants may be able to go home
brachytherapy nursing considerations
Private room, door closed
* Sign on door warning of radiation source
* Wear a dosimeter film badge
– Records personal amount of radiation
exposure
* Limit visitors to 30 minutes, remain 6 feet from
source
Nursing (cont’d)
* Lead apron when providing care
* Lead container in room, tongs available
* Follow protocol re: removal of dressings and
bedding
– Generally, kept in room until rad source is
removed
what is teletherapy
External does not cause client to be radioactive
teletherapy
Skin over target area marked with tattoos
– Guide position of external rad source
* Well balanced meal
– No red meat
– Can cause altered taste
* Fatigue
– Schedule activities w/rest periods
* Monitor for skin/mucous membrane injury
– Skin: blanching, redness, sloughing,
hemorrhage, outer layer of skin shedding
– Mouth: mucositis, dry mouth
– Neck: diff swallowing
– Abdomen: gastroenteritis
Mammogram screening
annually >40 y.o
Clinical breast exam
annually >40
y.o.; every 3 years 20 to 39
colonoscopy
At age 50, then q10
years
Fecal occult blood
annually for adults
Digital rectal exam
men greater than 50
Gene mutations screening
clients w/strong
family hx of breast or colon CA
cancer complications
malnutrition due to anorexia and weight loss
Constipation/gastric stasis/intestinal obstruction due to opioids
Paraneoplastic syndromes
– Result when ‘T’ cells attack normal cells rather than cancerous
cells
Oncological emergencies
Superior vena cava syndrome
– Tumor/lymph node compresses superior vena
cava; reduced blood flow to the heart & venous
congestion, put client in high fowlers and give radiation
hypercalcemia- Manifestations: anorexia, N/V, shortened QT interval, kidney stones, bone pain, changes in mental status
– Nursing: admin 0.9% NaCl, furosemide,
pamidronate, phosphates as rx.
Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)Findings: N/V, lethargy, hostility,
seizures, coma
* Hematologic disorders
– Caused by CA or CA tx
* Anemia
* Disseminated intravascular
coagulation (DIC)
Lung cancer complications
lung cancer prevention
stop smoking
– Use PPE (mask), proper ventilation in areas
where carcinogens may be in the air
– Screen annually for those at high risk (CT Scan)
lung cancer risk factors
Risk Factors
– Cigarette smoking (inc. secondhand)
– Radiation exposure
– Inhaled environmental irritants
lung cancer findings
Persistent cough – poss. hemoptysis
– Hoarseness
– Alteration in breathing
– Altered breath sounds (wheezing)
* Diminished/absent (obstruction)
– Clubbing of fingers
– Increased work of breathing
Leukemia
Cancer of the white blood cells
Hodgkin’s lymphoma (HL)
Peaks in teens/young adults & adults in 50’s and 60’s
* Viral infections and chemical agents
* Starts in node or chain of nodes containing Reed-
Sternberg cell.
* Predictable spread – one group of lymph nodes to next
* One of most treatable forms of cancer
Non-Hodgkin’s lymphoma (NHL)
More common – men & older adults
* Gene damage, viral infections, autoimmune disease,
exposure to radiation/toxic chemicals
* All lymphoid cancers that do not have Reed-Sternberg
cell
* Spreads in lymph system in erratic pattern
Leukemia
Bone pain
* Joint swelling
* Enlarged liver/spleen
* Anemia
* Bleeding
* Poor wound healing
Hodgkin’s and non-Hodgkin’s lymphoma
Enlarged lymph nodes
* Fever
* Night sweats
* Fatigue
* Infections
* Unplanned weight loss
Leukemia and Lymphoma
* Nursing care
– Monitor for and prevent infection
Neutropenic precautions
Frequent/thorough hand washing priority
– Private room
– Only healthy visitors; screen visitors
– Restrict foods – think bacteria – no fresh/raw
fruits or vegetables
– Eliminate standing water; live plants flowers
not allowed (depends on facility policy)
– Encourage personal hygiene
– Monitor WBC
Prevent injury
* Monitor platelets
* Assess for bleeding
* Protect and avoid trauma
– Conserve energy
Leukemia and Lymphoma
* Complications
Pantocytopenia
* Serious infection risk – ANC less than
1,000/mm3
* Neutropenic precautions
– Thrombocytopenia
* Increased risk of bleeding
– Greatest risk – platelets less than
50,000/mm3
– Spontaneous bleeding less than
20,000/mm3
– HSCT Complications
* Failure of stem cells to grow
* Graft rejection
Leukemia and Lymphoma
* Therapeutic procedures
Hematopoietic stem cell transplantation
Leukemia- chemo
