Week 11 - Chemo and Radiation Flashcards
what is the ultimate goal of chemo
- to reduce the number of cancer cells
what is combination therapy
- a multidrug regimen that kills cancer cells more effective while allowing normal cells to repair and proliferate
which cells are most effected by chemo (5)
- bone marrow stem cells
- epithelial cells of the GI tract
- ova
- testes
- hair follicles and skin cells
why does chemo affect normal tissue
- chemo agents cannot selectively distinguish between normal cells (esp. those that proliferate rapidly) & cancer cells
what are nursing considerations for chemo r/t admin (4)
- may pose hazards to HCP when handled
- drugs may be absorbed via inhalation or skin contact
- also risk in handling body fluids and excreta of pts receiving chemo
- HCP must read the guidelines and protocols for safe handling of chemo drugs
what are the most common routes for admin of chemo (2)
- oral
- IV
what risks are associated w IV admin of chemo (3)
- exravasation
- irritation or damage to the vessels
- infection
what is extravasation
- infiltration of drugs into tissues surrounding the infusion site = local tissue damage
why is extravasation a risk w chemo
- chemo is a vesiciant = causes severe local tissue breakdown and necrosis when infiltrated into the skin
what are signs of extravasation (6)
- pain **
- swelling
- redness
- presence of vesicles on skin
- ulceration
- necrosis
what is a way to minimize the risks associated w chemo admin
- may be administered thru a CVAD
what are imp nursing considerations when giving IV vesicants (3)
- assess IV site for pain, swelling, redness
- use caution during admin
- use CVAD whenever possible
if extravasation leads to ulceration & necrosis, what is often required?
- skin grafts for closure
what is radiation
- the emission and distribution of energy thru a space or a material medium
what is the overall goal of radiation theraoy
- destroy cancer cells
hoe does radiation kill cancer cells
- thru the energy produced by radiation
what impact does radiation have on normal cells
- normal cells within the radiation field are affected
what are 2 types of radiation
- internal
- external
what is external radiation
- most common form of radiation treatment delivery
- pt is exposed to radiation w a megavoltage treatment machine they lie under
what is internal radiation
- radioactive materials are implanted or inserted directly into the tumour or close to the tumour
what is another name for internal radiation therapy
- brachytherapy
internal radiation can be either… what are imp nursing considerations for both of these
- temporary = highly radioactive while in place
- permanent = low radioactive exposure to the outside or others , canbe discharged w precautions
when is brachytherapy clinically appropriate
- when the radiation dose necessary to eradicate the tumor exceeds the dose tolerance of nearby tissues
what are precautions to take w brachytherapy (5)
- use the principles of time, distance, and shielding
- radioactive pt in private room
- organize nursing care so time spent in direct contact w pt is at a mininum
- where a radiation badge
- pregnant women and children should not enter the room
what is involved in radiation treatment planning
- simulation
describe simulation r/t radiation planning
- pt lies on table in the treatment position
- identify under fluroscopy what part of the body needs radiation
- image is taken to verify the field, and marks are placed on the skin to ensure the field can be reproduced on a daily basis (these marks cannot be washed off)
amt of radiation treatments depends on..
- tumour size, type, and location
what complications/adverse effects can chemo & radiation lead to (9)
- impact hematological system
- GI effects
- pain
- fatigue
- skin reactions
- alopecia
- oral, oropharyngeal, and esophageal reactions
- pulmonary effects
- ## reproductive effects
what impact does chemo & radiation have on the hematological system
= myelosuppression = bone marrow suppression
what does bone marrow suppression lead to (3)
- anemia
- leukopenia (neutropenia)
- thrombocytopenia
in which order does chemo & radiation impact BMS
- WBCs first
- then plts
- then RBCs
what is included in nursing care for anemia (4)
- monitor hcg, hct, CBC
- encourage intake of foods that promote RBC production (see anemia deck)
- give colony stimulating factors (erythropoeitin)
- pt may require blood transfusions
what is the risk associated w neutropenia (2)
- risk of infection which can lead to sepsis and death
- classic signs of inflammation (and therefore infection) may not occur
what is included in nursing care for neutropenia r/t chemo & radiation (5)
- monitor the absolute neutrophil count
- monitor for S&S of infection
- if pt is febrile, assume its caused by infection and abx therapy is initiated immediately (within 1 hr)
- give colony stimulating factor (neupogen)
- pt may require reverse isolation (private room, glove, gown, mask)
what is included in pt teaching r/t neutropenia (4)
- avoid large crowds
- good hygeine
- no fresh fruit/flowers in the room
- pt needs to wear mask if leaves room
what is the risk associated w thrombocytopenia
- risk of bleeding and hemorrhage
what is included in nursing care for a pt with thrombocytopenia (6)
- admin of blood products
- admin of plts
- assess for signs of bleeding (petechia, bruising, etc.)
- assess for S&S of internal bleeding (blood in urine, melena, decreased LOC)
- minimize venipuncture and injections
- monitor plts, hct, hgb
what is included in pt teaching for thrombocytopenia (4)
- use an electric shavor, not a razor
- use a soft bristled toothbrush
- avoid drugs, foods, and herb that affect coagulation (aspirin, ginger)
- avoid injury (non-contact sports, wear gloves w household chores, etc.)
how common is fatigue in cancer pts
- effects 80-100%
what is the cause of cancer treatment induced fatigue
- unclear
- thought to be accumulation of metabolites as cells breakdown
what are nursing interventions for fatigue (4)
- maintain good nutrition and hydration
- alternate periods of rest and mild activity (ex. walking)
- encourage client to seek assistance and support from family and friends
- manage pain and anxiety to help reduce fatigue
what is including in nursing interventions for pain r/t chemo and radiation
- give opioids around the clock w extra for breakthrough pain
what impact does cancer treatment have on the GI system (5)
- anorexia
- NV
- DC
- hepatotoxicity
- decreased secretion of mucus, HCl acid, epsin
how does cancer treatment lead to anorexia and NV (4)
- TNF and IL-1 suppress appetite from cancer
- cellular breakdown stimulates the nausea center
- drug stimulate the nausea center
- destruction of GI lining (bc is v sensitive to chemo & radiation)
what is included in nursing care for anorexia, and NV (6)
- monitor pt’s weight during treatment
- encourage small, frequent meals
- anti-emetics prior to treatment
- assess for dehydration and alkalosis
- give high protein, high cal foods that are easy to swallow (ex. ensure, milkshakes)
- beware of anticipatory vomitting
what nursing interventions are used for diarrhea r/t cancer treatment (5)
- low residue diet
- meticulous skin care
- sitz baths
- antidiarrheals
- record #, consistency, and character of stools per day
what is anticipatory NV
- conditioned response that results in the experience of NV when the pt encounters cues associated w the treatment
ex. upon walking thru the doors of the cancer center
what impact does cancer treatment have on the skin (3)
destruction of skin cells from chemo and radiation =
- erythema
- wet desquamation
- dry desquamation
what is included in nursing care for skin reactions to cancer treatment (6)
- use gentle soap (ex. dove)
- use mild detergents
- avoid tight clothes and harsh fabrics
- avoid sun and extreme temps (no heating pads, ice packs, and hot water bottles in treatment field)
- avoid chlorine
- prevent infection
what is included in nursing care for dry skin reactions (2)
- lubricate w non-medicated, non-perfumed lotion
- remove lotion before radiation and reapply after
what is included in nursing care for wet skin reactions
- keep clean & protected
what are nursing interventions for alopecia r/t cancer treatment (5)
- provide options for hair loss (ex. scarves, head coverings, wigs)
- cut hair short
- provide emotional support
- avoid excessive brushing of hair & shampooing
- avoid use of hair drier and other electric appliances to har
what impact does chemo have on alopecia? radiation?
- chemo = temporary, but affects all body hair
- radiation = may be temp or permanent based on dose, but only impacts hair in treatment field
what oral, oropharyngeal, and esophageal impact does cancer treatment have (8)
destruction of mucosal lining of GI tract d/t chemo & radiation :
- decreased salivary flow = xerostomia (dry mouth)
- progressive taste loss (d/t loss of salivia)
- difficulty swallowing
- thick salivia less able to perform the function of cleansing teeth and moistening food
- oral stomatitis
- mucositis
- esophagitis
= compromised nutritional status
what are nursing interventions for the oral, oropharyngeal, and esophageal reactions to cancer treatment (9)
- meticulous oral assessment (examine teeth & gums daily)
- oral care before & after each meal and before bed time –> rinse w saline solution
- brush teeth w soft toothbrush
- drink small amts of water freq / saliva substitue
- avoid hot temp, alcohol, spicy foods, and tobacco
- assess ability to swallow, saliva, mucous membranes regularly
- eat soft, non-irritating, high-cal, high-protein foods
- monitor weight
- make foods visually pleasing d/t taste loss
what can be used to alleviate oral stomatitis, mucositis, and esophagitis r/t cancer treatment (4)
- antacids
- benadryl
- lidocaine cocktail
- anasthetic gel to oral lesions
what pulmonary effects can chemo cause (3)
- pulmonary edema
- interstitial fibrosis
- pneumonitis
what pulmonary effects can radiation cause (2)
- pneumoitis
- damaged lung tissue
the pulmonary effects of cancer therapies may be…
- irreversible and progressive
what are signs of pneumonitis and fibrosis (4)
- dry, hacking cough
- fever
- exertional dyspnea
- night sweats
what is included in nursing care for the pulm effects of cancer treatment (5)
- bronchodilators
- expectoants
- O2
- rest
- cough suppressants for night
what reproductive effects does radiation have (4)
- erectile dysfunction
- loss of vaginal lubrication
- narrowing of vagina
- damage to the ability to produce healthy eggs and sperm
the effects of chemo & radiation on the reproductive system depend on?
- the dose and type of chemo used
what is included in nursing care for the reproductive impacts of cancer treatment (4)
- pre-treatment harvesting of sperm or ova can be considered
- teach use of vaginal lubricant and vaginal dilator post-radiation
- potential infertility can be distressing –> counselling should be considered
- shield the ovaries whenever possible w radiation (unlike the testes, they have no avenue for repair)
what impact might cancer treatment have on the cardio system (3)
- pericarditis
- myocarditis
- cardiotoxicity
what is included in nursing care for CVS effects of cancer treatment (3)
- monitor for S&S of these disorders
- monitor ECG and cardiac ejection fraction
- may have to modify drug therapy
a nursing diagnosis r/t radiotherapy is fatigue. what nursing interventions are done for this (7)
- explain that it may cause fatigue
- assess severity of fatigue
- identify factors that contribute to fatigue
- promote factors that reduce fatigue
- consider pharmacological treatments in consultation w the oncologist
- assist pt & fam in strategies to help conserve energy
- ensure pharmacological therapies are taken as prescribed
a nursing diagnosis r/t neutropenia is risk for infection. what nursing interventions are done for this (9)
- maintain isolation techniques as appropriate
- screen all visitors for communicable disease
- remove fresh flowers & plants from pt areas
- follow neutropenic precautions
- monitor for S&S of infection and sepsis
- monitor lab values
- promote hand hygeine, oral care, skin hygeine, pulm hygiene
- teach pt & caregiver about S&S of infection
- instruct pt to take antibiotics as prescribed
