Week 9 Complications of Chemotherapy & Radiation Therapy Flashcards
What is external radiation?
-Comes from outside the patient
-Target a specific area
- Fluroscopy helps identify what part of the body needs radiation
What is internal radiation?
Targeted therapy right inside the tumour
1. temporary implants
2. permanent implants
Is radiation high or low in temporary internal radiation implants?
High radioactive while in place
Is radiation high or low in permanent internal radiation implants?
Low radioactive
patient can be discharged
What precautions need to be taken as the nurse for a patient with brachytherapy temporary radiation treatment?
-place radioactive patient in private room
- Pregnant people and children cannot enter room
-Time (short time)
-Distance (stay far away)
- Shielding (lead vests)
- radiation badge
how long can an uncompromised visitor stay with someone receiving brachytherapy temporary radiation and how far away must they stay?
- 30 min one time a day
- 6 feet from the person
What are acute head/brain effects of radiation?
*Alopecia and dermatitis of the scalp
- Ear and external auditory canal irritation
- Cerebral edema and increased intracranial pressure
- Nausea and vomiting
- Blurry vision
What are acute Head & Neck effects of radiation?
- Oral mucositis (inflammation/ulcers/etc)
- Taste changes
- Oral candidiasis, herpes, or other infections
- Acute xerostomia- very dry mouth
- Dental caries
- Esophagitis and pharyngitis
What are chest and lung effects of radiation?
Breast and Chest Wall
* Skin reactions
- Esophagitis
Chest and Lung
* Esophagitis and pharyngitis
- Taste changes
- Pneumonia
- Cough
What are abdomen and Pelvis effects of radiation?
- Anorexia
- Nausea and vomiting
- Diarrhea
- Cystitis or proctitis
- Vaginal dryness/vaginitis
- Sexual and fertility problems
What are eye effects of radiation?
Conjunctival edema and tearing
What is the most common side effect of radiation?
radiation dermatitis
radiation= SKIN PROBLEMS
What do we wash radiation areas with?
soap and water only
what is myelosuppression (bone marrow suppression) caused by?
- bone cancer
- Chemo
- Radiation
What causes dry itchy skin during cancer treatment? radiation, chemo, or medications?
radiation
What do we worry about with myelosuppression?
pancytopenia
What is pancytopenia?
anemia
neutropenia
thrombocytopenia
What do we monitor and teach a patient who is anemic d/t myelosuppression?
Monitor:
-HGB
-HCT
-Intake foods that promote RBC production
-balance rest and activity
Which1 of the 3 aspects of pancytopenia is the biggest problem in myelosuppression and why?
Neutropenia- reduction of neutrophils
Risk for infection that is severe and can lead to sepsis & death
What specific lab and signs/symptoms do we monitor for someone with neutropenia?
ANC (absoulte neutrophil count)
S&S of infection
What do we teach patients with neutropenia and what interventions do we do if they have infection?
1.Avoid large crowds- period/always
2. Good handwashing
3.No fresh fruit/flowers in room
4. If febrile, antibiotic therapy is initiated immediately (within 1 hr)
5. May need reverse isolation (private room, glove/ gown/ mask)
6.Patient wears mask if leaves room
7. Give colony stimulating factor (filgrastim-Neupogen (helps fight off infection))
what is thrombocytopenia?
A reduction of platelets resulting in abnormal hemostasis. At risk for bleeding and hemorrhage.
What does the nurse monitor & avoid in someone with thrombocytopenia?what are some interventions?
- S&S of internal bleeding
Blood in urine
Melena stools
Decreased LOC, confusion
2.Minimize venipuncture and injections - Administer blood products/platelets
4.Assess for petechiae, ecchymosis
what do we teach patients with thrombocytopenia?
1.Electric shaver -Not a razor
2.Soft bristle toothbrush
3.Avoid drugs & foods, and herbs that effect coagulation (for eg. Aspirin, ginger)
4.Avoid injury (contact sports-gloves for housework)
5. assess for petechiae, ecchymosis (go see doctor)
6. S&S of internal bleeding - blood in urine, melena stools, decreased LOC suddenly/confusion
What are 3 main signs of internal bleeding that can happen with thrombocytopenia?
blood in urine,
melena stools
decreased LOC suddenly/confusion
What causes Anorexia, Nausea and GI issues during Cancer treatment?
-(TNF- tumor necrotising factor) released= cellular breakdown and drugs stimulate nausea center
-destruction of GI lining (is extremely sensitive to Chemo/ radiation)
what do we monitor closely in someone going through cancer treatment with anorexia and nausea (think about the effects of N&V on I&O, nutrition, etc) ?
Weight
What should people with anorexia and nausea during cancer treatment, eat?
high protein
high calorie (easy to swallow) foods
What should we assess for in people going through cancer treatment (think N&V issues) ?
dehydration
alkalosis
What 4 things can people going through cancer treatment do for diarrhea/diarrhea related issues?
- Low residue diet (not dense grains, nuts, etc)
- meticulous skin care
- sitz baths
- anti-diarrheals
What do we teach someone to do who has brain fog and fatigue from cancer treatment?
*Encourage adequate hydration and nutrition
*Manage pain and anxiety (give opioids around the clock with extra for breakthrough pain)
*Balance mild physical activity (walking) and rest
*Encourage client to seek assistance and support from family and friends
What do we teach someone about mouth care who is going through cancer treatment?
*Decreased salivary flow (xerostomia - dry mouth)
*Examine teeth and gums daily
*Oral care before and after each meal and before bedtime (rinse with saline solution)
*Brush teeth with soft toothbrush
*Drinking small amounts of water frequently/ saliva substitute
*Antacids/Benadryl/Lidocaine cocktail (pink lady) or anesthetic gel to oral lesions
*Hot temperatures, alcohol, and tobacco should be avoided
*Soft non-irritating high calorie, high protein foods are
recommended
What might someone going through cancer treatment experience regarding peripheral neuropathy?
*Loss of sensory perception or motor function of peripheral nerves
*loss of sensation to hands and feet
*impaired gait and balance
*orthostatic hypotension
*Neuropathic pain
*Erectile dysfunction
*Loss of fine motor function (playing an instrument)
*Loss of taste discrimination,
*constipation
What’s the one thing we teach patients to be careful about when going through cancer treatment regarding peripheral neuropathy?
be aware of potential for injury and be careful
how does radiation affect reproductive system of people going through treatment?
- can cause erectile dysfunction
- can cause loss of vaginal lubrication
- can cause narrowing of vagina
- can damage the ability to produce healthy eggs and sperm
What are options available to manage reproductive effects of radiation?
-harvest sperm or ova pre-treatment
-vaginal lubricant and vaginal dilator post treatment
-counseling for potential infertility
What are two obstructive oncological emergencies?
- SVC syndrome- Superior vena cava obstructed
-by tumour
-or by blood clot in CVAD - Spinal cord compression - pain, trouble movig, paresthesia, reflex loss, constipation, urinary dysfunction
What are 2 Oncological Metabolic emergencies and another metabolic change?
- SIADH - too much water on board
- Tumor Lysis syndrome - triggered by chemo = rapid breadown of tumor
- electrolyte imbalances
- renal failure - Hypercalcemia - bone breakdown releases calcium = coma
What are the treatments for SIADH?
fluid restriction
hypertonic saline
increase sodium (b/c serum Na will be low)
what are treatments for hypercalcemia?
-biophosphate infusion (pamidronate)- b/c phosphate binds to calcium and lowers levels - hydration
- diuretic
What is the treatments for tumor lysis syndrome?
hydration- to preserve kidney function
allopurinol- to lower uric acid d/t sudden increase in serum lytes
what are the 4 hallmark lab signs of tumor lysis syndrome?
Hyperuricemia - high uric acid
Hyperphosphatemia - high phosphate
Hyperkalemia - high potassium
Hypocalcemia - high calcium
What do people with neutropenia from myelosuppresion or cancer treatment often die from?
Sepsis (increased risk for sepsis)
What does septic shock lead to?
Disseminated intravascular coagulation (DIC)- blood clots all over
What happens in DIC?
-extensive clotting depletes systemic platelets and clotting factors
-leads to bleeding and hemorrhage
-clots can travel to organs causing symptoms
