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NURS 3512 acute & chronic > Week 9 Complications of Chemotherapy & Radiation Therapy > Flashcards

Week 9 Complications of Chemotherapy & Radiation Therapy Flashcards

1
Q

What is external radiation?

A

-Comes from outside the patient
-Target a specific area
- Fluroscopy helps identify what part of the body needs radiation

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2
Q

What is internal radiation?

A

Targeted therapy right inside the tumour
1. temporary implants
2. permanent implants

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3
Q

Is radiation high or low in temporary internal radiation implants?

A

High radioactive while in place

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4
Q

Is radiation high or low in permanent internal radiation implants?

A

Low radioactive
patient can be discharged

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5
Q

What precautions need to be taken as the nurse for a patient with brachytherapy temporary radiation treatment?

A

-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

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6
Q

how long can an uncompromised visitor stay with someone receiving brachytherapy temporary radiation and how far away must they stay?

A
  1. 30 min one time a day
  2. 6 feet from the person
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7
Q

What are acute head/brain effects of radiation?

A

*Alopecia and dermatitis of the scalp

  • Ear and external auditory canal irritation
  • Cerebral edema and increased intracranial pressure
  • Nausea and vomiting
  • Blurry vision
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8
Q

What are acute Head & Neck effects of radiation?

A
  • Oral mucositis (inflammation/ulcers/etc)
  • Taste changes
  • Oral candidiasis, herpes, or other infections
  • Acute xerostomia- very dry mouth
  • Dental caries
  • Esophagitis and pharyngitis
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9
Q

What are chest and lung effects of radiation?

A

Breast and Chest Wall
* Skin reactions

  • Esophagitis

Chest and Lung
* Esophagitis and pharyngitis

  • Taste changes
  • Pneumonia
  • Cough
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10
Q

What are abdomen and Pelvis effects of radiation?

A
  • Anorexia
  • Nausea and vomiting
  • Diarrhea
  • Cystitis or proctitis
  • Vaginal dryness/vaginitis
  • Sexual and fertility problems
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11
Q

What are eye effects of radiation?

A

Conjunctival edema and tearing

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12
Q

What is the most common side effect of radiation?

A

radiation dermatitis
radiation= SKIN PROBLEMS

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13
Q

What do we wash radiation areas with?

A

soap and water only

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14
Q

what is myelosuppression (bone marrow suppression) caused by?

A
  1. bone cancer
  2. Chemo
  3. Radiation
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15
Q

What causes dry itchy skin during cancer treatment? radiation, chemo, or medications?

A

radiation

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16
Q

What do we worry about with myelosuppression?

A

pancytopenia

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17
Q

What is pancytopenia?

A

anemia
neutropenia
thrombocytopenia

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18
Q

What do we monitor and teach a patient who is anemic d/t myelosuppression?

A

Monitor:
-HGB
-HCT

-Intake foods that promote RBC production
-balance rest and activity

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19
Q

Which1 of the 3 aspects of pancytopenia is the biggest problem in myelosuppression and why?

A

Neutropenia- reduction of neutrophils

Risk for infection that is severe and can lead to sepsis & death

20
Q

What specific lab and signs/symptoms do we monitor for someone with neutropenia?

A

ANC (absoulte neutrophil count)
S&S of infection

21
Q

What do we teach patients with neutropenia and what interventions do we do if they have infection?

A

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))

22
Q

what is thrombocytopenia?

A

A reduction of platelets resulting in abnormal hemostasis. At risk for bleeding and hemorrhage.

23
Q

What does the nurse monitor & avoid in someone with thrombocytopenia?what are some interventions?

A
  1. S&S of internal bleeding
    Blood in urine
    Melena stools
    Decreased LOC, confusion
    2.Minimize venipuncture and injections
  2. Administer blood products/platelets
    4.Assess for petechiae, ecchymosis
24
Q

what do we teach patients with thrombocytopenia?

A

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

25
Q

What are 3 main signs of internal bleeding that can happen with thrombocytopenia?

A

blood in urine,
melena stools
decreased LOC suddenly/confusion

26
Q

What causes Anorexia, Nausea and GI issues during Cancer treatment?

A

-(TNF- tumor necrotising factor) released= cellular breakdown and drugs stimulate nausea center
-destruction of GI lining (is extremely sensitive to Chemo/ radiation)

27
Q

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) ?

A

Weight

28
Q

What should people with anorexia and nausea during cancer treatment, eat?

A

high protein
high calorie (easy to swallow) foods

29
Q

What should we assess for in people going through cancer treatment (think N&V issues) ?

A

dehydration
alkalosis

30
Q

What 4 things can people going through cancer treatment do for diarrhea/diarrhea related issues?

A
  1. Low residue diet (not dense grains, nuts, etc)
  2. meticulous skin care
  3. sitz baths
  4. anti-diarrheals
31
Q

What do we teach someone to do who has brain fog and fatigue from cancer treatment?

A

*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

32
Q

What do we teach someone about mouth care who is going through cancer treatment?

A

*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

33
Q

What might someone going through cancer treatment experience regarding peripheral neuropathy?

A

*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

34
Q

What’s the one thing we teach patients to be careful about when going through cancer treatment regarding peripheral neuropathy?

A

be aware of potential for injury and be careful

35
Q

how does radiation affect reproductive system of people going through treatment?

A
  1. can cause erectile dysfunction
  2. can cause loss of vaginal lubrication
  3. can cause narrowing of vagina
  4. can damage the ability to produce healthy eggs and sperm
36
Q

What are options available to manage reproductive effects of radiation?

A

-harvest sperm or ova pre-treatment
-vaginal lubricant and vaginal dilator post treatment
-counseling for potential infertility

37
Q

What are two obstructive oncological emergencies?

A
  1. SVC syndrome- Superior vena cava obstructed
    -by tumour
    -or by blood clot in CVAD
  2. Spinal cord compression - pain, trouble movig, paresthesia, reflex loss, constipation, urinary dysfunction
38
Q

What are 2 Oncological Metabolic emergencies and another metabolic change?

A
  1. SIADH - too much water on board
  2. Tumor Lysis syndrome - triggered by chemo = rapid breadown of tumor
    - electrolyte imbalances
    - renal failure
  3. Hypercalcemia - bone breakdown releases calcium = coma
39
Q

What are the treatments for SIADH?

A

fluid restriction
hypertonic saline
increase sodium (b/c serum Na will be low)

40
Q

what are treatments for hypercalcemia?

A

-biophosphate infusion (pamidronate)- b/c phosphate binds to calcium and lowers levels - hydration
- diuretic

41
Q

What is the treatments for tumor lysis syndrome?

A

hydration- to preserve kidney function
allopurinol- to lower uric acid d/t sudden increase in serum lytes

42
Q

what are the 4 hallmark lab signs of tumor lysis syndrome?

A

Hyperuricemia - high uric acid
Hyperphosphatemia - high phosphate
Hyperkalemia - high potassium
Hypocalcemia - high calcium

43
Q

What do people with neutropenia from myelosuppresion or cancer treatment often die from?

A

Sepsis (increased risk for sepsis)

44
Q

What does septic shock lead to?

A

Disseminated intravascular coagulation (DIC)- blood clots all over

45
Q

What happens in DIC?

A

-extensive clotting depletes systemic platelets and clotting factors
-leads to bleeding and hemorrhage
-clots can travel to organs causing symptoms

NURS 3512 acute & chronic (29 decks)

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