8 chemotherapy pp updates

8/8/2019 8 Chemotherapy PP Updates

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WHAT IS CANCER?

Large group of malignant diseases withsome or all of the ff characteristics:

a. Abnormal cell proliferationb. Lack of controlled growth anddivision

c. Ability to metastasize



WH AT IS CANCER?

A few diseases that result

from faulty or abnormalgenetic expression causedby changes that haveoccurred in the DNA.



WH AT IS CANCER?

The uncontrolledgrowth of cells due todamage to DNA(mutations) and,

ocassionally due to aninherited propensity todevelop tumors.



Chemotherapy

A systemic intervention used in thetreatment of certain diseaseconditions

In modern-day use, refers primarilyto the use of cytotoxic agents to treatCANCER.

CHEMOTHERAPEUTIC AGENTS-Used only when disease prognosisshows that patient would benefitfrom the treatment



The Cell Cycle



Broadly, most chemotherapeuticdrugs work by impairing mitosis (cell

division), effectively targeting fast-dividing cells.

In cancer, cells rapidly divide and

does not enter the resting phasebecause they are unresponsive togrowth-inhibitory signals.



Only a percentage of the cancer cellsare killed with each course of chemotherapy. Therefore, repeateddoses or cycles of chemotherapymust be done.



SITES OF ACTION OF CYTOTOXIC AGENTSSITES OF ACTION OF CYTOTOXIC AGENTS

Antibiotics

Antimetabolites

S

(2-6h)G2

(2-32h)

M

(0.5-2h)

Alkylating agents

G1

(2- gh)

G0

Vinca alkaloids

Mitotic inhibitors

Taxoids



GOALS

CURE

CONTROL

PALLIATION



Chemotherapy may be used as

1.) Adjuvant therapy

2.) Neoadjuvant therapy

3.) Chemoprevention4.) Myeloablation



Classification of Chemotherapy Drugs

CYCLE-SPECIFIC

Antimetabolites

± interfere with nucleic acidsynthesis

± Attack during S phase of cell cycle

Cytatabine, floxuridine, fluorouracil,

hydroxyurea, methotrexate,thioguanine




CYCLE-SPECIFIC

Enzymes

± Useful only for leukemias

Asparaginase

Plant Alkaloids

± Cycle-specific to M Phase

± Prevent mitotic spindle formation Vinblastine, vincristine



CYCLE-NONSPECIFIC

Alkylating Agents ± Disrupt deoxyribonucleic acid (DNA)

Carboplatin, Cisplatin,Cyclophosphamide, Ifosfamide, Thiotepa

Antibiotics

± Bind with DNA to inhibit synthesis of DNA and RNA Bleomycin, doxorubicin, idarubicin,

mitomycin, mitoxantrone




CYTOPROTECTIVE AGENTS

± Protect normal tissue by binding withmetabolites of other cytotoxic drugs Dexrazoxane

Mesna

FOLIC ACID ANALOGS

± Antidote for methotrexate toxicity Leucovorin




HORMONE AND HORMONE INHIBITORS

± Interfere with binding of normal hormones toreceptor proteins

± Manipulate hormone levels

± After hormone environment

± Usually palliative,not curative

Androgens, Antiandrogens, Antiestrogens,Estrogens, Gonadotropin, Progestins




Other AntiCancer Agents

Novel Agents

Monoclonal Antibody

± Trastuzumab (Herceptin), Rituximab

(Mabthera), Cetuximab (Erbitux) Tyrosine Kinase Inhibitor

± Imatinib (Glivec)

EG

FR Inhibitors ± Erlotinib (Tarceva), Gefitinib (Iressa)

VEGF Inhibitors

± Bevacizumab (Avastin)



BIOLOGICAL THERAPY

Consists mostly of the administration of biological response modifiers

Also includes the use of immunotherapy Biological response modifiers

± Alter the body¶s response to therapy

± May cause direct cytotoxicity



Immunotherapy

± Uses drugs to enhance the body¶s ability todestroy cancer cells

± Seeks to evoke effective immune responseto human tumors by altering the way cellsgrow, mature, and respond to cancer cells

± May include the administration of

monoclonal antibodies andimmunomodulatory cytokines



Immunotherapy

Monoclonal antibodies ± Specifically target tumor cells

± More recent form of biotherapy that

manipulates the body¶s natural resourcesinstead of introducing toxic substances thataren¶t selective

± Recognizes only a single unique antigen

Rituximab (Rituxan) Trastuzumab (Herceptin)



Immunotherapy

Immunomodulary cytokines

± Intracellular messenger proteins (proteinsthat deliver messages within cells)

Colony-stimulating factors ± Erythropoietin (Epogen), Granulocyte colony-stimulating

factor (Neupogen), Granulocyte-macrophage CSF(Leukine)

Interferon

Interleukins Tumor Necrosis factor



Routes of Administration

Oral Route

Subcutaneous andIntramuscular

IV administration

IV push IV piggy back (large

volume)

Direct Introduction

Intrathecal Intrapleural

Intraperitoneal

Chemoembolization

O

mmaya reservoir



ADMINISTERING CHEMOTHERAPEUTIC DRUGS

Gathering the equipment

± Prescribed drugs

± IV access supplies

± Sterile PNSS ± IV syringes and tubings with

luer lock

± Leakproof chemical waste

container ± Chemotherapy gloves

± Chemotherapy spill kit

± Extravasation kit



Preventing Infiltration

Use a low-pressure infusion pump toadminister vesicants through aperipheral vein, to decrease the riskof extravasation

Use a central venous catheter for

continuous vesicant infusions

ADMINISTERINGCHEMOTHERAPEUTIC DRUGS



Guidelines in giving vesicants

Use a distal vein that allowssuccessive proximal venipunctures

Avoid using the hand, antecubitalspace, damaged areas, or areaswith compromised circulation

Don¶t probe or ³fish´ for veins Place a transparent dressing over

the site




Guidelines in giving vesicants (cont¶n)

Start the push delivery or the infusionwith normal saline solution

Inspect the site for swelling anderythema

Tell the patient to report burning,stinging, pain, pruritus, or temperaturechanges near the site

After drug administration, flush the linewith 20mL of NSS





Concluding Treatment

Dispose of all used needles andcontaminated sharps in the orangesharps container

Dispose of PPE¶s in yellowchemotherapeutic waste container

Dispose of unused medications,considered hazardous waste,according to your facility¶s policy




Concluding treatment (cont)

Wash hands thoroughly

Document the ff.

± sequence in which the drugs were administered ± site accessed, the gauge and length of the

catheter, and the number of attempts

± name, dose, and route of the administered drugs

± Type and volume of the IV solutions and adversereactions and nursing interventions

According to facility policy, wear protectiveclothing when handling body fluids from thepatient for 48 hours after



MANAGING COMPLICATIONS OF CHEMOTHERAPY

ALOPECIA

Hair loss that occurs as chemotherapeuticdrugs destroy the rapidly growing cells of

hair follicles May be minimal or severe

Occurs 2-3 weeks after treatment begins

Almost always temporary

Signs and Symptoms

Hair loss that may include eyebrows,lashes and body hair



Nursing Interventions

Minimize shock and distress by warningthe patient of this possibility

Discuss with the patient why it occurs Describe to the patient how much hair loss

to expect

Emphasize to the patient the need for

appropriate head protection againstsunburn

Inform the patient that new hair may be adifferent texture or color




Give the patient sufficient time to decidewhether to order a wig

Inform the patient that his scalp willbecome sore at times due to folliclesswelling

Prevention measures

For patients with long hair, suggest cuttinghair shorter before treatment becausewashing and brushing cause more hair loss



ANEMIA

Occurs as chemo drugs destroy healthycells and cancer cells

RBCs are destroyed and can¶t bereplaced by the bone marrow

Signs and symptoms

Dizziness, fatigue, pallor, and shortnessof breath after minimal exertion

Low hemoglobin level and hematocrit

May develop slowly over several coursesof treatment




Monitor hemoglobin level, hematocrit,

RBC count; report dropping values Be prepared to administer a blood

transfusion or erythropoietin



Prevention Measures

Instruct the patient to take frequent rests,increase his intake of iron-rich foods, and

take a multivitamin with iron asprescribed

If the patient has been prescribed a drug

such as epoetin, make sure heunderstands how to take the drug andwhat adverse effects he should watch for and report



DIARRHEA

Occurs because the rapidly dividing cellsof the intestinal mucosa are killed

Complications include weight loss, F&Eimbalance, and malnutrition

Signs and symptoms

An increase in the volume of stoolcompared with the patient¶s normal bowelhabits



DIARRHEA


Assess frequency, color, and consistency

of stool Encourage fluids, give IV fluids and

potassium supplements as ordered

Prevention measures

Use dietary adjustments andantidiarrheal meds

Provide good perianal skin care



EXTRAVASATION

The inadvertent leakage of a vesicantsolution into the surrounding tissue

Signs and Symptoms

Initial signs and symptoms may resemblethose of infiltration ± blanching, pain,

swelling Symptoms possibly progressing to

blisters; to skin, muscle, tissue and fatnecrosis; and to tissue sloughing



EXTRAVASATION

Blood return is an INCONCLUSIVE test and shouldn¶t be used todetermine if IV catheter is correctlyseated in the peripheral vein. Toassess peripheral IV placement,

flush the vein with NSS and observesite for swelling.



Extravasation of Doxorubicin




Stop the infusion

Check your facility¶s policy to determine if

the IV catheter is to be removed or left inplace to infuse corticosteroids or aspecific antidote.

Notify the physician




Instill the appropriate antidote accordingto facility policy. Usually, you¶ll give the

antidote for extravasation either byinstilling it through the existing IVcatheter or by using a 1 mL syringe toinject small amounts subcutaneously in a

circle around the extravasated area After the antidote has been given,

remove the IV catheter



Preventive measures

Verify IV line patency andplacement by flushing with normalsaline sol¶n

Remember, ³W hen in doubt, takeit out! ́

Use a transparent, semi-permeable dressing for inspectionof site.



INFILTRATION

The inadvertent leakage of anonvesicant solution or medication intothe surrounding tissue

Infusion-site related



INFILTRATION

Signs and symptoms

Blanching Change in IV flow rate

Numbness and tingling in swollen areadue to nerve compression injury leading

to compartment syndrome Swelling around IV site (the swollen area

will be cool to touch)




Remove the IV catheter

Insert a new IV catheter in a differentlocation

Prevention Measures

Check for infiltration before, during, and

after the infusion by flushing the veinwith normal saline solution



LEUKOPENIA

Reduced leukocytes or WBCs

Occurs asW

BCs and cancer cells aredestroyed by chemo drugs

Signs and Symptoms

Susceptibility to Infections

Neutropenia



LEUKOPENIA


W

atch for the nadir, the point of lowestblood cell count

Be prepared to administer colony-stimulating factors

Institute neutropenic precautions



LEUKOPENIA


Teach the patient and caregiver about: ± Good hygiene practices

± Signs and symptoms of infection

± The importance of checking the patient¶s

temperature regularly ± How to prepare low-microbe diet

± How to care for vascular access devices



LEUKOPENIA


Instruct the patient to avoid ± Crowds

± People with colds or respiratory infections

± Fresh fruit

± Fresh flowers ± plants



NAUSEA and VOMITING

Can appear in 3 different patterns

± Anticipatory

± Acute

± Delayed



ANTICIPATOR Y NAUSEA and VOMITING

Signs and Symptoms

Nausea and vomiting that¶s a learned

response from prior nausea and vomitingafter a dose of chemotherapy

High anxiety levels (acts as a trigger)


Posttreatment control of nausea andvomiting may prevent future anticipatoryepisodes



ANTICIPATOR Y NAUSEA and VOMITING

Prevention measures

Pretreat the patient with lorazepam(Ativan) at least 1 hr before arriving for treatment

Patients with overwhelming anxiety may

need IV lorazepam before chemo isadministered



ACUTE NAUSEA and VOMITING

Signs and symptoms

Nausea and vomiting occurring withinthe first 24 hours of treatment


Treat the patient with acute nausea and

vomiting with antiemetic drugs ± Dexamethasone, Granisetron, Lorazepam,

Metoclopramide, Ondansetron



DELAYED NAUSEA and VOMITING

Signs and Symtoms

Nausea or vomiting starting or continuingbeyond 24 hours after chemo has begun


The administration of serotonin

antagoninsts, corticosteroids, variousantihistamines, benzodiapines, andmetoclopramide is usually effective intreating patients



DELAYED NAUSEA and VOMITING

Prevention Measures

Administer antiemetic before chemobegins

Some patients with delayed nause andvomiting are treated with an antiemetic for

3 days or longer



STOMATITIS

Inflammation of the lining of the oralmucosa

Can spread into the esophagus andpharynx

Signs and Symptoms

Painful mouth ulcers that range frommild to severe appearing 3 to 7 daysafter certain chemotherapeutic drugsare given




Instruct the patient to performmeticulous oral hygiene

Administer topical anesthetic mixturesas appropriate

If pain is severe, opioid analgesics may

be prescribed until the ulcers heal



Prevention Measures

Instruct the patient to suck on ice chipswhile receiving certain drugs that causestomatitis; this decreases the bloodsupply to the mouth, thus decreasingulcer formation



THROMBOC YTOPENIA

Reduced blood platelet count

Signs and Symptoms Bleeding gums

Coffee-ground emesis

Hematuria

Hypermenorrhea

Increased bruising



THROMBOC YTOPENIA

Signs and Symptoms (cont¶n)

Petechiae Tarry stools

Nursing interventions

Monitor patient¶s platelet count

Avoid unnecessary IM injections or venipuncture



If an IM injection or venipuncture isnecessary, apply pressure for at least 5minutes; apply a pressure to the site.

Instruct the patient to ± Avoid cuts and bruises

± Shave with an electric razor

± Avoid blowing his nose



Instruct the patient to

± Stay away from irritants that would trigger sneezing

± Avoid using rectal thermometers

Instruct the patient to report suddenheadaches (which could indicatepotentially fatal intracranial bleeding)



VEIN FLARE

Occurs during infusion of an irritant intothe vein

Signs and Symptoms Bright redness possibly appearing in the

vein along with blotches or hives on the

affected arm Burning pain or aching along the vein aswell as up through the arm



VEIN FLARE


If the reaction is severe, injection of an IV

steroid may be required If the patient complains of pain or burning

during the infusion:

±Increase the dilution of the infusedmedication

± Decrease the infusion rate

± Restart the IV in a different vein



Thank you for listening!! Thank you for listening!!

8 chemotherapy pp updates

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