Oncology part 2- Nursing 2

What do you do if infiltration occurs?

Stop infusion. DO NOT remove the needle May need to attempt to aspirate excess drug from needle, or instill antidote into tissue via intact needle. Follow Hospital policies Contact HCP. Implement HCP orders Document all s/s thoroughly Monitor client throughout the shift, and give a detailed report to the oncoming shift. Ice may be applied. Site elevated for 24-48 hrs.

Cancer treatment complication: Stomatitis?

Prevention: Encourage good oral care before & during treatment. - Avoid commercial mouthwashes, lemon glycerin swabs. - Use sponge "toothette" or very soft toothbrush. - Avoid acidic food, tobacco, alcohol. - Use of artificial saliva, products for xerostoma. -- Biotene products - Viscous Xylocaine if needed (Miracle mouthwash) - Mouthwash of baking soda and water or saltwater

Cancer treatment complication: Infection?

Primary cause of death in cancer patients Occurs due to Ulceration Compression of vital organs by the tumor Neutropenia caused by disease or treatment

Cancer treatment complication: GI effects? What to do and teaching?

Administer antidiarrheal, antimotility, and antispasmodic medications. Teach patients to examine oral cavity and maintain oral care routine. Dental work should be performed before initiation. Taste loss or dysphagia may develop. Use saliva substitutes or drink water frequently. Choose soft, nonirritating, high-protein, high-calorie foods Avoid extreme temperatures, alcohol, and tobacco.

Cancer treatment complication: Anorexia?

Anorexia Monitor carefully to avoid weight loss. Weigh twice weekly. Recommend small, frequent, high-protein, high-calorie meals. Encourage nutritional supplements. Assist to maintain good nutrition. Highly nutritious foods. - Offer favorite food choices. - Control N/V. - Small frequent feedings. - Treat / control stomatitis. - Supplemental feedings / hyperalimentation if needed. - Monitor weight. - Monitor for dysgeusia - loss of taste

Patient teaching for neutropenia?

Avoid contact with excreta from animals - No live virus vaccines - Fresh fruits & vegs. only if cooked, peeled, or washed thoroughly - May require administration of Granulocyte Colony stimulating agents filgrastim (Neupogen) pegfilgrastim (Neulasta)

Patient teaching for thrombocytopenia?

Black tarry stools, black or bloody emesis Bruising, red or purple spots on skin Prevent constipation Use electric razor, soft toothbrush, no floss Bleeding from mouth (or anywhere) Headache / vision changes S/S of stroke

What is a Hematopoietic Stem Cell Transplantation (HSCT)?

Bone marrow transplant (BMT) and Peripheral blood stem cell transplantation (PBSCT) Procedure with many risks, including death Highly toxic Overall cure rates still low but increasing Tumor cells are eradicated and bone marrow is rescued by infusing healthy cells. In this process, cancer cells - usually leukemia or bone marrow cancer or lymphoma - are killed with very high doses radiation and chemo. Next they are replaced with stem cells which proliferate and differentiate in the recipient. This was originally bone marrow transplant, but the technology has changed a lot Bone marrow used to be the source of stem cells, and is still used, but peripheral blood may be used or umbilical cord blood. The SOURCE of the cells may be ALLOGENEIC (from a compatible donor), SYNGENEIC (from an identical twin) or AUTOLOGOUS (from self) Bone marrow transplant requires surgical anesthesia, and is painful. Peripheral blood can be obtained via apheresis Umbilical cord blood is as it sounds

Nursing management for chemotherapy?

Chemo can't distinguish between healthy cells and cancer cells, so the side effects are due to the destruction of other cells - such as hair loss, bone marrow suppression, etc. Side effects must be balanced - below toxic but hopefully not above tolerable Toxicities, such as to the heart, kidneys, liver, lungs, may not be reversible Infection control needed for immunosuppression caused by chemo Bleeding precautions due to low platelets caused by chemo

Cancer treatment complication: Alopecia?

Chemo destroys hair follicles. Hair starts falling out 2-4 weeks after treatment begins. Suggest patient start wearing a wig, scarf or cap prior to treatment. Reassure that hair will grow back. (chemo curls) Discuss scalp hypothermia. Avoid harsh chemicals on hair / scalp. Avoid blow dryers, curling iron. Address effect of alopecia on self-image

What do you take into consideration with intra arterial chemotherapy?

Chemotherapy into an artery (Intra arterial) Intra arterial chemotherapy means having drugs injected directly into arteries close to the cancer. This gives a very high dose of chemo to the tumour, but less to the rest of the body. - for osteogenic sarcoma cancer of the head, neck, bladder, cervix, melanoma, liver, etc. **** Know what you are doing. Nurses generally NEVER give meds via artery****

Treatment plan for chemotherapy?

Combination drugs often given Drug calculated according to Body Surface Area - no, you don't have to know that math! Different modes of action minimizes side effects, maximizes chemo benefits. Also decreases the change, cancer cells killed more effectively, thus reducing the chance of mutations that are resistant to chemo.

Complications of HSCT?

During the period for the graft to take, the patient has PANCYTOPENIA and must be protected from exposure to infectious agents and supported with electrolytes, nutrition, and blood transfusions as needed. Failure to graft is a possibility. Graft versus host disease is a complication. That is when the GRAFT (the transplanted stem cells) attack the HOST (the patient) organs or tissues. Think of this as kind of the same as, but opposite of, a transfusion reaction or a transplant rejection. Instead of the body rejecting the transplant, the transplant rejects the body.

Cancer treatment complication: Anemia?

Encourage high intake of protein, iron, B6, B12, folic acid and Vit. C - Refer to dietician to ensure greatest nutrition when N/V are interfering with appetite - Report extreme fatigue, pallor, palpitations - Administer iron supplements - Administer erythropoietin stimulating agents as indicated by RBC counts: darbepoetin (Aranesp) epoetin (Procrit)

Priority Nsg. Actions—If Radiation Implant Becomes Dislodged??

Encourage the client to lie still. Use a long handled forceps to retrieve the radioactive source. Deposit the radioactive source in a LEAD container. Contact the radiation oncologist. Document the occurrence and the actions taken.

Cancer treatment complication: Nausea/ Vomiting?

Evaluate for fluid / electrolyte imbalance. - For severe diarrhea - evaluate skin of rectal area - prevent excoriation. Low fiber/ low residue diet. Anti-diarrheal meds as needed. - For constipation - increase fiber & fluid intake. Stool softeners. - Eat and drink when not nauseated. - Small feedings; high fluid intake. - Administer antiemetic prior to scheduled treatments, and prn. - Take antiemetics on a scheduled basis after treatments.

Cancer treatment complication: General fatigue? ?

Fatigue Identifying when patient is feeling better may allow more activity. Rest before activity. Get assistance with activity. Maintain nutritional and hydration status. May continue after treatments

Cancer treatment complication: GI effects?

Gastrointestinal (GI) effects Prophylactic administration of antiemetics Prior to treatments Assess for signs and symptoms of Alkalosis, dehydration, and I & O Nonirritating, low-fiber, high-calorie, high-protein diet Nutritional supplements: Boost Ensure Affects cells of GI mucosal lining, so they are very sensitive to chemo and radiation. This produces the famous nausea and vomiting associated with chemo. Can occur from one hour from administration of chemo to a day or week after chemo

Side effects of teletherapy?

Head / Neck - alopecia, xerostomia, stomatitis Chest - esophagitis, bone marrow suppression, chest wall inflammation. Abdomen - nausea, vomiting, bowel obstruction. Pelvic Cavity - diarrhea, cystitis, UTI Skin - erythema, dry desquamation, wet desquamation, temporary / permanent alopecia, destruction of sweat glands. Fatigue

What is sealed internal radiation?

Intracavitary - source inserted directly into a body cavity. Interstitial - source placed directly into the tumor (wire, needle or seeds). Pt. not considered radioactive but the implant is - so use precautions

Collab care for radiation therapy?

Low-energy beams Expend energy quickly Penetrate a short distance Useful for skin lesions High-energy beams Greater depth of penetration Suitable for optimal dosing of internal targets while sparing skin

What is radiation therapy?

May be used independently or in combination with chemotherapy to treat primary tumors or for palliative control of metastatic lesions.

Cancer treatment complication: Neutropenia?

May require neutropenic precautions if severe - Monitor WBCs / cell counts - Report temp > 100 degrees (orally) - Avoid crowds & people with infections - Good personal hygiene / frequent handwashing - Report any redness, swelling, discharge or unusual pain - Get flu / pneumonia shots per physician - Report cough, sore throat, mouth ulcers - No fresh flowers in room / no standing water - Do not work in garden or clean up after pets

What is gene therapy?

Missing or altered genes may lead to cancer. Transfer of exogenous genes into cells of patients in an effort to correct defective gene FDA announced first gene therapy approval for cancer treatment The treatment is called Kymriah Used to treat acute lymphoblastic leukemia (ALL)

Cancer treatment complication: Malnutrition?

Monitor albumin and prealbumin levels. Enteral or parenteral nutrition may be required. Fat and muscle depletion Supplements when 5% weight loss is noted Patient has potential for protein and calorie malnutrition

Nursing interventions when administering teletherapy?

Monitor for adverse effects. Cleanse skin in the tx. area with mild soap. Pat dry, do not rub. Apply non-medicated, non-perfumed cream or lotion such as aloe gel, Aquaphor to treat dry skin. Instruct pt. to avoid tight fitting clothes over the treatment area. Use mild detergent to wash clothes. Avoid use of cosmetics, perfumes, deodorant in the treatment area. Use only an electric razor. Avoid cuts/ trauma to tissue of the treatment area. Avoid direct exposure to sun. No tanning beds. DO NOT remove treatment markers! Avoid pregnancy

Cancer treatment complication: Thrombocytopenia?

Monitor platelet counts - Minimize injections / invasive procedures, dental cleansings, manicures, pedicures unless approved by physician - Avoid sharps, razors, cuts, punctures - Monitor for bleeding (petechiae, ecchymosis, hematuria) - Avoid constipation - Avoid use of ASA , antiplatelets, anticoagulants - Report / prevent dizziness, syncope episodes - Risk of serious bleeding with platelets < 50,000 /uL Platelet replacement required when platelets < 20,000/uL

Delayed side effects of chemo and radiation?

N/V, mucositis, alopecia, rashes, bone marrow suppression,

Nursing considerations when administering chemo drugs?

Observe for therapeutic effect. Monitor for side effects. Dosage is frequently based on body weight and skin surface area (mg/m2) Monitor labs for evidence of bone marrow suppression. Monitor renal / hepatic function.

What is myelosuppression?

One of most common effects of chemo and radiation Reduction in blood cell production Chemo: affects bone marrow throughout the body. Radiation: affects part being treated.

Signs and symptoms of infiltration/extravisation?

Pain - Swelling - Redness - Vesicles on skin - Later: - Severe local tissue breakdown - Ulceration - Necrosis - Scarring - Contractures - Joint pain - Nerve damage

Central vascular access device (VAD) administration for chemotherapy?

Placement in large blood vessels Frequent, continuous, or intermittent administration Can be used to administer other fluids (blood, electrolytes, etc.)

Nursing interventions for a patient that has undergone radiation?

Private room "Caution: Radioactive Material" sign may be required on the door Wear film badge (dosimeter badge) Check all linens / materials removed from the bed for presence of the implant. Keep long handled forceps and lead lined container in room. Keep linens & trash in room until checked for radioactivity by the radiation therapy dept. No pregnant women, infants / children in contact with patient during therapy. Maintain Time, Distance & Shielding precautions. Limit visitors to 30 minutes / day. Should stay at least 6 feet from bed.

What is teletherapy?

Radiation beam is delivered externally Most common radiation therapy Area to be treated is marked. Treatments given once a day for 5 days for 2-8 weeks. Patient is NOT radioactive Destroys or alters DNA - therefore cancer cells cannot reproduce. Immobilization devices are used to help pt. maintain a stable position.

What is brachytherapy?

Radiation is delivered from an internal source

What is unsealed internal radiation?

Radioactive material administered orally, IV or directly into a body cavity. Patient IS radioactive

Collaborative care for a patient that has had internal radiation?

Radioactive source administered Capsule or liquid or IV Patient is radioactive until body eliminates radioactive source Limit amount of time near patients being treated. Organize care. Use shielding. Wear film badge to monitor exposure.

Cancer treatment complication: Severe fatigue? ?

Reassure that this is not unusual - Encourage frequent rest throughout the day - Complete tasks when they have more energy - Exercise regularly (walking) - Encourage good nutrition and hydration - Get plenty of sleep

Acute side effects of chemo and radiation?

anaphylactic reactions, hypersensitivity, extravasation, cardia dysrhythmias

How do you harvest for HSCT?

harvest - obtain the stem cells. Either through bone marrow transplant - (requires general or spinal anesthesia). Painful Peripheral Blood Stem Cell Transplant - Apheresis (like dialysis) - peripheral blood is removed via a catheter, cycled through a machine to separate out the cells, red blood cells returned. Stem cells may be "treated" to remove any undetected cancer if it is autologous. Since there are less stem cells in the circulating blood than in bone marrow, donor may be given granulocyte stimulating medication increase the number of stem cells. umbilical cord stem cells - but only has about 50mL of blood - may need more donors, but often sufficient for children