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Chemotherapy

Chemotherapy. Carita Bird RANC NUR 112. Chemotherapy. Antineoplastic agents are used in an attempt to destroy tumor cells by interfering with cellular functions and reproduction Primarily used to treat systemic disease rather than localized lesions May be combined with radiation or surgery.

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Chemotherapy

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  1. Chemotherapy Carita Bird RANC NUR 112

  2. Chemotherapy • Antineoplastic agents are used in an attempt to destroy tumor cells by interfering with cellular functions and reproduction • Primarily used to treat systemic disease rather than localized lesions • May be combined with radiation or surgery

  3. Chemotherapy • Each time a tumor is exposed to chemotherapy 20-99% of tumor cells are destroyed depending on dosage • Goal to destroy enough of the tumor so the remaining tumor cells can be destroyed by the body’s immune system

  4. Classes of Chemotherapy • Cell-cycle specific drugs: destroy cells actively reproducing by means of the cell cycle • Some are specific to a certain cycle phase • Most affect the S phase by interfering with DNA and RNA synthesis • Others are specific to the M phase

  5. Cell Cycle Phases • G1 phase: RNA and protein synthesis occur • S phase: DNA synthesis • G2 phase: premitotic phase; DNA synthesis is complete • Mitosis: cell division occurs

  6. Classes of Chemo • Cell cycle nonspecific agents • Act independently of the cell cycle phases • Prolonged effect on the cell leading to cellular damage or death • Many treatment plans combine cell cycle specific and nonspecific

  7. Classes of Chemo • Alkylating agents • Antitumor antibiotics • Antimetabolites • Hormonal agents • Vinca alkaloids

  8. Alkylating Agents • Cisplatin, cyclophosphamide • MOA: alter DNA structure by misreading DNA code, initiating breaks in the DNA molecule, cross-linking DNA strands • Cell-cycle nonspecific • SE: bone marrow suppression, N/V, alopecia, stomatitis, renal toxicity

  9. Antitumor Antibiotics • Bleomycin, Adriamycin • MOA: Interfere with DNA synthesis by binding DNA; Prevents RNA synthesis • Cell-cycle nonspecific • SE: bone marrow suppression, N/V, alopecia, anorexia, cardiac toxicity

  10. Antimetabolites • 5-FU, methotrexate • MOA: interferes with the biosynthesis of metabolites or nucleic acids needed for RNA and DNA synthesis • Cell cycle specific (S phase) • SE: N/V, diarrhea, bone marrow suppression, renal toxicity (methotrexate) • Methotrexate requires leucovorin rescue

  11. Hormonal Agents • Estrogens, steroids • MOA: bind to hormone receptor sites that alter cellular growth; inhibit RNA synthesis • Cell-cycle nonspecific • SE: hypercalcemia, jaundice, vaginal dryness, hot flashes, increased appetite

  12. Vinca Alkaloids • Vincristine and vinblastine • MOA: inhibit DNA and protein synthesis • Cell cycle specific at the M phase • SE: bone marrow suppression, neuropathies, and stomatitis

  13. Side Effects of Chemotherapy • Bone marrow suppression • Gastrointestinal effects • Stomatitis • Alopecia • Fatigue • Xerostomia **These are the most common to all

  14. Administration of Chemo • In hospital, clinic, or home setting • Topical, oral, IV, intramuscular, subcutaneous, arterial, intracavitary, and intrathecal • Dosage: based on patient’s total body surface area, previous response to chemo, or radiation, and major organ function

  15. Chemo Adminstration • Problems • Extravasation: tissue necrosis is administered into subcutaneous tissue instead of vein • Adriamycin, vincristine, vinblastine are big ones that are vesicants and can cause extravasation

  16. Chemo Administration • Must be chemo certified through class to administer • You should be able to assess for extravasation • Absence of blood return from IV catheter • Resistance of flow to IV fluid • Swelling, pain, redness at site IF this occurs, stop and apply ice and notify MD

  17. Chemo Administration • GI system side effects • N/V up to 24 hours after administration • Good treatment is Zofran (SL or IV)

  18. Chemo Problems • Hematopoietic system • Myelosuppression: depression of bone marrow function • Leads to decrease in WBC production (leukopenia) when WBCs fall below 2,000mm³ • Anemia, low platelets (<50,000, institute precautions) • Depression of this is usually the reason for limiting dose

  19. Chemo Problems • To combat myelosuppression • We give bone marrow stimulants after chemo • ERYTHROPOIETIN (to produce RBC and decrease anemia) • To stimulate bone marrow to produce WBC especially neutrophils

  20. Problems with Chemo • Renal • Cisplatin and Methotrexate are renal toxic • Cell lysis after chemo leads to urinary excretion of uric acid which can cause renal damage • Monitor BUN, serum creatinine, creatinine clearance • Allopurinol to prevent side effects of uric acid (gout)

  21. Chemo problems • Cardiac • Antitumor antibiotics • Cogestive heart failure • Pulmonary function tests • Check ejection fraction

  22. Chemo Problems • Reproductive • Testicular and ovarian production as previously discussed

  23. Neurologic • Plant alkaloids (vincristine) • Peripheral neuropathies, loss of deep tendon reflexes, paralytic ileus

  24. Client Education for Immunosuppression • High risk for infection • Avoid crowds • Careful personal hygiene • Eat a low bacteria diet • Know the S & Sx of infection and when to report

  25. Client Education for Thrombocytopenia • Monitor stools and urine for bleeding • Use only an electric razor for shaving • Avoid contact sports • Avoid dental work or any other invasive procedures • Tell any healthcare worker about the chemo or radiation therapy • Avoid aspirin • Soft toothbrushes; no flossing

  26. Client Education for Stomatitis and Musositosis • Use soft toothbrush • Avoid mouth products with alcohol • Assess mouth daily • Treat xerostomia • Avoid smoking and alcohol intake • Teach the S & Sx of oral infection • Drink cool liquids • Avoid hot and irritating foods

  27. Client Education for Adequate Nutrition • Eat frequent small, low fat meals • Avoid spicy foods • Avoid extremely hot foods • Perform oral hygiene before and after meals • Maintain fluid intake at 2-3 liters minimum (unless contraindicated) • Use nutritional supplements as prescribed • Keep a food and fluid journal

  28. Nursing Management • Assess fluid and electrolyte status • Risks for bleeding and infection • Monitor infusion site • Monitor lab values • Neutropenic precautions • Provide a quiet and calm environment for the client during chemotherapy administration

  29. Concerns for Nurses with Administration of Chemo • Repeat UA for nurses who are always around chemo • Be aware of potential toxicity • Special thick chemo gloves are worn during administration • Cannot administer chemo if pregnant

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