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What
You Need to Knowabout
Chemotherapy?
__________________Jessie T. Orao, RN, RM
eacher
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Objectives
Define common terms regardingchemotherapy and radiation.
Identify the principles of chemotherapy andradiation therapy.
Discuss the purposes of chemotherapy andradiation to cancer patient.
Prioritize safety of the patient, self, and othersin preparation, administration, and the after
care procedure for chemotherapy andradiation.
List safety measures regarding chemotherapyadministration and radiation therapy.
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Definition
It is the use of antineoplastic drugs to
promote tumor cell destruction byinterfering with cellular function and
reproduction. It includes the use of
chemotherapeutic agents and hormones
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Personal Safety toMinimize Exposure via
Inhalation
Chemotherapeutic agents shouldbe prepared in a class II biologicsafety cabinet (vertical laminar flowhood)
Vent vials with filter needle toequalize the internal pressure or usenegative pressure techniques.
Wrap gauze or alcohol padsaround the neck of ampules whenopening to decrease dropletcontamination.
Wrap gauze or alcohol padsaround injection sites whenremoving syringes or needles from
IV injection ports. Do not dispose materials by
clipping or removing needles fromsyringes.
Use puncture-and leak-proofcontainers for non-capped, non-clipped needles
Do not eat, drink, chew gum, orsmoke while preparing orhandling chemotherapeuticagents.
Keep all food and drink awayfrom preparation area.
Wash hands before and afterhandling chemotherapy. Avoid hand-to-mouth or hand-to-
eye contact while handlingchemotherapeutic agents orbody fluids of the personreceiving chemotherapy.
Personal Safety toMinimize Exposure via
Ingestion
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PERSON L S FETY TO MINIMIZE EXPOSUREVI SKIN CONT CT
1. Wear powder-free latex gloves with at least .007 thickness at alltimes when preparing or working with chemotherapeutic agents.
2. Wash hands before putting on and after removing gloves.3. Change latex gloves after each use, tear, puncture or medication
spill or after every 30 minutes of wear.4. Wear a long-sleeve, non-absorbent gown with elastic at the wrists
and back closure.5. Eye and face shields should be worn if splashes are likely to occur.6. Use syringes and IV tubing with Luer locks.7. Label all syringes and IV tubing containing chemotherapeutic
agents as hazardous material.8. Place an absorbent pad directly under the injection site to absorb
any accidental spillage.9. If any contact with the skin occurs, immediately wash the area
thoroughly with soap and water.10. If contact is made with the eye, immediately flush the eye with
water and seek medical attention.11. Spill kits should be available in all areas where chemotherapy is
stored, prepared, and administered.
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Safe Handling
Chemotherapeutic Agents
Chemotherapeutic Drugs are hazardous drugs.
a hazardous drug is defined as an agent that
presents a danger to healthcare personnel due toits inherent toxicity.
They are carcinogenic
They are genotoxic
They are teratogenic
There is evidence of toxicity at low doses
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SAFE DISPOSAL OF ANTINEOPLASTIC AGENTS,BODY FLUIDS, AND EXCRETA
Discard gloves and gown into a leak-proofcontainer which should be marked as
contaminated or hazardous waste. Use puncture-and-leak-proof containers for
needles and other sharp or breakable objects. Linens contaminated with chemotherapy or
excreta from patients who have receivedchemotherapy within 48 hours should bemarked hazardous waste bags.
Wear latex gloves in disposal. In the home, wear gloves when handling
contaminated linen, clothing or even excreta ofthe patient receiving chemotherapy.
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSING
INTERVENTIONS
Alopecia
Hair loss that occurs as chemotherapeutic drugs
destroy the rapidly growing cells of hair follicles This is dependent on the dose, half-life of drug,
and duration of therapy.
Begins 2-3 weeks after administration of
chemotherapy Regrowth takes about 3-5 months.
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSING
INTERVENTIONS
Interventions:
Goal:Strengthening Coping with Altered Body Image
1. Reassure patient that hair usually grow back.
2. Suggest wearing of turban, wig or headscarf
3. Encourage patient to stay on therapeutic program.
4. Emphasize to the patient the need for appropriate headprotection against sunburn
5. Inform the patient that his scalp will become sore at
times due to follicles swelling
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Nursing Diagnosis:
Altered Body Image related to alopecia
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSINGINTERVENTIONS
Anorexia Chemotherapy changes
the reproduction of tastebuds.
Altered taste can lead to
decrease food intake. Renal or hepatic disease
can lead to anorexia.
Interventions:
Goal: Promoting nutrition
1. Encourage small, frequentmeals, appealing topatient preference.
2. Encourage to eat a diethigh in calories andproteins.
3. Discourage smoking andalcoholic beverages ,which may irritate mucousmembranes.
4. Discuss the importance ofincreasing fluid intake
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Nursing Diagnosis
Altered Nutrition: Less Than Body
Requirements related to side-effects oftherapy
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSING
INTERVENTIONS
Fatigue
The cause is unknownbut can be related toanemia, weight loss,altered sleep patternsand coping.
Interventions:Goal: Minimizing fatigue1. Monitor blood counts
(Hgb. and Hct.)2. Administer blood products
as prescribed.3. Caution the patient about
overexertion4. Plan frequent rest periods
between daily activities.5. Explain that BT may begiven.
6. Observe skin color.7. Monitor nutritional status
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Nursing Diagnosis
Fatigue related to anemia
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSING
INTERVENTIONS
Nausea and Vomiting
Caused bystimulation of thevagus nerve.
Incidence dependson the particularchemo- therapeuticagent.
3 Patternsa. Anticipatory
b. Acutec. Delayed
Interventions:Goal:Promoting Nutrition
1) Administer antiemetics prior tochemotherapy and on routineschedule.
2) For highly emetogenic regimens:Zofran & Decadron3) For Moderately emetogenic
regimens: Droperidol, Decadron,4) Metoclopramide, plus Benadryl5) For low emetogenic regimens: OTC
antiemetic drugs.
6) For delayed vomiting, continuetreatment for 24 to 48 hours.7) Consider measures for anticipatory
vomiting8) Encourage small, frequent meals.9) High protein diet, increase fluid
intake.
10) Monitor I & O.
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ACUTE NAUSEA and VOMITING
Signs and symptomsNausea and vomiting occurring within
the first 24 hours of treatment
Nursing InterventionsTreat the patient with acute nausea and
vomiting with antiemetic drugsDexamethasoneGranisetron
LorazepamMetoclopramideOndansetron
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DELAYED NAUSEAand VOMITING
Signs and SymtomsNausea or vomiting starting or continuingbeyond 24 hours after chemo has begun
Nursing InterventionsThe administration of serotonin
antagoninsts, corticosteroids, variousantihistamines, benzodiapines, and andmetoclopramide is usually effective intreating patients
Prevention Measures
Administer antiemetic before chemobeginsSome patients with delayed nause and
vomiting are treated with an antiemetic for3 days or longer
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Nursing Diagnosis
Risk for Fluid Volume Deficit related to side-
effects of chemotherapy
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Nursing Diagnosis
Altered Oral Mucous Membrane related to
stomatitis
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSINGINTERVENTIONS
Anemia
Occurs as chemo drugsdestroy healthy cells andcancer cells
RBCs are destroyed andcant be replaced by the
bone marrow It require RBC transfusion or
erythropoietin injection
Signs and symptomsDizziness, fatigue,
pallor, andshortness of breathafter minimalexertion
Low hemoglobinlevel andhematocrit
May developslowly over severalcourses oftreatment
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSINGINTERVENTIONS
Interventions:
Goal: Minimizing anemia
Nursing Interventions
Monitor hemoglobin level, hematocrit, RBC count; reportdropping values
Be prepared to administer a blood transfusion or erythropoietin
Prevention Measures
Instruct the patient to take frequent rests, increase his intake ofiron-rich foods, and take a multivitamin with iron as prescribed
If the patient has been prescribed a drug such as epoetin,make sure he understands how to take the drug and whatadverse effects he should watch for and report
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSINGINTERVENTIONS
Neutropenia
Absolute neutrophilcount 1,500/mm orless.
Occurs 7-14 daysafterchemotherapy.
Risk of infection isincreased.
Caused bysuppression of stemcell.
Interventions:Goal:Preventing Infection1. Monitor V/S q4h. Report
occurrence of fever.
2. Reinforce good personalhygiene habits.3. Avoid contact with persons
who have transmissible illness.Practice reverse isolation.Wear mask.
4. Encourage coughing anddeep-breathing.5. Follow-up monitoring of WBC
count.6. Administer prophylactic
antibiotics as prescribed.
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSINGINTERVENTIONS
LEUKOPENIAReduced leukocytes or WBCsOccurs as WBCs and cancer cells are destroyed bychemo drugs
Signs and SymptomsSusceptibility to InfectionsNeutropenia
Nursing InterventionsWatch for the nadir, the point of lowest blood cellcountBe prepared to administer colony-stimulating factorsInstitute neutropenic precautions
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Nursing Diagnosis
Risk for Infection related to neutropenia
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSINGINTERVENTIONS
Thrombocytopenia
Caused by suppression
of megakaryocytes. Risk of bleeding is
present when plateletcount falls below50,000/mm.
May require platelettransfusion if count dropsbelow 20,000/mm.
Interventions:Goal:Minimizing Bleeding1. Avoid invasive procedure
when platelet count is less
than 50,000/mm.2. Apply pressure on injectionsites fro 5 minutes.
3. Monitor platelet count.4. Abstain from the following:
a. Use of sharp objects.
b. Sexual intercourse.c. Dental workd. Use of NSAIDs, aspirin,and aspirin-containingproducts.
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Nursing Diagnosis
Risk for Bleeding related to
thrombocytopenia
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSINGINTERVENTIONS
DIARRHEA
Occurs because the rapidly dividing cells of the intestinal
mucosa are killed
Complications include weight loss, F&E imbalance, and
malnutrition
Signs and symptoms
An increase in the volume of stool compared with the
patients normal bowel habits
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SIDE-EFFECTS OF CHEMOTHERAPY AND ITS NURSINGINTERVENTIONS
DIARRHEA
Nursing InterventionsAssess frequency, color, and consistency of stool
Encourage fluids, give IV fluids and potassium supplements
as ordered
Prevention measuresUse dietary adjustments and antidiarrheal meds
Provide good perianal skin care
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EXTRAVASATIONThe inadvertent leakage of a vesicant
solution into the surrounding tissue
Signs and Symptoms Initial signs and symptoms may resemble
those of infiltrationblanching, pain,swelling
Symptoms possibly progressing to blisters; toskin, muscle, tissue and fat necrosis; and totissue sloughing
Blood return is an INCONCLUSIVE test andshouldnt be used to determine if IVcatheter is correctly seated in theperipheral vein. To assess peripheral IVplacement, flush the vein with NSS andobserve site for swelling.
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Extravasation of Doxorubicin
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INFILTRATION
The inadvertent leakage of a nonvesicantsolution or medication into the surroundingtissue
Infusion-site related
Signs and symptoms
BlanchingChange in IV flow rateNumbness and tingling in swollen area due
to nerve compression injury leading tocompartment syndrome
Swelling around IV site (the swollen areawill be cool to touch)
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Nursing Interventions
Remove the IV catheter
Insert a new IV catheter in a different location
Prevention Measures
Check for infiltration before, during, and after theinfusion by flushing the vein with normal saline
solution
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The art of being a nurse
lies in the power of giving what is best for ourpatients in some ways.
Life does not force us to be the best, it onlyasks constant care and love
Dr. Gregory House
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THE END!!!
Thank YouVery Much!!!