What is the goal of chemotherapy?
To eliminate or reduce the number of malignant cells present in the primary tumor and metastic tumor sites.
What are the two major categories of chemotherapeutic drugs?
Cell cycle phase nonspecific and cell cycle phase specific drugs.
What are Cell cycle phase nonspecific drugs?
Effect the cells during all phases of the cell cycle.
What are Cell cycle phase specific drugs?
Exert their most significant effects during specific phases of the cell cycle.
How are chemotherapeutic drugs classified?
General groups according to their molecular structure and mechanism of action.
How can chemotherapy be administered?
IV most common through CVAD, PICC, or inserted infusion ports.
What does the use of IV devices reduce the risk of?
What does regional treatment with chemotherapy involve?
Delivery of the drug directly to the tumor site.
What are the most common methods of regional chemotherapy?
Intraarterial, intraperitoneal, intravesical bladder and intrathecal and intraventricular.
What are chemotherapy side effects a result of?
Destruction of normal cells, especially those that are rapidly proliferating such as those in the bone marrow, lining of the GI system, and the integumentary system.
What are the general and drug specific adverse effects classified as?
Acute, delayed or chronic. Some fall into one or more categories.
What is the use of chemotherapy?
To treat systemic disease in combination with other treatments to reduce tumor size preoperatively, to destroy remaining cells postoperatively, to treat some forms of leukemia.
What are the different classification of antineoplastic drugs?
Mechanisms of action (alkylating agents, antimetabolites), sources (plan alkaloids, antibiotics), immunostimulants, hormones, hormone inhibitors, cytoprotectants.
How do Antineoplastic drugs work?
Kill malignant cells by interfering with cell replication and interfering with the supply and use of nutrients. Interfering with the genetic materials in the cell nucleus. Act during cells reproductive cycle. Each drug dose kills a specific percentage of cells. Most active against rapidly diving cells, both normal and malignant.
How are antineoplastic drug dose calcuated?
By type of cancer and clients size.
What are antineoplastic drug doses scheduled?
To maximize cancer cell killing, and minimize damage to the normal cells.
What is the route for drug administration of antineoplastic drug?
IV route preferred.
What are side effects of chemotherapy?
Nausea and vomiting, mucositis, alopecia, hematopoetic system suppression of bone marrow.
How is nausea and vomiting treated for the patient undergoing chemotherapy?
Serotonin blockers, dopaminergic blockers, phenothiazines, sedatives, corticosteroids, and histamines.
What are alternative treatments for nausea and vomiting?
Muscle relaxation, guided imagery, musci, acupressure, and distraction.
What is mucositis?
Sores in the mucous membranes.
What is nursing care for muscoitis?
Frequent assessment, oral hygiene, medications, encourage fluid intake, encourage soft bland foods.
What do you assess with nutritional status of a patient undergoing chemotherapy?
Diet history, medication history, difficulty chewing or swallowing, monitoring weight and caloric intake, monitoring laboratory data.
What are the oral interventions for nutritional support of a patient undergoing chemotherapy?
Avoid odors, small frequent meals, oral hygiene, medications.
What are aspects for enteral route nutritional support of a patient undergoing chemotherapy?
Supplementations, NG, G and J tubes.
What are aspects for parenteral route nutritional support of a patient undergoing chemotherapy?
Venous access devices, to treat malabsorption.
What do you teach for a patient undergoing chemotherapy that is suffering from alopecia?
Hair loss is usually temporary, wigs scarves and hats can be used, protection.
What are characteristics of bone marrow suppression?
Decreased leukocytes, erythrocytes and platelets.
What is therapy for Bone Marrow Suppression?
Frequent monitoring and BRMs.
What is nursing care of the client on chemotherapy related to education with prevention of infection?
Well balanced diet, avoid exposure, hand washing, daily hygiene, care of indwelling catheters and calling hcp when needed.
What is the nursing care of the client on chemotherapy related to education with protection from bleeding?
Avoiding trauma, use electric razor, check skin, urine, and stool for blood.
What systemtic effects can come from chemotherapy?
Renal, cardiopulmonary, reproductive, neurological and fatigue.
What are the renal systemic effects from chemotherapy?
Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia.
What is nursing care for renal systemic effects from chemotherapy?
Monitoring levels, adequate hydration, alkalinization of urine, allopurinal to reduce uric acid levels.
How is the cardiopulmonary system effected by chemotherapy?
Some drugs are toxic to the heart and lungs.
How can chemotherapy effect the reproductive system?
May cause sterility, may cause chromosomal defects, banking of sperm and birth control is recommended.
What are neurological effects from chemotherapy?
Neuropathies, hearing loss.
What do you teach the patient receiving chemotherapy about neurological symptoms?
Reporting symptoms and avoiding heat or trauma.
How can chemotherapy affect fatigue?
Can be debilitating. The patient should plan activities and rest periods, restrict visitors if necessary.
What is Biologic Therapy?
Consists of agents that modify the relationship between the host and the tumor by altering the biologic response of the host to the tumor cells.
What is Targeted Therapy?
Interferes with cancer growth by targeting specific cellular receptors and pathways that are important in tumor growth.
What is associated with biologic therapy?
Bone marrow depression and fatigue. Capillary leak syndrome and pulmonary edema are usually acute or dose limited and may require critical care.
What are the side effects of Interleukins?
Inflammatory reactions, fluid shifts, tissue swelling that can be life threatening.
What is nursing management of BRM therapy?
Educational needs, give support and guideance, and assist in planning and evaluating care.
What is Hematopoeitic Growth Factors?
Colony stimulating factors stimualte the production, maturation, regulation and activation of cells of the hematologic system (bone marrow) after suppression by chemotherapy.
When should erythopoiesis stimulating agents be used?
Only when treating anemia specifically caused by chemotherapy.
What does Hematopoetic growth factors decrease the risk of?
Infection and anemia.
What is Hematopoietic Stem Cell Transplantation?
An effective life saving procedure for a number of malignant and nonmalignant diseases.
How is hematopoetic stem cell transplantation categroized?
Allogenic, syngeneic, or autologous.
What is allogenic transplantation?
Stem cells are acquired from a donor who has been determined to be human leukocyte antigen (HLA) matched to the recipient.
What is syngeneic transplantation?
Type of allogeneic transplant that involves obtaining stem cells from one identical twin and infusing them into the other.
What is autologous transplantation?
Patients receive their own stem cells back following myeloablative (destroying bone marrow) chemotherapy.
How does the patient need to be prepared during hematopoeitic stem cell transplantation?
Conditioning regimen prior to transplantation. It is critical for the patient to be protected from expsoure to infectious agents, and supported with electrolyte supplements, nutrition, and blood componenent transfusions.
What are complications with hematopoeitic stem cell transplantation?
Infections. In allogeneic transplants graft verses host disease.
What is hormonal manipulation used for?
Some hormones can stimulate tumor growth, altering the availability of these hormones can directly effect the tumor growth. It is not a cure, slows tumor growht, may increase survival time.
What are side effects of hormonal manipulation?
Masculinization or feminization, acne, hypercalcemia, liver dysfunction, sexual dysfunction.
What is Gene Therapy?
Investigational treatment that involves using genetic material to fight disease or replace missing genes to prevent development of disease.