ONCOLOGY 5

Note: for inflammation – cold & decrease pain

For circulation – warm

ALERT: OBSERVE CLIENT FOR S/E OF A CHEMICAL AGENT IF EXTRAVASTION OCCURS:

A. STOP THE INFUSION: REMMOVE ANY REMAINING DRUG IN THE TUBING OR NEEDLE AND

ASPIRATE THE INFILTRATED AREA.

B. DO NOT REMOVE THE NEEDLE.

C. CONTACT PHYSICIAN AND CONSULT HOSPITAL POLICY & PRECAUTION FOR SPECIFIC MEDICATION.
D. ANTIDOTE MEDS MAY BE INSTILLED DIRECTLY INTO THE INFILTRATED AREA.
E. ICE MAY BE APPLIED TO THE SITE AND EXTREMITIES ELEVATED FOR THE FIRST 24-28H AFTER
EXTRAVASATION.

EXTRAVASATION: NURSING INTERVENTIONS (HEAT AND CCOLD COMPRESS)

A. Cold compression are indicated for DOXORUBICIN extravasation but are no benefit for Taxone or Oxaliplatin
(Eloxatin) extravasation.
B. Warm compression are recommended for VINCA ALKALOID extravasation.
C. Dependimg on the guidelines for specific agent, extravasation management may include aspiration of any
infiltrated meds from the tissues and injection of a neutralizing solutions into the area to reduce tissue damage.
D. Dexrazoxane(Totect) IV infusion for 3days has benefit in treatment of anthracycline (i.e doxorubicin) extravasation
with prevention of tissue necrosis.

IDEAL: central- subclavian

SOMETIMES: peripheral – coz of short courses in chemotherapy (ex: OPD clinic)

Note: vesicant chemo should never be administered in peripheral veins involving the hand and wrist. Peripheral
administration is permitted for short duration infusion only and placement of venipuncture site should be on the forearm
using a soft plastic catheter.

IONIZING AGENT

What is radiation therapy?

- Use of radiation which targets tumor itself

- Affects normal cell

Priciples:

- Uses ionizing radiation to kill or limit cancer cells

- Destroys or alters DNA
- Effects can’t be limited to cancer cells only
- It shrinks the tumor

CBQ: why muagi pag radiation before surgery?

- To lessen the size of tumor.

TYPES OF IONIZING RADIATION

ELECTROMAGNETIC RADIATION – e.i X-Raya and Gammarays

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PARTICULATE RADIATION – electron, beta and alpha articles, protons neutrons.

Non- ionizing – microwave

RADIATION DOSAGE:

- Lethal tumor disease

- Fractionated doses – outward/inward route/direction
-good killing effect

TYPES OF EBERGY EMMITTED:

ALPHA – particles can’t pass through the skin

BETA – particles can’t pass through the skin but somehow penetrating the alpha

GAMMA – penetrates deeper area of the body

- Mostly USED
- EXAMPLE: ETERNAL BEAM RADIATION (EBT)

TYPES OF READIATION ADMMINISTRATION:

1. TELETERAPHY (EBT)
2. BRACHYTHERAPHY (internal radiation/ implant therapy)
3. SYSTEMIC ( unsealed source, radiopharmaceutical or radioisotope)
4. Contacts or surface molds

NURSING PRIORITIES:

Clients who receive radiation therapy should not be gathered with soap over the radiation site and should avoid
use of lotions and powders.

NURSING RESPONSIBILITIES INCLUDE KNOWLEDGE ABOUT THE FF:

o Radiation source being used

o Method of administration
o Start of treatment
o Length of treatment
o Prescribed nursing precautions

ETERNAL RADIATION

EBRT – ( External Beam Radiation Therapy)

o Intensity Modulated Radiation Therapy (IMRT)

o Image Guided Radiation Therapy (IGRT) – used of UTZ video; respiratory gating
o Stereotatic Body radiotherapy
o Proton Therapy

INTERNAL RADIATION

o Intraluminal brachytherapy – insertion of halo tubes/ catheter

o Systemic brachytherapy – (blood vessels/ body) that contains radioisoptes
 Radioactive iodine (I 131) – x hyperthyroid
 Strontium 89 – for none metastasis; hypothyroidism
 Samarium – metastatic bone lesion
 Phosphorous 32 –malignant ascites
 YHrium 90 – non- Hodgkin’s lymphomas
o Intracavity radioisotopes (Peritoneum)
 High-dose radiation (HDR)
 For short course/time
o Interstitial implant ( Prostate, Breast, Pancreatic cancers)
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 Seeds
 Needles
 Wires
 Small catheter

IMPLANT THERAPY

Also known as:

 Sealed source radiotherapy

 Endocurietherapy
 Brachytherapy
 Closed therapy
o Radiation given very close to the tumor
o Maybe delivered temporary or permanent implant
o Delivers large doses of radiation to a small area of the body
o The proximity to the tumor minimizes sequela to adjacent organ.

UNSEALED SOURCE (means systemic)

o Also known as radiopharmaceutical isotope

o May be given intravenously or orally or may be implanted in a body cavity. Body fluids become
contaminated.
 NURSING PRIORITY –adverse effects are related to radiation dose delivered with a
specified, method of delivery, and client overall health status.

ADVERSE EFFECT OF RADIATION THERAPY

o SKIN REACTIONS
 Skin erythema
 dry squamation of the skin
 wet desquamation of the skin
 loss of hair on the skin
 skin pigmentation and discoloration
o GI DISTURBANCE
o OTHERS: FATIGUE – chemo; radiation

A: Desquamating eryhtrodermic feet (like psoriasis)

B: Desquamating eryhtrodermic hands

C: Hands

D: Abdomen

E: Ear
F: Nail pitting
G: Forehead
H: Knee, plaque form

FOLLOWING INTERVENTIONS --------------------- 6th ONCOLOGY NOTES