CHEMOTHERAPY

ANSAP
 CHEMOTHERAPY
• The use of powerful drugs to:
* kill cancer cells
* control their growth
* relieve pain symptoms
• A systemic treatment
• Directly or indirectly disrupts reproduction of cells
by altering essential biochemical processes.
• The desired outcome is control or eradication of
all malignant cells.
 Types of Chemotherapy
• Primary Chemotherapy
The use of chemotherapy alone for the
cure of a specific tumor.
• Adjuvant Chemotherapy
The use of chemotherapy after primary,
loco-regional treatment, with the intent of
decreasing the relapse rate and improving
survival.
 Types of Chemotherapy
• Neoadjuvant Chemotherapy
The use of chemotherapy before loco-regional
treatment with the intent of decreasing tumor
size enhancing chances for resectability and
preservation of normal structure.
• Concurrent Chemotherapy
The use of chemotherapy combined with
radiotherapy in order to increase local response
and control systemic spread.
 Types of Chemotherapy
• Palliative Chemotherapy
The use of chemotherapy in advanced
malignancies, the intent of which is not
cure but control of the disease and tumor-
related symptoms.
 Giving consent for treatment
No medical treatment can be given without
patient’s consent.
Patient should be provided with full information on:
•The type and extent of treatment the patient is
advised to have
•The advantages and disadvantages of the
treatment
•Any possible alternative treatments that may be
available.
•Any significant risks or side effects of the
treatment.
Safe Handling of Chemotherapy
Drugs
•Chemotherapy administration by a chemo
certified nurse
•Follow institutional guidelines
•Proper labeling and bagging during
transportation
•Disposal of needles in sharps container
•Care in handling of body fluids for 72 hrs.
after chemotherapy
 Accidental Exposure/Contact
Procedure
• Eye Contact – Flush the affected eye(s) with
copious amounts of clean water or normal saline
for a minimum of 15 minutes.
• Skin Contact – Remove any contaminated
clothing immediately. Wash the affected area
with soap and water for a minimum of 15
minutes.
• Skin Punctures – Wash puncture site thoroughly
with soap and running water for 15 minutes.
Allow the wound to bleed freely.
 Spill Management of Cytotoxic
Agents
• Small spills
* wear 2 pairs latex gloves
* wipe liquids with absorbent gauze pads
* clean spill area 3x using detergent
solution followed by clean water
•Large spills
* Obtain spill kit from pharmacy and follow
instructions on the spill kit.
 Chemotherapy Preparations
• All chemotherapy formulations are to be
prepared in the vertical laminar flow hood.
• Strict asepsis
 Protective Barriers
• Gown
• Goggle
• Respirator mask
• Gloves
• Sponges
 TERMS RELATED TO CHEMOTHERAPY
DRUG
• IRRITANTS - Drugs that are capable of producing pain
at the site or along the vein, with or without inflammatory
reaction; never give direct IVP.
• NON-VESICANT – Drugs that can be given by IV Bolus
through side arm of free-flowing IV containing no
additives.
• VESICANT – Drugs that are capable of causing blister
formation and tissue destruction; never give direct IVP.
• EXTRAVASATION – Escape of vein into the tissue.
 KNOWN CHEMOTHERAPEUTIC
VESICANTS

• Anthracyclines or Mitomycin – Cool

compress
• Mechlorethamine, Mustine – Cool
compress
• Vinca Alkaloids – Warm compress
 VESICANT CHEMOTHERAPY
EXTRAVASATION MANAGEMENT
• Immediately stop injection of the drug.
• Leave the needle in place and aspirate any residual drug
and blood from the tubing, needle, and suspected
infiltration site.
• Avoid applying pressure to the suspected infiltration site.
Cover lightly with an occlusive dressing
• Apply cold compress for 30 mins every 2 hrs or warm
compresses as prescribed for 24 hours.
• Elevate the extremity.
• Observe or teach the patient/relative to observe the site
for erythema induration or ulceration and report
immediately.
 CHEMOTHERAPEUTIC AGENTS

• Doxorubicin/Idarubicin
s/e: Cardiotoxicity
N/I: Monitor v/s and heart rate for arrhythmia
• Cyclophosphamide
s/e: Hemorrhagic Cystitis
N/I: >Encourage fluid intake
> Report any sign of bleeding, hematuria or
dysuria
 Chemotherapeutic Agents

• Cisplatin
s/e: Renal Toxicity
N/I: Encourage fluid intake
• Vincristine
s/e: Peripheral neuropathy
N/I: note for numbness or tingling in
fingers or toes
 Chemotherapeutic Agents

• L – asparaginase
s/e: Allergic Reactions
N/I: skin test to assess allergic reaction
before first use
Watch for signs of anaphylactic
shock.
 How are Chemotherapy drugs
Given?
• IV Injection: Cannula/central line
• Tablets or capsule
• Intramuscular injection
• Subcutaneous injection
• Intracavity Chemotherapy
• Chemotherapy creams
• Intrathecal
 Symptomatic Care in
Chemotherapy
• Septicemia
ND – Risk for infection r/t depressed immune
system
Teach patient to guard against infection
• Maintaining meticulous total body hygiene.
• Avoiding crowds & persons with infection
• Maintaining good nutrition and fluid intake
• Practicing good oral hygiene
• Getting adequate rest and exercise
• Reporting s/s of infection to health care
personnel immediately
 Reverse Isolation Technique
• Private room
• Sterile linen, sterile hygiene equipment
• Dedicated equipment
• Put on shoe covers, mask and cap, sterile gown
and gloves
• Low bacteria diet: no fresh fruits and vegetables;
avoid drinking water allowed to stand for more
than 15 min.
• No fresh flowers or potted plants
 Thrombocytopenia
ND – Bleeding r/t decreased platelet
• Monitor platelet count and coagulation studies
• Assess and report any s/s of bleeding
• Administer careful oral hygiene
• Avoid use of the following:
* rough towels
*straight-edge razors
*Restraints
*tight clothing
 Cont. Thrombocytopenia
• Provide night-light to prevent bumping into
objects or falling.
• Administer stool softeners as ordered
• Emphasize importance of avoiding OTC
medications especially those containing
ASA, without consulting physician
 Anemia
ND – Fatigue r/t anemia
• Provide adequate rest periods & sleep to
improve energy level.
• Conserve patient’s energy for desired activities.
• Observe safety precautions: instruct to sit at side
of bed before getting up
• Provide nutritious diet high in iron
• Administer oxygen therapy as ordered
• Administer blood components when ordered
 Nausea, Vomiting & Anorexia
ND – Altered nutrition:less than body requirements
r/t N/V anorexia & decreased food intake
• Monitor v/s
• Weigh patient daily
• Avoid motions conducive to nausea
• Small frequent feedings
• Small dietary intake before treatment
• Avoidance of greasy spicy foods
• Rest periods before and after meals
 Cont. N/V & Anorexia
• Quiet, restful environment
• Monitor I&O to assure adequate hydration.
• Administer IV replacement fluids as
ordered
• Administer anti-emetics before
administration of agents & q 4-6h for 24h
rather than PRN
 Stomatitis
ND – Altered oral mucous membranes r/t effects of
chemotherapy
• Institute oral hygiene regimen
• May use1/4 tsp salt, pinch of baking soda & 8
oz. Of water or saline
• Avoid alcohol or glycerine based mouthwash
• Use soft-bristled toothbrush
• Use foam stick moistened with mouthwash to
remove debris from mucosa
• May apply topical anesthetic, as prescribed
 Cont. oral care
• Encourage fluid intake 2000ml/day
• Encourage bland diet high in CHON to
promote healing
• If patient has difficulty in eating &
maintaining fluid intake, parenteral
nutrition may be necessary
• Assess the need for use of antifungal or
antifungal or antibacterial agents
 Diarrhea
ND – Diarrhea r/t chemotherapy effects on GI
mucosa
• Monitor I&O, weight & electrolytes
• Assess frequency, character & volume of
stool
• Assess abdomen including bowel sounds,
note distention, cramping or flatus
• Assess perineal/perianal region for skin
status
• Adjust diet as appropriate(avoid hot liquids,
coffee, fresh fruits & prune juice
• Include foods high in potassium
 Alopecia
• ND – Risk for impaired skin integrity, resulting in
hair loss r/t effects of chemotherapy
• Inform patient in advance about impending hair
loss
• Stress temporary nature of hair loss to alleviate
concern
• Assist with gentle scalp care during susceptible
period
• Keep head covered when exposed to sun to
prevent sunburn.
 Sexuality
• Sexual feelings may change because of fatigue,
worry, change in self-image, vaginal dryness.
• Potential for male and female sterility,
depending on drugs used, length of treatment,
age of patient.
• Important to counsel use of birth control while
undergoing chemotherapy-men women.
• Suppression of menses
 Summary of effects of
Chemotherapy
• Antineoplastic drugs affect both normal and
cancer cells by disrupting cell function and
division at various points of cell cycle.
• Most cancer drugs are most effective against
cell that multiply rapidly-neoplasm, bone marrow
cells, cells in the GI tract and cells in the skin or
hair follicles. Adverse reactions to cancer drugs
tend to occur in these organs.
• Chemotherapeutic agents should not be used
during pregnancy or lactation. Congenital
defects may occur in the fetus.
 Thank you
• Practice
makes
perfect