Transcript Cell cycle nonspecific Alkylating agents

Nursing Care & Interventions
in Managing Those with
Cancer
Keith Rischer RN, MA, CEN
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Today’s Objectives…
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Identify the goals of cancer therapy.
Distinguish between cancer surgery for cure and
cancer surgery for palliative care.
Discuss the nursing care needs for clients
undergoing therapy for cancer.
Discuss radiation therapy.
Identify nursing interventions for patients
undergoing chemotherapy.
Discuss care of patients with neutropenia
Discuss care of patients with thrombocytopenia
Explain the rationale for hormonal manipulation
therapy.
Explain the basis of targeted therapy for cancer.
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Consequences of Cancer
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Impaired immune and hematopoietic function
 Bone marrow
 Anemia and thrombocytopenia
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Altered gastrointestinal structure and function
 Tumors obstruct structures
 Tumors increase metabolic rate
 Tumors in liver reduce liver function
 Diet high in protein and carbohydrates
 supplement when 5% weight loss
 Monitor albumin
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Consequences of Cancer
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Motor and sensory
deficits
Bone metastases
 Spinal cord
compression
 Pain
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Decreased respiratory
function
Airway obstruction
 Tumor compression
 Pleural effusions
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Surgery as Cancer Treatment
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Oldest form of cancer
treatment used for:
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Prophylaxis
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Remove at risk tissue
Diagnosis (biopsy)
Cure
Control (debulks)
Palliation
Determining efficacy of therapy
(second look)
Reconstruction
Side effects of surgical
therapy
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Radiation Therapy
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Purpose
Mechanism of action
 Ionizing radiation
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Exposure
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amount delivered
Dose
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Cells die or unable to
divide
amount absorbed
Killing effects of radiation
 Given in a series of divided
doses
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Fractionation…180-280
rads qd typical
Some organs can tolerate
more radiation
YouTube - Radiation
Therapy to Treat Cancer
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Radiation Therapy
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Teletherapy (Beam)
 Distant-external treatment
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Brachytherapy
 Unsealed
 Body fluids potential hazard
 Isotopes given IV or instilled in body cavities
 Iodine ingestion for thyroid cancer
 Sealed
 Body fluids NOT hazard, but pt. may be
 Implanted in proximity to tumor
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Nursing Care w/Sealed Implants
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Private room with private bath
“Caution: Radioactive Material” note
Nurse wears dosimeter film badge
No pregnant women or children under 16 not to
visit
Limit visitors 30 min/day
 Stay 6 ft away
Never touch radioactive source with hands
Save all dressings and bed linens until
radioactive source is removed.
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Side Effects of Radiation Therapy
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Local skin changes
Hair loss
Altered taste sensations
Fatigue
Debilitating
 Can last for months
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Tissue fibrosis and
scarring of healthy tissue
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Nursing Care w/Radiation Therapy
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Education
Skin care
 Dry skin in path of radiation
 Do not use lotions or ointments.
 Avoid direct exposure of the skin to the sun.
Care for xerostomia (dry mouth).
Bone exposed to radiation is more vulnerable to fracture.
Reproductive effects
 Depends on site
 Harvest sperm or ova
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Chemotherapy
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Mechanism
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Cytotoxic
Some selectivity
Damages cell DNA
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cell division
Rapidly dividing cells more sensitive to chemo
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Skin, hair
Intestinal tissues
Spermatocytes
Blood-forming cells
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Chemotherapy Drug Categories
Table 28-6 p.492
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Antimetabolites
 Act as counterfeit metabolites so cells can’t divide
 Cell cycle specific
Antitumor antibodies
 Interrupt DNA and RNA
 Cell cycle nonspecific
Alkylating agents
 Cross link DNA-prevents DNA/RNA synthesis
 Cell cycle nonspecific
Antimitotic agents
 Interfere with mitosis-prevent division
 Cell cycle specific
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5-Fluorouracil (5-FU)
Anti-metabolite
 IV
 SE
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 Decr.
WBC & platelets
 Stomatitis
 Anorexia
 Darkening of skin…sun sensitivity
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Nursing responsibilities
 Use
sunscreen when outside
 Menstrual changes…decreased sperm counts
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Cytoxan (Cyclophosphamide)
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Alkylating agent
po or IV
SE
N&V 2-4 hours after tx
 Pancytopenia 14 days after tx
 Alopecia 2-3 weeks after tx
 Loss of appetite
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Nursing Considerations
Can cause hemorrhagic cystitis…incr. po and stop if
hematuria
 Mesna (Mesnex) often given to protect
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po or IV
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Vincristine (Oncovin)
Anti-mitotic
 IV
 SE
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 Constipation/abd.
Cramping
 Stomatitis
 Alopecia
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2-3 weeks after tx
Nursing considerations
 Increase
fiber
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Chemotherapy Treatment Issues
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Combination chemotherapy
 More effective-possible more toxic
Drug dosage
 Dependant on type of cancer & client size
Drug schedule –
 Usually every 3 to 4 weeks for 6-12x
Drug administration
 IV route most common
 Use central lines or ports to avoid vessel irritation
 Extravasation
 YouTube - P9290001 Getting her port
accessed www.freehelpforcancer.com
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Side Effects of Chemotherapy
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Fatigue
Alopecia or hair loss
Nausea and vomiting
 Antiemetics
 Zofran
 Ativan
 Compazine
Mucositis-open sores
 mouth (stomatitis) see Mouth
care chart 28-6 p.496
Skin changes
Bone marrow suppression
 Anemia
 Immunosuppression
 Thrombocytopenia
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Neutropenia
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Highest risk
Chemo/radiation
 Liver/kidney disease
 Tumors bone marrow, sm. Cell lung CA, lymphoma,
breast cancer, elderly >70 yrs
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Treatment
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Red Flag
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Filgrastim: granulocyte colony stimulating factor
T>100.4 and ANC <500
Medical management
Cultures
 IV abx
 Nursing assessments/priorities
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Neutropenic Precautions
chart 28-7 p.497
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Good handwashing!!!
Private room – cleaned daily
Do not use supplies from
common areas – straws, etc.
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No water pitchers
Limit # of health care providers,
visitors
VS q 4 hrs
 Watch for sepsis
Inspect mouth, skin, mucous
membranes q 8 hrs
Inspect any open areas for sx
infection
No flowers and potted plants
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Fungi
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Absolute Neutrophil Count (ANC)
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Normal Range
> 2,500/mm3
 1000-2500…safe to continue chemotherapy
 1000-1500 minimal risk
 500-1000 moderate risk
 <500 SEVERE risk
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WBC x(%neutrophils + % bands)
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Example: breast CA after chemo
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WBC 2000, neutrophils 14.8%, bands 5%
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2000 x (0.148 +.05)= 2000 x 0.198=396
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Thrombocytopenia
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Reduction of platelets below normal range
 Normal = 150,000-400,000 mm3
Etiology:
 Bone marrow suppression
Critical values
 50,000 or less- risk of bleeding
 <20,000 spontaneous life threatening hemorrhages
(brain bleed)
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Consider platelet transfusion if febrile or bleeding
<10,000 transfusions recommended
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Nursing Priorities w/Thrombocytopenia
chart 28-9 p.497
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Handle gently
Avoid punctures
Apply ice to trauma
No rectal temps, lubricate suppositories
Electric razor
Mouth care –
 no flossing, avoid dental work, avoid hard foods,
check denture fit
Avoid contact sports
Shoes with firm soles
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Hormone Therapy
Patho
 Types of CA
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 Breast,
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prostate, endometrium
Treatment
 Surgical
(remove the hormone producing organ)
 Pharmocologic suppression
 Steroids
or estrogen
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Stem Cell/Bone Marrow Transplant
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Goal
Give higher than usual dose of chemo to prepare way
for engraftment of stem cell transfusion
 Bone marrow wiped out WBC>0.1
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Bone marrow/stem cells harvested from
pelvis/iliac crest of matched donor or self
(autologous)
Strained-administered as IV infusion
 NHL, multiple myeloma, some breast/testicular CA
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Takes 2-4 weeks before stem cells will take
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very high risk of infection
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Oncology Case Study
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70yr male
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PMH:
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metastatic GB CA-dx 2006 w/hepatic resection, radiation therapy
completed, currently on weekly chemo
Malignant pleural effusions
CAD, HTN
HPI: Progressive worsening of SOB since last
thoracentesis 2 weeks ago. Sudden onset of severe SOB
early am. Incr. weakness w/nausea. No c/o CP
 VS: T-98.2 P-123 (ST) R-22 BP 101/68 sats 90% RA
 Assessment:
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Resp: severely diminished right side
Other systems WNL
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Oncology Case Study
Medical/Nursing Priorities…
 Nursing Assessments…
 Nursing Interventions…
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Oncology Case Study: Oncology Floor
83 yr. female new admission
 PMH: rectal CA 1987 w/surgical
resection/colostomy and radiation
 Chief c/o: Persistent low abd. crampy pain
w/nausea
 CT: large poorly differentiated carcinoma
in pelvis w/migration to lymph nodes
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 Small
bowel obstruction: ? tumor
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Oncology Case Study: Priorities
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Medical…
 NG
to LIS
 NPO
 IVF: NS @ 100cc/hr
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Nursing…
 Pain
control
 Nausea control
 Volume status
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Breast Cancer
Article
 YouTube - Breast cancer real story
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