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Cancer tx and care
| Question | Answer |
|---|---|
| principles of radiation | 1. sensitivity varies-resistant c bones, muscle, nerves (need larger dose, more at risk for toxicity), sensitive c ovary, lymphoid, bone marrow (fastest reproducers, can use smaller dose b/c easier to kill) 2. Interferes c cell division 3. External or i |
| External Radiation | -painless-teach pt -lie still, 15-30 minutes, may have to restrain body part, don't wash off 'target marks' -alone -no residual radioactivity -don't apply lotion-contain metal that heats up c next radiation tx -not dangerous afterwards |
| Internal Radiation (brachytherapy) | 1. Unsealed injection: tx thyroid c/ radioactive iodine, thyroid grabs it up quickly and it kills 2. Sealed-insertion of radioactive seeds: for specific area-prostate; pts are radioactive |
| Principle of Time | rotate nursing staff, family-less than 5 hours TOTAL spent c/ pt; nursing staff-less than 1 hour total; no children allowed |
| Principle of Distance | more than 6 feet away if possible |
| Principle of Shielding | Keep room door shut, and wear lead aprons; in isolation; apron especially over reproductive organs, infertility & birth defects; no prg staff or family around |
| Care of pt c unsealed source radiation | emits for 5 days; -body secretions contaminated, flush toilet 2X, radioactive bag for garbage, linens, food; -limit visitor contact (>5hrs); -isolation; -disposable dishes/separate linens; -assess for normal tissue damage, in local area of tx; -always glo |
| Care of pt c sealed source radiation | -isolation; -no pregnant or child visitors; -time, distance, shielding; -assess for normal tissue damage |
| Radiation Toxicity | Varies c: -intensity of dose -degree of exposure, how much of body was radiated -radiosensitivity of cells -individual differences |
| Radiation toxicity sx | -fatigue -n/v, only if abd area was radiated -skin (erythema, desquamation, pigmentation, ulcers-painful) -throat (dysphagia, dry mouth, hoarse-hard on salivary glands, may need artificial saliva) -abd (diarrhea, sterility-important to talk to pt, pos |
| Chemotherapy | -disrupts cell function -affects rapidly dividing cells -well-nourished cells are maximally affected: need increased amino acids c proteins -may need combination of drugs, almost always -very dramatic dx b/c poison in body |
| Typical chemo regimen | 1. chemotherapeutic medication- the toxic drug, wear gloves. 2. Steroids-to decrease swelling 3. Rescue drugs (leukavorin)-by-products end in bladder, often causing damage, given 60-90 mins after chemo has started to coat bladder to decrease damage. Enc |
| Chemo admin | 1st dose-specialized chemo nurse, stays c pt, often anaphylaxis; watch for extravasation-drug infused into tissue, flush c neutralizing solution continually, use mainly center IV sites; Timing is very important-often given @ NOC; Wear gloves-even c bags |
| WBC facts | normal count 5-10,000, 10-14 day lifespan, neutrophils 60-70% (3-7000), if neutrophils <1500, isolation |
| ANC | Absolute Neutrophil Count-(segs (mature) + bands (babies))/100 X Total WBC |
| Standing order for slight temp | Blood culture X2 (15 min. apart), and then give Tylenol |
| Bone Marrow Depression: Leukopenia | -monitor temp, could be high or low c/ overwhelming infection/septic -high protein, high calorie diet-to keep chemo working and to make new WBCs; -rest/hydration -Handwashing! -No fresh fruit or flowers-pseudomonas in water -No standing water -Skin |
| Platelet facts | normal count 150-450,000; 20,000 before transfusion, need to pool ppl's bood b/c causes Ab formation that increases risk of transfusion reaction in later years; lifepan 7-10 days |
| Bone Marrow Depression: Thrombocytopenia sx of bleeding | -petechiae -tarry stools -purpura (petechiae & ecchymosis) -Ecchymosis -coffee ground emesis -rectal bleeding -epitaxis -hemoptysis -hematuria-blood in urine, cloudy 1st; -change in LOC from brain bleeding -watch menstrual bleeding-count pads |
| Thrombocytopenia, cont... | -avoid injections, apply pressure 5 mins. -avoid blowing nose -avoid trauma to rectum (use stool softeners to avoid constipation) -no suctioning -Transfuse PRN |
| RBC facts | -normal Hgb: men-14-16, women 12-14; -anemia Hgb <9 (pale, activity intolerant) transfuse; -lifespan, 30-90 days; |
| NADIR | low point of WBC, RBC, platelets; maximum risk for sx; different for each chemo med |
| Bone marrow depression: anemia | blood transfusion if Hgb <9; sx: pallor, exercise intolerance, tachycardia |
| GI disorders: N/V | -small, frequent meals -eat food at room temp (no aroma) -clear liquids PRN-don't waste calories -bland foods-add protein -high protein (cheese, yogurt, cottage cheese) -anti-emetics, do this 1st & eval timing -steroids (decadron, solu-medrol-anti-s |
| GI disorders: taste changes | -avoid sweet, fatty, fried, spicy foods -salty foods are easier to tolerate -supplement diet c/ non-sweet foods -lozenges to remove metal taste |
| GI disorders: diarrhea | -monitor output -anti-diarrheals -IV therapy for fluid replacement -high risk for GI bleeding & infectino from skin breakdown |
| Skin Disorders: stomatitis | inflammation of mouth -careful assessment every shift -bland diet -50%H2O2 rinses-offer lozenges after -viscous xylocaine- to numb, caution, use q-tip to apply -assess for candida,hrush(nystatin-Swish & swallow, but sweet tasting, best if left in tac |
| Skin Disorders: other | Peri-anal or vaginal ulcerations-very painful. -may be caused from colon bact. -prevent c betadine washes and douches -caution c iodine or seafood allergy -possible fistulas |
| Skin burns: radiation | -keep dry -no soap or rubbing, pat dry -no lotions -no sun (use prescription sunscreen) -no heat to skin -soft loose clothing -don't wash off marks -no ice b/c it decreases circulation |
| Alopecia | -hair will fall out unevenly -hair will grow back -scalp hypothermia may work(ice pack to decrease blood flow & delivers less chemo to hair) but NOT in brain metastasis -wigs -referral |
| Urinary Sx | -cystitis from damage to tubules -increase in uric acid excretion from chemo -monitor uric acid, BUN, creatinine, UA (kidney infection); gout, uric acid crystals in system-visible in toes; -Allopurinol, helps excrete uric acid; -Assess: clarity of uri |
| Sexuality | -discuss risk of infertility before tx -sperm banking? -if WBC decreased, check c Dr about safety of sexual activity -irregular menses common -genetic mutation possible if prg -normal to have decreased libido, impotence during & after tx |
| Psychosocial issues | -pain -control -fear about pain; discuss options -social support -body image changes (hirsutism-endocrine), -Ascities-fluid in stomach |
| End of life issues | -control over living c cancer; could be about food, timing, bathing, etc. -grief-anger, may take it out on nurse, allow them to vent -finances -decision making |
Created by:
rlvander
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