Chemotherapy Chemotherapy a b c Is the use
Chemotherapy
Chemotherapy a. b. c. Is the use of drugs to treat cancer The drugs are often called anticancer drug. It destroy cancer cells by: Stopping their growing (non-specific cell cycle drugs) or. Multiplying at one or more point in their life cycle( specific cell cycle drug). Chemotherapy may consist of more than one drug called combination chemotherapy.
What can chemotherapy (Ch. T) be achieve? Depend on the type of cancer and its stage of development to: To cure cancer. To keep the cancer from spreading. To slow the cancer's growth. To kill cancer cell that may have spread to other part of the body from original tumor. To relieve symptoms that may be caused by the cancer. Can help people live more comfortable (palliative care). v Adjuvant therapy: using ch. t in addition to surgery and /or radiation therapy , may be used to shrink a tumor before surgery or radiation therapy , or after surgery to help destroy any cancer cells that may remain.
Chemotherapy protocol ü ü ü The schedule for Ch-T treatment depend on: the type of drugs which the child will receive depending on what kind of cancer the child have, where it is , the extent of its growth. Frequencies of the course: how much the child will take them e. g. every 21 days over 8 month each course duration 1 -7 days. The drug's dose depend on child body surface area according the monogram. The rout of administration of Ch-T, over the schedule e. g. - per orally: pill, caps, syrup. IT, IM, SC, TOPICAL. - IC__ intra cavity. As pelvis, plural. - IL__ intra lesion, - IV__ peripheral veins or central veins. When and where the Ch-T GIVEN, At home. Clinic, hospital. Is it daily, weekly, or monthly.
Types of chemotherapy Alkaliting agent: DNA synthesis inhibitor (e. g. cisplatinium). Anti metabolites: which block enzymes necessary for DNA and RNA synthesis , and inhibit cellular protein synthesis e. g. Cytosare. Antitumor antibiotics: e. g. Bleomycin. Plant alkaloid: vinca alkaloids e. g. Vincristine. Miscellaneous.
Precaution in administrating and handling Ch-T Many of CH-t agent are vesicants (sclerosing agents) which cause cellular damage if even minimal amount of the drug unfiltrate surrounding tissue. Only expert chemotherapy nurse who should administer vesicants drugs. Intervention for extravasations vary but each nurse should be aware of the institution's policies and implement them at once. Potentially fatal complication is anaphylaxis especially from L-asparagines , VP-18 the nurse must prepare for serious reactions. sign of it (cyanosis. Decrease blood pressure wheezing sever urticaria).
Precaution in administrating and handling Ch-T Handling chemotherapy with caution to safe the nurse herself. Ch-T drugs must be given through of treeflowing IV line. Frequent lab result &BMA are needed to determine the effective of chemotherapy.
Side effects of chemotherapy & Radiation. Every Childs's experience is different to side effect which depend on type of anticancer drug used, the dose, the age. Most Ch-T side effects are temporary as the body's normal cell recover, the side effect gradually go away. The child must receive a lot of supportive care, (fluid and nutrition support, transfusion support, physical therapy, and medicines). The common side effects are: § Fatigue is the most common side effect, its duration vary days, weeks, or months. So encourage the child to take rest and sleep,
Side effects of chemotherapy & Radiation - Nausea and vomiting (N&V): Ch-T is effecting the stomach and the area of the brain that control vomiting or both, N&V can be controlled or at least lessened by: Giving serotonin –receptor antagonist (e. g. , Zofran) with combination dexamethasone before emetogenic Ch-T. Avoid big meal. Drink liquid slowly. Stay away from sweet. Eat food cold or at room temp…… Chew food well for easier digestion. Rest in chair after eating , but don't lie flat for at least tow hours after meal finishing. . Breath deeply or slowly when feel nauseated.
Side effects of chemotherapy & Radiation Hair loss (alopecia) &scalp sensitivity: Hair loss from all parts of the body so the child can use: ü Mild shampoos. ü use soft hair brushes ü Use low heat drying hair. ü wearing hats, scarves, wig, bandanas. ü Hair will re-growth within 3 months following the end of treatment with slightly different color or texture (darker, thicker).
Side effects of chemotherapy & Radiation ü ü ü Anorexia: loss of appetite: Encourage child to eat what he loved in playing place not on food table. Put the food in colored especial dish which favorable to the child. Encourage NGT for feeding or TPN with child have significant nutritional problem. Mucosal ulceration: Ch. T can cause sores in the mouth, gum, throat, esophagus, stomach. Encourage the child to use the prescribe mouth rinse to reduce pain, dryness, and irritation( leukemic mouth wash= xylocain. Nystatin. Na. Hco 3 sterile water. Regular dental check up. soft, cool foods may be easier to chew and swallow.
Side effects of chemotherapy & Radiation ü Acidic foods and juices, hydrogen peroxide should be ü ü ü ü avoided. Use soft sponge tooth brush. Stomatitis require hospitalization for hydration, TPN, pain control. For rectal ulcers& constipation use stools softeners. Neuropathy: Vincristine and other drugs can cause various neurotoxic effect so: Administer softness or laxative for constipation carried by decrease bowel innervations. Maintain good body alignment and bed rest use footboard. Safety measures during ambulation because weakness & numbness of extremities. Provide soft or liquid diet for sever jaw pain
Side effects of chemotherapy & Radiation ü ü ü Urinary system problem: Hge cystitis: from cychlosphomide. So can prevent by: Frequent voiding immediately after feeding the urge. Increase fluid intake. Administer Mesna ( an agent that provide protection to the bladder). Moon face: short-term steroid therapy produced it. Increase appetite & sense of well being Moon face (rounded& puffy) which will return to normal after stopping the treatment. Mood change: with steroid that range from feeling of well -being and euphoria to depression. So provide continued and physical care and emotional supports.
Nursing consideration v The major nursing goals for childhood cancer are: 1. Child will receive appropriate primary health care. 2. child & family will be prepared for diagnostic and therapeutic procedures e. g. BMA, LP, multiple finger strikes, venipunctures for blood analysis so the child needs to: § An explanation of each procedure and what can be expected. § Non pharmacologic strategies are used to treat and reduce discomfort see box 22 -1.
Nursing consideration Ì 1. 2. 3. v 3. Child will experience minimal complication of myelosuppression/ The reduce numbers of blood cell result in secondary problem of: 1. Infection: Neutropenia __ in three phases of treatment: At time of diagnosis and relapse when leukemic process has replaced normal leukocyte. During immunosuppressive therapy. After prolonged antibiotic therapy. So using granulocyte colony stimulating factor (GCSF) will reduce the incidence of infection.
Nursing consideration ü ü ü ü ü Prevention of infection can be by: Private room. Restriction of all visitor and health personal with active infection. Strict hand washing technique with antiseptic solution. Evaluate the child for potential site of infection (mucosal ulceration, skin abrasion, skin tear_ hang nail. Any elevation of temp, Identify the sever of infection by, blood , stool, urine, sputum culture. IV AB. Family member encourage to take prevention aseptic as : hand washing technique. The child can return to his school when absolute neutophils count (ANC) greater than 500/mm 3. Normal ANC more than 1000/mm 3 Nutrition is important to prevent infection with high protein, high caloric diet.
Nursing consideration Ì Hemorrhage: leading cause of death. Prevent bleeding by: ü Administer of platelet concentration or platelet with plasma. ü Avoid skin puncture, if need for IM injection or BMA must be done under sterile technique and continue observe for bleeding. ü Medicuious mouth care (mucositis). ü Avoid harmful sport playing. ü Teach the parent to control epistaxis by pressure at the soft lower portion of the nose after sitting & leaning forward ü Emotional support for child and his parents during bleeding episode.
Nursing consideration Ì ü § § § Anemia: blood transfusion is necessary. 4. problem of irradiation and drug toxicity will be managed. 5. child and family will receive adequate support and education by: Child and family will receive support at the time of diagnosis: Parents must be to gather when inform the diagnosis, their initial attitude may be acceptance, rejection, hope despair. Informing session must be in private room which the parent feel free to express their feeling. Written information should provide for parents to answer their questions about the process of diesels, treatment, prognosis, complication…etc.
Nursing consideration ü Accept family's emotion reaction (denial, guilt, anger). - For denial: the nurse must to be active listening. - For guilt: unknown cause, in order not to be blamed, let ü - parent express their feeling before you give scientific rational. For anger: avoid losing one's temper & encourage to talk. Support family's coping methods: Parent support. Parent to-parent support. The child support. The siblings supports. Extended family member and community.
Nursing consideration ü ü § § Educate about the disorder and general health care. Activation of daily living. Safe transportation. Primary health care. Perspective on care of children at the end of life Palliative care: is the activ 4 e total of patients whose disease is not responsive to curative treatment so it is for: Control of pain. Psychological care. Social care. Spiritual care.
Tumor lyses syndrome TLS is the development of electrolyte and metabolic disturbance that may occur following the treatment of cancer and can result in life threatening complications if not managed appropriately. Causes: TLS is caused by the sudden, rapid death of cells particularly cancer cells in patients with leukemia or lymphoma in response to cancer therapy. Pathophysiology: when cancer cells are killed by therapy, they may spill their inner (intracellular) contents which accumulate in the body faster than can be elimination
Tumor lyses syndrome TLS - - Clinical manifestation: nausea, vomiting, shortness of breath, irregular heart beat, clouding of urine, lethargy and joint discomfort. Lab result: high k, high uric acid, high phosphorous level, and decrease calcium in the blood. Treatment: Intravenous hydration. Medication including allopurinal or Elites. Alkalization of the urine with sodium bicarbonate. Treat patient also for the special medical abnormality that is present, which typically includes one of the following:
Tumor lyses syndrome TLS Hyperuricemia: excess uric acid in the blood. uric acid: is the end product of the digestion of certain proteins and is normally eliminated through the urine. When it excess, it converted to crystals formed of sodium urate which deposited in tiny tubes of kidney__ kidney damage__ kidney failure. Treatment: IV fluid , diuretics, allopurinal to treat reduce the formation of uric acid and alkalization of urine. b Hyperkalemia: excess potassium in the blood, which cause irregular cardiac rhythms and neuromuscular dysfunction. Treatment: Calcium administration IV. Dextrose (sugar) and insulin__ potassium is taken into cell's __ reduce level in blood. Diuretics__ K execration in the urine. na. Hco 3__ neutralize the effect of hyperkalemia. a.
Tumor lyses syndrome TLS c. hyperphosphatemia: excess phosphate in the blood, can cause low level of calcium in the blood or hypocalcaemia. increase P in the blood__ deposit in tiny tubes of kidney __kidney failure. Treatment: - Diuretics to excrete of phosphates through the urine. - Dietary in take of phosphates should be restricted or eliminated. d. hypocalcaemia: low level of calcium in the blood result in sever cardiovascular effects and neurological dysfunction, seizures, hallucination, numbness. Treatment : - IV form of calcium. - Diuretic to promote excretion of phosphates ion the urine v Family & patients right: before starting treatment for cancer patients should discuss their risk of developing tumor lyses syndrome with their physician.
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