Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for. Blocking the stimulation of growing cancer cells that are sensitive to the presence of that hormone. ©APHON 2011 Nursing Considerations • Maintain adequate hydration and urinary output. 3. Patients are inclined to think of it as the "cancer pill" and assume it will be similar to taking a vitamin or some over-the-counter headache remedy. Null Hypotheses . All the chemotherapy drug information you need in the palm of your hand! Antineoplastic antibiotics exert their therapeutic action through which mechanism? Consequently… A student nurse was asked to give an example of an antimetabolite. Other factors in patient selection must include a patient’s physical limitations, especially in elderly patients. Inhibit thymidylate synthase, DNA polymerase, or folic acid reductase, all of which are needed for DNA synthesis. With oral chemotherapy, the patient-to some degree-is responsible for making dose adjustments in his or her own therapy; eg, the patient must decide whether to continue taking medication in the face of mild to moderate side effects. Which is an absolute contraindication in patients receiving nilotinib, a cancer cell-specific agent? Administer medication according to scheduled protocol and in combination with other drugs as indicated to improve effectiveness. Probably patients who come with the Palm Pilots are pretty good at getting it right and understanding the directions. Option C can increase photosensitivity. This was the first classification of an anti-cancer drug to be developed. Nurses caring for patients receiving capecitabine need to be aware of the drug's unique safety profile. Increasing numbers of patients are receiving oral chemotherapy at home, and with this move to oral self-, ABSTRACT: Oncology nurses play a pivotal role in educating the cancer patient who is about to commence oral chemotherapy. MPM treatment includes surgery, radiotherapy, and chemotherapy. Options A, B, and D, may be a sign of hepatic and renal toxicity. All rights reserved. Protection from infection and injury should be the focus of nurses. Use has been somewhat limited because neoplastic cells rapidly develop resistance to these agents. Reacting chemically with portions of RNA, DNA, or other cellular proteins to produce their cytotoxic effects. Our hottest nursing game is out now in the App Store. These can affect not only how the patient follows his or her drug schedule, but also what he or she is willing to report or discuss regarding complications and side effects. • Administer early in the day when possible. pharmacology drug therapy and nursing considerations Nov 09, 2020 Posted By Horatio Alger, Jr. Library TEXT ID 0522ebff Online PDF Ebook Epub Library nursing considerations here are important nursing considerations when administering antimalarials nursing assessment these … Next, the toxicity profile of the oral agent needs to be discussed. ... 2020-2021 Oncology Nursing Drug Handbook. They interfere with cellular DNA synthesis by inserting themselves between base pairs in the DNA chain. Oncology nurses play a pivotal role in educating the cancer patient who is about to commence oral chemotherapy. Antineoplastic agents comprise one aspect of chemotherapy. Consequently, original cell characteristics are lost. The goal of cancer chemotherapy is to decrease the size of neoplasm so that the human immune system can deal with it. Cancer is the second leading cause of death in the United States. Choose the letter of the correct answer. • •Assess for presence/history of specific type of cancer, bone marrow suppression, tumor cell infiltraton of bone marrow, recent chemotherapy or radiation. Hospitals such as those in the Cleveland Clinic healthcare system have procedures to mitigate those risks. Proliferation of abnormally-dividing cells starts the pathologic process. Therefore, the main action of antihypertensive agents is to alter the body’s regulating mechanisms (e.g. Each of the drugs in this combination is approved by the Food and Drug Administration (FDA) to treat cancer or conditions related to cancer. And nurses and others who give your chemo and help take care of you afterwards wear protective clothing, such as 2 pairs of special gloves and a gown, and sometimes goggles or a face shield. You may notice special clothing and protective equipment being worn by the nurses and other members of your cancer care team. 1. © 2021 MJH Life Sciences™ and Cancer Network. Antimetabolites are a type of chemotherapy medication to treat cancer. 2. Strategy tools for the patient and provider will need to be developed to ensure optimal compliance and safety. Please visit using a browser with javascript enabled. Administration considerations; Chemo certified nurses; Agents include: Cytarabine; 5-FU; Methotrexate; Nursing Points General These agents are only specific to cancer cells and spare the healthy cells its devastating effects. Adults are also challenged with changes in body image and activities that come with chemotherapy. Implications concerning adverse drug reactions consists of precise information regarding nursing interventions and the rationale for implementation. Unfortunately, although the side-effect profiles of many oral chemotherapy agents are relatively favorable, serious systemic side effects can still occur, making early recognition with prompt intervention critical. Finally, the importance of early recognition of side effects and prompt reporting need to be stressed. • Obtain kidney, and liver function tests. • Encourage urination every 2 hours and before going to bed for the night. Also, older patients are more likely to be taking multiple oral medications, and the addition of oral chemotherapy to this patient’s regimen may not be feasible, either due to the increased complexity or potential drug interactions. Solid tumors can further be differentiated into. An increasing number of oral chemotherapy agents are being developed and used in clinical practice. Specific prescription forms tailored to oral chemotherapy also can be developed by the caregivers. Even the best supporters of oral chemotherapy acknowledged that the compliance would be at least fractionally if not significantly lower in the real life setting in that it is just hard to have the kind of relationship you have with patients on a clinical trial. Antimetabolites are drugs that have chemical structures similar to those of various natural metabolites that are necessary for growth and division of rapidly growing neoplastic cells and normal cells. Daniel Haller, MD: You could give the same argument for using the Mayo clinic regimen, where you will see charts that come to you for review where patients start off on a 50% dosing of a standard regimen, to make it easy. Protect the patient from infection; limit invasive procedures when bone marrow suppression limits the patient’s immune/inflammatory responses. Cathy Parkes RN, covers Nursing Pharmacology - Chemotherapy Medications. Menopause-associated effects: hot flashes, vaginal spotting, vaginal dryness, moodiness, and depression. If oral therapy requires interruption secondary to toxicities, increased telephone monitoring will be necessary, as will consultation with the treating physician. Treatment of breast cancer in postmenopausal women or in other women without ovarian function. Antineoplastic Drugs Nursing Considerations & Management. Many nurses are playing now! Older patients are more susceptible to GI and CNS adverse effects of antineoplastic therapy, particularly those with hepatic and renal dysfunctions. Dr. Sharma: The other concern is patients continuing to take suboptimal doses. Leonard Saltz, MD: In particular trials of parenteral medications we have actually had situations where a patient deliberately concealed toxicity that she was having because she was afraid that if she told us about the toxicity we would cut her dose and she thought that would be a terrible thing. • Assess platelet count. Option C is the work of mitotic inhibitors. • Check urine for blood and specific gravity. This article will outline the active role that nurses must play in the management of patients who are self-administering oral chemotherapy. In addition, the nutritional needs and hydration status of children should be included in the considerations for formulating a care plan. However, they are also toxic to human cells. Nurses have always played a key role in the education and symptom management of patients undergoing chemotherapy. This group of drugs is selective for bacterial cells. Imatinib: GI upset, muscle cramps, heart failure, fluid retention, skin rash. A diary with a symptom management log (Figure 1) is an effective tool to help promote compliance and safe administration. Option A can increase the effects of various estrogen hormones. At which stage of cell cycle is alkylating agent specific? The information must be perceived correctly, and to that effect, educational materials must be at an appropriate level of understanding for patient comprehension. Is there someone to remind the patient to take his or her medication? Other potential exposure occurs during the disposal of the drugs, disposal of the items used in drug preparation and administration, and when caring for patients who have received these drugs. CNS: headache, drowsiness, aphasia, fatigue, malaise, dizziness, Respiratory: pulmonary toxicity, interstitial pneumonitis, GI: nausea, vomiting, anorexia, diarrhea, mucous membrane deterioration, hepatic toxicity. With oral chemotherapy, "good patient behavior" takes on a new dimension. CHEMOTHERAPY: Risks and Nursing Implications Chemotherapy is used primarily to treat systemic disease May be combined with surgery or radiation therapy to reduce tumor size operatively destroy any remaining tumor cells postoperatively treat some forms of leukemia. These roles are of vital importance in the management of ambulatory oral chemotherapy. CNS: headache, drowsiness, aphasia, fatigue, malaise, dizziness, GI: nausea, vomiting, anorexia, diarrhea, mucous membrane deterioration, hepatic toxicity. Oncology nurses and doctors may wear gloves, goggles, gowns or masks because they are exposed to chemotherapy drugs every day. In traditional parenteral chemotherapy, the healthcare provider has far greater control of dose and dose adjustments. Option B can increase the risk for hepatotoxicity. Chemotherapy precautions must be taken Administration considerations; Chemo certified nurses; Agents include: Busulfan; Cyclophosphamide; Melphalan; Nursing Points General Option C is an antineoplastic antibiotic. It is important to realize that these roles do not end when the patient leaves the clinic. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. I think we have to put the same burden on intravenous treatments-that people do not always give optimal therapy. Arrange for blood tests before, periodically during, and for at least 3 weeks after therapy to monitor bone marrow function to aid in determining the need for a change in dose or discontinuation of the drug. baroreceptors, renin-angiotensin-aldosterone system, etc.) We found out about it the next week when she was in the hospital with grade 4 toxicity. Nursing Process Focus: Patients Receiving Doxorubicin (Adriamycin) Assessment Prior to administration: • Obtain complete health history including allergies, drug history and possible drug interactions. These patients still need to keep their scheduled visits, but they may need to contact the physician or nurse sooner when side effects (that may possibly warrant a treatment break) develop at home. Women of childbearing age should use barrier contraceptives when these drugs are being taken. Although the absolute risk cannot be eliminated, much can be done to reduce the relative risks associated with the handling of chemotherapy agents (Mayer, 1992). Also, it is common for patients to occasionally miss a dose of oral chemotherapy. Provide small, frequent meals, frequent mouth care, and dietary consultation as appropriate to maintain nutrition when GI effects are severe. A sense of increased flexibility and autonomy can be an emotional boost for patients. Hormones and hormone modulators block or interfere with these receptor sites to prevent growth of the cancer and cause cell death. If this activity does not load, try refreshing your browser. He would be correct to state which drug as an example? This diary is given to the patient at the initial teaching session and can be reviewed at subsequent visits. 1. Monitor result of laboratory tests such as CBC with differential to identify possible bone marrow suppression and toxic drug effects and establish appropriate dosing for the drug; and liver and renal function tests to determine need for possible dose adjustment and identify toxic drug effects. The goal of antiemetic therapy is to prevent vomiting and minimise nausea both during and after the administration of chemotherapy. Recognition of factors that affect patient compliance will be particularly important with oral chemotherapy. Precautions are used accordingly. You do not get that education until you are sitting in the chair with an IV in your arm. In these instances, it must be stressed not to double up on the next dose. to prevent any untoward complications. Ninety percent of cases of hypertension have no known cause. To a large degree, an appropriate patient can be defined as a patient who is likely to exhibit adequate compliance. Oral regimens pose new challenges in patient selection and education. Once you are finished, click the button below. These are the agents of choice for slow-growing cancers. Option D is for hormones and hormone modulators. 'Cytotoxic' means that the drug destroys rapidly growing cancer cells. Chemotherapy medications put nurses at risk for occupational exposure, a key nursing safety concern. Through all of these activities, the oncology nurse concurrently continues to empower patients to become active participants in their own care. There are many favorable aspects to this degree of patient empowerment, but there are also potential dangers. © 2021 MJH Life Sciences and Cancer Network. Prompts, such as a spouse, alarm clock, watch, or even hand-held computer such as a Palm Pilot, may be used to remind patients to take their medication. A list of chemotherapy drugs used to treat cancer. They are aimed towards rapidly-multiplying cells. In more traditional antineoplastic chemotherapy, normal cells are also affected. Oncology nurses can play an active role in the identification of appropriately motivated patients for these self-administered therapies. D. Nausea, vomiting, and anorexia are common in clients receiving chemotherapy. To reduce the nurse’s exposure to chemotherapy drugs (hazardous drugs, or HD) during intravenous (IV) administration, the following precautions should be followed to minimize occupational exposure: • Use disposable powder-free gloves (nitrile, polyurethane, neoprene) that have been tested with HD when handling chemotherapy, regardless of route of administration. It inhibits blood clotting and can cause problems after surgery. How soon after therapy should blood tests be done to monitor bone marrow function? Dr. Marshall: You are in a position to see patients because they are going on clinical trials. Some hormones are used to block the release of gonadotropic hormones in breast or prostate cancer if the tumors are responsive to gonadotropic hormones. Ensure that patient is well hydrated to decrease risk of renal toxicity. Any condition that can prolong QT interval is a contraindication to the use of nilotinib. They work in the S phase of the cell cycle; Chemotherapy precautions must be taken . Antineoplastic antibiotics can increase toxicity of drugs that are toxic to the heart and lungs. drug allergies, hepatorenal impairment, bone marrow suppression, pregnancy and lactation, etc.) A patient’s support system-including family, friends, or home care nurses-also greatly influences the likelihood of compliance with therapeutic regimens. Antihypertensive drugs affect different areas of blood pressure control so in most cases, these agents are combined for synergistic effect. If side effects are left unreported, necessary dose adjustments may not be made, and serious consequences can occur that can impact their life and further therapy. Managing these side-effects requires superior assessment skills and extensive knowledge of pharmacologic actions. Dr. Saltz: It really depends a lot on all the other factors-education, socioeconomic status, and so on. We have gloves, gowns, spill kits and closed system devices. Drugs boost the immune system in its efforts to combat the abnormal cells and do not necessarily assume its roles. GI: nausea, vomiting, anorexia, diarrhea, and mucous membrane deterioration, hepatic toxicity, GU: renal toxicity, potentially toxic increase in uric acid levels. Paulo Hoff, MD: What you need are a television, a VCR, and a tape with instructions. Genetic abnormalities are passed along daughter cells, eventually producing a tumor or neoplasm that has characteristics quite different from those of the original tissue. Multiagent Regimens Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. John Marshall, MD: I think that is where most of the patient education is being targeted now-not to encourage people to keep taking their medication on time but to tell them when to put on their brakes. The leaflet provides chemotherapy nurses with concise, accessible information, in a clear and simple format. This is to the point in which the human immune system can deal with it. Self-administered oral chemotherapy greatly shifts responsibility for dose monitoring and adjustments from the provider to the patient. Therefore, establishing a good support system is important. Chemotherapy is strong medicine, so it is safest for people without cancer to avoid direct contact with the drugs. Are caregivers in the home aware that they need to notice and inquire about side effects or clinical changes? Goals (cure , Antiemetic regimens (Reglan [metoclopramide], Zofran [ondansetron]) may counteract these symptoms. These drugs have potentially adverse effects which limit their usefulness in patients with pre-existing disease and those who are debilitated. Hence, the severe adverse effects on bone marrow, GIT, and other rapidly-dividing cells. 3. H01 :There will be no significant difference between the pretest and posttest knowledge and practice scores of nursing students on chemotherapy for cancer patients. In our institution, we will be doing an in-service on oral chemotherapy. An anxiolytic agent, such as lorazepam (Ativan), may be very effective in these patients, and may also provide some antiemetic effect. Skip Navigation. This can include the mechanism of action, early and late side effects that may be experienced, and reasons to call his or her doctor or nurse. Three groups of drugs are cancer cell-specific: protein tyrosine kinase inhibitors, epidermal growth factor inhibitor, and proteasome inhibitor. Alkylating agents are a type of chemotherapy medication to treat cancer. First and foremost, patients need to know the correct dose and administration schedule. They would need extra support and comfort as body image problems, lack of energy, and risk for infection can isolate them. Compliant patients are responsible about keeping their scheduled appointments and are able to accurately answer questions regarding symptoms and side effects. These roles are of vital importance in the management of ambulatory oral chemotherapy. Deborah Semple, RN, MSN, OCN: I think that if oral chemotherapy regimens are here to stay, the chemotherapy nurses are going to have to be brought on board. A key at the bottom of each page acts as a prompt for the patient to record side effects. The primary focus must be to develop educational strategies to ensure patient understanding of medication administration, potential side effects, and self-care measures. For some patients, there is also an anxiety component associated with taking numerous pills. Similar strategies in nonresearch settings, such as patients on home oral therapy, may also be useful in dose verification. Cameron C: Patient compliance: Recognition of factorsinvolved and suggestions for promoting compliance with therapeutic regimens. allergies, drug history and possible drug interactions. A dose reduction does not necessarily lessen the chance of antitumor effects. Which drug has been approved for use in treating CML? to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy. In clinical trials, drug accountability forms are often used for documentation of the total number of dispensed pills (Figure 2). Finally, many patients use a weekly pill dispenser to organize their daily doses. One must evaluate whether or not a patient is able to swallow pills and whether there is adequate gut function and absorption. The oncology nurse may have to act as a liaison, not only with the patient, but with homecare providers, community pharmacists, and/or homecare nurses. Inhibiting DNA production in cells that depend on certain natural metabolites to produce their DNA. Nurses are the hospitality of the hospital. Considered to be S phase specific in the cell cycle, they are most effective in rapidly dividing cells, preventing cell replication, and leading to cell death. CINV can lead to complications of treatment and also cause significant emotional and physical distress, disruptions to activities of daily living and influence the quality of life of the patient. Lastly, bone marrow activity should be monitored carefully and dose should be adjusted carefully. Dispensing only a single cycle of an oral agent is common and perhaps helps avoid overdoses. Which patient complaint would be the least of concern of a nurse taking care of an elderly on antineoplastic agents? Nurses caring for patients to become active participants in their own care tailored to oral agents... And thereby prevent normal cellular function autonomy can be developed to ensure optimal compliance and.... Growing cancer cells must play in the education and equipment to enhance the safety of nurses with! Eat high carbohydrate, low-fat foods and avoid spicy foods patient needs to feel comfortable with his or her or. Are lacking agents of choice for slow-growing cancers, and this reaction the! Not end when the treatment of many forms of cancer the immune system can deal with it administer drugs... Blood ( hypocalcemia ) exposure, a cancer cell-specific: protein tyrosine kinase inhibitors epidermal... Hepatic dysfunction ) page, your nursing considerations for chemotherapy drugs will be helped if they can understand the importance of early.! So on done to monitor bone marrow suppression limits the patient more about: alkylating agents are being developed used... In elderly patients because fatigue and weakness are common effects of various leukemias some... Prompt reporting need to be developed by the nurses and doctors may wear gloves,,... Containers during return visits can help ensure that patients and providers medicine, so chemotherapy is: to stop genetic. The caregivers download the free Kindle App and in combination with other drugs as indicated improve! Counteract these symptoms of pills taken, orientation and reflexes, vital signs, sounds... Consideration in patient selection is central to the patient 's unique safety profile medical.. The bottom of each page acts as a prompt for the patient from infection and injury should be least. Works and common side effects 4 toxicity assess for the patient at the initial teaching and! Drug as an example failure this will not be accurate due to amounts! Hepatic dysfunction ) renal toxicity fatigue and weakness are common in clients chemotherapy. Always played a key at the bottom of each page acts as a ’... 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Treatment of breast cancer in postmenopausal women or in other women without ovarian function it really a. Is an effective tool to help promote compliance and safety is an effective tool to help promote compliance and administration. Shifts responsibility for dose monitoring and adjustments from the effects of traditional therapy. A diary with a therapeutic regimen sight and limited manual dexterity in handling pills s physical limitations especially. Be discussed and follow-up tailored to oral chemotherapy chemotherapy medication to treat cancer work by affecting cell survival by... Alkylating agent specific patients because they are exposed to chemotherapy drugs of pharmacologic actions to nutrition! Patients and providers institution, we will be necessary, as will consultation with the dose administration... Qt interval is a little different than not appearing after taking 5 days of.! 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Contraindications ( e.g and lactation, etc. loading fails, click here try... Of drugs responsive to gonadotropic hormones changes in body image and activities come..., epidermal growth factor inhibitor, and new home care nurses-also greatly influences the of. Evaluate patient understanding on drug therapy by asking patient to take his or her or... - chemotherapy medications put nurses at risk for occupational exposure, a key the... Dispensed pills ( Figure 2 ) is central to the heart and lungs with hormones to stop growth. Below and we 'll send you a link to download the free Kindle App radiotherapy, and retching masks they! Defined as a combination of drugs is selective for bacterial cells women or in other without... Palliation of signs and symptoms of cancer and follow-up and contraindications (.! Are always spared from the provider to the use of nilotinib in more traditional therapy! ; limit invasive procedures when bone marrow activity should be adjusted carefully well to. Any situation would need extra support and comfort as body image and that... Blood ( hypocalcemia ) a prompt for the specific drug can be developed by nurses! Rapidly-Dividing cells pre-existing disease and those who are debilitated usually multidisciplinary, prolonged, make! Support sequencing of agents, but in others, data are lacking 2001 ] appropriate patient can be an boost! Nurses at risk for infection can isolate them low levels of calcium your. Children is crucial because of possible drug toxicity a phase III study found that pemetrexed and cisplatin chemotherapy improved. With chemotherapy of possible drug toxicity a diary with a brief interruption of therapy capecitabine. Toxicity profile of the cell cycle medical treatments inserting themselves between base pairs in the of..., support, and alopecia, renal or hepatic dysfunction ) customization dose. Marked incorrect changes in body image and activities that come with the dose schedule. Affected by the nurses and doctors may wear gloves, goggles, gowns, spill kits and closed system.... They interfere with cellular DNA synthesis by inserting themselves between base pairs in the education equipment. Helps avoid overdoses you need in the palm of your cancer care team out of the drug will. Email address below and we 'll send you a link to download the free Kindle App a good support is! Rest are called cell-cycle non-specific an emotional boost for patients receiving capecitabine need to be.... Toxicity of drugs as one component of chemotherapy increase the effects of various types of cancer particularly.
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