3 CHEMOTHERAPY

ELLEN CORDENILLO|| SEPTERMBER 2021 MEDICAL SURGICAL

Transcribers: MARY ANNE R. ARCE
Editors: MARY ANNE R. ARCE

CHEMOTHERAPY chemotherapy
 Cytotoxic drugs that destroy cancer cells or prevent irritants, non-vesicants and vesicants
cellular replication by interfering with DNA and RNA and CHEMOTHERAPY MECHANISM OF ACTION
vital cellular proteins 1. Functions at cellular level by interrupting cell life-modifies
 Goal is to reduce the number of cells to a small number or interferes with DNA synthesis
that can be (theoretically) handled by the immune 2. Chemotherapeutic agents eradicate cells, both normal
system and malignant, that are in the process of cell
OBJECTVE OF CHEMOTHERAPY reproduction
 TO DESTROY ALL MALIGNANT TUMOR CELLS WITHOUT 3. Drug classified by group into those that act on a certain
EXCESSIVE DESTRUCTION OF NORMAL CELLS phase of cell reproduction (cell cycle specific) or those
CAUSES OF CHEMOTHERAPY that do not (cell cycle nonspecific)
 Extravasation 2 MAJOR CATEGORIES
The leakage of blood, lymph, or other fluid, such as an 1. CELL CYCLE PHASE SPECIFIC
anticancer drug, from a blood vessel or tube into the  Antimetabolites
tissue around it.  Metabolic inhibitors
 Vesicants  Topoisomerase inhibitors
The leakage of certain drugs called vesicants out of a vein 2. CELL CYCLE PHASE NON SPECIFIC
into the tissue around it. Vesicants cause blistering and  Alkylating agents
other tissue injury that may be severe and can lead to  Nitrosoureas
tissue necrosis (tissue death).  Platinum drugs
 Flare reaction  Antitumor antibiotics
a localized allergic response associated with the  Cortic0steroids
administration of an irritant, is one of the most common  Hormone therapy
chemotherapy infusion–related reactions. CELL CYCLE PHASE SPECIFIC
 Irritant  Drugs are active on cells undergoing division in the cell
Medication that can cause local inflammatory response. cycle
Like pain, inflammatory, phlebitis, swelling. But there is no  These drugs are most effective against actively growing
tissue damage
tumors that have a greater proportion of cells cycling
CHARACTERISTICS OF CHEMOTHERAPY through the phase in which the drug attacks the cancer
 It affects both normal and cancer cells cell
 Chemotherapy has fraction cell- kill ANTIMETABOLITES
 Chemotherapy may be cell cycle specific (CCS) or cell  Cell Cycle Phase - Specific
cycle non-specific (CCNS)  They exhibit their action by blocking essential enzymes
 CCS are Chemotherapy drugs that kill cancer cells only necessary for DNA synthesis or by becoming
when they are dividing, or during the stage od cell incorporated into the DNA and RNA, so that a false
division message is transmitted.
 CCNS are Chemotherapy drugs that kill cancer cells when  Azacitidine
they are at rest or at any stage of cell division.  5- flurouraucil (5-FU)
 The scheduling of chemotherapy is set based on the type  6 –mercaptopurine
of cells, rate at which they divide, and the time at which a
 (6-MP)
given drug is likely to be effective. This is why
 Capecitabine
chemotherapy is typically given in cycles.
 (Xeloda)
CHEMOTHERAPY
 Claridribine
PREPARATION AND HANDLING OF CHEMOTHERAPEUTIC
 Clofarabine
AGENTS
 Cytarabine (Ara-C)
 May pose an occupation hazard
 Decitabine
 Drugs may be absorbed through
 Floxudirine
- skin
- inhalation during preparation, transportation, and  Fludarabine
administration  Gemcitabine (Gemzar)
 Only proper trained personnel should handle drugs  Hydroxyurea
CHEMOTHERAPY IS ADMINISTERED BY NURSES WHO HAVE  Methotrexate
HAD A CLASS IN ADMINISTRATION OF CHEMOTHERAPY  Nelarabine
 Registered Nurses who certified in:  Pemetrexed (Alimta)
1. Chemotherapy administration  Pentotastin
2. Intravenous Therapy  Pralatrexate
3. Central Venous Access Devices  Thioguanine
 Are able to administer continuous and/ or direct  Trifluridine/tripiracil combination

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[NCM 112] 3. CHEMOTHERAPY – ELLEN CORDENILLO

 Carboplatin
 Carmusatine
MITOTIC INHIBITORS  Chlorambucil
 Mitotic inhibitors are also called plant alkaloids.  Cisplatin
 They are compounds derived from natural products, such  Cyclophosphamide
as plants.  Dacarbazine
 They work by stopping cells from dividing to form new  Ifosamide
cells, but can damage cells all phases by keeping enzymes  Lomusatine
from making proteins needed for cell reproduction.  Mechlorothamine
EXAMPLES OF MITOTIC INHIBITORS INCLUDE THE TAXANES  Melphalan
AND VINCA ALKALOIDS  Oxaliplatin
 Cabazitaxel  Temozolomide
 Docetaxel  Thiotepa
 Nab-paclitaxel  trabectedin
 Paclitaxel NITROSOUREAS
 Vinca alkaloids include: Cell Cycle Phase – Nonspecific
 Vinblastine  They have the ability to cross BBB
 Vincristine  Action is similar to alkylating agents
 Vincristine liposomal  Synthesis of both DNA and RNA is inhinited
 Vinorelbine  Carmustine
TOPOISOMERASE INHIBITORS  Lomustaine
 These drugs are also called plant alkaloids.  streptozocin
 They interfere with enzymes called topoisomerases, ANTIBIOTICS (ANTI TUMOR AGENTS)
which help separate the strands of DNA so they can be  Cell Cycle Phase – Non Specific
copied. (Enzymes are proteins that cause chemical  Drugs disrupts DNA transcription and inhibit DNA and
reactions in living cells.) RNA synthesis
ANTRACYCLINES
 Inhibitors are used to treat certain leukemias, as well as  Antracyclines are anti-tumor antibiotics that interfere
lung, ovarian, gastrointestinal, colorectal, and pancreatic with enzymes involved in copying DNA during the cell
cancers. cycle
Topoisomerase inhibitors are grouped according to which  They bind with DNA so it cannot make copies of itself,
type of enzyme they affect: and a cell cannot reproduce
Topoisomerase I inhibitors (also called camptothecins)  Daunorubicin
include:  Doxorubicin (Adriamycin)
 Irinotecan
 Doxorubicin liposomal
 Irinotecan liposomal
 Epirubicin
 Topotecan
 Idarubicin
TOPOISOMERASE II INHIBITORS (ALSO CALLED  Valrubicin
EPIPODOPHYLLOTOXINS) INCLUDE:
CUMULATIVE DOSE
 Etoposide (VP-16)
 Lifetime dose limits are often placed on these anti-
 Mitoxantrone (also acts as an anti-tumor antibiotic)
tumors antibiotics drugs because the major concern
 Teniposide
when giving these drugs is that they can – permanently
 Topoisomerase II inhibitors can increase the risk of a damage the heart if given in high doses
second cancer. ANTI TUMOR ANTIBIOTICS THAT ARE NOT ANTRACYLCINES
VINCA PLANT ALKALOIDS INCLUDE:
 Cell Cycle Phase - Specific  Bleomycin
 Exert a cytotoxic effect by binding to micro tubular  Dactinomycin
proteins during metaphase, causing mitotic arrest  Mitomycin-C
 The cell loses its ability to divide and die  Mitoxantrone
CELL CYCLE PHASE NON SPECIFIC CORTICOSTEROIDS
 Active on cells in either a dividing or resting state  Exert an inflammatory effect om body tissues
 These agents are active in all phases of the cell cycle and  They may also promote a feeling of well being and
may be effective in large tumors that have few active increase the appetite
cells dividing at the time of administration  Prednisone
ALKYLATING AGENTS  Methylprednisolone
 Cell Cycle Phase – Non specific
 dexamethasone
 Act primarily to form a molecular bond with the nucleic
HORMONES
acids, which interferes with the nucleic acid duplication,
 Cell Cycle Phase – Non Specific
preventing mitosis
 These chemicals, secreted by the endocrine glands, alter
 Altretamine
the environment of the cell by affecting the cell’s
 Bendamustine
permeability
 Busulfan

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 Manipulating of hormonal levels, tumor can be arte and load. Tumor cell heterogeneity, Tumor location,
suppressed Hormone receptor status, Blood supply to the tumor, The
 Not cytotoxic, therefore not curative blood brain barrier
 Purpose is to prevent cell division for hormone  Individual Characteristics
dependent tumors  Single agent Therapy
ANTI HORMONAL AGENTS  Combination Therapy
 Derive their antineoplastic effect from their ability to CELL KILL HYPOTHESES
neutralize the effect of or inhibit the production of  The inverse relationship between cell number and
natural hormones used by hormone – dependent tumors curability –Cardinal Rule of Chemotherapy
OTHER CHEMOTHERAPY DRUGS  Established by Skipper and Colleagues
 All-trans-retinoic acid ROUTES
 Arsenic trioxide 1. REGIONAL CHEMOTHERAPY
 Asparaginase  ORAL
 Eribulin  TOPICAL ADMINISTRATION
 Hydroxyurea  INTRAARTERIAL
 Ixabepilone  INTRACAVITY
 Mitotane  INTRAPERITONEAL
 Omacetaxine  INTRATHECAL
 Pegaspargase  INTRAVESICAL
 Procarbazine 2. SUBCUTANEOUS AND IM
 Romidepsin 3. INTRAVENOUS
 Vorinostat CHEMOTHERAPY REGIONAL ADMINISTRATION
OTHER TYPES OF DRUGS USED TO TREAT CANCER 1. Types of regional delivery methods
1. IMMUNOTHERAPY  Oral
 Immunotherapy is a type of treatment that uses drugs to  Topical administration
boost or alter a person’s immune system  Intraarterial
 These drugs are used with the certain types of cancer to  Intracavity
help a patient’s immune system recognize and attack  Intraperitoneal
cancer cells  Intrathecal or intraventicular
2. CELL CYCLE PHASE NON SPECIFIC  Intravesical bladder
 Targeted therapies work by finding specific substances ORAL
called proteins or receptors that some cancer cell have.  Emphasize the importance of compliance to prescribed
- This protein or receptor is precisely targeted by the schedule
drugs, so normal cells are not affected by the drugs  Plans for drugs with emetic potential to be taken with
- This is different than how traditional chemotherapy drugs meals
work  Cyclophosphamide (Cytoxan) requires hydration must be
 Targeted drugs can be used as the main treatment for a taken early in the morning
cancer, or they may be used after treatment to keep the TOPICAL
cancer under control to keep it from coming back  Cover surface area with a thin film of medication
3. GENETHERAPY  Instruct patient to wear loose-fitting cotton clothing
 Experimental as a cancer treatment  Wear gloves and wash hands thoroughly after procedure
 Monoclonal antibodies (binds to target receptor of  Caution not to touch the ointment
proteins within cancer cell, prohibiting cell survival) INTRA- ARTERIAL
 Renders tumor cells more susceptible to damage or  This method requires catheter placement in an artery
death by other treatments near the tumor
 Injection into tumor cells, enabling the immunes system  Drug is administered in a heparinized solution through an
to better recognize cancer cells as foreign and kill them infusion pump
 Antisense drugs (newer drugs which alters protein of  Monitor VS, color, and temp of extremities and site for
specific cancer cells) potential bleeding
COMPLEMENTARY MEDICINE AND ALTERNATIVE MEDICINE INTRACAVITY
 Many alternative treatments may include herbal extracts,  Instill the drugs into the bladder through a catheter or
diet changes, animal cartilage, teas, etc. into the pleural cavity via a chest tube
 Complementary and alternative medicines are not INTRPERITONEAL
regulated by any government agency, so manufacturers  Deliver drug into the intra abdominal cavity through the
are not under any guidelines about standardized doses implantable port of the external suprapubic catheter
from lot to lot of medication or other substances present (tenckhoff)
in the pills  Use dry heat to warm the infusate solution to body
FACTORS CONSIDERED IN DRUG SELECTION temperature before administration
 Patient’s eligibility for chemotherapy  Monitor the patient for abdominal pressure, pain, fever
 Cancer Cell Type and electrolyte imbalance
 Rate of Drug Absorption  Measure abdominal grith
 Tumor Characteristics (tumors burden , Tumor growth

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CHEMOTHERAPY OTHER ROUTES OF ADMINISTRATION

 Subcutaneous
 Intramuscular
 Intravenous
SQ AND IM
 Demonstration and return demonstration may be needed
if the patient is giving self injections
 Injection sites should be rotated for each dose and a log
kept of the drug dosing schedule
INTRAVENOUS
 May e given through central venous catheters or
peripheral venous access
 Methods of administration include IV push (bolus),
piggyback (secondary set-up) or continuous infusion
VEIN SELECTION AND VENIPUNCTURE
 Site must be changed every 48 hours
 Peripheral sites should be changed daily before
administration of vesicants
 A blister agent or vesicant , is a chemical compound that
causes severe skin, eye and musical pain and irritation

 Use distal veins first

 Choose a vein above the area of flexion
 Subsequent venipuncture should be done proximal to
previous sites
 Veins include the basilica, cephalic and metacarpal
 Large vein on the forearm are the preferred site
 If a drug extravasates in this area, maximum soft tissue
coverage is present to prevent functional impairment
 Do not use antecubital fossa and wrist
 Extravasation in these areas can destroy nerves and
tendons, resulting in loss of function

CRITERIA USED TO DESCRIBE RESPONSE OF A

INTRATHECAL
 Reconstitute all intra thecal medications with
preservative- free sterile normal saline or sterile water
 Maintain sterile technique at all time
 Medication should be injected slowly
 If chemotherapy drugs are given in high doses, monitor
patient for neurotoxicity
INTRAVESICAL BLADDER
 Agent added to bladder by urinary catheter and retained
for 1 to 3 hours
INTRAVESICAL BLADDER
 Agent added to bladder by urinary catheter and retained
for 1 to 3 hours
CHEMOTHERAPY
 COMPLETE RESPONSE
- The term used for the absence of all detectable cancer
after your treatment is complete. Complete response
doesn't necessarily mean that you are cured, but it is the
best result that can be reported. It means the cancerous
tumor is now gone and there is no evidence of disease
 PARTIAL RESPONSE
- A partial response or partial remission means the cancer
partly responded to treatment, but still did not go away.
A partial response is most often defined as at least a 50%
reduction in measurable tumor
 STABLE DISEASE
- Stable disease - the cancer has neither grown nor shrunk;
the amount of disease has not changed. A tumor marker
(if applicable) has not changed significantly. Disease
progression - the cancer has grown; there is more disease
now than before treatment.
 PROGRESSIVE DISEASE

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- defined as at least a 20 or 25 percent growth in the size of clearly marked special container “Leak-proof”, “puncture
the tumor or spread of the tumor since the beginning of proof”
treatment. In other words, if the size of a tumor is 20  Dispose “half empty” ampules, vials, IV bottles by putting
percent larger on a scan it would be called progressive into plastic bag, seal & then into another plastic bag or
disease. box, clearly marked before placing for removal Label as
CHEMOTHERAPY EFFECT ON NORMAL TISSUE “Hazardous waste”
 Chemotherapeutic agents cannot distinguish between  Handwashing should be done before and after removal
normal and cancer cells of gloves
 Body’s response to products of cellular destruction  Only trained personnel should be involved in use of drugs
- Fatigue (preferably, chemotherapy identified nurse)
- Anorexia  Ideally, preparation of chemotherapeutic drugs should be
- Taste alterations in laminar flow conditions, with filtered air to prevent
 Side effects from destruction of normal cells contamination with microorganisms
 General and drug-specific adverse effects are classified - DISPOSOAL OF SUPPLIES AND UNUSED DRUGS
- ACUTE a. Do not clip or recap needle or break syringes
- DELAYED b. Place all supplies used intact in a leak proof, puncture
- CHRONIC proof, appropriate labeled container
CHEMOTHERAPY EFFECT ON NORMAL TISSUE c. Place all unused drugs in containers in a leak proof,
ACUTE TOXICTY puncture proof, appropriate labeled container
 Occurs during and immediately after drug administration d. Dispose of container filled with chemotherapeutic
 Nausea supplies and unused drugs in accordance with
 Vomiting regulations or hazardous wastes
 Allergic reactions MANAGEMENT OF CHEMOTHERAPEITIC SPILLS
 Dysrhythmias  Chemotherapy spills should be cleaned up immediately
 Extravasation (flare reaction) by properly protected personnel trained in the
appropriate procedure. A spill should be identified with a
DELAYED EFFCETS ARE NUMEROUS
warning sign so that other person will not be
 Musositis
contaminated
 Alopecia
SUPPLIES REQUIRED
 Bone marrow suppression
 Chemotherapy spill kit contains
 Delayed nausea and vomiting
 Respirator mask for air borne powder spills
 Skin rashes
 Plastic safety glasses or googles
 Altered bowel function
 Heavy duty rubber gloves
 Cumulative neurotoxicities
 Absorbent pads to contain liquid spills
CHRONIC TOXICITIES
 Absorbent towels for clean up after spills
 Involve damage to organs
 Small scoop to collect glass fragments
- Heart
 Two large waste disposal bags
- Kidney
 Protective disposal gown
- Liver
 Containers of detergent solution and clear tap water for
- Lungs
post spill clean up
CONTRAINDICATIONS TO CHEMOTHERAPY
 Puncture proof and leak proof container approved for
 Infection
chemotherapy waste disposal
 Recent Surgery  Approved, specially labeled, impervious laundry bag
 Impaired Renal or Hepatic Function
SPILL ON HARD SURFACES
 Recent Radiation Therapy  Restrict area of spill
 Pregnancy  Obtain drug spill kit
 Bone Marrow Suppression  Put on protective gown, gloves, googles
SAFE HANDLING OF CHEMOTHERAPEUTIC AGENTS  Open waste disposal bags
 Wear mask, eye shield, gloves and back closing gown  Place absorbent pads gently on the spill; be careful not to
 Skin contact with drug must be washed immediately with touch spill
soap and water. Eyes must be flushed immediately with
PLACE ABSORBENT PAD IN WASTE
copious amount of water
 Cleanse surface with absorbent towels using detergent
 Sterile/alcohol- wet cotton pledgets should be used,
solution and wipe clean with clean tap water
wrapped around the neck of the ampule or vial when
 Place all contaminated materials in the bag
breaking and withdrawing the drug
 Wash hands thoroughly with soap and water
 Expel bubbles in wet cotton
SPILL ON PERSONNEL OR PATIENT
 Vent vials to reduce internal pressure after mixing
 Restrict area of spill
 Wipe external surface of syringes & IV bottles
 Obtain drug spill kit
 Avoid self inoculation by needle stab
 Immediately remove contaminated protective garments
 Clearly label the hanging IV bottle with “Antineoplastic
or linen
Chemotherapy”
 Wash affected skin area with soap and water
 Contaminated needles & syringes must be disposed in a
 If eye exposure-immediately flood the affected eye with

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[NCM 112] 3. CHEMOTHERAPY – ELLEN CORDENILLO

water for at least 5 minutes; obtain medical attention  Avoid eating high roughage, greasy and spicy food
promptly alcoholic beverages, tobacco and caffeine products
 Notify the physician if drug spills on patient  Avoid using milk products
 Documentation- document the spill  Eat low residue diet high in protein and calories
NURSING MANAGEMENT CHEMOTHERAPY  Include food high in potassium if fatigue is present like
Must differentiate between bananas, baked potatoes
 Tolerable side effects  Drink 3000 ml of fluid each day
 Toxic side effects  Eat small frequent meals; eat slowly and chew all food
Report serious reactions thoroughly
 Some toxicities are not reversible  Clean metal area each bowel movement
Combination chemotherapy is planned to avoid prescribing  Administered ant-diarrheal agents as prescribed
(medications) with “nadirs” (the time during which bone  Avoid eating/ drinking for 1-2 hours prior to and after
marrow activity amd WBC counts are at the lowest) at or near chemotherapy administration
the same time, to minimize immunosuppression  Eat frequent small meals. Avoid greasy & fatty foods
and very sweet foods and candies
 Avoid unpleasant sights, odors and tastes
 Follow a clear liquid diet
 If vomiting is severe inform the physician
 Consider diversionary activities
2. INTEGUMENTRAY SYSTEM
SIDE EFFECTS OF CHEMOTHERAPY - PRURITUS, UTICARIAL & SYSTEMIC SIGNS
 Mouth pain or ulcers  Provide good skin care
 Nausea and vomiting - STOMATITIS (ORAL MUCOSA)
 Hair loss  Provide good oral care
 Skin that is dry, discolored or sensitive to sunlight  Avoid hot and spicy food
 Nails may grow slowly and develop white or dark lines - ALOPECIA
 Anemia  Reassure that it is temporary
 Low white blood cell count  Encourage to wear wigs, hats and head scarf
NURSING INTERVENTIONS FOR CHEMOTHERAPY SIDE - NAIL CHANGES
EFFECTS  Reassure that nails may grow normally after
1. G.I SYSTEM – NAUSEA, VOMITTING, DIARRHEA , chemotherapy
CONSTIPATION STOMATITIS (ORAL)
NAUSEA AND VOMITTING  Symptoms occur 5-7 days after chemotherapy &persist
 Nausea is the conscious of the subconscious excitation upto 10 days
of an area of the medulla closely associated with or part  Continue brushing regularly with soft tooth brush
of the vomiting center. Nausea may cause the desire to  Use non irritant mouthwash
vomit &it often precede or accompanies vomiting  Avoid irritants to the mouth
 Administer antiemetic to relieve nausea and vomiting  Maintain a good nutritional intake, eat soft or liquid
 Replace fluid-electrolyte losses, low-fiber diet to relieve food high in protein
diarrhea  Follow prescribed medication schedule e.g drug for oral
 Increase fluid intake & fibers in diet to prevent candidiasis
constipation  Report physician if symptom persists
ANTIEMETIC TO RELIEVE N/V RELATED TO CHEMOTHERAPY  Increase the frequency of oral hygiene every 2 hours
 Dronabinol (Marinol)  Glycerin & lemon juice should never be used to clear
 Ondansetron (Zofran) mouth or teeth as it cause the tissues to become dry &
 Granisetron (Kytril) irritated
 Alparazolam (Zanax) ALOPECIA
 Lorazepam (Ativan)  Explain hair loss is temporary, and hair will grow when
 Haloperidol (Haldol) drug is stopped
 Prochlorperazine (Compazine)  Use a mild, protein based shampoo, hair conditioner
ANOREXIA every 4-7 days
 Freshen up before meals  Minimize the use of an electric dyer
 Avoid drinking fluids with meals to prevent feeling of  Avoid excessive brushing and combing of the air.
fullness  Combing with a wide- tooth comb is preferred
 High protein diet  Select wig, cap, scarf or turban before hair loss occurs
 Monitor and record weight weekly. Report weight loss  Keep head covered in summer to prevent sunburn and
DIARRHEA in winter to prevent heat loss
 Some clients experience diarrhea during and after 3. HEMATOPOIETIC
treatment with chemotherapy - ANEMIA
NURSING ACTION  Provide frequent rest periods
 Monitor number, frequency and consistency of diarrhea - NEUROTROPENIA
stools

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 Protect from infection  Avoid the use of tourniquets

 Avoid people with infection  Eats a soft, bland diet, avoid foods that are thermally,
 Report fever, chills, diaphoresis, heat, pain, erythema or mechanically and chemically irritating
exudates on any body surfaces  Maintain the integrity of the mucous membrane of GI
 Avoid fresh fruits, raw meat, fish, vegetables, fresh tract
flowers, potted plants  Promote hydrae to avoid constipation
 Change IV sites every day  Avoid enemas, harsh laxatives and the use of rectal
 Change all solutions & IV infusion sets every 48 hours thermometers
- THROMBOCYTOPENIA  Take steroids with an antacid or milk
 Protect from trauma  Avoid sources of infection
 Avoid ASA  Maintain good personal hygiene
 Nadir  Prevent trauma to skin & mucous membranes
4. GENITO- URINARY SYSTEM  Report s/s of infection to physician
- Hemorrhagic cystitis  Monitor counts
 Provide 2-3 Liters of fluids per day  Avoid invasive procedures, no…..
- Urine color changes  Raise the arm while pressure is applied after removal of
 Reassure that it is harmless a needle or catheter
CYSTITIS FATIGUES
 Is an inflammation of the bladder, which is usually  Assess for possible causes chronic pain, stress,
caused by an infection depression and insufficient rest or nutritional intake
 Sterile cystitis not induced by infection  Conserve energy & rest when tired
 Sterile cystitis not by infection, can be a side effect of  Plan for gradual accommodation of activities
 radiation therapy or due to cyclophosphamide  Monitor dietary & fluid intake . drink 3000 ml of fluid
(endoxan) administration intake daily, unless contraindicated, in order to avoid
 The metabolites of cyclophosphamide are excreted by the accumulation of cellular waste products
the kidneys in the urine DEPRESSION
NURSING ACTION  Assess for changes in mood and affect
 Fluid intake at least 3000 ml daily  Set small goals that are achievable daily
 Empty bladder as soon as the urge to void is  Participate e.g music, reading, outings
experienced  Share feelings
 Empty bladder at least every 2-4 hours  Reassurance
 Urinate at bed time to avoid prolonged exposure of the ADVERSE REACTION TO CHEMOTHERAPY
bladder wall to the effects of Cytoxan while sleeping 1. HYPERSENSITIVITY REACTION
 Take oral Cytoxan early in the morning to decrease the  Dyspnea, chest tightness/pain, pruritus (itching),
drug concentration in the bladder during the night urticarial (wheals), tachycardia, dizziness, anxiety,
 Report increasing symptoms of frequency bleeding agitation, inability to speak, abdominal pain , nauseas,
burning on urination, pain fever and chills promptly to hypotension, cloudy mental status, flushed appearance,
physician cyanosis
 Following comfort measures can be adopted if cystitis  HYPERSENSITIVITY REACTION NURSING
is present INTREVENTIONS :
 Ensure dilute urine by increasing the fluid intake  Stop the drug administration
 Avoid foods &beverages that may cause irritation to the  Maintain IV access with 0.9% NS (NaCl)
bladder- alcohol, coffee, strong tea, carbonated  Keep an open airway
beverages etc.  Keep client in modified Trendelenburg position, unless
5. REPRODUCTIVE SYSTEM contraindicated
- Premature menopause or amenorrhea  Notify the physician
 Reassure that menstruation resumes after  Monitor the client’s vital signs until he is table
chemotherapy  Administer epinephrine, aminophylline,
BONE MARROW DEPRESSION deiphenhydramine & corticosteroids as prescribed
This can lead to: 2. EXTRAVASTION
 Anemia  Vesicant chemotherapeutic agents can cause tissue
 Bleeding due to thrombocytopeni destruction
 Infection due to leukopenia  Irritant drugs can produce venous pain at the site &
NURSING ACTION along the vein
 Administer packed RBC according to the physician  Pain erythema, swelling &lack or blood return indicate
orders an extravasation
 Monitor hematocrit and hemoglobin especially during  NURSING INTREVENTIONS ON EXTRAVASATION
drug nadir  Stop the drug administration
 Maintain the integrity of the skin  Leave the needle in place &attempt to aspirate any
 Avoid activities with the greatest potential for physical residual drug from the tubing, needle &site
injury  Administer an antidote, as prescribed. Then remove the
 Use an electric razor when shaving needle

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[NCM 112] 3. CHEMOTHERAPY – ELLEN CORDENILLO

 Apply warm or cold compress

 Document the appearance of the site before and after
the chemotherapy
OUTPATIENT CHEMOTHERAPY DELIVERY
 Aggressive, complex and sophisticated cancer therapies
are currently being in ambulatory & home care settings.
This shift is provision of services from the Hospital
setting is a result or cost-contaminated efforts,
advanced technology, competition & increased
competence of nurses

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