Caring For Children Receiving

Chemotherapy, Antimicrobial
Therapy And Long-term Insulin
Therapy

Facilitator:
Rubina kousar
RN,RM,BScN Post RN
 What Is Chemotherapy
It is the use of anti neo plastics agents to attempt
to kill tumor cell by interfering with cellular
functions and reproduction”

Introduction

 The use of chemicals to treat cancer began in the early 1940’s

 The era of modern chemotherapy begun in 1948 with the
introduction of nitrogen mustard.
 It is only in the last 10 to 15 yrs, however , that chemotherapy has
become a major treatment modality.
Classification of Neo plastics drugs
Classification of Neo plastics drugs
Classification of Neo plastics drugs
 Administration Of Chemotherapy..
Planning drug doses and schedules
 Doses
• drugs are measured in milligrams (mg)
 Doses are determined based on
• Body weight in kilograms
• Body surface area
 Schedule (cycles):
• Chemotherapy is generally given at regular intervals called cycles
• One dose followed by several days or weeks without treatment
Administration of chemotherapy
 Oral Route
 Intravenous Route
a) Angiocatheter,
b) PICC Line,
e) Port A-cath
 Subcutaneous Routes
 Intraventricular/ Intrathecal Route
 Intra-arterial Routes
 Intraperitoneal Route
 Intra vesicular Route
 Intra pleural Route
Label For Cytotoxic Drugs
Safe Preparation , Handling And
Disposal Of Chemotherapy Agent
Exposure can be occur through
• Inhalation of aerosols
• Absorption through the skin
• Ingestion of contaminated material
Safe Preparation , Handling And Disposal Of Chemotherapy Agent
EXTRAVASATIONS
 Extravasation is the leakage of blood, lymph, or other fluid,
such as an anticancer drug, from a blood vessel or tube into
the tissue around
 In the case of inflammation, it refers to the movement of
white
  blood cells from the capillaries to the tissues
surrounding them.
 The leakage of a fluid out of its container into the
surrounding area, especially blood or blood cells from
vessels.
Hypersensitivity Reactions
 Dyspnea
 Tachycardia
 Chest tightness or pain
 Dizziness
 Pruritus
 Anxiety
 Inability to speak
 Nausea
 Abdominal pain
 Hypotension
 Cloudy sensorium
 Fused appearance and cyanosis
Nursing Actions in Hypersensitivity Reactions
Nursing Management Of Patient Undergoing Chemotherapy
Patient should be protected from infections
 Wash hands regularly with antibacterial agent
 Avoid crowd with cold, flu or infections
 Avoid raw fruits and vegetables
Help the patient to identify period of more fatigue and activeness Patient
 Should take rest prior to an activity
 Maintain good nutritional status and hydration status by taking balanced diet
Antiemetic's should be administered one hour prior to chemotherapy
 Patient should take light meal of non irritating food before treatment
 Ensure adequate fluid intake being consumed & retained
Nursing Management Of Patient Undergoing Chemotherapy
Low fiber and residue diet
(Eg. fresh fruits, vegetables , seeds and nuts) should
be recommended to patient as these food can cause
diarrhea.
 Fried food should be avoided as they produce gas .
Patient should be taught to maintain a record of
episodes of diarrhea &foods that cause diarrhea.
 Rectal area of patient should be kept clean &dry to
maintain skin integrity.
Nursing Management Of Patient Undergoing Chemotherapy
For oral mucositis
 Patient should be taught to do oral assessment and characteristics of saliva &
ability to swallow.
 Patient should be taught to do tooth brushing & flossing before and after each
meal and bed time.
 Patient should feed with soft non irritating high protein and high calorie foods.
 Tobacco and alcohol should be avoided
 Body weight should be measured at least twice a week.
 If patient is malnourished, give parenteral nutrition.
Nursing Management Of Patient Undergoing Chemotherapy

 For alopecia: patient should be addressed to use turban, cap or

wig as hair loss is very stressful to patient.
 Patient should be carefully assessed for pulmonary side effects
(pulmonary edema ) & cardiovascular effects (ventricular
dysfunction & heart failure).
 Patient should be taught about management of adverse effects
and interventions are planned so patient can self manage the
illness and facilitate coping strategies.
Nursing care of children receiving
Antimicrobial Therapy
Differentiating The Terms

Antibiotics:
Antimicrobial agents: Substances produced by
Synthetic as well as micro- organisms, which
naturally obtained selectively suppress the
drug that attenuate growth or kill the micro-
microorganisms organisms at very low
concentrations
Basis of classification of AMAs
 Type of organism against which primarily active Antibacterial
• Antifungal
• Antiviral
• Antiprotozoal
• anthelminthic
➢ Spectrum of activity
• Narrow spectrum
• Broad spectrum
➢Type of action
Primarily bacteriostatic or bactericidal
Factors Affecting The Choice Of An Antimicrobial Agent
 Age
 Renal or Hepatic Function
 Drug Allergy
 Impaired Host Defense
 Pregnancy
 Genetic Factors
 Drugs Contraindicated
 Antibiotics Nursing Implications
 Before beginning therapy, assess drug allergies; hepatic, liver, and cardiac
function; and thorough patient health history, including immune status.
 Assess for conditions that may be contraindications to antibiotic use, or that
may indicate cautious use.
 Assess for potential drug interactions.
 It is essential to obtain cultures from appropriate sites BEFORE beginning
antibiotic therapy
 Patients should be instructed to take antibiotics exactly as prescribed and for
the length of time prescribed.
 Assess for signs and symptoms of superinfection: fever, perineal itching,
cough, lethargy, or any unusual discharge.
The most common side effects of antibiotics are nausea, vomiting, and diarrhea.
 Sulfonamides – Should be taken with at least 2400 mL of fluid per day, unless
contraindicated. These agents reduce the effectiveness of oral contraceptives.
 Penicillin's – Any patient taking a penicillin should be carefully monitored for
an allergic reaction for at least 30 minutes after its administration.
 Tetracycline's – Milk products, iron preparations, antacids, and other dairy
products should be avoided because of the chelation and drug-binding .
 Aminoglycosides – Monitor peak and trough blood levels of these agents to
prevent nephrotoxicity and ototoxicity.
 Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss.
 Symptoms of nephrotoxicity include urinary casts, proteinuria, and
increased BUN and serum creatinine levels.
Caution……
 Instruct patients to consult their physician before taking any other
medication, including OTC medications.
 Some agents may cause the urine to have an asparagus-like odor, or cause
an unusual skin odor, or a metallic taste; be sure to warn the patient ahead
of time.
Monitor for
therapeutic effects:
Disappearance of
fever, lethargy,
drainage, and redness
Nursing care for children
on Long-term Insulin Therapy
 Nursing Interventions Rationale

Assess parents and child understanding Provides information essential to

of disease and ability to perform develop a learning program; children
procedures and care, for educational ages 8 to 10 may be able to take
level and learning capacity, and for responsibility for some of the care.
developmental level.
provide a quiet, comfortable
environment; allow time for teaching small Prevents distractions and facilitates
amounts at a time and for reinforcement, learning.
demonstrations and return demonstration; start
educating one day following diagnosis and
limit sessions to 30 to 60 minutes.

Include as many family members in teaching Promotes understanding and support of

sessions as possible. family and feeling of security for the
child.
Teach about the cause of disease, disease
process and pathology; use pamphlets
and other aids appropriate for the age of child
and level of comprehension of parents.
Provides basic information
that may be used as a rationale
for treatments and care and
allows for different teaching
strategies.

Instruct parents and child in insulin

administration including drawing up insulin into
the syringe, rotating vial instead of shaking, Promotes proper technique of
drawing clear insulin first if mixing 2 types in insulin administration to avoid
the same syringe, injecting SC, storing insulin, complications.
rotating sites,
adjusting dosages, reusing a syringe, and needle,
and disposing of them.
Teach parents and child on how to operate a Provides continuous
portable insulin pump to regulate insulin subcutaneous insulin infusion.
delivery.

Instruct parents and child to monitor blood Monitors blood and urine for the
glucose levels 4 times a day (before meals and presence of glucose and ketone.
before bed), with a lancet and blood-testing
meter.

Teach parents and child about dietary Provides information about an

planning with an importance on proper meal important aspect of the total care
times and adequate caloric intake of the child with diabetes.
according to age as ordered. Teach that food
intake depends on activity, and describe methods
to judge amounts of foods; provide a list of
acceptable food items.
Teach parents and child about the
role of
exercise and changes needed in food
and insulin intake with increased or
decreased activity.
Each parents and child about skin
problems associated with
diabetes, need for regular dental
examinations, foot care, protection of
and proper care of nails, prevention
of infections and exposure to
infections, eye examinations,
immunizations.
Provides information about
common activity pattern and
effect on dietary intake and
insulin needs.
Provides information about
common complications as a
result from chronic effects of
the disease.
Instruct parents and child to keep
a record of insulin administration,
glucose monitoring, responses to
diet and exercise, noncompliance
in medical regimen and effects.
Instruct the child to wear or carry
identification and information
about the disease, treatment, and
physician name.
Provides a method to improve
self-care and demonstrates the
need to notify physician
for treatment evaluation and
possible modification.
Provides information in case of an
emergency.