neoplastic disorders 3

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Author:
Prittyrick
ID:
311062
Filename:
neoplastic disorders 3
Updated:
2015-11-07 14:20:07
Tags:
cancersux
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Description:
it sucks
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  1. Chemo side effects
    • similar to RT
    • may be more generalized as chemo is systemic
    • acute, delay or chronic in nature
    • fatigue, anorexia, bone marrow suppresion, mucositis (inflammation of mouth, cankor, NV)
  2. chemo side effects 2
    NV
    • N/V most common
    • - maybe acute or delayed
    • - within 1 hr, may last > 24 hrs
    • - ondansetron (Zotran), metoclopramide (reglan)- parkinson syndrome, alters dopamine, tremors
    • - may be used prophylactically as well
    • - alternative methods: biofeedback, music, relaxation
  3. Chemo side effects
    anorexia
    • reaction to therapy,altered taste sensation (everything taste the same)
    • dehydration
    • daily weights
    • encourage frequent small high protein, high calorie foods
    • wt loss >/= 5% requires nutritional supplements (like ensure)
    • malnutrition- PPN, TPN
  4. chemo side effects
    fatigue
    • increase metabolic rate
    • anemia from bone marrow suppression
    • treatment as with RT
    • also, monitor H&H
    • iron in diet or supplements - constipation, dark stools
    • erythropoietin (kidney) (epogen)- synthetic drug stimulate RBC
    • - incr viscosity lead to h/a, blood clot
    • RBC transfusion may be necessary
    • - Hbg < 8, Hct < 24
  5. chemo side effects
    bone marrow
    • Bone marrow suppresion
    • - neutropenia, anemia, thrombocytopenia
    • - pancytopenia (all), aplastic anemia (w/out plasma cell)
    • - Nadir (lowest level of white blood cells)
    • infection could be fatal
    • know CBC norms
  6. chemo side effects
    nursing
    • pt teaching- bone marrow suppression
    • report temp > 100.4 x 1hr or>101 (sometimes this the only sign)
    • monitor CBC
    • report any signs of infection
    • monitor neutrophils < 100,000 reverse isolation- where the pt wears the mask cause at incr risk of infection
    • good handwashing
    • avoid others with infections
    • bleeding precautions
    • - for platelets less than 50,000
    • - spontaneous bleeding (from everywhere) < 20,000
    • norm platelet- 150-450
  7. chemo side effect: neutropenia
    • protective reverse isolation
    • 1. private room
    • 2. no one with cold/infection to enter- not trying to rush infection
    • 3. good handwashing
    • 4. good oral hygiene
    • 5. adequate nutrition and hydration
    • 6. no sharing of eating utensil
    • 7. avoid raw and uncooked foods
    • ANC- absolute true # of neutrophil count
  8. protective isolation
    • 8. avoid animal excrement
    • 9. no cut flowers
    • 10. adequate rest and excerise
  9. ANC
    • 2500-6000 WNL
    • < 2000 neutropenia
    • 1000-1500 min infection risk
    • 500-1000 mod infection risk
    • < 500- severe infection risk
  10. bleeding precautions
    • prevention
    • no aspirin, coumadin
    • no physical sports
    • no razors, mani/pedi
    • no enemas, tampons
    • no straining- colace
    • blow nose gently
    • no IM injections
    • soft toothbrush, no flossing
  11. chemo side effects
    stomatitis and mucositis
    • good oral hygience
    • soft toothbrush, non abrasive paste
    • magic mouth wash (viscous lidacane, mylanta- antacid, benadryl), warm saline rinse,
    • avoid mouth wash alcohol, tobacoo, irritating foods, and extreme temps
    • artifical saliva or mouth care mixtures- dry mouth, incr risk for break down
  12. chemo side effects
    alopecia
    • body image
    • usually temporary
    • cut long hair, mild shampoo
    • avoid heating style tools
    • wig/hats/ turban
  13. chemo side effects
    late/chronic effects
    • liver,  kidneys, reproductive organs, heart, nervous system, secondary melignancies (leukemia)
    • alters immune status
    • metastatis
  14. targeted therapies
    change immune system
    • alone or in combination
    • target specific cells or pathways
    • NOT cell kill- change immune system
    • direct effect on tumor or may augment (change), modulate, restore the immune system, or boost immune, or other biological effects
    • hematopoeitic growth factors, interferons, interleukins, monoclonal antibodies, cell transplantation, gene therapy
  15. hematopoeitic growth factors
    hema- blood
    poeitic- bone marrow
    • formation, development or release of blood cells
    • colony stimulating factors (CSF)- stimulate bone marrow recovery
    • - filgrastin (neupogen)- WBC s/e bone pain
    • - erthropoetin (epogen)- RBC se H/A blood clot, HTN
    • - orprelvekin (neumega)- platelets- allergy, hypersensitive (anaphalytic), edema, angioedema
  16. other treatments
    • bone marrow transplanation
    • stem cell transplantation
    • cancer vaccine
    • - prophlactic- guardasil to prevent HPV cancer, head and neck, rectal anal cancer
    • - therapeutic- clinical trials
  17. assessing tumor response
    • listen carefully
    • diagnostic studies
    • monitor for delay or chronic effects
    • watch for recurrence
    • f/u at 3m, 6m, 1 year- essential

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