4th Lecture (NCM106 CA I) Care of Clients in Cellular Aberrations, ABC, Emergency and Disaster...

jcmendiola_Achievers 2013

Care of Clients in Cellular Aberrations,

Acute Biologic Crisis (ABC), Emergency and Disaster Nursing

(NCM106)

Cellular Aberration I

Cellular Aberration

� Basic structural and functional unit of an organism

Cell Cycle

- Is a coordinated sequence of events resulting in duplication of

DNA and division into 2 daughter cell

4 Phases of the Cell Cycle

1. G1 / Gap Phase

• Lasts from hours to days / longer

• RNA and Protein synthesis occurs in preparation for DNA replication

2. S Phase / Synthesis Phase

• Lasts from 10 – 20 hours

• DNA replication in preparation for division

3. G2 / Gap 2

• Ranges from 2 – 10 hours

• DNA synthesis while RNA and Protein synthesis continues

4. M Phase / Mitosis Phase

• Lasts from 30 – 60 minutes

• Cell division occurs

• After mitosis the daughter cells enter the G1 Phase and begin the reproductive cycle again

5. G0 / Resting Phase

• Is activity to reenter the cell cycle in response to various stimuli that signal for cell renewal

CELL CYCLE

Oncology Nursing

- Field of specialty

- Nurse must be equipped to support patient and

family through a wide range of physical, emotional,

social, cultural and spiritual crises

- Provide realistic support to those receiving nursing

care and use standards of practice and nursing

process as basis of care

Cellular Aberration

- A group of disorders characterized by abnormal cell growth and the ability to metastasize with potential in

killing the host

- The term “cancer” refers to the group of diseases in which cells grow and spread unrestrained throughout

the body

- Derived from the Latin word ‘crab’ which means Cancer

- Synonymous with neoplasm

LOOKY

HERE ☺

1. Introduction on Cellular

Aberration

2. Multistage Theory of

Oncogenesis

3. Tumor Invasion and Metastasis

4. Primary Prevention and Control

5. Secondary Prevention and Early

Detection

6. Staging

7. Chemotherapy


INCIDENCE and EPIDEMICS

Male Female

Most Common Cause of Death Most Common Cause of Death

Prostate Cancer

(33%)

Lung Cancer

(31%)

Breast Cancer

(32%)

Lung Cancer

(27%)

Lung Cancer

(13%)

Prostate Cancer

(10%)

Lung Cancer

(12%)

Breast Cancer

(15%)

Colorectal Cancer

(10%)

Colorectal Cancer

(10%)

Colorectal Cancer

(11%)

Colorectal Cancer

(10%)

Bladder Cancer

(7%)

Pancreatic Cancer

(5%)

Endometrial Cancer

(6%)

Ovarian Cancer

(6%)

Cutaneous Melanoma

(5%)

Leukemia

(4%)

Non-Hodgkins Lymphoma

(4%)

Pancreatic Cancer

(6%)

TOP 5 Cancer Incidences by Site and Sex

Male Female

1. Prostate 1. Breast

2. Lungs 2. Lungs

3. Colon 3. Colon

4. Urinary Tract 4. Uterus

5. Leukemia 5. Leukemia and Lymphoma

Women Men

� Breast Cancer followed by lung

and colon and rectum

� High incidence of cancer of the lung and bladder

� Most common neoplasm aged 20 – 34; testicular Cancer

Etiologic Agent 1. Viruses and Bacteria

� “Oncogenic viruses”

� Prolonged / frequent viral infections may cause breakdown of the immune system / overwhelm the

immune system

2. Chemical Carcinogens

� Act by causing cellular mutation / alterations in cell enzymes and protein

� E.g. Industrial compounds – vinyl chloride, polycyclic aromatic hydrocarbons, fertilizers, weed

killers, dyes and drugs

3. Physical Agents

� Radiation – X-ray / radioactive isotopes and sunlight / UV Rays

� Physical Irritation/ trauma – Pipe smoking, multiple deliveries, ragged tooth, irritation of the

tongue, “overuse” of any organ / body part

4. Hormonal Agents

� Estrogen as replacement therapy ↑ incidence of vaginal and cervical adenocarcinoma

� Estrogen, diethylstilbestrol (DES)

5. Genetics and Familial Factors

� Oncogene � When exposed to carcinogens � Changes in the cell structure � Becomes

malignant

Predisposing Factors

1. Age – Older individuals exposed to carcinogens longer develop immune system alterations

2. Sex

• Women = Breast, Uterus, Cervix Cancer

• Men = Prostate, Lung Cancer

3. Occupation – E.g. Chemical factory worker, radiology department personnel

4. Hereditary – Greater risk with positive family history


Urban Versus Rural Incidence

- Common among URBAN DWELLERS than RURAL RESIDENCES

(Greater exposure to carcinogens)

- Geographic Distribution

o Cancer in stomach – Japan

o Breast Cancer – US; due to environmental diet, ethnic customs and types of pollution

5. Psychological Stress

� Depression, grieving, anger, aggression, despair or life stresses decreases immune competence

(Affects hypothalamus and pituitary gland)

� Immunodeficiency may spurt the growth and proliferation of Cancer cells

6. Precancerous Lesions

o May undergo transfer into cancer lesion and tumor

o E.g. Pigmented moles, burn scars, senile keratosis, leukoplakia, benign polyps, adenoma of the

colon / stomach fibrocystic disease of the breast

7. Obesity

Studies have linked obesity to breast and colorectal Cancer

Factors to Consider

MR JUAN DELA CRUZ

Etiology - Carcinogens – The process of transferring a

normal cell into cancerous cell which

consists of 3 Stages

1) Initiation (Carcinogen)

2) Promotion, repeated exposure to promote agents (Carcinogen)

3) Progression (↑ Malignancy behavior)

D Drugs

E Educational Attainment

L Living Conditions

A Ask family History

C Culture

R Radiation Therapy

U Ur Activity

Z Zex

M Marital Status

R Race

J Job

U Ur Life Style

A Age

N Nutrition


Multistage Theory of Oncogenesis

1. Cellular Transformation and Pre-agent Theory

� Conceptualize that normal cells may be transformed into cancer cells due to exposure to etiologic

agents

2. Failure of the Prime Resource Theory

� Advocates that all individuals possess cancer cells, however the cancer cells are recognized by the

immune system so the cancer cells undergo destruction

� Failure of the immune response system leads to inability to destroy the cancer cells

TERMS

1. Cell Proliferation

� Is the process whereby cells divide and bear offspring, it normally is regulated so that the number

of cells that are actively dividing is equal to the number of dying / being shed

2. Differentiation

� Is the process whereby proliferative cells are transformed into different and more specialized cell

types, as they proliferate it determines what a cells looks like, and how it functions, how long it

will live

3. Apoptosis

� It is the process of programmed death of unwanted cells

BENIGN GROWTH PATTERN

1. Hypertrophy

� ↑ In cell size resulting in an ↑ in organ size!

2. Hyperplasia

� A reversible ↑ in the number of cells in an organ or tissue in response to a specific growth stimulus

3. Metaplasia

� Conversion of one cell type to another cell type not usually found in the involved tissue

4. Dysplasia

� Characterized by abnormal changes in the size, shape, or organization of cells

� Reversible when stimulus is removed


5. Anaplasia � Disorganized irregular cells that have no structure and have loss of differentiation, the result is

almost malignant

CLASSIFICATIONS OF TUMORS

1. Benign

� Are tumors designated by attaching the suffix ‘–oma’ to the cells of organ

� E.g. Fibroma, Chondroma,, Osteoma

2. Malignant

� Tumors that are capable of spreading by invasion and metastasis

� E.g. Fibrosarcoma, Chondrosarcoma

CATEGORIES OF MALIGNANT NEOPLASMS

1. Carcinogens – Growth from epithelial cells, usually solid tumors

2. Sarcoma – Arise from muscle, bone, fat and connective tissue, may be solid

3. Lymphoma – Arise from lymphoid tissues

4. Leukemia and Myeloma – Grows from blood forming organs

Nomenclature of Tumors

Tissue of Organ Benign Malignant

Connective tissue and derivatives Fibroma

Lipoma

Chondroma

Osteoma

Fibrosarcoma

Liposarcoma

Chondrosarcoma

Osteogenic Sarcoma

Blood Vessels Hemangioma Angiosarcoma

Lymphatic Vessels Lympangioma Lymphangiosarcoma

Brain Meningioma Invasive Meningioma

Hematopoietic Cells Leukemia

Lymphatics Malignant lymph***

Smooth Muscles Leiomyoma Leiomyosarcoma

Stratified Muscles Rhabdomyoma Rhabdomyomasarcoma

Epithelial Tumors

Stratified Squamous Squamous cell papilloma Squamous cell carcinoma

Basal Cells Basal Cells carcinoma

Liver Cells Liver cell adenoma Hepatocellular Carcinoma

Placental epithelium

(Trophoblast)

Hydatidiform Mole

Tumor Invasion and Metastasis

• Invasion

� Occurs when cancer cells infiltrate adjacent tissues surrounding the neoplasm

• Metastasis

� Occurs when malignant cells travel through the blood / lymph and invade other tissues and organs

to form a secondary tumor

� Types of Metastasis

Extension and Invasion

1. Lymphatic Spread

2. Seeding of body cavities and surfaces

3. Hematogenous spread

� Spread of cancer cells from a primary tumor to distant sites

� “Break away”

� Only malignant cells has the capability

� Lymph, blood, serosal seeding


Comparison of the Characteristics of Benign and Malignant Neoplasms

Characteristics Benign Malignant

Speed of Growth Slow growth

Grows by expansion

Aggressive growth; rapid cell

division and growth

Mode of Growth Localizes and encapsulation Establishes new site malignant

lesion

Cellular Characteristics Well-differentiated Invade surrounding tissues

Metastasis It does not metastasize

No tissue damage

With poor cellular differentation

Prognosis Very good prognosis

Does not cause death, unless

localization affects vital functions

Malignant Cells – Mitosis

o Mitosis – Multiple daughter cells that may / may not resemble the parent, multiply mitotic spindles

1. Larger, grows more rapidly than normal cells

2. Cells not as cohesive, irregular pattern of expansion

3. Larger, more prominent nucleus

4. Lack characteristic pattern of organization of host cells

5. Anaplastic = Lack of differentiated cell characteristics specific function

Malignant Cells – Growth

1. Invade adjacent tissues

2. Proliferation in response to abnormal stimulus

3. Grow in adverse condition such as lack of nutrients

4. Do not exhibit contact-inhibition

5. Cell birth exceeds cell death

6. Loss of cell control as a result of cell membrane changes

7. Growth rate, erratic

8. Able to break off cells that migrate through blood stream / lympati** seed to distant sites and grow in other

sites

Malignant Cells – Function

1. Senseless, no useful purpose

2. Do not contribute to the well-being of the host, parasitic

3. If the cells function at all, they do not function normally may cause damage

Malignant Cells

1. Develop antigens completely different from a normal cell

2. Chromosomal aberrations occur as a cell matures

3. Has a more prominent and simplified metabolic enzyme pattern

4. Invasive and spreads

5. Grow in presence of necrosis and inflammatory cells such as lymphocytes and macrophages

6. Exhibit periods of latency that vary from tumor to tumor

7. Have own blood supply and suppository stoma (Angiogenesis factory 2 cm in diameter)


Primary Prevention and Control

WARNING SIGNS OF CANCER (CAUUUTIONALF)

C Change in bowel / bladder habits

A A sore that does not heal

U Unusual bleeding / discharge

U Unexplained sudden weight loss

U Unexplained anemia

T Thickening / lump in the breast or elsewhere

I Indigestion or difficulty in swallowing

O Obvious change in wart / mole

B Nagging cough / hoarseness

A Anemia

L Loss of weight

F Fever of unknown origin

Screening

1. Familial and environmental history

2. Physical Examination

3. Evaluation of laboratory findings and test findings

4. Screening methods

� Brest

� Monthly BSE = all women ages 20 and above 1 week after menses

� Mammography every year from age 40 years old

� Colon and Rectum

� Fecal occult blood test every year beginning at age 50

� Proctosigmoidoscopy every 3- 5 years after 50 years old following 2 negative annual

exams

� Uterus

� Yearly pelvic examination and PAP Smear test for sexually active girls and any woman

over 18 or less often for 3 consecutive negative results

� An endometrial sample at menopause for high risk women

� Prostate

� Digital Rectal Exam (DRE) yearly beginning at age 50

� Prostate-Specific Antigen (PSA) test yearly beginning at age 50

Secondary Prevention and Early Detection

NON INVASIVE DIAGNOSTIC PROCEDURES

� Diagnostic Imaging Methods

� Important in the diagnosis and staging of cancer

� Used to guide the surgeon to the appropriate area for biopsy

� Use of this modality is guided by physical examination

� Clinical instruction through collaboration with the radiology specialist

� X-RAY

� Sites speaks

� View the dynamic function of an organ

� Mammography

� Used to screen for malignancies of the breast

� Should be conducted with clinical findings

� CT Scan

� Obtain images from various angles through the body such as lungs, soft tissue, blood vessels

� Preferred method for diagnosis, liver, kidney and pancreatic cancer

10 Steps for Cancer

Prevention and Protective

Factors

1. Increase consumption of fresh

vegetables

2. Increase fiber intake

3. Increase Vitamin A

4. Increase Vitamin C

5. Practice weight control

6. Decrease dietary fat and

7. Decrease salt

8. Stop cigarette smoking

9. Decrease alcohol intake /

substance abuse

10. Void overexposure to sun


� MRI

� Preferred imaging technique for soft tissue structures, hematologic imaging, vascular imaging and

avascular necrosis

� Not exposed to radiation

INVASIVE DIAGNOSTIC PROCEDURE

� Histologic / Cytologic Examination

o For malignant tissues to be identified by name, grade and stage

o Morphologic feature of the cells are examined

3 Basic Methods of Specimen Collection

1. Exfoliation from an epithelial surface (pap smear) or bronchial washing

2. Aspiration of fluid from body cavities or blood

3. Needle suction aspiration of solid tumor

� Direct Visualization

1. Sigmoidoscopy (Viewing the sigmoid colon by use of fiberoptic flexible sigmoidoscopes

2. Cystoscopy (Viewing the urethra and bladder)

3. Endoscopy (Viewing of the upper GIT)

4. Bronchoscopy (Inspection of the tracheobronchial tree

LABORATORY STUDIES

• Tumor Markers

� Biochemical substances synthesized and released by tumor cells

� May be protein products exerted by cancer cells, released in response to the presence of cancer

cells or other conditions � Used to aid in the diagnosis of cancer to determine recurrence or identify regression of a known malignancy

TUMOR MARKER DESCRIPTION

1. Oncofetal Antigen Present in fetal tissue normally suppressed after birth

2. Hormones Present in considerable amount

High levels in hormone-secreting malignancies

3. Isoenzymes Elevated levels can promote hyperplasia of the tissue (Prostate acid

phosphatase)

4. Tissue-Specific Protein Narrows down the type of malignancy that can be increased in

hyperplastic disorders

5. Prostate-Specific Antigen Useful in evaluating response to treatment, recurrent surgery / radiation

therapy

Elevated in prostate cancer, can be elevated in BPH in older men, should

be accompanied with DRE

6. S-100 Found in melanoma cells

Elevated means METASTATIC MELANOMA

7. Thyroglobulin Protein made by the thyroid gland

Removal of the entire gland with or without radiation therapy

Rise in thyroglobulin levels indicate cancer recurrence

8. Estrogen and Progesterone

Receptors

Once diagnosed, breast cancer tissue become tested for the presence of

E and P receptors

Provides an indication of the aggressiveness of the cancer and how

likely the cancer will respond to specific types of endocrine therapy

9. Ca 15 – 3 and Ca 27 – 29 Specific for BREAST CANCER

Found in the blood of an affected patient

Ca 27 – 29 test is MORE sensitive than Ca 15 – 3

10. Carcinoembryonic Antigen

(CEA)

and Ca 19 – 9

Elevated in ADVANCED COLORECTAL CANCER

↑ CEA level before surgery – POORER PROGNOSIS

11. Human Chorionic

Gonadotropin (HCG) and

Alpha-fetoprotein (AFP)

With germ cell ovarian tumors in men with non-seminomatous

TESTICULAR CANCER = Elevated HCG and AFP

Proportionately ↑ to the size of tumors

AFP levels may also be increased in CHRONIC HEPATITIS


12. Beta-2-Microglobulin (B2M) Elevated in periods with multiple myeloma with chronic lymphocytic

leukemia, kidney disease

13. HER-2 / NEU Elevated in one-thirds of persons diagnosed with breast cancer

Laboratory Tests

- Complete Blood Count (CBC)

- Blood Chemistry

Serum electrolytes

ALT – Alanine Aminotransferase

AST – Aspartate Aminotransferase

LDH – For liver metastases

CEA – For colon cancer

STAGING

• Done during the pre-treatment phase

• After surgical resection

• Recurrence after disease free interval

STAGING – TUMOR

Tumor TNM Staging System

T0 No end of primary tumor

Tis Carcinoma in situ

T1, T2, T3, T4 Progressive increase in tumor size and involvement

Tx Tumor cannot be assessed

STAGES

Stage I The tumor is small, local, detected early

Stage II The tumor is somewhat larger and has started to spread to nearby lymph nodes

Stage III The tumor has spread to nearby lymph nodes

Stage IV Cancer has spread to other parts of the body and is generally in an advanced stage

STAGING – NODE

N0 Regional lymph nodes

N1, N2, N3 ↑ degree of demonstrable abnormality of regional lymph nodes

Nx Regional lymph nodes cannot be assessed clinically

STAGING – METASTASIS

M0 No evidence of distant metastasis

M1, M2, M3 Ascending degree of distant metastasis, including metastasis to different lymph nodes

GRADING

Gx Grade cannot be assessed

G1 Well differentiated

G2 Moderately well-differentiated

G3 and G4 Poorly to very poorly differentiated Poorer differentiation – poorer prognosis

Classification, Grading and Stages

� TNM Classification

T Extent of primary tumor

Tx Cannot be adequately assessed

T0 No evidence of primary tumor

Tis Tumor in situ 0 localized; no spread

T1 4 prognosis, increase in size

1.5 cm < 2: 6-9 cm

3:10-15 cm 4:15 cm >


STAGES

0 Benign state

I Spread to nearby tissue

II 2 – 5 cm sometimes involve lymph

III Greater than 5 cm spread – advanced spread to connective tissue

IV Metastasis

Grading of Tumor

Grade I Well differentiated

Grade II Moderately well differentiated

Grade III Poorly differentiated

Grade IV Undifferentiated

CHEMOTHERAPY

A systematic mode of treatment that uses cytotoxins and chemicals to effectively CURE (Leukemia,

Lymphomas, some solid tumors)

� ↓ Tumor size

� Adjunct to surgery / radiation

� Prevent / treat suspected metastasis

Most effective when the tumor is small and cell replication is rapid

Individualized to the patient and is often prescribed according to the patient’s calculated body surface area

and type of cancer

Example:

� Acute Lymphocytic Leukemia (ALL)

� Uses DVPA

� Daunorubicin – Given days 1 – 3

� Vincristine – Given days 1, 8, 15 and 22

� Prednisone – Given days 11 – 28

� Asparaginase – Given days 17 – 28

� Given in cycles with rest periods (especially if with toxic effects) until disease goes to remission

Chemotherapy Cell Cycle

- Used to disrupt the cell cycle in various phases in specific protocols that are given over varying periods of

time

Cell Kill Hypothesis

1. Several doses of chemotherapy are necessary

2. Each exposure kills: 20% - 99% depending on dosage

3. Repeated exposure targets even those in G0 and leads to regression

4. 100% eradication of tumor cells – IMPOSSIBLE

5. But the goal is: To reduce the amount that can be destroyed by the immune system

Factors Crucial to the Rate of Normal / Malignant Tissues

1. Cell Cycle Timing: Amount of time required for cells to remove from one mitosis to the next

2. Growth Fraction: Ratio of dividing cells to resting cells, fraction of cycling cells in the entire cell

population

3. Rate of Cell Loss: Fracture of cell die or leaves

Route of Chemotherapy

1. Oral – Hodgkin’s Lymphoma, Leukemia (Maintenance phase), Lung Cancer

2. Intravenous – Leukemia,

3. Intra-arterial – Hepatic tumors, head and neck cancer

4. Intracavity – Ovarian cancer

New RESEARCH!

� Use of chemotherapy based on

CIRCARDIAN RHYTHMS

� E.g. Colon Cancer


5. Intraperitoneal – Brain tumors

6. Intraventricular – Brain tumor

7. Intravesical – Bladder tumors

OBJECTIVES:

� To destroy all malignant tumor cells without excessive destruction of normal cells

� To control growth if cure is no longer possible

� Used as adjunct therapy

CONTRAINDICATIONS

� Infection: Anti-tumor drugs are immunosuppressive

� Recent surgery: Drugs may retard healing process

� Impaired renal / Hepatic Function: Drugs are nephrotoxic and hepatotoxic

� Recent Radiation Therapy: Immunosuppressive

� Pregnancy: Drugs may cause congenital defects

� Bone Marrow Depression: Drugs may aggravate the condition, WBC must be within normal levels

Safe Handling of Chemotherapeutic Agents

� Wear mask, gloves and back-closing gown

� Skin contact with drugs must be washed immediately with soap and water. Eye must be flushed

immediately with copious amount of water

� Sterile / Alcohol – Wet cotton pledgets should be used, wrapped around the neck of the ampule / vial

when breaking and withdrawing the drug

� Expel air bubbles or wet cotton

� Vent vials to reduce internal pressure after mixing

� Wipe external surface of syringe and IV bottles

� Avoid self-inoculation by needle stab

� Clearly label the hanging IV bottle with antineoplastic chemotherapy

� Contaminated needles and syringes must be disposed in a clearly marked special container “leak-proof” or

“puncture proof”

� Dispose half-empty ampules, vials, IV bottles by putting them into plastic bags sealed and then into

another plastic bag or box, clearly marked before placing for removal. Label as “Hazardous Wastes”

� Handwashing should be done before and after removal of gloves

� Trained personnel only should be involved in use of drugs

Effects of Chemotherapeutic Drugs

Tissues normally affected are:

1. Mucous Membranes

� Mouth, tongue, esophagus, stomach, intestine and rectum

� Results in anorexia, loss of taste, aversion to food, Erythema,

painful ulceration of GIT, NV, diarrhea

2. Hair Cells

� Alopecia

3. Bone Marrow Depression

� Affects: Granulocytes, lymphocytes, thrombocytes, erythrocytes

� Impaired ability to respond to infection, blood clot and severe

anemia

4. Organ

� Heart, lungs, bladder, kidney

� Due to specific agents

� E.g. Cardiac toxicity (Doxorubicin)

� Pneumocystis (Bleomycin)

Effects of CHEMO DRUGS

1. Combined medication

therapy is used to

enhance tumor cell

kill

2. Synergistic actions of

drugs will prevent the

development of drug

resistance

3. Combats resistance of

cells to

chemotherapeutic

agents


Classification of Chemotherapeutic Drugs

Related to the cell cycle

1. Cycle Specific Agents

� They are specific to certain phases of the cell cycle

� Destroy cells that are actively reproducing

� Most affects there in the S Phase of interfering with DNA and RNA synthesis

� M Phase (Vinca / Plant Alkaloids: Halt spindle function)

2. Cycle Non-Specific Agents

� Act independently of the cell cycle place

� Usually have prolonged effects or cells leading to cell death and damage

Classifications of Drugs

1. Alkylating Agents

� Contains alkyl groups which binds to DNA and prevents replication and mitosis

� Cell Cycle non-Specific

� Effective against many types of cancer, including acute and chronic leukemia, solid tumors

� Common Side Effects

� Bone marrow suppression

� N/V

� Alopecia

� Sterility

� Cystic cyclophosphamide

� Stomatitis

� Renal Toxicity (Cisplastin)

� E.g.

� Bisulfiram (Bisulflex)

� Cyclophosphamide (Cytoxan)

� Chlorambucil (Leukeran)

� Cisplastin (Planitol-AQ)

� Nursing Implications:

� Maintain good hydration

� Administer anti-emetics prior to chemotherapy

� Monitor WBC, Uric Acid

� Assess for possible infection

� Discuss concerns for hair loss

2. Nitrosoureas

� Similar to the alkylating agent

� ONLY CHEMODRUG THAT CAN CROSS THE BLOOD BRAIN BARRIER (BBB)

[Important for Central Nervous System diseases]

� Side Effects:

� Delayed cumulative myelosuppression (In 3 – 5 weeks) especially thrombocytopenia;

N/V


� Maintain good hydration

� Administer anti-emetics prior to chemotherapy

� Monitor WBC, Uric Acid

� Assess for possible infection


3. Anti Metabolites

� Interferes with the biosynthesis of metabolism or nucleic acid needed for RNA and DNA synthesis

� Cell specific (Best in S Phase)

� Used to treat acute leukemia, breast cancer, head and neck cancer, lung cancer, and osteosarcoma

� Side Effects:

� Bone Marrow suppression (Anemia, leukopenia)


� Stomatitis

� N/V

� Alopecia

� Hepatitis and renal dysfunction

� E.g.

� Methotrexate

� Lethal in high doses, must give antidote (Leucovorin) within 24 – 36 hours after

initiation of therapy

� 5-Flurouracil (5-FU)

� Cytarabine (Depocyt, Tarabine)

� 5-Azacytidine

� Side Effects

� N/V

� Diarrhea

� Bone Marrow suppression: Reaches NADIR in 1 – 2

weeks; with leukopenia being most severe

� Renal toxicity (Methotrexate)

� Hepatotoxicity

� Nursing Implications

� Monitor CBC, WBC, Uric acid

� Assess oral mucus membranes

� Assess for infection, bleeding

� Provide oral care

� Administer anti-emetics PRN

� Discuss concern for hair loss

� Evaluate hydration and nutritional status

4. Antitumor Antibiotics

� Inhibit RNA synthesis and bind DNA causing fragmentation; interfere with DNA repair

� These drugs bind to almost everything they contact and kill cells

� Main toxic effect is cardiac muscle toxicity (Limits the amount and duration of treatment)

� Side Effects are the same with other anti-Cancer drugs

� E.g.

� Doxorubicin (Adriamycin)

� Bleomycin (Blenoxane)

� Dactinomycin (Cosmegen)

� Nursing Implications

� Monitor ECG, CBC

� Assess for bleeding

� Assess for hydration and nutritional status

� Check for fever 36 hours after administration

� Administer anti-emetic PRN

5. Plant Alkaloids

� Two main Groups (From natural products)

1. Vinca Alkaloids – Mitosis phase, inhibit mitotic tubular formation (spindle); inhibit DNA

and protein synthesis

2. Etoposide (VP-16) or Mitotic Inhibitors – All phases; causes breaks in DNA and

metaphase arrest

� E.g.

1. Vincristine (Oncovin)

Vinblastin (Velban)

2. Etoposide (Toposar)

Teniposide (Venom)

� Side Effect:

� Hypotension (Too rapid IV administration), muscle weakness, areflexia, constipation,

N/V, alopecia


NADIR – Is the lowest level of

a red blood cell count while a

patient is undergoing

chemotherapy


� Assess neuromuscular functions

� Monitor CBC, GI function

� Manage constipation

� Hydration


6. Hormonal Agents

� Alter the deviate / environment to depress / prevent cell proliferation

� Corticosteroids (e.g. Prednisone: Mostly used in CA therapy; G1 Phase)

� E.g.

� Androgen, estrogen, anti-androgens, anti-estrogens

� Side Effects

� N/V

� Hyperglycemia

� Hypertension

� Weight gain; gynecomastia

� Mood changes

� Cessation of menstruation

� Acne, alopecia

Nursing Interventions for Chemical Side Effects

• GI System = N/V, diarrhea, constipation

� Administer anti-emetics to relieve N/V

� Replace fluids and electrolyte losses, low fiber diet to relieve diarrhea

� ↑ fluid intake and fibers in diet to prevent / relieve constipation

• Integumentary System

� Pruritus; urticaria and systemic signs

� Provide good skin care

� Stomatitis

� Provide good oral care, avoid HOT and SPICY food

� Alopecia

� Reassure that it is temporary, wear wigs / hats

� Skin Pigmentation

� Inform that it is temporary

� Nail changes (Grow normally after chemotherapy)

• Hematopoietic System

� Anemia

� Frequent rest periods, eat foods high in Iron!

� Neutropenia

� Protect from infection

� Avoid people with infection

� Thrombocytopenia

� Protect from trauma

� Avoid ASA

• Genito-Urinary System

� Hemorrhagic Cystitis

� Provide 2 – 3 L of fluids per day

� Urine color changes

� Reassure that it is harmless

4th Lecture (NCM106 CA I) Care of Clients in Cellular Aberrations, ABC, Emergency and Disaster...

Documents

Transcript of 4th Lecture (NCM106 CA I) Care of Clients in Cellular Aberrations, ABC, Emergency and Disaster...