Cancer Hcc

7/31/2019 Cancer Hcc

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Side Effects ofChemotherapy

Alopecia

N/V

Mucositis

Skin changes

Anxiety

Sleep disturbance Altered bowel elimination

Decreased mobility


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Nursing Interventions

Massage

Guided imagery

Reiki aromatherapy


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Cytoprotectants

Amifostine (Ethyol) Xerostomia

Dexrazoxane (Zinecard) Cardiomyopathy

Mesna (MESNEX) Hemorrhagic cystitis

Pamidronate (Aredia) Skeletal complications


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Alopecia

Reassure client that hair loss istemporary.

Inform client that the new hair maydiffer from the original hair in color,texture, and thickness.

Assist client in obtaining wigs or otherhead-covering device, as appropriate


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Nausea and Vomiting

Ensure adequate fluid intake Instruct client on proper oral hygiene

techniques

Provide nutritious, appetizing foods ofclients choice

Monitor nutritional status and weight Teach the client relaxation and

imagery techniques to use before,

during, and after treatments


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Nausea and VomitingDrug therapy for chemotherapy-induced N/V:

Serotonin antagonists Ondansetron, Granisetron, Dolasetron

CNS Depressant (Trimethobenzamide)

Benzodiazepine ( Lorazepam )

Phenothiazines

Prochlorperazine, chlorpromazine

Antihistamine (Dipenhydramine) Corticosteroids (Dexamethasone)

Prokinetic Agents (Metoclopramide)

Cannabinoids (Dronabinol)


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Mucositis

Mucous membrane cells are killedmore rapidly than they are replaced


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Nsg. Interventions

Examine the clients mouth every 4 hours.

Brush the teeth and tongue with a soft-bristled brush or sponges every 8 hours.

Rinse the mouth with a solution of one-half peroxide and normal saline every12hrs

Avoid the use of alcohol or glycerin-basedmouthwashes


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Nsg. Interventions

Administer topical analgesic medicationsas prescribed

Help conscious client to swish and spitroom temperature tap water or NSS

Apply petrolatum jelly to the clients lipsafter each mouth care as needed

Assist the client in using artificial salivaas needed

Instruct client to avoid spicy or hard food


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Bone Marrow Suppression

Reduces the circulating number ofleukocytes, erythrocytes, and platelets

Temporary

Anemia causes:

fatigue, and some tissues are hypoxic

Cardiac and respiratory systems maynot be able to maintain adequateoxygenation


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Drug Therapy

Biological Response Modifiers

stimulate bone marrow production ofimmune system cells


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Limit the number of health care personneland visitors entering clients room

Monitor V/S every 4hours

Inspect open areas such as IV sites, every4 hours

Change wound dressings daily Assist client in performing DBCE

Change IV tubing daily


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Keep frequently used equipment in theroom for use with this client only

Use strict aseptic technique

Avoid the use of indwelling catheters

Monitor WBC count, especially theabsolute neutrophil count

Keep fresh flowers and potted plants outof the clients room

Teach the client to eat a low-bacteria diet


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Thrombocytopenia

Handle the client gently Avoid IM injections and venipunctures

When injections or venipunctures are

necessary, use the smallest gauze-needle Apply firm pressure to the needle stick site

for 10 minutes or until the site no longer

oozes blood Apply ice to the areas of trauma

Test all urine and stool for the presence of

occult blood


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Thrombocytopenia

Observe IV sites every 2 hours forbleeding

Avoid trauma to rectal tissues

Do not take temperatures rectally

Do not administer enemas

Advise client not to have analintercourse

Use an electric razor

Teach the client to avoid mouth trauma


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Thrombocytopenia

Encourage the client not to blow the noseor insert objects into the nose

Instruct client to avoid contact sports

Advise client to wear shoes with firm soleswhenever he or she is ambulating

Instruct client not to take aspirin or anyaspirin-containing products

Take a stool softener to prevent strainingduring a bowel movement


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Hormonal Manipulation

Rationale

Some hormones make hormone-sensitivetumors grow rapidly

Some tumors require specific hormones todivide


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Mechanism of Action

-- upsets the balanceand disturbs the uptake of otherhormones

Androgen (Calusterone, Danocrine,Testosterone, Tenolactone)

Estrogen (Conjugated estrogens,Diethylstilbesterol, Ethinyl estradiol )

Progestin

Medroxyprogesterone, Megestrol

Leutenizing-hormone releasing hormone


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Mechanism of Action

- they bind to thespecific hoemone receptor on or in thetumor cell and prevent the needed

hormone from binding to the receptorAntiandrogens (Bicalutamide, Nilutamide,

Flutamide, Cyproterone acetate)

Antiprogestins ( Mifepristone )Antiestrogens ( Droloxifene, Idoxifene,

Toremifene, Zindroxifene )

GnRH ( Abarelix )


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Mechanism of Action

Aromatase inhibitor- therapy for breast Ca

Aromatase is an enzyme that leads to theproduction of estrogen in the adrenal gland

Anastrozole, Exemestane, Fulvestrant,

Letrozole


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Side Effects of HormoneTherapy

Androgens and antiestrogen receptor drugs:

Chest and facial hair may develop

Menstrual periods stop Breast tissue shrinks

Fluid retention

Acne Hypercalcemia

Liver dysfunction


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Estrogen or progestins

Irregular but havy menses

Fluid retention Breast tenderness

Increased risk for DVT


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Men taking estrogens, progestins, orandrogen receptor drugs

Facial hair thins or disappears

Facial skin becomes smoother Body fat is redistributed

Gynecomastia

Testicular and penile atrophy

Difficulty in achieving and maintainingerection


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Immunotherapy: BiologicalResponse Modifiers

Modify the clients biological response totumor cells

Cytokines small protein hormones made by WBC

Make the immune system work better


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BRMs for Cancer Therapy

Rationale

Enhance immune system

Stimulate immune system to recognizecancer cells and take actions to eliminateor destroy them

Stimulate faster recovery of bone marrowfunction after treatment-inducedsuppression


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Types of BRMs used

Interleukin

Recognize and destroy abnormal bodycells

Appear to charge up the immune systemand enhance attacks on cancer cells bymacrophages, NK cells, and tumor-infiltrating lymphocytes


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Types of BRMs used

Interferons Cell produced proteins that can protect

noninfected cells from viral infection and

replication Slow down tumor cell division

Stimulate growth and activation of NK

cells Help cancer cells resume a more normal

appearance and revert to their previous

cell features


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BRMs for Cancer Support

Induce more rapid recovery of the bonemarrow after suppression bychemotherapy

Benefits: Less risk for life-threatening infections and

anemia

Clients can receive their chemotherapy ontime and may even be able to toleratehigher doses, improving the curative

outcome of chemotherapy


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Side Effects Edema

Tissue swelling

Mild to severe inflammatory reactions

Fever ( acetaminophen), chills, rigors

(meperidine), flu-like general malaise Pheripheral neuropathy

Decreased sensory perception, visual

disturbances, decreased hearing, unsteadybalance and gait, orthostatic hypotension

Skin rashes, dryness, itching, and peeling

Increase depression


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Interventions

Advise clients to apply perfume-freemoisturizers to the skin and to use mildsoap to clean the skin

Involves areas must be protected from thesun with clothing or the use of sunscreenagents

Inform clients to avoid swimming and torefrain from using topical steroid creamson affected areas


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Gene Therapy

Mechanism of Action

Increased Tumor Cell Susceptibility

Increased Immune System Cell Activity Potential Uses of Gene Therapy for Cancer

Treatment


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Increased Tumor CellSusceptibility

Renders the tumor cells more susceptibleto damage or death

Viral enzyme is inserted into brain tumorcells making them more susceptible tobeing killed by antiviral agents

Inserting human leukocyte antigen (HLA)

genes different from the clients own HLAsinto the tumor cells


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Increased Immune SystemCell Activity

Involves inserting additional genes forcytokines into the clients own immunesystem cells

Remain active for up to 6 months and canparticipate in cancer-killing episodes

otent a ses o ene


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otent a ses o eneTherapy for Cancer

Treatment Inserting additional or healthy suppressorgenes into cancer cells

Inserting chemotherapy resistance genesinto normal cells so higher doses ofchemotherapy can be given withoutaffecting normal cells

Removing damaged, mutated, or activatedoncogenes


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Targeted Therapy

Combine biologic and gene therapy

Uses either antibodies that target acellular element of the cancer cell or

antisense drugs that work at the genelevel


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Mechanism of Action Mononucleal Antibodies

Trastuzumab (Herceptin) binds to a receptorfor a protein made by some breast cancercells which prevents the division of cancer

cellsAnti-epidermal growth factor receptor

Antisense drugs targets the process ofmaking proteins important to the cancer

development pathway

Bind to mRNA made by specific cancer genes,preventing them from making the cancer

causing protein


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Oncologic Emergencies


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Oncologic Emergencies

Sepsis

DIC

By the release of thrombin or thromboplastinfrom cancer cells, or by blood transfusions

Bleeding from many sites is most common

Clots block blood vessels and decrease blood

flow to major body organs Pain, stroke-like manifestations, dyspnea,

tachycardia, oliguria, and bowel necrosis


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Management

Prevention Practice strict adherence to aseptic

technique

Teach clients and family members theearly manifestations of infection andsepsis

IV antibiotic therapy Anticoagulant

Cryoprecipitated clotting factors


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SIADH

Causes:

Tumors make and secrete ADH, whereasothers stimulate the brain to make andsecrete ADH

Drugs (morphine, cyclophosphamide)


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Manifestations

Hyponatremia (115-120 mEq/L)

Weakness

Muscle cramps Loss of appetite

Fatigue

Weight gain Nervous system

changes

Personality changes

Confusion

Extreme muscle

weakness Seizures

coma


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Management

Fluid restriction (1 L/ day)

Increase sodium intake

Demeclocycline Monitor serum sodium levels

Cancer therapy


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Spinal Cord Compression

Manifestations:

Back pain

Numbness Tingling

Loss of urethral, vaginal, and rectal

sensation Muscle weakness

Paralysis


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Management

Assess for neurologic changes

High dose corticosteroids to reduceswelling and relieve symptoms

High dose radiation to reduce the size oftumor in the area

Surgery

External back or neck braces to reduce wt.borne by the spinal column


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Hypercalcemia

Tumor secretes PTH causing bone torelease calcium

Worsen by decreased mobility anddehydration


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Manifestations

Fatigue

Loss of appetite

N/V

Constipation

Polyuria

Severe muscleweakness

Loss of DTR

Paralytic ileus Dehydration

ECG changes

Renal impairment


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Management

Oral hydration

Normal saline for parenteral hydration

Oral glucocorticoids, calcitonin,diphosphonate, gallium nitrate andmithramycin

Dialysis

S i V C


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Superior Vena CavaSyndrome

SVC is compressed or obstructed by tumorgrowth


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Manifestations

Client arises after anights sleep

Edema of the face

Stokes sign Edema of the arms

and hands

Dyspnea Erythema of the

upper body

Epistaxis

Hemorrhage

Cyanosis

Mental status change

Decreased cardiacoutput

hypertension


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Management

High dose radiation therapy to themediastinal area

Metal stent placed in the vena cava

Follow-up angioplasty

T L i S d


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Tumor Lysis Syndrome

Large number of tumor cells are destroyed

rapidly

Positive sign that cancer treatment iseffective

Most often in clients receiving radiation orchemotherapy for leukemia, lymphoma,small cell lung cancer, & multiple myeloma

Hyperkalemia

Hyperuricemia

Acute renal failure

Management


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Management Hydration

Instruct clients to drink at least 3000-5000 mL

of fluid the day before, the day of, and for 3days after treatment

Some fluids should be alkaline (sodium

bicarbonate) to prevent uric acid precipitation Diuretics

allopurinol (Aloprim, Zyloprim) or rasburicase

(Elitek) to increase secretion of purines Sodium polystyrene sulfonate

IV infusions containing glucose and insulin

Cancer Hcc

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