I.

CANCER:

INTRODUCTION:

Cancer is a condition that results from abnormal cellular DNA. It is a condition wherein cells mutate and increase number, with changes in their morphology and without any function. The increase in the number of these cells infects other cells and causes them to behave the same way, a condition termed as malignancy.Cancer cells infiltrate normal and healthy tissue and they compete with normal cells for sustenance from the blood. Malignant cells compress and kill healthy tissue and deprive them of nutrition. In the long run, cancer cells cause cellular malignancy, nutritional deficiencies, and ultimately, death. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes, however, cells keep dividing even if new cells are not needed. These extra cells form a mass of tissue, usually called lump, swelling or tumor. TUMORS CAN BE CLASSIFIED AS: BENIGN TUMORS Which are not cancerous. They often can be removed, and in most cases, do not come back. MALIGNANT TUMORS Which are cancerous. cells in theses tumors are abnormal and they divide without control and they can invade and damage nearby tissues and organs.

GENERAL DANGER SIGNS: C- change in bowel or bladder habits A- sore that does not heal U- unusual bleeding or discharges U- unexplained sudden weight loss U- unexplained anemia T-hickening or lump in the breast or elsewhere I- indigestion or difficulty in swallowing O- obvious change in warts or mole N-nagging cough or horseness of voice STAGING AND GRADING OF NEOPLASIA: STAGING- Is determining the size of the tumor and existence of metastases. GRADING- is classification of tumor cells. THE AMERICAN JOINT COMMITTEE OF CANCER (AJCC) has developed the TNM classification system that can be applied to all tumor types. T- tumor size N- presence or absence of regional lymph node involvement M- presence or absence of distant metastasis T primary tumor Tx- primary tumor is unable to be assessed T0- no evidence of primary tumor TIS- carcinoma in situ

T1 T2 T3 T4 increase size and/or local extent of primary tumor N- presence or absence or regional lymph node involvement Nx- regional lymph nodes are unable to be assessed N0 no regional lymph node involvement N1 N2 N3 increasing involvement of regional lymph nodes M- absence or presence or distant metastasis Mx- unable to be assessed M0- absence or distant metastasis M1 presence of distant metastasis

CLASSIFICATION OF CANCER: CARCINOMA SARCOMA LYMPHOMA LEUKEMIA

LUNG CANCER (BROCHOGENIC CARCINOMA): In the Philippines, Lung Cancer is one of the leading cancer deaths among men and women. The steady increase in rates of people developing and dying from lung cancer is the delayed effects of increased smoking by the Filipinos. An estimated 17,238 new cases and 15,881 deaths due to lung cancer are expected to occur every year. Lung cancer tends to spread or metastasize very early after it forms; it is a very lifethreatening cancer and one of the most difficult cancers to treat. While lung cancer can spread to any organ in the body, certain organs particularly the adrenal glands, liver, brain, and bone are the most common sites for lung cancer metastasis. The lung also is a very common site for metastasis from tumors in other parts of the body. Tumor metastases are made up of the same type of cells as the original (primary) tumor. Lung cancers can arise in any part of the lung, but 90%-95% of cancers of the lung are thought to arise from the epithelial cells, the cells lining the larger and smaller airways (bronchi and bronchioles); for this reason, lung cancers are sometimes called bronchogenic cancers or bronchogenic carcinomas. (Carcinoma is another term for cancer.) Cancers also can arise from the pleura (called mesotheliomas) or rarely from supporting tissues within the lungs, for example, the blood vessels. BRAIN TUMOR: Brain tumor, formed by groups of abnormal cells, can be benign (non-cancerous) or malignant (cancerous) within the cerebellum. Either type can develop within the cerebellum itself, or results from cancer spreading from other areas in the body. Regardless of the type or location of tumor, they need to be treated or removed. Tumors within the cerebellum are classified as either primary or secondary tumors. Primary tumors originate in the cerebellum, while secondary tumors spread from other parts of the body. Medulloblastomas are the most common type of primary brain tumor that develops within the cerebellum. These fast-growing tumors comprise 20 percent of brain tumors in children and adults. Cerebellar astrocytoma, the other primary type of tumor that affects the cerebellum, may be comprised of benign or malignant cells. Secondary tumors occur when cancer metastasizes (spreads) from other parts of the body to the cerebellum. Skin, breast, colon, bowel, lung and kidney cancer can result in tumors within the cerebellum. LUNG CANCER FACTS: Almost 100% of all lung cancer cases are caused by smoking Smokers reach the cancer age at least 15 years earlier than non smokers.

 Non-smokers who are continuously exposed to tobacco smoke in enclosed spaces also run the risk of getting lung cancer. RISK FACTORS: CAUSES: CIGARETTE SMOKING INVOLUNTARY SMOKING PASSIVE SMOKING POLLUTION ASBESTOS FIBER RADON GAS FAMILIAL PREDISPOSITINS RADATION EXPOSURE Exposure to cancer-causing agents Cellular mutation Genetics and hormone exposure Occupation and environment factors Social and psychological factors Chemical in food Viral (herpes, HPV ) Medical factors

SYMPTOMS: Persistent dry cough that gets worse over time Constant chest pain Blood-stained sputum (phlegm) Extreme shortness of breath, wheezing or hoarseness Repeated pneumonia or bronchitis Swelling of the neck and face Weight loss Fatigue Difficulty in swallowing Pain- late manifestation and may be related to metastasis to the bone

PROGNOSIS: Prognostic factors in NSCLC include presence or absence of pulmonary symptoms, tumor size, cell type (histology), degree of spread (stage) and metastases to multiple lymph nodes, and vascular invasion. For patients with inoperable disease, prognosis is adversely affected by poor performance status and weight loss of more than 10%. Prognostic factors in small cell lung cancer include status, gender, stage of disease, and involvement of the central nervous system or liver at the time of diagnosis. Prognosis is generally poor. Of all patients with lung cancer, 15% survive for five years after diagnosis. Stage is often advanced at the time of diagnosis. At presentation, 3040% of cases of NSCLC are stage IV, and 60% of SCLC are stage IV. For NSCLC, the best prognosis is achieved with complete surgical resection of stage IA disease, with up to 70% five-year survival. For SCLC, the overall five-year survival for patients is about 5%. Patients with extensive-stage SCLC have an average five-year survival rate of less than 1%. The median survival time for limited-stage disease is 20 months, with a five-year survival rate of 20%.

Prognosis in lung cancer according to clinical stage Five-year survival (%) Clinical stage Non-small cell lung carcinoma IA IB IIA IIB IIIA IIIB IV 50 47 36 26 19 7 2 Small cell lung carcinoma 38 21 38 18 13 9 1

DIAGNOSTIC EXAM: TREATMENT: RADIOTHERAPHY Is useful in controlling neoplasm that cannot be surgically resected but are responsive to radiation. Radiation therapy usually is toxic to normal tissue within the radiation field, and this may lead to complication such as; esophagitis, pneumonitis, and radiation lung fibrosis. CHEMOTHERAPHY CHEST X-RAY CT SCAN (computerized tomography scan) LUNG BIOPSY ENDOSCOPY MRI CHEMOTHERAPHY SPUTUM EXAM

Is used to alter tumor growth patterns, to treat distant metastases or small cell cancer of the lung, and as an adjunct to surgery or radiation therapy. Chemotherapy may provide relief, specially of pain, but it doesnt usually curs the disease or prolonged life to any great degree. PALLIATIVE CARE May include radiation therapy to shrink the tumor to provide pain relief, a variety of bronchoscopic interventions to open a narrowed bronchus or airway, and pain management and other comfort measures.

NURSING RESPONSIBILITIES: Nursing care of patient with lung cancer is similar to that for other patient with cancer and addresses the physiologic and psychological needs of the patient. The physiologic problems are primary due to the respiratory manifestation of the disease. Nursing care include strategies to ensure relief pain and discomfort and to prevent complication.

II.

NURSING HISTORY

PATIENTS PROFILE PATIENT: Juan Dela Cruz ADDRESS: Purok 6, Patul, Mananabas City SEX: Male AGE: 60 CIVIL STATUS: Married OCCUPATION: N/A RELIGION: Roman Catholic DOCTOR/ATTENDING PHYSICIAN: Dr. Ambrocio ADMITTING DIAGNOSIS: Hemispheric Cerebellar Syndrome HISTORY OF PRESENT ILLNESS A 60 year old man was admitted last December 28, 2012 with a chief complaint of severe headache, blurring of vision and persistent cough. Patient has been experiencing also episodes of finger-nose incoordination lasting a few minutes but subside subsequently, the attacks are increasing in frequency. His wife and 2 children brought him to RCGCN (RACAGUCARIO MEDICAL CENTER) at 6:54 pm. The admitting physician is Dr. Ambrocio with an admitting diagnosis of hemispheric cerebellar syndrome and final diagnosis of Metastatic Lung Cancer T4N2M1b. The patient has also hypertension and Type 2 Diabetes Mellitus. PAST HEALTH HISTORY. The patient hadnt experience any serious disease when he was a child even when he turned into teenage life. But when he reaches the age of 60 where he experience having persistent cough and headache, blurring of vision and weakness resulting to Metastatic Lung Cancer. Factors are when he started smoking when he was 14 years old and consumes 1-2 packs per day, he was a factory worker before, and having a family history of Lung Cancer. The patient also undergone Cholecystectomy 3 years earlier.

FAMILY HEALTH HISTORY According to the patient his father suffered from lung cancer which caused his death, while his mother has hypertension.

PEARSONS FUNCTIONAL HEALTH PATTERN Date and Time of Interview: January 8, 2013 (9:00 AM) Functional Health Pattern Psychological Before hospitalization During hospitalization

The patient considers himself His reaction to admission is as a healthy person before bound by fear and anxiety confinement. He does because he never expected everything in their house that he will acquire Lung without assistant. Cancer though he knows that Lung Cancer is hereditary. The patient looks pale and weak. He perceived his condition as unhealthy and harmful. The patient usually voids 5 to 6 times a day with a characteristic of yellowish in color. He has problem in voiding since he has also Diabetes Type 2. He defecates regularly. The patient usually sleeps normally. He sleeps for about 6-8 hours at night. When he felt like he is tired already he used to put himself to rest to gain energy which he can use for the following hours and or days. He is fond of watching television and listening radio AM stations which he finds himself to relax. The patient voids for 2-3times a day and defecates once only for two days during his confinement.

Elimination

Rest and Sleep

The patient cant rest and sleep well because of the Hospital routines and discomfort specially when experiencing severe head ache.

Safety and Security

The patient just sleeps when The patient just lies on bed he is not feeling well. He also and sleeps when he considered the presence of experiences discomfort. his family as a factor in

relieving his stresses in life. Oxygenation The patient has experiencing difficulty in breathing prior to hospitalization The patient usually eats 3 times a day with a snack in between. He prefers vegetables in her diet and seldom eats pork. He drinks 10-12 glasses of water a day. After eating he used to smoke. He consumes 1-2 packs per day. The patients religion is Roman Catholic. He seldom attends to their church. The patient is supported by O2 inhalation via facial mask. He skips meals during confinement as the patient said he has no appetite.

Nutrition

Spirituality

The patient always pray to GOD to lessen the distress he is experiencing. He has strong faith and believes that whatever happens to him God will never leave him.

III.

PHYSICAL ASSESSMENT

Name: patient J

Date: January 08, 2013 Time: 9:45am

Vital signs: Blood Pressure: 150/100 Temperature: 37.2C Pulse Rate: 95bpm Respiratory Rate: 26 cpm General Appearance: Patient is lying flat on bed with ongoing IVF of .9 Nacl, with O2 inhalation via face mask. Anxious, thin, irritable, looks weak and with a chief complaint of severe headache, blurring of vision and persistent cough. The patient is oriented to time, place and person. PARTS TECHNIQUE USE ABNORMAL FINDINGS ANALYSIS

Inspection

Nasal flaring

Due to difficulty breathing

of

Posterior thorax Shape and symmetry

Inspection

Barrel chest, asymmetry

Due to increase anteroposterior to transverse diameter. of

Inspection

Use of accessory muscle Due to difficulty when breathing breathing. Areas of Dullness

Percussion

Due to presence of fluid in the lungs. to air passing

Auscultation Adventitious breath sounds Due (wheezing and crackles)

through a bronchus.

constricted

Anterior thorax Inspection Abnormal breathing pattern Due to difficulty and sounds breathing. Areas of Dullness of

Percussion

Due to presence of fluid in the lungs.

Balance

Inspection

TYPE OF TEST PERFORMED Romberg test

ABNORMAL FINDINGS (+) Romberg test

ANALYSIS Due to presence of cancer cells that metastases in the brain (cerebellum)

Standing on one foot with eyes Cannot maintain stand for 5 Due to presence of close seconds cancer cells that metastases in the brain (cerebellum) Finger to nose Misses the finger and moves Due to blurring of vision slowly and presence of cancer cells that metastases in the brain (cerebellum)

IV.

ANATOMY AND PHYSIOLOGY

Anatomy of the Brain The image on the left is a side view of the outside of the brain, showing the major lobes (frontal, parietal, temporal and occipital) and the brain stem structures (pons, medulla oblongata and cerebellum). The image on the right is a side view showing the location of the limbic system inside the brain. The limbic system consists of a number of structures, including the fornix, hippocampus, cingulate gyrus, amygdala, the parahippocampal gyrus and parts of the thalamus.

External part of the brain: Frontal Lobe- associated with reasoning, planning, parts of speech, movement, emotions, and problem solving ( recent memory deficits, poor concentration, behavioral disorder, flat affect, depression, impulsive , psychotic disorders.) Parietal Lobe- associated with movement, orientation, recognition, perception of stimuli (Motor sequencing, time and speed, ability to read draw and write) Occipital Lobe- associated with visual processing. Temporal Lobe- associated with perception and recognition of auditory stimuli, memory, and speech. BRAINSTEM: Pons contains centers for the control of vital processes, including respiration and cardiovascular functions. It also is involved in the coordination of eye movements and balance. Medulla oblongata contains centers for the control of vital processes such as heart rate, respiration, blood pressure, and swallowing.

INNER PART OF THE BRAIN Limbic System: The limbic system, often referred to as the "emotional brain", is found buried within the cerebrum. Like the cerebellum, evolutionarily the structure is rather old. This system contains the thalamus, hypothalamus, amygdala, and hippocampus. Amygdala limbic structure involved in many brain functions, including emotion, learning and memory. It is part of a system that processes "reflexive" emotions like fear and anxiety. Cerebellum governs movement. The Cerebellum: The cerebellum, or "little brain", is similar to the cerebrum in that it has two hemispheres and has a highly folded surface or cortex. This structure is associated with regulation and coordination of movement, posture, and balance. Cingulate gyrus plays a role in processing conscious emotional experience. Fornix an arch-like structure that connects the hippocampus to other parts of the limbic system. Hippocampus plays a significant role in the formation of long-term memories. Medulla oblongata contains centers for the control of vital processes such as heart rate, respiration, blood pressure, and swallowing. Parahippocampal gyrus an important connecting pathway of the limbic system. This region plays an important role in memory encoding and retrieval. Thalamus a major relay station between the senses and the cortex (the outer layer of the brain consisting of the parietal, occipital, frontal and temporal lobes).

ANATOMY OF THE LUNGS

The lungs are the primary organs of the respiratory system. The main function of the human respiratory system is to transport oxygen from the atmosphere into the blood, and to expel carbon dioxide from the body. Healthy levels of oxygen are absolutely crucial for the human body, as oxygen gives our cells energy and helps them regenerate. The lungs are a pair of spongy, air-filled organs located on either side of the chest (thorax). The trachea (windpipe) conducts inhaled air into the lungs through its tubular branches, called bronchi. The bronchi then divide into smaller and smaller branches (bronchioles), finally becoming microscopic. The bronchioles eventually end in clusters of microscopic air sacs called alveoli. In the alveoli, oxygen from the air is absorbed into the blood. Carbon dioxide, a waste product of metabolism, travels from the blood to the alveoli, where it can be exhaled. Between the alveoli is a thin layer of cells called the interstitium, which contains blood vessels and cells that help support the alveoli. The lungs are covered by a thin tissue layer called the pleura. The same kind of thin tissue lines the inside of the chest cavity -- also called pleura. A thin layer of fluid acts as a lubricant allowing the lungs to slip smoothly as they expand and contract with each breath. the body's ability to breathe and trade oxygen for carbon dioxide is one of its greatest marvels. Awake or asleep, conscious or unconscious, our bodies breathe automatically without thought on our part. When we are quiet our bodies breathe 15 times a minute on average. Every day an average, moderately active person breathes about 20,000 liters of air. Our bodies have sophisticated systems for filtering out particles (such as dust and soot, mold, fungi, bacteria and viruses) that can be deposited in our airways and on the surfaces of the air sacs. The estimated 300 million alveoli (air sacs) in our lungs create a surface area of more than 100 square meters, where our blood receives fresh oxygen and releases carbon dioxide and other waste gases produced by our bodies.

Tests Hemoglobin Monocyte

Normal Values M (12-18 g/dl) M(37-47%)

Results 13 30.0

Interpretation Normal Due to bacteria

V.

LABORATORY RESULTS

White blood 4.0-10.0 cell Granulocyte 44.2-80.2% Lymphocyte 28.0-48.0%

18.4

Due to infection

76 24

Normal Decreased due to chronic condition ( diabetes mellitus)

RESULT OF CHEST-XRAY

VI.

COURSE IN THE WARD

DATE 1228-12

TIME 6:45pm

DOCTORS ORDER Secure consent Insert IVF of .9 Nacl 1L x 8 hrs. x 3 cycles

RATIONALE

For purposes To maintain IV hooked fluid and regulated electrolyte recorded imbalances

NURSING RESPONSIBILITIES legal Secured consent and and

TPR every shift

To monitor baseline V/S and any changes after operation For CBC, Chest X-ray, To detect Sputum Culture and problems that Sensitivity may place patient at additional risk To alleviate pain, and to decrease BP

Monitored V/S q shift

Requested to the laboratory

Medication: 1. Tramadol 50mg q 4 2. Nifedipine 30mg for increase BP 140/100 For O2 inhalation via facial mask at 2-3 lpm

Assess for pain and monitor BP

To promote To provide airway sufficient oxygen in the body To prevent Maintain Diet increase BP To inform ROD Endorsed To maintain IV hooked fluid and regulated electrolyte recorded imbalances and and

Low-salt, low-fat diet. Refer as needed 1229-12 10:00 am Continue IVF .9 Nacl

For CT Scan and MRI

To detect problems that may place

Requested to the laboratory

patient at additional risk Medication: 1. Tramadol 50mg q 4 2. Nifedipine 30mg for increase BP 140/100 Refer as needed Continue IVF .9 Nacl To alleviate pain, and to decrease BP Assess for pain and monitor BP

1231-12

6:45 pm

To inform ROD Endorsed To maintain IV hooked fluid and regulated electrolyte recorded imbalances To detect problems that may place patient at additional risk To alleviate pain, and to decrease BP

and and

For Lung Biopsy

Requested to the laboratory

Medication: 1. Tramadol 50mg q 4 2. Nifedipine 30mg for increase BP 140/100 Refer as needed Continue IVF .9 Nacl

Assess for pain and monitor BP

1-713

9:30 am

To inform ROD Endorsed To maintain IV hooked fluid and regulated electrolyte recorded imbalances

and and

Final diagnosis: Metastatic lung cancer T4N2M1b Medications 1. Tramadol 50mg q 4 2. Nifedipine 30mg for increase BP 140/100 3. Etoposide 70mg/m2 4. Topotecan 1.5mg/m2/day for 5 days 5. Methotrexate Refer as needed Continue IVF .9 Nacl

To alleviate pain, and to decrease BP

Assess for pain and monitor BP

1-813

10:30 am

To inform ROD Endorsed To maintain IV hooked fluid and regulated electrolyte recorded imbalances

and and

 Medication: 1. Tramadol 50mg q 4 2. Nifedipine 30mg for increase BP 140/100 3. Etoposide 70mg/m2 4. Topotecan 2 1.5mg/m /day for 5 days 5. Methotrexate For radio therapy

To alleviate pain, and to decrease BP

Assess for pain and monitor BP

To detect problems that may place patient at additional risk To inform ROD

Requested to the laboratory

Refer as needed

Endorsed

VII.

NURSING CARE PLAN Diagnosis Planning Intervention Evaluation

Assessment

Subjective: Impaired gas exchange After 30 minutes of Nahihirapan akong related to increase continuous nursing huminga as verbalized production of bronchial intervention the patient by the patient. secretion. will be able to verbalize behaviors how to Objective: maintain clear airway. RR: 26cpm -use of accessory muscle -fatigue -wheezing -Irritability

-Monitor respirations and breath The patient can demonstrate ways how sounds, noting rate and sounds. to maintain clear airway. Rationale: To determine prognosis of breathing pattern, indicate respiratory distress and/or accumulation of secretion. -Position appropriately (head of the bed elevated, side lying and discourage use of oil based products). Rationale: To prevent vomiting with aspiration into the lungs. -Ascultate breath sounds and assess air movement. Rationae::to ascertain status and note progress. -Encourage /provide opportunities for rest, limit activities. Rationale: to reduce stress. -Teach deep breathing exercises. Rationale: to maximize effort.

Assessment

Diagnosis to as of 10

Planning After continuous nursing intervention the patient will be able to verbalize/demonstrate (non verbal cues) control pain/ discomfort.

Intervention Assess pain severity and defining characteristic Rationale: To know the characteristic if pain and the intervention that will be rendered because each individual may exhibit pain perception. - Teach nonpharmacological intervention to relieve pain Rationale: Massage, distraction, music therapy and support groups may enhance pharmacological intervention. -Encourage and assist family member to learn massage techniques. - identify and discuss potential hazards of unproved and or non medical therapies. - Administer pain medication as ordered. Rationale:

Evaluation After continuous nursing intervention the patient was able to verbalize/demonstrate (non verbal cues) control pain/ discomfort.

Subjective: Chronic pain related masakit ang ulo ko pati na physical condition ang buong katawan ko as manifested by pain scale verbalize by the patient. 10/10. 1 is the lowest and is the highest. Objective: -Vital signs: T: 37.2 0C P: 95 bpm R: 25 cpm Bp: 150/100 -pain scale of 10/10 - (+) facial grimace -irritable -restlessness

To minimize the pain that being felt by the patient.

Assessment Subjective: Natatakot ako sa pwedeng mangyari sa akin as verbalized by the S.O Objective: Confuse, Irritable, Restlessness

Diagnosis Anxiety related to change in health status as evidenced by confuses impaired attention and restlessness.

Planning

Intervention

Rationale To gain patient trust.

Evaluation

At the end of the shift Establish trust and the patient will discuss rapport. or verbalized of feelings about fears. Ascertain client perception of what is occurring and how this affects life.

At the end of the shift the patient is now able Fear is as defensive to discuss or verbalized mechanism in protecting of feelings about fears. oneself.

To note congruencies or misperception of Compare verbal and non situation. verbal response. To provide clients with Stay with the client or unusual desired make arrangement to support.Persons can have someone else to be diminish feelings of fear. there Promote atmosphere of Discuss clients caring and permits perceptions to fearful explanation. feelings.Active listening to client concerns. Enhance sense of trust Provide opportunity for and client-relationship. questions and answers honestly.

Assessment Subjective : wala siyang ganang kumain as verbalized by the s.o Objective: Weakness Pale Unwillingness to ingest food

Diagnosis Imbalanced nutrition related to inability to ingest or digest food due to biological factor such as loss of appetite.

Planning After 3 hours of continuous nursing intervention the patient will be able to demonstrate selection of food or meals.

Intervention Consult dietitian for further assessment and recommendations regarding food preferences and nutritional support

Rationale have Dietitians a greater understanding of the nutritional value of foods and may be helpful in assessing specific ethnic or cultural foods Attention to the social aspects of eating is important in both the hospital and home settings.

Evaluation After 3 hours of continuous nursing intervention the patient will be able to demonstrate selection of food or meals. Goal met.

Suggest liquid drinks for supplemental nutrition Provide companionship during mealtime

VIII.

DRUG STUDY

Drug

Indications

Side effects

Contraindication

Nursing Considerations

Generic Name: Etoposide Brand Name: VePesid Classifications: Antineoplastic Dosage: IV: 70mg/m2 (rounded to the nearest 50mg)

-Small cell lung carcinoma CNS: Dizziness, drowsiness, -use cautiously in patients with (first line therapy, used in fatigue. active infections, decreased bone combination with other marrow reserve, renal impairment. therapeutic agents) CV: hypotension. -GERI: elderly (maybe at high risk for GI: anorexia, diarrhea, nausea, adverse effects ) vomiting, abdominal pain, stomatitis, taste alterations. Derm: alopecia, Rashes, urticaria. Endo: sterility. Hemat: anemia , leucopenia, thrombocytopenia. Neuro: peripheral neuropathy. pruritis.

-monitor blood pressure before and every 15 min during infusion. -monitor for hypersensitivity reaction (fever, chills , dyspnea, pruritus, urticaria) -Assess for signs of infections(fever , chills) -Adjust diet as tolerated to help maintain fluid and electrolyte balance and nutritional status.

DRUG

INDICATION

SIDE EFFECTS

CONTRAINDICATION

NURSING CONSIDERATION

Generic Name: Topotecan BrandName: Hycamtin Classification: Antineoplastic Dosage: 1.5 mg/m2./day for 5days repeated every 21 days.

Used cautiously in -CNS: headache, fatigue. impaired renal Weakness function Patients with child -Resp: dyspnea. bearing potentials. GI: abdominal pain, diarrhea, nausea, vomiting , anorexia, constipations. Derm: Alopecia

-contraindicated hypersensitivity;pre myelosuppression.

in existing

Assess IV site frequently for extravasation, which causes mild local erythema and bruising. Nausea and vomiting are common. Pre treatment with antiemetics should be considered. Monitor vital frequently administration. signs during

-use cautiously in impaired renal function.

Hemat: anemia, leucopenia, thrombocytopenia. -

Monitor CBC with differential and platelet count prior to administration and frequently during therapy .

DRUGS

INDICATIONS

SIDE EFFECTS

CONTRAINDICATION

NURSING CONSIDERATIONS

Generic Name: Methotrexate

Classification -Antineoplastic Dosage:

alone or with other treatment modalities in the treatment of lung carcinoma, ovarian cancer, breast cancer, leukemia.

CNS: dizziness, headaches, malaise.

drowsiness, -use cautiously in renal impairment; Active infections; decrease bone EENT: blurred vision, dysarthria marrow reserve. transient blindness: - Geri: Geriatricnpatients or Resp: Pulmonary fibrosis patients with other chronic debilitating illnesses. GI: anorexia, hepatotoxicity, nausea, stomatitis, vomiting. GU: infertility. Derm: alopecia, painful plaque erosions, photosensitivity , pruritus, rashes, skin ulcer.

-Monitor vital signs periodically during administration. |report significant changes. Monitor intake and output ratios and daily weights. Report significant changes in totals.

Monitor serum methothrexate levels every 12-24 hour during high dose.

DRUG NAME TRAMADOL Classification: Analgesic Route: slow IV push Dosage: 50 mg- 4 doses

INDICATION Moderate severe pain

ACTION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES 1. Assess type, pain location, intensity of pain and 2-3 (peak) after administration. 2. Assess BP and respiratory rate before and periodically during administration. 3. Prolonged use may lead to, physical and psychological dependence and tolerance. If tolerance develops, changing to an opiod may be required to relieve pain.

to Binds to mu-opioid Hypersensitivity; cross CNS: dizziness, headache receptors. Inhibits sensitivity with opioids reuptake of may exist. serotonin and GI: constipation, nausea norepinephrine in the CNS. Therapeutic effects: decrease pain