ONCOLOGY 4

CARDIO PULMONARY SYSTEM

1. Anthracyclines – causing cardio pulmonary disease

 Irreversible cardiac toxicities
 Toxic dosages: 600mg/m 2 and 550mg/m2
 Thoracic radiation therapy
 Reduced to 450mg/m2 ( cumulative dose limit)
2. Cardioprotectant
 Dexrazoxane (Zinecard): cumulative dose of 300mg/m2
3. Pulmonary Fibrosis: cumulative toxic effects
 Bleomycin ( Blenoxane)
 Carmustine ( BCNU)
 Busulfan ( Busulfex, MyleRan)

Note: cardiotoxicity  exercise is the nonpharmacologic tx

Exercise increases heart contraction

Strengthens cardiac contraction

Dyspnea

Tachycardia DOXORUBICIN

Peripheral Edema

4. Total cumulative dosage should not exceed to:

 400 units – for bleomycin
 1400 mg – for carmustine
5. Capillary leak Syndrome
 Third spacing
 Toxic effect of Cytarabine, Mitomycin C, Cyclophosphamide, and BCNU
6. Maximizing clients pulmonary potential
 Elevated HOB
 Exhale through pursed lips – effect: Prolonged expiration
 Plan rest and exercise periods

REPRODUCTIVE SYSTEM

 Possible sterility to both sexes

 MEN
o Azoospermia (temporary or permanent)
o Sperm banking or banking sperm
 WOMEN
o Normal ovulation, early menopause or permanent sterility may occur.

NEUROLOGIC SYSTEM

o Affects CNS, PNS, Cranial Nerves

o Metabolic Encephalopathy
 Ifosfamide, Methotrexatet( high dose, Cytarabine)
o Peripheral damage
 Taxanes,
 Plant Alkaloids
 Vincristine
o Sensory alteration
 Feet and hands
 Tangling
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 Pricking
 Numbness
 Burning or freezing pain
 Sharp
 Stabbing
 Electric shock -like pain
 Hypersensitivity to touch
 If unreported or undetected: progressive motor axon damage:
 Loss of deep tendon reflex or DTR
 Muscles weakness
 Loss of balance and coordination
 Paralytic ileus – stool softeners
 Usually irrreversible
 May take many months to resolve
o Oxaliplatin [ precipitated by exposure to colds]
 Pharyngolaryngeal Dysesthesia
 Lip paresthesia
 Discomfort or tightness in the back of throat
 Inability to breathe
 Jaw pain
o Oxaliplatin [ prevent exacerbation]
 Avoid drinking cold fluids
 Avoid exposing hands and feet to cold temperatures
o Cisplatin
 Peripheral neuropathies
 Hearing loss ( acoustic nerve CN8)

o Others: Cerebellar Syndrome

 Unique long term side effects of 5-fluorouracil ( 5-FU)
 Signs and symptoms:
 Headache
 Disorientation
 Nystagmus
 Common side effects
 FATIGUE!

FATIGUE

o Can last for months after tx

o Interventions
 Rest periods especially before and after physical exertion
 Promote normal sleep habits
 Rearrange daily schedule and organize activities
 Reduce job workload
 Diet: Protein and Calorie intake
 Because it provides heat
 Encourage relaxation technique ( example: mental imagery)
 Blood products PRN
 Assess fluids and electrolytes
 Provide strategy to facilitate
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CARE OF THE CLIENTS HAVING COMMON SIDE EFFECTS ASSOCIATE WITH CHEMOTHERAPY ACCORDING TO
PRIORITIES:

o Cardiotoxicity or pulmonary toxicity

 Congestive heart failure
o Hepatotoxicity
 Bleeding increases
o Myelosuppression
 Risk of infection
o Neurotoxicity
 Unstable gait and peripheral neuropathy

Daeron Cuff – prevents entry of microorganism

Subclavian vein

Entrance site RIGHT ARTERIAL CATHETER

Superior vena cava

Exit site

Central Venous Catheter – 48H ang pag-charge sa dressing

-72-96H change infusion or solution sets

Home Care Checklist: chemotherapy administration

 Medication are highly toxic

 Combination Therapy
 More than 2 meds
 Prevent drug resistance
 Adjuvant therapy
 Nev Adjuvant (bali sa adjuvant)
 Bone
 Myelosuppression effects
 Vascular access methods of administration
 Peripherally inserted central catheters ideal
naa diha ang dagko long term nga mga ateries
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