Follow these guidelines to help your patient overcome adverse reactions.
* Monitor complete blood cell count before each treatment.
* Administer packed red blood cells (RBCs) as ordered.
* Administer growth factors as prescribed: granulocyte colony-stimulating factor, to decrease duration of nadir and epoetin alfa (Procrit) or darbepoetin alfa (Aranesp) to increase RBC production.
* Assess the patient for signs and symptoms of infection. Educate him about decreased absolute neutrophil count and infection risk.
* Monitor temperature daily. Call the oncologist/hematologist if the patient's oral temperature exceeds 100.5°F (38°C).
* Obtain baseline pulmonary function tests.
* Assess the patient's pulmonary status before each infusion.
* Teach him to report cough, dyspnea, or shortness of breath.
* Hold bleomycin if he reports any symptoms of altered pulmonary status.
* Make sure that the patient undergoes a MUGA (multiple-gated acquisition) scan or an echocardiogram to determine adequate left ventricular ejection fraction before his first chemotherapy dose.
* Teach him to report shortness of breath or palpitations.
* Monitor his total doxorubicin dose.
* Perform ongoing assessments for signs and symptoms of heart failure, including dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and fatigue.
* Administer antiemetics before administering chemotherapy.
* Assess the patient's level of nausea and vomiting with each treatment and modify his antiemetic regimen as indicated.
* Teach him how to use his prescribed antiemetic to prevent or treat delayed nausea and vomiting.
* Assess your patient's veins before and during each chemotherapy infusion.
* Teach him about the benefits of a central venous access device if peripheral access is poor.
* Assess blood return frequently during administration of vesicants such as doxorubicin, vinblastine, and dacarbazine.
* Treat extravasation promptly, according to facility policy.
* Assess your patient's baseline vital signs. Bleomycin in particular can cause fever.
* Administer premedications such as acetaminophen and steroids before therapy and have emergency equipment readily available in case of anaphylactic or anaphylactoid reaction.
* Teach him to promptly report any unusual symptoms such as dizziness, itching, or pain.
* Monitor his vital signs throughout the infusion. Increase the infusion rate every 30 minutes only if his vital signs remain stable and he doesn't develop signs of an adverse reaction.
* Stop the infusion if he develops a reaction.
* Assess him for sensory and perceptual changes before each treatment.
* Notify the oncologist of any changes (peripheral, gastrointestinal) that develop after he receives vinca alkaloids.
* Administer dacarbazine in 100 to 250 ml of I.V. fluid and infuse slowly over 1 hour.
* Apply heat or ice above the injection site.
* Premedicate with acetaminophen.
* Encourage the patient to drink plenty of fluids.
* Monitor his serum glucose level.
* Increase monitoring frequency if he has diabetes. The prescriber may need to modify his antihyperglycemic therapy.
Skilled care, teaching, emotional support
Anyone with lymphoma or leukemia requires skilled nursing care to cope with the diagnosis and to minimize adverse reactions to treatment. Remind your patient that most adverse effects of therapy can be managed and that many people continue working during treatment. To help him manage immediate and long-term problems, teach him about the following effects of his illness and therapy.
* Emotional issues. Encourage him to discuss his feelings; provide reassurance and support when he does. Teach him relaxation techniques and encourage him to seek help through a support group or counselor. If he's taking prednisone, advise him to take it with breakfast or lunch to prevent insomnia and to notify the oncologist/hematologist if he has mood changes, which can occur with prednisone therapy.
* Infection. Teach him about infection risk. Review the signs and symptoms and tell him to contact the oncologist/hematologist if he develops signs of infection.
* Hair loss and skin changes. Tell the patient about the potential for hair loss and explain that his hair will probably grow back after he finishes therapy. Encourage him to purchase a wig or hat before his first chemotherapy infusion. Tell him that his skin may dry and become more sensitive to sunlight so he may need to apply sunblock and wear protective clothing in the sunshine. He may also notice changes in his nails.
* Fatigue. Encourage your patient to pace his activities, rest frequently, and get help with activities of daily living.
* Reproductive issues. Discuss the potential for chemotherapy-induced sterility. For a male, review the need to prevent pregnancy in his partner because chromosome damage to sperm can negatively affect the fetus. Discuss sperm banking and provide resource information if he chooses this option. Teach a female patient that treatment can cause menstrual changes and menopause-like symptoms and make her susceptible to vaginal infections.
* Stomatitis. Encourage your patient to see a dentist before starting chemotherapy. Teach him to rinse his mouth with a solution of salt and baking soda in water to prevent infection and advise him to avoid drinking alcohol. Tell him to call the oncologist/hematologist if he develops mouth sores.
* Bladder and bowel changes. Advise your patient to drink plenty of fluids and to void frequently to prevent cystitis. Teach him to check his urine for blood and to call his health care provider if he develops frequency or discomfort with urination. Teach him to include fiber in his diet and encourage him to use a laxative if he can't move his bowels every 2 days. Tell him to call his health care provider if he develops diarrhea. Monitor his response to antidiarrheal medication and assess him for dehydration.
* Gastric irritation. If your patient takes prednisone, tell him to take it with food or milk. If he reports midepigastric distress, ask the oncologist/hematologist to prescribe medication to prevent gastrointestinal irritation.
2 comments:
Thank You Bonnie, We Appreciate All You Have Done and All That You Do To Make The Road Smoother For Us. Because only the Lord knows (and our classmates) how Nursing School tests all that you are.
You are welcome. You are right about the testing. If we help each other out we will be stronger for it. Remember everything that seems hard or frustrating for you and help those who come after you.
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