3. WHAT IS CHEMOTHERAPY?
Chemotherapy is the use of drugs to
destroy cancer cells. It usually works
by keeping the cancer cells from
growing, dividing, and making more
cells.
11. OBJECTIVES OF CHEMOTHERAPY
To maximize the death of malignant tumour cells.
To cure the client with cancer.
Control the tumour growth when cure is not possible.
To extent the life span and improve the quality of life
of client with cancer.
17. CLASSIFICATION OF CHEMOTHERAPEUTIC
DRUGS
1) PHASE SPECIFIC DRUGS: Agents that are most active against cells
in a specific phase of the cell cycle.
2) CELL CYCLE SPECIFIC DRUGS: Agents that are effective while cells
are actively in cycle but that are not dependent on the cell being in a
particular phase.
3) CELL CYCLE NONSPECIFIC DRUGS: A third group of drugs that
appear to be effective whether cancer cells are in cycle or are resting.
18.
19.
20.
21. SAFEHANDLING
CHEMOTHERAPEUTIC AGENTS
Chemotherapeutic Drugs are hazardous drugs.
A hazardous drug is defined as an agent that presents a danger to
healthcare personnel due to its inherent toxicity.
They are carcinogenic
They are mutagenic
They are teratogenic
22. PREPARING CHEMOTHERAPEUTIC DRUGS
GATHERING THE EQUIPMENT
Before preparing chemotherapeutic drugs, be sure to gather all the
necessary equipment, including:
– Patient’s medication order or record , Prescribed drugs , Appropriate
diluent (if necessary), Medication labels , Long-sleeved gown ,
Chemotherapy gloves, Face shield or goggles and face mask , 20G
needles, Hydrophobic filter or dispensing pin
23. -Syringes with luer-lock fittings and needles of various sizes
-IV tubing with luer-lock fittings
-70% alcohol
-Sterile gauze pads
-Plastic bags with “hazardous drug” labels
-Sharps disposal container
-Hazardous waste container
-Chemotherapy spill kit
24. PREPARING CHEMOTHERAPEUTIC DRUGS CONT..
ORGANIZING DRUG PREPARATION AREAS
Prepare chemotherapeutic drugs in well-ventilated workspace
Perform all drug admixing or compounding within a Class II Biological Safety Cabinet or a
“vertical” laminar airflow hood with a HEPA filter, which is vented to the outside
If a Class II Biological Safety Cabinet isn’t available, it is recommended to use a special respirator
Have close access to a sink, alcohol pads, and gauze pads as well as Chemotherapy hazardous
waste containers, sharps containers, and chemotherapy spill kits
Make sure that all hazardous waste containers are made of punctureproof, shatterproof, leakproof
plastic
Make sure that yellow biohazard labels are available for labeling all chemotherapy-contaminated
IV bags, tubings, filters, and syringes
Make sure that red sharps containers are available for disposal of all contaminated sharps such as
needles.
27. PREPARING CHEMOTHERAPEUTIC DRUGS CONT..
WEAR PROTECTIVE CLOTHING
Essential protective clothing includes a cuffed gown, gloves, and a face shield or goggles and
a face mask.
Gowns should be disposable, water-resistant, and lint-free with long sleeves, knitted cuffs,
and a closed front.
Gloves should be disposable, powder-free, and made of thick latex or thick nonlatex material.
Double gloving is an option when the gloves aren’t of the best quality.
29. SAFETY MEASURES GENERAL MEASURES
At the local level, most health care facilities require nurses and pharmacists involved in the
preparation and delivery of chemotherapeutic drugs and care of the patient with cancer.
Take care to protect staff, patients and the environment from unnecessary exposure to
chemotherapeutic drugs.
Make sure your facility’s protocols for spills are available in all areas where chemotherapeutic
drugs are handled, including patient-care areas.
Refrain from eating, drinking, smoking or applying cosmetics in the drug-preparation area
30. ACCIDENTAL EXPOSURE
If a chemotherapeutic drug comes in contact with your skin, wash the area thoroughly with
soap and water to prevent drug absorption into the skin
If the drug comes in contact with your eye, immediately flush the eye with water or isotonic
eyewash for at least 5 minutes, while holding the eyelid open
After an accidental exposure, notify your supervisor immediately
31. WASTE DISPOSAL
Place all contaminated needles in the sharps container; don’t recap needles
Use only syringes and IV sets that have a luer-lock fitting
Label all chemotherapeutic drugs with a yellow biohazard label
Transport the prepared chemotherapeutic drugs in a sealable plastic bag that’s prominently
labeled with a yellow chemotherapy biohazard label
Don’t leave the drug-preparation area while wearing the protective gear you wore during
drug preparation
32. CHEMOTHERAPY SPILL
Put on protective garments, if you aren’t already wearing them
Isolate the area and contain the spill with absorbent materials from a chemotherapy spill kit
Use the disposable dustpan and scraper to collect broken glass or desiccant absorbing
powder
Carefully place the dustpan, scraper and collected spill in a leakproof, punctureproof,
chemotherapy-designated hazardous waste container
Prevent aerosolization of the drug at all times
Clean the spill area with a detergent or bleach solution
33. ADMINISTERING CHEMOTHERAPEUTIC DRUGS
Gathering the equipment
– Prescribed drugs
– IV access supplies
– Sterile PNSS
– IV syringes and tubings with luer lock
–Leakproof chemical waste container
–Chemotherapy gloves
–Chemotherapy spill kit
– Extravasation kit
34. ADMINISTERING CHEMOTHERAPEUTIC DRUGS
Preventing Infiltration
Use a low-pressure infusion pump to administer vesicants through a peripheral vein, to
decrease the risk of extravasation
Use a central venous catheter for continuous vesicant infusions
Guidelines in giving vesicants
Use a distal vein that allows successive proximal venipunctures
Avoid using the hand, antecubital space, damaged areas, or areas with compromised
circulation
Don’t probe or “fish” for veins
Place a transparent dressing over the site
35. ADMINISTERING CHEMOTHERAPEUTIC DRUGS
Cont…
Start the push delivery or the infusion with normal saline solution
Inspect the site for swelling and erythema
Tell the patient to report burning, stinging, pain, pruritus, or temperature changes near the
site
After drug administration, flush the line with 20mL of NS
Dispose of all used needles and contaminated sharps in the orange sharps container
Dispose of PPE’s in yellow chemotherapeutic waste container
Dispose of unused medications, considered hazardous waste, according to your facility’s
policy
36. ADMINISTERING CHEMOTHERAPEUTIC DRUGS
Cont…
Start the Wash hands thoroughly
Document the sequence in which the drugs were administered
site accessed, the gauge and length of the catheter, and the number of attempts
name, dose, and route of the administered drugs
Type and volume of the IV solutions and adverse reactions and nursing interventions
According to facility policy, wear protective clothing when handling body fluids from the
patient for 48 hours after giving chemotherapy.
37. MANAGING COMPLICATIONS OF CHEMOTHERAPY
1. ALOPECIA
Hair loss that occurs as chemotherapeutic drugs destroy the rapidly growing cells of hair
follicles
May be minimal or severe
Occurs 2-3 weeks after treatment begins
Almost always temporary Signs and Symptoms
Hair loss that may include eyebrows, lashes and body hair
38. Nursing Interventions
Minimize shock and distress by warning the patient of this possibility
Discuss with the patient why it occurs
Describe to the patient how much hair loss to expect
Emphasize to the patient the need for appropriate head protection against sunburn
Inform the patient that new hair may be a different texture or color
Give the patient sufficient time to decide whether to order a wig
Inform the patient that his scalp will become sore at times due to follicles swelling
Prevention measures
For patients with long hair, suggest cutting hair shorter before treatment because washing
and brushing cause more hair loss
39. 2. ANEMIA
Occurs as chemo drugs destroy healthy cells and cancer cells
RBCs are destroyed and can’t be replaced by the bone marrow Signs and symptoms
Dizziness, fatigue, pallor, and shortness of breath after minimal exertion
Low hemoglobin level and hematocrit
May develop slowly over several courses of treatment
40. Nursing Interventions
Monitor hemoglobin level, hematocrit, RBC count; report dropping values
Be prepared to administer a blood transfusion or erythropoietin Prevention Measures
Instruct the patient to take frequent rests, increase his intake of iron-rich foods, and take a
multivitamin with iron as prescribed
If the patient has been prescribed a drug such as epoetin, make sure he understands how to
take the drug and what adverse effects he should watch for and report
41. MANAGING COMPLICATIONS OF CHEMOTHERAPY
3. DIARRHEA
Occurs because the rapidly dividing cells of the intestinal mucosa are killed
Complications include weight loss, F&E imbalance, and malnutrition Signs and symptoms
An increase in the volume of stool compared with the patient’s normal bowel habits.
Nursing Interventions
Assess frequency, color, and consistency of stool
Encourage fluids, give IV fluids and potassium supplements as ordered Prevention measures
Use dietary adjustments and antidiarrheal meds
Provide good perianal skin care
42. MANAGING COMPLICATIONS OF CHEMOTHERAPY
4. EXTRAVASATION
The inadvertent leakage of a vesicant solution into the surrounding tissue Signs and
Symptoms
Initial signs and symptoms may resemble those of infiltration – blanching, pain, swelling
Symptoms possibly progressing to blisters; to skin, muscle, tissue and fat necrosis; and to
tissue sloughing Blood return is an INCONCLUSIVE test and shouldn’t be used to determine if
IV catheter is correctly seated in the peripheral vein.
To assess peripheral IV placement, flush the vein with NS and observe site for swelling.
43. Extravasation of Doxorubicin
Nursing Interventions
Stop the infusion
Check your facility’s policy to determine if the IV catheter is to be removed or left in place to
infuse corticosteroids or a specific antidote.
Notify the physician
Instill the appropriate antidote according to facility policy. Usually, you’ll give the antidote for
extravasation either by instilling it through the existing IV catheter or by using a 1 mL syringe
to inject small amounts subcutaneously in a circle around the extravasated area
After the antidote has been given, remove the IV catheter
44. 5. INFILTRATION
The inadvertent leakage of a nonvesicant solution or medication into the surrounding tissue
Infusion-site related Signs and symptoms
Blanching
Change in IV flow rate
Numbness and tingling in swollen area due to nerve compression injury leading to
compartment syndrome
Swelling around IV site (the swollen area will be cool to touch)
45. Nursing Interventions
Remove the IV catheter
Insert a new IV catheter in a different location Prevention Measures
Check for infiltration before, during, and after the infusion by flushing the vein with normal
saline solution.
46. 6. LEUKOPENIA
Reduced leukocytes or WBCs
Occurs as WBCs and cancer cells are destroyed by chemo drugs Signs and Symptoms
Susceptibility to Infections
Neutropenia Nursing Interventions
Watch for the nadir, the point of lowest blood cell count
Be prepared to administer colony-stimulating factors
Institute neutropenic precautions
47. NURSING INTERVENTION
Teach the patient and caregiver about:
Good hygiene practices
Signs and symptoms of infection
The importance of checking the patient’s temperature regularly
How to prepare low-microbe diet
How to care for vascular access devices
Instruct the patient to avoid
Crowds
People with colds or respiratory infections
Fresh fruit ,Fresh flowers and plants
48. 7. NAUSEA and VOMITING
Can appear in 3 different patterns Anticipatory Acute Delayed
ANTICIPATORY NAUSEA and VOMITING
Signs and Symptoms
Nausea and vomiting that’s a learned response from prior nausea and vomiting after a dose
of chemotherapy
High anxiety levels (acts as a trigger)
Nursing Interventions
Posttreatment control of nausea and vomiting may prevent future anticipatory episodes
Prevention measures
Pre treat the patient with lorazepam (Ativan) at least 1 hr before arriving for treatment
Patients with overwhelming anxiety may need IV lorazepam before chemo is administered
49. MANAGING COMPLICATIONS OF CHEMOTHERAPY
ACUTE NAUSEA and VOMITING
Signs and symptoms
Nausea and vomiting occurring within the first 24 hours of treatment
Nursing Interventions
Treat the patient with acute nausea and vomiting with antiemetic drugs
Dexamethasone
Granisetron
Lorazepam
Metoclopramide
Ondansetron
50. DELAYED NAUSEA and VOMITING
Signs and Symtoms
Nausea or vomiting starting or continuing beyond 24 hours after chemo has begun
Nursing Interventions
The administration of serotonin antagoninsts, corticosteroids, various antihistamines,
benzodiapines, and and metoclopramide is usually effective in treating patients Prevention
Measures
Administer antiemetic before chemo begins
Some patients with delayed nause and vomiting are treated with an antiemetic for 3 days or
longer
51. 8. STOMATITIS
Inflammation of the lining of the oral mucosa
Can spread into the esophagus and pharynx Signs and Symptoms
Painful mouth ulcers that range from mild to severe appearing 3 to 7 days after certain
chemotherapeutic drugs are given
Nursing Intervention
Instruct the patient to perform meticulous oral hygiene
Administer topical anesthetic mixtures as appropriate
If pain is severe, opioid analgesics may be prescribed until the ulcers heal Prevention
Measures
Instruct the patient to suck on ice chips while receiving certain drugs that cause stomatitis;
this decreases the blood supply to the mouth, thus decreasing ulcer formation
53. Nursing interventions
Monitor patient’s platelet count
Avoid unnecessary IM injections or venipuncture
If an IM injection or venipuncture is necessary, apply pressure for at least 5 minutes; apply a
pressure to the site.
Instruct the patient to Avoid cuts and bruises, Shave with an electric razor, Avoid blowing his
nose, Stay away from irritants that would trigger sneezing, Avoid using rectal thermometers
Instruct the patient to report sudden headaches (which could indicate potentially fatal
intracranial bleeding)
54. 10. VEIN FLARE
Occurs during infusion of an irritant into the vein Signs and Symptoms
Bright redness possibly appearing in the vein along with blotches or hives on the affected
arms
Burning pain or aching along the vein as well as up through the arm
Nursing Interventions
If the reaction is severe, injection of an IV steroid may be required
If the patient complains of pain or burning during the infusion:
› Increase the dilution of the infused medication
› Decrease the infusion rate
› Restart the IV in a different vein
55. BIBLIOGRAPHY
• Paice JA (2007). Chemotherapy-induced peripheral neuropathy: A dangerous but understudied syndrome. Pain
Management SIG Newsletter, 17.
• Piredda M, Rocci L, Gualandi R, et al. (2008). Survey on learning needs and preferred sources of information to meet
these needs in Italian oncology patients receiving chemotherapy. Eur J Oncol Nurs, 12, 120-6.
• Schnell FM (2003). Chemotherapy-induced nausea and vomiting: the importance of acute antiemetic control.
Oncologist, 8, 187-98.
• Shapiro CL, Recht A (2001). Side effects of adjuvant treatment of breast cancer. N Engl J Med, 344, 1997-2008.
• Sun CC1, Bodurka DC, Donato ML, et al. (2002). Patient preferences regarding side effects of chemotherapy for
ovarian cancer: do they change over time? Gynecol Oncol, 87, 118-28.
• Sun CC, Bodurka DC, Weaver CB, et al. (2005). Rankings and symptom assessments of side effects from
chemotherapy: insights from experienced patients with ovarian cancer. Support Care Cancer, 13, 219-27
• Torpy JM, Lynm C, Glass RM (2010). JAMA patient page. Cancer: the basics. JAMA, 303, 1108.
