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STOMATITIS -It is a form of mucositis which is an inflammatory response of the oral tissues that is characterized by mild redness and edema or if severe by painful ulcerations, bleeding and secondary infections. INTER ENTI!N"# -$ssess the oropharyngeal cavity of patients prior to, throughout the course and after treatment. -Encourage and assist on oral hygiene -$dvice patients to avoid irritants such as commercial mouthwashes, alcohol beverages and tobacco. -%se soft bristle toothbrush. -%se normal saline mouth rinses every & hours while awa'e and every ( hours at night. -%se water soluble lip lubricant. -)rovide li*uid or pureed diet. - +edications# )alifermin 2. Bone Marrow Suppression -It results in decreased numbers of circulating platelets, leu'ocytes and erythrocytes. -,ecreased number of leu'ocytes cause immunosuppression. ,ecreased erythrocytes and platelets cause hypo-ia, fatigue and increased tendency to bleed. Interventions# -)lace client in a private room whenever possible. -+edical handwashing before and after contact with patients. -Inspect the client.s mouth for every / hours. -Inspect open areas such as I sites, every 0 hours for manifestation of infection. -1hange dressings daily. -2imit number of visitors. 3. ALOPECIA -The thinning or complete loss of hair. It usually begins &-3 wee's after the initiation of treatments. Regrowth usually begin within / wee's after the last treatment. INTER ENTI!N" -,iscuss potential hair loss and regrowth with patient and family. -To prevent or minimize hair loss through the following#

-1ut long hair before treatment -%se mild shampoo and conditioner -$void e-cessive combing -%se sunscreen or wear hat when in the sun. -)urchase wig or hairpiece before hair loss -E-plain that hair growth usually begins again once therapy is completed. 4. NAUSEA AND VOMITTIN -The vomiting center in the medulla can be stimulated by any of the five different afferent pathways or by arousal of the chemotherapy trigger zone located in the 0th ventricle in the brain. -The emetic potential of a particular chemotherapeutic regimen depends on the drug, dose, route of administration and the client.s susceptibility to emesis. T4REE T5)E" !6 N$%"E$ $N, !+ITTIN7 8. $NTI1I)$T!R5 N$%"E$- may occur before the administration of therapy. &. $1%TE )!"T-T4ER$)5- occur within minutes of the first &0 hours following therapy. 3. ,E2$5E, 9develop after &0 hours of vomiting. !. ANO"E#IA -1auses of anore-ia with patients with cancer are alterations in taste, manifested by increased salty, sour and metallic taste sensations. Taste alterations may result from mineral deficiencies, increase in circulating amino acids and cellular metabolites. $. MALABSO"PTION -1ancer patients are unable to absorb nutrients from the 7astrointestinal tract as a result of tumor activity and cancer treatment. They may impair enzyme production or produce fistulas. "ome tumors secretes hormones and enzymes such as gastrin that leads to increased gastrointestinal irritation, peptic ulcer disease and decreased fat digestion. %. CAC&E#IA -It is related to inadea*uate nutritional inta'e, along with increasing metabolic demand, increased energy e-penditure due to anaerobic metabolism of tumor, impaired glucose metabolism, competition of tumor cells for nutrients, altered lipid metabolism and suppressed appetite.

-It is characterized by loss of weight, adipose tissue, visceral protein and s'eletal muscle. INTER ENTI!N"# -)osition patient properly at mealtime. -Teach )atient to avoid unpleasant sight, odors, sound of the environment. -Encourage ade*uate fluid inta'e -4ave small fre*uent meals. -)romote rela-ed, *uiet environment during mealtime. -Encourage fre*uent oral hygiene. -+edications# +etoclopramide- increase gastric emptying in patients with early satiety and delayed gastric emptying. '. DIA""&EA AND CONSTIPATION -,iarrhea occurs as an increase in stool li*uid or fre*uency. It can result from 7I mucosal damage secondary to chemotherapy. -1onstipation is described as hard, dry stool with straining or decrease in number of defacations. 1auses# -decrease in either fluid or fiber inta'e -change in usual bowel routine -mechanical changes such as tumor pressure on the bowel. -metabolic changes such as hypo'alemia and hypercalcemia. Interventions# -2ow residue or li*uid diet for diarrhea -+onitor Inta'e and !utput -Increase fluid and bul' inta'e -%sing stool softeners -Increase physical activity -%se of 2a-atives when necessary.

R!%TE" 6!R 14E+!T4ER$)5 $,+INI"TR$TI!N Intrathecal 1hemotherapy !ral 1apsule, tablet, or li*uid 1hemotherapy drugs given IT

I :intravenous; )ush :bolus; or infusion over a specific time period

Intra-arterial Intracavitary "uch as peritoneal cavity

Intravesical Into uterus or bladder