CHEMOTHERAPY

TUTOR || September 19, 2022 MED-SURG

Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name

Outline CHEMOTHERAPY HAS THE FOLLOWING

CHARACTERISTICS
Legend:
Remember Previous
 It affects both normal and cancer cells.
(Exams)
Lecturer Book
Trans  The rapidly dividing cells, both the normal and
    cancer cells are vulnerable to destruction by
chemotherapy by disrupting cell function and
Heading 1 division.
1. Heading 2  Mucous membrane, blood cells, hair follicles,
• The quick brown fox jumps over the lazy dog skin cells are rapidly dividing cells.
 The quick brown fox jumps over the lazy dog
 Side effects of chemotherapy tend to occur in
▪ The quick brown fox jumps over the lazy dog
these structures.
• The quick brown fox jumps over the lazy dog
 Has fraction cell – kill. Only a certain no. of
Subheading
cancer cells is killed with each course of
CHEMOTHERAPY chemotherapy. Therefore, chemotherapy
 The use of chemicals as a systemic therapy must be given in a series.
for cancer.  May be cell – cycle specific (CCS) or cell –
 Antineoplastic agents are used in an attempt cycle non-specific (CCNS).
to destroy tumor cells by interfering with ➢ CCS chemotherapy may destroy cancer
cellular functions, including replication. cells at specific stage of cell division.
- CCNS chemotherapy may destroy cancer
GOALS: cells at any stage of cell dIvision.
 CURE
 CONTROL  Thus, combination chemotherapy (CCS &
 PALLIATION OF MANIFESTATIONS CCNS) destroys more malignant cells and
produces fewer side effects because each
GOALS OF CANCER TREATMENT drug strikes the cancer cells at different
1. CURE - treatment is offered that is expected stages in the cell cycle.
to have the greatest chance of disease
eradication Chemotherapy Drugs
2. CONTROL – is the goal of the treatment plan  Interfere with cancer cell’s ability to divide and
for many cancers that cannot be completely reproduce.
eradicated but are responsive to anticancer  A single drug or a combination of drugs is
therapies used
3. PALLIATION – relief /control of symptoms & Discussions:
the maintenance of a satisfactory quality of  These can be delivered either directly into the
life rather than cure/control of the disease bloodstream, to attack cancer cells
process throughout the body, or they can be targeted
to specific cancer sites
 CHEMOTHERAPY is a systemic intervention.
It is recommended when: Chemotherapy drugs can:
- disease is widespread
- risk of undetectable disease is high
- Tumor cannot be resected and is resistant
to RT

 The OBJECTIVE of CHEMOTHERAPY

- To destroy all malignant tumor cells
without excessive destruction of normal
cells
Page 1 of 5
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
CLASSIFICATION OF CHEMOTHERAPEUTIC
AGENTS
a. ALKYLATING AGENTS
 Are the oldest and the most commonly used
class of chemotherapy drugs, and work by
directly damaging DNA and preventing cancer
cells from reproducing
 They are cell-cycle phase non-specific,
meaning they kill cancer cells in any phase of
the cell cycle
 Ex: carboplatin, cisplatin, oxaliplatin
b. ANTIMETABOLITES
 Chemotherapy drugs that interfere with DNA
and RNA growth.
 They are cell-cycle specific, meaning they kill
cancer cells in a specific phase of cell
division.
 Ex: capecitabine, gemcitabine, pemetrexed
c. ANTHRACYCLINES
 Are anti-tumor antibiotics that interfere with
enzymes necessary for DNA replication.
 They are cell-cycle non-specific
 Ex: bleomycin, doxorubicin, mitomycin-C
d. PLANT ALKALOIDS
 Are derived from certain types of plants found
in nature, and inhibit or prevent mitosis.
 Cell-cycle specific
 Ex: taxanes, docetaxel, paclitaxel
ROUTES OF ADMINISTRATION OF
CHEMOTHERAPY
1. Oral Chemotherapy Medications (Taken by
Mouth)
 come in a variety of oral forms (pills, tablets,
capsules, liquid)
 Oral chemo medications that are
swallowed are encased in a protective
coating that is broken down by the digestive
juices in the stomach.
 Sub-lingual chemo medications. These
medications are placed under the tongue
where they dissolve and quickly absorb into
the circulation of the body.
Page 2 of 5
2. Subcutaneous Injection of Chemotherapy
Treatments
 are commonly used for some types of biologic
response modifiers and chemotherapy
support drugs.
 If a patient's platelet count is low
subcutaneous injections are less likely to
cause bleeding than intra- muscular
injections.
3. Intra-Muscular Chemotherapy Injections
 Intra-muscular injection is a popular method
for anti- nausea medications because it
bypasses an already irritated stomach.
 Most chemotherapy cannot be given intra-
muscularly because of the harshness of the
chemical.
Discussions:
Absorption of the medication is more rapid then
the oral form but slower then sub lingual,
subcutaneous injection and intravenous
administration
is avoided when possible in patients with low
platelets, as bleeding within the muscle can be a
complication.
4. Intravenous Chemotherapy Treatments
 This is the most common method of
chemotherapy administration, since most
chemo drugs are easily absorbed through the
blood stream.
 IV push chemo is given from a syringe into
your IV. It may take 10 to 15 minutes to get all
of the chemo.
 An infusion of chemo may last from 30
minutes to a few hours.
 A continuous infusion of chemo may last
from 1 to 7 days. This type of infusion is
controlled by an electronic IV pump.
Intravenous medications are given directly
into the blood stream through a variety of
methods.
a. An angiocatheter may be placed in a vein in
the arm or hand and then removed after the
chemo medication is given.
Discussions:
 This is a temporary venous-access device
inserted by a nurse prior to treatment then
removed after treatment has been completed
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
b. PICC line. Can be inserted and used for six
weeks to a few months before it is
discontinued.
c. Non-tunneled catheters. Non-tunneled
catheters are inserted directly through the
skin into the jugular or subclavian vein and
travel through the vessel to the superior vena
cava vessel at entrance of the right atrium of
the heart.
d. Tunneled Catheters, are placed through the
skin in the middle of the chest. They are
tunneled through the subcutaneous tissue
and inserted into the superior vena cava
vessel at entrance of the right atrium of the
heart.
e. Port-a-cath, the port-a-cath is placed under
the skin on the chest.
4. Intraventricular/Intrathecal Chemotherapy
Treatments
 is used when drugs need to reach the
cerebrospinal fluid (CSF), the fluid that is in
the brain and spinal cord.
There are two ways chemotherapy can be given
to the CSF:
1. Lumbar puncture
(Intrathecal). Chemotherapy can be given
through a lumbar puncture (spinal tap).
2. Ommaya reservoir (Intraventricular).
It is placed into the subcutaneous tissue (the
layer of tissue between the skin and the muscle)
on the scalp.
This procedure is used most commonly in acute
leukemias but can be used in other situations as
well.
5. Intraperitoneal Chemotherapy Treatments
 can be given directly into the abdominal
cavity.
 is done for cancer in the intra-abdominal
area, e.g., ovarian cancer.
 The patient is encouraged to change
positions from side to side and lying on the
back to facilitate the movement of the
medication.
Page 3 of 5
6. Intra-Arterial Chemotherapy Treatments
 Intra-arterial infusions enable major organs or
tumor sites to receive maximal exposure with
limited serum levels of medications.
7. Intravesicular Chemotherapy Treatments
 Intravesicular medications are given with the
use of a urinary catheter directly into the
bladder.
8. Intrapleural Chemotherapy Treatments
 Chemotherapy can be given into the pleural.
 Intrapleural chemotherapy is used to control
malignant pleural effusions
 The chemotherapy causes the lung to stick to
the pleural lining, allowing the lung to re-
expand and stay expanded.
Discussions:
 pleural cavity (the space between the lung
and the lining of the lung).
9. Topical Chemotherapy Treatments
 Some chemotherapy creams are applied
directly to the skin in certain cases of skin
cancer.
 The cream is then absorbed through the skin
directly into the cancerous lesion. The use of
topical preparations is very limited in cancer
treatments
CONTRAINDICATIONS TO CHEMOTHERAPY
a. INFECTION
b. RECENT SURGERY\
c. IMPAIRED RENAL/HEPATIC FUNCTION
d. RECENT RADIATION THERAPY
e. PREGNANCY
f. BONE MARROW DEPRESSION
Discussions:
➢ 1 anti-tumor drugs are immunosuppressive
➢ 2 the drugs may retard healing process
➢ 3 the drugs are nephrotoxic and hepatotoxic
➢ 4 also immunosuppressive
➢ 5 the drugs may cause congenital defects
➢ 6 the drugs may aggravate the condition.
WBC levels must be within normal limits
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
SAFE HANDLING OF CHEMOTHERAPEUTIC
AGENTS
1) Wear mask, eye shield, gloves and back –
closing gown.
2) Skin contact with drug must be washed
immediately with soap and water. Eyes must
be flushed immediately with copious amount
of water.
3) Sterile / alcohol – wet cotton pledgets should
be used, wrapped around the neck of the
ampule or vial when breaking and
withdrawing the drug.
4) Expel air bubbles on wet cotton.
5) Vent vials to reduce internal pressure after
mixing.
6) Wipe external surface of syringes and IV
bottles.
7) Avoid self - inoculation by needle stab.
8) Clearly label the hanging IV bottle with
“ANTINEOPLASTIC CHEMOTHERAPY”
9) Contaminated needles and syringes must be
disposed in a clearly marked special
container, “leak – proof”, puncture – proof”
Discussions:
 Vent – opening, outlet, aperture, escape,
exhaust
 Inoculation – immunization, vaccination, jab,
shot, injection, booster
10) Dispose half – empty ampules, vials, IV
bottles by putting into plastic bag, seal and
then into another plastic bag or box, clearly
marked before placing for removal. Label as
“HAZARDOUS WASTE.”
11) Hand washing should be done before and
after removal of gloves.
12) Only trained personnel should be involved in
use of drugs (preferably, chemotherapy
certified nurses).
13) Ideally, preparation of chemotherapeutic
drugs should be in laminar flow conditions
with filtered air to prevent contamination with
microorganisms
NURSING INTERVENTIONS FOR
CHEMOTHERAPY SIDE -EFFECTS
1. G.I. SYSTEM – nausea and vomiting,
diarrhea, constipation
✓ Administer antiemetic to relieve nausea and
vomiting
✓ Replace fluid – electrolyte losses, low – fiber
diet to relieve diarrhea
Page 4 of 5
✓ Increase fluid intake and fibers in diet to
prevent / relieve constipation
2. INTEGUMENTARY SYSTEM
✓ PRURITUS, URTICARIA & SYSTEMIC
SIGNS
- Provide good skin care
✓ STOMATITIS (ORAL MUCOSITIS)
- Provide good oral hygiene
- Avoid hot and spicy food
✓ ALOPECIA
- Reassure that it is temporary
- Encourage to wear wigs, hats or head
scarf
✓ SKIN PIGMENTATION
- Inform that it is temporary
✓ NAIL CHANGES
- Reassure that nails may grow normally
after chemotherapy
3. HEMATOPOIETIC SYSTEM
✓ Anemia
- Provide frequent rest periods
✓ Neutropenia
- Protect from infection
- Avoid people with infection
- Report fever, chills, diaphoresis, heat,
pain, erythema, or exudates on anybody
surface
Discussions:
 Neutropenia – is an abnormally low level of
neutrophils. Neutrophils are a common type
of white blood cell important to fighting off
infections — particularly those caused by
bacteria.
✓ Thrombocytopenia
- Protect from trauma
- Avoid ASA
- Nadir - It is the time after chemotherapy
administration when WBC or platelet count
is at the lowest point. It occurs within 7 to
14 days after drug administration.
Discussions:
 Thrombocytopenia – persistent decrease in
the number of platelets in the blood
4. GENITO – URINARY SYSTEM
✓ Hemorrhagic cystitis
- Provide 2-3 liters of fluids per day
✓ Urine color changes
- Reassure that it is harmless
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

5. Reproductive system NURSING INTERVENTIONS FOR

✓ Premature menopause or amenorrhea EXTRAVASATION include the following:
- Reassure that menstruation resumes after
chemotherapy

ADVERSE REACTIONS TO CHEMOTHERAPY

ARE AS FOLLOWS:
1. Hypersensitivity reaction
a. Dyspnea
b. Chest tightness or pain
c. Pruritus (itching)
d. Urticaria (wheals)
e. Tachycardia
f. Anxiety
g. Agitation
h. Inability to speak
i. abdominal pain
j. nausea
k. hypotension
l. cloudy mental status
m. flushed appearance
n. cyanosis

• If anaphylactic reaction occurs, the following

nursing interventions are implemented:
a. Stop the drug administration
b. Maintain IV access with 0.9% NS (NaCl)
c. Keep an open airway.
d. Keep client in modified Trendelenburg
position (supine with legs elevated at 20-
30’), unless contraindicated.

2. Extravasation
✓ Vessicant
chemotherapeutic
agents can cause or
form a blister and cause
tissue destruction. Eg., Adriamycin
(Doxurubicin), Oncovin (Vincristine).
✓ Irritant drugs can produce venous pain at the
site and along the vein
✓ Pain, erythema, swelling and lack of blood
return indicate an extravasation.

Page 5 of 5