A. general descritions of antineoplastic medications
1. kill or inhibit the reproduction of neoplastic cells.
2. the effect of antineoplastic medications may not be limited to neoplastic cells, normal cells are also affected by the medication.
3. cell cycle phase specific medications affect cells only during a certain phase of the reproductive cycle.
4. several medications are used in combination to increase the therapeutic response.
5. antineoplastic medications may be combined with other treatments such as surgery and radiation.
6. The routes of antineoplastic medication administration can vary; intravenous route is the most preferred route.
7. side effects result from the effects of teh antineoplastic medication on normal cells.
8. cell cycle nonphase specific affect cells in any phase of the reproductive cycle.
a. monitor complete blood count (CBC), WBC count, platelet count and electrolyte count.
b. initiate bleeding precuations if thrombocytopenia occurs.
c. when the platelet count is less than 50,000 cells/uL, any small trauma can lead to episodes of prolonged bleeding; when loss than 20,000 cells/uL, spontaneous and uncontrollable bleeding can occur.
d. Monitor for petechiae, ecchymosis, bleeding of the gums, and nose bleeds because decreased platelet count can precipitate bleeding tendencies.
e. Avoid intramuscular injections and venipunctures as much as possible to prevent bleeding.
f. Initiate neutropenic precautions if the WBC count decreases.
g. Monitor for fever, sore throat, unsual bleeding, or signs and symptoms of infection.
h. Inform the client that loss of appetite may also be due to a bitter taste in the mouth from medications.
I. Monitor for nausea and vomiting and provide a high calorie diet with protein supplements.
j. Antiemetics are administered several hours before chemotherapy and for 12 to 48 hours afterward, as prescribed , because antineoplastic medications stimulate the vomiting centers.
k. Encourage plenty of hydration; IV fluids will be administered before and during therapy.
l. Promote a fluid intake of atleast 2,000 ml a day to maintain adequate renal function.
m. Administer allopurinol (zyloprim) as prescribed to reduce the serum uric acid that occurs from the rapid destruction of cells by the antineoplastic medication.
2 safe, effective care environment.
a. IV chemotherapy is prepared in an air vented space.
b. antineoplastic medications are administered in short, high dose, intermittent courses as prescribed, to maximize antineoplastic effects while allowing normal cells to recover.
c. gloves, gown, and a mask are worn when handling IV medications.
d. monitor for phlebitis with IV administration, as these medications irritate the veins.
e. monitor for extravasation (leakage of medicine into the surrounding skin and subcutaneou tissue), which causes tissue necrosis, and the physician is notified if this occurs; heat or ice is applied depending upon the medication, and an antidote may be injected into the site.
f. discard Iv equipment in designated containers.
3. psychosocial integrity
a. instruct the client in teh potential for hair loss, and that varying degrees of hair loss may occur after the first or second treatment.
b. discuss the purchase of a wig before treatment starts
c. inform the client that new hair growth will occur several months after the final treatment.
d. instruct the client about the need for contraception, as these medications have teratogenic effects.
e. discuss teh potential effect of infertility which may be irreversible.
4. health promotion and maintenance
a. if diarrhea is a problem, instruct the client to avoid hot foods and high fiber foods, which increase peristalsis.
b. instruct the client to inspect the oral mucosa for erythema and ulcers, to rinse mouth after meals, and to provide good oral hygiene.
c. instruct the client to use saline or sodium bicarbonate mouth rinses for mouth sores.
d. instruct the client in use of antifungal medications for mouth sores, if prescribed for the development of a superinfection.
e. instruct the client to avoid crowds and persosn with infections and to report signs of infection such as fever, chills or sore throat.
f. instruct individuals with colds or infections to wear a mask when visiting or so avoid visiting the client.
g. instruct the client to use a soft tooth brush and an electric razor to minimize the risk of bleeding.
h. instruc the client to avoid alcohol to minimize the risk of toxicity.
j. instruc the client to consult the physician before receiving vaccinations.
C. anaphylactic reactions
a. obtain an allergy history
b. a test dose may be administered when prescribed by the physician.
c. stay with the client during the administration of medication.
d. monitor vital signs
e. have emergency equipment and medications readily available.
f. an IV line is needed for the administration of emergency medications if needed.
2. signs of anaphylactic reaction
b. chest tightness or pain
g. flushed appearance
h. inability to speak
i. nausea and abdominal pain.
k. decreased sensorium
insulin primarily acts in the liver, muscle, and adipose tissue by attaching to receptors on cellular membranes and facilitating the passage of glucose, potassium and magnesium. it is prescribed for clients with type 1 diabetes mellitus.
exposures to extremes in temperatures is avoided; insulin should not be frozen or kept in direct sunlight or a hot car.
before injection, insulin should be at room temperature. if a vial of insulin will be used at room temperature, the vial should be refrigerated.
insulin injection sites:-
the main areas for injections are the abdomen, arms (posterior surface), thighs (anterior surface), and hips.l
insulin injected into the abdomen may absorb more evenly and rapidly than at other sites.
systematic rotation within one anatomical area is recommended to prevent lipodystrophy, client should be instructed not to use the same site more than once in a 2 to 3 week period.
injections should be one and a half inches apart within the anatomical area.
heat, massage and exercise of the injected area can increase absorption rates and may result in hypoglycemia
injection into scar tissue may delay absorption of insulin.
to prevent dosage errors, be certain that there is a match of teh insulin concentration noted on the vial with the calibration of units on the insulin syringe. the usual concentration of insulin is U 100 (100 units per milliliter)
most insulin syringes have a 27 to 29 gauge needle that is approximately 0.5 inches long.
before use, roll, not shake (to avoid bubbles) the insulin bottle to ensure that the insulin and ingredients as mixed well; otherwise an inaccurate dose will be drawn.
premixed insulins (NPH to regular insulin) are available as 70/30 (most commonly used), 80/20, 60/40, and 50/50/
a 3 week supply of insuin may be prepared and kept in the refrigerator, prefilled syringes should be kept flat or with the needle in an upright position to avoid clogging of the needle.
inject air into the insulin bottle (a vaccum makes it difficult to draw up the insulin).
It is recommended to draw up the regular (shorter acting) insuin first. Regular insulin may be mixed with any other type of insulin.
insulin zinc suspensions may be mixed only with each other and Regular insulin, not with any other types of insulin.
administer a mixed dose of insulin within 5 to 15 minutes of preparation; after this time, the regular insulinbinds with the NPH insulin and its action is reduced.
aspiration is not recommended with self injection of insulin.
administer insulin at a 45 to 90 degree angle and at a 45 to 60 degree angle in thin persons.
regular insulin is teh only type of insulin that can be adminstered intravenously.
Glucagon is a hormone secreted by the alpha cells of the islets of langerhans in the pancreas. it increases blood sugar by stimultating glycogenolysis in the liver. (it destroys glycogen). it can be administered intravenously, intramuscularly, and subcutaneously. it is used to treat insulin induced hypoglycemia when the client is semiconscious or unconscious and is unable to ingest liquids. the blood glucose level begins to increase within 5 to 20 minutes after administration.
increases blood glucose by inhibiting insulin release from the beta cells and stimulating the release of epinephrine from the adrenal medulla. it is used to treat chronic hypoglycemia caused by hyperinsulinism resulting from islet cell cancer (a type of pancreatic cancer) or hyperplasia. it is not used for hypoglycemic reactions from insulin.