208
P A R T 2
Chemotherapeutic agents
■■
Antineoplastic antibiotics are toxic to rapidly
dividing cells.
■■
These drugs are cell cycle–specific, affecting the
S phase.
■■
Bone marrow suppression, alopecia and toxic
GI effects are common adverse effects of the
antineoplastic antibiotics.
KEY POINTS
Care considerations for
people receiving antineoplastic antibiotics
Assessment: History and examination
■
■
Assess for contraindications and cautions:
history of allergy to the antibiotic in use
to
avoid hypersensitivity reactions
; bone marrow
suppression
to prevent further suppression
; renal
or hepatic dysfunction
that might interfere with
drug metabolism and excretion
; respiratory or
cardiac disease; current status related to pregnancy
or breastfeeding
to prevent potentially serious
adverse effects to the fetus or breastfeeding
baby
; and GI ulcerative disease,
which could be
exacerbated by these drugs
.
■
■
Perform a physical assessment
to establish baseline
data for determining the effectiveness of the
drug and the occurrence of any adverse effects
associated with drug therapy
.
■
■
Assess orientation and reflexes
to evaluate any
CNS effects
; respiratory rate and adventitious
sounds
to monitor the disease and evaluate for
respiratory or hypersensitivity effects
; pulse,
rhythm, cardiac auscultation and baseline
electrocardiogram
to monitor for systemic or
cardiovascular effects
; and bowel sounds and
mucous membrane status
to monitor for GI effects
.
■
■
Monitor the results of laboratory tests such as FBC
with differential to identify possible bone marrow
suppression and toxic drug effects, as well as renal
and liver function tests,
to determine the need for
possible dose adjustment
.
Implementation with rationale
■
■
Arrange for blood tests to monitor bone marrow
function before, periodically during, and for
at least 3 weeks after therapy
to arrange to
discontinue the drug or reduce the dose as
needed
.
■
■
Monitor cardiac and respiratory function, as well
as clotting times as appropriate for the drug being
used,
to arrange to discontinue the drug or reduce
the dose as needed
.
■
■
Protect the person from exposure to infection
because bone marrow suppression will decrease
immune/inflammatory reactions
.
■
■
Administer medication according to scheduled
protocol and in combination with other drugs
as indicated
to improve the effectiveness of drug
therapy
.
■
■
Ensure that the person is well hydrated
to decrease
the risk of renal toxicity
.
■
■
Provide small, frequent meals, frequent mouth
care and dietary consultation as appropriate
to maintain nutrition when GI effects are severe
.
Anticipate the need for antiemetics as necessary.
(See Box 14.5.)
■
■
Arrange for proper head covering at extremes of
temperature if alopecia occurs; a wig, scarf or hat
is important for maintaining body temperature
.
If alopecia is an anticipated effect of drug therapy,
advise the person to obtain a wig or head covering
before the condition occurs
to promote self-esteem
and a positive body image
.
■
■
Provide the following teaching:
–– Follow the appropriate dosage regimen, including
dates to return for further doses.
–– Maintain nutrition if GI effects are severe.
–– Cover the head at extremes of temperature if
alopecia is anticipated.
–– Plan for appropriate rest periods because
fatigue and weakness are common effects of
the drugs.
–– Avoid exposure to possible infection, including
avoiding crowded places, sick people and working
in soil.
–– Use safety measures such as avoiding driving or
using dangerous equipment to prevent injury due
to possible dizziness, headache and drowsiness.
–– Consult with a healthcare provider, if
appropriate, due to the possibility of impaired
fertility.
–– Use barrier contraceptives to reduce the risk of
pregnancy during therapy.
Evaluation
■
■
Monitor response to the drug (alleviation of cancer
being treated and palliation of signs and symptoms
of cancer).
■
■
Monitor for adverse effects (bone marrow
suppression, GI toxicity, neurotoxicity, alopecia,
renal or hepatic dysfunction, and cardiac or
respiratory dysfunction).
■
■
Evaluate the effectiveness of the teaching plan
(person can name the drug, dosage, possible
adverse effects to watch for and specific measures
to help avoid adverse effects).
