Textbook of Medical-Surgical Nursing 3e

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Unit 3   Applying concepts from the nursing process

Plan of Nurs ing Care Care of patient with cancer ( continued )

CHART 11-4

Nursing interventions

Rationale

Expected outcomes

a. Bed rest with padded side rails. b. Avoidance of strenuous activity.

a. Reduces risk of injury. b. Increases intracranial pressure and risk of cerebral haemorrhage. c. Allergic reactions to blood products

c. Platelet transfusions as prescribed; administer prescribed hydrocortisone sodium succinate (Solu-Cortef) to prevent reaction to platelet transfusion. d. Supervise activity when out of bed. e. Caution against forceful nose blowing.

are associated with antigen– antibody reaction that causes platelet destruction.

d. Reduces risks of falls. e. Prevents trauma to nasal mucosa and increased intracranial ­pressure.

Many of these agents are specific to certain phases of the cell cycle. Most affect cells in the S phase by interfering with DNA and RNA synthesis. Others, such as the vinca or plant alkaloids, are specific to the M phase, where they halt mitotic spindle formation. Chemotherapeutic agents that act independently of the cell cycle phases are termed cell-cycle non-specific agents. These agents usually have a prolonged effect on cells, leading to cellular damage or death. Many treatment plans combine cell-cycle specific and cell-cycle non-specific agents to increase the number of vulnerable tumour cells killed during a treat- ment period (Polovich, White & Kelleher, 2005). Chemotherapeutic agents are also classified according to various chemical groups, each with a different mechanism of action. These include the alkylating agents, nitrosureas, anti- metabolites, antitumour antibiotics, plant alkaloids, hormonal agents and miscellaneous agents. The classification, mech- anism of action, common drugs, cell cycle specificity and common side effects of antineoplastic agents are listed in Table 11-7. Chemotherapeutic agents from each category may be used to enhance the tumour cell kill during therapy by creating multiple cellular lesions. Combined medication therapy relies on medications of differing toxicities and with synergis- tic actions. Using combination drug therapy also prevents develop­ment of drug-resistant mechanisms. New combinations of chemotherapy are being studied for effectiveness in resistant tumour lines. For more information about investigative drugs, see Chart 11-5. Administration of chemotherapeutic agents Chemotherapeutic agents may be administered in the hospital, clinic or home setting by topical, oral, intravenous, intra­muscular, subcutaneous, arterial, intracavitary and intra- thecal routes. The administration route usually depends on the type of agent, the required dose and the type, location and extent of tumour being treated. A position statement on the minimum education and safety requirements for nurses involved in the administration of chemotherapy has been developed by the Cancer Nurse Society of Australia (CNSA). Patient education is essential to maximise safety if chemotherapy is administered in the patient’s home (Chart 11-6).

8 o r m o r e h o u r s

6 – 8 h o u r s

G

1

S

I n d e f i n i t e T i m e

G

G

2

2 – 5 h o u r s

0

M I T O S I S

T

P

A

M

The G 0 phase, the resting or dormant phase of cells, can occur after mitosis and during the G 1 phase. In the G 0 phase are those dangerous cells that are not actively dividing but have the potential for replicating. The administration of certain chemotherapeutic agents (as well as administration of some other forms of therapy) is coordinated with the cell cycle. Classification of chemotherapeutic agents Certain chemotherapeutic agents (cell-cycle specific drugs) destroy cells actively reproducing by means of the cell cycle. Figure 11-1  Phases of the cell cycle extend over the interval between the midpoint of mitosis to the subsequent end point in mitosis in a daughter cell. G 1 is the postmitotic phase during which ribonucleic acid (RNA) and protein synthesis are increased and cell growth occurs. G 0 is the resting, or dormant, phase of the cell cycle. In the S phase, nucleic acids are synthesised and chromosomes replicated in preparation for cell mitosis. During G 2 , RNA and protein synthesis occurs as in G 1 . ((P 5 prophase, M 5 metaphase, A 5 anaphase, T 5 telophase.) From Porth, C. M. & Matfin, G. (2009). Pathophysiology: Concepts of altered health states (8th ed). Philadelphia: Lippincott Williams & Wilkins.)