Textbook of Medical-Surgical Nursing 3e

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Unit 3   Applying concepts from the nursing process

PHARMACOLOGY Investigational antineoplastic therapies and clinical trials

CHART 11-5

trials is to gather information concerning maximal tolerated doses, adverse effects and effects of the antineoplastic agents on tumour growth. • Phase III clinical trials establish the effectiveness of new medications or procedures as compared with conventional approaches. Nurses may assist in the recruitment, consent and education processes for patients who participate. In many cases, nurses are instrumental in monitoring adherence, assisting patients to adhere to the parameters of the trial and documenting data describing patients’ responses. The physical and emotional needs of patients in clinical trials are addressed in much the same way as those of patients who receive standard forms of cancer treatment. • Phase IV testing further investigates medications in terms of new uses, dosing schedule and toxicities.

Evaluation of the effectiveness and toxic potential of promising new modalities for preventing, diagnosing and treating cancer is accomplished through clinical trials. Before new chemotherapy agents are approved for clinical use, they are subjected to rigorous and lengthy evaluations to identify beneficial effects, adverse effects and safety. • Phase I clinical trials determine optimal dosing, scheduling and toxicity. • Phase II trials determine effectiveness with specific tumour types and further define toxicities. Participants in these early trials are most often those who have not responded to standard forms of treatment. Because phase I and II trials may be viewed as last-chance efforts, patients and families are fully informed about the experimental nature of the trial therapies. Although it is hoped that investigational therapy will effectively treat the ­disease, the purpose of early phase

HOME CARE CHECKLIST Chemotherapy administration At the completion of the home care instruction, the patient or carer will be able to: CHART 11-6

patient

carer

• Demonstrate how to administer the chemotherapy agent in the home.

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• Demonstrate safe disposal of needles, syringes, IV supplies or unused chemotherapy medications.

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• List possible side effects of chemotherapeutic agents.

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• List complications of medications necessitating a call to the nurse or doctor.

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• List complications of medications necessitating a visit to the emergency department.

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• List names and telephone numbers of resource personnel involved in care (i.e. community nurse, infusion services, IV vendor).

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• Explain treatment plan (protocol) and importance of follow-up visits to doctor.

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is responsible for the severe inflammatory reaction as well as the ability of these drugs to bind to tissue DNA. Sloughing and ulceration of the tissue may be so severe that skin grafting may be necessary. The full extent of tissue damage may take several weeks to become apparent. Cytotoxic agents classified as vesicants include some of the most commonly used agents: cisplatin, dactino­mycin, daunorubicin, doxorubicin, nitrogen mustard, mitomycin, paclitaxel, vinblastine, vincris- tine and vindesine (Sauerland et al., 2006). Only specially trained doctors and nurses should administer vesicants. Careful selection of peripheral veins, skilled veni- puncture and careful administration of cytotoxic agents are essential. Indications of extravasation during administration of vesicant agents include the following: • Absence of blood return from the intravenous catheter Institutional nursing policies should be available to identify nursing intervention, and an extravasation kit should be readily available with all of the emergency equipment and antidote medication as well as a quick reference for how to properly manage an extravasation of the specific vesicant agent used. Application of heat or cold is very dependent on the drug administered, and nurses should refer to their hospital policy. In general, cold compresses are indicated for doxorubicin • Resistance to flow of intravenous fluid • Swelling, pain, or redness at the site.

haematological, hepatic, renal, cardiovascular, gastrointestinal and pulmonary systems are critical in evaluating the response to chemotherapy (Duong & Loh, 2006; Nirenberg et al., 2006). Chemotherapy treatment regimens include standard dosage therapy, dose-dense regimens, and myeloablative regimens with bone marrow or peripheral stem cell transplant. For certain chemotherapeutic agents, there is a maximum lifetime dose limit that must be adhered to because of the danger of long-term irreversible organ complications (e.g. because of the risk of cardiomyopathy, doxorubicin [Adriamycin] has a cumulative lifetime dose limit of 550 mg/m 2 . Extravasation Antineoplastic chemotherapeutic agents are additionally clas- sified by their potential to damage soft tissue if they inadver- tently leak from a vein ( extravasation ). The consequences of extravasation range from mild discomfort to severe tissue destruction, depending on whether the agent is classified as a non-vesicant, irritant or vesicant. Irritant agents induce inflammatory reactions but usually cause no permanent tissue damage. Vesicants are those agents that, if deposited into the subcutaneous tissue (extravasation), cause tissue necrosis and damage to underlying tendons, nerves and blood vessels. Although the complete mechanism of tissue destruction is unclear, it is known that the pH of many antineoplastic drugs