Chemotherapy
Complications of Chemotherapy
Extravasation
Complication
Chemotherapy drugs burn the skin
Infiltration
Drug leaks into surrounding tissues
Prevention
Monitor closely
Priority
Stop the infusion. Do not flush. Treat like a burn
Bone Marrow Suppression
Neutropenia
Low WBCs ⇒ Immunosuppression. High risk for infection. Absolute neutrophil count < 1000 = place on neutropenic precautions
Monitor
Monitor for fever. Monitor skin and mucous membranes for breakdown/infection
Handwashing #1
Take good infection prevention measures, including education of family and patient
Priority
No live plants, no fresh fruits/vegetables, avoid crowds, no sick visitors, no undercook foods, and no unpasteurized milk products
Anemia
Symptoms
Fatigue, pallor, dizziness, and shortness of breath
Interventions
Frequent rest periods
Erythropoeitin & Iron
Such as Epogen to stimulate RBC production and Ferrous sulfate (Iron supplement).
Blood Transfusions
Administer blood transfusions as needed
Thrombocytopenia
Bleeding Precautions
Low platelets places client at risk for bleeding
Symptoms
Nosebleeds (epistaxis), excessive menstruation, petechiae, hematuria, melena (blood in stool), & gingival bleeding.
Fall Precautions
Safe environment. Protect from injury. Handle client with care
Interventions
No aspirin, No IM injections, apply pressure to bleeding site x 10 minutes, soft toothbrush, stool softener, electric razors, do not blow nose, no contact sports, no enemas, no tight clothes.
Nausea and Vomiting
Side effects
Most chemotherapy drugs cause nausea and vomiting
Low platelets places client at risk for bleeding
Antiemetic
Ondansetron is the best antiemetic. Administer antiemetic 30 minutes prior to chemotherapy, during chemo, and after chemo.
Alternatives
Imagery, distraction, remove anything that may cause vomiting such as odors.
Nutrition
Small frequent meals, liquids during meals, low fat/dry food such as crackers and toast, and give nutritional supplements/protein.
Alopecia
Onset
Starts 7 to 10 days after the start of treatment
Hair grows back
1 month after chemotherapy is finished, hair returns. Possible in different color or texture.
Avoid scalp injury
Avoid sun and wear sunscreen
Body Image
Wigs, scarf, hats.Â
Mucositis (Stomatitis)
Sores
Inflammatory sores inside the mouth which can lead to infection. Use nystatin or acyclovir as needed
Avoid
Avoid salt, acidic foods, and spicy foods. Avoid alcohol and smoking.
Lidocaine-based
Use lidocaine-based mouth wash
Mouthwash to avoid
Don’t use alcoholic/glycerin based mouthwashes
Kidney Damage
Tumor Lysis Syndrome
An emergency in which tumor breaks down releasing potassium, phosphorus, and uric acid. Damages kidneys.
Electrolytes
Hyperkalemia, Hyperphosphatemia, and hyperuricemia.
Monitor
Potassium, phosphorus, creatinine, BUN, uric acid, and urine output.
Allopurinol & Hydration
Give allopurinol for hyperuricemia. Fluids, Fluids, Fluids