Chemotherapy paper



Chemotherapy paperRegina NjorogeAzusa Pacific UniversityUNRS 312 PProfessor Vicki ClavirOctober 4, 2017Chemotherapy paperStudent: Regina Njoroge Date:10/04/2017SN is a 59-year- old female with a history of high blood pressure, obesity, diabetes, and high cholesterols. Ten months ago, prior to her admission, she was diagnosed with lung cancer on her left side. She presented herself to the ER seeking care of “shortness of breath.” SN stated prior to her diagnosis, she was doing great until one night she developed shortness of breath lying down flat in bed, she also noticed she was short of breath with exertion, to a point taking frequent stops to catch breath. She went to the ER for medical attention. CT scan confirmed a pleural effusion and chest mass. Biopsy was done and confirmed lung cancer. SN began chemotherapy treatments every 2 weeks. She stated she had been in and out of the hospital due to chemotherapy side effects and pleural effusion. Has been undergoing thoracentesis once a week for the last 5 weeks. The use of home oxygen has improved the shortness of breath. Her oncologist plan to continue chemotherapy for three more rounds. SN got admitted to hospital for further testing of her chief complaint of shortness of breath. The overall goals for chemotherapy patient According to (Bucher, Heitkemper, & Kwong, 2017), the three overall goals for patient receiving chemotherapy are;Complete cure of the specific cancerPalliate care to for better quality of lifeControlling cancer Classifications of cytotoxic drugsThese are drugs that can cause damage to the patient’s skin, though they are still given because the benefit out weights the damage. According to ("Cancer types," 2015) cytotoxic drug are classified according to the roles they play to the targeted cells. They are namely the, cell- cycle and non- cell specifics.Cell-cycle specific: aims at a specific cell phase and not effective on resting phrase of a cell. For example, infused for 5 days straight in a week.Non-cell-cycle specific: The drugs act against cancer cell at any given phase of the cell. For example, this type of infusion can be given in a span of one hour continuously to be effective on all phrase of the cell replication.Methods of administration.There are several methods chemotherapies can be administered namely, Oral - is routinely given as a capsule or tablet by the mouth with the intention of being absorbed in the gastrointestinal track via into the blood Intramuscular- this is directly given to a muscle usually to the deltoid or gluteal muscle Intravenous- this is administered directly to a vein by either as a IV push or infusion with a given time limit Intracavitary- usually this is administered directly to the peritoneum cavityIntrathecal, Intraarterial- this is given directly to the cerebro-spinal fluids through a lumbar puncture with a target of CNSContinuous Infusion – this is given directly a large blood vessel via to the central venous accessSubcutaneous- this is given under the skin with a very small, thin needle where it gets absorbed Topical – this is applied directly to the skinClassifications of chemoSkin damage can occur with cytotoxic drug, though they are still given because the benefit out weights the damage caused. According to, ("Cancer types," 2015) There are two groups that are classified according to the severity of the damage they cause. They are namely the, irritants and non-irritants.Non – irritants- are known not to cause either tissue or vein damage and is normally administered through a veinIrritants- causes damage to the vein but not the tissue. The symptoms to look for at the injection site will be warmth to the touch, tenderness and redness, or the patient will report itchy rash at the site. The most irritants medication are, bleomycin and the cisplatin.Vesicants- also known at the chemical cellulitis. It is normally given under the skin and depending on the amount given, a blistering redness blistering bump develops that causes itching and sometimes pain at the injection site, some of the medication used are streptozocin, mitomycin, dactinomycin, and tenoposide (Cancer types,2015) Complications of extravasation of a vesicant drugVesicant drugs can potentially cause some serious damage to the tissue to a point where these damaged cannot be irreversible. According to (" Cancer patient," 2016) if the damaged site does not get treated it can lead to necrosis of the tissue, patient unable to use the arm that is affected. Finally, it can lead to disfigurement that are permanent. Complications of extravasation of the vesicant drug can occur to patients who has obese, fragile veins, small numerous skin poke for labs collection, and a history of asthma because they are likely known to have decreased sensory of skin. Some of the common signs and symptoms may include, arm discomfort, swelling and redness at the site. It is highly recommended that this type of infusion to be administered through the central line.List of nursing assessmentsSome of chemotherapy drugs are highly toxic that they can cause life threatening situation thus, extensive nursing assessment needs to be done prior to the infusion of the drugs.(Clark, 2006) Some of the key nursing assessment that must be performed are, Health history of the patient Vital signs takingPatient coping ability with the cancer diagnosis and chemotherapy treatmentsAny obvious physical changes caused by the chemotherapy drugs, for example, hair loss, lymphedema, clubbing of the nailsReview of labs, pathology results and CT scan and Pet scan resultsHead to toe assessmentFrequency of monitoring and rationale SN has a very extensive health history thus; direct close monitoring care is needed. One thing I will make sure throughout this shift is that she is at 2 L of oxygen nasal cannula per the doctor’s order, thus to her chief complain. This will help SN to receive adequate oxygen to her lungs and circulatory system and prevent her from using some energy to breath. Lung sounds and heart sounds will be auscultated every 4 hours to ensure there is no abnormal lung sounds. This is in consideration to her past history of pleural effusion. The vital signs will be taken every one hour to make sure they are in normal limit and communicated her primary nurse. The bed will be placed in high fowler position to enhance easy breathing. And finally, the medications will be administered in a timely manner to ensure Role of the nurse in the chemo-infusion setting The chemo infusing nurses are the heart of the cancer patient because they act as a liaison between the patient and other health care providers. According to (Bucher et al., 2017) nurse plays a big role of making the patient will not experience any side effects from the chemo drugs.as well as performing the following roles,Patients care coordination with the other health care providersEducating the patient and family members on the diseases and treatmentsPrepares and administer the drugs to the patient in a safe wayMonitor patient for adverse reactions to the chemotherapy drugsFrequent vitals’ signs takingScheduling patient for additional chemotherapy sections and follow up appointments with the doctors.Ordering and inventory taking of chemo drugs from the pharmacyAddressing all patient’s question and concerns and offering assurance Patient educationSN will be instructed to avoid big crowds of people to reduce chances of getting infections, to seek medical attention if are experiencing high fever of over 100-degree F. I will also encourage SN to take frequent walks even when she is too tired to do so because, it helps to build muscle stronger and prevent muscle wasting. Eating a health balance meal will be ideal to make the body strong to continue with chemotherapy treatment and build back up the suppressed immune system. Join cancer survivors support groups for emotional and psychological growth.NANDA Nursing Diagnoses1) Risk for infection related to immunosuppression related to chemotherapy treatment (Ackley, Ladwig, & Makic, 2017)2) Risk for ineffective gaseous exchange related to chemotherapy treatment (Ackley, Ladwig, & Makic, 2017.Response to the chemo-infusion insight report I found this assignment very helpful because I was able to put my theoretical knowledge into practice. I was able to connect my already learned concept into action and broadened my understanding of why things are done in a particular way and not the other way. I feel like my anxiety level of taking care of a cancer patient has decreased, thus it leaves room for further considerations of becoming an oncology nurse.ReferencesAckley, B. J., Ladwig, G. B., & Makic, M. F. (2017). Nursing Diagnosis Handbook, An evidence - Based Guide to Planning Care. In (Ed.). 3251 Riverport Lane St Louis, Missouri 63043: Elsevier.Bucher, L., Heitkemper, H., & Kwong, R. (2017). Palliative Care at End of Life. In Medical Surgical Nursing (10th ed. St. Louis, MO: Elsevier.Clark, P. (2006). Tube feeding and persistent Vegetative State Patients: ordinary or extraordinary means [Non - Ecumenical studies in medical morality]. Christians Bioethics.Extravasation of Antineoplastic Agents: Prevention and Treatments. (2016). Retrieved from extravasation of cytotoxic drugs. (2015). Retrieved from Anal-cancer/.../Intravenous-extravasation-of-cytotoxic-drugs? lg...2 ................
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