Week 9 Complications of Chemotherapy & Radiation Therapy

Question 1

What is external radiation?

Answer 1

-Comes from outside the patient
-Target a specific area
- Fluroscopy helps identify what part of the body needs radiation

Question 2

What is internal radiation?

Answer 2

Targeted therapy right inside the tumour
1. temporary implants
2. permanent implants

Question 3

Is radiation high or low in temporary internal radiation implants?

Answer 3

High radioactive while in place

Question 4

Is radiation high or low in permanent internal radiation implants?

Answer 4

Low radioactive
patient can be discharged

Question 5

What precautions need to be taken as the nurse for a patient with brachytherapy temporary radiation treatment?

Answer 5

-place radioactive patient in private room
- Pregnant people and children cannot enter room
-Time (short time)
-Distance (stay far away)
- Shielding (lead vests)
- radiation badge

Question 6

how long can an uncompromised visitor stay with someone receiving brachytherapy temporary radiation and how far away must they stay?

Answer 6

1. 30 min one time a day
2. 6 feet from the person

Question 7

What are acute head/brain effects of radiation?

Answer 7

*Alopecia and dermatitis of the scalp

• Ear and external auditory canal irritation
• Cerebral edema and increased intracranial pressure
• Nausea and vomiting
• Blurry vision

Question 8

What are acute Head & Neck effects of radiation?

Answer 8

• Oral mucositis (inflammation/ulcers/etc)
• Taste changes
• Oral candidiasis, herpes, or other infections
• Acute xerostomia- very dry mouth
• Dental caries
• Esophagitis and pharyngitis

Question 9

What are chest and lung effects of radiation?

Answer 9

Breast and Chest Wall
* Skin reactions

• Esophagitis

Chest and Lung
* Esophagitis and pharyngitis

• Taste changes
• Pneumonia
• Cough

Question 10

What are abdomen and Pelvis effects of radiation?

Answer 10

• Anorexia
• Nausea and vomiting
• Diarrhea
• Cystitis or proctitis
• Vaginal dryness/vaginitis
• Sexual and fertility problems

Question 11

What are eye effects of radiation?

Answer 11

Conjunctival edema and tearing

Question 12

What is the most common side effect of radiation?

Answer 12

radiation dermatitis
radiation= SKIN PROBLEMS

Question 13

What do we wash radiation areas with?

Answer 13

soap and water only

Question 14

what is myelosuppression (bone marrow suppression) caused by?

Answer 14

1. bone cancer
2. Chemo
3. Radiation

Question 15

What causes dry itchy skin during cancer treatment? radiation, chemo, or medications?

Answer 15

radiation

Question 16

What do we worry about with myelosuppression?

Answer 16

pancytopenia

Question 17

What is pancytopenia?

Answer 17

anemia
neutropenia
thrombocytopenia

Question 18

What do we monitor and teach a patient who is anemic d/t myelosuppression?

Answer 18

Monitor:
-HGB
-HCT

-Intake foods that promote RBC production
-balance rest and activity

Question 19

Which1 of the 3 aspects of pancytopenia is the biggest problem in myelosuppression and why?

Answer 19

Neutropenia- reduction of neutrophils

Risk for infection that is severe and can lead to sepsis & death

Question 20

What specific lab and signs/symptoms do we monitor for someone with neutropenia?

Answer 20

ANC (absoulte neutrophil count)
S&S of infection

Question 21

What do we teach patients with neutropenia and what interventions do we do if they have infection?

Answer 21

1.Avoid large crowds- period/always
2. Good handwashing
3.No fresh fruit/flowers in room
4. If febrile, antibiotic therapy is initiated immediately (within 1 hr)
5. May need reverse isolation (private room, glove/ gown/ mask)
6.Patient wears mask if leaves room
7. Give colony stimulating factor (filgrastim-Neupogen (helps fight off infection))

Question 22

what is thrombocytopenia?

Answer 22

A reduction of platelets resulting in abnormal hemostasis. At risk for bleeding and hemorrhage.

Question 23

What does the nurse monitor & avoid in someone with thrombocytopenia?what are some interventions?

Answer 23

1. S&S of internal bleeding
   Blood in urine
   Melena stools
   Decreased LOC, confusion
   2.Minimize venipuncture and injections
2. Administer blood products/platelets
   4.Assess for petechiae, ecchymosis

Question 24

what do we teach patients with thrombocytopenia?

Answer 24

1.Electric shaver -Not a razor
2.Soft bristle toothbrush
3.Avoid drugs & foods, and herbs that effect coagulation (for eg. Aspirin, ginger)
4.Avoid injury (contact sports-gloves for housework)
5. assess for petechiae, ecchymosis (go see doctor)
6. S&S of internal bleeding - blood in urine, melena stools, decreased LOC suddenly/confusion

Question 25

What are 3 main signs of internal bleeding that can happen with thrombocytopenia?

Answer 25

blood in urine, melena stools decreased LOC suddenly/confusion

Question 26

What causes Anorexia, Nausea and GI issues during Cancer treatment?

Answer 26

-(TNF- tumor necrotising factor) released= cellular breakdown and drugs stimulate nausea center -destruction of GI lining (is extremely sensitive to Chemo/ radiation)

Question 27

what do we monitor closely in someone going through cancer treatment with anorexia and nausea (think about the effects of N&V on I&O, nutrition, etc) ?

Answer 27

Weight

Question 28

What should people with anorexia and nausea during cancer treatment, eat?

Answer 28

high protein high calorie (easy to swallow) foods

Question 29

What should we assess for in people going through cancer treatment (think N&V issues) ?

Answer 29

dehydration alkalosis

Question 30

What 4 things can people going through cancer treatment do for diarrhea/diarrhea related issues?

Answer 30

1. Low residue diet (not dense grains, nuts, etc) 2. meticulous skin care 3. sitz baths 4. anti-diarrheals

Question 31

What do we teach someone to do who has brain fog and fatigue from cancer treatment?

Answer 31

*Encourage adequate hydration and nutrition *Manage pain and anxiety (give opioids around the clock with extra for breakthrough pain) *Balance mild physical activity (walking) and rest *Encourage client to seek assistance and support from family and friends

Question 32

What do we teach someone about mouth care who is going through cancer treatment?

Answer 32

*Decreased salivary flow (xerostomia - dry mouth) *Examine teeth and gums daily *Oral care before and after each meal and before bedtime (rinse with saline solution) *Brush teeth with soft toothbrush *Drinking small amounts of water frequently/ saliva substitute *Antacids/Benadryl/Lidocaine cocktail (pink lady) or anesthetic gel to oral lesions *Hot temperatures, alcohol, and tobacco should be avoided *Soft non-irritating high calorie, high protein foods are recommended

Question 33

What might someone going through cancer treatment experience regarding peripheral neuropathy?

Answer 33

*Loss of sensory perception or motor function of peripheral nerves *loss of sensation to hands and feet *impaired gait and balance *orthostatic hypotension *Neuropathic pain *Erectile dysfunction *Loss of fine motor function (playing an instrument) *Loss of taste discrimination, *constipation

Question 34

What's the one thing we teach patients to be careful about when going through cancer treatment regarding peripheral neuropathy?

Answer 34

be aware of potential for injury and be careful

Question 35

how does radiation affect reproductive system of people going through treatment?

Answer 35

1. can cause erectile dysfunction 2. can cause loss of vaginal lubrication 3. can cause narrowing of vagina 4. can damage the ability to produce healthy eggs and sperm

Question 36

What are options available to manage reproductive effects of radiation?

Answer 36

-harvest sperm or ova pre-treatment -vaginal lubricant and vaginal dilator post treatment -counseling for potential infertility

Question 37

What are two obstructive oncological emergencies?

Answer 37

1. SVC syndrome- Superior vena cava obstructed -by tumour -or by blood clot in CVAD 2. Spinal cord compression - pain, trouble movig, paresthesia, reflex loss, constipation, urinary dysfunction

Question 38

What are 2 Oncological Metabolic emergencies and another metabolic change?

Answer 38

1. SIADH - too much water on board 2. Tumor Lysis syndrome - triggered by chemo = rapid breadown of tumor - electrolyte imbalances - renal failure 3. Hypercalcemia - bone breakdown releases calcium = coma

Question 39

What are the treatments for SIADH?

Answer 39

fluid restriction hypertonic saline increase sodium (b/c serum Na will be low)

Question 40

what are treatments for hypercalcemia?

Answer 40

-biophosphate infusion (pamidronate)- b/c phosphate binds to calcium and lowers levels - hydration - diuretic

Question 41

What is the treatments for tumor lysis syndrome?

Answer 41

hydration- to preserve kidney function allopurinol- to lower uric acid d/t sudden increase in serum lytes

Question 42

what are the 4 hallmark lab signs of tumor lysis syndrome?

Answer 42

Hyperuricemia - high uric acid Hyperphosphatemia - high phosphate Hyperkalemia - high potassium Hypocalcemia - high calcium

Question 43

What do people with neutropenia from myelosuppresion or cancer treatment often die from?

Answer 43

Sepsis (increased risk for sepsis)

Question 44

What does septic shock lead to?

Answer 44

Disseminated intravascular coagulation (DIC)- blood clots all over

Question 45

What happens in DIC?

Answer 45

-extensive clotting depletes systemic platelets and clotting factors -leads to bleeding and hemorrhage -clots can travel to organs causing symptoms