nursing management to side effects

7/30/2019 Nursing Management to Side Effects

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Nursing Management to Side effects

Decreased WBC count

(immunosuppression).

Avoid crowds; people with infections and small

children when WBC count is low

Consume a low-bacteria diet. Avoid overcooked

meat and raw fruits and vegetables


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Decreased platelet count

(thrombocytopenia)

When shaving use ellectirc razon only

Avoid contact sports and other activities that

may cause trauma

If trauma does occur, apply ice to the area andseek medical assistance

Avoid dental work or other invasive procedures

Avoid aspirin and aspirtin-containing products


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Decrease hemoglobin and hematocrit

(anemia).


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Gastrointestinal effects : anorexia,nausea, vomiting, and diarrhea

1. Client education for maintaining adequatenutrition , and fluid and electrolyte balance

Eat frequent, small, low-fat mealsAvoid spicy and fatty foods

Avoid extremely hot foods

Nursing management of inadequate nutrition

and fluid and electrolyte imbalances.Administer antiemetics prior to chemotherapy

Weigh client routinely and monitor for weightloss


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Stomatitis

Client education for stomatitis

Use a soft toothbrush. Mouth swabs maybe needed during an acute episode

Avoid mouthwashes containing alcohol.

Do not use lemon glycerin swabs or dentalfloss.


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Consider using artificial saliva and hard

candy or mints to help with dryness of the

mouth.

Avoid smoking and alcohol, which can

further irritate the oral mucosa


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Safety handling andadministration of chemotherapy


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To ensure your own safety and that of

your staff, the best way to avoid

unnecessary exposure to potential toxins

is by using proper handling techniques.Chemotherapy exposure occurs three

ways: aerosol, topical, and oral. To reduce

or prevent exposure the followingprotocols are recommended:


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GLOVE TIPS

Polyvinyl chloride (PVC) gloves are not recommended for handlingchemotherapy drugs.

Always use powder-free gloves. Glove powders contaminated withchemotherapy drugs can become airborne and may besubsequently inhaled. Also, powder residue will attach to supplies,work surfaces and the skin.

If double-gloving, insert first glove under the cuff and place thesecond glove over the cuff. If single-gloving, place the clean gloveover the cuff' of the gown.

Use extra-thick gloves, or better yet, use double gloves.

Before handling chemotherapy drugs, always inspect gloves forholes, tears or any type of defect. Unless the film is intact, it cannotprovide a barrier.

Although surgical gloves are recommended for preparation,administration, cleanup and general handling, sterility is not alwaysrequired especially with cleanup and housekeeping procedures.


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DRUG PREPARATION

Polyvinyl chloride (PVC) gloves are not recommendedfor handling chemotherapy drugs.

Neveruse powdered gloves during drug preparation.

Use double gloving unless it interferes with the drugpreparation technique. A double layer of gloves issubstantially less permeable to chemotherapy drugs.

Change all gloves regularly (hourly) or immediately if

they are torn or punctured. Do not wear gloves outside the preparation area.

Dispose of used gloves according to proper hospitaltoxic waste procedures.


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DRUG ADMINISTRATION

Wear high quality gloves that havedemonstrated safe use when handling

chemotherapy drugs. Double-gloving isrecommended.

Wash hands before putting on gloves.

Change contaminated gloves immediately.

Wash hands after removing gloves.Dispose of gloves according to proper hospital

toxic waste procedures.


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DRUG CLEAN UP and GENERALHANDLING

Wear high quality gloves that havedemonstrated safe use for handlingchemotherapy drugs when dealing with blood,

vomitus, excreta and other bodily fluids fromchemotherapy drug patients.

Discard gloves after each use.

Laundry personnel coming into contact with

linen contaminated with chemotherapy drugpatients' body fluids should wear high qualitygloves that have demonstrated safe use forhandling chemotherapy drugs.


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Housekeeping personnel should wear high qualitygloves that have demonstrated safe use for handlingchemotherapy drugs when handling waste containers.

Spills should only be cleaned up by personnel wearing a

double layer of gloves. Spill kits for use in responding to spills should include

two (2) pair of gloves; one outer pair of utility gloves andone inner pair of latex or Latex Free gloves.

All personnel involved in any aspect of handlingchemotherapy drugs must receive an orientation onchemotherapy drugs including proper use of protectiveequipment.


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Management of Accidental Exposureto Hazardous Drugs

Type of Exposure: Skin Exposure

Immediate Care: Remove contaminatedclothing and/or PPE.

Wash affected area thoroughly with soap

and water.Consult MSDS for drug-specific

instructions.


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Follow Up: Report to Employee Health

Professional.

Complete report of employee

injury/exposure.

Follow organizational policy related to

reporting requirements for Workers

Compensation.


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Eye Exposure

Flush eye(s) with water or isotonic eye wash for15 minutes.

Consult MSDS for drug-specific instructions.

Report to Emergency Department.

Report to Employee Health Professional.

Complete report of employee injury/ exposure.

Follow organizational policy related to reportingrequirements for Workers Compensation.


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Exposure by Inhalation or Ingestion

Acute symptoms may require emergencyintervention.

Consult MSDS for drug-specific instructions.

Report to Employee Health Professional orEmergency Department, based on symptoms.

Complete report of employee injury/ exposure.

Follow organizational policy related to reportingrequirements for Workers Compensation.


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Online Journal of issues in Nursing,

American Nurses Asociation.


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Biologic Therapy


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It is a form of treatment of cancers and

other illnesses that uses agents that affect

the body's immune system.

It can help fight cancer or help control side

effects (how your body reacts to the drugs

you are taking) from other cancer

treatments like chemotherapy.


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How does biological therapy fight cancer?

Doctors are not sure how biologicaltherapy helps your immune system fight

cancer. But they think it may:Stop or slow the growth of cancer cells.

Make it easier for your immune system to

destroy, or get rid of, cancer cells.Keep cancer from spreading to other parts

of your body.


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What is my immune system and how

does it work?

Your immune system includes your spleen,lymph nodes, tonsils, bone marrow, and whiteblood cells. These all help protect you fromgetting infections and diseases.

When your immune system works the way itshould, it can tell the difference between "good"cells that keep you healthy and "bad" cells thatmake you sick. But sometimes this doesn'thappen. Doctors are doing research to learnwhy some immune systems don't fight offdiseases like cancer.

I ll i l d h


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Immune system cells include the

following:

Lymphocytes are a type of white blood cell found in the blood andmany other parts of the body. Types of lymphocytes include B cells,T cells, and Natural Killer cells.

B cells (B lymphocytes) mature into plasma cells that secreteproteins called antibodies (immunoglobulins). Antibodies recognizeand attach to foreign substances known as antigens, fitting together

much the way a key fits a lock. Each type of B cell makes onespecific antibody, which recognizes one specific antigen.

T cells (T lymphocytes) work primarily by producing proteins calledcytokines. Cytokines allow immune system cells to communicatewith each other and include lymphokines, interferons, interleukins,and colony-stimulating factors. Some T cells, called cytotoxic T cells,

release pore-forming proteins that directly attack infected, foreign, orcancerous cells. Other T cells, called helper T cells, regulate theimmune response by releasing cytokines to signal other immunesystem defenders.


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Natural Killer cells (NK cells) produce powerfulcytokines and pore-forming proteins that bind to and killmany foreign invaders, infected cells, and tumor cells.Unlike cytotoxic T cells, they are poised to attack quickly,

upon their first encounter with their targets. Phagocytes are white blood cells that can swallow and

digest microscopic organisms and particles in a processknown as phagocytosis. There are several types ofphagocytes, including monocytes, which circulate in the

blood, and macrophages, which are located in tissuesthroughout the body.

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