NCM 112 RLE Module 8F Preparing Chemotherapeutic Agents and Gastrostomy Feeding PDF

NCM 112 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) RLE MODULE 8F Preparing Chemotherapeutic Agents and Gastrostomy Feeding Group...

NCM 112 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) RLE MODULE 8F Preparing Chemotherapeutic Agents and Gastrostomy Feeding Group H8 Members: Sullano, Jasper Tagoy, Christine Marie Tejano, Mark Albert Toroy, Ella Shealtiel Tualla, Phil Kenni Yap, Liannie Faith Yongson, Jirah Emmanuel Facilitator: Ms. Geniza Fatima V. Lipura, MSN, RN Date Submitted: August 12, 2024  Table Of Contents CLO#1 Define the terms used in preparing chemotherapeutic agents and gastrostomy feeding. CLO#2 State the purpose of preparing chemotherapeutic agents and gastrostomy feeding. CLO#3 Explain the indications and contraindications of chemotherapy and gastrostomy feeding. CLO#4 State the advantages and disadvantages of gastrostomy feeding. CLO#5 Differentiate the classification of chemotherapeutic agents. CLO#6 Enumerate the types of gastrostomy tube, types of formula feeding and methods of gastrostomy feeding. CLO#7 Discuss the guidelines involved in Administration Of Chemotherapeutic Agents and Gastrostomy Feeding. CLO#8 Cite common side effects of chemotherapy and the complications of gastrostomy and their appropriate nursing interventions. CLO#9 List the types of vascular access devices used for chemotherapy. CLO#10 Examine the methods of chemotherapeutic administrations. CLO#11 Explain the nursing responsibilities before, during and after chemotherapy and gastrostomy care. CLO#12 Document client responses and outcomes after chemotherapy gastrostomy care. CLO#13 Demonstrate beginning skills in Preparing Chemotherapeutic Agents gastrostomy care. CLO #1: Define the terms used in preparing chemotherapeutic agents and gastrostomy feeding. 1.1. Chemotherapeutic Agents 1.1.1. Chemotherapy - involves the use of antineoplastic drugs in an attempt to destroy cancer cells by interfering with cellular functions, including replication and DNA repair. 1.1.2. Adjuvant Therapy - refers to being treated with surgery first, followed by chemotherapy. This is done to eliminate any residual cancer cells that may remain in the body. It is administered after surgery to kill any remaining cancer cells with the goal of reducing the chances of recurrence. 1.1.3. Neoadjuvant Therapy - treatment where chemotherapy may be given first to help shrink a large tumor, so that it can be surgically removed. It is delivered before surgery with the goal of shrinking a tumor or stopping the spread of cancer to make surgery less invasive and more effective. 1.1.4. Cancer - a group of disorders characterized by abnormal cell proliferation, in which cells ignore growth-regulating signals in the surrounding environment. 1.1.5. Chemotherapeutic Agents - Pharmacological agents used to inhibit rapidly proliferating malignant cells. Also known as antineoplastic drugs. Cell cycle specific agents - exert their maximal effect during a specific phase of the cell cycle. Cell cycle nonspecific agents - agents that act independently of the cell cycle phases. 1.1.6. Antineoplastic - medications used to treat cancer. Antineoplastic drugs are also called anticancer, chemotherapy, chemo, cytotoxic or hazardous drugs. 1.1.7. Extravasation - leakage from a vein into the surrounding tissue. 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. 1.1.8. Metastasis - when cancer cells have spread and developed from other than the primary site of where the cancer developed. 1.2. Gastrostomy Feeding 1.2.1. Gastrostomy - A surgical opening into the stomach. 1.2.2. Gastrostomy Tube - A gastrostomy tube is a feeding tube placed through the abdomen and inserted to the stomach. 1.2.3. Gastrostomy Feeding - Gastrostomy tube feeding involves inserting a feeding tube endoscopically or surgically through the abdominal wall and directly into the stomach. 1.2.4. Irrigation - A surgical process of removing cellular debris and surface pathogens contained in wound exudates through flushing with fluids. 1.2.5. Total Parenteral Nutrition - Total parenteral nutrition, also known as IV nutrition, involves the administration of a nutrient-rich solution containing carbohydrates, proteins, fats, vitamins, and minerals through a central venous catheter. It is a method of delivering nutrition directly into the bloodstream. CLO #2: State the purpose of preparing chemotherapeutic agents and gastrostomy feeding. The preparation of both chemotherapeutic agents and gastrostomy feeding are crucial for the following purposes: Chemotherapeutic Agents - to deliver precise doses of anti-cancer drugs to eliminate or reduce cancer cells while minimizing harm to healthy cells. - to tailor the medication dosage and formulation to the specific needs of each patient with the most effective and individualized treatment plan. - to reduce the risk of adverse side effects by ensuring accurate dosing and handling, which is critical given the potent nature of chemotherapy drugs. - to protect healthcare providers and patients from accidental exposure to these toxic agents. Gastrostomy Feeding - to provide essential nutrients, hydration, and medications directly into the stomach for patients who cannot consume food orally due to medical conditions such as swallowing difficulties, neurological disorders, or severe illness. - to ensure that patients receive adequate nutrition to support healing, maintain body weight, and promote overall well-being, particularly when oral intake is not possible or sufficient. - to deliver nutrition in a safe and controlled manner, reducing the risk of complications such as malnutrition, aspiration, or gastrointestinal issues. CLO#3 Explain the indications and contraindications of Chemotherapy and Gastrostomy Feeding. 3.1 CHEMOTHERAPY INDICATIONS CONTRAINDICATIONS Primarily used to treat different types of Not recommended for patients who are cancer by destroying or slowing the in poor overall health, as it could growth of cancer cells. worsen their condition. Given after surgery or radiation therapy Severe issues with vital organs like the to lower the chance of the cancer liver, kidneys, or heart can make coming back. chemotherapy too risky. Sometimes, it is used before surgery to Some chemotherapy drugs are not safe shrink tumors and make them easier to during pregnancy because they can remove. harm the baby. In advanced cancer, it can help relieve If a person has an active infection, symptoms and improve the quality of chemotherapy might make it worse life. because it can weaken the immune system. Used together with other treatments to If someone is allergic to a particular improve the chances of survival. chemotherapy drug, that drug should be avoided or replaced with another option. 3.2 GASTROSTOMY FEEDING INDICATIONS CONTRAINDICATIONS Recommended when a person has Patients with severe blood clotting difficulty swallowing, making it hard for disorders, known as severe them to eat or drink normally. coagulopathy, may not be suitable for gastrostomy feeding due to the heightened risk of bleeding. Often necessary for individuals with If there is a severe infection at the site neurological conditions, such as stroke where the tube would be inserted, or cerebral palsy, that affect their ability performing a gastrostomy may not be to swallow or eat. safe. For patients who require long-term Patients who are medically unstable nutritional support but are unable to eat might not be able to tolerate the enough through the mouth, procedure required to place a gastrostomy feeding provides a reliable gastrostomy tube. way to ensure they receive the necessary nutrients. Chronic illnesses like cancer, muscular If there is an obstruction in the stomach dystrophy, or cystic fibrosis may make it or intestines, gastrostomy feeding may difficult for patients to maintain proper not be safe or effective. nutrition through regular eating, making gastrostomy feeding a viable option. Certain congenital conditions that In cases where a patient has a very impact the mouth, esophagus, or short life expectancy, the risks stomach may necessitate gastrostomy associated with the procedure may feeding to ensure adequate nutrition. outweigh the potential benefits. CLO#4 State the advantages and disadvantages of Gastrostomy Feeding. 4.1 GASTROSTOMY FEEDING ADVANTAGES DISADVANTAGES Provides a reliable way to ensure that The insertion of a gastrostomy tube patients who cannot eat or swallow requires a surgical procedure, which receive the nutrition they need to carries risks such as infection, bleeding, maintain their health. or complications from anesthesia. Allows for long-term nutritional support, Patients may experience discomfort, especially in patients with chronic irritation, or infection at the site where conditions, without the need for the tube is inserted. repeated procedures. Improve the quality of life by reducing Can lead to complications such as tube the stress and discomfort associated blockages, leakage, or dislodgment, with other feeding methods, such as which may require additional medical nasal tubes. attention. Enables caregivers to deliver medication There may be psychological or and hydration more easily, alongside emotional impacts on patients and their nutrition, through the same tube. families, as adjusting to tube feeding can be challenging. Reduces the risk of aspiration (food or Long term use will have dependency on liquid entering the lungs), which can gastrostomy feeding and may reduce occur with oral feeding in patients who the motivation or ability to regain have difficulty swallowing. natural eating skills, if recovery is possible. CLO#5 Differentiate the Different Classifications of Chemotherapeutic Agents Alkylating Agents Bonds with DNA, RNA, and protein molecules lead to impaired DNA replication, RNA transcription, and cell functioning which results in cell death. It is nonspecific in the cell cycle. Examples of alkylating agents are busulfan, carboplatin, and chlorambucil. Common side effects include bone marrow suppression, nausea, vomiting, stomatitis, and alopecia. Nitrosoureas Acts similarly to alkylating agents but this crosses the blood-brain barrier. It is nonspecific in the cell cycle. Examples of nitrosoureas are carmustine, lomustine, and semustine. Common side effects of using this chemotherapeutic agent are delayed and cumulative myelosuppression, thrombocytopenia, nausea, vomiting and renal damage. Antimetabolites Interferes with the biosynthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis; inhibits DNA replication and repair. Antimetabolites are cell-cycle specific (S phase). Examples of antimetabolites include capecitabine, cytarabine, edatrexate fludarabine and methotrexatepentostatin. Common side effects of using this chemotherapeutic agent are Nausea, vomiting, diarrhea, bone marrow suppression, stomatitis, and renal toxicity (methotrexatepentostatin). Antitumor Antitumor interferes with DNA synthesis by binding DNA and prevents RNA synthesis. It is nonspecific in the cell cycle. Examples of antitumors include bleomycin, dactinomycin, daunorubicin, and doxorubicin. Common side effects of taking this chemotherapeutic agent are bone marrow suppression, nausea, vomiting, alopecia, anorexia, cardiac toxicity (daunorubicin, doxorubicin) Miscellaneous Agents Asparaginase, procarbazine ○ Inhibits protein, DNA, and RNA synthesis. This chemotherapeutic agent cell cycle specificity only varies. Common side effects include anorexia, nausea, vomiting, bone marrow suppression, hepatotoxicity, hypersensitivity reaction, and pancreatitis. Arsenic trioxide ○ Causes fragmentation of DNA resulting in cell death; in acute promyelocytic leukemia, it corrects protein changes and changes malignant T-cells into normal white blood cells. This chemotherapeutic agent cell cycle specificity only varies. Common side effects include nausea, vomiting, electrolyte imbalances, fever, headache, cough, dyspnea, and electrocardiogram abnormalities. CLO#6 Enumerate the types of gastrostomy tube, types of formula feeding and methods of gastrostomy feeding A surgically implanted device known as a gastrostomy tube, or G tube, provides direct access to your child's stomach for the purpose of supplementing their diet, staying hydrated, or administering medication. While there are many medical uses for G tubes, feedings to improve your child's nutrition are the most popular application. Types of gastrostomy tube - Low Profile Tube One of the most popular varieties of G tubes is a low-profile tube, sometimes referred to as a "button," which sits on top of the abdominal wall and is secured in the stomach by a balloon filled with water.  Pediatric patients: Low-profile tubes are often used for pediatric patients who are at risk of dislodging their tube or pulling on longer tubing. Active lifestyle: Low-profile tubes are less bulky and can lie discreetly under clothing, making them a good option for those who are active. Long-term feeding: If a patient is indicated for long term use, he or she may be a candidate for a low-profile device - Long tubes These tubes are surgically placed into the stomach and secured with stitches or a water-filled balloon. They're usually only recommended if a low-profile tube isn't suitable. Used when someone needs to receive nutrients, fluids, and medications directly into their stomach. The traditional tube that is most commonly used. - Percutaneous Endoscopic Gastrostomy (PEG) Placing a feeding tube is known as a percutaneous endoscopic gastrostomy (PEG) procedure. PEG tubes or G tubes are common names for these feeding tubes. You can take nutrition directly into your  stomach thanks to the tube. Enteral nutrition or enteral feeding are other names for this kind of feeding. Used for enteral feeding or abdominal decompression in patients who have difficulty eating or drinking. They are a semi permanent option and can be used for up to 12–18 months. Types of formula feeding - Standard formulas are the most often utilized by individuals with G-tubes. They contain polysaccharides and intact proteins, which have not been broken down. Typically, the proteins are taken out of soybeans, cow's milk, or  protein isolates that come from different foods. Glucose polymers like maltodextrin, modified starches, and all types of sugar are commonly found in carbohydrates. Usually, heat or chemical extraction is used to extract the fats from plant sources for standard formulas. Fish oils and modified oils, like MCT oils made from coconut and palm oils, may also be included. - Elemental formulas additionally referred to as monomeric, hydrolyzed, or chemically defined formulas) differ from standard formulas in that, for patients with impaired digestive systems or issues with nutrient absorption, their macronutrients have already partially or completely broken down. Patients with oral cancer typically do not require these formulas. - Specialized formulas are prescribed to address specific disease categories or profiles, such as oral cancer patients with diabetes or allergies. Standard formulas typically contain a lot of sugar, which can cause a sugar rush. Specialized diabetic formulas have a higher percentage of fats and lower carbohydrates, allowing sugars to be converted more slowly. Examples of specialized formulas for diabetic patients include Glucerna and Boost Glucose Control, available over-the-counter or with a doctor's prescription. Methods of gastrostomy feeding - Bolus Feeding are a means of giving patients who are unable to consume enough food orally large doses of enteral nutrition, or tube feeding. Using gravity, the formula is gradually injected into a syringe that is fastened to a feeding tube or button over a brief period of time—typically five to twenty minutes. - Continuous Feeding a method of enteral nutrition (EN) administration that involves delivering nutrients at a constant rate over time, usually for 16–18 hours, using a feeding pump CLO#7 Discuss the guidelines involved in Administration Of Chemotherapeutic Agents and Gastrostomy Feeding. Administration Of Chemotherapeutic Agents Before Verify the doctor’s order, patient identity, and informed consent. Perform medical handwashing. Prepare the materials in a dimly lit room. Wear appropriate personal protective equipment (PPE) (cap, mask, gown, gloves). Disinfect the vial and PNSS bottle/diluent. Reconstitute the chemotherapeutic agent using a sterile syringe and mix thoroughly. Label the drug with complete details, including hazardous-drug warnings. Place the drug in a sealed, labeled bag for transport. Ensure the preparation area is decontaminated, and all waste is disposed of in hazardous-waste containers. During Hang the chemotherapeutic agent bottle on the IV stand. Attach the agent line to the disinfected Y-port on the main IV line. Monitor patient’s vital signs and reactions: ○ At the start of infusion (15 minutes). ○ At the infusion peak. ○ At the end of infusion. After Dispose of waste in a hazardous-waste container. Remove PPE and perform medical handwashing. Document the procedure, including the drug details, patient reactions, and vital sign monitoring results. Gastrostomy Feeding Before Verify the patient’s chart and confirm identity. Explain the procedure to the patient and family. Perform medical handwashing. Prepare and bring materials to the bedside; ensure patient privacy. Place the patient in a semi-Fowler’s position. Auscultate bowel sounds and assess the site for irritation or abnormalities. During Pinch or kink the gastrostomy tube to prevent air entry. Aspirate residual volume (withhold feeding if >100 mL and notify the physician). Attach the syringe to the gastrostomy tube and initiate feeding by gravity. Refill the syringe gradually until the prescribed amount is administered. Flush the tubing with 30 mL of water. After Cover the tube with a cap and keep the patient in a semi-Fowler’s position for 30–45 minutes. Rinse reusable equipment and allow it to dry. Document the procedure, including: ○ Date and time. ○ Type and amount of feeding solution and water. ○ Patient’s response and tolerance. ○ Any abnormalities like cramping or diarrhea​ CLO#8 Cite common side effects of chemotherapy and the complications of gastrostomy and their appropriate nursing interventions Side Effects Nursing Interventions Nausea and vomiting Administer antiemetic medications as prescribed before and after chemotherapy sessions. Encourage small, frequent meals. Provide clear liquids and bland foods. Monitor for dehydration. Extreme fatigue and weakness Allow for rest and balance activity with adequate periods of rest. Educate the patient on energy conservation techniques. Encourage gentle exercise if appropriate. Hair loss (Alopecia) Provide emotional support and help the patient cope with body image changes. Offer information about wigs, scarves, and hats. Encourage the use of gentle hair care products.  Myelosuppression Monitor blood counts regularly. Take (Low Blood Cell Counts) precautions to prevent infection (neutropenic precautions). Administer blood transfusions or growth factors as needed. Complications Nursing Interventions Infection at Gastrostomy Site Maintain proper hygiene and clean the site as per protocol. Monitor for signs of infection (redness, swelling, discharge). Administer prescribed antibiotics if infection is suspected. Gastrostomy Tube Dislodgement Educate caregivers and patients on proper tube care and securement. Have replacement tubes and supplies readily available. If dislodgement occurs, cover the stoma with sterile gauze and seek medical assistance. Granulation Tissue Formation Assess the site regularly. Cleanse the area as per protocol. Apply appropriate wound care products if needed. Consult with a healthcare provider for management. Gastrointestinal Leakage Ensure proper placement and securement of the tube. Monitor for leakage and skin irritation. Adjust tube placement if necessary. Consider using skin barriers and absorbent dressings. CLO #9: list the types of vascular access device used for chemotherapy Vascular Access Device Picture Description 1. Tunnelled Tunnelled catheters are Catheters thin catheters that are (Hickman),(Broviac usually inserted into a ),(Groshong) large vein near the collarbone called the Internal Jugular. This is often used for patients that require long term therapy and are often referred to by their brand names. 2. Peripherally Abbreviated as “PICC” Inserted Central pronounced as “pick” it is Catheters (PICCs) a type of vascular access that is implanted at a peripheral area such as a vein in the arm. The catheter is then threaded (guided) into a larger vein called the superior vena cava. This type of vascular access is typically for medium-term therapy and allows for weeks/months of fluid/drug transfusions without constant needle sticks. 3. Totally implantable Also known as a venous access port-a-caths, they are the devices (PORTs) most common type of central venous access device used for long-term therapy. They are surgically implanted under the skin usually in the chest and go into a vein. Advantages of PORTs is that injectable drugs and fluids are easy to perform without the need of  needle sticking. PORTs are also able to remain in place for as long as necessary making it great for long term therapy patients who need regular therapy. It is also convenient to remove once it has served it’s purpose. CLO #10: examine the methods of chemotherapeutic administrations Method Example Description Intravenous This is considered the Chemotherapy most common method. The drug is infused intravenously through a device on your arm or chest. It can also be pushed if necessary. Oral Chemotherapy Chemotherapy drugs are taken in as a pill or capsule. Advantage is its convenience and noninvasiveness however it can be less predictable on how much is actually absorbed into the bloodstream. Examples pills/capsules include: cyclophosphamide (Cytoxan) etoposide (VePesid) capecitabine (Xeloda) methotrexate (Trexall) temozolomide (Temodar) Parenteral Chemotherapy Chemotherapy is administered using a syringe and needle through - intramuscular -Subcutaneous Regional Administration Regional variating administration depends on where the tumor or cancer is located. It is called regional because it doesn’t affect the entire system as intravenous, oral, and parenteral would. Examples include Intra-arterial (drug is injected into an artery supply the tumor), Intraperitoneal (drug is injected into the abdomen), intrathecal (spinal fluid), intravesical (bladder). Topical Chemotherapy Gels, lotions, and cream are available for skin type cancers. These drugs are just applied locally onto the cancer affected skin. CLO #11: Explain the nursing responsibilities before, during and after 11.1. CHEMOTHERAPY BEFORE Rationale 1. Review the chemotherapy drugs prescription. It should contain To ensure the correct dose and drug are - Name of anti-neoplastic agent administered by the correct route. - Dosage - Route of administration - Date & Time 2. Review treatment plan with To confim and thoroughly review the oncologist. course of action for the patient’s cancer care. 3. Identify the client accurately. To ensure that the correct dose and drug are administered by the correct route to the right patient. 4. Prepare for potential Anticipate potential complications to complications (review policies and prepare, have easy acess to the obtain medications and supplies supplies, and have onhand the needed for immediate medications needed for the immediate intervention) intervention of the complications. 5. Assure accurate preparation of the This ensures patient safety by checking agent condition of the chemtherapeutic agent. - Accuracy of dosage calculation - Expiry of drug - Correct procedure of reconstitution - Right administration 6. Assess patients understanding of To ensure that the patient fully the chemotherapeutic agents and understands the procedure, promote administration procedures. proper communication between the patient and the HCPs, and promote patient’s compliance to the procedure. DURING 1. Explain purpose and procedure to To provide the patient an understanding the client about the procedure. 2. The nurse will assess the client’s A catheter is placed on the patient’s arm and start an IV in the arm. veins to access the bloodstream. This allows medication to enter and be absorbed by the body’s circulation rapidly. 3. The nurse will begin saline solution To ensure that the IV line is clean and to through an IV. help reduce risk for infection or occlusion. AFTER 1. The nurse should help manage To control and prevent worsening of the side effects of the treatment side effects. 2. Inform client that they should The immune system is weaker than avoid people as much as possible usual and it may be harder for the due to weakened immunity. patient’s body to fight off infections. Informing the patient makes the patient aware to prevent crowds especially those with infections, coughs, or fever. 3. Encourage client to drink plenty of Treatment and some medications have fluids for 48 hours to help move side effects that could cause severe the drugs through the body. dehydration. Drinking plenty of water during treatment help make recovery a smoother process. 4. Monitor for signs of infection, The treatment can affect the body’s bleeding, respiratory status and system. Monitoring side effects such as bowel functioning. bleeding, increased risk for infection, etc. helps to prevent further complications from the side effects. 5. Focusing on promoting home and To guide the patient and the family on Community-Based care. what are to be expected with the patient’s condition, guided about what type of pain or discomfort to expect, how long the pain is expected to last, and when the pain indicates a problem that should be re-ported. 6. Educate on management of To help patient identify undesired side adverse effects so that patient can effects that may require intervention/s. self manage the illness and This also provides the patient knowledge facilitate coping strategies on how to succesfully manage side effects by themselves. 11.2. GASTROSTOMY CARE BEFORE 1. The nurse should assess the To assess the patient and their family’s ability of both patient and family attitude towards changes body image to adjust to a change in body and to promote a positive attitude image and to participate in towards the changes. self-care. 2. Explain the procedure and Helps to reduce patient’s worries or expected postoperative anxiety about the procedure and help outcomes. improve patient’s compliance. 3. Let the patient know that the To make patient aware of the procedure feeding tube will bypass the and what to expect. mouth and esophagus 4. Make the patient aware if ever To make patient aware of the changes the tube will be there that will be done to their body due to permanently. the procedure. DURING 1. Explain procedure and purpose To provide the patient a clear to client. understanding about the procedure. 2. Put on gloves and mix formula To maintain sterility while mixing the and pour total amount to be formula. given into a feeding bag. 3. Drape the towel over the To protect the client from moisture and patient’s abdomen next to the any spillage during the procedure. gastrostomy. 4. Ensure that patient is upright at A semi-fowler’s position will help gravity least 30 degrees. to empty the stomach after feeding and prevents regurgitation. 5. Check placement of the tube To ensure that the tube is in the right prior to each feeding. position and is properly secured. 6. Slowly attach feeding adapter to To prevent the formula from running the feeding bag and clamp the unexpectedly through the tubing. tube prior to pouring the formula Priming gets the air out of the tubing. and prime the tubing. 7. Utilize a syringe filled with room To ensure the patency of the tube. temperature water (30-60 ml) to flush the gtube. 8. The nurse should always turn on To prevent air from entering the the clamp with correct settings. stomach.  AFTER 1. Assess the patient’s fluid and Ensures that the patient has proper nutritional needs to ensure intake of fluid and other nutrients. To proper intake and GI function. assess the beneficial as well as detrimental effects of treatment. 2. Evaluate patient’s body image To identify patient’s perspective on own and help them cope with body and provide measures that self-care measures. promote positive health outcomes such us measure to prevent stress and anxiety. 3. The nurse must inspect tube for To ensure that the tube is patent and proper maintenance and check without any defects. Checking and incision for any drainage, skin monitoring of incision site helps to breakdown, or any sign of assess and detect if there are infection. complications and prevent them from getting worse. 4. The nurse should notify the To be able to provide the patient primary provider if excessive pain accurate pain management and prevent occurs in the incision site. further complications. CLO #12: Document client responses and outcomes after chemotherapy Client responses and outcomes for Chemotherapy Client Responses - 50% reduction in measurable tumor for one month - Organ Damage - Thinking and memory changes - Sexual and fertility problems - Depression - Second tumors Outcomes of Chemotherapy 1. Fever and Infection - Chemo lowers the number of WBCs in the body. Neutrophils are the type of WBC that fights an infection. An infection is most likely to occur when the neutrophil count is low. 2. Flu-like symptoms - Muscle aches and pain may occur around the third day following chemotherapy 3. Nausea and fatigue 4. Hair Loss - hair loss begins about two to three week after starting chemotherapy 5. Appetite and taste changes - Heightened sensitivity and reflux 6. Diarrhea and Constipation - some chemotherapy drugs causes diarrhea 7. Mouth Sores - Chemotherapy rapidly divides cells that line the mouth and esophagus 8. Neuropathy - Chemotherapy includes tingling and burning, numbness or pain. Client responses and outcomes for Gastrotomy Client response for Gastrotomy - Complications usually occur within three months, mostly minor. - The probability for surviving PEG for ❖ 30 days is 78% ❖ 1.5 years is 35% ❖ 4 years is 27% - Patients are impaired in most activities of daily living (ADLs) with little change over time. Outcomes - Frequency of chest infections, and stridor - Growth improvement - Pneumonia - Heart disease - Vascular disease of the central nervous system REFERENCES Admin. (2018, June 5). Commercial Formulas for the Feeding Tube - Oral Cancer Foundation | Information and Resources about Oral. 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