Chemotherapy Administration PDF

CHEMOTHERAPY ADMINISTRATION Ma. Concepcion Maico-Bacus, EdD, MAN, RN Clinical Instructor  Chemotherapy, a cornerstone of cancer treatment, involves the use of drugs to kill cancer cells. While highly effective, it can also lead to adverse effects, including administration challen...

CHEMOTHERAPY ADMINISTRATION Ma. Concepcion Maico-Bacus, EdD, MAN, RN Clinical Instructor  Chemotherapy, a cornerstone of cancer treatment, involves the use of drugs to kill cancer cells. While highly effective, it can also lead to adverse effects, including administration challenges, extravasation, and hypersensitivity reactions. Administered in hospital outpatient centers or home settings. Routes depend on agent type, dosage, and cancer location. Route of Administration: Chemotherapy drugs can be administered intravenously, orally, topically, or intrathecally. Each route has its own challenges and potential complications.  Dosage Based on body surface area, weight, previous treatments, and organ (renal, hepatic) function. Dosage aims to maximize cancer cell kill while minimizing harm to healthy tissues. Dosage modifications may be needed due to toxicities. Mixing incompatible drugs can lead to precipitation or inactivation, affecting drug delivery and efficacy. Special regimens include: standard-dose therapy, dose-dense therapy (more frequent), and myeloablative therapy for stem cell transplant. Lifetime dose limits for certain drugs to avoid irreversible damage (e.g., doxorubicin at 550 mg/m² due to risk of cardiomyopathy).  Special regimen: Standard-Dose Therapy Description: The most commonly used chemotherapy regimen where drugs are administered at standard doses according to the patient's body surface area or weight. Purpose: Designed to kill cancer cells while limiting damage to healthy cells. Administration: Typically follows a fixed schedule (e.g., every 2-3 weeks) to allow the body time to recover between treatments.  Special regimen: Dose-Dense Therapy Description: Involves giving chemotherapy at shorter intervals than standard therapy (e.g., every 1-2 weeks instead of every 3 weeks). Purpose: By reducing the time between doses, the goal is to kill cancer cells more effectively before they have time to recover and grow. Administration: Requires careful management of side effects, such as low blood cell counts, often with the help of growth factors to boost blood cell production.  Special regimen: Myeloablative Therapy Description: Involves very high doses of chemotherapy that completely destroy bone marrow cells. Purpose: Used to eliminate cancer cells before a hematopoietic stem cell transplant (HSCT), where healthy stem cells are infused to restore bone marrow function. Administration: Typically reserved for aggressive cancers or hematologic malignancies like leukemia. It leaves the patient highly vulnerable to infection and bleeding until the new stem cells engraft.  Nursing Management Ensure proper training: Nurses must be certified in chemotherapy administration and knowledgeable in managing potential complications (e.g., extravasation). Patient education: Explain the purpose, side effects, and expected outcomes of chemotherapy. Educate on at-home safety practices if applicable, such as proper handling of oral chemotherapeutic agents and the importance of adhering to schedules. Pre-administration assessment: Review the patient's medical history, lab results (e.g., CBC, kidney/liver function), and baseline vital signs. Assess venous access sites if IV administration is used. Monitor patient during administration: Observe for signs of hypersensitivity reactions, nausea, vomiting, and psychological distress. Ensure adherence to institutional safety protocols: Use proper personal protective equipment (PPE) when handling chemotherapy drugs to prevent exposure. Accurate calculation: Ensure chemotherapy dosage is calculated based on body surface area (BSA), weight, and other specific patient factors. Monitor for toxicities: Assess for symptoms of organ dysfunction (kidneys, liver, heart). Regularly review laboratory results to determine the need for dosage adjustments. Adjustments for critical lab values: Collaborate with oncologists to modify dosage based on lab results or clinical signs of toxicities (e.g., neutropenia). Ensure maximum lifetime dose limits: For drugs like doxorubicin, monitor cumulative doses to avoid exceeding safe thresholds.  Extravasation Occurs when chemotherapy leaks from a vein into surrounding tissues. Types include: Irritants: Cause localized inflammation, generally not severe. Vesicants: Cause severe tissue damage, including necrosis. Common vesicants: Dactinomycin, daunorubicin, nitrogen mustard, etc. Vesicant administration precautions: Avoid peripheral veins in the hand or wrist. Use central venous access for frequent or prolonged infusions. Causes Clinical Manifestations Poor vein selection Inadequate fixation of the IV catheter Pain, redness, swelling, and Mechanical obstruction of the warmth at the infusion site vein Blistering or tissue necrosis Rapid infusion rate Potential for tissue damage and Drug-induced phlebitis scarring  Medical Management Immediate cessation of the infusion Application of a cold compress to the affected area Administration of a neutralizing agent (if available) Monitoring for tissue damage and scarring  Nursing Management Prevention Management Use central venous catheters (e.g., PICC lines Instruct patients to report any burning, pain, or portacaths) for vesicants. or discomfort at the infusion site immediately. Ensure proper site selection for peripheral IV Regularly monitor the infusion site for administration (preferably in the forearm). redness, swelling, or discomfort. Use a soft plastic catheter for short infusions Stop the infusion immediately if extravasation in peripheral veins. is suspected Select appropriate veins Notify the physician Secure the IV catheter properly Apply antidotes if applicable (e.g., hyaluronidase for vinca alkaloids). Monitor the infusion site for signs of extravasation Elected the affected limb and apply Administer drugs at a suitable rate cold/warm compresses as recommended (based on the drug) Document the incident  Hypersensitivity Reactions (HSRs) Definition: Hypersensitivity reactions are adverse immune responses to chemotherapy drugs. Types: Hypersensitivity reactions can be classified into four types: Type I (immediate): Allergic reactions, often involving histamine release à 5 mins to 6 hrs after infusion started Type II (cytotoxic): Drug-induced hemolysis or thrombocytopenia Type III (immune complex-mediated): Serum sickness-like reactions Type IV (delayed-type): Contact dermatitis à after infusion completion  Clinical Manifestations Urticaria, angioedema, pruritus Wheezing, dyspnea, chest tightness Hypotension, tachycardia Anaphylaxis  Medical Management Immediate cessation of the infusion Assessment of airway, breathing, circulation (ABCs) Administration of antihistamines, corticosteroids, and potentially epinephrine for severe reactions Monitoring for organ dysfunction  Nursing Management PREVENTION MANAGEMENT Obtaining a thorough allergy history Stop the infusion immediately if signs Premedicate with antihistamines, of a reaction occur corticosteroids, acetaminophen as Assess the pt’s ABCs indicated Notify the physician Observe patients closely, especially Desensitization protocols: If a critical during the first 15–30 minutes of agent causes an HSR, a slower infusion infusion. rate or desensitization may be Monitor for signs of hypersensitivity required for subsequent treatments. during infusion Administer medications as ordered Ensure resuscitation equipment and Document the incident and follow emergency medications (epinephrine) institutional protocols are readily available Chemotherapy Toxicities  GI System NAUSEA & VOMITING STOMATITIS & MUCOSITIS Administer antiemetics (e.g., Inspect oral cavity regularly serotonin blockers, corticosteroids) Perform regular oral care with non- before and after chemotherapy as irritating solutions; soft-bristled prescribed. toothbrush; avoid mouthwash Encourage small, frequent meals, containing alcohol bland foods and avoid foods that Encourage a soft diet and avoid spicy trigger nausea. or acidic foods. Teach relaxation techniques, imagery, Prescribe topical anesthetics or acupressure, or acupuncture protective agents (e.g., magic mouthwash) to alleviate pain.  Hematopoietic System MYSELOSUPPRESSION ANEMIA Monitor blood cell counts Monitor hemoglobin and frequently hematocrit levels and signs of Educate pts about strategies to fatigue or pallor protect against infection, injury, Erythropoietin (EPO) or blood blood loss transfusions as prescribed Administer colony-stimulating Encourage rest and energy factors as prescribed conservation  Hematopoietic System NEUTROPENIA THROMBOCYTOPENIA Educate pts on infection Monitor platelet counts and prevention (hand hygiene, signs of bleeding (bruising, avoiding large crowds) petechiae) Monitor WBC counts regularly Educate pts to avoid injury, use Administer granulocyte colony- soft toothbrushes and avoid stimulating factor (G-CSF) as sharp objects prescribed  Renal System RENAL DYSFUNCTION HEMATURIA/HEMORRHAGIC Monitor laboratory values (BUN, CYSTITIS serum creatinine, creatinine Encourage frequent voiding and clearance, serum electrolytes) diuresis Ensure adequate hydration and Increase fluid intake diuresis to prevent Monitor for signs of bleeding nephrotoxicity (agents like cisplatin) Administer medications like mesna to protect the bladder if Administer (renal protectants) cyclophosphamide or ifosfamide allopurinol or amifostine as is used prescribed  Cardiopulmonary System CARDIAC TOXICITY CAPILLARY LEAK SYNDROME Monitor cardiac ejection fraction Monitor for signs of respiratory and other signs of heart failure distress Administer cardioprotectant Administer supportive care as medications as prescribed needed PULMONARY TOXICITY Monitor pulmonary function test results Administer steroids and other supportive therapies as prescribed  Reproductive System INFERTILITY TERATOGENICITY Educate pts about potential Advise pts to use reliable changes in reproductive function methods of birth control Encourage sperm or eff banking before treatment  Neurological System NEUROTOXICITY PERIPHERAL NEUROPATHY Monitor for changes in Educate pts about strategies to sensation, motor function, and manage pain and discomfort cognitive function Consider physical therapy or Administer supportive care as occupational therapy needed  Cognitive Impairment Encourage strategies to improve memory and concentration Provide support and education to pts and their families  Fatigue Encourage a balanced schedule of rest and activity. Provide education on energy- conservation techniques. Consider pharmacological and non-pharmacological interventions for fatigue reduction (e.g., light exercise, nutrition support). ~ End of lecture ~