RN ADULT MEDICAL SURGICAL NURSING ( PDFDrive.com )_1012-1026.pdf

chapter 92 Unit 13 nursing care of clients with immune system disorders Section: Cancer-Related Disorders Chapter 92 Cancer Treatment Options Overview C...

chapter 92 Unit 13 nursing care of clients with immune system disorders Section: Cancer-Related Disorders Chapter 92 Cancer Treatment Options Overview Cancer treatment is based on the cell of origin of the cancer. When metastasis occurs, treatment is still based on the primary tumor origin even though the malignancy is located elsewhere in the body. Cancer treatment options focus on removing or destroying cancer cells and preventing the continued abnormal cell growth and differentiation. Treatments may be curative or palliative. The treatment plan is guided by many client factors (age, childbearing desire, pregnancy, current state of health expected lifespan) and may involve several treatment methods. Adjuvant treatment is what is given in addition to the primary treatment standard, and can include hormone, radiation, and targeted therapies; immunotherapy; and chemotherapy. Many cancers are curable when diagnosed early. Nursing care for clients who have cancer should include collaboration with supportive therapies and services, counseling, and transfer of care to another provider at discharge. Procedures Cancer treatment includes manipulation or removal of the tumor. ◯◯ Tumors may be reduced through topical procedures (cryosurgery, laser therapy, ablation) or by destruction of the main arteries that provide blood flow to the tumor (artery embolization). ◯◯ Tumor excision may be open or endoscopic (curettage and electrodissection for skin cancer). The tumor and tissue immediately surrounding it (tumor margin) are removed. The goal is that all of the outermost tissue that was removed does not contain cancer cells (a negative margin). Surgery may be done for excision, biopsy (diagnosis and staging), or for relief (palliation) based on clinical findings. Lymph node dissection or sentinel lymph node biopsy is done if the cancer spreads or there is added risk of spread. More extensive surgeries (tumors involving multiple organs or structures, lymph node involvement, deep lesions) increase the risk of complications and typically require longer recovery periods. Intensive care may be required. Nursing Actions: ☐☐ Obtain signed informed consent form. ☐☐ Prepare the client for procedures (NPO status, withhold or administer medications, as prescribed, monitor laboratory findings). ☐☐ Provide postoperative care as indicated by tumor location and procedure type. ☐☐ Prevent general postoperative complications (infection, fluid or electrolyte imbalance, hemorrhage, thromboembolism, inadequate oxygenation, shock). RN Adult Medical Surgical Nursing 999 CHAPTER 92 Cancer Treatment Options ☐☐ Prevent and treat pain as prescribed using pharmacological and nonpharmacological measures. ☐☐ Educate the client on care for drains, wounds, and implanted devices. ☐☐ Teach the client to monitor for complications after discharge. Chemotherapy Chemotherapy involves the administration of systemic or local cytotoxic medications that damage a cell’s DNA or destroy rapidly dividing cells. ◯◯ Chemotherapeutic agents are often selected in relation to their effect on various stages of cell division. Subsequently, combinations of anticancer medications are used to enhance destruction of cancer cells. ◯◯ Most chemotherapy agents are cytotoxic. The adverse effects of these agents are related to the unintentional harm done to normal rapidly proliferating cells, such as those found in the mucous membranes of the gastrointestinal tract, hair follicles, and bone marrow. ◯◯ Targeted therapy is a type of chemotherapy that is not cytotoxic. It blocks or slows actions that cause cell replication. ◯◯ Chemotherapy can be administered in a health care setting, provider’s office, clinic, or home. ◯◯ Depending on the agent, it can be given by the oral, parenteral, IV, intracavitary, or intrathecal route. Special training/certification is necessary for the administration of some agents. Implanted port – used when therapy is intended to be given on a long-term basis ☐☐ The port is comprised of a small reservoir that is covered by a thick septum. A central catheter is usually placed for chemotherapy administration or laboratory blood testing. Types include nontunneled percutaneous central catheter (triple lumen), peripherally inserted central catheter (PICC), tunneled percutaneous central catheter (Hickman, Groshong), and implanted port. (Refer to the chapter on Cardiovascular Diagnostic and Therapeutic Procedures.) Nursing Actions – Instruct the client/family in the proper use of vascular access devices. ◯◯ Extravasation of agents that are vesicants requires special, immediate attention to minimize tissue damage. Selection of a neutralizing solution is dependent on vesicant. Closely monitor the infusion site for evidence of infiltration. Intracavitary chemotherapy involves the administration of chemotherapy directly into a body cavity (pleural space, bladder). A small catheter may be used. ◯◯ Local irritation may be increased, but systemic adverse effects are usually prevented. ◯◯ In some cases, the medication may be removed following a “dwell time.” ◯◯ Nursing Actions Inform client that some discomfort may be present during infusion. Instruct the client to monitor for evidence of infection at the site of administration. Indications ◯◯ Chemotherapy can be used to cure a disease, help control its progression, or as palliative treatment for individuals who have a terminal disease. ◯◯ Chemotherapy is most commonly used for treatment of cancer, but it may also be used for other disorders, such as autoimmune diseases. 1000 RN Adult Medical Surgical Nursing  CHAPTER 92 Cancer Treatment Options Preprocedure ◯◯ Because administration of chemotherapeutic medications is limited to certified individuals, management of adverse effects is the primary focus of health care personnel. ◯◯ Instruct client on findings which indicate potential complications. Client should report findings immediately. Complications ◯◯ Immunosuppression due to bone marrow suppression by cytotoxic medications is the most significant adverse effect of chemotherapy. Nursing Actions ☐☐ Monitor temperature and white blood cell (WBC) count. ☐☐ A fever greater than 37.8° C (100° F) should be reported to the provider immediately. ☐☐ Monitor skin and mucous membranes for infection (breakdown, fissures, abscess). ☐☐ Cultures should be obtained prior to initiating antimicrobial therapy. ☐☐ If the client’s WBC drops below 1,000/uL, place the client in a private room and initiate neutropenic precautions. XX Have the client remain in his room unless he needs to leave for a diagnostic procedure or therapy. In this case, place a mask on him during transport. XX Protect the client from possible sources of infection (plants, change water in equipment daily). XX Have client, staff, and visitors perform frequent hand hygiene. Restrict visitors who are ill. XX Avoid invasive procedures that could cause a break in tissue unless necessary (rectal temperatures, injections). XX Keep dedicated equipment in the client’s room (blood pressure machine, thermometer, stethoscope). XX Administer colony-stimulating factors filgrastim (Neupogen, Neulasta) as prescribed to stimulate WBC production. Client Education ☐☐ Encourage the client to avoid crowds while undergoing chemotherapy. ☐☐ Take temperature daily. Report elevated temperature to the provider. ☐☐ Avoid food sources that could contain bacteria (fresh fruits and vegetables; undercooked meat, fish, and eggs; pepper and paprika). ☐☐ Avoid yard work, gardening, or changing a pet’s litter box. ☐☐ Avoid fluids that have been sitting at room temperature for longer than 1 hr. ☐☐ Wash all dishes in hot, soapy water or dishwasher. Always wash glasses and cups after one use. ☐☐ Wash toothbrush daily in dishwasher or rinse in bleach solution. ☐☐ Do not share toiletry or personal hygiene items with others. ☐☐ Report fever greater than 37.8° C (100° F) or other manifestations of bacterial or viral infections immediately to the provider. RN Adult Medical Surgical Nursing 1001 CHAPTER 92 Cancer Treatment Options ◯◯ Nausea and vomiting/anorexia Many of the medications used for chemotherapy are emetogenic (induce vomiting) or cause anorexia as well as an altered taste in the mouth. Serotonin blockers, such as ondansetron (Zofran), have been found to be effective and are often administered with corticosteroids, phenothiazines, and antihistamines. Nursing Actions ☐☐ Administer antiemetic medications at times that are appropriate for a chemotherapeutic agent (prior to treatment, during treatment, after treatment). ☐☐ Administer antiemetic medications for several days after each treatment as needed. ☐☐ Remove vomiting cues, such as odor and supplies associated with nausea. ☐☐ Implement nonpharmacological methods to reduce nausea (visual imagery, relaxation, acupuncture, distraction). ☐☐ Perform calorie counts to determine intake. Provide liquid nutritional supplements as needed. Add protein powders to food or tube feedings. ☐☐ Administer megestrol (Megace) to increase the appetite if prescribed. ☐☐ Assess for findings of dehydration or fluid and electrolyte imbalance. ☐☐ Perform mouth care prior to serving meals to enhance the client’s appetite. Client Education ☐☐ Instruct the client about the administration of antiemetics and schedule them prior to meals. ☐☐ Encourage the client to eat several small meals a day if better tolerated. Low-fat and dry foods (crackers, toast) and avoiding drinking liquids during meals can prevent nausea. ☐☐ Suggest that the client select foods that are served cold and do not require cooking, which can emit odors that stimulate nausea. ☐☐ Encourage consumption of high-protein, high-calorie, nutrient-dense foods and avoidance of low- or empty-calorie foods. Use meal supplements as needed. ☐☐ Encourage the use of plastic eating utensils, sucking on hard candy, and avoiding red meats to prevent or reduce the sensation of metallic taste. ☐☐ Teach the client to create a food diary to identify items that can trigger nausea. ◯◯ Alopecia is an adverse effect of certain chemotherapeutic medications related to their interference with the life cycle of rapidly proliferating cells. Nursing Actions ☐☐ Discuss the impact of alopecia on self-image. Discuss options such as hats, turbans, and wigs to deal with hair loss. ☐☐ Recommend soliciting information from the American Cancer Society regarding products for clients experiencing alopecia. ☐☐ Inform client that hair loss occurs 7 to 10 days after treatment begins (select agents). Encourage client to select hairpiece before treatment starts. ☐☐ Reinforce that alopecia is temporary, and hair should return when chemotherapy is discontinued. 1002 RN Adult Medical Surgical Nursing  CHAPTER 92 Cancer Treatment Options Client Education ☐☐ Instruct the client to avoid the use of damaging hair-care measures, such as electric rollers and curling irons, hair dye, and permanent waves. Use of a soft hair brush or wide-tooth comb for grooming is preferred. ☐☐ Suggest that the client cut her hair short before treatment to decrease weight on the hair follicle. ☐☐ After hair loss, the client should protect the scalp from sun exposure and use a diaper rash ointment/cream for itching. ◯◯ Mucositis (stomatitis) is inflammation of tissues in the mouth, such as the gums, tongue, roof and floor of the mouth, and inside the lips and cheeks. Nursing Actions ☐☐ Examine the client’s mouth several times a day, and inquire about the presence of oral lesions. ☐☐ Document the location and size of lesions that are present. Lesions should be cultured and reported to the provider. ☐☐ Avoid using glycerin-based mouthwashes or mouth swabs. Nonalcoholic, anesthetic mouthwashes are recommended. ☐☐ Administer a topical anesthetic prior to meals. ☐☐ Discourage consumption of salty, acidic, or spicy foods. ☐☐ Offer oral hygiene before and after each meal. Use lubricating or moisturizing agents to counteract dry mouth. Client Education ☐☐ Encourage the client to rinse mouth with a solution of half 0.9% sodium chloride and half peroxide at least twice a day, and to brush teeth using a soft-bristled toothbrush. ☐☐ Instruct client to take medications to control infection as prescribed (nystatin [Mycostatin], acyclovir [Zovirax]). ☐☐ Encourage the client to eat soft, bland foods and supplements that are high in calories (mashed potatoes, scrambled eggs, cooked cereal, milk shakes, ice cream, frozen yogurt, bananas, and breakfast mixes). ◯◯ Anemia and thrombocytopenia occur secondary to bone marrow suppression (myelosuppression). Nursing Actions for Anemia ☐☐ Monitor for fatigue, pallor, dizziness, and shortness of breath. ☐☐ Help the client manage anemia-related fatigue by scheduling activities with rest periods in between and using energy saving measures (sitting during showers and ADLs). ☐☐ Administer erythropoietic medications such as epoetin alfa (Epogen) and antianemic medications such as ferrous sulfate (Feosol) as prescribed. ☐☐ Monitor Hgb values to determine response to medications. Be prepared to administer blood if prescribed. RN Adult Medical Surgical Nursing 1003 CHAPTER 92 Cancer Treatment Options Nursing Actions for Thrombocytopenia ☐☐ Monitor for petechiae, ecchymosis, bleeding of the gums, nosebleeds, and occult or frank blood in stools, urine, or vomitus. ☐☐ Institute bleeding precautions (avoid IVs and injections, apply pressure for approximately 10 min after blood is obtained, handle client gently and avoid trauma). ☐☐ Administer thrombopoietic medications such as oprelvekin (Interleukin 11, Neumega) to stimulate platelet production. Monitor platelet count, and be prepared to administer platelets if the count falls below 30,000/mm3. Client Education ☐☐ Instruct the client and family how to manage active bleeding. ☐☐ Instruct the client about measures to prevent bleeding (use electric razor and soft-bristled toothbrush, avoid blowing nose vigorously, ensure that dentures fit appropriately). ☐☐ Instruct the client to avoid the use of NSAIDs. ☐☐ Teach the client to prevent injury when ambulating (wear closed-toes shoes, remove tripping hazards in the home) and apply cold if injury occurs. Radiation Therapy Radiation therapy involves the use of ionizing radiation to target tissues and destroy cells. ◯◯ Adverse effects include skin changes, hair loss, and debilitating fatigue. ◯◯ Can be administered internally with an implant(s) (brachytherapy) or externally with a radiation beam. ◯◯ The client’s body fluids are contaminated with radiation and should be disposed of appropriately, as directed by the facility. ◯◯ Radiation therapy can be given preoperatively to decrease the size of a tumor. ◯◯ Radiation exposure to health care personnel and visitors is reduced by limiting indirect contact time, maintaining indicated distances from sources of radiation, and preventing direct contact with the source. Internal Radiation Therapy ◯◯ Brachytherapy describes internal radiation that is placed close to the target tissue. This is done via placement in a body orifice (vagina) or body cavity (abdomen) or delivered via IV such as with radionuclide iodine, which is absorbed by the thyroid. ◯◯ Nursing Actions Place the client in a private room away from other clients when possible. Place appropriate sign on the door warning of the radiation source. Wear a dosimeter film badge that records personal amount of radiation exposure. Limit visitors to 30-min visits, and have visitors maintain a distance of 6 ft from the source. Visitors and health care personnel who are pregnant or under the age of 16 should not come into contact with the client or radiation source. Keep a lead container in the client’s room if the delivery method could allow spontaneous loss of radioactive material. Tongs are available for placing radioactive material into this container. Precautions listed above should be carried out at home if the client is discharged during therapy. 1004 RN Adult Medical Surgical Nursing  CHAPTER 92 Cancer Treatment Options ◯◯ Client Education Inform client of the need to remain in an indicated position to prevent dislodgement of the radiation implant. Instruct the client to call the nurse for assistance with elimination. Instruct client and family about radiation precautions needed in the health care and home environments. External Radiation Therapy ◯◯ External radiation or teletherapy is delivered over the course of several weeks and aimed at the body from an external source. ◯◯ Nursing Actions The client’s skin over the targeted area is marked with “tattoos” that guide the positioning of the external radiation source. Provide a well-balanced diet that does not contain red meat. Radiation can cause dysgeusia, making foods such as red meat unpalatable. Help the client manage fatigue by scheduling activities with rest periods in between and using energy-saving measures (sitting during showers and ADLs). Monitor for radiation injury to skin and mucous membranes and implement a skin care regimen. ☐☐ Skin – blanching, erythema, desquamation, sloughing, hemorrhage ☐☐ Mouth – mucositis, xerostomia (dry mouth) ☐☐ Neck – difficulty swallowing ☐☐ Abdomen – gastroenteritis Monitor CBC (possible decreased platelets and WBCs). ◯◯ Client Education Review nutrition considerations related to mucositis (avoid spicy, salty, acidic foods; hot foods may not be tolerated). Gently wash the skin over the irradiated area with mild soap and water. Dry the area thoroughly using patting motions. Do not remove or wash off radiation “tattoos” (markings) that are used to guide therapy. Do not apply powders, ointments, lotions, deodorants, or perfumes to the irradiated skin. Wear soft clothing and avoid tight or constricting clothes. Do not expose the irradiated skin to sun or a heat source. Inspect skin for evidence of damage and report to the provider. RN Adult Medical Surgical Nursing 1005 CHAPTER 92 Cancer Treatment Options Hormonal Therapy Hormone therapy is effective against tumors that are supported or suppressed by hormones. By giving a similar hormone, uptake of the support hormone is blocked, or production reduced. Hormone agonists, gonadotropin-releasing hormone agonists (GnRH) like leuprolide (Eligard, Lupron) are effective against tumors that require a particular hormone for support. ◯◯ The use of androgenic hormones in a client who has estrogen-dependent cancer can suppress growth of this type of cancer. ◯◯ Conversely, the use of estrogenic hormones for a testosterone-dependent cancer can suppress growth of this type of cancer. Hormone antagonists compete with the support hormone for binding sites on or in the tumor cell and are effective against tumors that require a particular hormone for support. ◯◯ The use of an anti-estrogen hormone in a client who has estrogen-dependent cancer can suppress growth of this type of cancer. ◯◯ The same is true for anti-testosterone hormones. Nursing Actions ◯◯ GnRH – Monitor cardiac status, along with blood pressure and for the occurrence of pulmonary edema. Client Education ☐☐ Inform male clients about the impact on sexual functions (decreased libido, erectile dysfunction) and feminizing effects of hormone therapy (gynecomastia, hot flashes, bone loss). ☐☐ Instruct the client to increase intake of calcium and vitamin D. ☐☐ Inform female clients of masculinizing effects (chest and facial hair growth, amenorrhea, decreased breast tissue). ◯◯ Androgen antagonists (flutamide [Eulexin]) – Monitor laboratory findings (CBC [anemia], calcium, increased liver enzymes). Client Education ☐☐ Alert the male client about the feminizing effects of hormone therapy (gynecomastia, erectile dysfunction). ☐☐ Advise the client to notify the provider of sore throat or bruising. ◯◯ Estrogen antagonists – tamoxifen (Nolvadex), anastrozole (Arimidex), trastuzumab (Herceptin) Ongoing Care ☐☐ Monitor CBC, clotting times, lipid profiles, calcium and cholesterol serum levels, and liver function for medication-related changes. ☐☐ Neurologic and cardiovascular functioning is monitored for changes. Client Education ☐☐ Inform the client of adverse effects, which include nausea, vomiting, hot flashes, weight gain, vaginal bleeding, and increased risk of thrombosis. ☐☐ Reinforce the need for yearly gynecologic exams and the need to take calcium and vitamin D supplements. 1006 RN Adult Medical Surgical Nursing  CHAPTER 92 Cancer Treatment Options Immunotherapy Immunotherapy (biotherapy) uses biologic response modifiers (BRMs), which alter a client’s biological response to cancerous tumor cells. Antibodies, cytokines, and other immune substances normally produced by the immune system are administered to increase the body’s defense against cancer. ◯◯ Interleukins and interferons are the two primary cytokines (immune response modulators) used in immunotherapy. Interleukins help coordinate the inflammatory and immune responses of the body, in particular, the lymphocytes. Interferons, when stimulated, can exert an antitumor effect by activating a variety of responses. ◯◯ Cytokines are the primary BRMs currently used, and they work to enhance the immune system. They help the client’s immune system recognize cancer cells and use the body’s natural defenses to destroy them. Nursing Actions ◯◯ Interleukins – Monitor for influenza-like symptoms and edema. ◯◯ Interferons – Monitor for altered mental status and lethargy. Monitor for peripheral neuropathy that may affect vision, hearing, balance, and gait. Take precautions for orthostatic hypotension. Client Education ☐☐ Instruct the client to immediately report influenza-like manifestations or changes consistent with peripheral neuropathy. ☐☐ Alert the client that skin rashes are common and use of a perfume-free moisturizer may be helpful. ☐☐ Instruct the client to avoid sun exposure and swimming if skin manifestations develop. Photodynamic Therapy Photodynamic therapy involves the injection of a photosensitizing agent that is absorbed by all the cells in the body. One to three days later when the agent remains in only the cancer cells, the tumor is exposed to a specific wavelength of light via an endoscope. Cells are subsequently destroyed and tumors are eliminated or reduced in size. ◯◯ Used to treat non-small cell lung cancer and esophageal cancer. ◯◯ Effective with small tumors close to body surface (within 1 cm). ◯◯ Adverse effects are related to the area of the body being treated. ◯◯ Nursing Actions – Instruct the client to avoid sun exposure for 6 weeks (limit time outdoors, wear sunglasses). RN Adult Medical Surgical Nursing 1007 CHAPTER 92 Cancer Treatment Options Supportive Treatment In addition to cancer treatment, the client may require assistance for altered body function or to meet emotional and spiritual needs. Clients who have cancer are at risk for inadequate nutrition related to diagnosis or treatment. (Refer to the chapter on Cancer and Immunosuppression Disorders in the Nutrition Review Module.) ◯◯ Nursing Actions Administer nutritional supplements or substitutes as prescribed. Monitor feeding tube or central line as appropriate. Encourage the addition of protein- and calorie-dense foods. Monitor for effectiveness of nutrition modifications (laboratory values, urine and bowel elimination, absence of GI upset). Monitor weight. Consult nutrition services. Clients may experience altered elimination. ◯◯ Nursing Actions Assist with alternate means of elimination (insert indwelling or intermittent urinary catheter, apply drainage devices) as indicated. Monitor urine and bowel output. Instruct the client on self-management of elimination. Body image changes are a factor in clients where surgery is disfiguring, especially cancers of the face or sexual organs (breasts or genitalia). ◯◯ Nursing Actions Encourage the client to express feelings. Encourage the client to look at or touch affected body areas. Assist the client with prosthetic devices, as indicated. Encourage the client to use positive measures to promote proper body image (makeup, clothing). Altered sexuality results from functional impairment or body image changes related to cancer treatments. Pain with sexual intercourse can also be a factor. ◯◯ Nursing Actions Encourage the client and partner to communicate feelings to each other. Administer hormone therapy, as prescribed. Instruct the client about medications to promote erection or manage pain sensation, as prescribed. The client’s ability to cope with the diagnosis and prognosis may be ineffective. ◯◯ Nursing Actions Administer medications for anxiety or depression, as prescribed. Encourage the client to express feelings verbally or through journaling and blogging. Encourage the client to participate in a support group (physical or online) for clients who have similar cancers. Make a referral to a community resource. 1008 RN Adult Medical Surgical Nursing  CHAPTER 92 Cancer Treatment Options Make a referral to counseling services for the client and family, as needed. Educate the client on anticipatory grief and the stages of grief. Consult palliative services, as indicated. Incorporate client’s beliefs and preferences regarding spirituality and illness/death. Cancer or cancer treatment may place the client in an immunocompromised state. ◯◯ Nursing Actions – Teach the client to avoid individuals with colds/infections/viruses. Other supportive nursing actions ◯◯ Facilitate safe activity, providing assistive devices when necessary for clients who have altered mobility or require assistance with self-care activities. ◯◯ Coordinate transfer of client care to home health, hospice, or tertiary care setting (rehabilitation center) as appropriate. ◯◯ Provide alternate means of communication for clients who have cancer affecting the mouth, throat, larynx, or vocal cords. ◯◯ Use assistive aids and devices for clients who have visual or hearing impairment. ◯◯ Consult physical therapy, and genetic or other counseling services as indicated. ◯◯ Consult pain management for persistent or uncontrolled pain. (See the chapter on Pain Management for Clients with Cancer.) RN Adult Medical Surgical Nursing 1009 CHAPTER 92 Cancer Treatment Options Application Exercises 1. A nurse is planning care for a client who is undergoing chemotherapy and is placed on neutropenic precautions. Which of the following interventions should be included in the plan of care? (Select all that apply.) A. Encourage a high-fiber diet. B. Remove plants from the room. C. Have the client wear a mask when leaving the room. D. Have client-specific equipment remain in the room. E. Eliminate raw foods from the client’s diet. 2. A nurse is caring for a client who is undergoing chemotherapy and reports severe nausea. Which of the following statements is appropriate for the nurse to make? A. “Your nausea will lessen with each course of chemotherapy.” B. “Hot food is better tolerated because of the aroma.” C. “Try eating several small meals throughout the day.” D. “Increase your intake of red meat as tolerated.” 3. A nurse is planning care for a client who has a platelet count of 25,000/mm3. Which of the following interventions should be included in the plan of care? A. Apply prolonged pressure to puncture site after blood sampling. B. Administer epoetin alfa (Epogen) as prescribed. C. Place the client in a private room. D. Have the client use an oral topical anesthetic before meals. 4. A nurse is caring for a client who has cervical cancer and undergoing brachytherapy. Which of the following are appropriate nursing interventions? (Select all that apply.) A. Permit visitors to stay 30 min at a time. B. Place the client on bed rest. C. Insert an indwelling urinary catheter. D. Administer fiber laxatives. E. Allow the skin “tattoo” guides for therapy to remain in place. 1010 RN Adult Medical Surgical Nursing  CHAPTER 92 Cancer Treatment Options 5. A nurse is caring for a client who has mucositis due to chemotherapy to treat cancer. Which of the following actions should the nurse take? A. Use a glycerin-soaked swab to clean the client’s teeth. B. Encourage increased intake of citrus fruit juices. C. Obtain a culture of the lesions. D. Provide an alcohol-based mouthwash for oral hygiene. 6. A nurse is leading a discussion with a group of female clients who have alopecia and are undergoing chemotherapy. What should be included in the discussion? Use the Active Learning Template: Systems Disorder to complete this item to include the following sections: A. Pathophysiology of the Problem B. Client Education: Describe at least four teaching points. C. Nursing Interventions: Describe at least two. RN Adult Medical Surgical Nursing 1011 CHAPTER 92 Cancer Treatment Options Application Exercises Key 1. A. INCORRECT: There is no benefit in placing a client who has neutropenia on a high-fiber diet. B. CORRECT: Neutropenic precautions include the client not having contact with flowers and plants due to the presence of surface infectious agents in the water and soil. C. CORRECT: Neutropenic precautions include having the client wear a mask when leaving the room to reduce the incidence of infection. D. CORRECT: Neutropenic precautions include having equipment available that is only for use in caring for the client to reduce the incidence of infection. E. CORRECT: A client who is neutropenic should avoid consuming raw foods due to the presence of surface infectious agents on peeling and rind. NCLEX® Connection: Pharmacological and Parenteral Therapies, Pharmacological Pain Management 2. A. INCORRECT: Nausea usually occurs to the same extent with each session of chemotherapy. B. INCORRECT: Cold foods are better tolerated than warm/hot foods because odors from heated foods can induce nausea. C. CORRECT: Several small meals a day are usually better tolerated by the client who has nausea. D. INCORRECT: Red meat is not tolerated well by the client undergoing chemotherapy because the taste of meat is frequently altered and unpalatable. NCLEX® Connection: Pharmacological and Parenteral Therapies, Pharmacological Pain Management 3. A. CORRECT: Bleeding precautions should be implemented for the client who has thrombocytopenia. B. INCORRECT: Epoetin alfa (Epogen) is administered to the client who has anemia. C. INCORRECT: The client who is neutropenic is placed in a private room. D. INCORRECT: A topical oral anesthetic is used for the client who has mucositis. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures 1012 RN Adult Medical Surgical Nursing  CHAPTER 92 Cancer Treatment Options 4. A. CORRECT: The client who has cervical cancer will have a vaginal radiation implant, so visitors should remain for 30 min at a time and maintain a distance of 6 ft. B. CORRECT: The client who has cervical cancer will have a vaginal radiation implant, and bed rest is needed to prevent displacement of the implant. C. CORRECT: The client who has cervical cancer will have a vaginal radiation implant, and a catheter is needed to prevent displacement of the implant during ambulation. D. INCORRECT: Fiber laxatives, which stimulate bowel movements, are not used to prevent displacing the vaginal radiation implant. E. INCORRECT: Skin “tattoo” guides are used for the client undergoing external radiation therapy, not brachytherapy. NCLEX® Connection: Physiological Adaptations, Alterations in Body Systems 5. A. INCORRECT: Glycerin-based swabs should be avoided when providing oral hygiene to the client who has mucositis. B. INCORRECT: Acidic foods should be discouraged for the client who has oral mucositis. C. CORRECT: A culture of oral lesions is obtained to identify pathogens and determine appropriate treatment. D. INCORRECT: Nonalcoholic mouthwashes are recommended for the client who has mucositis. NCLEX® Connection: Physiological Adaptations, Unexpected Response to Therapies 6. Using the Active Learning Template: Systems Disorder A. Pathophysiology of the Problem Alopecia occurs as an adverse effect of chemotherapy medications. They interfere with the life cycle of rapidly proliferating cells, such as those found in hair follicles, resulting in hair loss. B. Client Education Wear hats, turbans, and wigs. Avoid the use of damaging hair-care measures, such as electric rollers and curling irons, hair dye, and permanent waves. Use a soft hair brush or wide-tooth comb for grooming. Avoid sun exposure. Use a diaper rash ointment or cream for itching. Alopecia is temporary, and hair will return when chemotherapy is discontinued. C. Nursing Interventions Discuss the impact of alopecia on self-image. Encourage the client to express feelings. Recommend use of information from the American Cancer Society on managing alopecia. Provide referral to a cancer support group. NCLEX® Connection: Physiological Adaptations, Alterations in Body Systems RN Adult Medical Surgical Nursing 1013