jcmendiola_Achievers 2013

Care of Clients in Cellular Aberrations,

Acute Biologic Crisis (ABC), Emergency and Disaster Nursing
(NCM106)
Cellular Aberration I

Cellular Aberration
- Basic structural and functional unit of an organism

Cell Cycle
- Is a coordinated sequence of events resulting in duplication of
DNA and division into 2 daughter cell

4 Phases of the Cell Cycle
1. G1 / Gap Phase
Lasts from hours to days / longer
RNA and Protein synthesis occurs in preparation for DNA replication
2. S Phase / Synthesis Phase
Lasts from 10 20 hours
DNA replication in preparation for division
3. G2 / Gap 2
Ranges from 2 10 hours
DNA synthesis while RNA and Protein synthesis continues
4. M Phase / Mitosis Phase
Lasts from 30 60 minutes
Cell division occurs
After mitosis the daughter cells enter the G1 Phase and begin the reproductive cycle again
5. G0 / Resting Phase
Is activity to reenter the cell cycle in response to various stimuli that signal for cell renewal

CELL CYCLE

Oncology Nursing
- Field of specialty
- Nurse must be equipped to support patient and
family through a wide range of physical, emotional,
social, cultural and spiritual crises
- Provide realistic support to those receiving nursing
care and use standards of practice and nursing
process as basis of care





Cellular Aberration
- A group of disorders characterized by abnormal cell growth and the ability to metastasize with potential in
killing the host
- The term cancer refers to the group of diseases in which cells grow and spread unrestrained throughout
the body
- Derived from the Latin word crab which means Cancer
- Synonymous with neoplasm

LOOKY
HERE
1. Introduction on Cellular
Aberration
2. Multistage Theory of
Oncogenesis
3. Tumor Invasion and Metastasis
4. Primary Prevention and Control
5. Secondary Prevention and Early
Detection
6. Staging
7. Chemotherapy


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INCIDENCE and EPIDEMICS
Male Female
Most Common Cause of Death Most Common Cause of Death
Prostate Cancer
(33%)
Lung Cancer
(31%)
Breast Cancer
(32%)
Lung Cancer
(27%)
Lung Cancer
(13%)
Prostate Cancer
(10%)
Lung Cancer
(12%)
Breast Cancer
(15%)
Colorectal Cancer
(10%)
Colorectal Cancer
(10%)
Colorectal Cancer
(11%)
Colorectal Cancer
(10%)
Bladder Cancer
(7%)
Pancreatic Cancer
(5%)
Endometrial Cancer
(6%)
Ovarian Cancer
(6%)
Cutaneous Melanoma
(5%)
Leukemia
(4%)
Non-Hodgkins Lymphoma
(4%)
Pancreatic Cancer
(6%)

TOP 5 Cancer Incidences by Site and Sex
Male Female
1. Prostate 1. Breast
2. Lungs 2. Lungs
3. Colon 3. Colon
4. Urinary Tract 4. Uterus
5. Leukemia 5. Leukemia and Lymphoma

Women Men
- Breast Cancer followed by lung
and colon and rectum
- High incidence of cancer of the lung and bladder
- Most common neoplasm aged 20 34; testicular Cancer

Etiologic Agent
1. Viruses and Bacteria
Oncogenic viruses
Prolonged / frequent viral infections may cause breakdown of the immune system / overwhelm the
immune system
2. Chemical Carcinogens
Act by causing cellular mutation / alterations in cell enzymes and protein
E.g. Industrial compounds vinyl chloride, polycyclic aromatic hydrocarbons, fertilizers, weed
killers, dyes and drugs
3. Physical Agents
Radiation X-ray / radioactive isotopes and sunlight / UV Rays
Physical Irritation/ trauma Pipe smoking, multiple deliveries, ragged tooth, irritation of the
tongue, overuse of any organ / body part
4. Hormonal Agents
Estrogen as replacement therapy incidence of vaginal and cervical adenocarcinoma
Estrogen, diethylstilbestrol (DES)
5. Genetics and Familial Factors
Oncogene When exposed to carcinogens Changes in the cell structure Becomes
malignant

Predisposing Factors
1. Age Older individuals exposed to carcinogens longer develop immune system alterations
2. Sex
Women = Breast, Uterus, Cervix Cancer
Men = Prostate, Lung Cancer
3. Occupation E.g. Chemical factory worker, radiology department personnel
4. Hereditary Greater risk with positive family history


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Urban Versus Rural Incidence
- Common among URBAN DWELLERS than RURAL RESIDENCES
(Greater exposure to carcinogens)
- Geographic Distribution
o Cancer in stomach Japan
o Breast Cancer US; due to environmental diet, ethnic customs and types of pollution

5. Psychological Stress
Depression, grieving, anger, aggression, despair or life stresses decreases immune competence
(Affects hypothalamus and pituitary gland)
Immunodeficiency may spurt the growth and proliferation of Cancer cells

6. Precancerous Lesions
o May undergo transfer into cancer lesion and tumor
o E.g. Pigmented moles, burn scars, senile keratosis, leukoplakia, benign polyps, adenoma of the
colon / stomach fibrocystic disease of the breast
7. Obesity
Studies have linked obesity to breast and colorectal Cancer

Factors to Consider
MR JUAN DELA CRUZ

Etiology
- Carcinogens The process of transferring a
normal cell into cancerous cell which
consists of 3 Stages
1) Initiation (Carcinogen)
2) Promotion, repeated exposure to promote agents (Carcinogen)
3) Progression ( Malignancy behavior)


D Drugs
E Educational Attainment
L Living Conditions
A Ask family History
C Culture
R Radiation Therapy
U Ur Activity
Z Zex
M Marital Status
R Race
J Job
U Ur Life Style
A Age
N Nutrition



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Multistage Theory of Oncogenesis
1. Cellular Transformation and Pre-agent Theory
+ Conceptualize that normal cells may be transformed into cancer cells due to exposure to etiologic
agents
2. Failure of the Prime Resource Theory
+ Advocates that all individuals possess cancer cells, however the cancer cells are recognized by the
immune system so the cancer cells undergo destruction
+ Failure of the immune response system leads to inability to destroy the cancer cells

TERMS
1. Cell Proliferation
Is the process whereby cells divide and bear offspring, it normally is regulated so that the number
of cells that are actively dividing is equal to the number of dying / being shed
2. Differentiation
Is the process whereby proliferative cells are transformed into different and more specialized cell
types, as they proliferate it determines what a cells looks like, and how it functions, how long it
will live
3. Apoptosis
It is the process of programmed death of unwanted cells




















BENIGN GROWTH PATTERN
1. Hypertrophy
In cell size resulting in an in organ size!
2. Hyperplasia
A reversible in the number of cells in an organ or tissue in response to a specific growth stimulus
3. Metaplasia
Conversion of one cell type to another cell type not usually found in the involved tissue
4. Dysplasia
Characterized by abnormal changes in the size, shape, or organization of cells
Reversible when stimulus is removed


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5. Anaplasia
Disorganized irregular cells that have no structure and have loss of differentiation, the result is
almost malignant

CLASSIFICATIONS OF TUMORS
1. Benign
+ Are tumors designated by attaching the suffix oma to the cells of organ
+ E.g. Fibroma, Chondroma,, Osteoma
2. Malignant
+ Tumors that are capable of spreading by invasion and metastasis
+ E.g. Fibrosarcoma, Chondrosarcoma

CATEGORIES OF MALIGNANT NEOPLASMS
1. Carcinogens Growth from epithelial cells, usually solid tumors
2. Sarcoma Arise from muscle, bone, fat and connective tissue, may be solid
3. Lymphoma Arise from lymphoid tissues
4. Leukemia and Myeloma Grows from blood forming organs

Nomenclature of Tumors
Tissue of Organ Benign Malignant
Connective tissue and derivatives Fibroma
Lipoma
Chondroma
Osteoma
Fibrosarcoma
Liposarcoma
Chondrosarcoma
Osteogenic Sarcoma
Blood Vessels Hemangioma Angiosarcoma
Lymphatic Vessels Lympangioma Lymphangiosarcoma
Brain Meningioma Invasive Meningioma
Hematopoietic Cells Leukemia
Lymphatics Malignant lymph***
Smooth Muscles Leiomyoma Leiomyosarcoma
Stratified Muscles Rhabdomyoma Rhabdomyomasarcoma
Epithelial Tumors
Stratified Squamous Squamous cell papilloma Squamous cell carcinoma
Basal Cells Basal Cells carcinoma
Liver Cells Liver cell adenoma Hepatocellular Carcinoma
Placental epithelium
(Trophoblast)
Hydatidiform Mole

Tumor Invasion and Metastasis
Invasion
Occurs when cancer cells infiltrate adjacent tissues surrounding the neoplasm
Metastasis
Occurs when malignant cells travel through the blood / lymph and invade other tissues and organs
to form a secondary tumor
Types of Metastasis
Extension and Invasion
1. Lymphatic Spread
2. Seeding of body cavities and surfaces
3. Hematogenous spread
Spread of cancer cells from a primary tumor to distant sites
Break away
Only malignant cells has the capability
Lymph, blood, serosal seeding

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Comparison of the Characteristics of Benign and Malignant Neoplasms
Characteristics Benign Malignant
Speed of Growth Slow growth
Grows by expansion
Aggressive growth; rapid cell
division and growth
Mode of Growth Localizes and encapsulation Establishes new site malignant
lesion
Cellular Characteristics Well-differentiated Invade surrounding tissues
Metastasis It does not metastasize
No tissue damage
With poor cellular differentation
Prognosis Very good prognosis
Does not cause death, unless
localization affects vital functions


Malignant Cells Mitosis
o Mitosis Multiple daughter cells that may / may not resemble the parent, multiply mitotic spindles
1. Larger, grows more rapidly than normal cells
2. Cells not as cohesive, irregular pattern of expansion
3. Larger, more prominent nucleus
4. Lack characteristic pattern of organization of host cells
5. Anaplastic = Lack of differentiated cell characteristics specific function

Malignant Cells Growth
1. Invade adjacent tissues
2. Proliferation in response to abnormal stimulus
3. Grow in adverse condition such as lack of nutrients
4. Do not exhibit contact-inhibition
5. Cell birth exceeds cell death
6. Loss of cell control as a result of cell membrane changes
7. Growth rate, erratic
8. Able to break off cells that migrate through blood stream / lympati** seed to distant sites and grow in other
sites

Malignant Cells Function
1. Senseless, no useful purpose
2. Do not contribute to the well-being of the host, parasitic
3. If the cells function at all, they do not function normally may cause damage

Malignant Cells
1. Develop antigens completely different from a normal cell
2. Chromosomal aberrations occur as a cell matures
3. Has a more prominent and simplified metabolic enzyme pattern
4. Invasive and spreads
5. Grow in presence of necrosis and inflammatory cells such as lymphocytes and macrophages
6. Exhibit periods of latency that vary from tumor to tumor
7. Have own blood supply and suppository stoma (Angiogenesis factory 2 cm in diameter)

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Primary Prevention and Control
WARNING SIGNS OF CANCER (CAUUUTIONALF)
C Change in bowel / bladder habits
A A sore that does not heal
U Unusual bleeding / discharge
U Unexplained sudden weight loss
U Unexplained anemia
T Thickening / lump in the breast or elsewhere
I Indigestion or difficulty in swallowing
O Obvious change in wart / mole
B Nagging cough / hoarseness
A Anemia
L Loss of weight
F Fever of unknown origin

Screening
1. Familial and environmental history
2. Physical Examination
3. Evaluation of laboratory findings and test findings
4. Screening methods
Brest
Monthly BSE = all women ages 20 and above 1 week after menses
Mammography every year from age 40 years old
Colon and Rectum
Fecal occult blood test every year beginning at age 50
Proctosigmoidoscopy every 3- 5 years after 50 years old following 2 negative annual
exams
Uterus
Yearly pelvic examination and PAP Smear test for sexually active girls and any woman
over 18 or less often for 3 consecutive negative results
An endometrial sample at menopause for high risk women
Prostate
Digital Rectal Exam (DRE) yearly beginning at age 50
Prostate-Specific Antigen (PSA) test yearly beginning at age 50

Secondary Prevention and Early Detection
NON INVASIVE DIAGNOSTIC PROCEDURES
^ Diagnostic Imaging Methods
Important in the diagnosis and staging of cancer
Used to guide the surgeon to the appropriate area for biopsy
Use of this modality is guided by physical examination
Clinical instruction through collaboration with the radiology specialist
^ X-RAY
Sites speaks
View the dynamic function of an organ
^ Mammography
Used to screen for malignancies of the breast
Should be conducted with clinical findings
^ CT Scan
Obtain images from various angles through the body such as lungs, soft tissue, blood vessels
Preferred method for diagnosis, liver, kidney and pancreatic cancer
10 Steps for Cancer
Prevention and Protective
Factors
1. Increase consumption of fresh
vegetables
2. Increase fiber intake
3. Increase Vitamin A
4. Increase Vitamin C
5. Practice weight control
6. Decrease dietary fat and
7. Decrease salt
8. Stop cigarette smoking
9. Decrease alcohol intake /
substance abuse
10. Void overexposure to sun


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^ MRI
Preferred imaging technique for soft tissue structures, hematologic imaging, vascular imaging and
avascular necrosis
Not exposed to radiation

INVASIVE DIAGNOSTIC PROCEDURE
* Histologic / Cytologic Examination
o For malignant tissues to be identified by name, grade and stage
o Morphologic feature of the cells are examined
3 Basic Methods of Specimen Collection
1. Exfoliation from an epithelial surface (pap smear) or bronchial washing
2. Aspiration of fluid from body cavities or blood
3. Needle suction aspiration of solid tumor
* Direct Visualization
1. Sigmoidoscopy (Viewing the sigmoid colon by use of fiberoptic flexible sigmoidoscopes
2. Cystoscopy (Viewing the urethra and bladder)
3. Endoscopy (Viewing of the upper GIT)
4. Bronchoscopy (Inspection of the tracheobronchial tree
LABORATORY STUDIES
Tumor Markers
Biochemical substances synthesized and released by tumor cells
May be protein products exerted by cancer cells, released in response to the presence of cancer
cells or other conditions
Used to aid in the diagnosis of cancer to determine recurrence or identify regression of a known malignancy
TUMOR MARKER DESCRIPTION
1. Oncofetal Antigen Present in fetal tissue normally suppressed after birth
2. Hormones Present in considerable amount
High levels in hormone-secreting malignancies
3. Isoenzymes Elevated levels can promote hyperplasia of the tissue (Prostate acid
phosphatase)
4. Tissue-Specific Protein Narrows down the type of malignancy that can be increased in
hyperplastic disorders
5. Prostate-Specific Antigen Useful in evaluating response to treatment, recurrent surgery / radiation
therapy
Elevated in prostate cancer, can be elevated in BPH in older men, should
be accompanied with DRE
6. S-100 Found in melanoma cells
Elevated means METASTATIC MELANOMA
7. Thyroglobulin Protein made by the thyroid gland
Removal of the entire gland with or without radiation therapy
Rise in thyroglobulin levels indicate cancer recurrence
8. Estrogen and Progesterone
Receptors
Once diagnosed, breast cancer tissue become tested for the presence of
E and P receptors
Provides an indication of the aggressiveness of the cancer and how
likely the cancer will respond to specific types of endocrine therapy
9. Ca 15 3 and Ca 27 29 Specific for BREAST CANCER
Found in the blood of an affected patient
Ca 27 29 test is MORE sensitive than Ca 15 3
10. Carcinoembryonic Antigen
(CEA)
and Ca 19 9
Elevated in ADVANCED COLORECTAL CANCER
CEA level before surgery POORER PROGNOSIS
11. Human Chorionic
Gonadotropin (HCG) and
Alpha-fetoprotein (AFP)
With germ cell ovarian tumors in men with non-seminomatous
TESTICULAR CANCER = Elevated HCG and AFP
Proportionately to the size of tumors
AFP levels may also be increased in CHRONIC HEPATITIS

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12. Beta-2-Microglobulin (B2M) Elevated in periods with multiple myeloma with chronic lymphocytic
leukemia, kidney disease
13. HER-2 / NEU Elevated in one-thirds of persons diagnosed with breast cancer

Laboratory Tests
- Complete Blood Count (CBC)
- Blood Chemistry
) Serum electrolytes
) ALT Alanine Aminotransferase
) AST Aspartate Aminotransferase
) LDH For liver metastases
) CEA For colon cancer

STAGING
Done during the pre-treatment phase
After surgical resection
Recurrence after disease free interval

STAGING TUMOR
Tumor TNM Staging System
T0 No end of primary tumor
Tis Carcinoma in situ
T1, T2, T3, T4 Progressive increase in tumor size and involvement
Tx Tumor cannot be assessed

STAGES
Stage I The tumor is small, local, detected early
Stage II The tumor is somewhat larger and has started to spread to nearby lymph nodes
Stage III The tumor has spread to nearby lymph nodes
Stage IV Cancer has spread to other parts of the body and is generally in an advanced stage

STAGING NODE
N0 Regional lymph nodes
N1, N2, N3 degree of demonstrable abnormality of regional lymph nodes
Nx Regional lymph nodes cannot be assessed clinically

STAGING METASTASIS
M0 No evidence of distant metastasis
M1, M2, M3 Ascending degree of distant metastasis, including metastasis to different lymph nodes

GRADING
Gx Grade cannot be assessed
G1 Well differentiated
G2 Moderately well-differentiated
G3 and G4 Poorly to very poorly differentiated
Poorer differentiation poorer prognosis

Classification, Grading and Stages
TNM Classification
T Extent of primary tumor
Tx Cannot be adequately assessed
T0 No evidence of primary tumor
Tis Tumor in situ 0 localized; no spread
T1 4 prognosis, increase in size
1.5 cm < 2: 6-9 cm
3:10-15 cm 4:15 cm >

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STAGES
0 Benign state
I Spread to nearby tissue
II 2 5 cm sometimes involve lymph
III Greater than 5 cm spread advanced spread to connective tissue
IV Metastasis

Grading of Tumor
Grade I Well differentiated
Grade II Moderately well differentiated
Grade III Poorly differentiated
Grade IV Undifferentiated

CHEMOTHERAPY
E A systematic mode of treatment that uses cytotoxins and chemicals to effectively CURE (Leukemia,
Lymphomas, some solid tumors)
Tumor size
Adjunct to surgery / radiation
Prevent / treat suspected metastasis
E Most effective when the tumor is small and cell replication is rapid
E Individualized to the patient and is often prescribed according to the patients calculated body surface area
and type of cancer
E Example:
Acute Lymphocytic Leukemia (ALL)
Uses DVPA
Daunorubicin Given days 1 3
Vincristine Given days 1, 8, 15 and 22
Prednisone Given days 11 28
Asparaginase Given days 17 28
Given in cycles with rest periods (especially if with toxic effects) until disease goes to remission

Chemotherapy Cell Cycle
- Used to disrupt the cell cycle in various phases in specific protocols that are given over varying periods of
time

Cell Kill Hypothesis
1. Several doses of chemotherapy are necessary
2. Each exposure kills: 20% - 99% depending on dosage
3. Repeated exposure targets even those in G0 and leads to regression
4. 100% eradication of tumor cells IMPOSSIBLE
5. But the goal is: To reduce the amount that can be destroyed by the immune system

Factors Crucial to the Rate of Normal / Malignant Tissues
1. Cell Cycle Timing: Amount of time required for cells to remove from one mitosis to the next
2. Growth Fraction: Ratio of dividing cells to resting cells, fraction of cycling cells in the entire cell
population
3. Rate of Cell Loss: Fracture of cell die or leaves

Route of Chemotherapy
1. Oral Hodgkins Lymphoma, Leukemia (Maintenance phase), Lung Cancer
2. Intravenous Leukemia,
3. Intra-arterial Hepatic tumors, head and neck cancer
4. Intracavity Ovarian cancer
New RESEARCH!
Use of chemotherapy based on
CIRCARDIAN RHYTHMS
E.g. Colon Cancer

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5. Intraperitoneal Brain tumors
6. Intraventricular Brain tumor
7. Intravesical Bladder tumors

OBJECTIVES:
- To destroy all malignant tumor cells without excessive destruction of normal cells
- To control growth if cure is no longer possible
- Used as adjunct therapy

CONTRAINDICATIONS
* Infection: Anti-tumor drugs are immunosuppressive
* Recent surgery: Drugs may retard healing process
* Impaired renal / Hepatic Function: Drugs are nephrotoxic and hepatotoxic
* Recent Radiation Therapy: Immunosuppressive
* Pregnancy: Drugs may cause congenital defects
* Bone Marrow Depression: Drugs may aggravate the condition, WBC must be within normal levels

Safe Handling of Chemotherapeutic Agents
- Wear mask, gloves and back-closing gown
- Skin contact with drugs must be washed immediately with soap and water. Eye must be flushed
immediately with copious amount of water
- Sterile / Alcohol Wet cotton pledgets should be used, wrapped around the neck of the ampule / vial
when breaking and withdrawing the drug
- Expel air bubbles or wet cotton
- Vent vials to reduce internal pressure after mixing
- Wipe external surface of syringe and IV bottles
- Avoid self-inoculation by needle stab
- Clearly label the hanging IV bottle with antineoplastic chemotherapy
- Contaminated needles and syringes must be disposed in a clearly marked special container leak-proof or
puncture proof
- Dispose half-empty ampules, vials, IV bottles by putting them into plastic bags sealed and then into
another plastic bag or box, clearly marked before placing for removal. Label as Hazardous Wastes
- Handwashing should be done before and after removal of gloves
- Trained personnel only should be involved in use of drugs

Effects of Chemotherapeutic Drugs
Tissues normally affected are:
1. Mucous Membranes
Mouth, tongue, esophagus, stomach, intestine and rectum
Results in anorexia, loss of taste, aversion to food, Erythema,
painful ulceration of GIT, NV, diarrhea
2. Hair Cells
Alopecia
3. Bone Marrow Depression
Affects: Granulocytes, lymphocytes, thrombocytes, erythrocytes
Impaired ability to respond to infection, blood clot and severe
anemia
4. Organ
Heart, lungs, bladder, kidney
Due to specific agents
E.g. Cardiac toxicity (Doxorubicin)
Pneumocystis (Bleomycin)

Effects of CHEMO DRUGS
1. Combined medication
therapy is used to
enhance tumor cell
kill
2. Synergistic actions of
drugs will prevent the
development of drug
resistance
3. Combats resistance of
cells to
chemotherapeutic
agents

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Classification of Chemotherapeutic Drugs
Related to the cell cycle
1. Cycle Specific Agents
They are specific to certain phases of the cell cycle
Destroy cells that are actively reproducing
Most affects there in the S Phase of interfering with DNA and RNA synthesis
M Phase (Vinca / Plant Alkaloids: Halt spindle function)
2. Cycle Non-Specific Agents
Act independently of the cell cycle place
Usually have prolonged effects or cells leading to cell death and damage

Classifications of Drugs
1. Alkylating Agents
Contains alkyl groups which binds to DNA and prevents replication and mitosis
Cell Cycle non-Specific
Effective against many types of cancer, including acute and chronic leukemia, solid tumors
Common Side Effects
- Bone marrow suppression
- N/V
- Alopecia
- Sterility
- Cystic cyclophosphamide
- Stomatitis
- Renal Toxicity (Cisplastin)
E.g.
Bisulfiram (Bisulflex)
Cyclophosphamide (Cytoxan)
Chlorambucil (Leukeran)
Cisplastin (Planitol-AQ)
Nursing Implications:
Maintain good hydration
Administer anti-emetics prior to chemotherapy
Monitor WBC, Uric Acid
Assess for possible infection
Discuss concerns for hair loss
2. Nitrosoureas
Similar to the alkylating agent
ONLY CHEMODRUG THAT CAN CROSS THE BLOOD BRAIN BARRIER (BBB)
[Important for Central Nervous System diseases]
Side Effects:
Delayed cumulative myelosuppression (In 3 5 weeks) especially thrombocytopenia;
N/V
Nursing Implications:
Maintain good hydration
Administer anti-emetics prior to chemotherapy
Monitor WBC, Uric Acid
Assess for possible infection
Discuss concerns for hair loss
3. Anti Metabolites
Interferes with the biosynthesis of metabolism or nucleic acid needed for RNA and DNA synthesis
Cell specific (Best in S Phase)
Used to treat acute leukemia, breast cancer, head and neck cancer, lung cancer, and osteosarcoma
Side Effects:
Bone Marrow suppression (Anemia, leukopenia)

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Stomatitis
N/V
Alopecia
Hepatitis and renal dysfunction
E.g.
Methotrexate
- Lethal in high doses, must give antidote (Leucovorin) within 24 36 hours after
initiation of therapy
- 5-Flurouracil (5-FU)
- Cytarabine (Depocyt, Tarabine)
- 5-Azacytidine
Side Effects
N/V
Diarrhea
Bone Marrow suppression: Reaches NADIR in 1 2
weeks; with leukopenia being most severe
Renal toxicity (Methotrexate)
Hepatotoxicity
Nursing Implications
Monitor CBC, WBC, Uric acid
Assess oral mucus membranes
Assess for infection, bleeding
Provide oral care
Administer anti-emetics PRN
Discuss concern for hair loss
Evaluate hydration and nutritional status
4. Antitumor Antibiotics
Inhibit RNA synthesis and bind DNA causing fragmentation; interfere with DNA repair
These drugs bind to almost everything they contact and kill cells
Main toxic effect is cardiac muscle toxicity (Limits the amount and duration of treatment)
Side Effects are the same with other anti-Cancer drugs
E.g.
Doxorubicin (Adriamycin)
Bleomycin (Blenoxane)
Dactinomycin (Cosmegen)
Nursing Implications
Monitor ECG, CBC
Assess for bleeding
Assess for hydration and nutritional status
Check for fever 36 hours after administration
Administer anti-emetic PRN
5. Plant Alkaloids
Two main Groups (From natural products)
1. Vinca Alkaloids Mitosis phase, inhibit mitotic tubular formation (spindle); inhibit DNA
and protein synthesis
2. Etoposide (VP-16) or Mitotic Inhibitors All phases; causes breaks in DNA and
metaphase arrest
E.g.
1. Vincristine (Oncovin)
Vinblastin (Velban)
2. Etoposide (Toposar)
Teniposide (Venom)
Side Effect:
Hypotension (Too rapid IV administration), muscle weakness, areflexia, constipation,
N/V, alopecia
Nursing Implications:
NADIR Is the lowest level of
a red blood cell count while a
patient is undergoing
chemotherapy

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Assess neuromuscular functions
Monitor CBC, GI function
Manage constipation
Hydration
Discuss concerns for hair loss
6. Hormonal Agents
Alter the deviate / environment to depress / prevent cell proliferation
Corticosteroids (e.g. Prednisone: Mostly used in CA therapy; G1 Phase)
E.g.
Androgen, estrogen, anti-androgens, anti-estrogens
Side Effects
N/V
Hyperglycemia
Hypertension
Weight gain; gynecomastia
Mood changes
Cessation of menstruation
Acne, alopecia

Nursing Interventions for Chemical Side Effects
GI System = N/V, diarrhea, constipation
Administer anti-emetics to relieve N/V
Replace fluids and electrolyte losses, low fiber diet to relieve diarrhea
fluid intake and fibers in diet to prevent / relieve constipation
Integumentary System
Pruritus; urticaria and systemic signs
- Provide good skin care
Stomatitis
- Provide good oral care, avoid HOT and SPICY food
Alopecia
- Reassure that it is temporary, wear wigs / hats
Skin Pigmentation
- Inform that it is temporary
Nail changes (Grow normally after chemotherapy)
Hematopoietic System
Anemia
- Frequent rest periods, eat foods high in Iron!
Neutropenia
- Protect from infection
- Avoid people with infection
Thrombocytopenia
- Protect from trauma
- Avoid ASA
Genito-Urinary System
Hemorrhagic Cystitis
- Provide 2 3 L of fluids per day
Urine color changes
- Reassure that it is harmless