Question

The oncology clinical nurse specialist is asked to develop a staff development program for registered nurses who will be administering chemotherapeutic agents. Because the nurses will be administering a variety of chemotherapeutic drugs to the oncology patients,the CNS plans on presenting an overview of agents, classifications, and special precautions related to safe handling and administration of these drugs.

a. What does CNS describe as the goals of chemotherapy

b. How should the CNS respond to the following question “ Why do patients require rounds of chemotherapeutic drugs, including different drugs and varying intervals

C. In teaching about the administration of chemotherapeutic agents, what signs of extravasation should the nurse include

d. What clinical manifestation of myelosuppression to chemotherapy administration should the CNS include in this program

Answer 1

a. ANS: The goals of chemotherapy are:

To destroy cancer cells and slowing the growth of cancer cells

To shrink tumor

To destroy any remaining cancer cells

To relieve symptoms of advanced cancer.

To slow or stop the growth of rapidly dividing cancer cells in the body.

Palliative- Maximize survival time while maintaining good quality of life

b. ANS: Cancer patients are given different types and combination of chemo drugs based on the type and stage of cancer. Cycles are planned in a way that allows the drugs to effectively attack the cancer, while also providing time for normal cells to rest and recover from damage. Chemo is given in a series of treatment periods known as chemo-cycles. During a cycle chemo is given several times in pre-decided intervals. However, the schedule used for specific patients with specific cancers varies greatly. Sessions may be held every other day or may be divided by weeks. The interval between two chemo treatments helps the patient to recover from side effects of chemo drugs and produce new healthy cells.

c. ANS: Extravasation is the inadvertent leaking of an IV fluid into the subcutaneous tissue. Tissue damage can range from mild discomfort to severe tissue destruction. Extravasation during administration chemotherapeutic agents is suspected if one or more of the following signs is observed during or immediately after the injection

Signs and symptoms may include no blood return from the IV catheter, resistance to flow of IV fluids, and swelling, pain, or redness at the insertion site. If induration, swelling or leakage is observed at the injection site. If resistance is felt on syringe plunger during administration. Tissue necrosis is possible. The damage related to a vesicant extravasation may take weeks to become fully apparent.

d. ANS:

Myelosuppression, also known as bone marrow suppression and the myelosuppression typically occurs 7 to 14 days following the administration of chemotherapy. It is a common side effect of chemotherapy that is characterized by a decrease in blood cell production. Clinical manifestations of myelosupprssion secondary to chemotherapy administration include-

1. A decrease in red blood cells, this type of myelosupprssion is called anemia.

2. A drop in a specific type of white blood cells known as neutrophils, this type of myelosupprssion is called neutropenia.

3. A drop in platelet count, this type of myelosupprssion is called thrombocytopenia.

The patient should bemonitored for any signs of bleeding and/or infection, including fever.

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