Question

What is the clinical manifestation and special precautions of myelosuppression to chemotherapy administration should the CNS include in this program of administering a variety of chemotherapeutic drugs to the oncology patients

Answer 1

Myelosuppression or bone marrow suppression, is a common side effect of chemotherapy that is characterized by a decrease in blood cell production.

The majority of chemotherapy drugs have been associated with myelosuppression.The most common cancer drugs such as Fluorouracil (cause all forms of myelosuppression), Oxaliplatin(neutropenia and thrombocytopenia), Irinotecan(cause neutropenia), Capecitabine( cause all forms of myelosuppression) are some examples that cause myelosuppression.

Myelosuppression does not hurt in and of itself. However, a number of side effects that result from low blood cell counts can have significant effects on an individual's health.

The clinical features of myelosuppression includes-
Symptoms associated with myelosuppression vary depending on the specific type.

1. Side effecs of anemia includes:

• Fatigue
• Dizziness
• Shortness of breath
• Pale skin
• Increased heart rate

2. Neutropenia resuls in reduction in the body's ability to fight off disease, as a result:

• Fever and chills
• signs of infection including swelling, redness
• Diarrhea
• rashes occurs.

3. Thrombocytopenia is most commonly characterized by

• Easy bruising and bleeding from the nose, gums or mouth.
• Blood may also show up in urine or bowel movements.
• Petechiae (Small red spots on the skin )

Special precautions of myelosuppression to chemotherapy administration :

• Once chemotherapy is completed, blood counts should return to normal after a few weeks. Before starting the chemotherapy complete blood count should be assessed. If early signs of damage are identified, or blood counts dip dangerously low, then chemotherapy may be stalled, reduced or stopped altogether to allow the bone marrow to recover.
• If the patient is neutropenic and febrile with or without clinical signs (such as vomiting, diarrhea, trembling, dehydration, weakness, lethargy) chemotherapy should be discontinued.
• Check for occult infections such as in the urinary tract or skin prior to therapy, and reduce chemotherapy drug doses in patients that have previously shown extreme sensitivity to these agents may be helpful in reducing its occurrence.
• The nurses should must wear approved chemotherapy mask, gown, and gloves while preparing chemotherapy agents.
• Most chemotherapeutics are administered intravenously, a well-placed catheter should be established and flushed with 0.9% sodium chloride before and after administration of he chemotherapy drug.
• Strict adherence to IV catheter rules can eliminate the occurance of extravasation.
• The nurse should advice the clients about some simple ways to reduce visible symptoms of myelosuppression. These include:

1. Avoiding strenuous activities such as contact sports
2. Engaging in low-impact exercise
3. Avoiding foods with sharp edges that may promote bleeding
4. Abstaining from alcohol
5. Washing hands frequently to avoid infection
6. Eating a high-protein diet
7. Staying hydrated
8. Stop shaving the arms, legs and face.