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Chemotherapeutic Drugs Cytotoxic Drugs

Common Side Effects of Chemotherapeutic Drugs

 Chemotherapy

Chemotherapy is the use of chemicals to treat disease. Paul Erlich, considered to be the father of chemotherapy, coined this word to describe  a specific chemical utilized in the treatment of parasites.

Chemotherapeutic Drugs

Chemotherapy (chemo) usually refers to the use of medicines or drugs to treat cancer. The thought of having chemotherapy frightens many people.  It can also give you a better sense of control over your cancer treatment.

Nausea & Vomiting

Nausea is the conscious recognition of the subconscious excitation of an area of the medulla closely associated with or part of the vomiting center. Nausea may cause the desire to vomit & it often precedes or accompanies vomiting.

  • Avoid eating/drinking for 1-2 hrs prior to and after chemotherapy administration
  • Eat frequent, small meals.
  • Avoid greasy & fatty foods and very sweet foods & candies.
  • Avoid unpleasant sights, odors & testes
  • Follow a clear liquid diet
  • If vomiting is severe inform the physician.
  • Consider diversionary  activities
  • Sip liquids slowly or suck  ice cubes and avoid drinking a large volume of water if vomiting is present
  • Administer antiemetics to prevent or minimize nausea. Patient may require routine antiemetics for 3-5 days following  some protocols.
  • Monitor fluid and electrolyte status.
  • Provide frequent, systemic mouth care.

Bone marrow Depression

This can lead to….

  • Anaemia
  • Bleeding due to thrombocytopenia
  • Infection due to leukopenia

Nursing Actions

  • Administer packed RBC according to the physician orders.
  • Monitor hematocrit and haemoglobin especially during drug nadir
  • Maintain the integrity of the skin
  • Avoid activities with the greatest potential for physical injury
  • Use an electric razor when shaving
  • Avoid the use of tourniquets
  • Eat a soft, bland diet, avoid foods that are thermally, mechanically and chemically irritating.
  • Maintain the integrity of the mucous membranes of G I tract
  • Promote hydrate to avoid constipation
  • Avoid enemas, harsh laxatives & the use of rectal thermometers.
  • Take steroids with an antacid or milk.
  • Avoid sources of infection
  • Maintain good personal hygiene.
  • Prevent trauma to skin & mucous membranes
  • Report s/s of infection to physician
  • Monitor counts
  • Avoid invasive procedures, no ……
  • Raise the arm while pressure is applied after removal of a needle or catheter

Alopecia

  • Explain hair loss is temporary, and hair will grow when drug is stopped.
  • Use a mild, protein based shampoo, hair conditioner every 4-7 days
  • Minimize the use of an electric dyer.
  • Avoid excessive brushing and combing of the air. Combing with a wide –tooth comb is preferred.
  • Select wig, cap, scarf or turban before hair loss occurs.
  • Keep head covered in summer to prevent sunburn and in winter to prevent heat loss.

Fatigue

  • Assess for possible causes chronic pain, stress, depression and in-sufficient rest or nutritional intake.
  • Conserve energy & rest when tired
  • Plan for gradual  accommodation of activities.
  • Monitor dietary & fluid intake daily.
  • Drink 3000 ml of fluid daily, unless contra-indicated, in order to avoid the accumulation of cellular waste products.

Anorexia

  • Freshen up before meals
  • Avoid drinking fluids with meals to prevent feeling of fullness
  • High protein diet
  • Monitor and record weight weekly. Report weight loss

Stomatitis (Oral)

  • Symptoms occur 5-7 days after chemotherapy & persist upto 10 days
  • Continue brushing regularly with soft tooth brush
  • Use non irritant mouthwash
  • Avoid irritants to the mouth
  • Maintain good  nutritional intake, eat soft or liquid foods high in protein
  • Follow prescribed medication schedule e.g. drug for oral candidiasis.
  • Report physician if symptom persists
  • Increase the frequency of oral hygiene every 2 hrs
  • Glycerin & lemon juice should never be used to clear mouth or teeth as it cause the tissues to become dry& irritated.

Diarrhoea

Some clients experience diarrhoea during and after treatment with chemotherapy.

Nursing Action

  • Monitor number, frequency and consistency of diarrhoea stools.
  • Avoid eating high roughage, greasy and spicy food alcoholic beverages, tobacco and caffeine  products
  • Avoid using milk products
  • Eat low residue diet high in protein and calories
  • Include food high in potassium if fatigue is present like bananas, baked potatoes.
  • Drink 3000 ml of fluid each day.
  • Eat small frequent meals ; eat slowly and chew all  food thoroughly
  • Clean metal area after each bowel movement.
  • Administer anti-diarrhoeal agents as prescribed.

Depression

  • Assess for changes in mood and affect.
  • Set small goals that are achievable daily
  • Participate e.g. music, reading, outings
  • Share feelings
  • Reassurance

Cystitis

  • Is an inflammation of the bladder, which is usually caused by an infection. Sterile cystitis not induced by infection. Sterile cystitis not induced by infection, can be a side effect of radiation therapy or due to cyclophosphamide (endoxan) administration. The metabolites of cyclophosphamide are excreted by the kidneys in the urine

Nursing Actions

  • Fluid intake at least 3000 ml daily
  • Empty Bladder as soon as the urge to void is experienced.
  • Empty bladder at least every 2-4 hrs.
  • Urinate at bed time to avoid prolonged exposure of the bladder wall to the effects of cytoxan while sleeping.
  • Take oral cytoxan early in the morning to decrease the drug concentration in the bladder during the night
  • Report increasing symptoms of frequency bleeding burning on urination, pain fever and chills promptly to physician

Following comfort measures can be adopted if cystitis is present….

  • Ensure dilute urine by increasing the fluid intake
  • Avoid foods & beverages that may cause irritation to the bladder – alcohol, coffee, strong tea, Carbonated beverages etc.