Cancer
Many medications used for cancer chemotherapy cause nausea and vomiting due to stimulation of the chemoreceptor trigger zone or CTZ in the brain. Emesis can occur prior to chemotherapy in anticipation of the medication, during chemotherapy, and for some anticancer medications, several days after chemotherapy. Nausea and emesis (vomiting) may last for several days. Antiemetics are more effective when given prior to the beginning of emesis, so knowing when a particular medication typically causes nausea and vomiting is important for effective treatment. Antiemetics may be given orally or parenterally if the oral route is not tolerated. Concurrent administration of dexamethasone and an antianxiety agent may increase the effectiveness of the antiemetic. Maintenance of adequate nutritional and fluid intake may be challenging at this time, and intravenous fluids may be necessary on a short-term basis.
mercaptopurine
Constipation is a significant side effect in clients who are receiving vincristine—especially clients who are children. Vincristine decreases gastrointestinal motility and can cause a paralytic ileus—or upper colon impaction—to occur. Parents of children who are receiving vincristine should keep a record of their child’s bowel movements, as well as the consistency and frequency. A diet that is high in fiber and fluids is also beneficial if the child can tolerate it. If not, the provider may need to prescribe a medication to prevent paralytic ileus and constipation.
vincristine
When caring for a client who is taking an aromatase inhibitor, check to see if the client has a family history of osteoporosis. If they do and are not also taking medication to prevent osteoporosis, such as alendronate, clarify the client’s medication therapy with the provider and ensure the provider is aware of the family history.
anastrozole
Up to 98% of clients receiving enfuvirtide experience injection site skin reactions. Extreme caution should be taken when giving this medication in an effort to reduce the incidence of these reactions. Be sure to let the medication warm to room temperature before it is given, rotate the sites of the injections, inject at a depth that is adequate for a subcutaneous injection but no deeper than necessary, and avoid giving the injection in a site that has a current injection site reaction. Monitor the sites of previous injections that are exhibiting a reaction for signs of infection
enfuvirtide
Stevens-Johnson syndrome is a rare type of reaction that occurs secondary to certain medications. It manifests as a painful red to purple skin rash that spreads rapidly and includes the development of blisters on the skin and in the mouth. A fever and sore throat may occur prior to the development of the rash. The blisters actually cause sloughing of the skin that can become infected and leave scars and irregular pigmentation upon healing. The most important thing to do when this type of reaction is observed is to immediately stop the offending medication. Cool moist compresses, antihistamines for itching, and analgesics for pain will be needed to promote comfort during the acute phase. If the area of lesions is large, ensure that the client is getting adequate fluid replacement for that which is being lost through the lesions either orally, intravenously, or both. Early identification of this syndrome can increase clients’ chances of stopping the reaction in its early stages before it gets to the point where recovery will take months and even involve the use of skin grafts to repair the damage.
delavirdine
Nadir means the time following chemotherapy when blood cell counts, especially the leukocytes and platelets, reach their lowest level. Depending on the medication being given, knowing the nadir helps caregivers know when monitoring the client for signs of a low platelet or leukocyte is vital and when these blood counts may be expected to start rising again. For example, with cytarabine, the nadir usually occurs 5 to 7 days after the previous dose was given.
cytarabine
Superinfections are common adverse effects of broad-spectrum antibiotics. Overgrowth of Candida—or yeast in the mouth, which is called thrush—is a very common superinfection. When caring for a client who is immunosuppressed, evaluate the client’s mouth for signs of thrush. These signs include inflammation and white patches on the oral mucosa and tongue that cannot be removed, and reports of oral pain, pain upon swallowing, and loss of taste. Early recognition of the development of thrush will allow for early treatment with an antifungal medication such as nystatin. Also, ensure that clients being treated for thrush receive adequate nutrition and hydration because the severity of the oral and throat pain often makes clients want to avoid eating and drinking.
doxorubicin
Tamoxifen is given to block the estrogenic receptors located in the breast tissue, causing a decrease in estrogen-dependent cancers. Unfortunately, tamoxifen activates the estrogen receptors in the uterus, increasing the client’s risk for endometrial cancer. Clients who are premenopausal should observe for abnormal bleeding and spotting that may indicate endometrial hyperplasia. Prompt diagnosis and treatment of this condition can prevent hyperplasia from developing into uterine cancer. Postmenopausal women who no longer have menses should report any type of uterine bleeding immediately to the provider.
tamoxifen
Medication resistance to antivirals used against HIV infections occurs less frequently if clients strictly adhere to the therapeutic regimen their provider prescribes. When clients’ laboratory values indicate their HIV infection is not being kept in check, a phenotype and/or genotype assay may be done to determine if the HIV is continuing to grow—even in the presence of the medication or if the virus has mutated and is no longer sensitive to the medications currently being used. The ability of HIV to become resistant has made treatment of this disease difficult. Be sure to reinforce to clients the importance of rigidly sticking to their prescribed regimen to enhance the long-term efficacy of the medication by preventing resistance.
zidovudine
Influenza yearly
Tetanus and diphtheria every 10 years
Pneumococcal - 65 yr or older or younger if you have risk such as smoking
Hepatitis A/B, Measles, Mumps, Rubella,Varicella may be necessary
Herpes Zoster recommended for adults 50yr or older
adults/older adults vacciness
Cells that have a high growth fraction are very susceptible to cancer chemotherapy medications. Because the cells of a fetus reproduce at an accelerated pace, they are very susceptible to cancer chemotherapy medications, especially alkylating agents such as nitrosoureas. Because they can interfere with the reproduction of cells, fetal malformations or death can occur. Because the risk of fetal damage is the highest during the first trimester of pregnancy, clients who are of childbearing age should be instructed to use a reliable method of birth control to prevent pregnancy.
carmustine
As previously stated, many cancer chemotherapy medications cause bone marrow suppression, which can decrease the number of circulating white and red blood cells and platelets. Platelets are an important component of the clotting process. Without an adequate number of platelets, bleeding can occur spontaneously, secondary to minor blunt or sharp trauma, and in the gastrointestinal tract. When caring for a client who has thrombocytopenia, avoid the use of needles whenever possible, and when injections are needed, use the smallest gauge possible. When taking the client’s blood pressure, use only the amount of pressure needed to avoid bruising of the arm. Monitor for nose bleeds and test stool samples for occult blood as prescribed. A change in the mental status of a client may also indicate a cerebral bleed and should be reported to the provider immediately. The use of NSAIDs should be avoided, and acetaminophen given when a mild analgesic is needed. For severe thrombocytopenia, a platelet transfusion may be given. The production of platelets can also be stimulated with the medication oprelvekin, but the side effects of this medication limit its use.
topotecan
When helping to prepare an interferon for administration, make sure the pharmacy has sent up the correct medication. Interferon alfa-2a and interferon alfa-2b are given for the treatment of various types of cancers, as previously listed. Be sure the correct interferon alfa medication is being administered in relation to the prescription designation of 2a or 2b; they are not interchangeable. There is also an interferon alfacon-1 that is used to treat hepatitis C, and interferon beta 1a and 1b, which are given to help treat multiple sclerosis. Ensure that these medications are not confused with the interferon alfa medication that is being given as a part of the therapeutic regimen for cancer. Remember to check each medication three times before it is administered.
alfa-2A and alfa 2B
Monitor for fluid retention in clients taking imatinib. It manifests with fluid collecting in and around the lungs as pulmonary edema and pleural effusion, respectively, and in the abdomen in the form of ascites. Each of these can make it difficult for the client to breathe and adequately exchange oxygen. Be sure to notify the provider of pulse oximetry readings that are below the expected reference range or dyspnea that is severe or becoming worse. A thoracentesis may need to be done or a diuretic added to the medication regimen to draw the excess fluid off the lungs and abdomen. Keeping the client in a high-Fowler’s position or an orthopneic position, which is a position that has the client sit on the side of the bed with the arms resting on the bedside table, will also help the client breathe more easily.
imatinib (cancer)
Tdap booster: 11-12yr
HPV- 3 dose series
Meningococcal- 11-18yr
Influenza
Any other vaccines that may have been missed at the younger age
7-18
Alopecia occurs with several types of cancer chemotherapy medications. Although it is a temporary condition, it can have a significant effect on a client’s self-esteem. When working with a client who has been prescribed a medication that causes alopecia, talk to the client before starting therapy about ways to manage this change in self-image. If appropriate, also discuss options regarding wearing a wig or stylish scarf. Encourage a conversation about how the client feels about this body image change and support them as they go through it.
cyclophosphamide
It is the nurse's responsibility to check the neutrophil count of clients prior to the administration of a chemotherapeutic medication. Allowing chemotherapy to be administered to a client who is already severely immunocompromised can reduce the neutrophil count even further, leaving the client at high risk for a life-threatening infection. If a client’s neutrophil count does not meet the established parameters, the provider should be notified, and the chemotherapy delayed until the client’s neutrophil count has recovered.
paclitaxel
The monoclonal antibody, trastuzumab, can cause heart failure due to its effect on the ventricles of the heart. The symptoms that are manifested depend on whether the right or left side of the heart is failing. Right-sided failure allows blood to back up into the right side of the heart and in the veins leading to the heart. This causes the abdomen to become distended, the lower extremities to become edematous, and the client to feel anorexic. Nocturia, which is increased urination at night, can occur secondary to the reabsorption of the fluid from the lower parts of the body that occurs when the body is in a supine position. Left-sided failure causes blood to back up in the left side of the heart—and in the lungs and pulmonary arteries that flow into the heart. This causes the client to experience fatigue, weakness, tachycardia, a cough worse at night when lying in a supine position, and frothy, pink sputum if the failure is severe. Any of these symptoms should be immediately reported to the provider.
trastuzumab
Nurses should know how to interpret their client’s HIV-related laboratory values so they can report to the provider values that may indicate the current medication therapy is not effective. The primary laboratory tests used to gauge the efficacy of current medication therapy are the CD5 T-cell counts and the HIV viral load assays. A high viral load is undesired and is usually responsible for a low CD5 T-cell count due to the destruction of these cells by the virus. In contrast, a high CD5 T-cell count is desired and is usually made possible by a low viral load. Clients should be taught to understand the relationship between these two laboratory values so they, too, can monitor the progression of their disease.
raltegravir
Hepatitis A
Hepatitis B
Rotavirus (RV)
Diphtheria/Tetanus/Pertussis (DTaP)
Haemophilus Influenzae B (Hib)
Pneumococcal Vaccine (PCV)
Measles/Mumps/Rubella (MMR)
Varicella
Influenza (>6 months
birth to 6 years of age
Bone marrow suppression is a common side effect of chemotherapy for cancer because the medications used to kill cancer cells also kill the blood cell-forming cells of the bone marrow. The cells affected are the leukocytes, erythrocytes, and platelets. Neutrophils are the most common form of leukocytes, and a decrease in their number is called neutropenia. Chemotherapy is usually stopped temporarily when a client’s neutrophil count reaches the level for which neutropenic precautions are instituted. Additional precautions that should be taken when the client is hospitalized for neutropenia include placing the client in a private room, limiting the number of health care personnel who enter the room and restricting those who are ill from providing care, limiting the number of invasive procedures such as blood draws and using aseptic technique when they are necessary, keeping designated client care equipment in the client’s room such as the thermometer and sphygmomanometer, and if the client becomes febrile notify the provider immediately and begin looking for the source of infection.
methotrexate
You can help minimize the adverse effects cisplatin has on the kidneys by hydrating the client with one to two liters of IV fluid before treatment—and continuing hydration for 24 hr following treatment as necessary. Obtain baseline serum creatinine, urinary creatinine clearance, and BUN, and monitor weekly for 2 weeks following each treatment. Also, monitor the client’s urine output before and after each treatment and notify the provider immediately for an output less than the hourly amount
cisplatin
When caring for a client who is receiving flutamide, be sure the client is also receiving a GnRH such as leuprolide. Both of these medications are antiandrogens, which are given to treat prostate cancer by stopping the hormone testosterone from being produced by the body. The medications should be given together to stop the production of testosterone from both the testes and adrenal glands. If flutamide is being given without a GnRH, such as leuprolide, clarify this treatment plan with the provider.
flutamide
Hepatitic injury in clients taking maraviroc may be indicated by the presence of a rash. The appearance of a rash—no matter how mild—should be taken very seriously, and the provider immediately notified. A prescription for laboratory evaluation of liver enzymes will determine if liver dysfunction is occurring. Also, observe for jaundice—particularly in the sclera of the eyes—and ask the client about anorexia or itching of the skin.
maraviroc
Reinforce to clients the effect protease inhibitors have on their cholesterol and triglyceride levels and the related increased risk for heart disease. Clients should maintain a strict schedule for having their lipid profile drawn to monitor these values. Evaluation of these levels should be done every 3 to 4 months, and increases reported to the provider. Clients can also take an active part in preventing heart disease by eating a healthy diet, exercising at least three times a week, and taking a fibrate antilipemic medication that lowers cholesterol. Due to the deleterious effect these medications can have on the liver, liver function tests should also be closely monitored.
ritonavir