Chemotherapy patient care 1. Local Stimulation of antitumor drugs are generally stronger in normal tissue cells in vitro. Drugs, such as nitrogen mustard extravasation, can cause local skin and tissue necrosis. Be properly applied in case of leakage against drugs, such as nitrogen mustard extravasation with sodium thiosulfate, vincristine class with local care with sodium bicarbonate.
2. Systemic toxicity reactions Most patients, whether oral or intravenous administration appears most of the digestive tract, bone marrow suppression and immune system suppression and other symptoms of more serious degree, and even become one of the leading causes of death.
3. Requires time-sensitive Application of anticancer drugs requires high technical conditions. Such as intravenous injection of Ara-C must be 3 to 5 seconds in the end note, nitrogen mustard unstable performance, injection must be completed within 10 seconds.
4. Antitumor agents demanding storage conditions Such as cyclophosphamide should be protected from light, stored at room temperature 32 the following, thiotepa should be dark, dry, kept at room temperature below 12 .
5. More limited usage of each drug Vincristine intravenous drugs only, not intramuscular, subcutaneous or intrathecal injection.
6. More incompatible combination Antibiotics can not be combined with penicillin G salt.
7. Allergic side effects Some drugs with negative skin test to be done before the application or only after the pilot injection of large doses. Application of anti-cancer drugs can occur in most patients stomatitis or ulcers.
Chemical route of administration of anticancer drugs and nursing care:
1. Oral drug To be made into capsules or enteric preparations, in order to avoid stimulation of the gastric mucosa and prevent destruction of drugs by the stomach.
2. Intramuscular injection In order to avoid damage to blood vessels and some not suitable for oral administration of drugs, often used intramuscular injection, choose a long needle deep injection, and often replaced to avoid the injection site induration.
3. Intravenous administration (1) intravenous injection: clinical application is very broad approach. Drug directly into the blood vessels, the dose accurately. Because cancer patients with medication for a long time, nurses should pay attention to the use of vessels from around the remote start alternating upper and lower limbs. Must have the skilled way, to guard against leakage of certain drugs, to the extravascular infiltration, resulting in local tissue necrosis, or even physical disability. (2) into the vein: the use of certain chemotherapy drugs often requires 2 to 3 minutes to reach the body quickly. Before administration of glucose or saline to be through the input after the injection of chemotherapy drugs from the dropper, 2 to 3 minutes, then restore the original drip rate. Such as mitomycin C, vincristine and other drugs often adopt this method.
4. Artery injection Not apply to certain advanced or recurrent surgery and limited tumor. For cancer drugs directly into the arterial blood can increase the local concentration of anticancer drugs and reduce systemic toxicity. Intra-arterial drug delivery requires the maintenance of catheter patency, prevention of air embolism, thrombosis, avascular necrosis or infection.
5. Articular injection For malignant ascites and pericardial effusion. After injection to observe the patient's response, according to the location of lesions in time replace the patient's position needs to make the full spread of liquid in the lesion.
6. Intratumoral injection Such as bladder cancer, the clinical studies used camptothecin as bladder tumor in the bladder endoscopic injection, efficacy is better than other methods.
Observation of chemotherapy drug response and prevention:
Chemotherapy patient care 1. To prevent reaction Many anticancer drugs such as mechlorethamine, dactinomycin, vincristine, and so have a strong local stimulation, if the operator inadvertently injected into the skin, can cause tissue necrosis or prolonged unhealed, can cause improper injection phlebitis. In use, patients should do well to explain the work to eliminate the psychological tension, and describes the nature of drug, side effects, so that patients know what in advance, to prevent strong or barely tolerated by the patient to endure pain, not to medical reports adverse consequences. Side edge of inquiry should be injected to observe the symptoms and toxicity. If accidentally injected into the skin, local injection of saline to be, and also with the corresponding antidote or antagonist, partial wishful coated with gold powder or wet dressing with 50% magnesium sulfate 6 to 12 hours, can also be coated with hydrocortisone , ice for 24 hours. Most anticancer drugs have damaging effects on the gastrointestinal mucosa often appears as loss of appetite, nausea, vomiting, diarrhea and other gastrointestinal reactions. Such as fluorouracil and methotrexate can cause frequent diarrhea, or hematochezia. The first treatment most patients respond more weight, then gradually reduced. Application of the process of anti-cancer drugs, patients should be concerned about the eating situation, to give light digestible low fat diet. Heavier drug reactions are advised to arrange medication at bedtime or after a meal to affect consumption. Eat small meals often severe vomiting should be necessary rehydration. Supplemented by acupuncture, taking the full three years, Hegu, Qu pool and other points on the reaction to reduce a role in the gastrointestinal tract. Close observation of vomit, abdominal pain, the nature and defecation, if necessary, to stay stool examination for timely processing.
Chemotherapy patient care 2. Bone marrow suppression Most anticancer drugs have varying degrees of bone marrow suppression side-effects, such as busulfan, cyclophosphamide and so may cause leukopenia, while ADM and plugs for self-piperazine and so easy to cause thrombocytopenia, and with the increase in dose may be the whole blood to reduce, or even cause aplastic anemia. Operate on cancer patients, we must strictly aseptic technique, and note the changes in body temperature, to prevent secondary infection, such as blood test every week 1 or 2 times, when the white blood cells less than 3.0 109 / L, platelets less than 8.0 109 / L suspension of administration required to give blood and drugs, and strengthening nutrition. WBC less than 1.0 109 / L, the need for protective isolation. Should not be a serious inhibitor of platelet injection. Taken to avoid skin damage, observe the skin, not without bruising, bleeding, with or without gingival bleeding, epistaxis, hematuria, and blood in the stool and other symptoms. Observed changes in vital signs, listen to the patient's chief complaint, and to try to remove the incentive could lead to internal bleeding. Gastrointestinal bleeding in patients on the vomit and stool to observe nature, and hemoptysis of hemoptysis patients to record blood and color.
Chemotherapy patient care 3. Mucocutaneous damage Because tumor immunity in patients with lower than normal, chemotherapy patients are prone to herpes zoster, usually unilateral, along the nerve distribution, accompanied by fever, local skin burning sensation, severe pain and other symptoms of paroxysmal nerve. Where the application of anticancer drugs can cause dermatitis, they should tell patients in advance, and asked the patient to promptly report skin disorders found in health care, try not to scratch, so as to avoid secondary infection. Calamine lotion can be used locally or ask a dermatologist to help diagnosis and treatment. Some drugs such as methotrexate, busulfan (busulfan), etc. can cause pigmentation. When hair loss is quite common in the application of alkylating agents. Hair loss is the most distressing side effects of patients,
one can be prepared when the hair loss bald wig. Anti-metabolism drugs, particularly caused by large doses of oral mucositis often, showed congestion, edema, inflammation and ulceration, can be the right amount of folic acid tablets or intravenous folic acid control, light only 1: 200 folic acid rinse solution can be . With doxorubicin or bleomycin-induced stomatitis should be discontinued, such as mergers fungal infection of 3% sodium bicarbonate solution used mouthwash, and with nystatin 100,000 U / ml rinse. Patients with severe stomatitis, bacterial culture and sensitivity should be testing for the right remedy. Ulcers or Bingpeng San Xileisan top coat. And pain with 2% lidocaine spray.
Chemotherapy patient care 4. Liver, kidney and heart and lung damage Since most anticancer drugs from the urine and bile excretion, and albumin is not a drug by glomerular filtration. Should therefore be to prevent toxicity. C Carbazide (a benzyl hydrazine) can cause toxic hepatitis. Antibiotics such as doxorubicin and metal substances can cause ECG abnormalities. Bleomycin can cause "chemical lung" and fiber lung. Therefore, especially during chemotherapy with cyclophosphamide, the instruct patient to drink more water, so that urine dilution. High-dose methotrexate may be poor because of their metabolites soluble, easy to form in the acidic environment of the yellow precipitate should be appropriate to take sodium bicarbonate to keep urine alkaline. To record 24 hours urine output, if the normal and oliguria intake, could consider the use of diuretics, and regular monitoring of liver function. Application of bleomycin, observe the patient's lung function, for regular X-ray examination, the drug dosage and side effects often proportional to the nurses must understand the patient's course of treatment and drug accumulation, alert, observe whether the signs and symptoms of pulmonary insufficiency occurred.
Chemotherapy patient care 5. Immune suppression suppression Most anticancer drugs on the body's immune system has a different degree of inhibition. Use of immune function during the decline, often leaves patients complicated infection, bleeding or rash. To observe the evolution of the disease, strengthen basic care, with particular attention to prevention and surveillance to the perineum and vagina, and other susceptible site of infection, often used in clinical practice 1: 5000 potassium permanganate solution bath for the treatment and prevention.