4. Cervical Cancer Chemotherapy

1. Cisplatin

Drug Classification: Antineoplastic (Alkalynating Agent)

Dosage, Route, Frequency: 1 mg/ml in 50- and 100- mg vials q 3 wk

Mechanism of Action: This drug alters DNA structure resulting in inhibition of cell growth and reproduction.

Desired Effect: This drug is used to kill the rapidly replicating cells, particularly malignant ones.

Side Effects/Adverse Effects:

CNS: seizure, malaise, weakness; EENT: ototoxicity, tinnitus; GI: severe nausea, vomiting, diarrhea, hepatotoxicity; GU: nephrotoxicity, sterility; Derm: alopecia; F&E: hypocalcemia, hypokalemia, hypomagnesemia ; Hemat: leukopenia, thrombocytopenia, anemia ; Local: phlebitis @ IV site; Metab: hyperurecemia; Neuro: peripheral neuropathy; Misc: anaphylactoid reaction

Nursing Responsibilities:

Nursing Responsibilities Rationale

1. Monitor for vital signs frequently during administration.

To identify problems early and take measures to prevent them from becoming serious.

2. Monitor intake and output and specific gravity of urine frequently during therapy. Report discrepancies immediately.

This drug can cause nephrotoxicity. Thus, to reduce the risk for nephrotoxicity

3. Assess for bleeding (bleeding gums, bruising, petechiae, stools, uring and emesis). Assess for signs of infecto

This drug may cause bone marrow depression causing a high risk for bleeding and infection. Thus, to render immediate action

4. Monitor for signs of anaphylaxis (facial edema, wheezing, dizziness, fainting, tachycardia). Notify physician if these manifestations occur. Epinephrine and resuscitation equipment should be readily available.

This drug may cause hypersensitivity side effects including anaphylactic-like reactions. Thus, to render immediate action.

5. Assess patient frequently for dizziness, tinnitus, hearing loss, loss of coordination, loss of taste, tingling of extremities. Notify physician promptly if these occur.

Because these drug may cause ototoxicity and neurotoxicity and may be irreversible. Hence, to render action immediately.

6. Monitor CBC and platelet count before and routinely throughout therapy. Withold further doses until WBC is <4000/mm³ and platelet count is >100,000/mm³

Because these drug causes leokopenia and thrombocytopenia and anemia. Thus, preventing the risk for injury.

Nursing Care Plan

Nursing Diagnosis

Fatigue related to anemia secondary to chemotherapeutic drug side effect as manifested by constantly exhausted, decreased performance of daily routines and difficulty in completing tasks.

Nursing Inference

Chemotherapeutic agents such as cisplatin kill cells that are growing at a fast rate. Since blood cells are dividing at a rapid rate, this agent also attacks the blood cells including red blood cells thereby decreasing the amount of red blood cells going in the body that leads to inadequate nutrition to the tissues which then causes fatigue.

Hence, the body receives inadequate nutrition thus, fatigue occurs.

Nursing Goal

After 2-3 weeks of rendering interventions, the patient will be able to report improved sense of energy as manifested by absence of exhaustion, increase performance of daily routines and able to complete tasks.

Nursing Interventions

Nursing Interventions Rationale

1. Ask the client to rate fatigue (1-10 scale, 10 is the highest)

To serve as baseline data

2. Assess patient’s ability to perform normal task or activities of daily living.

To influences choice of interventions or needed assistance

3. Provide a quiet atmosphere, bed rest if indicated

To promote rest in order to lower body’s oxygen requirements, and reduces strain on the heart and lungs

4. Elevate the head of the bed as tolerated

To promote lung expansion in order to maximize oxygenation for cellular uptake

5. Provide or recommend assistance with activities or ambulation as necessary, allowing patient to do as much as possible as tolerated

To reduce physical stress

6. Encourage food intake rich in iron such as (Flour, bread, and some cereals are fortified with iron) if not contraindicated.

To maintain adequate iron intake

7. Give iron supplements as ordered To maintain adequate iron intake

Nursing Evaluation

After 3 weeks of rendering interventions, the patient was able to report improved sense of energy as manifested by absence of exhaustion, increased performance of daily routines and able to complete tasks.

Nursing Diagnosis

Imbalance Nutrition less than body requirements related to inability to ingest food secondary to chemotherapeutic drug side effect- nausea and vomiting- as manifested by weight loss, weakness and fatigue.

Nursing Inference

Chemotherapy causes the release of a substance called serotonin and of other chemicals in the small intestine, which through a series of signals stimulate the vomiting center in the brain to induce emesis. Causing inability to ingest food which then will lead to decreased nutrients receiving by the body. Thus, imbalance nutrition less than body requirements occurs.

Nursing Goal

After 3-4 weeks of rendering interventions, the patient will be able to gain optimum nutrition as manifested by gain weight of 1lb/week, absence of weakness and absence of fatigue.

Nursing Interventions

Nursing Interventions Rationale

1. Monitor weight daily with the same time, clothes, person and weighing scale

To serve as baseline data and obtain accurate readings

2. Monitor daily food intake; have patient keep food diary as indicated.

To identify nutritional strengths and deficiencies that will serve as a guide in rendering interventions

3. Control environmental factors (strong or noxious odors or noise). Avoid overly sweet, fatty, or spicy foods.

Can trigger nausea and vomiting response. Hence, to prevent nausea and vomiting

4. Encourage use of relaxation techniques, visualization, guided imagery, moderate exercise before meals.

May prevent onset or reduce severity of nausea, decrease anorexia, and enable patient to increase oral intake.

5. Encourage patient to eat high-calorie, nutrient-rich diet, with adequate fluid intake, use of supplements and frequent or smaller meals spaced throughout the day (if not contraindicated)

To maintaining adequate caloric and protein intake.

6. Administer antiemetic on a regular schedule before or during and after administration of antineoplastic agent as appropriate.

Nausea and vomiting are frequently the most disabling and psychologically stressful side effects of chemotherapy.

7. Review laboratory studies as indicated (total lymphocyte count, serum transferrin, and albumin or prealbumin).

Helps identify the degree of biochemical imbalance, malnutrition and influences choice of dietary interventions. Note: Anticancer treatments can also alter nutrition studies, so all results must be correlated with the patient’s clinical status.

8. Maintain parenteral fluids as ordered To provide the patient needed fluids and electrolytes

9. Refer to dietitian or nutritional support team.

Provides for specific dietary plan to meet individual needs and reduce problems

associated with protein, calorie malnutrition and micronutrient deficiencies.

Nursing Evaluation

After 4 weeks of rendering interventions, the patient was able to gain optimum nutrition as manifested by gain weight of 1lb/week, absence of weakness and absence of fatigue.

Nursing Diagnosis

Disturbed body image related to alopecia secondary to chemotherapeutic agent side effect as manifested by aloofness, anxiousness, and a verbalization of “jak kayat rumwar nga kastoy ti langak”

Nursing Inference

Chemotherapy agent such as cisplatin kills both cancerous cells and other normal cells in the body. The normal cells in the body that are most at risk for being killed by chemotherapy are those that are growing at a fast rate. Because the cells responsible for hair growth are dividing at a rapid rate, they are sometimes destroyed by chemotherapy. Thinning of hair and, in some cases, complete hair loss may result. This then will lead to the development of anxiety to the patient due to changes in physical appearance. Thus, body image is disturbed.

Nursing Goal

After 3-5 days of rendering intervention, the patient will be able to express positive feelings about self as manifested by mingling with others, relaxed and a verbalization of “confident nak nga rumwaren”

Nursing Intervention

Nursing Interventions Rationale

1. Encourage verbalization of positive or negative feelings about actual or perceived changed.

To decrease anxiety of the patient

2. Inform patient that hair loss is usually temporary.

To decrease anxiety of the patient

3. Encourage use of wig or cap To compensate with the hair loss

4. Refer patient to support groups comprised of individuals with similar alterations

To lay the patient in similar situations that offers different type of support which is perceived as helpful

5. Monitor weight daily To ensure effectiveness of interventions

6. Monitor daily food intake; have patient keep food diary as indicated.

To identify nutritional strengths and deficiencies that will serve as a guide in rendering interventions

7. Encourage patient to eat high-calorie, nutrient-rich diet, with adequate fluid intake, use of supplements and frequent or smaller meals spaced

To maintaining adequate caloric and protein intake.

throughout the day (if not contraindicated)

8. Refer to dietitian or nutritional support team.

Provides for specific dietary plan to meet individual needs and reduce problems associated with protein, calorie malnutrition and micronutrient deficiencies.

Nursing Evaluation

After 5 days of rendering interventions, the patient was able to express positive feelings about self as manifested by mingling with others, relaxed and a verbalization of “confident nak nga rumwaren”

Nursing Diagnosis

Risk for infection related to bone marrow suppression secondary to chemotherapeutic agent

Nursing Inference

Cisplatin can kill both cancerous cells and other normal cells in the body. The normal cells in the body that are most at risk for being killed by chemotherapy are those that are growing at a fast rate. Since blood cells are dividing at a rapid rate, they are sometimes destroyed by chemotherapy decreasing the production of blood cells,including WBC, leaving people susceptible to infection. 

Nursing Goal

After 2-3 hours of rendering interventions, the nurse will be able to minimize exposure to microorganisms to the patient.

Nursing Interventions

Nursing Interventions Rationale

1. Monitor changes or abnormalities in CBC and vital signs (increased WBC, increased body temp., increased pulse)

To render immediate action

2. Wash hands before and after handling the patient

To prevent contamination of pathogens

3. Maintain asepsis for dressing changes, and wound care, catheter care, etc.

To prevent transmitting of pathogens

4. Limit visitors To reduce the risk of increase number of microorganisms in the patient’s environment

5. Administer antibiotic as ordered To prevent infection

6. Encourage a low-microbial diet (e.g. cooked foods, no unwashed fresh fruits and vegetables)

To reduce the risk of infection

Nursing Evaluation

After 3 hours of rendering interventions, the nurse was able to minimize exposure to microorganisms to the patient.