Page 42 nursing.elitecme.com Complete Your CE Test Online - Click Here the chest, which is placed under the skin during minor surgery. Special needles can be inserted into the port for chemo or drawing blood [152]. These long term access devices can also be used to give fluids, blood products, and other drugs. They can be a very convenient to draw blood, which most patients really appreciate. But all of these devices pose the risk of infection. The patient should be taught to watch for and report redness, tenderness, drainage or cording at the catheter site [152]. Pumps are often used to control how fast IV chemotherapy goes in. These may be used for inpatient or outpatient chemotherapy, and may be internal or external. Internal pumps must be positioned under the skin during surgery and refilled at intervals, so follow-up appointments should be emphasized with the patient [152]. If the patient goes home with an implanted pump, s/he must know how to care for it, and know to observe for and report swelling, drainage, redness, or pain near the injection site when any pump is in use. For external pumps, the patient and at least one family member also need to know how to operate the pump and deal with tubing, disconnections, batteries, etc. Other types of access There are also intra-arterial catheters that may be inserted for localized injection of drugs directly into a tumor area. Only trained professionals should use these devices, and patients must be well educated on safety measures and how to handle leakage or bleeding [79]. Intrathecal and intraperitoneal chemotherapy require specialized access devices that are typically inserted by physicians. Training on device use is essential for the nurse, and the patient and other staff must also understand what can and cannot be used in them. The intrathecal space is especially sensitive, and many IV drugs cannot be used for injections there without risk of death or serious damage. It is important that the pharmacist know when a drug is ordered for intrathecal use, to be sure that the right formula makes it to the patient. A bedside double-checking procedure is extremely important here and should be performed independently by two professionals. Patients who are receiving intraperitoneal chemotherapy will need to lie on one side and switch sides periodically. A number of chemotherapy drugs often given via IV can be used for intraperitoneal treatment, and the same side effects tend to result. There are additional side effects from increased pressure, such as abdominal pain, shortness of breath, and diarrhea. Besides the drugs for nausea, pain medications may be needed. Shortness of breath may be helped by raising the head of the bed to reduce pressure on the diaphragm [79]. Nursing management of access devices Many different devices are used in different settings. The nurse should thoroughly understand: how his or her patients’ devices work; how to use them; device care and maintenance; possible risks and complications of each; and how to determine when they might be failing. Documentation of assessments and maintenance are essential. Patients must be instructed on what to do at home, what to report, and how to deal with unexpected complications as well as provided a 24- hour contact number for emergencies. Chemotherapy regimens There are numerous chemotherapy drugs given in combination. Treatment is based mostly on: ● ● The type of cancer. ● ● The stage of cancer. ● ● Whether the patient has had chemo before. ● ● Whether there are co-morbidities such as diabetes, renal failure, or heart disease. Most patients get chemo in cycles. A cycle is a period of treatment followed by a break. For instance, chemo may be given every day for one week followed by three weeks with no chemotherapy. This is one-four-week cycle. The break gives the patient a chance to recover before the next cycle. Regimens may be modified based on the patient’s tolerance and side effects. Some side effects like myelosuppression are serious enough to merit a longer break, changing the dose or regimen, or even suspending treatment until the patient recovers enough to resume the same or a modified treatment [152]. It is important when patients return home after treatment, that they and caregivers have a listing of problems for which the doctor must be notified, especially which ones may be emergencies. This partly based on the types of drugs the patient received or will be taking at home, and expected or serious side effects, e.g. [6]: ● ● Bleeding or unexplained bruising. ● ● Blood in the stool or urine. ● ● Fever of 100.5°F or higher. ● ● Shaking chills. ● ● Shortness of breath. ● ● Cough, sore throat, or burning on urination. ● ● Unusual pain, including severe headaches or abdominal pain. ● ● Diarrhea of more than two days’ duration. ● ● Vomiting or the inability to keep down medicines. ● ● Signs of allergic reaction such as swelling of the mouth or throat, trouble breathing or swallowing, dizziness or faintness, severe itching, or hives. Patient safety and safe medication practices for chemotherapy In the process of preparing and administering chemotherapy medications, nurses need to be sure that there are mechanisms, procedures, and qualified staff to independently verify drug names and doses, times and dates each is due, routes of administration, and patient identification. It is important to be sure that drugs are fully labeled as they leave their original containers (including individual syringes, medicaton containers, or basins), and are transported safely to the bedside. Nurses also must have quick access to extravasation kits in case of vesicant leaks, and procedures to minimize exposures to dangerous drugs in the event of breakage or spills, including safe disposal of cleanup materials. These are just some of the minimum standards covered in the American Society of Clinical Oncology/ Oncology Nursing Society Chemotherapy Administration Safety Standards (see “Nursing Resources” for details) [223]. Targeted therapy Most targeted therapies are either small-molecule drugs or monoclonal antibodies [199]: ● ● Small-molecule drugs are small enough to enter cells easily, so they are used for targets that are intracellular. ● ● Monoclonal antibodies are not able to enter cells easily. Instead, they attach to specific targets on the outer surface of cells. Who receives targeted therapy Targeted therapy can be used for some types of cancer. Many patients with cancer will have a target for a certain drug, so they can be treated with that drug. In order to find out, the tumor will need to be tested to look for targets for which there are drugs. Tumor testing for targets may involve an additional biopsy [199]. How targeted therapy works against cancer Most targeted therapies help treat cancer by interfering with specific proteins that help tumors grow and spread throughout the body. They treat cancer in many different ways. They can [199]: ● ● Help the immune system destroy cancer cells. Certain targeted therapies can mark cancer cells so it is easier for the immune system to find and destroy them. Other targeted therapies help boost the immune system to work better against cancer.