Use: kills parasites, helminths (pinworm and tapeworm), protozoa (amebiasis and malaria)
anthelmintics: GI upset, CNS disturbances, skin rash, headache
amebicides: GI upset, blood dyscrasias, skin rash, CNS disturbances
antimalarials: GI upset, blood dyscrasia, visual disturbances
administer medication with food
monitor vital signs, blood work during therapy
use safety precautions if CNS disturbances manifested
teach client to prevent further infection
with antimalarials: frequent visual examinations, urine may turn rust colored
Total Parenteral Nutrition (TPN)
A form of specialized nutritional support in which nutrients are provided by the intravenous route
Purpose: to sustain clients nutritionally. Solutions consist of water, amino acids, glucose, minerals, vitamins and lipid emulsions, and trace elements which are calculated for each client individually.
Used for clients who are unable to digest or absorb sufficient enteral nutrition
Catheter - related sepsis
Central venous thrombosis
Via peripheral administration - up to 10% glucose solutions
Via central administration - up to 35% glucose solutions
Before administration of TPN
check label of solution with medical order
check rate of infusion with medical order
inspect TPN bottle for precipitates or turbidity
administer via an infusion pump
monitor vital signs every four hours
observe for signs of air embolism, pneumothorax, or allergic responses (such as chills, increased temperature, urticaria etc.)
monitor client's weight daily
monitor laboratory values; if blood glucose levels rise, may need to use sliding-scale insulin therapy
monitor client for fluid overload
monitor respiratory rate: tachypnea may indicate excess carbohydrates are increasing carbon dioxide production
Highly toxic agents that attack all rapidly dividing cells, both normal and malignant
Represents a systemic approach that bases its action on disruption of the cell life cycle
Most agents modify or interfere with DNA synthesis
Alkalyting agents: mechlorethamine HCl (Nitrogen Mustard), cyclophosphamide (Cytoxan): produce breaks in DNA molecule and cross-linking of strands thus interfering with DNA replication; most effective in hematologic malignancies
Antitumor antibiotics: Biomycin; bind directly with DNA changing its configuration and inhibiting replication
Antimetabolites: methotrexate, 5-fluorouracil, floxuridine, cytosine arabinoside, 6-mercaptopurine, 6-thioguanine: inhibit DNA synthesis; most effective against rapidly growing tumors enzymes necessary for cell function and replication
Plant alkaloids: Vinblastine, Vincristine, Etoposide: Bind to substances needed to form mitotic spindle, thus preventing cell division
Hormones and hormone inhibitors: Tamoxifen alters the endocrine environment to make it less conducive to cell growth; used in cancers of the breast, prostate, and other reproductive organs
Routes of administration
Intravenous (peripheral or central venous access)
Via ventricular reservoir
To cure, control or palliate results of neoplasm
May be used as an adjunct to surgery and radiation
Adverse effects: result from the damage to normal cells
Nausea/ vomiting, stomatitis, alterations in taste, anorexia
Administer antiemetic agents as ordered and prophylactically before chemotherapy.
Give antihistamines as ordered
Withhold food and fluids for four to six hours before treatment
Between treatments, give small, frequent, bland meals
Give antidiarrheals as ordered
Monitor for signs of dehydration and encourage fluids as tolerated
Provide frequent oral hygiene, lubricate lips as indicated
For stomatitis, use topical anesthetics before eating and as indicated
Apply lotion to skin as indicated; avoid harsh, drying soaps
Provide a restful environment, emotional support and anxiolytics as ordered
medications and side effects
alopecia is temporary
avoid bruising, aspirin products, and persons with infections
recognize signs of bleeding; anemia, infection
use a soft-bristle toothbrush
avoid use of razors
Special nursing considerations
Exposure to chemotherapeutic agents can lead to adverse reactions
nausea and vomiting
Exposure during pregnancy can lead to
increased risk of fetal abnormalities
Guidlines for reducing risks when handling cytotoxic antineoplastic drugs
wear a mask to avoid inhaling powder when handling a powder form of a drug.
do not prepare drugs in eating places Wear gloves, eye protectors and protective clothing when in contact with injectable solutions.
dispose of contaminated materials in puncture-proof containers labeled as hazardous material.
wear gloves when handling linens contaminated with drugs for at least 48 hours after contamination.
wash hands thoroughly before and after exposure to drugs.
follow organizational procedure to clean-up after chemical spill.
Use: restore blood volume or blood components
Nursing responsibilities and interventions
Verify that blood had been typed and cross matched
Verify five factors:
Pretransfusion assessment includes baseline vital signs, lung sounds, level of consciousness, IV site, and prescence of pain
Verify informed consent
Start infusion with blood administration set, filter, and normal saline IV
Watch for signs of hemolytic reaction; usually occurs within the first 15 minutes (shivering, headache, lower back pain, oliguria, hypotension)
Watch for signs of febrile reaction; usually occurs within first 30 minutes (hematemesis, confusion, back pain, elevated temperature, headache, shaking)
Watch for allergic reaction (hives, wheezing, pruritus, joint pain)
Monitor vital signs
If reaction occurs
stop blood immediately
maintain IV with saline
send blood and urine specimen to lab
monitor client during transfusion
monitor lab results - hemoglobin and hematocrit
The dosage of medication needed for a therapeutic effect can vary with age, weight, gender, health status and environmental factors.
Most drugs produce a mixture of therapeutic and adverse effects.
Medications require a written order from a physician or a nurse practitioner legally permitted to prescribe them.
Because most drugs are metabolized in the liver, it is especially susceptible to drug induced injury.
The nurse is responsible to judge independently before giving a prescribed medication.
The route of administration will be chosen to achieve a certain therapeutic action, at a certain speed.
Medications interact with foods, and that interaction can block or slow therapeutic action
People metabolize medications differently, depending on age, gender, body size, health status, drug tolerance, cumulative effect of medication, and genetics.
Inhalers are most effective when their users know the right technique. Teach the technique and then test how well the client uses it.
Medications are especially likely to cause hypotension in elderly people.
There are two types of drug dependence: psychic and physical. Psychic dependence implies a craving to use the drug periodically. Physical dependence implies physical symptoms when the drug is withheld.