Case Assignment: Chemotherapy

A 10-year-old who is receiving chemotherapy has received Odansetron ( Zofran) before this therapy session. About an hour later, the child tells the nurse that his mouth feels really dry. The child has urinated several times and his skin turgor is normal. Which response by the nurse would be most appropriate?
2. After teaching the parents of a 6-year-old child about caring for a sprained wrist, which statement by the parents indicates the need for additional teaching?Case Assignment: Chemotherapy Essay
3. A grandparents of a 3-month old infant asks the nurse what kind of toys they should purchase to have in their home when the infant grandchild comes to visit. Which should the nurse not recommend for purchase at this time?

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4. After returning from cardiac catheterization, the nurse determines that the pulse distal to the catheter insertion site is weaker. The nurse should do which of the following?
5. When planning care for a child with ketoacidosis, which consideration is highest in priority?
6.The nurse is discussing the risks and benefits of vaccines with a family, and must secure signed, informed consent for the children to be immunized. The nurse emphasizes that which of the following reactions to vaccines is very rare?
7. A child with rhabdomyosarcoma is to undergo radiation therapy after surgical removal of the tumor. The parents should be taught to:Case Assignment: Chemotherapy Essay
8. The parent of a child with AIDS tells the nurse they are confused about whether or not their child can be immunized The nurse would be most correct in advising these parents that there child with AIDS:
9. When discussing alopecia with a child who is receiving chemotherapy, the nurse should instruct the child and family:
10. A healthcare provider tells the nurse that a certain medication will be prescribed for a client. After the prescription is written, the nurse notes that the provider has prescribed another medication that sounds similar to the medication that the provider and nurse originally discussed. What action should the nurse implement? .
11. When caring for a17- year old athlete who is scheduled for a leg amputation for treatment of osteosarcoma, what should the nurse’s approach include:
12. Which school related activity might the school nurse prohibit for a child with asthma ?
13. A 6-year-old child is being admitted with newly diagnosed acute lymphocytic leukemia. The multidisciplinary team is meeting to plan care for this child and family. Which statement by the parents should receive priority in the nursing planning process?Case Assignment: Chemotherapy Essay
14. Probably the most important criterion on which to base the decision to report suspected child abuse is which of the following?
15. The nurse is teaching a adolescent diabetic client how to self-administer a subcutaneous injection. To help ensure sterility of the procedure, which subject is most important for the nurse to include in the teaching plan?
16. Provider’s Order: Procaine Penicillin G 180,000 Units IM x 1 dose, STAT

a. Child’s weight: 8 lb

b. Dispensed as: Penicillin G 300,000 Units/ml

c. Recommended daily dose: 50,000 Units/kg IM every 24 hours

Based on the recommended daily dose, is the order appropriate based on the child’s weight?

If it is outside of the recommended daily dose range, what should you do, next?

If the dosage is within the recommended range, how many milliliters will you administer?
17. A child had an appendectomy after a ruptured appendix. The nurse anticipates orders for which interventions? Select all that apply.
18. Following the administration of morphine sulfate 10 mg IV to a pediatric client in pain, the nurse determines that the client’s respirations are six breaths per minute. What action should the nurse take first?
19. A teenager is accompanied by the mother to the annual physical examination. The nurse is aware of privacy issues related to the teenager. While the mother is in the room, the nurse should avoid questions about which of the following? Select all that apply.
20. The RN observes a nursing student entering a toddler’s room to check vital signs and begins to take the child’s temperature first. The RN should:
21. The child with asthma reports to the school nurse, who checks the child’s peak expiratory flow rate and finds that it reads 84% of personal best. Which interpretation by the nurse would be best:
22. A child has been diagnosed with a Wilms’ tumor; preoperative nursing care would involve:
23. A school-age client that is morbidly obese is receiving an intramuscular injection at the ventrogluteal site. At what angle should the nurse insert the needle?
24. A female teen volunteer is assigned to the pediatric unit for the day and reports to the charge nurse for an assignment. Which of the following assignments is unsafe for the volunteer?Case Assignment: Chemotherapy Essay

An inf An infant with Tetralogy of Fallot experiences a hypercyanotic spell during a IV insertion. While simultaneously administering 100% oxygen by face mask to the infant the nurse should also:

A.

B

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Types, Uses and Side Effects of Chemotherapy

Introduction

Chemotherapy (chemo) is a type of treatment that includes a medication or combination of medications to treat cancer. The goal of chemo is to stop or slow the growth of cancer cells. Chemo is considered a systemic therapy

However, chemotherapy may also include the use of antibiotics or other medications to treat any illness or infection.Case Assignment: Chemotherapy Essay

Chemotherapy has five possible goals

Total remission – to cure the patient completely. In some cases chemotherapy alone can get rid of the cancer completely.
Combination therapy – chemotherapy can help other therapies, such as radiotherapy or surgery have more effective results.
Delay/Prevent recurrence – chemotherapy, when used to prevent the return of a cancer, is most often used after a tumor is removed surgically.
Slow down cancer progression – used mainly when the cancer is in its advanced stages and a cure is unlikely. Chemotherapy can slow down the advancement of the cancer.
To relieve symptoms – also more frequently used for patients with advanced cancer.

Types and Uses of Chemotherapy

Alkylating Agents: Alkylating agents are most active in the resting phase of the cell. These types of drugs are cell-cycle non-specific. There are several types of alkylating agents used in chemotherapy treatments:Case Assignment: Chemotherapy Essay

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Mustard gas derivatives: Mechlorethamine, Cyclophosphamide, Chlorambucil, Melphalan, and Ifosfamide.
Ethylenimines: Thiotepa and Hexamethylmelamine.
Alkylsulfonates:
Hydrazines and Triazines: Altretamine, Procarbazine, Dacarbazine and Temozolomide.
Nitrosureas: Carmustine, Lomustine and Streptozocin. Nitrosureas are unique because, unlike most types of chemo treatments, they can cross the blood-brain barrier. They can be useful in treating brain tumors.
Metal salts: Carboplatin, Cisplatin, and Oxaliplatin.

Plant Alkaloids: Plant alkaloids are chemotherapy treatments derived made from certain types of plants. The plant alkaloids are cell-cycle specific. This means they attack the cells during various phases of division.Case Assignment: Chemotherapy Essay

Vinca alkaloids: Vincristine, Vinblastine and Vinorelbine.
Taxanes: Paclitaxel and Docetaxel.
Podophyllotoxins: Etoposide and Tenisopide.
Camptothecan analogs: Irinotecan and Topotecan.
Antitumor Antibiotics: Antitumor antibiotics are chemo treatments made from natural products produced by species of the soil fungus Streptomyces. These drugs act during multiple phases of the cell cycle and are considered cell-cycle specific.

Topoisomerase Inhibitors: Toposiomerase inhibitors are types of chemotherapy drugs that interfere with the action of topoisomerase enzymes (topoisomerase I and II). During the process of chemo treatments, topoisomerase enzymes control the manipulation of the structure of DNA necessary for replication.

Sometimes, chemotherapy is used as the only cancer treatment. But more often, patient will get chemotherapy along with surgery, radiation therapy, or biological therapy. Chemotherapy can:Case Assignment: Chemotherapy Essay

Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant chemotherapy.
Destroy cancer cells that may remain after surgery or radiation therapy. This is called adjuvant chemotherapy.
Help radiation therapy and biological therapy work better.
Destroy cancer cells that have come back (recurrent cancer) or spread to other parts of your body (metastatic cancer).

Side Effects of Chemotherapy

Most people worry about whether they’ll have side effects from chemo, and, if so, what they’ll be like. Here are some of the more common side effects caused by chemotherapy:

Fatigue
Hair loss
Easy bruising and bleeding
Infection
Anemia (low red blood cell counts)
Nausea and vomiting
Appetite changes
Constipation
Diarrhea
Mouth, tongue, and throat problems such as sores and pain with swallowing
Nerve and muscle problems such as numbness, tingling, and pain
Skin and nail changes such as dry skin and color change
Urine and bladder changes and kidney problems
Weight changes Case Assignment: Chemotherapy Essay
Chemo brain, which can affect concentration and focus
Mood changes
Changes in libido and sexual function
Fertility problems
Some chemo drugs can damage cells in the heart, kidneys, bladder, lungs, and nervous system. Sometimes, patient can take medicines with the chemo to help protect their body’s normal cells. There are also treatments to help relieve side effects.

Doctors try to give chemo at levels high enough to treat cancer, while keeping side effects at a minimum. They also try to avoid using multiple drugs that have similar side effects. Case Assignment: Chemotherapy