McKenna's Pharmacology for Nursing, 2e

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P A R T 2  Chemotherapeutic agents

Care considerations for people receiving antineoplastic antibiotics

to maintain nutrition when GI effects are severe . Anticipate the need for antiemetics as necessary. (See Box 14.5.) ■ ■ Arrange for proper head covering at extremes of temperature if alopecia occurs; a wig, scarf or hat is important for maintaining body temperature . If alopecia is an anticipated effect of drug therapy, advise the person to obtain a wig or head covering before the condition occurs to promote self-esteem and a positive body image . ■ ■ Provide the following teaching: –– Follow the appropriate dosage regimen, including dates to return for further doses. –– Maintain nutrition if GI effects are severe. –– Cover the head at extremes of temperature if alopecia is anticipated. –– Plan for appropriate rest periods because fatigue and weakness are common effects of the drugs. –– Avoid exposure to possible infection, including avoiding crowded places, sick people and working in soil. –– Use safety measures such as avoiding driving or using dangerous equipment to prevent injury due to possible dizziness, headache and drowsiness. –– Consult with a healthcare provider, if appropriate, due to the possibility of impaired fertility. –– Use barrier contraceptives to reduce the risk of pregnancy during therapy. Evaluation ■ ■ Monitor response to the drug (alleviation of cancer being treated and palliation of signs and symptoms of cancer). ■ ■ Monitor for adverse effects (bone marrow suppression, GI toxicity, neurotoxicity, alopecia, renal or hepatic dysfunction, and cardiac or respiratory dysfunction). ■ ■ Evaluate the effectiveness of the teaching plan (person can name the drug, dosage, possible adverse effects to watch for and specific measures to help avoid adverse effects).

Assessment: History and examination

■ ■ Assess for contraindications and cautions: history of allergy to the antibiotic in use to avoid hypersensitivity reactions ; bone marrow suppression to prevent further suppression ; renal or hepatic dysfunction that might interfere with drug metabolism and excretion ; respiratory or cardiac disease; current status related to pregnancy or breastfeeding to prevent potentially serious adverse effects to the fetus or breastfeeding baby ; and GI ulcerative disease, which could be exacerbated by these drugs . ■ ■ Perform a physical assessment to establish baseline data for determining the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy . ■ ■ Assess orientation and reflexes to evaluate any CNS effects ; respiratory rate and adventitious sounds to monitor the disease and evaluate for respiratory or hypersensitivity effects ; pulse, rhythm, cardiac auscultation and baseline electrocardiogram to monitor for systemic or cardiovascular effects ; and bowel sounds and mucous membrane status to monitor for GI effects . ■ ■ Monitor the results of laboratory tests such as FBC with differential to identify possible bone marrow suppression and toxic drug effects, as well as renal and liver function tests, to determine the need for possible dose adjustment . Implementation with rationale ■ ■ Arrange for blood tests to monitor bone marrow function before, periodically during, and for ■ ■ Monitor cardiac and respiratory function, as well as clotting times as appropriate for the drug being used, to arrange to discontinue the drug or reduce the dose as needed . ■ ■ Protect the person from exposure to infection because bone marrow suppression will decrease immune/inflammatory reactions . ■ ■ Administer medication according to scheduled protocol and in combination with other drugs as indicated to improve the effectiveness of drug therapy . ■ ■ Ensure that the person is well hydrated to decrease the risk of renal toxicity . ■ ■ Provide small, frequent meals, frequent mouth care and dietary consultation as appropriate at least 3 weeks after therapy to arrange to discontinue the drug or reduce the dose as needed .

KEY POINTS

■■ Antineoplastic antibiotics are toxic to rapidly dividing cells. ■■ These drugs are cell cycle–specific, affecting the S phase. ■■ Bone marrow suppression, alopecia and toxic GI effects are common adverse effects of the antineoplastic antibiotics.