McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 4  Antineoplastic agents

or hepatic dysfunction that might interfere with drug metabolism and excretion ; current status of pregnancy or breastfeeding to prevent potentially serious adverse effects on 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 ; skin to evaluate for lesions ; hair and hair distribution to monitor for adverse effects ; respiratory rate and adventitious sounds to monitor the disease and to evaluate for respiratory or hypersensitivity 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 ; and renal and liver function tests to determine the need for possible dose adjustment as needed and to evaluate toxic drug effects . ■ ■ Regularly inspect IV insertion sites for signs of extravasation or inflammation, which need to be treated quickly . ■ ■ Arrange for blood tests to monitor bone marrow function before, periodically during, and for at least 3 weeks after therapy to arrange to discontinue the drug or reduce the dose as needed . ■ ■ Avoid direct skin or eye contact with the drug. Wear protective clothing and goggles while preparing and administering the drug to prevent toxic reaction to the drug . ■ ■ 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 . ■ ■ Monitor injection sites to arrange appropriate treatment for extravasation, local inflammation or cellulitis . ■ ■ Protect the person from exposure to infection because bone marrow suppression will decrease immune/inflammatory responses . ■ ■ Provide small, frequent meals, frequent mouth care and dietary consultation as appropriate to maintain nutrition if 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 or epilation occurs; a wig, Implementation with rationale

Safe medication administration

drugs known to have the same adverse effect. Check specific drug–drug interactions for each agent in a drug guide. Preventing and treating extravasation When an IV antineoplastic drug extravasates or infiltrates into the surrounding tissue, serious tissue damage can occur. These drugs are toxic to cells, and the resulting tissue injury can result in severe pain, scarring, nerve and muscle damage, infection and, in very severe cases, even amputation of the limb. Prevention is the best way to deal with extravasation. Interventions that can help to prevent extravasation include the following: use a distal vein, and avoid small veins on the wrist or digits; never use an existing line unless it is clearly open and running well; start the infusion with plain 5% dextrose in water (D5W) and monitor for any sign of extravasation; check the site frequently and ask the person to report any discomfort in the area; and, if at all possible, do not use an infusion pump to administer one of these drugs because it will continue to deliver the drug under pressure and can cause severe extravasation. Prototype summary: Vincristine Indications: Acute leukaemia, Hodgkin’s disease, non-Hodgkin’s lymphoma, rhabdomyosarcoma, neuroblastoma, Wilms tumour. Actions: Arrests mitotic division at the stage of metaphase; the exact mechanism of action is not understood. Pharmacokinetics: Route Onset Peak IV Varies 15–30 mins T 1/2 : 5 minutes, then 2.3 hours, then 85 hours; metabolised in the liver and excreted in the faeces and urine. Adverse effects: Ataxia, cranial nerve manifestations, neuritic pain, muscle wasting, constipation, leucopenia, weight loss, loss of hair, death.

Care considerations for people receiving mitotic inhibitors

Assessment: History and examination

■ ■ Assess for contraindications or cautions: history of allergy to the drug used (or related drugs) to avoid hypersensitivity reactions ; bone marrow suppression to prevent further suppression ; renal