A patient I'll call Lavern King, 67, was admitted to a small rural hospital with a temperature of 101.8[degrees]F (38.8[degrees]C), painful mouth sores, and complaints of progressive weakness and chills. Newly diagnosed with lymphoma, she had received her first course of chemotherapy a little over a week before. In that short time, she'd lost five pounds and a significant amount of hair, developed neutropenia, and had stomatitis severe enough to make it difficult to swallow.
Like many of the 1.3 million people in the United States who were newly diagnosed with cancer in 2003, Mrs. King was administered chemo as an outpatient. (1) And like increasing numbers of these patients, she ended up in the hospital because of the side effects of treatment.
As powerful antineoplastic agents keep more and more cancer patients alive, it's likely that the number of patients hospitalized with chemo side effects will continue to grow. (2) Indeed, Andrew von Eschenbach, MD, director of the National Cancer Institute, recently predicted that in the near future, cancer will be treated as a chronic disease much like hypertension, diabetes mellitus, and other serious but manageable conditions. (3)
But with long-term management of cancer comes the burden of coping with treatment's debilitating side effects. These include conditions that can interrupt chemotherapy--myelosuppression, stomatitis, and severe nausea and vomiting (N/V)--and those that don't (but are still troubling), such as hair loss. Whatever the side effect, your support, nursing interventions, and patient education will enable many oncology patients to continue the aggressive treatment they need to stay alive.
Understanding how chemo works
If you're caring for a newly diagnosed patient like Mrs. King or are unaccustomed to caring for oncology patients, a review of chemotherapy basics will help guide your care. As you know, cancer cells divide rapidly, and chemotherapeutic agents work by disrupting a specific part of this cancer-cell cycle. Different classes of drugs target different stages of the cycle.
Because each class has unique properties, chemotherapeutic agents are often combined to deliver a knockout punch to cancer cells in various stages of development. Unfortunately, though, most chemotherapeutic agents can't differentiate between a healthy cell and a cancer cell, so they attack both. As a result, the effects of chemo are systemic, with the bone marrow, GI tract, and integumentary systems among those most commonly affected. (4)
Myelosuppression: A major issue
Myelosuppression is not only the most common side effect of chemotherapy but also potentially the most lethal. (5) When bone marrow production is interrupted by chemotherapy, the numbers of leukocytes, erythrocytes, and thrombocytes decrease. Generally, white blood cell production is the most sensitive to chemotherapy drugs. (6)
Mrs. King, like many patients undergoing chemotherapy, developed neutropenia, a drop in white blood cells--specifically, her neutrophils. A CBC, ordered when she was admitted, revealed a WBC count of 900/[mm.sup.3]. (Normal WBC values are 4,500 - 11,000/[mm.sup.3].) (4)
Nursing care for an immunosuppressed patient centers on the prevention of infection. More than 60% of patients with neutropenia become infected, many of them by...
This is a preview. Get the full text through your school or public library.