Medical 7-Cancer Red Book Handout

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What is chemotherapy?: use of chemical drugs to destroy cancer cells
How does chemo fight cancer?: by interfering with cancer cells' ability to grow and duplicate
Chemo attacks which cells?: all rapidly dividing cells, both malignant and normal...harm to healthy cells is what causes side effects
Examples of normal cells that are OFTEN harmed by chemo are (4)?: bone marrow
digestive tract
reproductive system
hair follicles
Chemo harm to normal cells of bone marrow causes (3)?: infection
bleeding
energy loss
Chemo harm to normal cells of the digestive tract causes (5)?: constipation
diarrhea
mouth sores
nausea
vomiting
Chemo harm to normal cells of the reproductive system causes?: temporary or permanent loss of reproductive ability or harm to developing fetus
Chemo harm to normal cells of the hair follicles causes?: temporary loss of body hair
The frequency and length of treatment will depend on which several factors?: type/site of cancer
chemotherapy drugs used
how side effects are
tolerated...
how the body responds to
treatments
What routes is chemo administered by (6)?: oral
IV
IM
subcut
venous access device
applied on skin

(the chemo should not hurt...some meds may cause a cool or burning sensation, but NEVER cause pain)
What do side effects depend on?: drug dose
extent of disease
physical status
how body reacts
route of delivery
What is the most frequent TEMPORARY side effect of chemo?: bone marrow suppression
Where are blood cells produced?: bone marrow which is the spongy tissue filling in the center of the flat and long bones
ex: sternum
vertebrae
ribs
skull
Why is bone marrow suppression serious?: impairs ability of body to fight infection and clot blood
What is nadir?: the time during chemotherapy cycle when BLOOD count reaches its LOWEST point

Normal WBCs: 5,000 to 10,000

(when blood count is low, patient can continue most normal activities)
When does nadir occur?: about 7-14 days after first day of chemo treatment
What are some illnesses a chemo patient should avoid?: colds
flu
chicken pox
cold sores
What kind of recently administered vaccines clients should a chemo patient avoid?: live virus vaccines...live oral polio vaccine
All sources of stagnant water should be avoided including?: flower vase water
pitchers
denture cups
humidifiers
respiratory equipment
All raw fruits and vegetables should be washed thoroughly in case they are contaminated with?: bacteria...and wash hands thoroughly before eating...bathe or shower daily
Change the ____ litter box. Avoid malls and waiting rooms.: cat
Practice good oral hygeine by brushingn teeth after every meal...do not floss or brush teeth with a ______ _____ brush.: stiff bristle...this would allow germs to enter blood stream...mouth rinse is okay...check with doctor before having dental work done
Report physician immediately a fever above _______degrees F, after checking twice...use oral thermometer: 100 degrees F
Tylenol okay for pain relief: okay
Protect hands from cuts and _____.: burns
Women should use _____ _____ instead of tampons?: sanitary napkins
Symptoms to report (9)?: chills
burning or frequency of
urination
headache or stiff neck
any sores, open cuts or
infected areas
fever above 100 degrees F,
after checking twice
cough, sore throat or runny
nose
chest pain or shortness of
breath
sores or white patches in
mouth
loose, watery stools
(diarrhea)
What is normal hemoglobin?: 12 to 18
What is normal hematocrit?: 37 to 52
If cancer treatment causes anemia, patient may do the following?: take frequent rest periods
ask for help
change positions slowly if
dizziness experienced
prioritize activities
eat balanced diet
ask doctor about Procrit or
Aranesp for supportive
therapy
Report the following with chemo treatment?: dizziness
feeling as if heart
is "pounding" or beating
very fast
ringing in ears
shortness of breath
unusual tiredness or weakness
What is normal platelet count?: 130,000 to 400,000
Nadir for platelets?: 7 to 14 days after treatment
Chemo patients may prevent problems related to low platelets by?: avoiding physical activity
that could cause injury
avoid toothpicks
use caution with knives or
tools
shave with an electric razor
Tylenol okay if doctor
approves.
Blow nose gently.
Don't use enemas
Supportive therapy for low
platelets may include use
of oprelvekin if doctor
prescribes
If bleeding occurs due to low platelet count, apply pressure to site for how long?: 5 minutes...if bleeding lasts longer than 5 minutes, call doctor
What medication disrupts platelet function and should be avoided unless doctor prescribes?: aspirin
aspirin-containing medication
If platelets are running low, report the following effects?: bleeding gums
blood in urine or stools
easy bruising
nose bleeds
small red dots under skin
(petechiae)
prolonged bleeding from a
cut
What does a complete blood count (CBC) measure?: kinds of cells in blood
What does the Absolute Neutrophil Count (ANC) measure?: neutrophils, which fight infection and represent a subset of WBC
Red blood cells carry oxygen to the cells...which tests analyze it?: hemoglobin
hematocrit
What do platelets do?: clot blood
What does a lowered (less than 1000) ANC or absolute neutrophil count reflect?: that bone marrow is recovering and new blood cells are beginning to grow and mature
What is there a risk for if ANC is less than 1000?: serious or fatal infection...patient's own normal bacteria rather than exogenous exposure
Take temperature four times daily. Contact medical staff immediately if a fever runs greater than _____ and ANC is less than ____. Prompt hospitalization and initiation of IV antibiotic therapy is necessary to avoid life threatening infection: 100
1000
Excessive bleeding (nosebleeds, bruises, blood in stool) rarely occurs unless platelet count is under?: 50,000
Platelet count should register over _____ to not be at risk for bleeding.: 175,000
Normal WBC?: 5,000 to 10,000
Expected WBC values during chemotherapy?: 2,000 to 5,000
WBC danger values?: less than 1,000
Normal Absolute neutrophil count (ANC) values?: 1,500 to 3,000
Expected ANC values during chemotherapy?: 1,000 to 2,000
ANC danger values?: less than 1,000
Normal hemoglobin values?: 12-18
Expected hemoglobin values during chemotherapy?: 9-11
Danger values for hemoglobin?: less than 7
Normal values for hematocrit?: 13-52
Expected values for hematocrit during chemo?: 27-33
Danger values for hematocrit?: less than 20
Normal values for platelets?: 130,000 to 400,000
Expected values for platelets during chemo?: 75,000 to 175,000
Danger values for platelets?: less than 50,000
Most patients don't get ____ or have _____ if blood counts stay down for only a few days. Patient may still feel well.: infected
bleeding
The most common and and potentially serious side effect of chemo is lowered ______ counts.: blood
Two agents used in bone marrow suppression supportive therapies include?: Neupogen (GCSF)
Neulasta
Neupogen is administered how many days after chemo treatment as a bone marrow suppression supportive therapy?: 7 to 14
Nuelasta is given ____ of or ____ after chemo treatment as a bone marrow suppression supportive therapy?: day
day
The goal of bone marrow suppression supportive therapy is to stimulate production of falling ____ and reduce chances of _____.: wbcs
infection
Medications that may increase RBCs are?: erythropoetin (Procrit)
Aranesp
The goal of bone marrow suppression supportive therapy drugs such as erythropoetin (Procrit) and Aranesp is to stimulate production of RBCs which have decreased as a result of chemo and treat _____ which may have occurred as a result of chemo.: anemia
What drug and/or method might be used to improve platelet count?: oprevelkin
platelet transfusion
Most _____ (killed or inactivated) do not represent a danger to immunocompromised patients.: vaccines
Patients undergoing chemo should not be given ____ vaccines.: live
If a chemo patient comes in contact with a recent _____ ______ recipient, observe strict personal hygeine (wash hands before eating, drinking, food preparation): polio vaccine
How long may a polio virus vaccine recipient pass it in stools?: 6 weeks
MMR (measles-mumps-rubella vaccine) is not ________.: contraindicated
During flu season, it is generally recommended to chemo patients to ______ flu and pneumonia vaccine.: receive
If constipation occurs while on chemo, it's okay to use a ____ ______: stool softener or laxatives
Have the patient report these 3 following symptoms of constipation due to some chemo?: any change in bowel pattern
no relief from symptoms
severe abdominal pain
Chemo patient should report the following symptoms of diarrhea to physician?: more than 6 watery bowel
movements per day
blood in stool
symptoms that persist for
more than 24 hours or if
diarrhea with pain
and cramping
loss of 5 lbs or more after
diarrhea starts
no urination for 12 hours or
more
Chemo patient may avoid bouts of mild to severe diarrhea by doing the following?: increase intake of cheese,
bananas, apple sauce, and
white rice or cereal...
eat small, frequent meals...
stop eating nuts, whole
grains, bran cereals,
fresh fruits and raw
vegetables
avoid milk products
speak with your nurse/dr
regarding OTC meds
Chemo patient may feel fear, anxiety, anger, depression so patient should report the following to health care (2)?: sleep disturbances
persistent feelings of
sadness or hopelessness
Chemo patients may be more sensitive to light or sun and can do the following to help?: sunglasses
artificial tears or eye
lubricant can be used to
assist with excessive
tearing, blurred vision,
and dry eyes
change prescription eyewear
after chemo course
completed
The following eye conditions may be experienced by chemo patients...report the following (4)?: eye infections
blind spots
a sudden change in vision or
blurring of vision
pain
Due to fatigue, report persistent ________: insomnia
Hair loss usually occurs how many weeks following first chemo treatment?: 2-3 weeks...may experience scalp sensitivity...sleep on satin pillowcases
Report increase or decrease in weight of ____ lbs or more in one week or any major change in appetite: 5
Chemo can damage the lining of the mouth causing small, painful _____ on tongue, lips, gums, and insides of cheeks...can become infected: ulcers
Mouth sores and ulcers can occur how many days after chemo start and can take how many weeks to heal.: 5 to 12 days

2 to 3 weeks
What therapy is recommended to lessen or prevent mouth sores?: oral cryotherapy (use of cold)
What is oral cryotherapy?: Five minutes before chemotherapy is given, place a spoonful of ice chips in mouth and swish it around...repeat for 30 minutes...remember to remove dentures first
What kind of foods and juices should not be eaten to avoid mouth stinging?: highly acidic

ex: tomatoes
oranges
grapefruit
apricot
pear nectar
squash
beans
peas
Avoid mouth irritants such as smoking, alcohol and rough foods like?: potato chips...use straw...brush teeth with soft bristle brush within 30 minutes of meal or bedtime
Avoid mouthwashes that contain?: alcohol...

mix 1/2 tsp salt with 8 oz. warm water to make own mouth-wash...consult doctor before having dental work done
Antiemetics may be given orally, IV or rectally to prevent or decrease ___ and ____: nausea and vomiting
What are 3 different types of nausea and vomiting?: anticipatory
acute
delayed
What is anticipatory nausea and vomiting (ANV)?: occurs at the beginning of a new cycle of chemo in response to conditioned stimuli, such as sights and sounds of treatment room
What is acute nausea and vomiting?: occurs during the first 24 hours after chemo
What is delayed nausea and vomiting?: occurs more than 24 hours after chemo
To ease feeling of nausea and vomiting?: don't lie flat immediately
after eating
drink carbonated beverages
or take ice chips made with
carbonated beverages...

(if patient vomits more than 3 times an hour for more than 3 hours or cannot keep down meds, call doctor)
Chemo patient experiencing peripheral neuropathy can protect peripheral extremities by what methods?: by wearing shoes or slippers, avoid exposure to extreme cold and heat...
do not use heating pads or hot water bottles
7: pain as bad as it can be
6: extreme pain
5: severe pain
4: moderate pain
3: mild pain
2: slight pain
1: no pain
Chemo can cause skin problems such as?: redness
itching
peeling
dryness
acne
nails may become brittle
and discolored
(effects disappear once treatment is over...report
any rash or persistent skin problem that does not go away)
Food items to use for sore throat?: butter
margarine
gravy
sauces
broth
dunk foods in beverages
use blender
use straw
eat soft foods

report any throat soreness that interferes with nutritional or liquid intake or causes discomfort
Chemo can cause changes in taste and smell sensations...things that can help?: substitute red meat for fish, chicken, eggs, tofu...
try cold foods like milk-
shakes, cold cuts, tuna fish,
egg salad...
adding sugar can mask flavor of salty foods and adding salt can decrease the
sweetness of sugary foods..try stronger seasonings such as cayenne and curry...
if food tastes metallic, use plastic utensils and dishes..tart foods may also overcome metallic taste...try citrus juices, cranberry juice, pickles or relish...
try sugar-free candies or gum to eliminate bad taste; fresh fruits also help...
marinate food in wine, fruit juice, beer, soy sauce, butter, or b-b-q sauce

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