Acute care nursing
Recommendations of the national consultant nursing care during drug administration
Nursing care of patients undergoing chemotherapy is carried out comprehensively based on identified needs and problems of these patients.
An important element in the work of nurses is to oversee the proper and safe administration of cytostatic drugs.
Recall that the rules of conduct in this regard are clearly defined and similar in the European Union.
Cytostatic action causes many side effects. Only the absolute observance of the principles of conduct during the administration of a guarantee of good-quality care and not to compromise human safety and the environment.
Therefore, nursing care is focused on controlling these symptoms and systematic in their mitigation. In therapy plays a vital role proactive patient.
This requires large-scale mobilization of the psychic and the acceptance of new life situation.
Particular attention is paid to the problems that threaten the patient's psychological sense of security - especially since therapy is usually a lengthy process, arousing anxiety and fear of adverse effects.
Standard as a reference point
In order to ensure adequate quality of nursing care of patients treated with cytotoxic Chemotherapy Department of the Oncology Centre, with a standard of "Nursing care of patients undergoing chemotherapy piers."
The results of these activities show the analysis of questionnaires, which asked patients to fill the branch of chemotherapy. Questionnaire was filled in 65% of first-time patients.
They confirmed that given the necessary information about the process of treatment of side effects, diet.
They admitted that as a result of various measures of anxiety before chemotherapy is minimized.
Patients in response to our attention the need to familiarize them to the treatment of extravasation of cytostatic drugs.
Standard "Care of the patient with subcutaneous port" is introduced and monitored in the Outpatient Chemotherapy CO. To reduce the risk of supraclavicular phlebitis in patients who will be cannulation of the vein to the intended port, the procedures will be applied to reduce the risk of this complication.
Inserting a needle into the port Huber was performed in 125 of the 13 667 patients treated with chemotherapy (0.91%). Complicated by obstruction of the harbor was reported in 1.6% of these patients.
In each case, performed X-ray port, then the port is flushed by the surgeon. Always after the removal of the needle port flushed with 20 ml 0.9% NaCl solution with heparin (100 U of heparin per 1 ml 0.9% NaCl).
Standards of nursing care are a reference point in the planning and implementation of changes and evaluation of nursing care quality.
Usually cytostatic therapy affects the bodily condition of the patient. However, many patients during this treatment lead a normal life and do not limit his physical activity, or limited to a small extent.
This kind of behavior, if possible, have a beneficial effect on mental state of the patient, the treatment course and its tolerance.
However, some chemical treatment programs are held in high levels of side effects, requiring a reduction of physical activity of the patient and to adapt it to current capabilities.
Due to the time of the complications of chemotherapy can be divided into immediate, early, delayed and late.
Immediate complications are those that occur within a few hours (usually in the first 24 hours) or a few days of starting treatment. These include such as nausea and vomiting, allergic reactions.
To early complications, occurring in the first weeks of chemotherapy, include, among other's symptoms of bone marrow suppression (leukopenia, thrombocytopenia), mucositis of the mouth and digestive tract, diarrhea and hair loss.
Complications arise with a delay (up to several weeks or months after the application of cytostatic drugs) are among other's peripheral neuropathy, cardiomyopathy, anemia, pulmonary fibrosis, hepatocyte damage, aspermia.
After many months or even years after chemotherapy may have late complications, such as hypogonadism, premature menopause, infertility, azoospermia, secondary malignancies: acute leukemia, lymphoma and cancers of organs.
Knowing all the side effects is essential for nurses because it is the first person to whom you reported the occurrence.
First Nausea and vomiting
Chemotherapy can cause nausea and vomiting, acting on the stomach and the brain region liable for the emetic response.
Some people feel sick the whole time of treatment; some complain of not periodically.
The first symptoms may occur soon after initiation of therapy or a few hours later. If nausea or vomiting is present for longer than one day, tell your doctor, who may use this medicine relieve symptoms.
In order to reduce adverse events must use the following tips: * avoid large meals, so as not to burden the stomach,
- Drink liquids at least an hour before or after a meal, not during eating,
- Avoid sugary foods, fatty and fried foods,
- Eat and drink steadily, and the best foods cold or at room temperature. When nausea breathed deeply and slowly, to avoid irritating odors. If you are sick during chemotherapy, you should not eat for 1-2 hours before drug administration.
Second Diarrhea
If diarrhea occurs more than 24 hours, or if it is accompanied by pain or cramps, you should report to your doctor. Your doctor may prescribe agents.
To stop diarrhea include:
- Eat smaller meals more often in portions,
- Beware of foods rich in fiber (whole-grain bread, grain bread, cereals, raw vegetables, beans, nuts, fresh and dry fruits), and choose products low in fiber: white bread, white rice or pasta, ripe bananas, cottage cheese, yogurt, eggs, sawn vegetables, chicken or turkey without skin, fish.
Rather, they are prohibited: coffee, tea, alcohol, sweets and fatty foods, fried and spicy.
For this you need to eat more foods rich in potassium (if your doctor tells you otherwise): bananas, oranges, potatoes, peach nectar or nectarines, halibut, asparagus.
A deficiency of potassium in the order of a physician may be supplemented by drugs.
It is advisable to drink plenty of liquids (room temperature) to supplement the loss of fluids from diarrhea: apple juice, water, weak tea, clear broth. A liquid diet may be used only by the doctor and for no longer than 3-5 days.
Third Constipation
Constipation during chemotherapy may be caused by drugs (cytostatic or analgesics), or reduced physical activity and deficits in nutrients.
To cope with constipation include:
- Drink plenty of fluids, that they will cause loosening of the stool, particularly effective are warm or hot liquids,
- Eat plenty of foods rich in fiber: coarse bread and cereals, raw or cooked vegetables, fresh and dried fruits, nuts. Do not forget to frequent the gym, even a simple walk can be helpful.
If the evacuation did not occur for 48-72 hours, use an enema or pharmaceutical drugs exactly as your doctor.
Eat plenty of foods rich in fiber: coarse bread and cereals, raw or cooked vegetables, fresh and dried fruits, nuts. Do not forget to frequent the gym, even a simple walk can be helpful.
If the evacuation did not occur for 48-7hours, use an enema or pharmaceutical drugs exactly as your doctor. For the treatment of certain cytostatics doctor may prescribe preventive measures against constipation.
4th StomatitisCytostatic can dry out or irritate the mucous membranes, cause minor injuries in the mucosa of the mouth and throat, and bleeding.
Wounds in the oral cavity may be exposed to infections that are difficult to treat during chemotherapy; so you should take all possible precautions to prevent them.
Here are some suggestions how to keep your mouth, gums and throat in good health. Before starting chemotherapy is indicated for dental control (cure cavities, gum disease). Regular oral hygiene should include brushing your teeth with a soft brush after each meal and rinse the mouth with delicate fluid recommended by the doctor (finished formulations should be avoided). When it comes to nutrition, you should use a high-protein diet and abirritating foods, acidic (citrus fruits and juices), eat and drink often in small portions (food and beverages, preferably at room temperature).
Lubricate lip's greasy cream or lotion, and if necessary use general or topical analgesics.
5th Alopecia
Hair loss is a common side effect of chemotherapy, but not always present.
We observe the deterioration of the hair structure, or a total loss. Normally, hair grows back after treatment.
Symptom concerns not only the head, but also other parts of the body: legs, arms, pubic hair.
The nurse can give patients advice about hair care: to use a gentle shampoo, soft hair brush, absolutely not dye your hair or do not perm.
You can offer to supply the wig matched to the color and type of natural hair.
The proposal for a doctor writes a wig, it is valid for one month.
Another solution is to wear hats or turbans, which can be a decorative outfit.
6th Problems with the skin and nails.
While chemotherapy may experience skin problems such as redness, itching, peeling, dryness and blemishes. The nails may become breakable or brittle.
Sometimes they can occur at the vertical lines or grooves. To prevent dry skin, you should take quick showers, wash with a damp sponge, avoid long baths in the tub.
In the wet skin is good to rub lotions, avoid perfume and cologne that contain alcohol.
Some cytotoxic drugs administered intravenously, can cause darkening of the skin over the vein.
After the treatment, the dark areas on the skin usually on their own after a few months disappear.
Do not expose the skin to the sun, as this may increase the negative effects of certain chemical drugs on the skin.
Certain drugs given intravenously, if the leak from the vein, can cause serious and permanent tissue damage.
It should be immediately reported to the nurse while receiving injections if there is pain or burning. These symptoms do not always indicate a problem, but you have to check it out.
Immediately tell your doctor or nurse if you experience sudden or severe itching or skin rash, and breathing problems.
These symptoms may mean that an allergic reaction that requires immediate intervention.
In the event of tissue damage due to extravasation outside the vein to the tasks of nurses include:
- Discontinuation of treatment without removal of the injection,
- Extravasation inhaled drug by needle left behind,
- Delete wenflonu,
- Make a compress, depending on the given FU: cold in case extravasation farmorubicin or Adriablastina, warm, where there has been extravasation of Vincristine, vinblastine, vepesid, Navelbine.
Social problems of the patient
The treatment process is also important to recognize the social problems of the patient: it looks like his family situation and occupational activity and physical conditions.
The tasks of the nurse to prepare the patient for lifestyle changes the need arise in connection with the course of therapy.
Chemotherapy can affect the schedule, prevent the realization of social roles exercised prior to treatment (mother cannot take care of the child, cannot be available for the job).
Some patients will continue to work while receiving chemotherapy, but most use during the period of sick leave.
All these factors cause patients fear that they can function normally. Therefore, it is necessary to help the family and patient acceptance of the environment.
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