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Now for our cancer drugs. The big drugs to know for chemotherapy is doxorubicin and cisplatin. So before we get into this, just a little heads up.
Don't let the NCLEX trick you with sound-alike drug names. Doxorubicin is not doxycycline. So just think the O's in doxorubicin is for chemo.
for on oncology clients. And doxycycline is an antibiotic that we cycle on and cycle off for infections. Okay, now that that's cleared up, let's begin here. So chemo drugs are given to slow or stop the growth of tumors by directly inhibiting the growth of cells in the body. So the good news is that tumors, which are fast-growing cells, they stop growing and the cancer dies.
But the bad news is that chemo is typically nonspecific, so it kills all the fastest growing cells in the body. Chemo is like an atomic bomb where no one is spared. So bone cells die, skin cells die, and hair follicles die, since these are some of the fastest growing cells inside the body. Again, chemo is the nuke where everyone dies, the good guys and the bad guys, the healthy cells and even the cancer cells too.
So that's why the main side effect we get from chemo is hair loss and weak skin. But most of all is the bone marrow suppression. This one is the biggest to know for the NCLEX and exit exams since it's the most deadly. So just think chemo is bad to the bone. So cue the music.
So chemo says I'm bad to the bone. I'm bad. Chemo's bad to the bone. Okay, okay. So yes, it's bad for the bones, but why is it so deadly?
Well, just think about the patho here and what the bone does. The bone marrow is responsible for making all the most important blood cells in the body to help protect us as well as give us perfusion and oxygenation. So when the bones get suppressed, we get suppressed blood and suppressed immune system.
Low RBCs and low CBCs results in low blood volume, aka anemia, normally between 4.5 to 6 million RBCs, but these will be decreased. We also get low platelets, normally between 150 to 400,000, which results in big bleeds. Remember, platelets less than 100,000 is called thrombocytopenia. So we teach patients to not use razor shaves. Use electric shavers.
No bearing down to poop. We use stool softeners. And no falls.
We avoid rugs. And we use well-lit hallways. Now lastly, the most deadly of all here is the low WBCs called leukopenia. Less than 4,000.
Normally, white blood cells should be between 5,000 to 10,000. Now WBCs are the police of the body, which I call the WBC elite squad. They clean up the streets, kick out infection, which are the criminals, and keep the body safe and free from infection.
But the atomic bomb of chemo that has been dropped kills almost all of these WBCs, which wipes out our defenses, making the body a deserted ghost town where infection can run wild, like the Wild Wild West. It's pretty sad. I miss the WBC elite squad. Now, this leads too low to no immune defenses, which is called immunodeficiency and immunocompromised, which is very deadly, since any infection can kill the patient. So the big key term here is that fever is priority, and a key number to know for the NCLEX is any temperature over 100.3 Fahrenheit or 38 degrees Celsius.
So just think, 38 is not great, since a low-grade fever can indicate a big-time infection. Now that's the reason why we call it neutropenic precautions, or we use that reverse isolation. We're doing this to protect the patient.
So two big test tips to know is no fresh flowers and no fresh fruit. And we always avoid crowds and sick people who are immunocompromised. Typically, these two come up a lot on question banks, since they can be the most deadly.
Now, Kaplan mentioned this, saying that doxorubicin temperature is highest priority over 100.5, or that 38 degrees Celsius. Yes, it's over 100.3, so it's very priority. So, think... Doxorubicin, we get a ruby red body like a fever, and it's priority, guys. Fever is always priority with chemo drugs.
Now, this drug also causes decreased insulin sensitivity. So clients end up with hyperglycemia, basically that high sugar. So the HESI mentions doxorubicin, monitor for hyperglycemia.
Remember, insulin helps sugar into the cell. So without insulin effectiveness, sugar is not going. into the cell, and now it just hangs out in the bloodstream, causing high sugar. Now, two side notes for all chemo patients. Since, what we talked about before, the skin cells are very weak, we never use rectal thermometers to check body temperature, since it can lead to a perforated bowel in the lining of the rectum.
Pretty crazy, right? Well, that's how sensitive the skin really is. And number two, the nausea is a common side effect.
So ATI mentions a patient scenario where the patient's in chemo and the child reports nausea and vomiting. So the priority nursing action is to stop the chemo, flush the line, and administer undanzatrone, which is an anti-nausea medication, brand name Zofran. Okay, now switching gears here, the main highlights for cisplatin, the other chemo drug. The key point here is renal toxicity.
So write this down. We monitor urine input and output, basically the I's and O's. And for all kidney function, remember, creatinine over 1.3 means bad kidney, and BUN over 20 is really bad.
And urine output 30 mLs per hour or less means the kidneys are in distress. So guys, you have to know these for the NCLEX. These are key numbers that are tested time and time again for renal toxicity, or normal renal function here.
So the memory trick we use for cisplatin, just think pissplatin, because you can't urinate or piss with cisplatin. Now Kaplan mentions four criteria here for cisplatin. We give anti-emetics, that nausea medication, prophylactically, or just in case.
We also use a saline rinse before and after meals. We increase fluid intake for the next three days, and we teach the patient to manage the fatigue. Now, Side note here, hydration is key for the renal. So don't let them trick you here.
Good indication of hydration status include a good blood pressure, good skin turgor, adequate cap refill, less than three seconds, and good I's and O's. Remember the key number, over 30 mLs per hour typically is the best indicator of renal function, other than creatinine. Now the last two chemo drugs that were not mentioned by... any of the question banks we surveyed, but may come up on some nursing exams. Here are the need-to-know key points.
So we have cyclophosphamide, given to treat tumors and cancer by stopping protein synthesis. The big side effect, like all the other chemo drugs, was the bone marrow suppression. So we get anemia, that low blood, neutropenia, those low white blood cells, and thrombocytopenia, those low platelets.
So naturally, like all chemo drugs, We have a big risk for infection and huge risk for bleeding. So the key point here is be careful with the sound-alike drug names. Cyclophosphamide is not cyclobenzaprine, which is a muscle relaxer.
And it's not cyclosporine, which is immunosuppressant. So just think cyclophosphamide, the bones have died with cyclophosphamide. And phospha in the drug name kind of sounds like phosphate to remind you that it makes...
bones weak. And cyclobenzaprine, think cyclo-back. It's a muscle relaxer given for the back. And cyclosporine, just think cyclosporine.
It spares organ from rejection after an organ transplant. So just focus on this and you'll be okay for your exam and not get tricked. Now the last chemotherapy drug is vincristin, also given to treat tumors and cancer by Bye-bye.
stopping cell division during mitosis. So you're probably saying, yeah, we know how chemotherapy drugs work. But here's the key point.
It's the only chemo drug that does not cause bone marrow suppression. So it's not b-b-b-bad to the bone. It's actually kind to the bone, and it doesn't beat it up. So it loves the bone, specifically the bone marrow. So you're probably saying, say what?
So yeah, that's right, ladies and gentlemen, boys and girls. We have no anemia, no neutropenia, and no thrombocytopenia. Basically means that we don't have a weak immune system, and there's no risk for bleeds. So the memory trick we say is, I call Vin-Kristen.
A very cool Christian. Just a knight's gentle, saintly soul. That follows the golden rule. Basically, it's kind to others. Someone who's kind to the bone.
So just think, Vin Christian is a very cool Christian. Or you can think Vin Christian is like Vin Diesel from Fats and the Furious. Because it's a cool drug, man. It's like one of a kind.
It's really tough, but then again, it's really nice too. Now the main side effect that wasn't tested on directly... was neuropathy, that nerve damage that causes weakness, numbness, and pain, typically in the hands and feet.
But again, it wasn't tested directly, so probably not a need to know. Now for breast cancer, we have tamoxifen, which is an estrogen modulator that basically blocks estrogen receptors in the breast and stops estrogen-dependent cancer, like breast cancer and endometrial cancer. So Hesse question mentioned, Tamoxifen treats breast cancer. And Kaplan mentioned endometrial cancer.
We report heavy periods and excessive bleeding. So the key word here, remember the ABCs. Bleeding is a circulation issue, and it's always priority.
And another key word is report, which typically means priority in terms of the NCLEX. So anytime you read report, it's typically a priority situation. Now the key point here is the big clot risk. Remember, any drug that modifies estrogen typically ends up with an emboli, like with birth control 2. So just think of the double E's.
E for estrogen, think E for emboli, which is a big clot risk. So naturally, we avoid anyone with clot history. So the key term is contraindication for a history of a DVT or PE.
We need to clarify this order with the provider. And to help you out, DVT is typically a clot in the leg, and PE is a clot in the lung. So we always clarify any drug that can cause harm to the patient.
So the memory trick we use is the E's in tamoxifen. So just remember the double E's in tamoxifen. So E for emboli risk and E for endometrial cancer. We have to report heavy bleeding. Now, a side effect that is normal is...
hot flashes. Technically, we do not need to report this, so don't get tricked. It's to be expected since tamoxifen, we call tamahoxifen.
Basically, hot flashes are normal. Now, our next drugs in the cancer section are the new cell stimulators. So we have oprelvacin, given to increase platelet production, particularly with chemo patients who have that thrombocytopenia, basically that low platelet count. which reduces the bleeding here. So ATI says that it stimulates growth in hemopoietic stem cells, and oprelvacin is effective to increase platelets.
And Hesse says the big adverse effects is fluid retention, AFib, and anaphylaxis, due to that new hemo growth effects. Now the second drug in this category is filgrastim, or PEG filgrastim. Now, this one is the one to know. So, filgrastim is the brand name, nupagin, which you've probably given in your clinicals.
Now, these aren't mentioned by the ATI, HESI, or Kaplan, but it may show up on your nursing exam. So, we give these to stimulate those WBCs, or neutrophil production. And the expected outcome here is increased neutrophil count.
Now, don't let the NCLEX trick you. There is no effect on hemoglobin, that is erythropoietin, and not filgrastim. The next drug we have is interferon, which is a type of immunotherapy given to stimulate the body's immune system, basically to detect and kill cancer cells as well as viral infections. But the bad part here is that it gives flu-like symptoms, so we call interferon interfluon. So Fever, muscle ache, weakness, and chills are all normal and to be expected.
And just think, interferon interferes with cancer and viral infections by increasing the body's immune response to beat up those nasty infections. Now, Hesse mentioned that interferon beta, we apply warm compress before giving injections to reduce the risk of pain at the site, and we administer the medication late in the day so flu-like symptoms occur during sleep. Now, no other question banks had anything about this drug, so I wouldn't focus on it too much.
Now, our last cancer treatment is technically not a drug, but still a treatment. We have radiation and brachytherapy. Typically, radiation is given outside the body with big, huge x-ray-looking machines, and usually used in combination with chemotherapy to help shrink down those cancerous tumors before they're taken out with surgery. Now, as you can see, this type of radiation is given outside the body and can be very harsh on the skin, making it red, dry, and itchy.
Not to mention, very sensitive. So, we do not use anything that will cause skin irritation. So, no lotions, creams, perfumes, powders, or even makeup cosmetics. Definitely no tape or deodorants, and definitely not shaving. So, just remember, be soothing to the skin and not...
Now, ATI mentions this, giving a client with cancer undergoing radiation therapy, stating, I will use my hands rather than a washcloth to clean the radiation area. So yes, never harsh on the skin. We're using the hands instead of that washcloth. Now, switching gears to brachytherapy, which is a different type of radiation in that it goes inside the body, which makes it very dangerous.
So. A radioactive implant is placed directly inside the tumor for about 24 to 72 hours, making this patient like a radioactive hazard. So, typically it's used with two most common types of cancer, mentioned by multiple question banks. So write these down.
Endometrial cancer and cervical cancer. Those are the two to know. Now the nursing interventions, this is where all the test questions come from. So remember, Radiation is really bad, since it's super toxic to the patient and anyone in close contact.
So on the NCLEX, the number one goal here is safety. So anyone with an implanted radiation, keyword, it's really bad. We need to limit time, distance, and we need to shield the body. So the big key points to write down for time here.
We need a cluster care 30 minutes per shift. Typically, we rotate the staff. And staff is to wear a radiation film badge called a dosimeter, a small little device that monitors the radiation exposure. Now, for distance, we teach all visitors to be at least six feet away.
No pregnant company, basically any pregnant family members or anyone coming to visit. And no one less than 18 years old. And a private room and private toilet.
Next, we always close the door to the room at all times, and we place a sign on the door that says, caution, radioactive. Now, lastly, shielding. We always use this key term here, a lead apron, when in direct contact with the patient.
So watch those key words there. Only during direct contact or direct patient care. Now, lastly, a nice to know.
We teach patients not to get up if they have the implant. inside the cervical area, since the implant can fall out. So we teach patients not to touch.
So no touchy, the radiation-y. Always use a long-handled object and place inside a lead container. So guys, big risk for toxicity. So just think again, radiation is really bad.
Now for the top two missed questions for cancer pharmacology. Question number one, when preparing to administer Tamoxifen to a patient with breast cancer, the nurse is most concerned by which patient reports. So this question is asking for the most concerning, for the key problem, administering tamoxifen.
So typically when you hear the word most concerning, just think who dies first or what's the worst case scenario. And we're always thinking ABCs, airway, breathing, and circulation. Okay. So before looking at the options. Think of the two things you know about tamoxifen.
So, the double E's. E for emboli risk, which means a clot risk, and E for endometrial cancer. We report heavy bleeding.
Two big circulation issues for our ABCs. Option number one. I have been experiencing really heavy menstrual cycles recently. So we have to choose this as correct. Guys, even if you don't know what this medication does, this technically says heavy menstrual cycles.
So we just think ABCs. In this case, circulation means bleeding. Now option two.
My hot flashes seem to be decreasing in frequency. So this is incorrect. Decreasing hot flashes is actually a good thing.
And by the way, hot flashes are to be expected with tamoxifen, since we call it temihoxifen, basically hot. Now the last two options are also incorrect. So I feel like I may be developing a sinus infection. So no, sinus infections are not the top priority here.
And lastly, Bye. Bye. I just don't have energy for sex the way I used to. So no, sex is not a top priority.
Well, at least not in this case. Now, question number two. The nurse is caring for a client with ovarian cancer taking doxorubicin. Which assessment finding should the nurse report to the health care provider? Select all that apply.
So this question is asking for a priority finding. Which assessment finding should the nurse report? The key problem. taking doxorubicin.
So before looking at the options, a little side note here. All priority questions. Guys, always think, what kills the patient first?
So remember, let the question help you. When you see words like assessment findings to report, or most concerning, or even first action by the nurse, this always indicates a worst case scenario. Basically, a priority question. Always ask yourself, what kills this patient first?
Now, in this case, doxorubicin, even if you don't know, just let the name help you here. The question states that the client has cancer, and the worst case scenario is a chemo drug that kills all the blood cells in the body. So, we have low blood cells. So, just think, low RBCs, we have anemia. Low WBCs, we have infection and fevers, over 100.3.
And we have low platelets. big bleed risk. That's technically what kills first.
So looking at our options. Option one is incorrect. Partial thrombotin of 55. Technically, PTT is normal between 46 and 70. And it's not technically a cell.
It's a coagulation factor, typically not affected by chemo. But this is a good try. Now I can see if you were thinking platelets, which is option number two.
Platelet count of 48. Yes, we have to choose this as correct. Huge risk for bleeding. So remember, platelets less than 50 is very risky. Big bleed risk because normally it's 150 to 400,000. Now option three, red blood cell count of 5 million.
This is normal since 4.5 to 6 is the correct range for RBCs. Now the last two options are both correct. A temperature of 100.7 or 38.2 Celsius. Yes, this is a fever.
So remember the key numbers here. 100.3 indicates a fever with any cancer patient. Now lastly, option number five, white blood cells at 3,600.
So yes, this is less than 4,000, so it's critical for chemo patients. Normally, 2,000 to 10,000 for the NCLEX is normal. All right, guys, that wraps it up for this segment.