anaplastic lymphoma

8/8/2019 Anaplastic Lymphoma

1/27

Name of Drug General Action Specific Action Adverse Effect Indication Contraindication Nursin

TRAMADOL 50mg

1cap q8

ANALGESIC,

centrally acting

Binds to mu-opoid

receptors & inhibits thereuptake of

norepinephrine &serotonin; causes many

effects similar to theopoidsdizziness,

somnolence, nausea,constipationbut does

not have the respiratorydepressant effects.

CNS: sedation,dizziness orvertigo,

headache,confusion,

dreaming,sweating,

anxiety,seizures

CV:hypotension,

tachycardia,bradycardia

DERMATOLOGIC:

sweating,pruritus, rash,pallor, urticaria

GI: nausea,vomiting, dry

mouth,constipation,

flatulence OTHER:potential forabuse,

anaphtylactoidreactions,

Relief of moderate to

moderately severepain.

Contraindicated with allergyto tramadol or

opiods or acuteintoxication

with alcohol,opiods or

psychoactivedrugs.

Use cautiouslyin pregnancy,

lactation,seizures,

concomitantdysfunction or

hepaticimpairment.

BEFORE

Assessm

y Hh

ta

a

poa

su

dM

hp

o

y Pt

ob

a

Bnr

DURING

y C(

se


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W

p

pad

AFTER:

y Yt

da

ot

na

em

y Rdc


3/27


Prednisone 15mg/

5ml 3-5ml TID aftermeals and afternoon

snacks

Corticosteroid Enters target cells and

binds to intracellularcorticosteroid receptors,

thereby initiating manycomplex reactions that

are responsible for itsanti-inflammatory and

immunosuppressiveeffects.

yCNS: Vertigo,headache,

paresthesias,insomnia, seizures,

psychosis, cataracts,increased IOP,

glaucoma (long-term

therapy)yCV: Hypotension,shock, hypertensionand CHF secondary

to fluid retention,thromboembolism,

thrombophlebitis, fatembolism, cardiac

arrhythmiasyElectrolyte

imbalance:Na+ andfluid retention,

hypokalemia,hypocalcemia

yEndocrine: Growthretardation,decreased

carbohydratetolerance, diabetes

mellitus, cushingoidstate (long-term

effect), increasedblood sugar,

yReplacementtherapy in adrenal

corticalinsufficiency

yHypercalcemiaassociated withcancer

yShort-termmanagement ofvariousinflammatory and

allergic disorders,such as rheumatoid

arthritis, collagendiseases (eg, SLE),

dermatologicdiseases (eg,

pemphigus), statusasthmaticus, and

autoimmunedisorders

yHematologicdisorders:thrombocytopenia

purpura,erythroblastopenia

yUlcerative colitis,acute exacerbationsof multiple sclerosis

and palliation in

yContraindicatedwithinfections,

especiallytuberculosis, fungal

infections,amebiasis, vaccinia

and varicella, and

antibiotic-resistantinfections; lactation.

yUse cautiously withkidney or liver

disease,hypothyroidism,

ulcerative colitiswith impending

perforation,diverticulitis, active

or latent pepticulcer, inflammatory

bowel disease,CHF, hypertension,

thromboembolicdisorders,

osteoporosis,seizure disorders,

diabetes mellitus;hepatic disease;

pregnancy (monitorinfants for adrenal

insufficiency).

yDo nowithou

health

yAvoidinfecti

yReporswelli

muscltarry s

prolonor oth

worsefor wh

taken.

yInstrudrug w

yThe ordilutedflavor

solid f

yMonitpressu

potassyWeigh

report

to pre


4/27

increased serum

cholesterol,

decreased T3 and T4levels, HPAsuppression with

systemic therapylonger than 5 days

yGI: Peptic oresophageal ulcer,pancreatitis,

abdominaldistention, nausea,

vomiting, increasedappetite, weight gain

(long-term therapy)

yHypersensitivity:Hypersensitivity or

anaphylactoidreactions

yMusculoskeletal:Muscle weakness,steroid myopathy,

loss of muscle mass,osteoporosis,

spontaneous

fractures (long-termtherapy)

yOther:Immunosuppression,

aggravation ormasking of

infections; impairedwound healing; thin,

some leukemias and

lymphomas

yTrichinosis withneurologic ormyocardialinvolvement


5/27

fragile skin;

petechiae,

ecchymoses,purpura, striae;subcutaneous fat

atrophy.


6/27


Dolan Syrup

(Ibuprofen)

Analgesic

NSAIDPropionic acid

derivative

Anti-inflammatory,

analgesic and antipyreticactivities larely related to

inhibition ofprostaglandin synthesis;

exact mechanisms ofaction are not known.

y CNS: headache,dizziness,

somnolence,insomnia, fatigue,

tiredness, tinnitus

y CV: hypertension,palpitations,

arrhythmia, heartfailure

y GI: nausea,dyspepsia, GI pain,diarrhea, vomiting,

constipation,flatulence, GI

bleeding

y GU: dysuria, renalimpairment,

menorrhagia

y HEMATOLOGIC:bleeding, platelet

inhibition withhigher doses,

neutropenia,eosinophilia,

leukopenia,pancytopenia,

thrombocytopenia

y RESPIRATORY:dyspnea,

hemoptysis,

yRelief of s/s ofrheumatoid

arthritis andosteoarthritis

yRelief of mild tomoderate pain

yTreatment ofprimarydysmenorrhea

yFever reductionyUnlabeled uses:prophylactic for

migraine; abortivetreatment for

migraine

y Contraindicatedwith allergy to

ibuprofen,salicylates, or

other NSAIDs

y Contraindicatedfor treatment of

perioperative painafter coronary

artery bypass graft

y Use cautiouslywith CV

dysfunction,hypertension,

peptic ulceration,GI bleeding,

pregnancy,lactation, impaired

hepatic and renalfunction.

y Asseibupr

y Assecolorophth

evaluevalu

sensaclott

y Admor afoccu

y Use suggover

y Avoidrug

y Instrany s

y Reporash,

swel

visio


7/27

bronchospasm,

rhinitis

y OTHER:peripheral edema,anaphylactoidreactions to

anaphylactic shock


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Ponstan

(Mefenamic acid)8F 5ml TID in

between Dolan syrup

NSAID Anti-inflammatory,

analgesics, andantipyretic activities

related to inhibition ofprostaglandin synthesis,

exact mechanism ofaction are not known.

CNS:Headache,

dizziness, somnolence,insomnia, fatigue,

tiredness, tinnitus,ophthalmic effects.

DERMATOLOGIC:Rash, pruritus,

sweating, dry mucousmembranes, stomatitis.

GI:Nausea, dyspepsia,GI pain, diarrhea,

vomiting, constipation,flatulence.

GU: Dysuria, renalimpairment.

HEMATOLOGIC:Bleeding, platelet

inhibition with higherdoses, neutropenia,

eosinophilia,leukopenia,

pancytopenia,thrombocytopenia,

agranulocytosis,granulocytopenia,

aplastic anemia,decreased Hgb orHct,

bone marrowdepression,

menorrhagia.

Relief ofmoderate pain

when therapywill not exceed

1 week. Treatment of

primary

dysmenorrheal.

Contraindicated withhypersensitivit

y tomefenamic

acid, aspirinallergy, and as

treatment ofperioperative

pain withcoronary artery

bypassgrafting.

Use cautiouslywith asthma,

renal orhepatic

impairment,peptic ulcer

disease, GIbleeding,

hypertension,heart failure,

pregnancy,lactation.

BEFOR

1. Assesrenal, he

conditiolactation

2. Assesskin colo

orientatiophthalm

audiomeperipher

adventitievaluatio

time, LFtest; seru

guaiac.DURIN

1. Be awbe at an

events, Gaccordin

2. Give wdecrease

3. Arranophthalm

during lo4. If ove

emergensupporti

induced


9/27

RESPIRATORY:Dyspnea, hemoptysis,

pharyngitis,bronchospasm, rhinitis.

OTHER:Peripheraledema, anaphylactoid

reactions toanaphylactic shock.

charcoal

cathartic

AFTER1. Instruwith foo

prescribthe drug

week.2. Instru

and cons

providerdigestive


10/27


Catapres 75mg tab

BID

Antihypertensive

A2- adrenergicagonist

Clonidine treats high

blood pressure bystimulating 2 receptors

in the brain, whichdecreases cardiac output

and peripheral vascularresistance, lowering

blood pressure. It hasspecificity towards the

presynaptic 2 receptorsin the vasomotor center

in the brainstem. Thisbinding decreases

presynaptic calciumlevels, and inhibits the

release ofnorepinephrine (NE).

The net effect is adecrease in sympathetic

tone.

Body as a Whole:Fatigue, fever,headache, pallor,

weakness, andwithdrawal syndrome.

Also reported were aweakly positive

Coombs' test andincreased sensitivity to

alcohol.

Cardiovascular:Bradycardia,congestive heart

failure,electrocardiographic

abnormalities(i.e.,sinus node arrest,

junctional bradycardia,high degree AV block

and arrhythmias),orthostatic symptoms,

palpitations, Raynaud'sphenomenon, syncope,

and tachycardia. Casesof sinus bradycardia

and atrioventricularblock have been

reported, both with andwithout the use of

concomitant digitalis.

Central Nervous

y Used to treathypertension

(high bloodpressure).

y Catapres has alsobeen used torelieve alcohol

withdrawal, as anaid in methadone

and opiatedetoxification, as

an aid in quittingsmoking, to treat

diabetic diarrhea,to treat Tourette's

Syndrome.y Catapres has also

been used toreduce

menopausalflushing, to treatpostherpetic

neuralgia, to treat

ulcerative colitis,and to diagnosepheochromocyto

ma.

yCatapres tabletsshould not be

used in patientswith known

hypersensitivityto clonidine

y Asscata

y Asshistor s

disediso

hearkidn

y Takit w

takelarg

for reco

docy Cat

in th

bedinst

y Stortemmoi


11/27


12/27

micturition, erectile

dysfunction, loss of

libido, nocturia, andurinary retention.

Hematologic:Thrombocytopenia.

Metabolic:Gynecomastia,transient elevation of

blood glucose or serum

creatinephosphokinase, andweight gain.

Musculoskeletal: Legcramps and muscle or

joint pain.

Oro-otolaryngeal:Dryness of the nasal

mucosa.Ophthalmological:Accommodationdisorder, blurred

vision, burning of theeyes, decreased

lacrimation, anddryness of eyes.


13/27


Ondansetron tab 4mg

TID

Antiemetic Blocks specific receptor

sites (5-HT3), which areassociated with nausea

and vomiting in thechemoreceptor trigger

zone, centrally and atspecific sites

peripherally. It is notknown whether its

antiemetic actions arefrom actions at the

central, peripheral,combined sites.

y CNS: headache,dizziness,

drowsiness,shivers, malaise,

fatigue, weakness,myalgia

y CV: chest pain,hypotension

y DERMATOLOGIC: pruritus

y GI: abdominalpain, constipation

y GU: urinaryretention

y Local: pain atinjection site

y Prevention of nauseaand vomitingassociated withemetogenic cancer

chemotherapy inpatients older then 6

months

y Prevention of post-operative nausea andvomiting

y Allergy toondansetron

y Use cautiouslywith pregnancyand lactation.

yAssesondan

yAssestexturreflex

examoutpu

yEnsurdrug dthat oradiat

yAdmifollowchem

y Repeffecdizz

shivweak

yReporand vinject

palpit


14/27

Name of Drug General Action Specific Action Adverse Effect Indication Contraindication Nurs

Doxorubicin Antibiotic

Antineoplastic

Cytotoxic: binds to DNA

and exhibits DNAsynthsis in susceptible

cells, causing cell death

y CV: cardiactoxicity, heart

failure,phlebosclerosis

y DERMATOLOGIC: complete butreversible alopecia,

hyperpigmentationof nail beds and

dermal creases,facial flushing

y GI: nausea,vomiting,

mucositis, anorexia,diarrhea

y GU: red uriney HEMATOLOGIC:

myelosuppression,hyperuricemia due

to cell lysis

y HYPERSENSITIVITY: fever, chills,

urticaria,anaphylaxis

y LOCAL: severelocal cellulitis,vesication and

tissue necrosis ifextravasation

occurs

y To produceregression on thefollowingneoplasms: acute

lymphoblasticleukemia, acute

myeloblastic

leukemia, Wilms

tumor,neuroblastoma, soft

tissue and bone

sarcoma, Hodgkinand non-Hodgkinslymphomas

y Liposomal form:treatment of AIDS-related Kaposis

sarcoma, ovarian

cancer that hasprogressed.

y Allergy todoxorubicin,

malignantmelanoma,

kidney sarcoma,large bowel

sarcoma, brain

tumors, CNSmetastases,myelosuppression

, cardiac disease

y Use cautiouslywith impaired

hepatic function,previous courses

of doxorubicin,prior mediastinal

irradiation,current

cyclophosphamide therapy

y Assdox

y Asscolnai

ausper

adv

evameuric

y Dosub

sevtiss

y Moext

burDis

ano

subLoccor

ord

nor

comulcconsur

y Mofreq

the

lev


15/27

y OTHER:carcinogenesis

for reqdos

risk

my

damrec

dos

oftedos

y Ensdurto p

y Inscalfor

y Avusin

y Arrfoll

y Repy Rep

bre

gaipaible


16/27

DRUG STUDY


17/27

NURSING CARE

PLANPatient: Epis, Argean MayAge: 6 years old

Diagnosis: Anaplastic large cell lymphoma


18/27

Cues Nursing Diagnosis Rationale Goal of Care Nursing Intervention Rationale

Subjective:

pinapalimpyo kopermi amun room

didi para diri maka-impeksyon akon

anak as verbalized

by the mother

Objective:

y Dust particlessurroundingthe room

y WBC count:5.8 x 10

9/L

y Presence ofbacteria in the

urine

Vital signs: BP:110/70mmHg

P: 122bpmR: 24cpm

T: 37.4Wt: 19kgs

H: 115cm

Risk for infection

related to alteredimmune response

because of lymphomaand leukopenia caused

by chemotherapy

Infection and bleeding,

often the result ofdiminished production

ofWBCs and platelets,secondary to treatment

are common cause of

death in clients withcancer. The time afterchemotherapyadministration when the

WBC or platelet count isthe lowest point is

referred to as nadir. Formost chemotherapeutic

agents, the nadir occurs7-14 days after drug

administration. Theetiology of infection

associated with cancer ismultifactorial. Some

cancers cause specificdefects in the immune

response. Side effects oftreatment can result in

myelosuppression(decreased RBCs,

WBCs, platelets). Animpaired integumentary

system increasesvulnerability to

After 1-2 days of

nursing intervention,client will be:

yRemain afebrileand achieve

timely healing asappropriate.

yIdentify andparticipate in theintervention to

prevent/ reducerisk of infection.

INDEPENDENT:

1.Monitortemperature.

2.Assess all systems(eg., skin,

respiratory,genitourinary) for s/s

of infection on acontinual basis.

3.Promote goodhandwashingprocedures by staff

and visitors. Screenor limit visitors who

may have infections.Place in reverse

isolation asindicated.

4.Emphasize personalhygiene.

INDEPENDENT:

1.Temperatureelevation may occurbecause of various

factors, eg.,

chemotherapy sideeffects, diseaseprocess or infection.

2.Early recognitionand intervention may

prevent progressionto more serious

situation/ sepsis.

3.Protects patient fromsources of infection,such as visitors and

staff who may havean upper respiratory

infection.

4.Limits potentialsource of infection/secondary


19/27

infection. Neutropenia

predisposes the client to

infection, especiallyinfection byopportunistic

endogenous organisms.More than half of the

infections in clients withneutropenia are

associated with

organisms from the localenvironment.

Source: Medical-Surgical Nursing by

Black and Hawks Vol. 1page 290

5.P

romote adequaterest/ exerciseperiods.

6.Stress importance ofgood oral hygiene.

DEPENDENT:

1.Administerantibiotics as

indicated.

(Doxorubicin)

COLLABORATIVE:

1.Minor CBC withdifferentialWBC

and granulocytecount, and platelet as

indicated.

overgrowth.

5.Limits fatigue, yetencourages sufficientmovement to prevent

stasis ofcomplications.

6.Development ofstomatitis increases

the risk of infection.Secondary growth.

DEPENDENT:

1. May be used to treatidentified infection

or given

prophylactically inimmunocompromis

ed patient.

COLLABORATIVE:

1. Bone marrowactivity may be

inhibited by theeffects of

chemotherapy, thedisease state or

radiation therapy.


20/27


Subjective: masakit akon tiyan!

Objective:

y Headachey Hypogastric

pain

y Guardingbehavior

y Protectivegestures

y Positioning toavoid pain

y Expressivebehavior (irritable,moaning in

pain)

y Diaphoresisy Pain

assessment

scale:

Vital signs:BP: 110/70mmHg

P: 122bpmR: 24cpm

T: 37.4Wt: 19kgs

Height: 115cm

Acute pain related tocompression of nerve

tissue/ body organs

Although pain does notusually arise suddenly

or unexpectedly, it isoften regarded as an

oncologic emergencybecause it is such a

pervasive problem. As

many as one thirdclients in an activetreatment and 60% to

90% clients withadvanced cancer have

pain. Pain interfereswith the ability to enjoy

activities and

relationships that aremeaningful. Whencancer causes pain,

some probable causesinclude the pressure of

a tumor on one of thebody's organs or on

bone or nerves.Sometimes cancer can

cause pain when bloodvessels become

obstructed by thetumor. There are a

variety of treatmentsfor cancer and some of

After 30 minutes ofnursing intervention,

client will:

y Report maximalpain control

with minimalinterference

with ADLs.y Follow

prescribed

pharmacological regimen

y Demonstrateuse of

relaxation skillsand diversional

activities asindicated for

individualsituation.

INDEPENDENT:

1.Assess pain history,location of pain,

frequency, durationand intensity.

2.Evaluate or be awareof painful effects of

particular therapies(eg., surgery,

radiation,chemotherapy,

biotherapy.

3.Provide non-pharmacological

comfort measures(eg., massage,

respositioning, backrub) and diversional

activities (eg. Music,television)

4.Provide cutaneousstimulation (eg. Heator cold compress)

INDEPENDENT:

Information providesbaseline data to

evaluate need foreffectiveness of

interventions.

A wide range ofdiscomforts are

common depending onthe procedure/ agent

being used.

Promotes relaxationand helps refocus

attention.

May decreaseinflammation and

muscle spasms,reducing associated

GP

P

a

pr

dd

a


21/27

them are less than

pleasant. However,

please remember thatnot all people beingtreated for cancer

experience all of thearray of side effects of

these treatments. A sideeffect one person feels

may never happen to

another. It is also veryimportant to rememberthat many treatment-

related side effects canbe successfully

prevented in somecases, and treated if

they occur.

Source: Medical-

Surgical Nursing byBlack and Hawks Vol.

1 page 295-296

5.Inform patient/ SOof the expected

therapeutic effectsand discussmanagement of side

effects.

DEPENDENT:

6. Administermedications asindicated (

Ponstan, Dolansyrup, tramadol)

pain.

This information helpsestablish realisticexpectations,

confidence in ownability to handle what

happens.

DEPENDENT:

A wide range ofanalgesics and

associated agents maybe used around the

clock to manage pain.


22/27


Subjective: Kulang gud it katurog

niya, permi la hya nghihinigda.un as

verbalized by the mother.

Objective:

y Overwhelminglack of energy

y Inability tomaintain usualroutines

y Decreasedperformance

yDisinterest insurroundings

y IrritableVital signs:BP: 110/70mmHg

P: 122bpmR: 24cpm

T: 37.4Wt: 19kgs

H: 115cm

Fatigue related toaltered body chemistry:

side effects of pain andother medications,

chemotherapy

Anemia is an importantcomponent of cancer-

related fatigue, which isone of the most

common and distressingmanifestations

experienced by the

client. Fatigue is poorlyunderstood; no onedefinition describes all

experiences. Researchon cancer related

fatigue is inconclusive.It is difficult to predict

with certainty which

interventions will havetherapeutic benefit forwhich clients. Careful

evaluation ofexacerbating and

relieving factors, theeffect of daily life and

personal or culturalinfluences as well as

review of laboratorydata add depth to the

assessment of clientsfatigue and guide

interventions. Anychemotherapy drug may

After 1-2 days ofnursing intervention,

client will be ableto:

yReport improvedsense of energy

yPerform ADLsand participate indesired activities

at level of ability

INDEPENDENT:

1.Monitorphysiological

response to activity,eg., changes in BP or

heart/ respiratory

rate.

2.Performa painassessment andprovide pain

management.

3.Plan care to allow forrest periods.

Schedule activitiesfor periods when

patient has mostenergy.

4.Assist with self care

INDEPENDENT:

1.Tolerance variesgreatly depending

on the stage of thedisease process,

nutrition state, fluid

balance, andreaction totherapeutic regimen.

2.Poorly managedcancer pain maycontribute to fatigue.

3.Frequent restperiods/ naps are

needed to restore/conserve energy.

Planning will allowpatient be active at

all times whenenergy level is

higher, which mayrestore a feeling of

well-being and asense of control.

4.Weakness may


23/27

cause fatigue, but it

may be a more common

side effect of drugssuch as vincristine,vinblastine, and

cisplatin. Fatigueusually develops after

several weeks ofchemotherapy. In some,

fatigue lasts a few days,

while others say theproblem persiststhroughout the course

of treatment and evenafter the treatment is

complete.

Source: Medical-

Surgical Nursing byBlack and Hawks Vol.

1 page 291-292

needs when

indicated; keep bed

in low position;assist withambulation.

5.Encouragenutritional intake.

make ADls difficult

to complete or place

patient at risk forinjury duringactivities.

5.Adequate intake ofnutrients isnecessary to meet

energy needs and

build energyreserves for activity.


24/27


Subjective:tutusukon naliwat

ako!! (crys) asverbalized by the

patient.

Objective:

y Increasedtension

y Apprehensiony Irritabley Cries a loty Shaking of

head

Vital signs: BP:

110/70mmHgP: 122bpm

R: 24cpmT: 37.4

Wt: 19kgsH: 115cm

Anxiety related tosituational crisis Anxiety is a normal

reaction to cancer. Onemay experience anxiety

while undergoing acancer screening test,

waiting for test results,

receiving a diagnosis ofcancer, undergoingcancer treatment, or

anticipating a recurrenceof cancer. Anxiety

associated with cancermay increase feelings of

pain, interfere with

one's ability to sleep,cause nausea andvomiting, and interfere

with the patient's (andhis or her family's)

quality of life. If leftuntreated, severe

anxiety may evenshorten a patient's life.

Persons with cancer willfind that their feelings

of anxiety increase ordecrease at different

times. A patient maybecome more anxious as

After 30 min. ofnursing intervention,

client will be able to:

y Displayappropriate rangeof feelings and

lessen anxiety.

y Appear relaxedand report anxietyis reduced to

manageable level.

y Demonstrate useof effective

copingmechanism and

activeparticipation intreatment

regimen.

Independent:

1. Review patients orS.Os previous

experience withcancer.

2. Encourage patientto share thoughtsand feelings.

3. Provide openenvironment inwhich patient feelssafe to discuss

feelings or torefrain from

talking.

4. Maintain frequentcontact with

patient. Talk withand touch patient as

appropriate.

5. Permit expressions

Clarifies patients perception, assist in

identification of fearsand misconceptions

based on diagnosis and

experiences.

Provides opportunity to

examine realistic fearsand misconceptions

about diagnosis.

Helps patient feel

accepted in presentcondition withoutfeeling judged and

promotes sense ofdignity and control.

Provides assurance that patient is not alone or

rejected, conveysrespect for and

acceptance of theperson, fostering trust.

Acceptance of feelings

GOPati

appfeel

App

Demcop


25/27

cancer spreads or

treatment becomes moreintense.

Source:Medicine.net.com

of anger, fear,

despair, withoutconfrontation. Give

information thatfeelings are normal

and are to beappropriately

expressed.

6. Promote calm, quietenvironment.

allows patient to begin

to deal with situation.

Facilitates rest, conserve

energy and may enhancecoping abilities.


26/27


Subjective:Nagsuka, pero guti

la man as verbalizedby the mother.

Objective:

y Fatiguey Drowsyy Irritabley Nauseay Vomiting

Vital signs: BP:

110/70mmHgP: 122bpm

R: 24cpmT: 37.4

Wt: 19kgsH: 115cm

Risk for fluid volumedeficit related to

vomiting as an adverseeffects of

chemotherapy

Gastrointestinal effectsof chemotherapyinclude nausea and

vomiting, anorexia,alteration in taste,

weight loss, oralleukocytis, diarrhea,

and constipation. The

vomiting center in themedulla can bestimulated by any of

five different afferentpathways or by arousal

of the chemoreceptortrigger zone located in

the fourth ventricle of

the brain. The emeticpotential of a particularchemotherapeutic

regimen depends on thedrugs given, the dose,

the route ofadministration and the

clients susceptibility toemesis. Uncontrolled

nausea and vomiting,among the most feared

treatment related side reffects are experienced

by as many as 60% ofpeople receiving

After 1 to 2 days ofnursing intervention,client will be able to:

y Display adequatefluid balance as

evidenced bystable vital signs,

moist mucousmembranes, good

skin turgor,prompt capillary

refill andadequate urine

output.

Independent:1. Monitor I&O

and specific

gravity, includeall output

sources.

2. Monitor vitalsigns, evaluateperipheral

pulses andcapillary refill.

3. Assess skinturgor andmoisture of

mucousmembranes.

Note reports ofthirst.

4. Observe forbleeding

tendencies.

Continued negativefluid balance,

decreasing renaloutput and

concentration of urinesuggests developing

dehydration and need

for increased fluidreplacement.

Reflex adequacy ofcirculating volume.

Indirect indicators ofhydration status or

degree of deficit.

Early identification of

problems allows forprompt intervention.

GO

Patiade


27/27

chemotherapy and can

result in anorexia, dmalnutrition,

dehydration, metabolicimbalances,

psychologicaldepression and

decreased immunity.

Source:Medical Surgical

Nursing by Black andHawks Vol.1 page 292

Dependent:

5. Provide IV(PNSS) fluid asindicated.

6. Administeranti-emetic

therapy asindicated(Ondansetron).

Given for general

hydration and to diluteantineoplastic drugs

and reduce adverseside effects.

Alleviation of nausea

and vomiting

decreases gastriclosses and allows forincreased oral intake.

anaplastic lymphoma

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