Section 5: Side Effects Of Treatment

Front 1

Molly is a 8 yo with ALL who completed her first round of chemotherapy 10 days ago. She comes to clinic today with reports of "raw" areas in her mouth that are painful when she eats or drinks. What is likely the cause?

Back 1

Oral mucositis or stomatitis - inflammation or an ulceration of the mucous membranes of the oral cavity.

Front 2

What are some local palliation options for mucositis?

Back 2

Viscous lidocaine
Diphenhydramine
Carafate

Front 3

A 2 yo boy with neuroblastoma is day +15 post AUTO PBSCT. His tongue has confluent ulcerations and is inflamed and bleeding. His gums are also very inflamed and are oozing. His saliva is very thick and ropy with dry mouth. What grade would you rate his mucositis?

Back 3

Grade 4
Lips: Very dry, inflamed, cracked, ulcerated, and bleeding
Tongue: Confluent ulcerations, inflamed, bleeding
Teeth: Very dull, covered in debris; bleeds easily
Gums: Very inflamed and swollen, may have continuous oozing without trauma
Saliva: Very thick, ropy or mucoid appearing. Mouth is very dry.

Front 4

A 12 month old female with neuroblastoma will be starting chemotherapy soon. The nurse is educating the mom on the importance of good mouth care. The mom inquires how she can provide meticulous oral care if her daughter is too young to swish and spit. What should the nurse tell the mother is an acceptable alternative to swish an spit.

Back 4

For younger children foam brushes or toothettes can be swabbed to the affected areas.

Front 5

Medical management of diarrhea should include:

Back 5

1. Restoring and maintining fluid balance
2. Restoring and maintaing electrolyte balance
3. Provide comfort
4. Protect skin integrity

Front 6

If blood is present in the stool, a platelet count of ____ should be maintained?

Back 6

50K

Front 8

T/F
A nurse is educating the family regarding perianal care to a patient with diarrhea. The nurse should tell the family to rub the area after each bowl movement to ensure meticulous skin care.

Back 8

FALSE
The area should be patted dry. DO NOT rub the area to avoid excoriation.

Front 9

What kind of dietary recommendations should be made to a patient with constipation?

Back 9

Eat a high fiber diet with increased fluid intake

Front 10

T/F
Antibiotics should be intitiated at the first sign of perianal discomfort or tenderness.

Back 10

True
Such treatment includes specific antianaerobic agents and a broad spectrum antibiotic.
Other measures influce administration of antipyretics, pain meds, stool softener, sitz bath or perineal irrigation 3-4x daily.

Front 11

A 17 yo male with osteosarcoma received Adriamycin 7 days ago and today presents to clinic with right upper quadrant pain, n/v, pruritis and significant jaundice. What should be included in your nursing assessment?
A. Careful inspection of the perineum
B. Perform a routine physical assessment to determine the patients neurologic status.
C. Obtain the patients weight
D. Assess for functional impairment in speech, swallowing and drooling.

Back 11

B
This patient has chemical hepatitis related to the administration of Adriamycin. Since the patient has "significant jaundice" a neurologic exam should be performed.

Front 12

A patient with hepatitis should have serum chemistries, LFTs and CBC checked routinely, what other labs should be monitored in a patient with hepatitis?

Back 12

Coagulation profile

Front 13

A patient with hepatitis should be put on a low ____ and high ____ diet with Vitamin ___ and Vitamin ___ additives.

Back 13

Low fat, high glucose diet with Vitamin B and C additives

Front 14

What chemotherapeutic agent is known for causing pancreatitis?

Back 14

L-asparaginase

Front 15

A patient received L-asparaginase yesterday. Today he presents to the ER with n/v and severe abdominal pain. Work up includes abdominal ultrasound and chemistries. What other labs should be drawn.

Back 15

Serum lipase, amylase
This patient likely has pancreatitis.

Front 16

What teaching should be given to a patient with pancreatitis regarding diet?

Back 16

The patient should not take anything by mouth (as directed by the MD) and may need an NG tube. When oral intake is resumed, the patient should follow a bland, low-fat diet.

Front 17

What precaution should the nurse know regarding pain medication administration related to pancreatitis?

Back 17

Many pain medications cause spasms in the sphincter of Odi which can cause an increase in pain.

Front 18

Nausea and vomiting related to chemotherapy and radiation therapy are mediated by the vomiting center of the brain, this occurs through 4 different mechanisms. List the 4 mechanisms:

Back 18

1. Activation of the chemoreceptor triggor zone (CTZ) in the 4th ventricle of the brain.
2. Peripheral stimulation by neurotransmitter receptors in the gut wall.
3. Cortical pathway activation by learned response (anticipatory n/v)
4. Vestibular pathway disruption related to motion and balance.

Front 19

List 3 HIGHLY emetogenic chemotherapeutic agents:
*Acute symptoms

Back 19

Actinomycin-D
Cisplatin (>40mg/m2)
Cyclophosphamide (>1g/m2)
Cytarabine (>1g/m2)
Dacarbazine
Ifosphamide
Mechlorethamine

Front 20

What chemotherapy known to cause DELAYED SEVERE nausea and vomiting?

Back 20

Cisplatin

Front 21

A 6 yo meduloblastoma is day +6 post her PBSCT and is scheduled to receive Vincristine. The mother asks if this chemotherapy will make her nauseated. What should the nurse tell the mother?

Back 21

NO, Vincristine is classified as a nonemetogenic chemotherapy. IF she does get nauseate, it is likely related to something else. Other "nonemetogenic" chemotherapeutic agents are:
Asparaginase
Mercaptopurine
Low dose Methotrexate
Steroids
Thioguanine

Front 22

List 3 chemotherapy drugs that are classified as MODERATELY emetogenic:
*Acute symtpoms

Back 22

Anthracyclines
Carboplatin
Cisplatin (<40mg/m2)
Cyclophosphamide (<1g/m2)
Cytarabine (IV ,1g/m2 or IT)
Mercaptopurine (IV)
Methotrexate (IV >1 g/m2)
Nitrosoureas (Carmustine, Lomustine)

Front 23

What is an antiemetic that is a serotonin receptor antagonist?

Back 23

Zofran
Kytril

Front 24

What is an antiemetic that is a dopamine antagonist?

Back 24

Phenothiazines (thorazine)
Prochlorperazine (compazine)

Front 25

What is an antiemetic that is a glucocorticoid?

Back 25

Dexamethasone
prednisolone

Front 26

What is an antiemetic that is a NK1 agonist?

Back 26

aprepitant (Emend)

Front 27

What are the main side effects of zofran and/or kytril?

Back 27

headache
transient elevation of liver enzymes

Front 28

What are the main side effects of dopamine antagonists?

Back 28

extrapyramidal effects
sedation
hypotension
arrhythmias
contipation
dry mouth

Front 29

What are the main side effects of glucocorticoids?

Back 29

Depression
euphoria
Euphoria
hypertension
acne
cushingoid appearance

Front 30

What are the main side effects of NK1 antagonists?

Back 30

Fatigue
Diarrhea
Hiccups