Chemotherapy Competency Week 1

1. What teaching is necessary in the patient who is expected to experience mucositis?

Oral assessment

Mouth care

Nutritional support

All of the above

Instruct the patient and family on the proper technique to use in assessing the oral cavity. Successful mouth care begins with chemotherapy administration to maintain mouth hygiene and moisture and ameliorate mucositis. Patients who will develop mucositis at home need to be provided with instructions and solutions for mouth care. If the patient develops mucositis, his or her ability to eat may be compromised. Provide eating hints for ways to maintain nutrition. (Beck, 2004; Polovich, White, & Kelleher, 2005)

Explanation

Instruct the patient and family on the proper technique to use in assessing the oral cavity. Successful mouth care begins with chemotherapy administration to maintain mouth hygiene and moisture and ameliorate mucositis. Patients who will develop mucositis at home need to be provided with instructions and solutions for mouth care. If the patient develops mucositis, his or her ability to eat may be compromised. Provide eating hints for ways to maintain nutrition. (Beck, 2004; Polovich, White, & Kelleher, 2005)

2. You are making your rounds in the treatment room when you notice an IV rate that is inconsistent with the drug & volume being infused. Your next action should be

Ignore it. It is not your patient.

Pause the infusion. Find the patients nurse and clarify rate desired.

Leave as is. Find the patients nurse and clarify rate desired.

Change the rate and say nothing.

Infusion nurses work as a team and are expected to monitor all patients in room, not just those that have been assigned. Checking on IV rates is part of a safety system involving checks and double checks. Pausing the rate temporarily decreases the likelyhood of an undesireable outcome due to rapid or delayed infusion. Your co-worker will appreciate your attention to detail and would do the same in a similar situation.

Explanation

Infusion nurses work as a team and are expected to monitor all patients in room, not just those that have been assigned. Checking on IV rates is part of a safety system involving checks and double checks. Pausing the rate temporarily decreases the likelyhood of an undesireable outcome due to rapid or delayed infusion. Your co-worker will appreciate your attention to detail and would do the same in a similar situation.

3. Your patient asks, "Why exactly does chemotherapy make you lose your hair?" How will you answer?

"I'm not sure. Your should ask your provider during your next visit."

"Cells responsible for hair growth are rapidly dividing and chemotherapy kills rapidly dividing cells."

"Wearing an ice cap on your head will prevent hair loss."

"Don't worry. It happens to everyone. It will grow back>"

At any given time, 85-90% of hair is in the growth phase. Alopecia is a misunderstood and feared side effect of therapy. By understanding the reason for hair loss, patients will be better able to cope with it. (Polovich, White, & Kelleher, 2005; Reeves, 2004).

Explanation

At any given time, 85-90% of hair is in the growth phase. Alopecia is a misunderstood and feared side effect of therapy. By understanding the reason for hair loss, patients will be better able to cope with it. (Polovich, White, & Kelleher, 2005; Reeves, 2004).

4. Advanced age causes an increased risk of neutropenia.

True

False

As people age, the bone marrow becomes fibrotic, and production of white blood cells is slowed. There is a smaller white blood cell reserve in the marrow of the elderly. (Camp-Sorrell, 2005; Polovich, White, & Kelleher, 2005; Wujcik, 2004.

Explanation

As people age, the bone marrow becomes fibrotic, and production of white blood cells is slowed. There is a smaller white blood cell reserve in the marrow of the elderly. (Camp-Sorrell, 2005; Polovich, White, & Kelleher, 2005; Wujcik, 2004.

5. What drug is given with fluorouracil (Adrucil/5FU) to potentiate its effects and with methotrexate to protect normal cells?

Leucovorin

Vitamin B12

Folate

Camptosar

Leucovorin is similar to folic acid. Methotrexate works by competing with the folic acid in cancer cells, leading to a folic acid deficiency and cancer cell demise. Leucovorin is given to block the uptake of methotrexate into normal cells (after 24 hours to allow methotrexate to exert its anti-cancer effect) that also become folic acid deficient after methotrexate administration. Fluorouracil has a very short life span in blood and body tissues. Leucovorin enhances the binding of fluorouracil to an enzyme that prolong its life span in the blood and body tissues, which can lead to a greater anti-cancer effect. (Camp, Gullatte, Gilmore, & Hutcherson, 2001; Polovich, White, & Kelleher, 2005)

Explanation

Leucovorin is similar to folic acid. Methotrexate works by competing with the folic acid in cancer cells, leading to a folic acid deficiency and cancer cell demise. Leucovorin is given to block the uptake of methotrexate into normal cells (after 24 hours to allow methotrexate to exert its anti-cancer effect) that also become folic acid deficient after methotrexate administration. Fluorouracil has a very short life span in blood and body tissues. Leucovorin enhances the binding of fluorouracil to an enzyme that prolong its life span in the blood and body tissues, which can lead to a greater anti-cancer effect. (Camp, Gullatte, Gilmore, & Hutcherson, 2001; Polovich, White, & Kelleher, 2005)

6. A common Benzodiazepine used to treat nausea and vomiting in chemotherapy is

Aloxi (palonosetron)

Emend (aprepitant)

Ativan (lorazepam)

Compazine (prochlorperazine)

Although lorazapam is frequently given for acute and delayed nausea and vomiting for its sedating and amnesic effect, lorazepam is best used for anticipatory nausea and vomiting. (Polovich, White, & Kelleher, 2005; Wickham, 2004).

Explanation

Although lorazapam is frequently given for acute and delayed nausea and vomiting for its sedating and amnesic effect, lorazepam is best used for anticipatory nausea and vomiting. (Polovich, White, & Kelleher, 2005; Wickham, 2004).

7. What is often the first symptom of oral mucositis?

Pain and ulceration in the mouth and throat

Mouth bleeding

Visible ulcerations in the mouth

Burning sensation in the mouth

The burning sensation in the mouth is generally followed by difficulty swallowing or a sensation of a lump in the throat. signs and symptoms of advanced mucositis are esophageal pain or burning, mouth swelling, excessive secretions, redness in the mouth and throat, mouth bleeding, ulcerated areas, and pain in the mouth and throat. ( Beck, 2004; Polovich, White, & Kelleher, 2005.

Explanation

The burning sensation in the mouth is generally followed by difficulty swallowing or a sensation of a lump in the throat. signs and symptoms of advanced mucositis are esophageal pain or burning, mouth swelling, excessive secretions, redness in the mouth and throat, mouth bleeding, ulcerated areas, and pain in the mouth and throat. ( Beck, 2004; Polovich, White, & Kelleher, 2005.

8. What non-hematopoietic secondary malignancy is associated with cyclophosphamide (Cytoxan) administration?

Bladder Cancer

Uterine cancer

Lung cancer

Leukemia

The metabolite from cyclophosphamide, acrolein is thought to cause bladder cancer as a secondary malignancy for some patients. (Camp et al. 2001; Cleri & Haywood, 2002;, Polovich, White, and Kelleher, 2005)

Explanation

The metabolite from cyclophosphamide, acrolein is thought to cause bladder cancer as a secondary malignancy for some patients. (Camp et al. 2001; Cleri & Haywood, 2002;, Polovich, White, and Kelleher, 2005)

9. When does the nadir most commonly occur?

3-5 days post chemotherapy

10-14 days post chemotherapy

7-10 days post chemotherapy

14-18 days post chemotherapy

Although 7-10 days is the most common time for nadir, the nadir varies with different drugs and drug classes. (Camp et al., 2001; Cleri and Haywood, 2002; Polovich, White, & Kelleher, 2005).

Explanation

Although 7-10 days is the most common time for nadir, the nadir varies with different drugs and drug classes. (Camp et al., 2001; Cleri and Haywood, 2002; Polovich, White, & Kelleher, 2005).

10. Mrs Smith will be receiving T/C for her breast cancer. Taxotere iIV s ordered at 75 mg per m2 and Cytoxan IV is ordered at 600 mg per m2. Mrs. Smith is 5'7" and weighs 146 pounds. Her expected dose of each of these drugs would be

Taxotere 133 mg, Cytoxan 700 mg.

Taxotere 125 mg, Cytoxan 1000mg.

Taxotere 133 mg., Cytoxan 1062 mg.

Taxotere 120 mg., Cytoxan 1062 mg.

BSA = 1.77 m2. (rounded from 1.769 m2)
Taxotere 75mg x 1.77m2 = 132.75 rounded to 133 mg
Cytoxan 600 mg x 1.77 =1062

Explanation

BSA = 1.77 m2. (rounded from 1.769 m2)
Taxotere 75mg x 1.77m2 = 132.75 rounded to 133 mg
Cytoxan 600 mg x 1.77 =1062