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Because some patients have nausea and vomiting after chemotherapy and may not feel like drinking fluids, stress the importanceof following the antiemetic regimen. Instruct patients to contact the oncologist immediately if nausea prevents adequate fluid intakeso parenteral fluids can be started.If cancer treatment is expected to rapidly decrease tumor burden, prophylaxis is necessary. Monitor daily weights and serumelectrolyte values. Management becomes more aggressive for patients who develop hyperkalemia or hyperuricemia. In addition tofluids, diuretics are given to increase urine flow through the kidney. These agents are used cautiously to avoid dehydration. Drugsthat promote uric acid excretion, such as allopurinol, rasburicase, or febuxostat, are given. To reduce serum potassium levels formild-to-moderate hyperkalemia, sodium polystyrene sulfonate can be given orally or as a retention enema. For more severehyperkalemia, IV infusions containing glucose and insulin may be given. Patients who have severe hyperkalemia and hyperuricemiamay need dialysis and intensive care.
SurvivorshipAs the landscape of cancer care is changing, patients are living longer with the disease. What used to be a death sentence is nowbeing considered a chronic disease. Survivors have unique physical and psychosocial needs, including long-term effects fromtreatment. NCCN (2018)specifically outlines follow-up care and considerations for survivors. Routine imaging, blood work, andfollow-up care with the primary health care provider are of utmost priority. Patients need to be educated on the importance ofroutine follow-ups and adherence to the recommended schedule. Chemotherapy can lead to cardiac and pulmonary toxicity,infertility, menopause, and peripheral neuropathy as well as an increased risk of secondary malignancies. If lymph nodes wereremoved during surgery, the risk of lymphedema is lifelong. Radiation can cause fibrosis and permanent skin changes in the radiationpath. Nurses are uniquely positioned to provide acute cancer care and also support the patient through the survivorship journey.Fluid DistributionExtracellular vs IntracellularBody fluid is divided into two main compartments (spaces)—the fluid outside the cells (extracellular fluid [ECF]) and the fluid inside the cells (intracellular fluid [ICF]). The ECF space is about one third (about 15 L) of the total body water Filtration vs Diffusion vs OsmosisFiltrationActionsFiltrationis the movement of fluid (water) through a cell or blood vesselmembrane because of hydrostatic pressure (water pressure)differences onboth sides of the membrane. Hydrostatic pressureis the pressure exerted bywater molecules against the surfaces (membranes or walls) of a confiningspace. Water molecules in a confined space constantly press outward againstthe membranes, creating hydrostatic pressure. This is a “water-pushing”pressure because it forces water outward from a confined space through a membrane (Fig. 13.2).