Because some patients have nausea and vomiting after

This preview shows page 19 - 21 out of 49 pages.

Because some patients have nausea and vomiting after chemotherapy and may not feel like drinking fluids, stress the importance of following the antiemetic regimen. Instruct patients to contact the oncologist immediately if nausea prevents adequate fluid intake so parenteral fluids can be started. If cancer treatment is expected to rapidly decrease tumor burden, prophylaxis is necessary. Monitor daily weights and serum electrolyte values. Management becomes more aggressive for patients who develop hyperkalemia or hyperuricemia. In addition to fluids, diuretics are given to increase urine flow through the kidney. These agents are used cautiously to avoid dehydration. Drugs that promote uric acid excretion, such as allopurinol, rasburicase, or febuxostat, are given. To reduce serum potassium levels for mild-to-moderate hyperkalemia, sodium polystyrene sulfonate can be given orally or as a retention enema. For more severe hyperkalemia, IV infusions containing glucose and insulin may be given. Patients who have severe hyperkalemia and hyperuricemia may need dialysis and intensive care.
Survivorship As the landscape of cancer care is changing, patients are living longer with the disease. What used to be a death sentence is now being considered a chronic disease. Survivors have unique physical and psychosocial needs, including long-term effects from treatment. NCCN (2018) specifically outlines follow-up care and considerations for survivors. Routine imaging, blood work, and follow-up care with the primary health care provider are of utmost priority. Patients need to be educated on the importance of routine 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 were removed during surgery, the risk of lymphedema is lifelong. Radiation can cause fibrosis and permanent skin changes in the radiation path. Nurses are uniquely positioned to provide acute cancer care and also support the patient through the survivorship journey. Fluid Distribution Extracellular vs Intracellular Body 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 Osmosis Filtration Actions Filtration is the movement of fluid (water) through a cell or blood vessel membrane because of hydrostatic pressure (water pressure) differences on both sides of the membrane. Hydrostatic pressure is the pressure exerted by water molecules against the surfaces (membranes or walls) of a confining space. Water molecules in a confined space constantly press outward against the 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 ).

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture