Integumentary S/E A)Alopecia: usually hair starts to grow back 3-4 weeks after Tx, but can have diff color or texture B)Radiation Skin Reactionstend to be more severe than chemo skin rxns i)Dry Desquamation looks like a sunburnii)Wet Desquamation sloughing greatly outpaces new skin growth – more of a typical wound.iii)Radiation Skin Care (a)Loss of epidermis requires some wound care: NS soaked compresses, burrow’s solution, cover with vapor permeable dressing or Vaseline gauze (b)Avoid rubbing, avoid heating pads and ice packs, avoid constrictive garments(c)Clean with mild soap and tepid water. Pat dry. (d)Non-medicated, non-perfumed lotion or cream(e)Rinse with saline – allow area to be open to aired out. Non-adhesive dressings for drainage. (f)Avoid sun or wear SPF(g)Avoid swimming(h)If shaving needed, use electric razor (i)Don’t wash off markings from radiation (guides)C)Chemotherapy Skin Changes can be treated with topicalsi)Mild Erythema and Hyperpigmentationii)Acral Erythema and Erythrodysesthesia Syndrome XV.GU S/EA)Hemorrhagic Cystitis bleeding in bladder; can give Mensa as protective agent alongside Tx B)Reproductive DysfunctionC)Nephrotoxicity: monitor BUN/creatinine/GFR. If they do develop toxicity: monitor I&O, weightsXVI. Nervous SystemS/EA)ICP: uncommon, but monitor neuro exam for mental status, coordination changes i)Often treated with Steroids bc inflammation-based B)Peripheral Neuropathy can extend far past Tx because nerves die i)Gabapentin (Neurontin); AntidepressantsC)Cognitive Changes “Chemo Brain”i)Characterized by short-term difficulty with dates, numbers, multitasking, etc., can be long termXVII.Respiratory S/E: Pneumonitis XVIII.Cardiovascular S/EHeart Failure can develop after chemo, which doesn’t resolve after Tx is completed A)Pericarditis and Myocarditis B)Cardiotoxicity Cell Replacement Therapies I.Growth (“Colony”) Stimulating Factorsstimulate production, maturation, regulation, and activation of cells of the hematologic systemA)Erythropoietin: stimulates RBCproduction in cases of Anemiai)S/E: Clotting issues, e.g. thromboembolism. Goal is to have minimal Hgb without side effects or need for transfusion: 7-8. Because above 12, patient has risk of thromboembolic event. B)To avoid Infection:i)GM-CSF: Sargramostim (Leikine)ii)G-CSF: Filgrastim (Neupogen) & Pegfilgrastim (Neulasta)II.Bone Marrow Transplant (BMT) & Peripheral Stem Cell Transplant (PSCT) Hematopoietic Stem Cell Transplantation A)Goal of treatmentis to replace bone marrow function r/t damage from Chemo or Radiation B)Engraftment: Takes 2-5 weeks for stems cells to graft and begin making new RBC, WBC, plateletsi)If it doesn’t graft, must do another transplantC)Post-Transplanti)Patient has no natural immunityuntil engraftment occurs – Infection and Thrombocytopenia riskii)Strict isolation precautions – perhaps daily infusions of RBC and PLT
iii)Bleeding is another concern D)Graft vs. Host Disease (GVHD) is a complication of BMT, T-Cell Mediated i)
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