1. Pediatric Chemotherapy
Gina Brandl, RN BSN, MSN-Cand
Nursing Instructor
MSTC - Pediatrics
Presentation for pediatric clinical rotation by Gina Brandl.

2. Objectives
The student will describe how chemotherapy works on cells normal and cancerous cells
The student will describe the common side effects of chemotherapy
The student will assist in developing a nursing care plan appropriate for the pediatric patient receiving chemotherapy
Objectives to be met.

3. Chemotherapy Chemotherapy Specific drugs Administration
Kill normal and cancerous cells
Given simultaneously
Achieves greatest cellular destruction
Alters DNA
Administration
Intrathecal (into spinal canal), oral or intravenous
“Chemotherapy is the administration of specific drugs that kill both normal and cancerous cells” (London et al., 2006, p. 1522, para 6). Often times various chemotherapy drugs are given simultaneously to achieve the greatest cellular destruction possible. Giving chemotherapy drugs simultaneously maximizes the drugs lethal impact on cells at any stage of activity. Healthy cells grow and divide in an orderly manner replacing old and damaged cells. Chemotherapy interferes with the cancer cells as they grow and reproduce. Following chemotherapy the DNA in a normal cell can repair itself whereas the DNA in a cancer cell cannot. The chemotherapy drugs given interfere with division by preventing copying of cellular components, prevent froth of the cell by replacing or eliminating the essential enzymes needed for survival, and initiate self-destruction of cells (Saint Joseph’s Hospital, 2006, p. 3-1). Chemotherapy medications are administered to the patient orally, intrathecally or intravenously.

4. Protocols Type of cancer Cell type Location and spread Drug Dose
Interval of treatment
Treatment for side effects
Necessary laboratory studies
The chemotherapy protocol used is based upon research and depends upon the type of cancer identified, the stage and cell type. Chemotherapy protocols are maps or plan of action when administering chemotherapy to patients. The protocol directs the type of therapy to be administered by identifying the type of drug to be used and any accompanying treatments used.
(London et al., 2007)

5. Other Drugs Used Other drugs used in cancer treatment
Colony-stimulating factor
Erythropoietin (Epoetin)
Filgrastim (Neupogen)
Antimetics
Ondansetron (Zofran)
Nutritional supports
Help to maintain nutritional support
TPN & Lipids
There are other drugs that are used when treating children with cancer and include colony-stimulating factors, antimetics and nutritional supports. Colony-stimulating factors enhance blood cell production and counteract the myelosuppressive (suppression of the bone marrow's production of blood cells and platelets) effects of chemotherapy agents given. Erythropoietin is produced by the kidneys and Epoetin is a recombinant form which is used to treat anemia cancers, which decreases the amount of blood transfusions needed. Epoetin “substantially raised the hemoglobin concentrations of hundreds of thousands of patients with cancer, diminishing their need for red-cell transfusions during chemotherapy” (Steinbrook, 2007, p. 2448, para 1). Filgrastim increases the production of white blood cells by the bone marrow. Antimetics are given to treat nausea and vomiting, which is a common side effect of chemotherapy. Nutritional supplements, (TPN – total parental nutrition and lipids IV) are given to help maintain the patients nutritional support.

6. Side Effects of Chemotherapy
Occur when healthy cells are damaged
Occurrence
Immediately
Week to ten days
Months to years
Permanent or temporary
Includes: hair loss, mouth sores, constipation, bone marrow suppression, nausea and emesis, anorexia and weight loss
Side effects from chemotherapy occur when healthy cells are damaged. Depending upon the type of treatment, radiation or chemotherapy, the side effects vary. Side effects from chemotherapy can occur immediately, a week to ten days later or months to years post-treatment. The side effects of chemotherapy vary. Some have no side effects while others do. Chemo can make you sick because the drugs used are strong. The side effects can be permanent or temporary and may include: hair loss, mouth sores, constipation, pain, bone marrow suppression, nausea and vomiting, and/or anorexia and weight loss.

7. Side Effects of Chemotherapy
Hair loss
Mouth sores
Pain
Constipation
Bone marrow suppression
Nausea and vomiting
Anorexia and weight loss
Side effects occur because the chemotherapy given is strong. Chemotherapy drugs work well on any cell type that is dividing and affects healthy and cancerous cells. Hair loss can involve all the hair on your body. Bone marrow suppression (usually appears 7-10 days after chemotherapy has been administered and recovery is completed in 3-4 weeks) causes the patient to be tired, can easily bruise and bleed and the patient may have a higher risk of infection than other patients. The cells in the skin and mouth are involved causing sores in the mouth and dry skin. Finally the cells in the stomach and intestine are affected causing the patient to feel sick to his or her stomach, have vomiting or may have diarrhea. Inadequate nutrition from nausea and vomiting causes the patient to lose weight and become anorexic. Pain occurs at any time during treatment and is subjective so should be treated appropriately. Constipation occurs at any time during chemotherapy because as therapy progresses the child’s dietary intake and physical activity decreases.

8. Nursing Care Plan Nursing diagnosis
Risk for infection r/t immunosupression, invasive procedures, malnutrition, or pharmaceutical agents
Goals, interventions with rationale and expected outcomes
Ineffective individual coping r/t situational crisis
Common nursing diagnoses for a patient undergoing chemotherapy. Discussion will revolve around the nursing diagnosis, which includes goals, interventions with rationale and expected outcomes.

9. References
London, M. L., Ladewig, P. W., Ball, J. W., & Bindler, R. C. (2007). Maternal & child nursing care (2nd ed.). Upper Saddle River, NJ: Prentice Hall.
Saint Joseph’s Hospital. (2006). Pediatric oncology – Education & resource guide. Marshfield, WI; Ministry Health Care
Steinbrook, R. (2007). Erthropoietin, the FDA, and oncology. The New England Journal of Medicine. 356(24), p Retrieved December 16, 2007, from the website
References used to complete PPP.