Adverse reactions to chemotherapy Extravasation Vesicant chemotherapeutic agents can cause or form a blister and cause tissue destruction.

. e.g Adriamycin (doxorubicin), Oncovin(vincristine) Irritant drugs can produce venous pain at the site and along the vein. Pain, erythema, swelling and lack of blood return indicate an extravasation

Nursing responsibilities for extravasation include the following: Stop the drug administration Leave the needle in place, and attempt to aspirate any residual drug from the tubing, needle, and site. Administer an antidote, as prescribed. Then remove the needle. Apply warm and cold compresses as indicated. Document the appearance of the site before and after chemotherapy.

For severe and irreversible cases of Extravasation, amputation maybe required.

Oncologic emergencies: 1. Infection and pain Infection arises from neutropenia. People with advanced cancer have pain. Severe infection and pain can interfere with the persons ability to enjoy quality life. Pain management is the priority in care of clients with advanced cancer.

2. Hypercalcemia This is due to bone resorption (demineralization). Serum Ca > 11mg/dL.

 It usually occurs in solid tumors like breast, lung, head, neck, and renal cancers, it may also occur in hematologic cancer like multiple myeloma, leukemia. Severe hypercalcemia may lead to renal failure, coma, cardiac arrest and death. Calcitonin(miacalcin) and oral glucocorticoids are given to lower serum calcium.

3. Tumor Lysis Syndrome The destruction of large number of malignant cells may rapidly release intracellular potassium, phosphorus and nucleic acid into the circulation. Electrolyte imbalances and acute renal failure may occur. Clients with malignancies that are very responsive to treatment are at higher risk, especially if they have large tumor burden (lymphomas, leukemias and small cell carcinoma).

The clinical manifestation of tumor lysis syndrome are as follows:

1. Weakness 2. Nausea 3. Diarrhea 4. Flaccid paralysis 5. ECG changes 6. Muscle cramps and twitching 7. Oliguria 8. Hypotension 9. Edema 10.Altered mental status

 Collaborate management or tumor lysis syndrome include the following: 1. Intravenous hydration. 2. Allopurinol to decrease uric acid concentration. 3. Sodium bicarbonate with IV hydration to promote fecal excretion of excess phosphate. 4. Lowering of serum potassium leveks with medicaions, retention enemas, IV 50% dextrose

4. SIADH (Syndrome of inappropriate antidiuretic hormone hypersecretion) results from the abnormal production of antidiuretic hormone (ADH). This may be caused by small cell lung cancer, infection, pulmonaru disorders, emotional stress, CNS disorders and some drugs, including antineoplastic agents like Cytoxan(cylosphosphamide), Oncovin (Vincristine), Velban (vinblastine), Platinol AQ (Cisplatin). SIADH is manifested by water retention and decrease in sodium. The sign and symptoms of SIADH are as follows: 1. Confusion 2. Irritability 3. Headache 4. Muscle weakness 5. Lethargy 6. Decreased urine output 7. Edema 8. Nausea and Vomiting 9. Anorexia The collaborative management of SIADH are as follows: 1. Fluid excretion (diuretics) 2. IV infusion of hypertonic saline (3-5%) if severe, to prevent pulmonary edema.

3. Monitor intake and output 4. Administer medications Lithane(Lithium), and urea. like Declomycine (Demeclocycline),

5. Disseminated Intravascular Coagulation (DIC) This condition is characterized by development of extensive, abnormal clots in the microcirculation(small blood vessels). The widespread clotting depletes the general circulation with clotting factors and platelets, leading to excessive bleeding in different sites of the body. Clots that are obstructing the circulation decrease blood flow to major organs, causing pain, stroke-like manifestations, dyspnea, tachycardia, oliguria, bowel necrosis. In clients with cancer, DIC is usually caused by gram negative infection or sepsis, release of clotting factors from cancer cells, or blood transfusion. DIC is most commonly associated with leukemia and adenocarcinomas of the lung, pancreas, stomach and prostate. Diagnostic findings that support DIC are prolonged prothrombin time and acrivated partial thromboplastin time, very low platelet count and prolonged clotting times. The medical management for DIC are as follows: 1. Correction of the basic problem (e.g infection) 2. Administer blood products and medication as prescribed. 3. IV heparin if controversial). with manifestations of thrombosis (although,

4. Monitor the client for signs and symptoms of bleeding. 6. Spinal Cord Compression It is caused by direct pressure on or compromise of vascular supply to the spinal cord. Back pain is the often the only presenting clinical manifestation in majority of clients This may result to irreversible neurologic damage with paralysis and loss of bowel and bladder control.

 Treatment is usually with RT. A laminectomy may be an alternative. Steroids may be given to reduce inflammation and swelling around the spinal cord. 7. Superior Vena Cava Syndrome (SVC) It results from external and internal obstruction of the superior vena cava. The obstruction reduces venous return to the heart and decreases cardiac output. SVC syndrome is usually secondary to lung cancer or lymphoma. The clinical manifestations of SVC syndrome are as follows: 1. Dyspnea 2. Facial swelling 3. Jugular vein distention 4. Sitting up and leaning forward to breath 5. Swelling of arms, chest pain, dysphagia. External beam RT and curative chemotherapy are used for palliation. 8. Cardiac Tamponade Fluid collects in the pericardial sac (pericardial effusion), it leads to cardiac tamponade. Pericardiocentesis may be performed to draw off the fluid.