Common Side Effects and Nursing Management

Chemotherapy

Targets both normal and cancer cells; side effects include fatigue, anorexia, and acute toxic effects like vomiting.

Biologic Therapy

Induces immune responses; side effects vary with dose and schedule, causing flu-like symptoms and organ damage.

Nausea/Vomiting

Result from GI lining breakdown; managed with Zofran and hydration.

Anorexia

Caused by TNF release; eat small, frequent meals.

Diarrhea/Constipation

Due to intestinal lining destruction; manage with increased fiber/fluids and stool softeners.

Hepatotoxicity/Nephrotoxicity

Medication-induced organ damage; monitor changes in stool, urine color, and jaundice.

Anemia

Results from bone marrow suppression; symptoms include fatigue, feeling cold, and shortness of breath.

Leukopenia

Bone marrow suppression; risk for infection, managed with Neupogen.

Thrombocytopenia

Low platelets causing bleeding risk; monitor for petechiae, bruising, and bleeding gums.

Alopecia

Hair loss from damaged follicles; manage for psychological well-being.

Cystitis

Bladder inflammation; presents with urinary frequency, hematuria, and abdominal distention.

Reproductive Dysfunction

Damage to ova and testes; discuss fertility preservation options like sperm banking.

Increased ICP

Brain tumor radiation-induced edema; monitor for headache, vision changes, and decreased LOC.

Peripheral Neuropathy

Medication side effect causing paresthesia and numbness; increases fall risk.

Pneumonitis

Inflammation 2-3 months post-treatment; presents with cough, fever, and shortness of breath.

Fibrosis

Develops 6-12 months post-treatment; symptoms include cough, fever, and shortness of breath.

Pericarditis/Myocarditis

Can occur up to 1 year post-treatment; monitor for chest pain, edema, and SOB.

Hyperuricemia

Increased uric acid levels; monitor for gout symptoms and swelling, manage with increased fluids.

Fatigue/Pain

Result from decreased nutrition and cell breakdown; manage with pain meds and antiemetics.

Skin Reactions

Desquamation causing red rash; avoid scented products and wear loose clothing.

Malnutrition

Protein and calorie depletion; refer to dietitian for supplements and enteral/parenteral nutrition.

Altered Taste Sensation

Caused by cancer cell substances; affects sweet, sour, salty, and bitter taste perceptions.

Infection

Common in cancer patients due to ulceration, necrosis, and neutropenia; treat with antibiotics.

Obstructive Emergencies

Life-threatening events from tumor obstruction; include superior vena cava syndrome, spinal cord compression, third space syndrome, and intestinal obstruction.

Metabolic Emergencies

Result from ectopic hormone production; include Syndrome of Inappropriate Antidiuretic Hormone.

Superior Vena Cava Syndrome

Obstruction of superior vena cava; presents with facial edema, distended veins, and headache.

Spinal Cord Compression

Malignant tumor in spinal cord; symptoms include back pain, weakness, and sensory loss.

Third Space Syndrome

Fluid shift from vascular to interstitial space; due to extensive surgeries or septic shock.

Intestinal Obstruction

Partial or complete blockage of intestines; presents with N/V, abdominal pain, and bowel necrosis.

Syndrome of Inappropriate Antidiuretic Hormone

Results from abnormal ADH production by cancer cells; leads to fluid imbalance.

Lung Carcinoma

Manifests as weight gain, N/V, weakness, anorexia, seizures, and coma

Hypercalcemia

Elevated calcium levels with symptoms like depression, fatigue, muscle weakness, ECG changes, increased urine, anorexia, N/V; >3 mmol/L is life-threatening

Tumor Lysis Syndrome

Rapid tumor cell destruction leading to hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia, muscle weakness, paralysis, cramps, abdominal distention, palpitations, numbness/tingling

Cardiac Tamponade

Fluid accumulation in pericardial sac, tumor constriction, pericarditis leading to symptoms like ↑ sweating, SOB, N/V, pulsus paradoxus, muted heart sounds, ↑ HR, cough, hiccups; treated with fluid removal, O2 therapy, IV fluids, and vasopressors

Carotid Artery Rupture

Result of tumor invasion or erosion post-surgery/radiation in head/neck cancer, leading to rapid death; managed with immediate pressure, IV fluids, blood administration, and surgery

Psychosocial Support

Offering counseling, active listening, coping strategies, essential information, trust-based relationship, goal setting, healthy lifestyle encouragement, and maintaining hope

Nursing Management of Pain

Assessing pain regularly, minimizing irritants, administering medications, providing non-pharmacological therapies, evaluating pain relief effectiveness, and avoiding delays in pain relief

Delirium

Confusion, disorientation, restlessness, reversible process managed by assessment, creating a calm environment, reorientation, medication administration, reassurance, and emotional support

Anxiety/Restlessness

Managed by assessing anxiety disorder, distress, urinary retention, and stool impaction without restraint

Dysphagia

Difficulty swallowing due to weakness, managed by alternative medication routes, oral suction, modified diet, small meals, and elevated head position

Weakness and Fatigue

Expected at end of life, managed by assessing tolerance, timing interventions, assisting with desired activities, and providing rest periods

Dehydration

Occurs in last days of life, managed by assessing mucous membranes, oral care, encouraging ice chips/fluids, applying lip lubricant, and reassuring family

Dyspnea

Subjective symptom with fear of suffocation, managed by regular respiratory assessment, positioning, pursed lip breathing, oxygen therapy, and suctioning

Suction

Cautiously clear airways in terminal phase

Expectorant

Medication to aid in mucus removal

Myoclonus

Severe jerking or twitching, possibly opioid-related

Skin breakdown

Difficulty maintaining skin integrity at end of life

Bowel Patterns

Constipation or diarrhea management in palliative care

Urinary Incontinence

Loss of bladder control due to disease progression

Nausea

Feeling of sickness, worsened by various factors

Vomiting

Forceful expulsion of stomach contents

Candidiasis

Oral fungal overgrowth common in immunosuppression

Withdrawal

Patient appears disconnected from surroundings near death

Unusual Communication

Restlessness, agitation, or repetitive actions in terminal phase

Vision-Like Experiences

Seeing or interacting with non-existent entities before death

Saying Goodbyes

Encouraging emotional closure and farewells

Spiritual Needs

Request for spiritual support in end-of-life care

Bereavement

Period of mourning after a loved one's death

Grief

Normal reaction to loss, can be psychological or physiological

Anticipatory grief

Grieving before the actual death occurs

Adaptive grief

Finding positive aspects in the loss

Prolonged grief disorder

Intense mourning lasting over 6 months

Advance care plan

Directive for care when patient can't communicate

DO-NOT-RESUSCITATE

Order reflecting patient's wish to not be resuscitated

MAID

Medical Assistance in Dying for eligible patients

Palliative Sedation

Sedation to relieve suffering without hastening death

Organ and Tissue Donation

Option for organ donation after nonrecoverable injury

Special needs of family caregivers

Support and resources for caregivers of dying patients