Cervical cancer, chemotherapy toxicity and nursing

1, chemotherapy

Chemotherapy is systemic treatment, for the treatment of advanced cases. Ever, that the efficacy of chemotherapy for cervical cancer is not ideal to ease the rate is low, a short remission. For the terminally ill, they can only play a relieve suffering, and prolong life palliative role. In recent years, with the constant introduction of new anti-cancer drugs, routes of administration of the improvements, the joint application of multiple drugs in the treatment of cervical cancer, chemotherapy has become an effective adjuvant treatment, can be used in advanced cases or in connection with surgery, radiotherapy combination can also be used to treat recurrent cancer. Chemical drugs can act directly on cancer, some drugs can enhance the biological effects of radiation therapy.

' Single-drug treatment: before chemotherapy for cervical cancer multi-purpose single-drug treatment, commonly used drugs such as nitrogen mustard, bleomycin, mitomycin C ,5-FU and so on. Application discovered in recent years the efficacy of cisplatin in the treatment of cervical cancer is better than the other drugs.

' combined treatment: combination therapy generally based on drug mechanism of action, the role of points and toxicity of drugs to choose more than two kinds of drug treatment. Many of the programs combined chemotherapy of cervical cancer, of which cis-platinum and bleomycin-based chemotherapy regimen better effect. Commonly used programs such as cisplatin + bleomycin + vincristine, cisplatin + bleomycin + doxorubicin. Combined with adriamycin-based programs are adriamycin + methotrexate.

' chemotherapy and radiation combined treatment: chemotherapy combined with radiotherapy may increase the therapeutic effect of advanced cervical cancer. Its application method can be chemotherapy before radiotherapy, chemotherapy and radiotherapy at the same time applications, such as after radiotherapy plus chemotherapy.

' Comprehensive chemotherapy and surgical treatment: application of methods of preoperative chemotherapy and postoperative chemotherapy.

' intraarterial regional chemotherapy: general cervical cancer is a systemic route of administration of chemotherapy intravenous medication, arterial regional chemotherapy in recent years the development of a chemotherapy through the abdominal wall to the iliac artery common iliac artery was inserted into arterial levels of infusion. Commonly used drugs 5-FU, ammonia mustard, bleomycin, cisplatin, doxorubicin and so on.

Ammonia mustard generally the first choice.

Second, the major toxicity of chemotherapy

2.1 digestive toxicity of many anti-cancer drugs can cause varying degrees of digestive response, generally appeared earlier than the bone marrow suppression. Clinically visible oral ulcers and gastrointestinal mucosa, there anorexia, nausea, vomiting, abdominal pain, diarrhea, severe, causing gastrointestinal bleeding, intestinal obstruction and intestinal necrosis. Nausea and vomiting is a common gastrointestinal reactions, persistent nausea and vomiting can cause repeated in patients with mental stress, fear: anxiety, appetite reduction, weight loss, electrolyte imbalance, and even patient refused medication, affecting drug efficacy.

2.2 The majority of bone marrow suppression caused by chemotherapy drugs can be varying degrees of bone marrow suppression, manifested as leukopenia, of which the most obvious decline in granulocytes. As the dose increases, platelets and red blood cells can also be reduced, in severe cases can reduce hemoglobin.

2.3 urinary system toxicity of many chemotherapy drugs in the liver metabolism, metabolites can cause kidney damage, kidney dysfunction, proteinuria, hematuria, severe cases can be oliguria, anuria, and even life-threatening. Chemotherapy should pay attention to monitoring by the renal function, adequate hydration. Taking combination therapy and the use of diuretics, nurses should pay attention to record urine output to maintain urine output> 100mL / h or 24 hours of not less than 2000mL. Encourage patients to a large number of drinking water, to drink more green tea, water or clothing diuretic Tonglin Chinese medicine, dilute urine, to reduce the urinary system toxicity.

2.4 cardiovascular system toxicity of some chemotherapeutic drugs on the cardiovascular system of toxic side-effects, such as the alkylating agent can cause high blood pressure, heart rate increased and fast, adriamycin (ADb1) barriers to enable the local vessel wall occurs, but also bow ! from cardiac disease, manifested as heart failure, arrhythmia and so on. Therefore, the medication before and drug use should be to observe the patient's heart and found that abnormal immediate withdrawal, timely treatment. Change to have heart disease should avoid the use of cardiac toxic effects of chemotherapy drugs.

2.5 nervous system toxicity of the more common for the DDP, ifosfamide (IFO) can occur after treatment such as paresthesia, mental confusion, headache, lethargy, body ache, and other neurological reflex weakening is still a lack of effective treatment for toxic should be withdrawal observation, nutritional support, application Vit and may contribute to vasodilator nerve function recovery. For the physical activity or sensory abnormalities may provide a passive activity, massage.
Third, care of patients with cervical cancer chemotherapy

3.1 Psychological care nurses should listen to patients complain of their fears, discomfort and pain, care for them, in order to obtain the trust. Providing them with needed assistance to enable them to understand the role of chemotherapy drugs, adverse reactions, medication when the attention, to encourage interaction among sufferers to introduce the successful cases, so that cheerful mind, emotional stability, and foster confidence in disease-fighting and do a good job families, so that patients and their families able to cope with the treatment.

3.2 intravenous care for the full effect of chemotherapy, medication, said before you get an accurate body weight (preferably in the morning, fasting, they gain weight after row 2). According to doctor's advice seriously seven pairs of three investigations, the correct dissolved and diluted drugs and are now done with the concept of distribution, when the combination therapy according to the nature of the drug, discharge the order, and some see the light of drug decomposition, should pay attention to dark. Puncture technique to improve and protect the vein, there are plans to start using from the remote right and left turn choose a suitable vein, do not puncture within 24 hours before the bottom of the vein puncture once again to prevent leaking. Conditions of the patients or the hospital may make use of catheter use. Lost when the first intravenous saline and confirmed that the needle be in the administration of intravascular transfusion medicine blood vessel wall and then washed with saline to reduce wall stimulation; needle injection, when attention to the protection veins, press 3 ~ 5 minute infusion, strengthening observation, master Disu to prevent liquid leakage. If liquid inadvertently omitted in the skin should immediately stop liquid input, then to retain the needle syringe, withdraw sword skin of the liquid can then be injected into the skin antidote.

3.3 The toxicity of chemotherapy drugs on the hematopoietic system of care in nursing toxicity strictly controlled indications, the general poor condition, recently done radiotherapy or chemotherapy should be used with caution in patients or reduce the dose of medication can be the necessary support during the treatment of , such as increased nutrition, for righting, Bu Zhong Yi Qi Chinese medicine and vitamins such as white blood cell count regularly checked by your doctor. Pairs of normal white blood cell counts in patients to prevent infection, reduce or decline to visit, live in single room, regular air disinfection. Use of antibiotics by your doctor, application l white blood drugs, a small number enter the new blood component transfusion or given to observe the changes in vital signs, observe whether the bleeding tendency in patients to avoid the use of aspirin until the drugs, intravenous infusion needle injection pressure when five minutes. For the loss of appetite, loss of appetite in patients, first of all to enable patients to understand the importance of nutrition. Zhu Huanzhe eat sweets, try to eat greasy, fried food, you can Shaoliangduocan, eating digestible, nutrient-rich diet. For severe cases, nausea and vomiting can be 30-60 minutes before chemotherapy and chemotherapy given after the 4-6 hours of antiemetic drugs. For abdominal pain, diarrhea, patients should pay attention to observe the nature of abdominal pain, stool characteristics, frequency, and timely submission Zhu Huanzhe eat soft, low residue, low fiber, non-irritating food. If the three days is not defecation, shall be used laxatives. Oral ulcers are generally more severe impact of pain in patients with swallowing eating, you can pre-meal with 0.5% tetracaine plus Gentamicin cable coating, eating bogey spicy, hot, cold, hard, over-stimulate the rough, and alcohol and tobacco. May be granted the same with the temperature of the liquid without stimulation, soft food, serious oral care and balanced nutrition to help heal ulcers caused by chemotherapy mucosal swelling of the throat or esophagus and cause pain and even difficulty swallowing, shall be encouraged to talk too much , ground water, promote pharyngeal activity, reduce congestion and edema caused by pharyngeal ulcer.