Medical surgical nursing

KEMOTHERAPI

CHAPTER I
INTRODUCTION

Background
Since time immemorial known several ways of treatment to cure cancer. The oldest way is surgery, then after irradiation against malignant tumor cells are sensitive to gamma rays and with the development of knowledge about the structure, function, regulation of cell proliferation and the mechanism therein, the chemical treatment in recent years developed rapidly.
Cytostatica is one of the most cancer treatment showed improvement in the treatment of cancer patients. Because it is also the hope and the medical world depends on the effect of treatment with cytostatica continue to rise. Sejala with the hope that efforts to cure or at least shrink the size of the cancer with cytostatica continues to escalate.

CHAPTER II
THEORY REVIEW

A. Understanding cytostatica
Cytostatica is a treatment to kill cells - the cells are fractional (a certain fraction of dead), so that 90% successful passage and 10% did not succeed.
(Hanifa Wignjosastro, 1997)
B. Giving purpose Chemotherapy
? Relieve symptoms
? Controlling the growth of cancer cells

C. Giving way
Cytostatica drug delivery mode can be done:
1. PO: Per Oral
2. SC: Sub Cutan
3. IM: Intra Muscular
4. IV: Intra Venous
5. IT: Intra Thecal
6. IP: Intra-peritoneal / pleural

• Selection and venous puncture site
Selection of appropriate venous and arterial and equipment should be used is determined by the patient's age, status and venous drug administered intravenously. Make a selection above venous flexural areas and the selection of the most short-iv cateter and the smallest in size accordingly. Veins are commonly used are: Basillic, cephalica and metacarpal. Place the stabbing must be replaced every 72 hours and veins that are suitable for the stabbing was smooth and soft, not hard and prominent veins and choose wide enough to place equipment, media, chemotherapy can irritate the vein and jarigan software.

D. Procedure
1. a. Preparation
• Before you are given chemotherapy, it must be prepared in the size of TB, BB, wide body, complete blood count, renal function, liver function, blood sugar, complete urine, ECG, thorax photograph AP / lateral, echocardiography, BMP.
• Check the protocol and therapy program that is used, and the time before drug administration.
• Check the patient name, drug dosage, drug type, mode of administration of drugs.
• Check for concernt inform both patients and families.
• Prepare cytostatica drug
• Prepare a solution of NaCl 0.9%, D5% or intralit.
• Pengalas plastic, with paper or cloth thereon absorption
• long-sleeved gown, mask, hat, goggles, gloves, shoes
• Spuit disposible 5cc, 10cc, 20 cc, 50 cc.
• venous catheter infusion sets and small
• Alcohol 70% with sterile cotton
• large syringe Bak
• Label medications
• Plastics former landfill
• Kardex (special note)

b. How it works
All drugs are mixed by the pharmacy staff who are skilled pharmaceutical division by wearing the appliance "laminary airflow biosafety" and then sent to a special ward in the place closed. Accepted by the nurse to record patient name, medication type, medication dosage and time of mixing.
When you do not have the biosafety laminary airflow, mixing done specific subjects covered by:

1.
The table was covered with plastic pengalas thereon absorbent paper or cloth are
2.
Wear long-sleeved dresses, hats, masks, goggles, shoes.
3.
Take medications according to the program cytostatica, dissolving with 0.9% NaCl, D5% or intralit.
4.
Before opening the ampoule confirm that the liquid is not at the top of the ampoule. Use the screen when opening ampoules to prevent injuries and contaminated with skin. Make sure that the drug is taken is enough, by not taking 2 times
5.
Remove the air which is still in the syringe with cotton or gauze cover with a sterile syringe needle tip.
6.
Enter the drug slowly into flabot 0.9% NaCl or D5% by volume of fluid that has been determined
7.
Do not spill during mixing, preparing, and when entering into flabot drug or infusion bottles.
8.
Create a label, the name of patient, type of drug, date, hour and late delivery or delivery with a syringe pump.
9.
Enter into a container that has been provided.
10.
Enter the garbage directly into plastic bags, tie and give the sign or needles inserted into specific places to avoid a puncture.

2. Procedures for granting chemotherapy
• Check the patient, type of drug, drug dosage, type of fluid, fluid volume, mode of administration, timing and late delivery.
• Wear protection: long-sleeved dresses, hats, masks, goggles, gloves and shoes.
• Perform aseptic and antiseptic techniques
• Place the plastic-coated paper pengalas absorption area under the IV puncture
• Give anti-nausea ½ hours before the granting of anti neoplastic (primperan, zofran, kitril intra venous)
• Perform aspiration with 0.9% NaCl
• Give perlahn cancer drugs are slowly (if necessary with a syringe pump) according to the program
• When finished rinse again with 0.9% NaCl
• All equipment that has been used is inserted into a plastic bag and tied and labeled.
• Open dress, hat, Asker, glass eyes and then soak with detergent. When disposible masukkkan plasrtik then tied in a bag and labeled, send to the incinerator / offering.
• Record all procedures
Keep an eye on the general state of the patient, monitor blood pressure, pulse, RR every half hour and watch for signs ekstravasasi.

E. Chemotherapy Working Principle
Chemotherapy working principle is to kill the cells that proliferate rapidly (particularly cancer cells) to destroy or disrupt the process of cell division.

F. Handling Chemotherapy Side Effects
Side effects of chemotherapy is often the case and its handling:
1. Hair loss / thinning
Temporary. Hair will grow back if the drug is stopped.
2. Nausea / vomiting
Equipment provided meals in small portions but frequently. Avoid foods that are too sweet, oily / fatty and candy. Anti-vomiting drugs are usually given by a physician.
3. Constipation
Provide high-fiber food, eg vegetables and fruits. Drink lots. Usually if more than three days without defecation, will be given medication by your doctor.
4. Diarrhea
Avoid foods that spicy / sour. Give drink plenty of food and soft. If diarrhea is more than one day will be given medication by your doctor.
5. Stomatitis / cold sore / gomen
Maintain oral hygiene. Use a soft toothbrush. Topical medications will usually be given by a physician.
6. Decrease in endurance
Avoid sources of infection by removing the child from people who have the flu, sore throat, chicken pox, sore skin and others. Maintain cleanliness of the body. Wash hands before eating and before or after touching the child.
7. Skin changes: dry, itchy
Keep your skin clean. Use a moisturizer that contains no alcohol. Wear loose clothing.
G. Chemotherapy drug administration Terms
Before treatment the patient started a few conditions must be met, namely:
1. General condition should be good enough
2. Patients understand the treatment and knowing the side effects will occur
3. Kidney function (urea levels <40 mg% and creatinine levels <1.5 mg%) and good liver function
4. Hispatologik known diagnosis
5. Type of cancer known to be sensitive to chemotherapy
6. Hemoglobin> 10 gr%
7. Leucosit> 5000 / ml
8. Thrombocyte> 100,000 / ml


CHAPTER III
CLOSING

Cytostatica is a treatment to kill cells - the cells are fractional (a certain fraction of dead), so that 90% successful passage and 10% did not succeed.
The purpose Chemotherapy: Alleviate symptoms, Controlling the growth of cancer cells
Cytostatica drug delivery mode can be either:
PO: Per Oral, SC: Sub Cutan, IM: Intra Muscular, IV: Intra Venous, IT: Intra Thecal, IP: Intra-peritoneal / pleural
Chemotherapy working principle is to kill the cells that proliferate rapidly (particularly cancer cells) to destroy or disrupt the process of cell division.
Preparation of mixing drug use instruments of "biosafety laminary airflow" to avoid any effect on the officer who prepared the drugs kemotherapi.
Chemotherapy side effects that often occur are:
Hair loss / thinning, nausea / vomiting, constipation, diarrhea, stomatitis / cold sore / gomen, Decreased endurance, change of skin: dry, itchy