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and MOPP.

stage IV disease

Other Regimes: Stanford V: doxorubicin, vinblastine, mustard, bleomycin, vincristine, etoposlde, and prednisone. The drugs are administered weekly, alternating the myelo-suppressive and nonmyelosuppressive agents for 12 weeks, followed by radiation therapy. BEACOPP: Bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone.

Other Regimes: Stanford V: doxorubicin, vinblastine, mustard, bleomycin, vincristine, etoposlde, and prednisone. The drugs are administered weekly, alternating the myelo-suppressive and nonmyelosuppressive agents for 12 weeks, followed by radiation therapy. BEACOPP: Bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone.

Note: ABVD refers to doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine. COPP refers to cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone. MOPP refers to mechlorethamine (nitrogen mustard), vincristine (Oncovin), procarbazine, and prednisone.

Independent

The primary nursing roles are to maintain comfort, protect the patient from infection, provide teaching and support about the complications of the treatment, and give emotional support. During mantle irradiation, the patient may suffer from a variety of uncomfortable or painful conditions. Dry mouth, loss of taste, dysphagia, nausea, and vomiting can be managed with frequent mouth care. Manage skin irritation and redness. Encourage the patient to avoid applying lotions, perfumes, deodorants, and powder to the treatment area. Explain that the skin must be protected from sunlight and extreme cold. Before starting treatments, arrange for the patient to have a wig, scarf, or hat to cover any hair loss, which occurs primarily at the nape of the neck. Explain to the patient that pneumonitis and hypothyroidism may occur; explain the signs and symptoms of each and when to notify the physician. During inverted-Y irradiation, nausea, vomiting, anorexia, diarrhea, and malaise require nursing management.

If the patient develops bone marrow suppression during hospitalization, make sure that all staff and visitors use good hand-washing techniques. Do not assign a nurse who is caring for infected patients. Encourage staff and visitors with infections to avoid all contact with the patient. If the patient receives chemotherapy, the side effects are equally uncomfortable. In addition to many of the symptoms that occur in response to radiation therapy (gastrointestinal symptoms, oral lesions, hair loss, bone marrow depression), the patient may develop joint pain, fever, fluid retention, and a labile emotional state (euphoria or depression) that need specific interventions based on their incidence and severity.

The disease presents severe emotional stressors to the patient and her or his significant others. The complexity of the diagnostic and staging process may make the patient feel lost in a crowd of specialists. It is important for the nurse to provide supportive continuity. Patience and repeated explanations are needed. Provide the patient with information about support groups, and refer the patient to either a clinical nurse specialist, support groups associated with the American or Canadian Cancer Society, or counselors.

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