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Medication or

Drug Class Dosage

Description

Rationale

Chemotherapy Varies with drug

Some common regimens are CHOP (cyclophosphamide doxorubicin, vincristine, prednisone); BACOP (bleomycin, doxorubicin, cyclophosphamide, vincristine, prednisone); and MACOP-B (methotrexate with leucovorin rescue factor, doxorubicin, cyclophos-phamide, vincristine, prednisone, bleomycin, plus trimethoprim-sulfamethoxazole and ketoconazole)

Chemotherapy is used for stage IVA and all stage B patients; usually lasts for 6-8 mo

Other Therapy: Common side effects are alopecia, nausea, vomiting, fatigue, myelo-suppression, and stomatitis. Patients who are receiving chemotherapy are administered antinausea drugs, antiemetics, and pain medicines as needed to help control adverse experiences. Experimental drugs currently in clinical trials include paclitaxel, topoiso-merase-3 inhibitors, nucleoside analogues, monoclonal antibodies, and interferon.

Independent

Maintain the patient's comfort, protect the patient from infection, provide teaching and support about the complications of the treatment, and provide emotional support. Fatigue, one of the most common side effects of cancer treatment, can last for several months to several years. A program entitled "Fatigue Initiative Research and Education" (FIRE) is available through the Oncology Nurses Society (www.ons.org).

During irradiation, the patient may suffer from dry mouth, loss of taste, dysphagia, nausea, and vomiting, which can be managed with frequent mouth care. Explore ways to limit discomfort, such as ice chips. Attempt to provide desired foods to support the patient's nutrition. Keep any foul-smelling odors clear of the patient's environment, particularly during meals. Manage skin irritation and redness by washing the skin gently with mild soap, rinsing with warm water, and patting the skin dry. Encourage the patient to avoid applying lotions, perfumes, deodorants, and powder to the treatment area. Explain that the patient needs to protect the skin 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.

If the patient develops bone marrow suppression, institute infection controls. Treat the discomfort that may arise from chemotherapy—joint pain, fever, fluid retention, and a labile emotion state (euphoria or depression)—all of which need specific interventions, depending on their incidence and severity. 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 a clinical nurse specialist, support groups associated with the American Cancer Society (www.cancer.org), or counselors.

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