Clinical journal of oncology nursing
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Ongoing diligent patient assessment is the most important step in the equianalgesic conversion process. The conversion must take into account individual patient characteristics such as age, renal function, side effects, and the patient's pain syndrome. In addition, if the opioid dose is not adequate to begin with, the conversion dose is less likely to be effective. ⋯ Nurses play a major role in the assessment of patients receiving opioids for pain management. Inadequate pain management despite escalating doses, untoward side effects, loss of a route of administration, and sometimes cost and reimbursement issues necessitate an opioid conversion or rotation. Nurses also play a role in recommending the change and ensuring that patients receive the correct dose.
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Paclitaxel, a mitotic inhibitor, is used to treat a variety of cancers. A significant incidence of paclitaxel-related hypersensitivity reactions (HSRs) occurs because of the diluent used. ⋯ Paclitaxel-related HSRs should be managed immediately and appropriately by (a) stopping the infusion, (b) administering oxygen, (c) infusing fluids, (d) continuously monitoring blood pressure, pulse, and oxygenation, and (e) initiating standing orders for i.v. corticosteroids and diphenhydramine or other emergency medications. Oncology nurses are key to the rapid recognition and treatment of paclitaxel-related HSRs.
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Malnutrition is the most common secondary diagnosis in patients with cancer and is a major prognostic indicator for poor response to cancer therapy and shortened survival. The word CANCER can be used as an acronym to guide early nutritional intervention that combines an understanding of cancer cachexia with a plan to optimize patients' nutritional status during the stress imposed by cancer and its treatment. Conversations with patients reveal nutrition-related information that is valuable as part of a comprehensive assessment. ⋯ An awareness of potentially life-threatening Complications of enteral and parenteral nutrition is essential. An ongoing Evaluation of patients' status and responses to the nutrition plan guides changes to the plan as needed. Reassurance/Removal are important parts of care during all stages of treatment and nutrition support.
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The ability to provoke emesis is defined by the emetogenic potential of each antineoplastic agent and by individual prognostic factors that determine the risk for each patient. The risk of chemotherapy-induced emesis is increased for females, patients between the ages of 6 and 50, and patients who drink little or no alcohol. ⋯ The 5-HT3 receptor antagonists are the most effective agents against chemotherapy-induced nausea and should become standard antiemetic therapy for high-risk patients. Knowledge of factors affecting emesis and the antiemetic agents available for treating high-risk patients are the keys to successful nursing management of emesis in patients receiving chemotherapy.