Nurses Corner – Professional opinions
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Posts
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EGFR Inhibitors: Cutaneous Side Effects and Their Management
(Side effects noted in the skin).
Patient tools/mobile apps from the Oncology Nursing Society including ” Self-Care During Cancer Treatment”, and “My Care Plan” for Apple and Android.
https://www.journeyforward.org/planning-tools/my-care-plan
-Karen
KarenD wrote:To add to Michelle’s great post:Essential oils of spearmint and peppermint have been used with success in randomized controlled trials. In fact, I have witnessed a decrease in nausea in some of my own patients who had intractable nausea and were given aromatherapy with peppermint.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562057/
I’ve also included a study on medical marijuana and nausea. Currently I work in a large community hospital which is north of New York City and I have not generally seen the use of medical marijuana in those whom I care for, nor the prescribing of synthetic THC within the inpatient setting. When I lived and worked in other regions such as the Pacific NW, this type of medication was used with much more frequency. On a personal note, my mother in law used Marinol when her nausea became severe. She was able to eat a few small meals that she found pleasurable, which greatly added to her quality of life at the time. She did however, dislike the drowsy feeling that she personally experienced when taking this medication.
http://oncology.jamanetwork.com/mobile/article.aspx?articleid=2504173
Another anti-nausea aid that can be used is ginger. Uptodate discusses it’s use in chemotherapy induced nausea and vomiting (CINV).
-Karen D. BSN, RN, CHPN
Hi everyone,
this is my first post. I am a nurse practitioner and care for patients iwiho have GI cancers iincluding cholangiocarcinoma. The patients I care for primarily receive radiation and chemotherapy.
Medical Marijuana (as well as recreational ) is legal in the state where I reside. I have seen medical marijuana relieve nausea for patients with refractory nausea.Cannabis/Cannabinoids are one of the interventions listed as recommended for practice by the Oncology Nursing Society – Putting evidence into practice committee- based on review of studies. A
metanalysis of the literature is posted below.I am emphasizing safety is always first and foremost. Medical marijuana needs to be discussed with your oncologist just as any other prescription medication. Side effects and contraindications need to be reviewed. It is always important for your health care providers to have an accurate and updated list of your medications. Also, not all cannabis formulations ( oils, oral, oral spray, or smoking, have the same results.
In the state of Massachusetts, there are certified prescribing specialists for medical marijuana, and they must be physicians who go through a certification process. Nurse practitioners do not prescribe medical marijuana.It is always good to have more options to treat nausea .
I am not advocating recreational marijuana.
Smith, L.A., Azariah, F., Lavender, V.T., Stoner, N.S., & Bettiol, S. (2015). Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database of Systematic Reviews, 11, CD009464.
doi: 10.1002/14651858.CD009464.pub2
Patient Education for Mucositis
The link provided is from the Oncology Nursing Society (ONS), and is a guide for patients on how to manage oral and gastrointestinal mucositis. Mucositis is a potential side effect of chemotherapy and head and neck radiation, and can range from mild to severe. Mild oral mucositis can begin as a burning sensation in your mouth or throat or a sore throat, and progress to mouth and throat ulcerations. Self care and careful monitoring of your mouth, lips, gums, and teeth while receiving chemotherapy is very important.
Gastrointestinal mucositis can begin as diarrhea, and is equally important to monitor.The webpage link includes other patient teaching topics from ONS as well, including xerostomia and dysphagia.
-Karen D., BSN, RN, CHPN
When receiving chemotherapy, have you as a patient ever received education on infiltration or extravasation of chemotherapy agents? The most important thing a nurse can do to prevent and or minimize tissue damage due to the leakage of chemotherapy into the skin, is to educate the patient who is receiving the drug.
When individuals receive chemotherapy via a peripheral i.v., frequent assessments should occur to make sure the vein is intact, and the drug is not leaking into the surrounding tissue. Although much less common, leakage of medication can occur with the use of a port a cath as well, if the needle is too short, becomes dislodged, and so forth.
Here is some information although directed at nurses, which includes a lot of great patient teaching information. It is best to be well informed as a patient, so you will know if there is an issue with your intravenous site.
https://cjon.ons.org/sites/default/files/GonzalezFeb2013PAGE1.pdf
https://www.ncbi.nlm.nih.gov/pubmed/23372097
-Karen
Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update
http://ascopubs.org/doi/full/10.1200/JCO.2016.70.1474
More on palliative care. This article is from the Journal of Clinical Oncology, published by the American Society of Clinical Oncology (ASCO).
Patients with advanced cancer or a high symptom burden, should have a referral to a palliative care physician in addition to their other physicians as palliative care greatly improves quality of life.
-Karen
Updated Guidelines on Chemotherapy Induced Nausea and Vomiting: American Society of Clinical Oncology (ASCO)
-Karen
<b>How to find health care information that is accurate and reliable</b>
It is important to remember when doing your own research on this cancer or any other medical issue, it is good practice to turn to reliable and accurate information as a basis for your health care decisions in addition to your physician’s input and care. General web searches <b><i>may</i></b> provide access to information which is accurate, but more likely than not lead individuals to websites or people/groups who<i> <b>claim</b></i> to have performed real research on their chosen topics but in fact, did not.
Read studies, learn how to decipher the scientific language, or use sources which are accurate and written in non-medical language such as http://www.medscape.com/
Here are some websites which provide information which is reliable, accurate, and up to date.
http://www.jointcommission.org/assets/1/18/patient_101.pdf
How do you find information which is believable/reliable when there is so much information out there?
Here are some tips from UCSF on how to find accurate information when doing your own research.
https://www.ucsfhealth.org/education/evaluating_health_information/
When I do research on a medical topic I will only go to certain places to find this information and will look to see how old the information is. Anything over five years old is less desirable than more recent studies as everything in the medical world is constantly being updated/is changing. Additionally I will look to see who sponsors the website. Is it a .org, .edu, or .gov? Websites with these addresses are sponsored by non-profits, universities, or the government and are therefore more reliable than a .com.
Does the website have editors, or is it written by one person? Does the website link their claims to actual studies or do they use testimonials only? Testimonials do not prove that their product or idea works. Please think about these things when reading information on the web.Here are some of the places I go for information:
https://www.ebscohost.com/nursing/products/cinahl-databases/cinahl-complete
-Karen D
The information provided is not intended nor implied to be taken as medical advice. Please consult your health care provider if you have questions or concerns.
So i will add as a patient and practitioner… great referral to the palliative doctors if they are available but this is what was in my handbag for my personal treatments.
chemo with Emend (Aprepitant), Aloxi ( Palonosetron)( Dexamethasone, ===== ALL IV .. It is absorbed better this route that is per their packaging instructions for providers.
Emend and Aloxi are the anti nausea drugs
dexamethasone is a steroid
All of these are supposed to give a few days of support for the nausea.Once worn off this is what is in my medicine bag for symptoms.
1) ZOFRAN– who can live without this… I keep the ODT preparation… this is quick dissolving tablets.
2) Promethizine- an old but goody anti nausea medicine… but will make you sleepy… might be good after that steroid to help with insomnia.
3) Reglan- helps with digestion…. gets the system working if a bit slow and helps with nausea.
4) Ativan- if all else fails and I am not keeping anything down will work.. only had to use this when I was on oxaliplatin… did not agree with me.
5) And if all else fails i go to a cup of mint/ginger tea….
Not sure about anything else out there but I am sure there are tons other medications .. you just need to discuss with your doctor and make them think outside of the box for relief!
Michelle
Mucositis management for patients undergoing chemotherapy
Easy to understand guide to oral mucositis management from the American Cancer Society:
Guidelines in Spanish
http://www.mascc.org/assets/Guidelines-Tools/guidelines_mucositis_spanish.pdf
Link to guidelines in other languages (French, Portuguese, Turkish, Italian, etc.).
http://www.mascc.org/mucositis-guidelineshttp://www.mascc.org/assets/StudyGroups/mucositis/mascc-chemotherapy.pdf
Mucositis can develop anywhere within the oral cavity (mouth), and throughout the gastrointestinal tract (esophagus, intestines) of patients undergoing chemotherapy and site specific radiation. Oral mucositis can start as soreness, burning, and stinging, progressing to ulceration, pain, and the inability to eat or drink.
Mucositis can manifest as diarrhea, rectal bleeding, as well as ulcers.
Be vigilant about your oral health when receiving chemotherapy, and alert your oncologist or oncology nurse if you experience any change in your mouth/lips, bowel movements, eating, etc.
-Karen
More biliary drain, PTC tube, biliary stent instructions from various facilities.
University of Mississippi
University of Michigan
http://www.med.umich.edu/1libr/aha/umliver11.htm
NHS Birmingham
https://www.uhb.nhs.uk/Downloads/pdf/PiPtcBiliary.pdf
Georgetown
All,
The NCI link discussing nausea and vomiting is broken in the former posting. Here is the correct link.
https://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-pdq
-Karen
Hello Lou!
I’m so sorry to hear that your wife is experiencing so much nausea. As you posted this message on Tuesday, I’m hoping perhaps that she has seen her oncologist since then and discussed her recurrent nausea and found some relief.
In looking over your message and thinking about a few things, the first question I had is concerning the medications that she takes for her nausea before chemotherapy, the day of chemotherapy, and for the days following her infusion.
One of the medications she is receiving, Cisplatin, is referred to as a “highly emetogenic” agent, or in layman’s terms, it causes severe nausea. There are clear guidelines on the management of chemotherapy induced nausea and vomiting for medications such as Cisplatin, and it wouldn’t hurt to ask if your wife is receiving the medications as recommended.If we were to look at days 1-4 of chemotherapy, she should be receiving medication like Emend (Aprepitant), Zofran, Dexamethasone, etc. The Emend is a pill and should be taken before chemotherapy and then orally on day 2 and 3 along with Decadron (Dexamethasone) i.v. or by mouth on days 2, 3, and 4.
The guidelines are actually quite lengthy, so I only included the first top section of the National Comprehensive Cancer Network (NCCN) antiemesis guidelines from 2017.
For the professional guidelines an account is needed, but is free to set up.
https://www.nccn.org/patients/resources … ausea.aspx
There may be other reasons for her persistent nausea as well including the effects of the tumor. Here is a great resource for you to look through from the National Cancer Institute on nausea and vomiting in cancer.https://www.cancer.gov/about-cancer/tre … nausea-pdq
This can be an issue that will require a lot of trial and error, changing of medications, working to find foods/beverages that are easily digested, etc. I have also seen some good success with the use of peppermint oil on a cotton ball in a little dish, and having an individual gently inhale the aroma of this. Yes I know it sounds silly, but I have seen it work for some individuals who were struggling with ongoing nausea due to liver, colon, and endometrial cancers…or cancers that are prone to causing nausea.
It is low-tech, but worth a try but do always ask her oncologist or oncology nurse before trying anything new, and do not use this if your wife as an allergy to peppermint.
http://ecancer.org/journal/7/full/290-a … miting.php
Does the facility where your wife is being treated have palliative care physicians on staff? If so, it might be a good idea to see if someone from their service could be a consult and work with the oncologist to treat her nausea.
Palliative care specialists are not hospice doctors, but practitioners who specialize in symptom management on a short term or long term basis. This physician team (Oncologist/Palliative care physician) could work together to trial different medications, or work with a nutritionist, manage pain medications, constipation, etc. They work wonders and are a great asset when struggling with persistent and distressing symptoms.Lou, I will be thinking of the both of you and keeping good thoughts and hope for relief of the nausea. Please let us know how you are both doing.
-Karen
Individuals suffering from “chemo-brain” who participated in a brain training program similar to an online game, found to have statistically significant improvement in cognition. Additionally, participants exhibited less anxiety, depression, and fatigue.
-Karen
Native GF
Funny you should mention feeling bloated after eating. This happens to me, but I thought it was just because I ate way too much. I feel guilty that I still enjoy food so much (I said long ago that even if I got cancer I would not lose weight). I am so hungry in the morning I have to make myself stop shoveling food in my mouth, otherwise I just feel so uncomfortable for hours. Guess I should mention this to my ONC. Thanks for bringing it up.
I was diagnosed with CC July 2016. Am on Gemz/cis chemo 7th cycle ( 14th treatment I guess). I went from 107 platelet count to 37K last Thursday. In one week week! Have had blood transfusion, venofer drip (anemia) and aranesp shot (anemia), And still platelets dropped to 37K. I’ll find out more next Thursday I guess.
There is so much to learn about this–very confusing. I’ll ask my ONC about bloating and gt back with ya.
Janet in Phoenix
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