Alkylating
Busulfan (Busulfex, Myleran)
carboplatin (Paraplatin)
chlorambucil (Leukeran)
cisplatin (Platinol-AQ),
cyclophosphamide (Cytoxan)
dacarbazine (DTIC-Dome)
altretamine (Hexalen)
ifosfamide (Ifex)
melphalan (Alkeran)
nitrogen mustard (Mustargen)
oxaliplatin (Eloxatin)
thiotepa (Thioplex)
Bond with DNA, RNA and protein molecules leading to impaired DNA
replication, RNA transcription, and cell functioning; all resulting in
cell deathCell cycle�nonspecific Bone marrow suppression, nausea,
vomiting, cystitis (cyclophosphamide, ifosfamide), stomatitis,
alopecia, gonadal suppression, renal toxicity (cisplatin), and
development of secondary malignancies
Mechanism of Action
Cell Cycle Specificity
Common Side Effects
Bond with DNA, RNA and protein molecules leading to impaired DNA
replication, RNA transcription, and cell functioning; all resulting in
cell death
Cell cycle�nonspecific
Bone marrow suppression, nausea, vomiting, cystitis
(cyclophosphamide, ifosfamide), stomatitis, alopecia, gonadal
suppression, renal toxicity (cisplatin), and development of secondary malignancies
Nitrosoureas
Carmustine (BCNU [BiCNU, Gliadel]),
lomustine or CCNU (CeeNU),
semustine (methyl-CCNU [MeCCNU]),
streptozocin (Zanosar)
Similar to alkylating agents; cross the blood�brain barrier
Cell cycle�nonspecific
Delayed and cumulative myelosuppression, especially
thrombocytopenia; nausea, vomiting, pulmonary, hepatic and renal damage
Topoisomerase I Inhibitors
Irinotecan (Camptosar)
Topotecan (Hycamtin)
Topoisomerase II Inhibitors
Etoposide (Etopophos, VePesid)
Teniposide (Vumon, VM-26)
Induce breaks in the DNA strand by binding to enzyme topoisomerase,
preventing cells from dividing
Cell cycle�specific (S phase)
Bone marrow suppression, diarrhea, nausea, vomiting, flulike
symptoms (topotecan), rash (etoposide), hepatotoxicity (teniposide)
Antimetabolites
5-Azacytidine (Vidaza),
capecitabine (Xeloda),
cytarabine (DepoCyt, Tarabine)
edatrexate fludarabine (Fludara),
5-fluorouracil (5-FU),
gemcitabine (Gemzar),
hydroxyurea (Droxia, Hydrea),
cladribine (Leustatin),
6-mercaptopurine (Purinethol),
methotrexate (Trexall, Rheumatrex), pentostatin (Nipent),
6-thioguanine (Tabloid)
Interferes with the biosynthesis of metabolites or nucleic acids
necessary for RNA and DNA synthesis; inhibits DNA replication and
repairCell cycle�specific (S phase)Nausea, vomiting, diarrhea, bone
marrow suppression, stomatitis, renal toxicity (methotrexate),
hepatotoxicity (6-thioguanine), hand-foot syndrome (capecitibine)
Antitumor Antibiotics Bleomycin (BLM, Blenoxane), dactinomycin
(Cosmegen), daunorubicin (DaunoXome), doxorubicin (Adriamycin),
epirubicin, idarubicin (Idamycin), mitomycin (Mutamycin), mitoxantrone
(Novantrone), plicamycin (Mithracin)
Interfere with DNA synthesis by binding DNA; prevent RNA synthesis
Cell cycle�nonspecific Bone marrow suppression, nausea, vomiting,
alopecia, anorexia, cardiac toxicity (daunorubicin, doxorubicin), red
urine (doxorubicin, idarubicin, epirubicin), pulmonary fibrosis (bleomycin)
Mitotic Spindle Inhibitors Plant alkaloids: vinblastine (Velban),
vincristine (VCR [Oncovin]), vinorelbine (Navelbine)
Arrest metaphase by inhibiting mitotic tubular formation (spindle);
inhibit DNA and protein synthesis Cell cycle�specific (M phase) Bone
marrow suppression (mild with VCR), peripheral neuropathies, nausea
and vomiting
Mitotic Spindle Inhibitors Taxanes: paclitaxel (Taxol), docetaxel (Taxotere)
Arrest metaphase by inhibiting tubulin depolymerization Cell
cycle�specific (M phase) Hypersensitivity reactions, bone marrow
suppression, alopecia, peripheral neuropathies, mucositis
Mitotic Spindle Inhibitors Epothilones: ixabepilone (Ixempra)
Alters microtubules and inhibits mitosis Cell cycle�specific (M
phase) Peripheral neuropathies, bone marrow suppression,
hypersensitivity reactions, hepatic impairment
Hormonal Agents Androgens and antiandrogens, estrogens and
antiestrogens, progestins and antiprogestins, aromatase inhibitors,
luteinizing hormone�releasing hormone analogues, steroids
Bind to hormone receptor sites that alter cellular growth; block
binding of estrogens to receptor sites (antiestrogens); inhibit RNA
synthesis; suppress cytochrome P450 system Cell cycle�nonspecific
Hypercalcemia, jaundice, increased appetite, masculinization,
feminization, sodium and fluid retention, nausea, vomiting, hot
flashes, vaginal estrogen dryness
Miscellaneous Agents Asparaginase (Elspar), procarbazine (Matulane)
Inhibits protein, DNA, and RNA synthesis Varies Anorexia, nausea,
vomiting, bone marrow suppression, hepatotoxicity, hypersensitivity
reaction, pancreatitis
Arsenic trioxide (Trisenox)
Causes fragmentation of DNA resulting in cell death; in acute
promyelocytic leukemia, it corrects protein changes and changes
malignant cells into normal white blood cells. Nausea, vomiting,
electrolyte imbalances, fever, headache, cough, dyspnea,
electrocardiogram abnormalities
Patients receiving _____________ must be instructed to avoid drinking
cold fluids or going outside with hands and feet exposed to cold
temperatures to avoid exacerbation of these symptoms.
________ may cause peripheral neuropathies and hearing loss
due to damage to the acoustic nerve.
oxaliplatin
Cisplatin
_______________ ______________should never be administered in
peripheral veins involving the hand or wrist
Vesicant chemotherapy
_____________administration is permitted for short-duration infusions
only, and placement of the venipuncture site should be on the forearm
area using a soft, plastic catheter
Peripheral
Endoscopy: Used for direct visualization of
body organs/cavities to detect abnormalities.
Scans (e.g., magnetic resonance imaging [MRI], CT,
gallium) and ultrasound: May be done for
diagnostic purposes, identification of metastasis, and evaluation of
response to treatment.
Biopsy (fine-needle aspiration [FNA], needle core,
incisional/excisional): Done to differentiate
diagnosis and delineate treatment and may be taken from bone marrow,
skin, organ, and so forth. Example: Bone marrow is done in
myeloproliferative diseases for diagnosis; in solid tumors for
staging.
Tumor markers (substances produced and secreted by
tumor cells and found in serum, e.g., carcinogenic embryonic
antigen [CEA], prostate-specific antigen [PSA],
alpha-fetoprotein, human chorionic gonadotropin [HCG], prostatic
acid phosphatase, calcitonin, pancreatic oncofetal antigen, CA
15-3, CA 19-9, CA 125, and so on): Helpful in
diagnosing cancer but more useful as prognostic indicator and/or
therapeutic monitor. For example, estrogen and progesterone
receptors are assays done on breast tissue to provide information
about whether or not hormonal manipulation would be therapeutic in
metastatic disease control. Note: Any hormone may be
elevated because many cancers secrete inappropriate hormones
(ectopic hormone secretion).
Screening chemistry tests, e.g., electrolytes (sodium,
potassium, calcium), renal tests (BUN/Cr), liver tests
(bilirubin, AST, alkaline phosphatase, LDH), bone tests
(calcium):Depend on individual condition, risk
factors.
CBC with differential and platelets: May
reveal anemia, changes in RBCs and WBCs; reduced or increased
platelets.
Chest x-ray: Screens for primary or
metastatic disease of lungs
Test selection depends on history, clinical manifestations, and index
of suspicion for a particular cancer.
Nursing Priorities
Support adaptation and independence. Promote
comfort. Maintain optimal physiological functioning.
Prevent complications. Provide information about
disease process/condition, prognosis, and treatment needs.
Discharge Goals
Patient is dealing with current situation
realistically. Pain alleviated/controlled.
Homeostasis achieved. Complications
prevented/minimized. Disease process/condition, prognosis,
and therapeutic choices and regimen understood. Plan in
place to meet needs after discharge.
Cancer
2. Situational Low Self-Esteem
May be related to
Biophysical: disfiguring surgery, chemotherapy or
radiotherapy side effects, e.g., loss of hair, nausea/vomiting,
weight loss, anorexia, impotence, sterility, overwhelming fatigue,
uncontrolled pain Psychosocial: threat of death; feelings
of lack of control and doubt regarding acceptance by others; fear
and anxiety
Possibly evidenced by
Verbalization of change in lifestyle; fear of
rejection/reaction of others; negative feelings about body; feelings
of helplessness, hopelessness, powerlessness Preoccupation
with change or loss Not taking responsibility for
self-care, lack of follow-through Change in
self-perception/other�s perception of role
Desired Outcomes
Verbalize understanding of body changes, acceptance of
self in situation. Begin to develop coping mechanisms to
deal effectively with problems. Demonstrate adaptation to
changes/events that have occurred as evidenced by setting of
realistic goals and active participation in work/play/personal
relationships as appropriate.
Nursing InterventionsRationaleDiscuss with patient and SO how the
diagnosis and treatment are affecting the patient�s personal life,
home and work activities.Aids in defining concerns to begin
problem-solving process.Review anticipated side effects associated
with a particular treatment, including possible effects on sexual
activity and sense of attractiveness and desirability (alopecia,
disfiguring surgery). Tell patient that not all side effects occur,
and others may be minimized or controlled.Anticipatory guidance can
help patient and SO begin the process of adaptation to new state and
to prepare for some side effects (buy a wig before radiation, schedule
time off from work as indicated).Encourage discussion of concerns
about effects of cancer and treatments on role as homemaker, wage
earner, parent, and so forth.May help reduce problems that interfere
with acceptance of treatment or stimulate progression of
disease.Acknowledge difficulties patient may be experiencing. Give
information that counseling is often necessary and important in the
adaptation process.Validates reality of patient�s feelings and gives
permission to take whatever measures are necessary to cope with what
is happening.Evaluate support structures available to and used by
patient and SO.Helps with planning for care while hospitalized and
after discharge.Provide emotional support for patient and SO during
diagnostic tests and treatment phase.Although some patients adapt or
adjust to cancer effects or side effects of therapy, many need
additional support during this period.Use touch during interactions,
if acceptable to patient, and maintain eye contact.Affirmation of
individuality and acceptance is important in reducing patient�s
feelings of insecurity and self-doubt.Refer for professional
counseling as indicated.May be necessary to regain and maintain a
positive psychosocial structure if patient and SO support systems are deteriorating.
Risk for Fluid Volume Deficit
Risk factors may include
Excessive losses through normal routes (e.g., vomiting,
diarrhea) and/or abnormal routes (e.g., indwelling tubes,
wounds) Hypermetabolic state Impaired intake of
fluids
Desired Outcomes
Display adequate fluid balance as evidenced by stable
vital signs, moist mucous membranes, good skin turgor, prompt
capillary refill, and individually adequate urinary output.
Nursing
Interventions Rationale Monitor I&O and
specific gravity; include all output sources, (emesis, diarrhea,
draining wounds. Calculate 24-hr balance).Continued negative fluid
balance, decreasing renal output and concentration of urine suggest
developing dehydration and need for increased fluid replacement. Weigh
as indicated. Sensitive measurement of fluctuations in fluid balance.
Monitor vital signs. Evaluate peripheral pulses, capillary refill.
Reflects adequacy of circulating volume. Assess skin turgor and
moisture of mucous membranes. Note reports of thirst. Indirect
indicators of hydration status and degree of deficit. Encourage
increased fluid intake to 3000 mL per day as individually appropriate
or tolerated. Assists in maintenance of fluid requirements and reduces
risk of harmful side effects such as hemorrhagic cystitis in patient
receiving cyclophosphamide (Cytoxan).
Observe for bleeding tendencies (oozing from mucous membranes,
puncture sites); presence of ecchymosis or petechiae.Early
identification of problems (which may occur as a result of cancer or
therapies) allows for prompt intervention.Minimize venipunctures
(combine IV starts with blood draws).
Encourage patient to consider central venous catheter
placement.Reduces potential for hemorrhage and infection associated
with repeated venous puncture.Avoid trauma and apply pressure to
puncture sites.Reduces potential for bleeding and hematoma
formation.Provide IV fluids as indicated.Given for general hydration
and to dilute antineoplastic drugs and reduce adverse side effects
(nausea and vomiting, or nephrotoxicity).Monitor laboratory studies
(CBC, electrolytes, serum albumin).Provides information about level of
hydration and corresponding deficits.
Fatigue
May be related to
Decreased metabolic energy production, increased energy
requirements (hypermetabolic state and effects of treatment)
Overwhelming psychological/emotional demands Altered
body chemistry: side effects of pain and other medications,
chemotherapy
Possibly evidenced by
Unremitting/overwhelming lack of energy, inability to
maintain usual routines, decreased performance, impaired ability to
concentrate, lethargy/listlessness Disinterest in
surroundings
Desired Outcomes
Report improved sense of energy. Perform ADLs
and participate in desired activities at level of ability.
Nursing Interventions Rationale :Have patient rate fatigue, using a
numeric scale, if possible, and the time of day when it is most
severe.Helps in developing a plan for managing fatigue.Plan care to
allow for rest periods. Schedule activities for periods when patient
has most energy. Involve patient and SO in schedule planning.Frequent
rest periods and naps are needed to restore and conserve energy.
Planning will allow patient to be active during times when energy
level is higher, which may restore a feeling of well-being and a sense
of control.Establish realistic activity goals with patient.Provides
for a sense of control and feelings of accomplishment.Assist with
self-care needs when indicated; keep bed in low position, pathways
clear of furniture; assist with ambulation.Weakness may make ADLs
difficult to complete or place the patient at risk for injury during
activities.Encourage patient to do whatever possible (self-bathing,
sitting up in chair, walking). Increase activity level as individual
is able.Enhances strength and stamina and enables patient to become
more active without undue fatigue.Monitor physiological response to
activity (changes in BP, heart and respiratory rate).Tolerance varies
greatly depending on the stage of the disease process, nutrition
state, fluid balance, and reaction to therapeutic regimen.Perform pain
assessment and provide pain management.Poorly managed cancer pain can
contribute to fatigue.Provide supplemental oxygen as
indicated.Presence of anemia and hypoxemia reduces
O2available for cellular uptake and contributes to
fatigue.Refer to physical or occupational therapy.Programmed daily
exercises and activities help patient maintain and increase strength
and muscle tone, enhance sense of well-being. Use of adaptive devices
may help conserve energy.
Risk for Infection
Risk factors may include
Inadequate secondary defenses and immunosuppression,
e.g., bone marrow suppression (dose-limiting side effect of both
chemotherapy and radiation). Malnutrition, chronic disease
process Invasive procedures
Desired Outcomes
Remain afebrile and achieve timely healing as
appropriate. Identify and participate in interventions to
prevent/reduce risk of infection.
Nursing Interventions Rationale: Promote good handwashing procedures
by staff and visitors. Screen and limit visitors who may have
infections. Place in reverse isolation as indicated.Protects patient
from sources of infection, such as visitors and staff who may have an
upper respiratory infection (URI).Emphasize personal hygiene.Limits
potential sources of infection and secondary overgrowth.Monitor
temperature.Temperature elevation may occur (if not masked by
corticosteroids or anti-inflammatory drugs) because of various factors
(chemotherapy side effects, disease process, or infection). Early
identification of infectious process enables appropriate therapy to be
started promptly.Assess all systems (skin, respiratory, genitourinary)
for signs and symptoms of infection on a continual basis.Early
recognition and intervention may prevent progression to more serious
situation or sepsis.Reposition frequently; keep linens dry and
wrinkle-free.Reduces pressure and irritation to tissues and may
prevent skin breakdown (potential site for bacterial growth).Promote
adequate rest and exercise periods.Limits fatigue, yet encourages
sufficient movement to prevent stasis complications (pneumonia,
decubitus, and thrombus formation).Stress importance of good oral
hygiene.Development of stomatitis increases risk of infection and
secondary overgrowth.Avoid or limit invasive procedures. Adhere to
aseptic techniques.Reduces risk of contamination, limits portal of
entry for infectious agents.Monitor CBC with differential WBC and
granulocyte count, and platelets as indicated.Bone marrow activity may
be inhibited by effects of chemotherapy, the disease state, or
radiation therapy. Monitoring status of myelosuppression is important
for preventing further complications (infection, anemia, or
hemorrhage) and scheduling drug delivery.Obtain cultures as
indicated.Identifies causative organism(s) and appropriate
therapy.Administer antibiotics as indicated.May be used to treat
identified infection or given prophylactically in immuno- compromised patient.
Risk forConstipation/Diarrhea
Risk factors may include
Irritation of the GI mucosa from either chemotherapy or
radiation therapy; malabsorption of fat Hormone-secreting
tumor, carcinoma of colon Poor fluid intake, low-bulk diet,
lack of exercise, use of opiates/narcotics
Desired Outcomes
Maintain usual bowel consistency/pattern.
Verbalize understanding of factors and appropriate
interventions/solutions related to individual situation.
Nursing InterventionsRationaleAscertain usual elimination habits.Data
required as baseline for future evaluation of therapeutic needs and
effectiveness.Assess bowel sounds and record bowel movements (BMs)
including frequency, consistency (particularly during first 3�5 days
of Vinca alkaloid therapy).Defines problem (diarrhea, constipation).
Note: Constipation is one of the earliest manifestations of
neurotoxicity.Monitor I&O and weight.Dehydration, weight loss, and
electrolyte imbalance are complications of diarrhea. Inadequate fluid
intake may potentiate constipation.Encourage adequate fluid intake
(2000 mL per 24 hr), increased fiber in diet; regular exercise.May
reduce potential for constipation by improving stool consistency and
stimulating peristalsis; can prevent dehydration associated with
diarrhea.Provide small, frequent meals of foods low in residue (if not
contraindicated), maintaining needed protein and carbohydrates (eggs.,
cooked cereal, bland cooked vegetables).Reduces gastric irritation.
Use of low-fiber foods can decrease irritability and provide bowel
rest when diarrhea present.Adjust diet as appropriate: avoid foods
high in fat (butter, fried foods, nuts); foods with high-fiber
content; those known to cause diarrhea or gas (cabbage, baked beans,
chili); food and fluids high in caffeine; or extremely hot or cold
food and fluids.GI stimulants that may increase gastric motility
frequency of stools.Check for impaction if patient has not had BM in 3
days or if abdominal distension, cramping, headache are
present.Further interventions and alternative bowel care may be
needed.Monitor laboratory studies as
indicated:ElectrolytesElectrolyte imbalances may contribute
to altered GI function.Administer IV fluids;Prevents dehydration,
dilutes chemotherapy agents to diminish side effects.Antidiarrheal
agents;May be indicated to control severe diarrhea.Stool softeners,
laxatives, enemas as indicated.Prophylactic use may prevent further
complications in some patients (those who will receive Vinca alkaloid,
have poor bowel pattern before treatment, or have decreased motility).
Risk for Altered Sexuality Patterns
Risk factors may include
Knowledge/skill deficit about alternative responses to
health-related transitions, altered body function/
structure, illness, and medical treatment Overwhelming
fatigue Fear and anxiety Lack of privacy/SO
Desired Outcomes
Verbalize understanding of effects of cancer and
therapeutic regimen on sexuality and measures to correct/
deal with problems. Maintain sexual activity at a
desired level as possible.
Nursing InterventionsRationaleDiscuss with patient and SO the nature
of sexuality and reactions when it is altered or threatened. Provide
information about normality of these problems and that many people
find it helpful to seek assistance with adaptation
process.Acknowledges legitimacy of the problem. Sexuality encompasses
the way men and women view themselves as individuals and how they
relate between and among themselves in every area of life.Advise
patient of side effects of prescribed cancer treatment that are known
to affect sexuality.Anticipatory guidance can help patient and SO
begin the process of adaptation to new state.Provide private time for
hospitalized patient. Knock on door and receive permission from
patient and SO before entering.Sexual needs do not end because the
patient is hospitalized. Intimacy needs continue and an open and
accepting attitude for the expression of those needs is
essential.Refer to sex therapist as indicated.May require additional
assistance in dealing with situation.
Types of HSCT are based on the source of donor cells and the
treatment (conditioning) regimen used to prepare the patient for stem
cell infusion and eradicate malignant cells. These include:
� Allogeneic HSCT (AlloHSCT): From a donor other than the
patient (may be a related donor such as a family member or a matched
unrelated donor from the National Bone Marrow Registry or Cord Blood Registry)
� Autologous: From the patient
� Syngeneic: From an identical twin
� Myeloablative: Consists of giving patients high-dose
chemotherapy and, occasionally, total-body irradiation
� Nonmyeloablative: Also called
mini-transplants; does not completely destroy bone marrow cells
�Staging � classify size, location and involvement of tumor
�Grading � pathologists classifies how close to normal tissue or
not the tumor is
STAGING AND GRADE
�Localized surgery
�Used to treat surgery bed
�Palliative use
�External beam
�Brachytherapy
RADIATION THERAPY
�Low-dose rate implant (LDR)
1 to 7 days of treatment
Typically in hospital
�High-dose rate implant (HDR)
Catheter left in place
Short term
� Permanent implant
Prostate treatment
Seeds left in place
Radioactive for short period of time
RADIATION THERAPY
�Compounded in special cabinet
�Needless systems
�Power-free gloves
�Disposable gowns
�Chemo disposal bins
�Spill kit location
�Specialized education for administration � IV and oral
CHEMO SAFETY
�Superior Vena Cava Syndrome
�Spinal Cord Compression
�Hypercalcemia
�Tumor Lysis Syndrome
Oncologic Emergencies
CELLULAR REGENERATION
...
�Angiogenesis
�Tumor-specific antigens
�Uncontrolled proliferation
�Replicative immortality
�Invasion
�Metastasis
�Resistance to cell death
�Evasion of growth suppression signals
uTable 15-1
CHARACHTERISTICS OF CANCER
�Initiation
�Promotion
�Progression
CARCINOGENISIS
�Cellular DNA is transformed
�Immunity
�Exposure
�Genetics
CAUSES OF CANCER
�Primary prevention = Risk reduction
�Secondary prevention = Screening & Detection
�Tertiary prevention = Monitoring and prevention of recurrence
Table 15-3
CANCER PREVENTION
�Surgery
�Medication
�Radiation
CANCER MANAGEMENT
�Minimal amount of tissue removed
�Nursing care centers on area where surgery occurred
CANCER SURGERY
�Alkylating Agents
�Antimetabolics
�Mitotic Spindle Inhibitors
�Hormonal Agents
�Biologic Response Modifiers
MEDICATIONS CANCER
�Extensive support
�Family involvement
�Multidisciplinary approach
�Mortality
�Advanced directives
�Barriers to care
PSYCHOSOCIAL
Patients receiving oxaliplatin must be instructed to avoid drinking
cold fluids or going outside with hands and feet exposed to cold
temperatures to avoid exacerbation of these symptoms. Cisplatin may
cause peripheral neuropathies and hearing loss due to damage to the
acoustic nerve.
If extravasation is suspected, the medication administration is
stopped immediately, and depending on the drug, the nurse may attempt
to aspirate any remaining drug from the extravasation site.
Superior Vena Cava Syndrome (SVCS)
Clinical
Compression or invasion of the superior vena cava by tumor, enlarged
lymph nodes, intraluminal thrombus that obstructs venous circulation,
or drainage of the head, neck, arms, and thorax. Typically associated
with lung cancer, SVCS can also occur with breast and testicular
cancers, thymoma, lymphoma, and mediastinal metastases (Lewis,
Hendrickson, & Moynihan, 2011). If untreated, SVCS may lead to
cerebral anoxia (because not enough oxygen reaches the brain),
laryngeal edema, bronchial obstruction, and death.
Gradually or suddenly impaired venous drainage giving rise to:
� Progressive shortness of breath (dyspnea), cough, hoarseness,
chest pain, and facial swelling
� Edema of the neck, arms, hands, and thorax and reported sensation
of skin tightness, difficulty swallowing, and stridor
� Possibly engorged and distended jugular, temporal, and arm veins
� Dilated thoracic vessels causing prominent venous patterns on the
chest wall
� Increased intracranial pressure, associated visual disturbances,
headache, and altered mental status
Diagnostic
� Diagnosis is confirmed by:
� Clinical findings
� Chest x-ray
� Thoracic computed tomography (CT) scan
� Thoracic magnetic resonance imaging (MRI)
� Venogram if intraluminal thrombosis is suspected
Medical
Radiation therapy to shrink tumor size and relieve symptoms
� Chemotherapy for sensitive cancers (e.g., lymphoma, small cell
lung cancer) or when the mediastinum has been irradiated to maximum
tolerance (Lewis et al., 2011)
� Anticoagulant or thrombolytic therapy for intraluminal thrombosis
� Percutaneously placed intravascular stents or bypass surgical
graft placement (synthetic or autologous) may be considered for
chronic or recurrence of this syndrome (Camp-Sorrell, 2010).
� Supportive measures such as oxygen therapy, corticosteroids, and
diuretics (in cases of fluid overload)
Nursing
� Identify patients at risk for SVCS.
� Monitor and report clinical manifestations of SVCS.
� Monitor cardiopulmonary and neurologic status.
� Avoid upper extremity venipuncture and blood pressure measurement;
instruct patient to avoid tight or restrictive clothing and jewelry on
fingers, wrist, neck.
� Facilitate breathing and drainage from upper portion of body by
instructing patient to maintain some elevation of head and upper body
with semi-Fowler�s position; avoid completely supine or prone position
(this helps to promote comfort and reduce anxiety associated with
dependent and progressive edema).
� Promote energy conservation to minimize shortness of breath.
� Monitor the patient�s fluid volume status; administer fluids
cautiously to minimize edema.
� Assess for thoracic radiation-related problems such as mucositis
with resultant dysphagia (difficulty swallowing) and esophagitis.
� Monitor for chemotherapy-related problems, such as myelosuppression.
� Provide postoperative care as appropriate.