Bleomycin

INTRODUCTION

Indications

Treatment of Lymphomas, Squamous cell carcinoma, Testicular embryonal cell carcinoma, Choriocarcinoma, Teratocarcinoma. Intrapleural administration to prevent the reaccumulation of malignant effusions.

Action

Inhibits DNA and RNA synthesis. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: aggressive behavior, disorientation, weakness. Resp: PULMONARY FIBROSIS, pneumonitis. CV: hypotension, peripheral vasoconstriction. GI: anorexia, nausea, stomatitis, vomiting. Derm: hyperpigmentation, mucocutaneous toxicity, alopecia, erythema, rashes, urticaria, vesiculation. Hemat: anemia, leukopenia, thrombocytopenia. Local: pain at tumor site, phlebitis at IV site. Metab: weight loss. Misc: ANAPHYLACTOID REACTIONS, chills, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess pulmonary function periodically by measuring lung volumes, breath sounds, and respiratory rate (See Appendices I, J, K). Notify physician immediately if patient experiences signs of pulmonary fibrosis or pneumonitis such as dry cough, dyspnea, chest pain, shortness of breath, cyanosis, and fever.

• Monitor signs of anaphylactoid reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Be alert for disorientation, aggressive behavior, or other alterations in mental status (See Appendix D). Notify physician promptly if these symptoms develop.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness, fainting, or other symptoms.

• Monitor signs of peripheral vasoconstriction, such as extreme coldness in the hands and feet, cyanosis, and muscle cramping. Notify physician of severe or prolonged signs of vasoconstriction.

• Watch for signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums) or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician or nursing staff.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or decreased body fat.

• Monitor IV injection site for pain, swelling, and inflammation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

• Because of the risk of pulmonary fibrosis and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, breathing responses, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Advise patient about the likelihood of GI reactions ...