Pharmacologic: alkylating agents
Bladder Instillation: Management/prophylaxis of superficial tumors of the bladder after local resection. IV: Breast and ovarian cancer (palliative). Intracavitary Instillation: Prevention of recurrent malignant effusions in pleura, pericardium, or peritoneum.
Disrupts protein, DNA, and RNA synthesis by crosslinking strands of DNA and RNA (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones. Has immunosuppressive properties.
Adverse Reactions/Side Effects
CNS: dizziness, headache, blurred vision. EENT: throat tightness. GI: anorexia, nausea, stomatitis, vomiting. GU: gonadal suppression, dysuria, urinary retention. Derm: alopecia, hives, pruritus, rash. Hemat: anemia, leukopenia, thrombocytopenia. Local: pain at IV site, pain at site of intracavitary instillation. Metab: hyperuricemia. Misc: allergic reactions, fever, fatigue, weakness.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
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 immediately.
Monitor signs of allergic 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.
Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.
Assess IV site during and after IV administration, and report signs of phlebitis or other injection-site reactions (local pain, swelling, inflammation). Also report prolonged or severe pain that might occur if this drug is administered into the bladder or other body cavity.
Instruct patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.
Advise patient and family/caregivers that fatigue and weakness are likely, and may be severe. Implement assistive devices (walker, cane, wheelchair) as needed to help maintain mobility and prevent falls.
Advise patient about the likelihood of GI problems (nausea, vomiting, loss of appetite, irritation in/around the mouth) or skin reactions (rash, hair loss, itching, hives). Instruct patient to report excessive or unusual GI problems or skin reactions.
Instruct patient or family/caregivers to report other side effects such as severe or prolonged headache, blurred vision, throat tightness, fever, or problems with urination (urine retention, difficult/painful urination).