What is three reasons that children who receive chemotherapy experience nausea and vomiting? When chemotherapy is introduced to a person’s immune system it creates a reaction that often causes nausea and vomiting. Within a child, their immune system and bodily systems are still developing thus making them even more likely to develop the negative side effects of the treatment. The theory behind chemo therapy is one in which the therapy kills most of the cells and bodily systems thus eradicating the cancer. However, at the same time chemotherapy will also kill the positive and healthy aspects of a person’s bodily system. The brain recognizes chemotherapy as a foreign invader that is toxic. Therefore, the response to a foreign invader such as chemotherapy results in a reflex of vomiting and nausea. Some individual’s do not develop nausea when chemotherapy is received. However there are some factors that constitute the likelihood of a person having nausea and vomiting. These consist of the age of the person. Additionally, a young person is more likely to receive chemotherapy through IV administration which increases the chance of vomiting. Lastly, the sensitivity of a child’s immune system is less developed than a full grown adult. Often, chemotherapy drugs are given close together. An adult has a more developed immune system which means it can heal faster. If chemotherapy drugs are given in close succession a child is more likely to suffer from nausea and vomiting because of their inability to heal at a fast rate (Turan, Esenay, Guven, 2016).

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If the physician wrote the following order which one would have the best outcome preventing nausea and vomiting? Address the drug and its actions, the route, and the times it was ordered to explain your answer.

Administer Zofran 4 mg IV prn nausea and vomiting.
The administration of IV Zofran is good in the fact that a child is able to receive the drug at a much faster rate. Additionally, sensitivity to pills and oral medication may be an issue with children. Therefore, IV serves the function of quick administration and the overall bioavailability of the drug would be greater than oral administration. However, the major issue with the drug being utilized as a prn is the potential for toxicity within the child. The recommended clinical dose for this drug is to not exceed 16mg at any given dose. However, the prn option presents the issue of overusing the drug thus leading to further complications.

Administer Zofran 4mg IV every 6 hours for nausea and vomiting.
An IV administration of Zofran every 6 hours is the more favorable of the two options. It controls the dosage of the drug thus limiting potential for toxicity and complications from overusing the drug. In addition IV administration ensures a high bioavailability (Morrow, Hickok, Rosenthal, 1995).

The physician orders Protonix for the child as part of the post-operative orders. State the rationale for ordering this medication.
The physician chose to use Protonix for the child as part of the post-operative orders because of the likelihood of vomiting and nausea in response to chemotherapy. This drug serves to decrease the amount of stomach acid that is produced in a person thus limiting the potential for esophageal problems resulting from vomit and acid reflux. The less stomach acid decreases the likelihood of nausea in the patient.

What four other intervention would be implemented to enhance food intake?
The first would be developing a coordinated meal plan. This would allow the patient to specific what they want to eat at any given time. Secondly, small meals on a consistent basis would not overload the patient but allow them to eat small amounts with a high frequency. This would decrease potential for nausea and vomiting and allow the body to breakdown food and utilize it as energy in a more efficient manner. Limiting fluid intake is also an option. Fluid tends to fill up the stomach thus resulting in the person feeling less hungry. Limiting fluid allows for more surface area of the stomach to be filled with food. Lastly, creating an atmosphere that is not stressful and warm is important. Eating a meal is often a social experience and ensuring the environment is pleasant will likely deliver positive results.

The child is discharge on Emend. Why would this medication be selected upon discharge? Please include the actions of the drug and the route in the answer.
The drug Emend inhibits the 5-HT3 production thus resulting in stopping nausea and vomiting. This drug is administered through capsules but also through injecting the drug. In this case I would recommend the injection because the sensitive nature of the patient’s stomach. More than likely this medication was administered because it helps to stops nausea and vomiting that can come on post chemotherapy treatment. Due to the nature of chemotherapy some patients do not experience nausea and vomiting while receiving chemotherapy but rather after, often post-discharge.

    References
  • Morrow, G. R., Hickok, J. T., & Rosenthal, S. N. (1995). Progress in reducing nausea and emesis. comparisons of ondansetron (zofran), granisetron (kytril), and tropisetron (navoban). Cancer, 76(3), 343-357. doi:10.1002/1097-0142(19950801)76:3<343::AID-CNCR2820760302>3.0.CO;2-V
  • Turan, S. A., Esenay, F. I., & Güven, M. (2016). Symptoms in children after chemotherapy. Güncel Pediatri, 14(2), 74-81. doi:10.4274/jcp.03164