2)

Statement​:-​ A study to assess the effectiveness of

SIM on knowledge regarding dosage calculation of
chemo-theraphy drugs among the staff nurse in
selected hospitals.

What is Chemotherapy?

Chemotherapy is a kind of treatment that uses drugs to attack cancer cells. It is called a "systemic
treatment" since the drug, entering through the blood stream, travels throughout the body and kills cancer
cells at their sites. The drugs may rarely be intended to have a local effect, but in most cases, the
intention is to destroy cancer cells wherever they may exist in the body.
Chemotherapeutic drugs are chemically designed to target cells that are dividing and growing rapidly.
Once they reach the cancer cells, they act to retard their growth, eventually resulting in their destruction.
Chemotherapy may be given at home, in a clinic or in a hospital. The frequency of chemotherapy can be
daily, weekly, monthly or an on-off schedule depending on the type of drug, the body�s response and the
type of cancer. The chemotherapy is decided on the basis of the type of cancer. The dosage is calculated
on the basis of the patient�s body weight and the drug�s toxicity.
At present more than 50 anticancer drugs have been discovered. They are used in several ways:
● Monotherapy or only one drug
● Combination chemotherapy or a group of drugs which work together
● Combined modality or chemotherapy along with other treatment such as surgery and
radiotherapy
The drugs are delivered to the affected cells in the following forms:
● Oral (tablet form, by mouth)
● Intravenous or Intramuscular (injected by needle into a vein or muscle)
● Intrathecal chemotherapy (injected through a needle in the back)
Since chemotherapy also affects normal actively dividing cells such as those in the bone marrow, the
gastrointestinal tract, the reproductive system and in the hair follicles, most patients experience some
degree of side effects, which may include any or all of the following:
● Nausea and vomiting: This is a common side effect of chemotherapy. It can be controlled with
anti-sickness drugs (anti-emetics), which your doctor will prescribe.
● Fatigue: Chemotherapy affects different people in different ways. Some find they can lead fairly
normal lives during treatment, but many find they become tired and have to take things more
slowly. Just do as much as you can and be careful not to over-strain. Taking short naps may help.
● Hair loss: This is the least harmful side effect, yet can be the hardest to bear. The use of a cold
compress around the scalp when taking chemotherapy helps stop hair loss to some extent. Hair
will grow back surprisingly quickly once treatment is over.
● Susceptibility to infections: When the drugs act on cancer cells, they also destroy normal cells
including white blood cells, which fight infections. When white blood cells are in short supply, the
body�s immune system is weakened making you susceptible to infections. Any fever should be
 reported so that your doctor can prescribe antibiotics.
● Decrease in blood cell count: During chemotherapy, you may become anemic. Regular blood
tests are done to ensure this does not happen. If necessary, blood transfusions are given.
● Mouth sores and ulcers: Some chemotherapy drugs cause sores and ulcers in the mouth.
Regular use of a mouthwash is very important.
It should be emphasized that side effects depend on the type and number of drugs used, that individuals
react very differently, and that all side effects are temporary and disappear once treatment is complete.
Chemotherapy refers to the treatment of cancer and other disease with chemicals that kill cells. Most
chemotherapy drugs can’t differentiate between healthy and malignant cells. Because these drugs are
toxic, it is very important to calculate each chemotherapy dose given to a patient carefully.

Further complicating giving a chemotherapy dose is complex delivery systems. In order to speed the
chemicals into the patient’s body a pump is often used, which is connected either to an IV or port line. The
chemotherapy dose is then calculated by how much of a drug is pumped into the patient’s system per
minute. It’s very important this calculation is done properly since if too little of a drug is given the therapy
will be ineffective, and too much can be seriously harmful to the patient.

The main purpose of isolating a limb or organ is to deliver a powerful chemotherapy dose to one specific
area or tumor site thus avoiding overwhelming systemic damage to the rest of the patient’s body.
Whatever the treatment plan or delivery system it’s very important that the chemotherapy dose be
calculated by a trained medical professional.
Dosage of chemotherapy can be difficult: If the dose is too low, it will be ineffective against the tumor,
whereas, at excessive doses, the toxicity (side effects,​neutropenia​) will be intolerable to the patient. This
has led to the formation of detailed "dosing schemes" in most hospitals, which give guidance on the
correct dose and adjustment in case of toxicity. In immunotherapy, they are in principle used in smaller
dosages than in the treatment of malignant diseases.

In most cases, the dose is adjusted for the patient's ​body surface area​, a measure that correlates with
blood volume. The BSA is usually calculated with a mathematical formula or a ​nomogram​, using a
patient's weight and height, rather than by direct measurement.

The variability of the drug dose actually given to cancer patients was analyzed. Three 
variability factors were quantitatively examined (​body surface calculation, personalized 
dose calculation, and drug residuum in commercially available vials​) and their variability 
was experimentally measured. A systematic reduction (mean, 7%; range, 2%–15%) and a 
random variability (4%–5%) of the dose given were demonstrated. These results draw 
attention to the role of some of the procedures of routine clinical activity in determining 
the amount of drug actually delivered. The analysis suggests that personalization of doses 
must be very accurate in both measurement and calculation and that the staff giving the 
drug needs to be carefully informed about the importance of drug residuum. The 
variability of the delivered dose can lead to the misclassification of patients in 
investigations on the dose-response relationship. This factor may be added to pitfalls 
previously reported to affect this type of retrospective analysis. 
Chemotherapy is usually dosed by square meter of body surface area
(BSA). BSA has been chosen rather than body weight as the basis for
calculation for two reasons. First, BSA has been demonstrated to provide a
more accurate cross-species comparison of activity and toxicity for certain
drugs. Second, BSA can be more closely correlated with cardiac output,
which determines the blood flow to the liver and kidneys, thus influencing
drug elimination.
Nurses need to be able to calculate accurate drug calculations in order to safely
administer drugs to their patients (NMC, 2002). Studies have shown however that
nurses do not always have the necessary skills to calculate accurate drug
dosages and are potentially administering incorrect dosages of drugs to their
patients (Hutton, M. 1998. Nursing Mathematics: the importance of application.
Nursing Standard 13(11), 35-38; Kapborg, I. 1994. Calculation and administration
of drug dosage by Swedish nurses, Student Nurses and Physicians. International
Journal for Quality in Health Care 6(4), 389-395; O'Shea, E. 1999. Factors
contributing to medication errors: a literature review. Journal of Advanced
Nursing 8, 496-504; Wilson, A. 2003. Nurses maths: researching a practical
approach. Nursing Standard 17(47), 33-36). The literature indicates that in order to
improve drug calculations strategies need to focus on both the mathematical
skills and conceptual skills of student nurses so they can interpret clinical data
into drug calculations to be solved.
So according to the study nurses should know and well enough skilled in
calculating the dosage of chemotheraphy drugs.
OBJECTIVES: