1358 Nursing management of patients with metastatic melanoma treated in day hospital (D.H.) with: Cis-platin (CDPP), dacarbazine (DTIC), interleukin (IL-2), tamoxifen (TAM)

Abstract

The goal of nursing care in this protocol is to improve the patients’ (pts) quality of life during this treatment and to reduce the time of treatment in D.H. Treatment day 1: CDDP 100 mg/m2 e.v.—DTIC 750 mg/m2—TAM per os. After CBC and biochemistry the patients started the treatment according to the following schedule: 5HT antagonist infusion (20 min), hydration with 500 ml normal saline plus furosemide (30 min), diuresis control (> 300 ml) CDDP 50 mg/100 ml normal saline (45 min)—hydration 1500 ml (2 hours)—DTIC in 500 ml of normal saline (1 hour)—5HT antagonist infusion (30 min). The time necessary to complete the treatment and to educate the patients is about five hours. During the treatment the nurses give to the patients informations about the sequence and duration of treatment—reasons for antiemetic, diuretics and hydratation-education and dietetics advices before, during and after treatment. Moreover the nurses educate the patients for home care on the use of antiemetic drugs for os, dietetics advices, anticipations of side effects (fatigue, nausea and vomiting, danger for infection and bleeding, alopecia, mucositis), check for the correct TAM schedule and side effects. From day 12 to day 23 the patients receive IL2 and the nurses control the blood pressure and the premedication with aspirin, indomethacin and torecan before IL2 administration; at the end of IL2 the nurses check the blood pressure and give information about the side effects (fever, myalgia, hypotension, nausea and vomiting, diarrhea, sleeplessness, chills, itching). With this intense nurses–patients relationship we have achieved the following results: (I) The waiting time before IL2 administration was reduced (2) The side effects of IL2 were significantly reduced because of a better management (3) The informations collected from the patients were more detailed and precise as we went on with this treatment. We feel that a good nurse/patient relationship can improve the wellbeing of the patients during this toxic treatment.