Nursing Responsibilities for Patient Receiving Chemotherapy

By: Ligaya P. Paragas, RN, BSN, MAN

Chemotherapy
general term for any treatment involving the use of chemical agents to stop cancer cells from growing.  treatment of a disease using chemicals, especially by killing microorganisms or cancerous cells.  acts by killing cells that divide rapidly, one of the main properties of most cancer cells.

chemotherapy is considered a systemic treatment.Chemotherapy can eliminate cancer cells at sites great distances from the original cancer.  As a result.  A chemotherapy regimen (a treatment plan and schedule) usually includes drugs to fight cancer plus drugs to help support completion of the cancer treatment  .

So chemotherapy eliminates not only the fastgrowing cancer cells but also other fast-growing cells in your body. unfortunately.  Chemotherapy can be administered through a vein. injected into a body cavity. including hair and blood cells. it cannot tell the difference between a cancer cell and some healthy cells.  . depending on which drug is used  Chemotherapy works by destroying cancer cells. or delivered orally in the form of a pill.How Chemotherapy works? Chemotherapy is designed to kill cancer cells.

Side Effects of Chemotherapy Low white blood cell count  Low red blood cell count  Low platelet count  Nausea  Vomiting  Hair loss  Fatigue  .

Vomiting  .FOCUS of Nursing Care for Patient Receiving Chemotherapy Infection  Bleeding  Mouthcare  Fluid balance  Nutrition  Nausea.

Be aware of medications received by patient that mask signs and symptoms of infections (steroids. b. General Nursing Care for Patient Receiving Chemotherapy Infection (Neutropenia): a.) daily.1. skin folds and any body orifices. c. d. oral cavity. intravenous sites. Inspect all body sites associated with high risk for infection (wounds. institute appropriate breathing exercises if indicated. . antipyretics). peri-rectal area. etc. Auscultate lungs with vital signs. Monitor VS every 4 hours or per doctor’s order or more often as patient’s clinical condition warrants.

obtain cultures. Observe for these specific signs and symptoms of infection every 4 hours/PRN: 1) Temperature > 37.e.. Initiate treatment for identified/suspected infection as ordered. joints. swelling. skin. i. diaphoresis 3) Shaking chills 4) White patches in oral cavity 5) Redness. throat. abdomen and perirectal areas 6) Productive or non-productive cough/tachypnea/dyspnea 7) Changes in character and/or color of urine. administer prescribed antibiotics and antipyretics.8o C 2) Flushing. . heat and/or pain of eyes. stool and sputum 8) Urinary frequency/burning 9) Flu-like symptoms 10) Rash f. ears.e.

6) Change intravenous tubing every 24 hours. Prevent patient exposure to known source of infection. Instruct patient/visitors to follow this procedure. 4) Instruct patient to maintain meticulous personal hygiene including daily bathing (shower preferred).g. . 3) DO NOT take temperature by rectum. Initiate sitz baths as needed. DO NOT administer suppositories. 2) Use meticulous hand-washing technique. perineal care and oral hygiene routine. 7) Keep bone marrow aspiration/biopsy sites covered and dry for 24 hours after procedure. 5) Avoid use of vaginal tampons. 1) Persons with recent or current infections should not visit patient (instruct patient and family members). Remove dressing after 24 hours and inspect area for inflammation. 8) Neutropenic precautions as per MD order.

Monitor for platelet count < 20.000/mm3 PRN. b. Monitor for signs of minor bleeding every 4 hours.positive stools 9) Vaginal spotting 10) Bleeding at puncture sites . 1) Petechiae 2) Ecchymoses 3) Conjunctival hemorrhages 4) Epistaxis 5) Bleeding gums 6) Hematemesis 7) Heme . Bleeding (Thrombocytopenia): a.2.positive urine 8) Guaiac .

1) Headache/change in neurological signs 2) Blurred vision. Monitor platelet count as ordered.c. . loss of part/all of visual field 3) Hemoptysis 4) Hematemesis 5) Melena 6) Hypotension/tachycardia/orthostatic changes/dizziness 7) Uncontrolled vaginal bleeding d. Monitor for signs and symptoms of serious bleeding every 4 hours.

5) Apply pressure to puncture site(s) for 5 minutes or until bleeding ceases. 8) Lubricate lips and nostrils PRN. 7) Provide foam sticks (toothettes) or cotton gauze sponges to clean teeth. 4) No rectal temperatures. 6) Avoid traumatic or invasive procedures including suctioning. 1) Maintain type and cross-match. suppositories (rectal or vaginal) or tampons. Apply sandbag to bone marrow biopsy site if platelet count < 20. cupping.e. enemas. chest clapping. Institute precautionary measures. 3) Do not administer aspirin or aspirin-containing products. 9) Maintain safe environment. 2) Determine if blood products are readily available. .000/mm3. douches or IM injections.

Provide patient instruction regarding oral self-examination and self oral hygiene measures. On admission. Obtain dental history including:  1) Oral care habits  2) Previous complications c. refer to dental clinic for any mouth problems prior to chemotherapy. Mouthcare: a. In collaboration with physician. assess oral cavity for baseline status. . d. b.3.

e. h. Monitor patient's mouth every 12 hours. white plaque. the nurse and/or family member will provide oral hygiene for the patient.) f. difficulty in swallowing. g. i. (If the patient is unable to provide self care hygiene. BMT patients should not wear dentures unless approved by MD and/or Dentists. Monitor patient compliance with self oral hygiene after meals and at bedtime. Instruct patient to report the following to nurse or physician: 1) Mouth tenderness. dry mucous membranes. retainers. General oncology patient will remove dentures. . decreased saliva. or dry lips with reddened areas. or bands for at least 8 hours daily (it is preferable to do so at bedtime). Patients will perform mouth care after meals and at bedtime.

g. Provide oral fluids as tolerated. c. monitor every 8 hours. Administer prescribed antiemetic and evaluate effectiveness. If patient is not orthostatic. Strict intake and output monitoring.4. e. . Obtain daily weights on patients as ordered. d. b. f. Fluid Balance (Prevent/minimize fluid volume deficit): a. If patient is orthostatic. Assess for orthostatic blood pressure and pulse as ordered. Consult with physician regarding institution of parenteral therapy. monitor every 4 hours or more or as indicated. Inspect oral cavity for dryness.

5. . Nutrition: a. daily weights. Monitor calorie counts as needed. Dietary supplements as needed. Collaborate with Registered Dietitian. Assess nutritional status prior to treatment. c. b. d. Provide small frequent high protein and high calorie meals. Monitor nutritional labs.

Monitor dietary intake every shift. many patients prefer not to eat during chemotherapy. persistent encouragement. . Explain to patient and family that a change in taste and an aversion to food are common responses to disease and treatment. i.e. f. Encourage intake with an attitude of gentle. Assess the need for tube feeding or hyperalimentation support. g.

d. Allow for adequate rest periods. meals. f. c. Encourage/provide mouth care. .6. Evaluate effectiveness of antiemetic and consult physician when adjustments are indicated. b. Nausea. Limit excessive activity. especially after nausea/vomiting episodes. Vomiting and Diarrhea: a. Administer prescribed antiemetic half an hour prior to chemotherapy. and PRN as ordered. e. Remove unpleasant odors/sounds and sights from environment.

flow of chemotherapeutic content to surrounding tissues and not in blood vessels . 7. . Anticipate possibility of extravasations and hypersensitivity reaction.Extravasation.

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chest pain. Sudden onset of restlessness. . shortness of breath. chills. numbness. Any sudden change in VS. diaphoresis.REPORTABLE CONDITIONS: Notify MD if: 1. 2. or any other potential side effect of chemotherapy.

Use Leur-Lok fitting on all intravenous tubings used to deliver chemotherapy . long sleeves gown when preparing and administering chemotherapy agent 4. Wear disposable. Wear sugical gloves when handling antineoplastic agents and the secretions of patients who recieves chemotherapy 3. 2.Preparation/Handling of Antineoplastic Agents: OSHA/ONS 1. Use biologic cabinet for the preparation ofchemotherapy agents.

puncture proof containers. Dispose of all chemotherapy wastes as hazardous materials. Dispose of all equipment used in chemotherapy preparation and administration in appropriate.5. 6. these precautions greatly minimize the risk of exposure to chemotherapy agents. * Spill Kit should be accessible in cases of breakages and accidental spills of Chemotherapy agents. . leak proof. When followed.

Thank You! .

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