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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.

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

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

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.

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

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

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

Monitor for signs of minor bleeding every 4 hours.000/mm3 PRN. Bleeding (Thrombocytopenia): a. 1) Petechiae 2) Ecchymoses 3) Conjunctival hemorrhages 4) Epistaxis 5) Bleeding gums 6) Hematemesis 7) Heme .positive stools 9) Vaginal spotting 10) Bleeding at puncture sites . Monitor for platelet count < 20.2.positive urine 8) Guaiac . b.

. Monitor platelet count as ordered. 1) Headache/change in neurological signs 2) Blurred vision. 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.c.

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

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

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

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

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

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

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

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

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

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

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

Thank You! .