NURSING%20CARE%20OF%20PATIENTS%20%20RECEIVING%20CHEMOTHERAPY%20%20Maj%20R%20Bhattacharya%20M%20Sc%20(N)%20Sister%20Tutor%20SON,%20CH(EC)%20Kolkata

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NURSING CARE OF PATIENTS RECEIVING
CHEMOTHERAPY
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Chemotherapy -is the use of chemicals to treat
disease.-Paul Erlich, considered to be the
father of chemotherapy,
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. The drugs used in cancer treatment vary in
their chemical structure , biological side
effects and toxicities. Some are effective in
treating one specific types of cancer while
others are utilized in the treatment of wide
variety of malignancies. The methods of
administration also vary according to the
chemotherapeutic and new techniques for safer and
more effective administration.
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Nursing management - requires knowledge about
the treatment -, skill in assessment- technical
expertise,- ability and desire to support the
client physically and emotionally. -
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Nursing care begins with..........- thorough
understanding of the patients condition -goal of
therapy , drug dose, route, schedule,
administration principles- and potential side
effect- monitoring responses to the therapy,-
reassessing - documenting signs and symptoms,-
communicating pertinent information to other
members of the health care team.
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There are five ways 1. Adjuvant therapy-
conjunction with another treatment
.2. Neoadjuvant chemotherapy-y to shrink the
tumor prior to surgical removal 3. Primary
therapy- localized cancer which there is an
alternative but less than completely effective
treatment.4. Induction chemotherapy- primary
treatment which no alternative treatment
exists.5. Combination chemotherapy- two or
more chemotherapeutic agents, allowing each
medication to enhance the action of other.
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ROLE OF A NURSEPrior to chemotherapy
administration1 Review- The chemotherapy drugs
prescription which should have -Name of
anti-neoplastic agent.-Dosage-Route of
administration-Date and time that each agent to
be administered.2. Accurately identify the
client 3.Medications to be administered in
conjunction with the chemotherapy e.g
antiemetics, sedatives etc.
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4.. Assess the clients condition including -
Most recent report of blood counts including
hemoglobin ,hematocrit, white blood cells and
platelets. -Presence of any complicating
condition eg infection ,bleeding -Physical
status -Level of anxiety -Psychological
status.
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5. Prepare for potential complications.-Review
the procedure and have medication available
anaphylaxis6.Assure accurate preparation of the
agent -dosage calculation -Expiry
date checked - correct reconstitution
-Method of administration7.Assess patients
understanding of chemotherapeutic agents and
administration procedures.
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II. Calculation of drug dosage- based on body
surface area.III. Drug reconstitution/Preparatio
n-according to hospital policy and guidelines by
the manufacturer
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-Aseptic technique should be followed.-Personal
protective equipment includes disposable
surgical gloves, long sleeves gown and elastic or
knit cuffs.-Protective eye goggles -To
minimize exposure -Wash hands before and after
drug handling.-Limit access to drug preparation
area
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1. Drug administration 1. Route- i)Oral -
   Emphasize the importance of compliance by the
   patient with prescribed schedule.
2. - Drugs with emetic potential
   should be taken with meals.

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1. ii) Intramuscular and subcutaenous
2. -can be administered I/M or subcutaneously are
   few in number.
4. -Non-vesicants like L-asperaginase, bleomycin,
   cyclophosphamide, methotraxate. Cyta arabine,and
   some hormonal agents are given I/M or
   subcutaneously.
6. -Use the smallest gauge needle possible for the
   viscosity of the medication.

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iii) Intravenous -Common method . -May be
given through central venous catheters or
peripheral access. -Absorption is more reliable.
-This route is required for administration of
vesicants and it also reduces the need of
repeated injection. -Because the I/V provides
direct access to the circulatory system, the
potential for infection and life threatening
sepsis is a serious complication of I/V
chemotherapy.
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The following guidelines to be kept in
mind-Inspect the solution, container and tubing
for signs of contamination including particles,
discoloration, cloudiness, and cracks or tears in
bottle or bag-Aseptic technique to be
followed-Prepare according to manufacturers
directions-Select a suitable vein-Large veins
on the forearm are the preferred site.-Use
distal veins first, and choose a vein above areas
of flexion.-For non-vesicant drugs, use the
distal veins of the hands (metacarpal veins)
then the veins of the forearms(basilic and
cephalic veins)
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-For vesicants, use only the veins of the
forearms. Avoid using the metacarpal and radial
areas. -Avoid the antecubital fossa and the
wrist because an extravasation in these areas can
destroy nerves and tendons, resulting in loss of
function. -Peripheral sites should be changed
daily before administration of vesicants-Avoid
the use of small lumen veins to prevent damage
due to friction and the decreased ability to
dilute acidic drugs and solutions. Select the
shortest catheter with the smallest gauge
appropriate for the type and duration of the
infusion (21g to 25g for I/V medications and 19 g
for blood products).
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-Avoid a vein which has been used for venous
access within the past 24 hrs to prevent leakage
from a prior puncture site. Prevent trauma and
infection at the insertion site. -Apply a
small amount of iodine based antiseptic ointment
over the insertion site cover the area with
sterile gauze.Intravenous Chemotherapy Via
Central Vein Infusion (Hickman Catheter)
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V. Documentation -chemotherapeutic
drugs, dose, route ,and time
-Premedications, postmedications, prehydration
and other infusions and supplies used for
chemotherapy regimen. -Any complaints by the
patient of discomfort and symptoms experienced
before, during, and after chemotherapeutic
infusion.
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VI. Disposal of supplies and unused drugs a)Do
not clip or recap needles or break
syringes. b)Place all supplies used intact in
a leak proof ,puncture proof, appropriate
labeled container. c)Place all unused drugs in
containers in a leak proof, puncture proof,
appropriately labeled container. d)Dispose of
containers filled with chemotherapeutic
supplies and unused drugs in accordance with
regulations of hazardous wastes.
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VII. Management of chemotherapeutic
spillsChemotherapy spills should be cleaned up
immediately by properly protected personnel
trained in the appropriate procedure. A spill
should be identified with a warning sign so that
other person will not be contaminated.
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Supplies Required Chemotherapy spill kit
containsRespirator mask for air borne powder
spillsPlastic safety glasses or gogglesHeavy
duty rubber glovesAbsorbent pads to contain
liquid spillsAbsorbent towels for clean up after
spillsSmall scoop to collect glass fragmentsTwo
large waste disposal bags
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Protective disposable gownContainers of
detergent solution and clear tap water for post
spill clean up.Puncture proof and leak proof
container approved for chemotherapy waste
disposalApproved, specially labeled, impervious
laundry bag.
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Spill on hard surfaceRestrict area of
spillObtain drug spill kitPut on protective
gown, gloves, gogglesOpen waste disposal
bagsPlace absorbent pads gently on the spill be
careful not to touch spill.
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Place absorbent pad in waste bagCleanse surface
with absorbent towels using detergent solution
and wipe clean with clean tap water.Place all
contaminated materials in the bag.Wash hands
thoroughly with soap and water.
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Spill on personnel or patientRestrict area of
spillObtain drug spill kitImmediately remove
contaminated protective garments or linenWash
affected skin area with soap and waterIf eye
exposure-immediately flood the affected eye with
water for at least 5 mts obtain medical
attention promptlyNotify the physician if drug
spills on patient.Documentation- Document the
spill.
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VIII. Staff EducationAll personnel involved in
the care should receive an orientation to chemo.
Drugs including their known risk , relevant
techniques and procedures for handling, the
proper use of protective equipment and materials,
spill procedures, and medical policies covering
personnel handling chemo. agents.Personnel
handling blood, vomitus, or excreta from patients
who have received chemotherapy should wear
disposable gloves and gowns to be appropriately
discarded after use.
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IX. Extravasation management-Etravasation is
the accidental infiltration of vesicant or
irritant chemotherapeutic drugs from the vein
into the surrounding tissues at the I/V site. -A
vesicant is an agent that can produce a blister
and /or tissue destruction. -An irritant is an
agent that is capable of producing venous pain at
the site of and along the vein with or without an
inflammatory reaction. -Injuries that may occur
as a result of extravasation include sloughing of
tissue , infection, pain ,and loss of mobility of
an extremity.
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1.Prevention of extravasation-Nursing
responsibilities for the prevention of
extravasation include the following -Knowledge
of drug s with vesicant potentialSkill in drug
administration-Identification of risk factors
e.g. multiple vene punctures-Anticipation of
extravasation and knowledge of management
protocol-New venepuncture site daily if
peripheral access is used
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-Central venous access for 24 hrs vesicants
infusion-Administration of drug in a quiet,
unhurried environment-Testing vein patency
without using chemotherapeutic agents-Providing
adequate drug dilution-Careful observation of
access site and extremity throughout the
procedure-Ensuring blood return from I/V site
before, during, and after vesicant drug
infusion.-Educating patients regarding symptoms
of drug infiltration , e.g. pain, burning,
stinging sensation at I/V site.
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2.Extravasation management at peripheral
site -According to hospital policy and approved
antidote should be readily available.-The
following procedure should be initiated-Stop the
drug-Leave the needle or catheter in
place-Aspirate any residual drug and blood in
the I/V tubing, needle or catheter, and suspected
infiltration site-Instill the I/V
antidote-Remove the needle
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If unable to aspirate the residual drug from the
IV tubing , remove needle or catheterInject the
antidote sub-cutaneously clockwise into the
infiltrated site using 25 gauge needle change
the needle with each new injectionAvoid applying
pressure to the suspected infiltration siteApply
topical ointment if orderedCover lightly with an
occlusive sterile dressingApply cold or warm
compresses as indicatedElevate the
extremityObserve regularly for pain, erythema,
induration, and necrosisDocumentation of
extravasation management. All nursing personnel
should be alert and prepared for the possible
complication of anaphylaxis.
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Nursing Management of common side effects of
Chemotherapeutic drugs..
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Nausea Vomiting . Nausea may cause the
desire to vomit it often precedes or
accompanies vomiting.
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Avoid eating/drinking for 1-2 hrs prior to and
after chemotherapy administration Eat frequent,
small meals. Avoid greasy fatty foods and
very sweet foods candies. Avoid unpleasant
sights, odors testesFollow a clear liquid
diet If vomiting is severe inform the
physician.
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Sip liquids slowly or suck ice cubes and avoid
drinking a large volume of water if vomiting is
present Administer antiemetic to prevent or
minimize nausea. Patient may require routine
antiemetic for 3-5 days following some
protocols. Monitor fluid and electrolyte
status. Provide frequent, systemic mouth care.
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.Bone marrow Depression This can lead to
-Anaemia-Bleeding due to thrombocytopenia-Infec
tion due to leukopenia
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Nursing Actions Administer packed RBC according
to the doctores order orders. Monitor
hematocrit and hemoglobin Maintain the
integrity of the skin
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Avoid activities with the greatest potential for
physical injury Use an electric razor when
shaving Avoid the use of tourniquets Eat a
soft, bland diet, avoid foods that are thermally,
mechanically and chemically irritating. Maintain
the integrity of the mucous membranes of GI
tract Promote hydrate to avoid constipation
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Avoid enemas, harsh laxatives the use of rectal
thermometers. Take steroids with an antacid or
milk.
Avoid sources of infection Maintain good
personal hygiene.Prevent trauma to skin mucous
membranesAvoid invasive procedures, no
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AlopeciaExplain hair loss is temporary, and hair
will grow when drug is stopped. Use a mild,
protein based shampoo, hair conditioner every 4-7
days Minimize the use of an electric
dyer. Avoid excessive brushing and combing of
the air. Combing with a wide tooth comb is
preferred.
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Select wig, cap, scarf or turban before hair loss
occurs. Keep head covered in summer to prevent
sunburn and in winter to prevent heat loss.
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Fatigue Assess for possible causes chronic
pain, stress, depression and in-sufficient rest
or nutritional intake. -Conserve energy rest
when tired -Plan for gradual accommodation of
activities. -Monitor dietary fluid intake
daily. Drink 3000 ml of fluid daily, unless
contra-indicated, in order to avoid the
accumulation of cellular waste products.
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Anorexia
Freshen up before meals Avoid drinking fluids
with meals to prevent feeling of fullness High
protein diet Monitor and record weight weekly.
Report weight loss
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Stomatitis (Oral) -Symptoms occur 5-7 days
after chemotherapy persist upto 10
days -Continue brushing regularly with soft
tooth brush -Use non irritant
mouthwash -Avoid irritants to the
mouth -Maintain good nutritional intake, eat
soft or liquid foods high in protein
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-Follow prescribed medication schedule e.g. drug
for oral candidacies. -Report physician if
symptom persists -Increase the frequency of
oral hygiene every 2 hrs -Glycerin lemon juice
should never be used to clear mouth or teeth as
it cause the tissues to become dry irritated.
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Diarrhoea - Some clients experience diarrhoea
during and after treatment with
chemotherapy. Nursing Action Monitor number,
frequency and consistency of diarrhoea stools.
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Avoid eating greasy and spicy food alcoholic
beverages, tobacco and caffeine products Avoid
using milk products Eat low residue diet high in
protein and calories
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Include food high in potassium if fatigue is
present like bananas, baked potatoes. Drink 3000
ml of fluid each day. Eat small frequent meals
eat slowly and chew all food thoroughly Administ
er anti-diarrhoeal agents as prescribed.
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Depression -Assess for changes in mood and
affect - small goals that are achievable
dailyParticipate e.g. music, reading,
outingsShare feelingsReassurance
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Cystitis--An inflammation of the bladder,
-usually caused by an infection. -Sterile
cystitis not induced by infection, can be a side
effect of radiation therapy or due to
cyclophosphamide (endoxan) administration. -The
metabolites of cyclophosphamide are excreted by
the kidneys in the urine
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Nursing Actions -Fluid intake at least 3000 ml
daily -Empty Bladder as soon as the urge to void
is experienced. -Empty bladder at least every
2-4 hrs. -Urinate at bed time to avoid prolonged
exposure of the bladder wall to the effects of
cytoxan while sleeping.
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Take oral cytoxan early in the morning to
decrease the drug concentration in the bladder
during the night Report symptoms of frequency
bleeding burning on urination, pain fever and
chills promptly to physician Following comfort
measures can be adopted if cystitis is present
-Ensure dilute urine by increasing the fluid
intake - Avoid foods beverages that may
cause irritation to the bladder alcohol,
coffee, strong tea, Carbonated beverages etc.
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Outpatient Chemotherapy DeliveryAggressive,
complex and sophisticated cancer therapies are
currently being in ambulatory home care
settings. .
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Advantages
This shift is provision of services from the
Hospital setting is a result of cost-containment
efforts, advanced technology, competition
increased competence of nurses

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Conclusion Chemotherapy offers patients with
cancer a great deal of hope for a cure or a
means of control cancer for a long period of
time. Hope and optimism are vital ingredients in
care plan.