9 Care of Patients Receiving Chemotherapy

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Ateneo de Zamboanga UniversityCollege of nursing

NURSING SKILLS OUTPUT (NSO)

Report

No.: 9

CARE OF PATIENTS RECEIVING CHEMOTHERAPY

Description: The term chemotherapy (pronounced: kee-mo-ther-uh-pee), which issometimes shortened to chemo, refers to the use of medications to treatcancer. In chemotherapy,Antineoplastic agents are used in an attempt to destroy tumor cells byinterfering with cellular functions and reproduction. Chemotherapy is usedprimarily to treat systemic disease rather than lesions that are localized and

amenable to surgery or radiation. Chemotherapy may be combined withsurgery or radiation therapy, or both, to reduce tumor size preoperatively, todestroy any remaining tumor cells postoperatively, or to treat some forms of leukaemia. The goals of chemotherapy (cure, control, palliation) must berealistic because they will define the medications to be used and theaggressiveness of the treatment plan.

Materials / Equipment needed:

• Chemotherapy drug

• IV Set

• needles

• Alcohol wipe

• Protective equipment includes:

Syringe

Disposable surgical gloves

Long sleeves gown

Protective eye goggles

Elastic or knit cuffs

Procedures:1. All chemotherapeutic drug should be prepared according to package insert in

class II BSC. Aseptic technique should be followed.2. Personal protective equipment includes disposable surgical gloves, long

sleeves gown and elastic or knit cuffs. Protective eye goggles if no BSC tominimize exposure.

3. Explain the procedure to the patient.4. Wash hands before and after drug handling.5. Limit access to drug preparation area6. Keep labelled drug spill kit near preparation area. Apply gloves before drug

handling.7. Open drug vials/ ampoules away from body.8. Place absorbent pad on work surface.9. Wrap alcohol wipe around neck of ampoule before opening.

10.Cover tip of needle with sterilize gauge when expelling air from syringe.11.Label all chemotherapeutic drugs.12. Clean up any spill immediately.

of 4CHEW, MARIA ARIANNE REI M.

BSN III - E



January 31 – February 02, 2011 Ms. Karen V.Abulencia, RN Date Clinical

Instructor

Diagram/Illustration

Nursingresponsibilities: Before the procedure:

1. Explain the importance of the procedure to the patient.2. Provide privacy.3. Teach the patient on how the procedure is done.4. A number of medical tests are done before chemotherapy is started.

The oncologist will determine how much the cancer has spread fromthe results of x rays and other imaging tests and from samples of thetumor taken during surgery.

5. 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.6. Medications to be administered in conjunction with the chemotherapy

e.g antiemetics, sedatives etc.7. Assess the clients condition including

Most recent report of blood counts including hemoglobin,hematocrit, white blood cells and platelets.

Presence of any complicating condition which couldcontraindicate chemotherapeutic agent administration i.e.infection, severe stomatitis , decreased deep tendon reflexes, orbleeding .

Physical status

Level of anxiety

Psychological status8. When a chemotherapy treatment takes a long time, Advise the patient

that he may prepare for it by wearing comfortable clothes. Bringing a

book to read or a tape to listen to may help pass the time and ease thestress of receiving chemotherapy. Some patients bring a friend orfamily member to provide company and support during treatment.


BSN III - E



January 31 – February 02, 2011 Ms. Karen V.Abulencia, RN Date Clinical

Instructor

9. Advise Sometimes, patients taking chemotherapy drugs known tocause nausea are given medications called antiemetics beforechemotherapy is administered. Anti- emetic drugs help to lessenfeelings of nausea. Two anti-nausea medications that may be used areKytril and Zofran.

10. Other ways to prepare for chemotherapy and help lessen nauseaare:

Regularly eat nutritious foods and drink lots of fluids.

Eat and drink normally until about two hours before

chemotherapy. Eat high carbohydrate, low-fat foods and avoid spicy foods.

During the procedure:1. Prepare measures when administering chemotherapy.2. Use gloves when handling chemotherapy drugs and excretions from

clients receiving chemotherapy.3. Wear disposable long-sleeves gowns when preparing and

administering chemotherapy.4. Use Luer-lock fittings on IV tubing used in delivering chemotherapy.5. Observe the 10 Rights

After the procedure:1. Dispose of all equipment used in chemotherapy preparation and

administration in designated containers.2. Dispose all chemotherapy wastes as hazardous materials.3. Monitor client for symptoms of anaphylactic reaction Urticaria (hives),

pruritus (itching), sensation of lump in the throat, shortness of breath.4. Asses for electrolyte imbalances.5. Teach client and family to report excessive fluid loss or gain, change in

level of consciousness, increased weakness or ataxia, paresthesia,seizures, persistent, headache, muscle cramps or twitching, nausea

and vomiting/diarrhea.6. Prevent extravasation of vesicant drugs, implement measures to treat

extravasation of vesicant medications if it occurs.7. Teach the client to increase fluid intake to 2500 to 3000 ml/day unless

contraindicated.8. Assess for signs of bone marrow depression: decreased White blood

Cell and Red Blood Cell, granulocyte, platelet counts.9. Assess for signs of bleeding and infection.10. Monitor for signs of renal insufficiency.

elevated urine specific gravity

Abnormal electrolyte values

Insufficient urine output (< 30 ml/hour)

Elevated BP, BUN, Serum Creatinine


BSN III - E



Reference:http://www.herceptin.com/adjuvant/breast-cancer-treatment/what-to-

expect.jsp

January 24 – 26, 2011 Ms. Karen V.Abulencia, RN

Date Clinical Instructor


BSN III - E

9 Care of Patients Receiving Chemotherapy

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