Chemotherapy Nursing Care: Basics, Side Effects, and Precautions

Understanding Chemotherapy

• 💡 Chemotherapy is a pharmacological cancer treatment using cytotoxic drugs that target rapidly dividing cells.
• 🎯 Its goals can be curative, to control tumor growth, or palliative to improve quality of life.
• 🧠 Different classes of chemotherapy drugs exist, including alkylating agents, anti-metabolites, anti-microtubular agents, antibiotics, and miscellaneous categories, each with unique mechanisms and side effect profiles.
• ⚠️ While targeting cancer cells, these drugs also affect healthy, rapidly dividing cells in the bone marrow, hair follicles, and GI tract, leading to widespread side effects.

Chemotherapy Administration and Nurse's Role

• 🏥 The nurse's role in chemotherapy administration is crucial before, during, and after treatment, even if not directly administering the drugs (which requires chemo certification).
• 💊 Pre-treatment may involve verifying labs, administering antiemetics, hypersensitivity medications, and IV fluids.
• ⚠️ During infusion, close monitoring for adverse effects and extravasation is vital as chemotherapy agents are vesicants.
• 🔒 Post-treatment, nurses monitor for delayed reactions and implement chemo precautions for 48 hours to protect staff and visitors.

Chemo Precautions and Exposure Management

• 🦺 Chemo precautions involve posting signs, wearing appropriate PPE (gown, goggles, double chemo-rated gloves), and using designated yellow waste bins for contaminated items.
• 🚽 Double flushing toilets and proper disposal of soiled linen are essential steps.
• 💧 In case of accidental exposure, wash affected skin with soap and water and flush eyes for at least 15 minutes.
• 🚨 Follow facility protocols for chemo spills, ideally using readily available chemo spill kits.

Common Chemotherapy Side Effects and Management

• 📉 Myelosuppression (low blood counts: leukopenia, anemia, thrombocytopenia) increases infection and bleeding risks. The nadir (lowest point of WBCs) typically occurs 6-10 days post-administration.
• 🦠 Neutropenia (ANC < 1500) requires strict infection control, positive pressure rooms, PPE for all visitors/staff, and avoidance of fresh flowers and uncooked foods.
• 🌡️ Neutropenic fever (>100.4°F or 38°C) is a medical emergency requiring immediate MD notification, cultures, and broad-spectrum IV antibiotics.
• 🤢 Nausea and vomiting are managed with antiemetics, small bland meals, and alternative therapies like aromatherapy or acupuncture.
• 👄 Mucositis (inflammation of mouth/throat) is treated with topical anesthetics, magic mouthwash, and soft, bland foods.
• 🚽 Bowel irregularities (diarrhea or constipation) are managed with medications, fluid replacement, dietary changes, and increased activity.
• 💇 Alopecia (hair loss) can be emotionally distressing; scalp cooling is a promising intervention.
• 😴 Fatigue is managed by balancing rest with light activity and exercise.
• ⚖️ Weight loss and appetite changes require addressing underlying causes and prioritizing favorite, high-protein foods, often in smaller, more frequent meals.
• 🧠 Chemobrain or brain fog involves cognitive changes managed with routine, list-making, exercise, and brain-stimulating activities.
• 😔 Anxiety and depression can be addressed with sleep, exercise, therapy, support groups, or medication.
• 🦶 Peripheral neuropathy (numbness, tingling, weakness) increases fall and wound risk, managed with medications like gabapentin and careful monitoring.