Chemotherapy, a cornerstone in cancer treatment, employs potent cytotoxic drugs to combat cancer cells. This antineoplastic therapy is crucial for managing various malignancies, including solid tumors and hematologic cancers like leukemia and lymphomas. The primary goal of chemotherapy is to diminish or eradicate cancerous cells at both primary and metastatic sites. It serves diverse roles in cancer management: as a curative agent, an adjuvant therapy alongside surgery and radiation, or as palliative care to alleviate pain and symptoms.
While chemotherapy is effective against rapidly dividing cancer cells, it also affects healthy cells, leading to a range of side effects:
- Diarrhea
- Constipation
- Nausea
- Vomiting
- Appetite loss
- Hair loss
- Fever
- Fatigue
- Pain
- Mouth sores
- Bleeding
- Easy bruising
Chemotherapy administration requires specialized expertise. Medical professionals trained in chemotherapy handling techniques prepare and administer these agents. Common routes and examples of chemotherapeutic agents include:
- Oral: cyclophosphamides, capecitabine
- Intramuscular: bleomycin
- Intravenous: doxorubicin, cisplatin, fluorouracil, paclitaxel
- Intraarterial: dacarbazine, methotrexate
- Intracavitary: radioisotopes, methotrexate, alkylating agents
- Intrathecal: methotrexate, cytarabine
- Subcutaneous: cytarabine, bortezomib
- Topical: fluorouracil
Chemotherapy can be administered in various settings, including outpatient units, hospitals, doctor’s offices, or even at home when oral medications are prescribed.
The Nursing Process in Chemotherapy Care
Nurses are integral to the safe administration of chemotherapy and in supporting patients through the challenging side effects. Education for patients and their families is paramount, starting before treatment initiation and continuing throughout and after therapy completion. Consistent reinforcement of accurate information and tailored nursing care are vital for treatment adherence and complication prevention, ultimately contributing to successful therapy outcomes.
Chemotherapy Nursing Care Plans: Examples and Interventions
Identifying relevant nursing diagnoses is the first step in creating effective chemotherapy nursing care plans. These plans then guide the prioritization of assessments and interventions, addressing both immediate and long-term patient care goals. Below are examples of nursing care plans focusing on common nursing diagnoses associated with chemotherapy.
Disturbed Body Image Nursing Care Plan
Chemotherapy can significantly impact a patient’s psychological well-being, often leading to a disturbed body image. Physical changes such as hair loss, scarring, skin changes (dryness, redness, rashes), sensory alterations (numbness, pain), and functional impairments (dysarthria, dysphagia, impotence) are common.
Nursing Diagnosis: Disturbed Body Image
Related Factors:
- Adverse effects of chemotherapy treatment
- Body consciousness
Evidenced By:
- Avoiding body touch
- Avoiding looking at body
- Expressing concerns about sexuality
- Depressive symptoms
- Preoccupation with changes in appearance
- Fear of others’ reactions
- Monitoring body changes excessively
- Hair loss
- Weight loss
- Scarring
- Dry skin
- Rashes
Desired Outcomes:
- Patient will verbalize understanding and acceptance of changes in their body appearance.
- Patient will demonstrate adaptive lifestyle modifications to cope with changes in body and appearance.
Nursing Assessments and Interventions:
1. Assess Chemotherapy-Related Adverse Effects on Body Image.
Rationale: Chemotherapy’s side effects such as hair loss, skin changes, and scarring directly contribute to body image disturbances. Proactive preparation and management strategies are crucial.
Intervention: Thoroughly assess and document specific physical changes experienced by the patient due to chemotherapy. Provide detailed information about potential changes and strategies to manage them proactively.
2. Evaluate the Patient’s Perceived Impact of Body Image Alterations.
Rationale: Body image disturbances can affect various facets of life, including social roles, daily activities, work, and intimacy.
Intervention: Explore the patient’s perception of how these body image changes are impacting their life. Use open-ended questions to encourage them to discuss effects on relationships, self-esteem, and daily routines.
3. Encourage Verbalization of Feelings and Concerns.
Rationale: Open communication builds trust and facilitates healthy coping mechanisms.
Intervention: Create a safe and supportive environment for the patient to express their feelings and concerns about body image changes. Actively listen and validate their emotions, acknowledging the difficulty of these changes.
4. Proactive Hair Loss Management.
Rationale: Preparing for hair loss can empower patients and provide a sense of control.
Intervention: Discuss hair loss as a potential side effect before it occurs. Offer options like wigs, scarves, hats, or embracing baldness. Provide resources for wig fitting or head covering options.
5. Promote Self-Care and Body Kindness.
Rationale: Self-care strategies can mitigate physical discomfort and improve self-perception.
Intervention: Advise patients to practice self-compassion. Recommend gentle self-care activities: wearing soft clothing, lymphatic drainage massage for swelling, fragrance-free moisturizers for skin irritation, and bland, soothing foods for mouth discomfort.
6. Refer to Support Groups and Resources.
Rationale: Connecting with other cancer survivors offers invaluable peer support and practical advice.
Intervention: Connect patients with cancer support groups or online communities. Peer support can provide encouragement and practical tips for managing both physical and emotional changes.
Alt Text: Smiling woman with headscarf, chemotherapy patient managing hair loss, body image support.
Fatigue Nursing Care Plan
Chemotherapy-related fatigue can be profound and prolonged, lasting weeks to months post-treatment. This stems from the widespread damage to both cancerous and healthy cells. Energy levels typically recover within 6 to 12 months after treatment completion.
Nursing Diagnosis: Fatigue
Related Factors:
- Adverse effects of chemotherapy
- Depressive symptoms
- Increased physical and mental exertion
- Immunosuppression
- Stress
- Disease process
Evidenced By:
- Difficulty maintaining usual physical activity
- Disinterest in activities
- Drowsiness
- Expressing lack of energy
- Expressing weakness
- Expressing tiredness
- Increased need for rest
- Inadequate role performance
Desired Outcomes:
- Patient will identify contributing factors and aggravating factors to their fatigue and implement fatigue-reducing interventions.
- Patient will report an improved sense of energy and ability to participate in activities.
Nursing Assessments and Interventions:
1. Assess Fatigue Extent, Severity, and Frequency.
Rationale: Understanding the fatigue pattern helps tailor management strategies.
Intervention: Use a standardized fatigue assessment scale (0-10) to quantify fatigue levels. Inquire about the timing and severity of fatigue throughout the day.
2. Evaluate Nutrition, Hydration, and Dehydration Signs.
Rationale: Dehydration and malnutrition can exacerbate fatigue.
Intervention: Assess fluid intake, dietary habits, and signs of dehydration (dry mucous membranes, poor skin turgor). Address any nutritional deficits or dehydration promptly.
3. Monitor for Underlying Medical Causes of Fatigue.
Rationale: Severe or persistent fatigue may indicate other medical conditions.
Intervention: Investigate potential underlying causes for unrelenting fatigue, such as cancer metastasis, infection, or anemia. Report any concerning findings to the healthcare provider.
4. Schedule Rest Periods Strategically.
Rationale: Planned rest conserves energy without disrupting sleep patterns.
Intervention: Integrate frequent, short rest periods (limit to 30 minutes) into the daily schedule to promote energy restoration. Avoid prolonged daytime naps that may interfere with nighttime sleep.
5. Modify Work and Activity Demands.
Rationale: Adjusting responsibilities can reduce energy expenditure.
Intervention: Discuss options for reduced work hours, remote work, or temporary leave. Encourage task delegation and prioritization of essential activities.
6. Encourage Gentle Physical Activity.
Rationale: Exercise has been shown to counter chemotherapy-related fatigue.
Intervention: Recommend light to moderate physical activity, such as walking or yoga, as tolerated. Yoga can improve flexibility, strength, and sleep quality. Tailor activity recommendations to the patient’s current functional level.
Alt Text: Cancer patient doing yoga, managing chemotherapy fatigue with exercise, improved energy.
Risk for Infection Nursing Care Plan
Chemotherapy-induced immunosuppression significantly elevates the risk of infection. Chemotherapy non-selectively targets both cancer cells and healthy cells, including white blood cells, the body’s primary defense against infection.
Nursing Diagnosis: Risk for Infection
Related Factors:
- Inadequate primary defenses (decreased white blood cell count)
- Immunosuppression
- Disease process
- Side effects of chemotherapy
Evidenced By:
Risk diagnoses are not evidenced by existing signs and symptoms, as the problem is potential, not actual. Interventions are focused on prevention.
Desired Outcomes:
- Patient will remain free from infection throughout chemotherapy treatment.
- Patient will demonstrate and consistently implement infection control measures.
Nursing Assessments and Interventions:
1. Vigilant Monitoring for Infection Signs.
Rationale: Early detection of infection is critical in immunocompromised patients.
Intervention: Educate patients and families about infection signs: fever, redness, warmth, drainage from wounds, oral thrush, or other unusual symptoms. Instruct them to report any signs of infection immediately.
2. Regularly Evaluate Laboratory Values.
Rationale: Blood counts and cultures provide objective data on infection risk and presence.
Intervention: Monitor CBC (complete blood count), especially WBC (white blood cell) count and neutrophil count. Review serum protein levels and culture results as indicated. Neutropenic fever (fever with low neutrophils) requires immediate medical attention.
3. Emphasize Meticulous Hand Hygiene.
Rationale: Handwashing is the most effective way to prevent pathogen transmission.
Intervention: Reinforce proper handwashing techniques for both patients, families, and healthcare providers before and after all patient contact and procedures.
4. Promote Personal Hygiene Practices.
Rationale: Good hygiene reduces the risk of opportunistic infections.
Intervention: Educate patients on maintaining personal hygiene, including oral care to prevent thrush. Provide specific instructions on oral hygiene techniques during chemotherapy.
5. Administer Prophylactic or Therapeutic Antibiotics as Prescribed.
Rationale: Antibiotics may be necessary to prevent or treat infections in immunocompromised patients.
Intervention: Administer antibiotics as ordered, which may be prophylactic (preventive) before procedures or therapeutic for active infections.
6. Ensure Aseptic Technique in All Procedures.
Rationale: Maintaining asepsis during invasive procedures minimizes infection risk.
Intervention: Strictly adhere to aseptic technique when administering IV chemotherapy, accessing ports or central lines, and performing any invasive procedures to prevent bloodstream infections.
Alt Text: Nurse teaching handwashing to patient, infection prevention during chemotherapy, hygiene education.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Chemotherapy. American Cancer Society. 2022. From: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy.html
- Chemotherapy: How It Works and How You’ll Feel. WebMD. Reviewed: February 8, 2021. From: https://www.webmd.com/cancer/chemotherapy-what-to-expect
- Chemotherapy to Treat Cancer. National Cancer Institute. Reviewed: August 23, 2022. From: https://www.cancer.gov/about-cancer/treatment/types/chemotherapy
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
