1. ONCOLOGY NURSINGONCOLOGY NURSING
ByBy
Yasmeen RahimYasmeen Rahim

2. OBJECTIVES:OBJECTIVES:
By the end of this presentation, learnersBy the end of this presentation, learners
will be able to:will be able to:
 Define 7 cardinal signs of cancer.Define 7 cardinal signs of cancer.
 Differentiate between benign andDifferentiate between benign and
malignant tumor.malignant tumor.
 Discuss goals of cancer therapy.Discuss goals of cancer therapy.
 Explain in detail about the surgery,Explain in detail about the surgery,
radiation therapy and chemotherapyradiation therapy and chemotherapy
along with there nursing interventions.along with there nursing interventions.

3. 7 WARNING SIGNS OF7 WARNING SIGNS OF
CANCERCANCER
 C=C= change in bowel / bladder habitschange in bowel / bladder habits
 A=A= a sore throat that does not heala sore throat that does not heal
 U=U= unusual bleedingunusual bleeding
 T=T= thickening or lump in breastthickening or lump in breast
 I=I= indigestion / difficulty in swallowingindigestion / difficulty in swallowing
 O=O= obvious change in warts or molesobvious change in warts or moles
 NN= nagging, cough and hoarseness= nagging, cough and hoarseness

4. Malignant tumorMalignant tumor
 Rapid growthRapid growth
 Invasive growthInvasive growth
 PoorlyPoorly
demarcateddemarcated
 InvasionInvasion
 MetastasisMetastasis
 Life threateningLife threatening
DIFFERENCE BETWEEN BENIGN AND
MALIGNANT TUMORS
Benign tumorBenign tumor
 Slow growthSlow growth
 Expansive growthExpansive growth
 Well demarcatedWell demarcated
 No invasionNo invasion
 No metastasisNo metastasis
 Rarely a life threatRarely a life threat

6. GOAL OF CANCER THERAPYGOAL OF CANCER THERAPY
 Treatment goals may includeTreatment goals may include
the followingthe following
 CURATIVE:CURATIVE: treatment shouldtreatment should
completely eradicate thecompletely eradicate the
malignant disease.malignant disease.
 CONTROL:CONTROL: managementmanagement
should prolong patient survivalshould prolong patient survival
and inhibition of cancer cellsand inhibition of cancer cells
growth.growth.
 PALLIATION:PALLIATION: effectiveeffective
symptomatic treatment shouldsymptomatic treatment should
be given to the patients.be given to the patients.

7. Cont.Cont.
 Our main goal for cancer therapyOur main goal for cancer therapy
is to improveis to improve ““QUALITY OFQUALITY OF
LIFE”LIFE” of patients.of patients.

8. MEDICAL MANAGEMENTMEDICAL MANAGEMENT
 SurgerySurgery
 Radiation therapyRadiation therapy
 ChemotherapyChemotherapy

9. NURSING MANAGEMENT INNURSING MANAGEMENT IN
CANCER SURGERYCANCER SURGERY

10. Cont.Cont.
 Nursing care of the patient undergoingNursing care of the patient undergoing
surgery for cancer includes fosteringsurgery for cancer includes fostering
the patient's understanding of thethe patient's understanding of the
specific procedure and expectedspecific procedure and expected
outcome, preparing the patientoutcome, preparing the patient
physically and psychologically for thephysically and psychologically for the
surgery, reducing anxiety, supportingsurgery, reducing anxiety, supporting
the patient's postoperative physiologicthe patient's postoperative physiologic
stability, relieving pain, preventingstability, relieving pain, preventing
complications, and promotingcomplications, and promoting
compliance with postoperativecompliance with postoperative
instructions.instructions.

11. Cont.Cont.
 Cancer patients who areCancer patients who are
undergoing surgery requireundergoing surgery require
general perioperative nursinggeneral perioperative nursing
care.care.
 When surgery is used with otherWhen surgery is used with other
treatment methods liketreatment methods like
chemotherapy and radiationchemotherapy and radiation
therapy then postoperativetherapy then postoperative
complications like infection,complications like infection,
impaired wound healing, DVT,impaired wound healing, DVT,
altered renal and pulmonaryaltered renal and pulmonary
functions can be expected.functions can be expected.

12. Cont.Cont.
 Nurse should provide educationNurse should provide education
and emotional support to patientand emotional support to patient
and their family by assessingand their family by assessing
the needs.the needs.
 Nurse should discuss their fearsNurse should discuss their fears
and coping mechanisms withand coping mechanisms with
them.them.
 Nurse should encourage patientNurse should encourage patient
and family to participate activelyand family to participate actively
in decision making process.in decision making process.

13. Cont.Cont.
 When patient or family ask about
the results of diagnostic testing and
surgical procedures then nurse’s
response is guided by the
information which physician has
previously conveyed to the patient
and family.
 Nurse should frequently
communicate with other health
care team members to be certain
that the information provided is
consistent.

14. Cont.Cont.
 After surgery nurse should assessAfter surgery nurse should assess
patient’s response to surgery andpatient’s response to surgery and
monitor patient for possiblemonitor patient for possible
complications like hemorrhage, fluidcomplications like hemorrhage, fluid
electrolyte imbalance,electrolyte imbalance,
thrombophlebitis, homodynamicthrombophlebitis, homodynamic
instability and organ dysfunction.instability and organ dysfunction.
 Postoperative teachings regardingPostoperative teachings regarding
self care, nutrition, wound care andself care, nutrition, wound care and
medications should be addressedmedications should be addressed
properly.properly.

15. Cont.Cont.
 Nurses have a responsibility toNurses have a responsibility to
coordinate early dischargecoordinate early discharge
planning and home care, asplanning and home care, as
indicated, to ensure continuity ofindicated, to ensure continuity of
care.care.
 Referrals must be sent toReferrals must be sent to
appropriate professionals andappropriate professionals and
community support services.community support services.

16. BASIC FACTORS INBASIC FACTORS IN
RADIATION PROTECTIONRADIATION PROTECTION
 DISTANCE:DISTANCE: greater distancegreater distance
from source, less exposure tofrom source, less exposure to
radiation.radiation.
 TIME:TIME: try to spend less time withtry to spend less time with
in close contact with patient.in close contact with patient.
 SHIELDING:SHIELDING: use appropriateuse appropriate
material to absorb radiationmaterial to absorb radiation
energy like lead aprons, glass orenergy like lead aprons, glass or
aluminum shields or rubberaluminum shields or rubber
gloves.gloves.

17. TOXIC EFFECTS OFTOXIC EFFECTS OF
RADIATION & NURSINGRADIATION & NURSING
MANAGEMENTMANAGEMENT
 MAINTAIN TISSUE INTEGRITY:MAINTAIN TISSUE INTEGRITY:
 Handle skin gently.Handle skin gently.
 Inspect skin for integrity and doInspect skin for integrity and do
frequent reassessmentsfrequent reassessments
 Do NOT rub affected areaDo NOT rub affected area
 Avoid using ointments, powders orAvoid using ointments, powders or
lotion.lotion.
 Wash skin only with moisturizing soapWash skin only with moisturizing soap
and waterand water
 Protect skin from exposure to sunlight,
chlorinated swimming pools, extreme
temperature.

18. Cont.Cont.
 ALOPECIA:ALOPECIA:
 Alopecia begins within 2 weeks ofAlopecia begins within 2 weeks of
therapytherapy
 Regrowth within 8 weeks ofRegrowth within 8 weeks of
terminationtermination
 Encourage to acquire wig before hairEncourage to acquire wig before hair
loss occursloss occurs
 Encourage use of attractive scarvesEncourage use of attractive scarves
and hatsand hats
 Provide information that hair loss isProvide information that hair loss is
temporary BUT anticipate change intemporary BUT anticipate change in
texture and colortexture and color

19. Cont.Cont.
 STOMATITIS:STOMATITIS:
 Use soft-bristled toothbrushUse soft-bristled toothbrush
 Gentle oral hygiene is essential toGentle oral hygiene is essential to
remove debris, prevent irritation andremove debris, prevent irritation and
promote healing.promote healing.
 Oral rinses with saline gargles/ tapOral rinses with saline gargles/ tap
waterwater
 Avoid ALCOHOL-based rinsesAvoid ALCOHOL-based rinses
 Frequent reassurance thatFrequent reassurance that
symptoms are a result of treatmentsymptoms are a result of treatment
and do not represent deterioration ofand do not represent deterioration of
disease.disease.

20. Cont.Cont.
 PROMOTE NUTRITION:PROMOTE NUTRITION:
 Serve food in ways to make itServe food in ways to make it
appealingappealing
 Consider patient’s preferencesConsider patient’s preferences
 Provide small frequent mealsProvide small frequent meals
 Avoids giving fluids while eatingAvoids giving fluids while eating
 Oral hygiene PRIOR toOral hygiene PRIOR to
mealtimemealtime
 Vitamin supplementsVitamin supplements

21. Cont.Cont.
 RELIEVE PAIN:RELIEVE PAIN:
 Mild pain- NSAIDSMild pain- NSAIDS
 Moderate pain- Weak opioidsModerate pain- Weak opioids
 Severe pain- MorphineSevere pain- Morphine
 Administer analgesics round theAdminister analgesics round the
clock with additional dose forclock with additional dose for
breakthrough painbreakthrough pain

22. Cont.Cont.
 DECREASE FATIGUE:DECREASE FATIGUE:
 Plan daily activities to allowPlan daily activities to allow
alternating rest periodsalternating rest periods
 Light exercise is encouragedLight exercise is encouraged
 Small frequent mealsSmall frequent meals

23. Cont.Cont.
 RADIATION SICKNESS:RADIATION SICKNESS:
 Bed restBed rest
 Small frequent feedingsSmall frequent feedings
 Increased calories, increasedIncreased calories, increased
protein dietprotein diet
 Adequate fluid intakeAdequate fluid intake
 Administer vitamins, sedatives,Administer vitamins, sedatives,
antihistamine, antiemeticsantihistamine, antiemetics
 Monitor intake and outputMonitor intake and output

24. Cont.Cont.
 BONE MARROW DEPRESSION:BONE MARROW DEPRESSION:
 Vital signs especially temperatureVital signs especially temperature
 CBC monitoringCBC monitoring
 Observe signs and symptoms ofObserve signs and symptoms of
infectioninfection
 Good oral hygiene-prevent gumGood oral hygiene-prevent gum
bleeding; use soft-bristle toothbrushbleeding; use soft-bristle toothbrush
or non-sting mouthwash.or non-sting mouthwash.

25. Cont.Cont.
 IMPROVE BODY IMAGE:IMPROVE BODY IMAGE:
 Therapeutic communication isTherapeutic communication is
essentialessential
 Encourage independence inEncourage independence in
self-care and decision makingself-care and decision making
 Offer cosmetic material likeOffer cosmetic material like
make-up and wigsmake-up and wigs

26. Cont.Cont.
 ASSIST IN GRIEVINGASSIST IN GRIEVING
PROCESS:PROCESS:
 Some cancers are curableSome cancers are curable
 Grieving can be due to loss ofGrieving can be due to loss of
health, income, sexuality, andhealth, income, sexuality, and
body imagebody image
 Answer and clarify informationAnswer and clarify information
about cancer and treatmentabout cancer and treatment
optionsoptions
 Identify resource peopleIdentify resource people
 Refer to support groupsRefer to support groups

28. CHEMOTHERAPYCHEMOTHERAPY
 Use of antineoplastic agents toUse of antineoplastic agents to
cure or palliative cancer in ancure or palliative cancer in an
attempt to destroying tumorattempt to destroying tumor
cells by interfering with cellularcells by interfering with cellular
functions.functions.
 It is used primarily to treatIt is used primarily to treat
systemic disease rather thansystemic disease rather than
localized treatment. or as anlocalized treatment. or as an
adjuvant therapyadjuvant therapy to reduce
tumor size preoperatively, to
destroy any remaining tumor
cells postoperatively,

29. ADMINISTRATION OFADMINISTRATION OF
CHEMOTHERAPEUTIC AGENTSCHEMOTHERAPEUTIC AGENTS
 ROUTES:ROUTES:
 TopicalTopical
 OralOral
 IntravenousIntravenous
 IntramuscularIntramuscular
 SubcutaneousSubcutaneous
 ArterialArterial
 IntracavitaryIntracavitary
 IntrathecalIntrathecal
 Dosage:Dosage:
 Based on theBased on the
total bodytotal body
surface areasurface area
 PreviousPrevious
response toresponse to
chemotherapychemotherapy
or radiationor radiation
therapytherapy
 Functions ofFunctions of
major organmajor organ
system.system.

30. Cont.Cont.
 Extravasations is a seriousExtravasations is a serious
problem and has to beproblem and has to be
monitored carefully whilemonitored carefully while
administration ofadministration of vesicantsvesicants
(agents that deposited into(agents that deposited into
subcutaneous tissue and causesubcutaneous tissue and cause
tissue necrosis and damage totissue necrosis and damage to
underlying tendons, nerves andunderlying tendons, nerves and
blood vessels).blood vessels).

32. Cont.Cont.
 Indications for extravasations are asIndications for extravasations are as
followfollow
 Absence of blood return fromAbsence of blood return from
intravenous catheter.intravenous catheter.
 Resistance to blood flow ofResistance to blood flow of
intravenous fluid.intravenous fluid.
 Swelling, pain or redness at the site.Swelling, pain or redness at the site.
 If it is suspected then medicationIf it is suspected then medication
administration should beadministration should be STOP
immediately, ice should be applied, ice should be applied
and we have to notify physician as heand we have to notify physician as he
has to aspirate the infiltratedhas to aspirate the infiltrated
medication.medication.

33. TOXIC EFFECTS OFTOXIC EFFECTS OF
CHEMOTHERAPEUTIC AGENTSCHEMOTHERAPEUTIC AGENTS
 Gastrointestinal system:Gastrointestinal system: nausea /nausea /
vomiting, stomatitis, anorexia,vomiting, stomatitis, anorexia,
mucositis of GI tract, diarrhea.mucositis of GI tract, diarrhea.
 Hematopoietic system:Hematopoietic system: bone marrowbone marrow
depression leading to leukemiadepression leading to leukemia
(WBC) , anemia (RBC) and(WBC) , anemia (RBC) and
thrombocytopenia (platelets).thrombocytopenia (platelets).
 Renal system:Renal system: damage to kidney,damage to kidney,
hyperkalemia, hyperphosphatemia,hyperkalemia, hyperphosphatemia,
hypocalcemia so have to monitorhypocalcemia so have to monitor
serum electrolytes.serum electrolytes.

34. Cont.Cont.
 Cardiopulmonary system:Cardiopulmonary system: irreversibleirreversible
cardiac toxicities, so have to closelycardiac toxicities, so have to closely
monitor ejection fraction (volume of bloodmonitor ejection fraction (volume of blood
with each heart beat) and signs of heartwith each heart beat) and signs of heart
failure.failure.
 Reproductive system:Reproductive system: testicular andtesticular and
ovarian functions are affected.ovarian functions are affected.
Reproductive cell are damaged resulting iReproductive cell are damaged resulting i
chromosomal abnormalities in offsprings.chromosomal abnormalities in offsprings.
 Integumentary system:Integumentary system: alopecia, localalopecia, local
skin irritation.skin irritation.

35. Cont.Cont.
 Neurologic system:Neurologic system: neurologicneurologic
damage can occur withdamage can occur with
repeated doses. Peripheralrepeated doses. Peripheral
neuropathies, loss of DT,neuropathies, loss of DT,
hearing losshearing loss and paralytic ileusand paralytic ileus
may occur.may occur.
 Miscellaneous:Miscellaneous: Fatigue whichFatigue which
can affect quality of life.can affect quality of life.

36. NURSING MANAGEMENT INNURSING MANAGEMENT IN
CHEMOTHERAPYCHEMOTHERAPY
 The goal of nursing interventions isThe goal of nursing interventions is
to prevent or minimize side effectsto prevent or minimize side effects
caused by cancer treatments.caused by cancer treatments.
 Providing nursing care to patientsProviding nursing care to patients
receiving chemotherapy presentsreceiving chemotherapy presents
many challenges.many challenges.
 Antineoplastic drugs have systemicAntineoplastic drugs have systemic
effects on normal cells as well aseffects on normal cells as well as
on malignant cells, thereforeon malignant cells, therefore
chemotherapy usually affect manychemotherapy usually affect many
body systems.body systems.

37. Cont.Cont.
 The nurse must have knowledge ofThe nurse must have knowledge of
the pharmacology of antineoplasticthe pharmacology of antineoplastic
agents, proper techniques of drugagents, proper techniques of drug
preparation and administration, drugpreparation and administration, drug
interactions, and possible adverseinteractions, and possible adverse
effects of individual agents.effects of individual agents.
 The nurse must be skilled in theThe nurse must be skilled in the
technique of venipuncture and thetechnique of venipuncture and the
management of various types ofmanagement of various types of
venous access devices and drugvenous access devices and drug
administration systems.administration systems.

38. Cont.Cont.
 Nurses should prepare patients andNurses should prepare patients and
families to manage anticipated sidefamilies to manage anticipated side
effects of chemotherapy and to reporteffects of chemotherapy and to report
symptoms of potentially serious sidesymptoms of potentially serious side
effects early to avoid seriouseffects early to avoid serious
consequences.consequences.
 An important responsibility of nursesAn important responsibility of nurses
involved in the delivery of chemotherapyinvolved in the delivery of chemotherapy
is to ensure that the correct dose of theis to ensure that the correct dose of the
correct drug is administered by thecorrect drug is administered by the
correct route to the right patient.correct route to the right patient.

39. Cont.Cont.
 Nurses frequently triage patientNurses frequently triage patient
problems and assist in theproblems and assist in the
evaluation of symptoms andevaluation of symptoms and
initiation of interventionsinitiation of interventions
 Subjective and objective data,Subjective and objective data,
including information about theincluding information about the
last chemotherapy treatmentlast chemotherapy treatment
and knowledge of the patient'sand knowledge of the patient's
history, guide the nurse inhistory, guide the nurse in
determining the patient'sdetermining the patient's
disposition and treatment.disposition and treatment.

40. Cont.Cont.
 Patient education is facilitatedPatient education is facilitated
when side effects are classified aswhen side effects are classified as
immediate, early, delayed, andimmediate, early, delayed, and
late.late.
 Immediate side effects, such asImmediate side effects, such as
hypersensitivity reactions, occurhypersensitivity reactions, occur
within the first 24 hours.within the first 24 hours.

41. Cont.Cont.
 Diarrhea and alopecia have anDiarrhea and alopecia have an
onset of days to weeks and areonset of days to weeks and are
considered early side effects.considered early side effects.
 Delayed effects, such asDelayed effects, such as
anemia or pulmonary fibrosis,anemia or pulmonary fibrosis,
occur within weeks to months,occur within weeks to months,
and late effects, such as secondand late effects, such as second
malignancies, may not appearmalignancies, may not appear
for months or years.for months or years.

42. NURSING DIAGNOSISNURSING DIAGNOSIS
 Fear/anxietyFear/anxiety
 situational crisissituational crisis
 Threat to/change in health/socio-Threat to/change in health/socio-
economic status, role functioning,economic status, role functioning,
interaction patterninteraction pattern
 Threat of deathThreat of death
 Separation from familySeparation from family
 Grieving, anticipatoryGrieving, anticipatory
 Loss of physiologic well being (loss ofLoss of physiologic well being (loss of
body part, change in body functionbody part, change in body function
 Perceived potential deathPerceived potential death

43. NURSING DIAGNOSISNURSING DIAGNOSIS
 Situational low self-esteemSituational low self-esteem
 BiophysicalBiophysical
 PsychosocialPsychosocial
 Acute/Chronic PainAcute/Chronic Pain
 Disease processDisease process
 Side-effects of therapeutic agentsSide-effects of therapeutic agents
 Altered nutrition, less than bodyAltered nutrition, less than body
requirementsrequirements
 Hypermetabolic state, consequencesHypermetabolic state, consequences
of chemo, radiation, surgery,of chemo, radiation, surgery,
emotional distress, fatigue, poor painemotional distress, fatigue, poor pain
controlcontrol

44. NURSING DIAGNOSISNURSING DIAGNOSIS
 Risk for fluid volume deficitRisk for fluid volume deficit
 FatigueFatigue
 Risk for infectionRisk for infection
 Risk for altered mucousRisk for altered mucous
membranemembrane
 Risk for skin/tissue integrityRisk for skin/tissue integrity
 Risk for Constipation / diarrheaRisk for Constipation / diarrhea
 Risk for Altered sexualityRisk for Altered sexuality
patternspatterns

45. NURSING MANAGEMENTNURSING MANAGEMENT
 Assess fluid & electrolytesAssess fluid & electrolytes
 Modify risk for infection &Modify risk for infection &
bleedingbleeding
 Administer chemotherapyAdminister chemotherapy
 Protect caregiversProtect caregivers

46. PATIENT EDUCATIONPATIENT EDUCATION
• THROMBOCYTOPENIA
• Use soft toothbrush to avoid bleedingUse soft toothbrush to avoid bleeding
gumsgums
• When shaving, use electric razorWhen shaving, use electric razor
• Avoid constipation, enemas, rectal tempsAvoid constipation, enemas, rectal temps
• Do not use products that contain aspirin,Do not use products that contain aspirin,
NSAIDNSAID
• Avoid IM or sc injectionAvoid IM or sc injection
• Notify MD/RN if petechiae, bruising, frankNotify MD/RN if petechiae, bruising, frank
or tarry stools, change in colour of urine –or tarry stools, change in colour of urine –
frank blood, dark amber, bleeding fromfrank blood, dark amber, bleeding from
any part of body such as nosebleedany part of body such as nosebleed

47. Cont.
• MINIMIZE SIDE EFFECTS OF
NAUSEA AND VOMITING:
• Avoid offensive odorsAvoid offensive odors
• Small frequent feedings rather thanSmall frequent feedings rather than
3 big meals3 big meals
• Adjust oral and fluid intakeAdjust oral and fluid intake
• Relaxation exercises, mindRelaxation exercises, mind
diversional therapies, etc.diversional therapies, etc.

48. SPECIAL CONCERNS
 BleedingBleeding
 Skin problemsSkin problems
 Hair lossHair loss
 NutritionNutrition
 PainPain
 FatigueFatigue
 PsychosocialPsychosocial
statusstatus
 Body imageBody image
 StomatitisStomatitis
 AnorexiaAnorexia
 MalabsorptionMalabsorption
 Cachexia (lossCachexia (loss
of body weight,of body weight,
adipose,visceradipose,viscer
al proteins,andal proteins,and
skeletalskeletal
muscle)muscle)

49. SAFE HANDLINGSAFE HANDLING
 Essential to reduce risks toEssential to reduce risks to
involved personnel.involved personnel.
 Cytotoxic drugs are carcinogenic,Cytotoxic drugs are carcinogenic,
mutagenic and teratogenic.mutagenic and teratogenic.

50. SAFE HANDLING cont’dSAFE HANDLING cont’d
Potential exposure to staff occursPotential exposure to staff occurs
during:during:
 Preparation of medicationPreparation of medication
 Administration and changing linesAdministration and changing lines
etcetc
 Handling of body fluids e.g. urineHandling of body fluids e.g. urine
 Handling of chemo waste productsHandling of chemo waste products
e.g. lines, medication bottlese.g. lines, medication bottles
 Spillage / leakage of chemotherapySpillage / leakage of chemotherapy
 TransportationTransportation

51. PRIOR TO CHEMOTHERAPYPRIOR TO CHEMOTHERAPY
ADMINISTRATIONADMINISTRATION
1.1.Review- The chemotherapy drugsReview- The chemotherapy drugs
prescription which should haveprescription which should have
-Name of anti - neoplastic agent.-Name of anti - neoplastic agent.
-Dosage-Dosage
-Route of administration-Route of administration
-Date and time that each agent to be-Date and time that each agent to be
administered.administered.
2.2. Accurately identify the clientAccurately identify the client
3.3.Medications to be administered inMedications to be administered in
conjunction with the chemotherapy e.gconjunction with the chemotherapy e.g
antiemetics, sedatives etc should also beantiemetics, sedatives etc should also be
prepare prior.prepare prior.
ROLE OF A NURSEROLE OF A NURSE

52. 4.4. Assess the clients condition includingAssess the clients condition including
- Most recent report of blood counts- Most recent report of blood counts
including hemoglobin ,hematocrit, whiteincluding hemoglobin ,hematocrit, white
blood cells and platelets.blood cells and platelets.
-Presence of any complicating condition-Presence of any complicating condition
which could contraindicatewhich could contraindicate
chemotherapeutic agent administration i.e.chemotherapeutic agent administration i.e.
infection, extravasations, severe stomatitisinfection, extravasations, severe stomatitis
, decreased deep tendon reflexes, or, decreased deep tendon reflexes, or
bleeding .bleeding .
-Physical status-Physical status
-Level of anxiety-Level of anxiety
-Psychological status.-Psychological status.

53. 5.5.Prepare for potential complicationsPrepare for potential complications
6.6.Assure accurate preparation of theAssure accurate preparation of the
agentagent
-Accuracy of dosage calculation-Accuracy of dosage calculation
- Check expiry date of the drug.- Check expiry date of the drug.
-Recommended administration route-Recommended administration route
7.7.Assess patients understanding of theAssess patients understanding of the
chemotherapeutic agents andchemotherapeutic agents and
administration procedures.administration procedures.

54. CALCULATION OF DRUG DOSAGECALCULATION OF DRUG DOSAGE
It is calculated based on body surfaceIt is calculated based on body surface
area.area.
DRUG PREPARATION-DRUG PREPARATION-
Pharmacy staff should reconstitute allPharmacy staff should reconstitute all
drugs pre-prime the intravenous tubingdrugs pre-prime the intravenous tubing
under a class II biologic safety cabinetunder a class II biologic safety cabinet
(BSC) which provide personnel,(BSC) which provide personnel,
environmental and product safety. Inenvironmental and product safety. In
certain conditions nurses may be requiredcertain conditions nurses may be required
to reconstitute medications. Whento reconstitute medications. When
preparing and reconstituting safe handlingpreparing and reconstituting safe handling
guidelines to be followed.guidelines to be followed.

55. -All chemotherapeutic drug should be-All chemotherapeutic drug should be
prepared according class II BSC.prepared according class II BSC.
-Aseptic technique should be followed.-Aseptic technique should be followed.
-Personal protective equipment includes-Personal protective equipment includes
disposable surgical gloves, long sleevesdisposable surgical gloves, long sleeves
gown and elastic or knit cuffs.gown and elastic or knit cuffs.
-Protective goggles if no BSC-Protective goggles if no BSC
-Wash hands before and after drug-Wash hands before and after drug
handling.handling.
-Limit access to drug preparation area-Limit access to drug preparation area

56. -Keep labeled drug spill kit near-Keep labeled drug spill kit near
preparation area.preparation area.
-Apply gloves before drug handling.-Apply gloves before drug handling.
-Open drug vials/ ampoules away from-Open drug vials/ ampoules away from
body.body.
-Place absorbent pad on work surface.-Place absorbent pad on work surface.
-Wrap alcohol wipe around neck of-Wrap alcohol wipe around neck of
ampoule before opening.ampoule before opening.
-Label all chemotherapeutic drugs.-Label all chemotherapeutic drugs.
- Clean up any spill immediately- Clean up any spill immediately

57. IV.IV. Drug administrationDrug administration
1. Route-1. Route-
i)Oral - Emphasize the importance of compliance by thei)Oral - Emphasize the importance of compliance by the
patient with prescribed schedule.Drugs with emeticpatient with prescribed schedule.Drugs with emetic
potential should be taken with meals.potential should be taken with meals.
Assure that chemotherapeutic agents are stored asAssure that chemotherapeutic agents are stored as
directed by the manufacturer(refrigerate, avoid exposure todirected by the manufacturer(refrigerate, avoid exposure to
direct light,etc).direct light,etc).
ii) Intramuscular and subcutaenous – Chemotherapeuticii) Intramuscular and subcutaenous – Chemotherapeutic
agents that can be administered I/M or subcutaneously areagents that can be administered I/M or subcutaneously are
few in number. Non-vesicants like L- asperaginase,few in number. Non-vesicants like L- asperaginase,
bleomycin, cyclophosphamide, methotraxate. Cyta arabinebleomycin, cyclophosphamide, methotraxate. Cyta arabine
and some hormonal agents are given I/M & /Orand some hormonal agents are given I/M & /Or
subcutaneously.subcutaneously.

58. --Use the smallest gauge needle possible for theUse the smallest gauge needle possible for the
viscosity of the medication.viscosity of the medication.
-Change the needle after withdrawing the-Change the needle after withdrawing the
agent from a vial or ampoule.agent from a vial or ampoule.
-Select a site with adequate muscle and/or SC-Select a site with adequate muscle and/or SC
tissue.tissue.
iii) Intravenous – It is the most common methodiii) Intravenous – It is the most common method
of administration of cancer chemotherapy. Mayof administration of cancer chemotherapy. May
be given through central venous catheters orbe given through central venous catheters or
peripheral access. Absorption is more reliable.peripheral access. Absorption is more reliable.
This route is required for administration ofThis route is required for administration of
vesicants and it also reduces the need ofvesicants and it also reduces the need of
repeated injection. Because the I/V providesrepeated injection. Because the I/V provides
direct access to the circulatory system, thedirect access to the circulatory system, the
potential for infection and life threatening sepsis ispotential for infection and life threatening sepsis is
a serious complication of I/V chemotherapy.a serious complication of I/V chemotherapy.

59. The following guidelines to be kept in mind:The following guidelines to be kept in mind:
-Inspect the solution, container and tubing for-Inspect the solution, container and tubing for
signs of contamination including particles,signs of contamination including particles,
discoloration, cloudiness, and cracks or tears indiscoloration, cloudiness, and cracks or tears in
bottle or bagbottle or bag
-Aseptic technique to be followed-Aseptic technique to be followed
-Prepare medicines according to manufacturer’s-Prepare medicines according to manufacturer’s
directionsdirections
-Select a suitable vein-Select a suitable vein
-Large veins on the forearm are the preferred site.-Large veins on the forearm are the preferred site.
-Use distal veins first, and choose a vein above-Use distal veins first, and choose a vein above
areas of flexion.areas of flexion.
-For non-vesicant drugs, use the distal veins of the-For non-vesicant drugs, use the distal veins of the
hands (metacarpal veins): then the veins of thehands (metacarpal veins): then the veins of the
forearms(basilic and cephalic veins)forearms(basilic and cephalic veins)

60. -For vesicants, use only the veins of the forearms.-For vesicants, use only the veins of the forearms.
Avoid using the metacarpal and radial areas.Avoid using the metacarpal and radial areas.
-Avoid the antecubital fossa and the wrist-Avoid the antecubital fossa and the wrist
because an extravasation in these areas canbecause an extravasation in these areas can
destroy nerves and tendons, resulting in loss ofdestroy nerves and tendons, resulting in loss of
function.function.
-Peripheral sites should be changed daily before-Peripheral sites should be changed daily before
administration of vesicantsadministration of vesicants
-Avoid the use of small lumen veins to prevent-Avoid the use of small lumen veins to prevent
damage due to friction and the decreased abilitydamage due to friction and the decreased ability
to dilute acidic drugs and solutions. Select theto dilute acidic drugs and solutions. Select the
shortest catheter with the smallest gaugeshortest catheter with the smallest gauge
appropriate for the type and duration of theappropriate for the type and duration of the
infusion (21g to 25g for I/V medications and 19 ginfusion (21g to 25g for I/V medications and 19 g
for blood products).for blood products).

61. --Avoid a vein which has been used forAvoid a vein which has been used for
venous access within the past 24 hrs tovenous access within the past 24 hrs to
prevent leakage from a prior puncture site.prevent leakage from a prior puncture site.
Prevent trauma and infection at thePrevent trauma and infection at the
insertion site.insertion site.
-Apply a small amount of iodine-Apply a small amount of iodine
based antiseptic ointment over thebased antiseptic ointment over the
insertion site & cover the area with sterileinsertion site & cover the area with sterile
gauze.gauze.
Intravenous Chemotherapy Via CentralIntravenous Chemotherapy Via Central
Vein Infusion (Vein Infusion (Hickman CatheterHickman Catheter))

62. A Hickman catheter is a flexible polymericA Hickman catheter is a flexible polymeric
silicon rubber catheter which is threadedsilicon rubber catheter which is threaded
through the cephalic vein and into thethrough the cephalic vein and into the
superior vena cava or through thesuperior vena cava or through the
venacava and into the right atrium of thevenacava and into the right atrium of the
heart. Placement in a large vein permitsheart. Placement in a large vein permits
the use of a catheter large enough forthe use of a catheter large enough for
infusion of chemotherapy, hyper osmolarinfusion of chemotherapy, hyper osmolar
fluids for nutrition purposes, bloodfluids for nutrition purposes, blood
products and other needed intravenousproducts and other needed intravenous
fluids.fluids.

63. The silicon rubber material of catheter isThe silicon rubber material of catheter is
chemically inert to prevent decompositionchemically inert to prevent decomposition
and it is anti-thrombogenicand it is anti-thrombogenic
A felt cuff near the exit site anchors theA felt cuff near the exit site anchors the
catheter on the patient’s chest and acts ascatheter on the patient’s chest and acts as
an anatomic barrier to prevent entry ofan anatomic barrier to prevent entry of
infection causing agents.infection causing agents.
It is either single lumen or double-lumen.It is either single lumen or double-lumen.
IV) Intra-arterialIV) Intra-arterial
VV))Intra-peritonealIntra-peritoneal

64. VIVI))Intrathecal- Infusion of medication can be givenIntrathecal- Infusion of medication can be given
through an Ommaya reservoir, implantablethrough an Ommaya reservoir, implantable
pump and /or usually through lumbar puncture.pump and /or usually through lumbar puncture.
aa))Wear protective equipment (gloves,Wear protective equipment (gloves,
gown andgown and eyewear).eyewear).
bb))Inform the patient that chemotherapeuticInform the patient that chemotherapeutic
drugsdrugs are harmful to normal cells and thatare harmful to normal cells and that
protectiveprotective measures used by personnelmeasures used by personnel
minimize their exposureminimize their exposure to these drugs.to these drugs.
cc))Administer drugs in a safe and unhurriedAdminister drugs in a safe and unhurried
environment.environment.

65. dd))Place a plastic backed absorbent pad underPlace a plastic backed absorbent pad under
thethe tubing during administration to catch anytubing during administration to catch any
leakage.leakage.
Do not dispose of any supplies or unusedDo not dispose of any supplies or unused
drugs indrugs in patient care areas.patient care areas.
V.V. DocumentationDocumentation
RecordRecord
-chemotherapeutic drugs, dose, route ,and time-chemotherapeutic drugs, dose, route ,and time
-Premedications, postmedications, prehydration-Premedications, postmedications, prehydration
and other infusions and supplies used forand other infusions and supplies used for
chemotherapy regimen.chemotherapy regimen.
-Any complaints by the patient of discomfort and-Any complaints by the patient of discomfort and
symptoms experienced before, during, and aftersymptoms experienced before, during, and after
chemotherapeutic infusion.chemotherapeutic infusion.

66. VI.VI. Disposal of supplies and unused drugsDisposal of supplies and unused drugs
aa))Do not clip or recap needles or breakDo not clip or recap needles or break
syringes.syringes.
bb))Place all supplies used intact in a leakPlace all supplies used intact in a leak
proof ,puncture proof, appropriate labeledproof ,puncture proof, appropriate labeled
container.container.
cc))Place all unused drugs in containers in aPlace all unused drugs in containers in a
leakleak proof, puncture proof, appropriately labeledproof, puncture proof, appropriately labeled
container.container.
dd))Dispose of containers filled withDispose of containers filled with
chemotherapeutic supplies andchemotherapeutic supplies and
unusedunused drugs indrugs in accordance withaccordance with
regulations of hazardous wastes.regulations of hazardous wastes.

67. VII.VII. Management ofManagement of
chemotherapeutic spillschemotherapeutic spills
Chemotherapy spills should be cleanedChemotherapy spills should be cleaned
up immediately by properly protectedup immediately by properly protected
personnel trained in the appropriatepersonnel trained in the appropriate
procedure. A spill should be identified withprocedure. A spill should be identified with
a warning sign so that other person willa warning sign so that other person will
not be contaminated.not be contaminated.

68. Supplies RequiredSupplies Required
Chemotherapy spill kit containsChemotherapy spill kit contains
Respirator mask for air borne powderRespirator mask for air borne powder
spillsspills
Plastic safety glasses or gogglesPlastic safety glasses or goggles
Heavy duty rubber glovesHeavy duty rubber gloves
Absorbent pads to contain liquid spillsAbsorbent pads to contain liquid spills
Absorbent towels for clean up after spillsAbsorbent towels for clean up after spills
Small scoop to collect glass fragmentsSmall scoop to collect glass fragments
Two large waste disposal bagsTwo large waste disposal bags

69. Protective disposable gownProtective disposable gown
Containers of detergent solution and clear tapContainers of detergent solution and clear tap
water for post spill clean up.water for post spill clean up.
Puncture proof and leak proof container approvedPuncture proof and leak proof container approved
for chemotherapy waste disposalfor chemotherapy waste disposal
Approved, specially labeled, impervious laundryApproved, specially labeled, impervious laundry
bag.bag.
Spill on hard surfaceSpill on hard surface
Restrict area of spillRestrict area of spill
Obtain drug spill kitObtain drug spill kit
Put on protective gown, gloves, gogglesPut on protective gown, gloves, goggles
Open waste disposal bagsOpen waste disposal bags
Place absorbent pads gently on the spill; bePlace absorbent pads gently on the spill; be
careful not to touch spill.careful not to touch spill.

70. Spill on hard surfaceSpill on hard surface
Restrict area of spillRestrict area of spill
Obtain drug spill kitObtain drug spill kit
Put on protective gown, gloves, gogglesPut on protective gown, gloves, goggles
Open waste disposal bagsOpen waste disposal bags
Place absorbent pads gently on the spill;Place absorbent pads gently on the spill;
be careful not to touch spill.be careful not to touch spill.

71. Place absorbent pad in waste bagPlace absorbent pad in waste bag
Cleanse surface with absorbent towelsCleanse surface with absorbent towels
using detergent solution and wipe cleanusing detergent solution and wipe clean
with clean tap water.with clean tap water.
Place all contaminated materials in thePlace all contaminated materials in the
bag.bag.
Wash hands thoroughly with soap andWash hands thoroughly with soap and
water.water.

72. Spill on personnel or patientSpill on personnel or patient
Restrict area of spillRestrict area of spill
Obtain drug spill kitObtain drug spill kit
Immediately remove contaminatedImmediately remove contaminated
protective garments or linenprotective garments or linen
Wash affected skin area with soap andWash affected skin area with soap and
waterwater
If eye exposure-immediately flood theIf eye exposure-immediately flood the
affected eye with water for at least 5 mts;affected eye with water for at least 5 mts;
obtain medical attention promptlyobtain medical attention promptly
Notify the physician if drug spills onNotify the physician if drug spills on
patient.patient.
Documentation- Document the spill.Documentation- Document the spill.

73. Chemotherapy offersChemotherapy offers
patients with cancer apatients with cancer a
great deal of hope for agreat deal of hope for a
cure or a means of controlcure or a means of control
cancer for a long period ofcancer for a long period of
time. Hope and optimismtime. Hope and optimism
are vital ingredients in careare vital ingredients in care
plan.plan.

74. END OF LIFE CAREEND OF LIFE CARE
 End of LifeEnd of Life is considered to beis considered to be
the period of time marked bythe period of time marked by
disability or disease that isdisability or disease that is
progressively worse until death.progressively worse until death.
 End of Life CareEnd of Life Care is the careis the care
provided to a person in theirprovided to a person in their
final stages of life.final stages of life.
 It is also known as hospice care,It is also known as hospice care,
comfort care, supportive care,comfort care, supportive care,
palliative care or simplypalliative care or simply
symptom management.symptom management.

75. ONCOLOGICAL EMERGENCIESONCOLOGICAL EMERGENCIES
 Hematologic emergenciesHematologic emergencies
 Bone marrow dysfunctionBone marrow dysfunction
 Anatomical structure disordersAnatomical structure disorders
 Cardiac temponadeCardiac temponade
 Carotid artery ruptureCarotid artery rupture
 Obstruction of superior vena cavaObstruction of superior vena cava
 Pleural effusionPleural effusion
 Spinal cord compressionSpinal cord compression
 Tracheobronchial obstructionTracheobronchial obstruction
 Metabolic disruptionsMetabolic disruptions
 Electrolyte imbalanceElectrolyte imbalance

76. NURSING DIAGNOSISNURSING DIAGNOSIS
 Risk for Infection related toRisk for Infection related to
impaired or deficient leukocytesimpaired or deficient leukocytes
 Risk for Injury related toRisk for Injury related to
thrombocytopenia and bleeding.thrombocytopenia and bleeding.
 Risk for Ineffective TissueRisk for Ineffective Tissue
Perfusion due to reducedPerfusion due to reduced
erythrocytes, or vascularerythrocytes, or vascular
disruption by tumordisruption by tumor

77. CONT.CONT.
 Potential for Impaired Gas ExchangePotential for Impaired Gas Exchange
due to cancer involvement of thedue to cancer involvement of the
lungs or alterations in fluid statuslungs or alterations in fluid status
 Potential for Impaired SensorimotorPotential for Impaired Sensorimotor
Function due to spinal cordFunction due to spinal cord
compressioncompression
 Potential for Imbalanced FluidPotential for Imbalanced Fluid
Volume due to disease or treatmentVolume due to disease or treatment
 Potential for Fatigue due toPotential for Fatigue due to
malignant illness or its treatmentmalignant illness or its treatment

78. CONT.CONT.
 Potential for Impaired MobilityPotential for Impaired Mobility
due to disease complicationsdue to disease complications
 Anxiety related to fear ofAnxiety related to fear of
disease or treatmentdisease or treatment
 Deficient Knowledge related toDeficient Knowledge related to
disease, or anticancer therapiesdisease, or anticancer therapies
 Potential for Ineffective CopingPotential for Ineffective Coping
related to severity of illness orrelated to severity of illness or
prognosisprognosis
 Potential for Role Conflict due toPotential for Role Conflict due to
chronic serious illnesschronic serious illness

79. SUMMARYSUMMARY
The potential benefit to theThe potential benefit to the
patient of treatment as anpatient of treatment as an
option must always outweighoption must always outweigh
the toxic effects.the toxic effects.