Nursing Care Plan on Chemotherapy

Chemotherapy, also referred to as antineoplastic therapy, is a treatment that utilizes cytotoxic chemicals to kill cancer cells.

This treatment is a mainstay for cancer, especially for solid tumors and hematologic cancers like leukemia and lymphomas. Chemotherapy aims to reduce or eliminate the number of cancer cells in the primary and metastatic tumor sites. Chemotherapy may be used as curative treatment against cancer, adjuvant treatment along with surgery and/or radiation, or palliative treatment to relieve pain or symptoms. 

Chemotherapy targets fast-growing cancer cells but also destroys other cells in the body, causing many unwanted side effects, including:

• Diarrhea
• Constipation
• Nausea
• Vomiting
• Loss of appetite
• Hair loss
• Fever
• Fatigue
• Pain
• Mouth sores
• Bleeding
• Easy bruising

Chemotherapy is prepared and administered by medical professionals specially trained in chemotherapy handling techniques. The most common chemotherapeutic agents and their routes include:

• Oral for cyclophosphamides and capecitabine
• Intramuscular for bleomycin
• Intravenous for doxorubicin, cisplatin, fluorouracil, and paclitaxel
• Intraarterial for dacarbazine, methotrexate
• Intracavitary for radioisotopes, methotrexate, alkylating agents
• Intrathecal for methotrexate, cytarabine
• Subcutaneous for cytarabine and bortezomib
• Topical for fluorouracil

Chemotherapy may be given in an outpatient chemotherapy unit, hospital, doctor’s office, or at home when oral medications are prescribed. 

Nursing Process

Nurses play a key role in administering chemotherapy safely and helping patients manage uncomfortable side effects. Patient and family education begins before chemotherapy is initiated and continues during and after the treatment is completed. To ensure adherence and prevention of complications, continuous reinforcement of accurate information and appropriate nursing care can help ensure the success of the therapy. 

Nursing Assessment

Prior to the initiation of chemotherapy, a thorough baseline assessment is vital. This includes:

• Patient History: Reviewing past medical history, current medications, allergies, and previous treatments.
• Physical Examination: A comprehensive physical examination to evaluate the patient’s overall condition and identify any pre-existing conditions that may affect chemotherapy tolerance.
• Laboratory Tests: Pre-treatment lab tests, including complete blood count (CBC), liver and kidney function tests, and electrolyte levels.
• Psychosocial Assessment: Evaluating the patient’s mental and emotional state, social support systems, and coping mechanisms.

Nursing Interventions

Effective management of chemotherapy side effects is paramount to maintaining patient quality of life and ensuring treatment adherence. Key interventions include:

• Antiemetic Therapy: Administering prescribed antiemetics to prevent or reduce nausea and vomiting associated with chemotherapy.
• Nutritional Support: Providing dietary recommendations and supplements to address altered taste, appetite loss, and gastrointestinal disturbances.
• Oral Care: Educating patients on proper oral hygiene practices to prevent and manage oral mucositis.
• Pain Management: Administering analgesics and implementing non-pharmacological pain relief methods, such as relaxation techniques and physical therapy.

Nursing Care Plans 

Once the nurse identifies nursing diagnoses for chemotherapy, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for chemotherapy.

Disturbed Body Image

Chemotherapy has been shown to have various psychological effects, including disturbed body image. This treatment regimen often causes alterations in physical appearances like scarring, hair loss, skin dryness and redness, rashes, sensory changes like numbness and pain, and functional impairment like dysarthria, dysphagia, and impotence.

Nursing Diagnosis: Disturbed Body Image

Related to:

• Adverse effects of treatment 
• Body consciousness

As evidenced by:

• Avoids touching one’s body
• Avoids looking at one’s body
• Expresses concerns about sexuality 
• Depressive symptoms 
• Expresses preoccupation with change 
• Expresses fear of reaction by others 
• Monitors changes in one’s body
• Hair loss
• Weight loss
• Scarring
• Dry skin
• Rashes

Expected outcomes:

• Patient will verbalize understanding and acceptance of changes in appearance.
• Patient will demonstrate lifestyle modifications to cope with bodily or appearance changes.

Assessment:

1. Assess the adverse effects of chemotherapy contributing to disturbed body image.
Chemotherapy causes various side effects that can contribute to disturbed body image, including hair loss, dry skin, scarring, and rashes. Prepare the client for changes that may occur and how they can be managed.

2. Assess the perceived impact of the alterations in body image.
Alterations in body image can impact various aspects of the patient’s life, such as the patient’s role performance, activities of daily living, occupational activities, and sexuality.

Interventions:

1. Encourage the patient to verbalize feelings and concerns about body image.
Allowing the patient to verbalize feelings and acknowledging them encourages a trusting relationship and enhances the patient’s coping.

2. Prepare for hair loss.
Preparing for hair loss before it occurs can empower the patient. They may choose a wig, colorful scarves or head coverings, hats, or to go bald.

3. Encourage self-care.
Encourage the patient to be kind to themselves as their body changes. Wear warm, soft clothing, receive lymphatic drainage massages for swelling, treat skin irritation with fragrance-free moisturizers, and eat foods that are soothing to the mouth.

4. Refer the patient to appropriate support groups.
Other cancer survivors can be a tremendous source of encouragement for a patient undergoing chemotherapy. They can offer advice for managing physical and emotional changes.

Fatigue

Fatigue caused by chemotherapy can last for several weeks to several months, even after a treatment cycle ends. This happens due to the sustained damage to both cancer and healthy cells during the treatment. Energy levels usually return to normal within 6 to 12 months after treatment.

Nursing Diagnosis: Fatigue

Related to:

• Adverse effects of chemotherapy
• Depressive symptoms
• Increased physical and mental exertion
• Immunosuppression
• Stress
• Disease process

As evidenced by:

• Difficulty maintaining usual physical activity 
• Disinterest in activities
• Drowsiness
• Expresses a lack of energy
• Expresses weakness 
• Expresses tiredness 
• Increased need for rest
• Inadequate role performance 

Expected outcomes:

• Patient will identify factors that cause and aggravate fatigue and demonstrate interventions that can help alleviate fatigue. 
• Patient will verbalize an increased sense of energy and ability to perform activities.

Assessment:

1. Assess the extent, severity, and frequency of fatigue.
Understanding the patient’s level of fatigue and the times when fatigue is most severe can help develop a plan for managing fatigue. The patient can also be asked to rate their fatigue on a 0-10 scale.

2. Assess nutrition, fluid intake, and signs of dehydration.
Dehydration is a side effect of chemotherapy and radiation and can happen due to other side effects like vomiting, fever, and diarrhea. Dehydration can worsen fatigue. If the patient is experiencing a lack of appetite, they may not be eating enough to support metabolic demands.

3. Monitor for an underlying cause.
If fatigue is severe or unrelenting, the patient may need to be assessed for cancer metastasis, an infection, or anemia.

Interventions:

1. Plan care with rest periods in between interventions.
Frequent rest periods enable restoration and conservation of energy. Rest should be limited to 30 minutes so as not to interrupt sleep at night.

2. Alter work demands.
The patient may need to take time off work during chemotherapy or may be able to complete tasks by working from home.

3. Delegate responsibilities.
Chemotherapy often requires support from friends and family. The patient may need to delegate their responsibilities such as cooking, childcare, or errands to their spouse or another support person.

4. Encourage movement.
Research shows that physical activity during and after chemotherapy decreases fatigue. Yoga can improve flexibility, strength, and sleep and can be adjusted to the patient’s activity level.

Risk for Infection

Patients who are undergoing chemotherapy treatment are at risk of developing an infection. Chemotherapy kills cancer and healthy cells, including white blood cells, resulting in immunosuppression.

Nursing Diagnosis: Risk for Infection

Related to:

• Inadequate primary defenses
• Immunosuppression
• Decreased white blood cell count
• Disease process
• Side effects of chemotherapy

As evidenced by:

A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions will be directed at the prevention of signs and symptoms.

Expected outcomes:

• Patient will remain free from any signs of infection. 
• Patient will demonstrate infection control interventions.

Assessment:

1. Assess for signs of infection.
Patients undergoing chemotherapy are immunosuppressed and have a higher risk for infection. This can manifest as redness, warmth, or drainage from a wound, fever, oral thrush, or other candida infections.

2. Evaluate laboratory values like CBC, serum protein, and cultures.
Abnormal laboratory values, such as an elevated white blood count, indicate a developing infection. Neutropenic patients with a fever need prompt medical intervention.

Interventions:

1. Promote good handwashing before and after patient interventions.
Good handwashing techniques reduce pathogens on the hands and help prevent transmission of infection to the patient.

2. Encourage personal hygiene.
Maintaining personal hygiene helps prevent infection and positively impacts the patient’s self-confidence and overall well-being. The patient should be instructed on proper oral hygiene to prevent thrush.

3. Administer antibiotics as indicated.
Antibiotics may be given prophylactically prior to procedures or surgery or as a treatment for a current infection in patients undergoing chemotherapy.

4. Ensure interventions and procedures are performed aseptically.
Chemotherapeutic agents are often administered intravenously, and the patient may have an implanted port or central line. Maintaining aseptic technique when accessing these devices is vital to prevent contamination and bloodstream infections.

Nursing Diagnosis and Rationale for Chemotherapy

1. Risk for Infection

Rationale: Chemotherapy can suppress the immune system, making patients more susceptible to infections. Nurses should monitor the patient’s temperature regularly, assess for signs of infection such as redness, swelling, or drainage at intravenous sites, and educate patients on the importance of hand hygiene and avoiding crowds. Prophylactic antibiotics may be prescribed, and nurses should ensure proper administration and adherence to the medication regimen.

2. Nausea and Vomiting

Rationale: Chemotherapy often leads to gastrointestinal side effects including nausea and vomiting. These symptoms can significantly impact the patient’s nutrition and hydration status. Nurses should assess the severity of nausea and provide antiemetic medications as prescribed. Offering small, frequent meals and encouraging the intake of non-irritating, bland foods can help manage these symptoms. Educating patients on avoiding foods that can trigger nausea is also crucial.

3. Fatigue

Rationale: Chemotherapy can induce profound fatigue, affecting the patient’s ability to perform daily activities. Nurses should assess the patient’s energy levels, encourage regular but gentle physical activity, and promote adequate rest periods. Education on energy conservation techniques and prioritizing activities is essential. Nutritional support and hydration also play a role in mitigating fatigue.

4. Risk for Bleeding

Rationale: Chemotherapy can lower platelet counts, increasing the risk of bleeding. Nurses should monitor the patient’s platelet levels, educate on signs of bleeding (such as unusual bruising, petechiae, or prolonged bleeding from minor cuts), and advise on precautions to minimize injury. Avoiding invasive procedures when possible and using gentle techniques for activities like tooth brushing and shaving can help prevent bleeding.

5. Body Image Disturbance

Rationale: Chemotherapy can lead to changes in physical appearance, such as hair loss, weight changes, and skin alterations, which can affect the patient’s body image and self-esteem. Nurses should provide emotional support, offer resources such as wigs or cosmetic advice, and encourage open communication about feelings and concerns. Involving mental health professionals for counseling and support groups can also be beneficial.

6. Knowledge Deficit

Rationale: Patients and their families may have limited knowledge about chemotherapy, its side effects, and management strategies. Providing comprehensive education on the treatment plan, potential side effects, and self-care measures is essential. Nurses should use clear, non-medical language, visual aids, and written materials to enhance understanding. Demonstrating techniques and providing opportunities for questions can further support patient education.

7. Anxiety

Rationale: The prospect of chemotherapy can cause significant anxiety due to fears about the treatment and its side effects. Nurses should assess the patient’s emotional state and provide psychological support through active listening, reassurance, and clear communication about what to expect. Techniques such as relaxation exercises, guided imagery, and referrals to mental health professionals can help manage anxiety. Involving family members in the care plan can also provide additional support.

REFERENCES

1. ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
2. Chemotherapy. American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy.html
3. Chemotherapy: How It Works and How You’ll Feel. WebMD. https://www.webmd.com/cancer/chemotherapy-what-to-expect
4. Chemotherapy to Treat Cancer. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/types/chemotherapy
5. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.

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