Ateneo de Zamboanga University

College of Nursing NURSING SKILLS OUTPUT (NSO) Report No.

Preparing Client for Chemotherapy Description:

Chemotherapy, in the most simple sense, is the treatment of an ailment by chemicals especially by killing micro-organisms or cancerous cells. In popular usage, it refers to antineoplastic drugs used to treat cancer or the combination of these drugs into a cytotoxic standardized treatment regimen.

Materials/ Equipment Needed:

*IV Line/catheter
* *Chemotherapy medications (IV, PO) *Needle *Alcohol wipe *eye goggles *long sleeves gown

disposable surgical gloves * elastic or knit cuffs

Procedure:
*All chemotherapeutic drug should be prepared according to package insert in class II BSC * Aseptic technique should be followed. *Personal protective equipment includes disposable surgical gloves, long sleeves gown and elastic or knit cuffs. *Protective eye goggles if no BSC *To minimize exposure *Wash hands before and after drug handling. *Limit access to drug preparation area *Keep labeled drug spill kit near preparation area. *Apply gloves before drug handling. *Open drug vials/ ampoules away from body. *Place absorbent pad on work surface. *Wrap alcohol wipe around neck of ampoule before opening. *Cover tip of needle with sterilize gauge when expelling air from syringe. *Label all chemotherapeutic drugs. *Clean up any spill immediately *Emphasize the importance of compliance by the patient with prescribed schedule.Drugs with emetic potential should be taken with meals. Assure that chemotherapeutic agents are stored as directed by the manufacturer (refrigerate, avoid exposure to direct light,etc). *Chemotherapeutic agents that can be administered I/M or subcutaneously are few in number. Non-vesicants like L-asperaginase, bleomycin, cyclophosphamide, methotraxate. Cyta arabine,and some hormonal agents are given I/M & /Or subcutaneously. *Use the smallest gauge needle possible for the viscosity of the medication. *Change the needle after withdrawing the agent from a vial or ampoule. *Select a site with adequate muscle and/or SC tissue. iii) Intravenous It is the most common method of administration of cancer chemotherapy. May be given through central venous catheters or peripheral access.

The following guidelines to be kept in mind:

-Inspect the solution, container and tubing for signs of contamination including particles, discoloration, cloudiness, and cracks or tears in bottle or bag Febuary 3, 4, 5, 2011 MAN Date Initials Que, Honey Sharlotte L. Clinical Instructors Mrs.Christine Oraa, RN

-Aseptic technique to be followed -Prepare medicines according to manufacturers directions -Select a suitable vein -Large veins on the forearm are the preferred site. -Use distal veins first, and choose a vein above areas of flexion. -For non-vesicant drugs, use the distal veins of the hands (metacarpal veins): then the veins of the forearms(basilic and cephalic veins) -For vesicants, use only the veins of the forearms. Avoid using the metacarpal and radial areas. -Avoid the antecubital fossa and the wrist because an extravasation in these areas can destroy nerves and tendons, resulting in loss of function. -Peripheral sites should be changed daily before administration of vesicants -Avoid the use of small lumen veins to prevent damage due to friction and the decreased ability to dilute acidic drugs and solutions. Select the shortest catheter with the smallest gauge appropriate for the type and duration of the infusion (21g to 25g for I/V medications and 19 g for blood products). -Avoid a vein which has been used for venous access within the past 24 hrs to prevent leakage from a prior puncture site. Prevent trauma and infection at the insertion site. -Apply a small amount of iodine based antiseptic ointment over the insertion site & cover the area with sterile gauze. -Intrathecal- Infusion of medication can be given through an Ommaya reservoir, implantable pump and /or usually through lumbar puncture.a)Wear protective equipment (gloves, gown and eyewear).b)Inform the patient that chemotherapeutic drugs are harmful to normal cells and that protective measures used by personnel minimize their exposure to these drugs.c) Administer drugs in a safe and unhurried environment. d)Place a plastic backed absorbent pad under the tubing during administration to catch any leakage. -Do not dispose of any supplies or unused drugs in patient care areas.

Documentation
Record: -chemotherapeutic drugs, dose, route ,and time -Premedications, postmedications, prehydration and other infusions and supplies used for chemotherapy regimen. -Any complaints by the patient of discomfort and symptoms experienced before, during, and after chemotherapeutic infusion.

Disposal of supplies and unused drugs

-Do not clip or recap needles or break syringes. -Place all supplies used intact in a leak proof ,puncture proof, appropriate labeled container. -Place all unused drugs in containers in a leak proof, puncture proof, appropriately labeled container. -Dispose of containers filled withchemotherapeutic supplies and unused drugs in accordance with regulations of hazardous

Diagram/ Illustrations

Febuary 3, 4, 5, 2011 MAN Date Initials Que, Honey Sharlotte L.

Mrs.Christine Oraa, RN Clinical Instructors

Nursing Responsibilities:
* instruct patient to get plenty of sleep. * instruct patient to eat healthy meals and drink plenty of fluids. * instruct patient to wash hands regularly, especially before eating, after using the bathroom, and after touching animals. This helps to prevent infection. * instruct patient to avoid large crowds and anyone who has a cold, the flu, or chicken pox. *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. *Accurately identify the client *Medications to be administered in conjunction with the chemotherapy e.g antiemetics, sedatives etc. *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 could contraindicate chemotherapeutic agent administration i.e. infection, severe stomatitis , decreased deep tendon reflexes, or bleeding ,physical status, level of anxiety, psychological status. Prepare for potential complications Review the policy and have medication and supplies available for immediate intervention the event of extravasation. *Review the procedure and have medication available for possible anaphylaxis *Assure accurate preparation of the agent, accuracy of dosage calculation, expiry date of the drug to be checked, procedure for correct reconstitution and recommended procedures for administration *Assess patients understanding of the chemotherapeutic agents and administration procedures. *watch out for side effects. *Dispose the medications and materials properly.

Febuary 3, 4, 5, 2011 MAN Date Initials Que, Honey Sharlotte L.

Mrs.Christine Oraa, RN Clinical Instructors

Reference:
http://www.breastcancer.org/treatment/chemotherapy/ http://www.google.com.ph/#hl=en&source=hp&biw=1024&bih=607&q=responsibil ities+during+chemothrapy+&btnG=Google+Search&aq=f&aqi=g-s2gsv4&aql=&oq=responsibilities+during+&fp=602b8f993af78a79

Febuary 3, 4, 5, 2011 MAN Date Initials Que, Honey Sharlotte L.

Mrs.Christine Oraa, RN Clinical Instructors