Chemotherapy Nursing Diagnosis and Nursing Care Plan

Chemotherapy Nursing Care Plans Diagnosis and Interventions

Chemotherapy NCLEX Review and Nursing Care Plans

Chemotherapy, otherwise known as systemic anti-cancer therapy, encompasses a group of highly potent drugs administered with the intention to destroy as many cancer cells with as minimal effect on healthy cells as possible. It is a type of cancer treatment wherein powerful chemicals are used to kill cancer cells.

What Happens During Chemotherapy?

Chemotherapy is a systemically applied therapy, which means that it travels throughout the body from the bloodstream to other locations. There are various forms and types of chemotherapy. Generally, medications classified as chemotherapy are extremely potent chemicals that cure cancer by assaulting the cells during the stages of the cell cycle.

Because all cells follow the cell cycle, healthy, normal cells and deformed, cancer cells are both affected by chemotherapy, thereby bringing changes and disturbances to the patient’s body. This is particularly observed for normal, healthy cells that grow fast, such as hair cells. This damage in the otherwise normal cells can cause side effects such as balding and nausea, to name a few.

Goals of Chemotherapy

 There are various goals of chemotherapy, such as:

  • Curative. The goal of curative chemotherapy is to treat the cancer, getting rid of all its components and eliminating the possibility of relapse. It is also known as the primary treatment goal for malignancies.
  • Adjuvant. This involves a short course of high-dose chemotherapy, usually used in combination chemotherapy for a patient with no evidence of residual cancer after surgery or radiotherapy. It is given with the intent of destroying a low number of residual tumor cells. This treatment is given after other options are given.
  • Neoadjuvant. It is a goal of chemotherapy commonly given in the preoperative or perioperative period. This chemotherapy is given before a planned surgery so as to decrease first the size of the tumor (i.e., debulking), to allow for easier extraction and removal of the tumor.
  • Palliative.  Palliative chemotherapy is another sub type wherein the main goal of this treatment is to control the untoward symptoms or likewise, prolong life in a patient in whom cure is already unlikely.
  • Salvage.  It is a potentially curative, high-dose, usually combination, regimen given in a patient who has failed or recurred following a different curative regimen. Salvage regimen, from the term itself, could be considered a last resort treatment for patients with malignancies who had already tried a variety of treatment protocols that has been proven ineffective or inadequate for the patient.

Types of Chemotherapy

There are various terms utilized in describing the types of chemotherapy given to patients. They are the following:

  • Alkylating agents. This group of drugs are a type of chemotherapy that inhibits the cancer cell from producing by damaging the DNA. This drug acts on the phases of the cell cycle.
  • Antimetabolites. This group of drugs hinder cancer cells by acting as substitutes for building the DNA and RNA. Because of this, cancer cells cannot make copies of themselves thereby limiting their reproduction capacity.
  • Anti-tumor antibiotics.  Anti-tumor antibiotics react with the various enzymes responsible for DNA duplication during the cell cycle, thereby eliminating cell reproduction.
  • Topoisomerase inhibitors.  Also called plant alkaloids, topoisomerase inhibitors complicate the processes of the enzyme topoisomerase, which is responsible for helping the strands of DNA to proliferate.
  • Mitotic inhibitors. Another form of plant alkaloids derived from natural plants that stop cancer cells in forming new ones by giving detrimental effects to the cell by inhibition of necessary enzymes of proliferation.

Combination Therapy: Chemotherapy and Other Cancer Treatments

Other treatment options given together or in combination with chemotherapy are as follows:

  • Hormone therapy.  This is a form of treatment that utilizes hormones to remove, block or add certain components to the body. Its alternative name is hormonal therapy or endocrine therapy. Hormone therapy can be utilized to address various cancer conditions.
  • Immunotherapy.  This is a form of cancer treatment that empowers the body’s natural immune system to fight cancer cells. Immunotherapy is now considered an integral part of cancer treatment.
  • Targeted therapy. This is a form of therapy that marks certain and specific genes or proteins in cancer cells that is necessary to cancer proliferation.

Common Side Effects of Chemotherapy

Chemotherapy has a variety of side effects, each or a combination of it, will depend on the kind of medication utilized. These side effects may occur on any part of the treatment regimen, ranging from within a few hours or days, or even long term that could take weeks or years to develop. The following side effects are reflected per body system and are as follows:

  • Integumentary
    • Hair loss. The scalp is not the only place where hair may be lost. Areas such as the eyebrows and eyelashes may also have depleted hair due to cancer therapy.
    • Skin and nail changes. Color changes in the patient’s nails and skin texture dryness may happen to patients receiving chemotherapy due to the depletion of healthy cells in these areas as a side effect of treatment.
  • Cardiovascular
    • Fatigue. Patients receiving chemotherapy treatment feel fatigue as a result of the lowering levels of red blood cells in the body. Due to this, the oxygen capacity and supply is diminished, thereby depleting the body of the needed oxygen for various processes of the tissues.
    • Heart problems.  Some chemotherapy, such as those from the anthracycline group, can cause significant damage to the cardiac muscles that can result in congestive heart failure, myocarditis, etc.
  • Gastroenterology
    • Nausea and vomiting. This clinical manifestation happens due to the stomach lining of patients being reduced by the chemotherapy regimen as part of its mechanism of attacking rapidly growing cells, an example of which are the cells in the stomach. The reduction of stomach cells and the innate presence of hydrochloric acid further compounds the feeling of nausea, and eventually vomiting.
    • Constipation and diarrhea.  Another side effect of chemotherapy due to altered gastrointestinal tissues which can affect the normal process of the gut.
    • Mouth and throat sores. This manifestation happens due increasing gastric acid that can damage the mucosal tissues.
    • Appetite and weight changes. This manifestation will eventually happen because of the alterations in the patients’ gastrointestinal tract when subjected to chemotherapy.
  • Hematologic
    • Bleeding and bruising.  This can happen due to diminished platelet levels brought about by chemotherapy.
    • Anemia. This can happen due to diminished erythrocyte levels brought about by chemotherapy.
    • Infection. This can happen due to diminished leukocyte levels brought about by chemotherapy.
  • Neurological
    • Nerve changes. A side effect of chemotherapy can present as sensations of numbness or “pins and needles”.
    • Pain.  Pain can be a side effect of chemotherapy due to the body’s reaction to treatment and the eventual debulking of the cancer, thereby promoting the inflammatory process.
    • Chemo brain. Due to uneasiness in sleeping caused by other chemotherapy side effects, patients would tend to have poor memory and trouble in focusing and memorization.
    • Mood changes. An overall accompanying side effect caused by the general uneasiness brought by other body system disturbances.
  • Genitourinary
    • Urinary tract problems. Some chemotherapy drugs can negatively affect the renal system that would eventually cause issues in micturition, etc.
    • Sex-related changes. A compounding effect from other chemotherapy side effects stemming from fatigue, thereby reducing the patient’s drive and libido.
    • Fertility problems. The reproductive organs are affected because of the general diminishing effect to the hormones, sperm or egg cell count of the patient.

How Chemotherapy is Delivered

  • Oral – Chemotherapy may come in oral preparations such as pills, capsules, or liquids.
  • Intravenous – Chemotherapy drugs are most commonly given as a liquid through a drip inserted into a vein (intravenous infusion).
  • Injection – In this method, the drug is given as a shot into the muscle, either in your arm, thigh, or hip, (i.e., the intramuscular route) or under the skin through the fat portion of your arm, leg, or belly (i.e., subcutaneous route).
  • Intrathecal – Chemotherapy drugs are injected into the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord.
  • Intraperitoneal – Hyperthermic Intraperitoneal Chemotherapy (HIPEC) surgery is a two-step procedure that treats certain cancers in the abdomen. In this instance, the cancer tissues are surgically resected, and followed through with the application of heated chemotherapy directly inside the abdomen, washing and to eliminate the remnants of malignant cells.
  • Intra-arterial – Trans-arterial Chemoembolization (TACE) is a procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor. This permits more drug doses to reach the cancer for prolonged periods, which eventually eliminate more malignant cells. It also causes lesser issues because of the limited drug dose that circulates to other locations. TACE is a treatment choice for liver cancer.
  • Topical – In this form, cytotoxic drugs may be applied directly by smearing it to the patient’s skin or via drops to the eyes or ears.

Factors Related to the Choice of Chemotherapy

The following considerations have been recognized as a means of directed treatment selection in combination regimens of chemotherapy:

  • Single agents that are found to be active in eliminating cancer cells should be included when doing drug combination regimens. Favorably, medications that bring complete remissions from cancer should be incorporated.
  • Combining medications with varied action potentials should be employed and combined in order to promote pharmaceutical synergistic effects in eliminating the cancer.
  •  Drugs with varying dose-limiting harmfulness should be enjoined and utilized in order for each drug to be administered at full or nearly full therapeutic doses.
  • Medications should be utilized in accordance with their dose and time of use.
  • Drugs should be given at consistent intervals. Consider that intervals between treatment cycles are of the shortest waiting time possible necessary for the sensitive tissues to recuperate.
  •  Drugs with varied forms of resistance should be enjoined to reduce cross-resistance.

Pre-Procedure Nursing Care: Preparing the Patient for Chemotherapy

The following procedures or statements are necessary health education necessary in preparation for chemotherapy.

  • Advise the patient to have someone accompany them during treatments. This promotes patient safety and comfort due to some treatment side effects can be a challenge to deal with solo.
  • Educate the patient of proper scheduling of treatments. Advising the patient in complying with treatment schedules and setting a “chemo day” will help in anticipating possible side effects that may hinder in the accomplishment of activities of daily living.
  • Emphasize the need for assistance with meal preparations and childcare.  Chemotherapy sessions can be proven difficult for patients in doing their daily activities, especially in taking care of children and in preparing healthy meals. Employing others to assist will ensure that these needs are met.
  • Advise on the management and handling of waste. A patient who received chemotherapy 48 hours prior would still have little amounts of it in the body. Educating on the proper management and handling will ensure that other people would not be contaminated with chemotherapy.
  • Advise the patient to visit the dentist. Mouth sores are usual side effects of chemotherapy. Ensuring that oral hygiene and health is maintained before chemotherapy will prevent complications when sessions start.
  • Remind the patient of the important changes in pet care. Because the patient will have a weakened immune system, it is advisable that patients steer away from handling them and arrange for other people to care for pets.
  • Educate the patient regarding fertility, sexual concerns, and planning for safe sex. Chemotherapy can damage the sperm and egg cells that  can eventually cause birth defects. Utilizing barrier protection (i.e., condoms) is advisable to limit exposure of a partner to chemotherapy by bodily fluids.

Home Care for Patients Receiving Chemotherapy

Patients on chemotherapy have weakened immune systems and are prone to opportunistic infections. This can be prevented by:

  • Correct and proper cleaning and disinfection of surroundings
  • The use of face masks
  • Removal of fresh plants inside the house
  • Refraining from taking care of pets
  • Ensuring that a thermometer is available to assess for fever
  • Practicing proper hand hygiene
  • Avoiding possible causes of injuries, such as cuts and burns
  • Staying away from sick people

Nursing Diagnosis for Chemotherapy

Nursing Care Plan for Chemotherapy 1

Risk for Altered Oral Mucous Membranes

Nursing Diagnosis: Risk for Altered Oral Mucous Membranes related to the side effects of the chemotherapeutic agents secondary to chemotherapy for breast cancer.

Desired Outcomes:

  • The patient will display intact mucous membranes, which are pink, and moist.
  • The patient’s mucus membranes will be free from inflammation and ulcerations.
  • The patient will express an understanding of the causative factors for the condition.
  • The patient will show understanding of the techniques to maintain and restore the integrity of his or her oral mucosa.
InterventionRationale
1. Regularly check and evaluate the patient’s dental health and oral hygiene.This will help identify the patient’s need for prophylactic treatment before initiating chemotherapy or radiation. This assessment will also provide baseline patient oral hygiene data that can be used for future comparison.
2. Instruct the patient to assess his or her oral cavity daily and instruct the patient to note any changes in his or her mucous membrane.Assessing for any changes in the mucous membrane will help in controlling the stomatitis complications.
3. Instruct the patient to include oral hygiene programs which include: Advise him or her to avoid commercial mouthwash, lemon, and glycerin swabs.

Advise him or her to use warm saline, a diluted solution of hydrogen peroxide, and water when washing the mouth.

Advise him or her to use a soft toothbrush or foam swab

Advise the patient to Floss the mouth/teeth cautiously

Advise the patient to keep the moisture of the lips by using lip gloss, balm, K-Y jelly, or chapstick
Oral hygiene programs will help soothe the mucous membranes of the patient. Oral hygiene will also improve the patient’s sense of taste and will help in promoting comfort for the patient.  
4. Instruct the patient about the importance of having adequate fluid intake as tolerated.Proper hydration will help the patient to keep the mucous membranes moist and this will prevent cracking and drying of the lips and mouth.
5. Refer the patient to a dentist before doing chemotherapy.A prophylactic examination from the dentist before therapy will reduce the risk of infection.

Nursing Care Plan for Chemotherapy 2

Risk for Impaired Bowel Elimination (Constipation/ Diarrhea)

Nursing Diagnosis: Risk for Impaired Bowel Elimination (Constipation/ Diarrhea) related to the irritation of the GI mucosa secondary to chemotherapy for colon cancer.

Desired Outcomes:

  • The patient will be able to maintain the usual bowel consistency and pattern.
  • The patient will express understanding of factors and appropriate interventions and solutions related to the condition.
Chemotherapy Nursing InterventionsRationale
1. Ask the patient about his or her usual elimination habits.Assessing the patient’s elimination habits will help in evaluating the therapeutic need and effectiveness of the intervention in the future.
2. Evaluate the patient’s bowel sounds and note the patient’s bowel movements including the bowel frequency and consistency.This will help in defining problems such as constipation and diarrhea. The nurse should note that constipation is one of the earliest signs of neurotoxicity.
3. Check and monitor the patient’s intake and output as well as the patient’s weight.It is important to check the patient’s intake, output and weight because diarrhea may cause dehydration, weight loss, and electrolyte imbalance and inadequate fluid intake will cause constipation.
4. Advise the patient to have adequate fluid intake and increase fiber in the diet and encourage them to have regular exercise as tolerated.Adequate fluids may reduce the risk of constipation and dehydration and will improve stool consistency.
5. Advise and encourage the patient to have small, frequent meals of foods that are low in residue if not contraindicated and maintain needed protein and carbohydrates. Adjust the patient’s diet as appropriate.This will reduce gastric irritation and may increase the gastric motility frequency of stools. Eating low-fiber foods will reduce irritability and will provide bowel rest when diarrhea is present.
6. Check and monitor the patient’s laboratory studies as indicated.Evaluating the laboratory studies is important to prevent complications.

Nursing Care Plan for Chemotherapy 3

Risk for Infection

Nursing Diagnosis: Risk for Infection related to inadequate secondary defenses, immunosuppression secondary to chemotherapy for skin cancer.

Desired Outcomes:

  • The patient will remain free from infection and will be able to achieve timely healing as appropriate.
  • The patient will be able to identify and participate in interventions that will prevent and decrease the risk of infection.
Chemotherapy Nursing InterventionsRationale
1. Check and monitor the patient’s vital signs, especially the temperature, and check the skin, genitourinary, and respiratory system of the patient.An increase in the patient’s temperature may happen because of various factors such as chemotherapy side effects, disease process, or infection. Identifying the infectious process enables appropriate intervention to be given to the patient to avoid complications.
2. Instruct and encourage the patient, staff, and visitors about good hand washing procedures and emphasize proper personal hygiene. Limit and screen visitors that may have an infection and place them in reverse isolation if indicated.Handwashing will protect the patient from different sources of infection such as visitors and staff who are experiencing an upper respiratory infection. Limiting a potential source of infection is important to cancer patients.
3. Change the position of the patient frequently and always keep the linen of the bed dry and wrinkle-free.The repositioning will decrease pressure and irritation to the patient’s tissue and will prevent skin breakdown that potentiates the site for bacterial growth.
4. Check and monitor the patient’s CBC including the WBC and granulocyte count and the platelet as indicated.An increase in WBC or white blood cell count indicates infection and inflammation. Monitoring the CBC will help in preventing further infection and complications.
5. Give medications such as antibiotics as indicated and as prescribed by the physician.Medications may be used to treat infections and may be given prophylactically in immunocompromised patients.

Nursing Care Plan for Chemotherapy 4

Risk for Impaired Skin Integrity

Nursing Diagnosis: Risk for Impaired Skin Integrity related to the effects of radiation, chemotherapy, immunologic deficit, altered nutritional state, and anemia secondary to chemotherapy for lymphoma.

Desire Outcomes:

  • The patient will be able to identify appropriate interventions for the specific condition.
  • The patient will be able to participate in techniques in preventing complications and promote healing as appropriate.
Chemotherapy Nursing InterventionsRationale
1. Check the patient’s skin regularly and assess for side effects of cancer therapy. Assess for the breakdown of the skin and the presence of delayed wound healing.A radiation reaction such as reddening and tanning effect may happen within the field of radiation. Dry desquamation, moist desquamation, ulceration, hair loss, and loss of dermis and sweat glands may also happen.
2. Advise the patient to bathe with lukewarm water and use mild soap.Using lukewarm water and using mild soap will help in maintain cleanliness without irritating the patient’s skin.
3. Instruct and advise the patient to avoid rubbing and scratching the skin. Review the protocols for skin care for a patient having radiation therapy.This will help the patient in preventing friction and trauma of the sensitive tissues and to the area of radiation therapy. The patient’s skin is sensitive during and after the treatment.
4. Reposition and turn the patient frequently and properly.Doing repositioning will help the patient to promote circulation and will decrease pressure on skin and tissues.
5. Advise the patient to wear soft, loose clothing and advise the patient to avoid wearing a bra if it creates pressure.This will help protect the patient’s skin from ultraviolet rays and will reduce the risk of recall reactions.
6. Check the patient’s skin and IV site and the vein for presence or erythema, edema, tenderness, welt-like patches, itching, burning, soreness, blisters progressing to ulceration or tissue necrosis.The presence of phlebitis vein flare or extravasation of the skin requires immediate discontinuation of the antineoplastic agent and medical management.

Nursing Care Plan for Chemotherapy 5

Fatigue

Nursing Diagnosis: Fatigue related to decreased metabolic energy production, increased energy requirements, emotional demands, and side effects of chemotherapy secondary to lung cancer as evidenced by disinterest in the surroundings, and inability to perform usual routines.

Desired Outcomes:

  • The patient will express an improved sense of energy.
  • The patient will be able to perform activities of daily living and will be able to participate in desired activities at the patient’s level of ability.
Chemotherapy Nursing InterventionsRationale
1. Ask the patient about the rate of his or her fatigue using the numeric scale and ask the time of day when it is most severe.Assessing the rate of fatigue will help the nurse in developing a plan of care for managing the patient’s fatigue.
2. Allow the patient to have adequate rest periods and schedule activities for periods when the patient has his or her most energy.Rest and naps are needed by the patient to restore his or her energy, especially after chemotherapy. Allow the patient to be active during the times when the patient’s energy level is higher to restore a feeling of sense of control.
3. Assist the patient when doing self-care and ambulation as indicated and keep the bed of the patient in a low position and the pathways are clear from the furniture.The nurse should assist the patient’s activities of daily living because the patient’s ability to do activities may be affected because of fatigue and the patient may be at risk of having an injury.
4. Check for the patient’s physiologic response to activities including pain assessment and vital signs taking.The patient’s tolerance varies depending on the stage of the disease process, nutritional state, fluid balance, and the patient reaction to the therapeutic regimen.
5. Refer the patient to a physical or occupational therapist to help program daily exercises.The patient will be able to maintain and increase his or her strength because of programmed daily exercises that the physical and occupational therapist may advise. The patient may be also advised to use adaptive devices to help conserve energy.


Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Nursing Stat Facts
Nursing Stat Facts

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Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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