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ST. TAMMANY PARISH HOSPITAL COVINGTON, LOUISIANA TITLE: PURPOSE: LEVEL: PLAN OF CARE FOR THE CHEMOTHERAPY PATIENT / TEACHING PROTOCOL TO INVOLVE THE PATIENT/SIGNIFICANT OTHER IN THE PLAN OF CARE AND TO PROVIDE TEACHING TO THE SIGNIFICANT OTHER & PATIENT RECEIVING CHEMOTHERAPY. INDEPENDENT THE PLAN OF CARE FOR THE CHEMOTHERAPY PATIENT IS INDIVIDUALIZED AND APPROPRIATE TO THE PATIENT’S NEEDS, STRENGTHS, LIMITATIONS, & GOALS. EDUCATION INCLUDES INFORMATION REGARDING CHEMOTHERAPY SIDE EFFECTS, THE TREATMENT ITSELF, AND SELF-CARE ACTIVITIES. PATIENT/SIGNIFICANT OTHER OUTCOME STANDARDS: RESPONSE KEY: PHYSIOLOGIC: THE CLIENT WILL REMAIN FREE OR EXPERIENCE MINIMAL SIDE EFFECTS OR TOXICITIES THROUGHOUT THE CHEMOR = REFERRED FOR OUT-PATIENT THERAPY TREATMENT PERIOD. INSTRUCTIONS; PSYCHOLOGIC: THE CLIENT/SIGNIGICANT OTHERS WILL DEMONSTRATE S = SUCCESSFULLY MEETS POSITIVE COPING MECHANISMS IN RELATION TO OUTCOME. CHEMOTHERAPY AND ITS SIDE EFFECTS. N = NEEDS FURTHER INSTRUCTION. COGNITIVE: THE CLIENT/SIGNIFICANT OTHERS WILL VERBALIZE UNDERU = UNABLE TO COMPREHEND. STANDING OF SELF-CARE MEASURE TO AVOID/MINIMIZE * = SEE PROGRESS NOTES. SIDE EFFECTS OF THE CHEMOTHERAPY REGIME. PLAN OF CARE METHODOLOGY DATE/ COMMENTS TIME 1. Assessment of client/caregiver, a. Determine if prior experience with chemo therapy, either knowledge of cancer diagnosis, personally or a loved one. (Yes _____/No _____) and chemotherapy as a treatment. IF personal, any severe side effects? (Yes _____/No _____) b. Determine if the patient/caregiver has specific Cancer Diagnosis: ________________ concerns or information needs about chemotherapy. Date Diagnosed: __________________ c. Plan teaching sessions with patient/caregiver according to Stage of Cancer (if known): _________ needs and present anxiety level/ability to learn. Physician who diagnosed your cancer: d. Provide Chemotherapy Education Packet, Mouth Care _______________________________ Protocol, and Micromedex Drug Specific Patient Education Sheets. e. Individualize chemotherapy treatment plan using verbal, written and audio materials. Use PamLab videos if indicated. 2. Knowledge Deficit & Selfa. Reinforce that the majority of side effects from Management of general side chemotherapy are reversible and are easily effects common to all controlled both in the hospital and at home chemotherapy: (blood counts recover, hair grows back). a. Nausea/Vomiting b. Refer to the following for reinforcement of b. Diarrhea information post-treatment: c. Mouth Care i. Chemo & You, Eating Hints, and Taking Time d. Dental care ii. Mouth Care Protocol. e. Constipation iii. Bowel Protocol for constipation. f. Hair Loss iv. Micromedex Drug Specific Chemotherapy Information g. Potential for infection Sheets for each medication patient receiving. h. Potential for bleeding v. Chemotherapy Home care Instruction and Safety i. Potential anemia/fatigue Information Sheets j. Potential sunburn c. Instruct patient/caregivers to thoroughly cook shellfish (shrimp, k. Birth control measures crab, etc.) to decrease the chance of infection. l. Safety measures post treatment CONTENT: 3. Knowledge Deficit and SelfManagement of EXTRAVASATION Occurs when vesicants leak outside of vein and cause damage to the skin and underlying tissues. 4. Knowledge Deficit and SelfManagement of HYPERSENSITIVITY 1. 2. Reinforce preventive measures used to avoid complications. a. Fresh IV site or central line monitored continuously with vesicant IVP. b. Continuous infusion via central line site and blood return monitored periodically around the clock. Instruct to: a. Notify nurse of any discomfort, burning, stinging, etc. at IV site during chemotherapy administration. b. Notify oncologist of any redness, pain, or swelling at IV site after discharge from hospital. 1. a. b. Can happen with any medication. c. Instruct patient: Nurse is with them during the initial part of treatment and will be close by to monitor. Pre-medication ordered by the oncologist must be taken on time. If doses are missed, treatment may need to be rescheduled. Skin redness, itching, or hives appearing after discharge should be reported to oncologist. PLAN OF CARE METHODOLOGY 5. DISCHARGE PLANNING / EDUCATION DATE/ TIME COMMENTS 1. Determine if patient has a support person who can help at home post-treatment if needed. 2. Explain importance of compliance with follow- up tests (CBC, 24-Hour Urine, etc) or or injections (Neulasta, etc). 3. Verify patient/caregiver know: a. Oncologist’s office phone number. b. Dates of follow-up appointments. c. Fill prescriptions given in case of nausea, diarrhea, etc. d. Do not take any new medications without consulting their oncologist, even over the counter medications. 4. Review side effects to monitor and notify oncologist about on Chemotherapy Discharge Instructions and provide a copy to the patient/caregiver. 5. Reinforce the need for patient and caregivers to: a. Review information given. b. Call oncologist’s office with questions or symptoms 6. Provide Cancer Resource Packet and/or Newsletter (Cancer Connection); make referral if patient desires (898-4481). 7. Reinforce the need to schedule any future Infusion Center/ lab/ or other STPH appointments by calling the Scheduling desk at 871-5665. PROGRESS NOTES: INSTRUCTION SESSION: DATE/TIME: STAFF SIGNATURE: DATE/TIME: STAFF SIGNATURE: ___________ ________________________ ___________ ________________________ ___________ ________________________ ___________ ________________________ References: Cancer Chemo Guidelines/Recommendations for Practice (2 nd Edition). ONS, 2005. Date of Original Approval: 11/94 Date of Revisions: K:\Oncology\CHEMO Protocols\patient ed materials.teaching protocols\Chemotherapy teaching protocol.plan of care.doc 12/96; 8/99; 7/07; 1/08; 9/08