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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