Z.O.'s wound and neurologic status are monitored and he continues to improve. Z.O. is transferred to the

Question

oncology service on postoperative day 7 for initiation of chemotherapy.

Outline a plan of care that addresses common risks secondary to chemotherapy, describing
at least two nursing interventions that would be appropriate for managing risks for infection,
bleeding, dehydration, altered growth and nutrition, altered skin integrity, and body image.

Answer 1

Infection risk:
• Maintain careful hand hygiene.
• Monitor for fever and inflammation of skin and oral mucosa.
• Monitor central venous line site and surgical dressing and site.
• Maintain aseptic technique.
• Monitor visitors for signs and symptoms of illness.
• Avoid immunizations with live attenuated viruses.
• Administer granulocyte colony-stimulating factor as ordered.
• Monitor absolute neutrophil count (ANC).
Bleeding risk:
• Monitor platelet count
• Monitor for sources of bleeding (e.g., urine, stool, epistaxis).
• Avoid skin punctures when possible, but if necessary, keep prolonged pressure on site.
• Avoid rectal temperature taking and suppositories.
• Maintain good oral hygiene with soft toothbrush or Toothettes.
Nausea and risk for dehydration:
• Administer antiemetics before chemotherapy and per the physician's orders. Some antiemetics
have specific time frames for administration related to chemotherapy administration.
• Ensure no strong odors near child.
• Strictly monitor I&O.
• Maintain IV hydration as indicated.
• Assess and monitor hydration status—LOC, oral mucous membranes, skin turgor, capillary refill,
and weight.
Altered growth and nutrition:
• Obtain a nutrition consultation.
• Review child's likes and dislikes for food and fluids.
• Relax pressure regarding eating.
• Encourage favorite high-calorie, high-protein foods and high-calorie fluids.
• May add supplements (e.g., cream instead of milk or full-fat instead of low-fat items) to favorite
food to increase calories and protein).
• Supplement with enteral or parenteral feedings as ordered.
• Daily weights.
Altered skin integrity:
• Monitor for oral and rectal ulceration.
• Use Toothette and saline rinses for oral hygiene.
• Avoid alcohol-based oral rinses and glycerin swabs.
• Oral antifungal troches or prescribed mouthwashes might be indicated.
• Avoid fruits and juices with citric acid (e.g., oranges).
• Give sitz bath and ensure meticulous perianal hygiene.
• Administer stool softener if indicated.
• May need pressure-reducing mattress if very thin.
Body image:
• Prepare patient and family for anticipated alopecia.
• Explore types of head coverings: wig, scarf, hat.
• Discuss scalp protection (i.e., sunscreen, hygiene).
• Prepare for side effects of steroid therapy if applicable (i.e., Cushingoid appearance).