4.

Cervical Cancer Chemotherapy

1. Cisplatin
Drug Classification: Antineoplastic (Alkalynating Agent)
Dosage, Route, Frequency: 1 mg/ml in 50- and 100- mg vials q 3 wk
Mechanism of Action: This drug alters DNA structure resulting in inhibition of cell growth and
reproduction.
Desired Effect: This drug is used to kill the rapidly replicating cells, particularly malignant ones.
Side Effects/Adverse Effects:
CNS: seizure, malaise, weakness; EENT: ototoxicity, tinnitus; GI: severe nausea, vomiting,
diarrhea, hepatotoxicity; GU: nephrotoxicity, sterility; Derm: alopecia; F&E: hypocalcemia,
hypokalemia, hypomagnesemia ; Hemat: leukopenia, thrombocytopenia, anemia ; Local:
phlebitis @ IV site; Metab: hyperurecemia; Neuro: peripheral neuropathy; Misc: anaphylactoid
reaction
Nursing Responsibilities:
Nursing Responsibilities

Rationale

1. Monitor for vital signs frequently during

administration.

To identify problems early and take measures

to prevent them from becoming serious.

2. Monitor intake and output and specific

gravity of urine frequently during
therapy.
Report
discrepancies
immediately.

This drug can cause nephrotoxicity. Thus, to

reduce the risk for nephrotoxicity

3. Assess for bleeding (bleeding gums,

bruising, petechiae, stools, uring and
emesis). Assess for signs of infecto

This drug may cause bone marrow depression

causing a high risk for bleeding and infection.
Thus, to render immediate action

4. Monitor for signs of anaphylaxis (facial

edema, wheezing, dizziness, fainting,
tachycardia). Notify physician if these
manifestations occur. Epinephrine and
resuscitation equipment should be
readily available.

This drug may cause hypersensitivity side

effects including anaphylactic-like reactions.
Thus, to render immediate action.

5. Assess patient frequently for dizziness,

tinnitus,
hearing
loss,
loss
of
coordination, loss of taste, tingling of
extremities. Notify physician promptly if
these occur.

Because these drug may cause ototoxicity and

neurotoxicity and may be irreversible. Hence,
to render action immediately.

6. Monitor CBC and platelet count before Because these drug causes leokopenia and
and routinely throughout therapy. thrombocytopenia
and
anemia.
Thus,
Withold further doses until WBC is preventing the risk for injury.
<4000/mm and platelet count is
>100,000/mm
Nursing Care Plan
Nursing Diagnosis

Fatigue related to anemia secondary to chemotherapeutic drug side effect as manifested by

constantly exhausted, decreased performance of daily routines and difficulty in completing
tasks.
Nursing Inference
Chemotherapeutic agents such as cisplatin kill cells that are growing at a fast rate. Since blood
cells are dividing at a rapid rate, this agent also attacks the blood cells including red blood cells
thereby decreasing the amount of red blood cells going in the body that leads to inadequate
nutrition to the tissues which then causes fatigue.
Hence, the body receives inadequate nutrition thus, fatigue occurs.
Nursing Goal
After 2-3 weeks of rendering interventions, the patient will be able to report improved sense of
energy as manifested by absence of exhaustion, increase performance of daily routines and
able to complete tasks.
Nursing Interventions
Nursing Interventions

Rationale

1. Ask the client to rate fatigue (1-10

scale, 10 is the highest)

To serve as baseline data

2. Assess patients ability to perform

normal task or activities of daily living.

To influences choice of interventions or

needed assistance

3. Provide a quiet atmosphere, bed rest if

indicated

To promote rest in order to lower bodys

oxygen requirements, and reduces strain on
the heart and lungs

4. Elevate the head of the bed as

tolerated

To promote lung expansion in order to

maximize oxygenation for cellular uptake

5. Provide or recommend assistance with To reduce physical stress

activities or ambulation as necessary,
allowing patient to do as much as
possible as tolerated
6. Encourage food intake rich in iron such
as (Flour, bread, and some cereals are
fortified with iron) if not contraindicated.

To maintain adequate iron intake

7. Give iron supplements as ordered

To maintain adequate iron intake

Nursing Evaluation
After 3 weeks of rendering interventions, the patient was able to report improved sense of
energy as manifested by absence of exhaustion, increased performance of daily routines and
able to complete tasks.
Nursing Diagnosis
Imbalance Nutrition less than body requirements related to inability to ingest food secondary to
chemotherapeutic drug side effect- nausea and vomiting- as manifested by weight loss,
weakness and fatigue.

Nursing Inference
Chemotherapy causes the release of a substance called serotonin and of other
chemicals in the small intestine, which through a series of signals stimulate the vomiting center
in the brain to induce emesis. Causing inability to ingest food which then will lead to decreased
nutrients receiving by the body. Thus, imbalance nutrition less than body requirements occurs.
Nursing Goal
After 3-4 weeks of rendering interventions, the patient will be able to gain optimum
nutrition as manifested by gain weight of 1lb/week, absence of weakness and absence of
fatigue.
Nursing Interventions
Nursing Interventions

Rationale

1. Monitor weight daily with the same

time, clothes, person and weighing
scale

To serve as baseline data and obtain accurate

readings

2. Monitor daily food intake; have patient

keep food diary as indicated.

To
identify
nutritional
strengths
and
deficiencies that will serve as a guide in
rendering interventions

3. Control environmental factors (strong

or noxious odors or noise). Avoid overly
sweet, fatty, or spicy foods.

Can trigger nausea and vomiting response.

Hence, to prevent nausea and vomiting

4. Encourage
use
of
relaxation
techniques,
visualization,
guided
imagery, moderate exercise before
meals.

May prevent onset or reduce severity of

nausea, decrease anorexia, and enable
patient to increase oral intake.

5. Encourage patient to eat high-calorie,

nutrient-rich diet, with adequate fluid
intake, use of supplements and
frequent or smaller meals spaced
throughout
the
day
(if
not
contraindicated)

To maintaining adequate caloric and protein

intake.

6. Administer antiemetic on a regular

schedule before or during and after
administration of antineoplastic agent
as appropriate.

Nausea and vomiting are frequently the most

disabling and psychologically stressful side
effects of chemotherapy.

7. Review
laboratory
studies
as
indicated (total
lymphocyte
count,
serum transferrin, and albumin or
prealbumin).

Helps identify the degree of biochemical

imbalance, malnutrition and influences choice
of dietary interventions. Note: Anticancer
treatments can also alter nutrition studies, so
all results must be correlated with the patients
clinical status.

8. Maintain parenteral fluids as ordered

To provide the patient needed fluids and

electrolytes

9. Refer to dietitian or nutritional support

team.

Provides for specific dietary plan to meet

individual needs and reduce problems

associated with protein, calorie malnutrition

and micronutrient deficiencies.
Nursing Evaluation
After 4 weeks of rendering interventions, the patient was able to gain optimum nutrition
as manifested by gain weight of 1lb/week, absence of weakness and absence of fatigue.
Nursing Diagnosis
Disturbed body image related to alopecia secondary to chemotherapeutic agent side effect
as manifested by aloofness, anxiousness, and a verbalization of jak kayat rumwar nga kastoy ti
langak
Nursing Inference
Chemotherapy agent such as cisplatin kills both cancerous cells and other normal cells
in the body. The normal cells in the body that are most at risk for being killed by chemotherapy
are those that are growing at a fast rate. Because the cells responsible for hair growth are
dividing at a rapid rate, they are sometimes destroyed by chemotherapy. Thinning of hair and, in
some cases, complete hair loss may result. This then will lead to the development of anxiety to
the patient due to changes in physical appearance. Thus, body image is disturbed.
Nursing Goal
After 3-5 days of rendering intervention, the patient will be able to express positive
feelings about self as manifested by mingling with others, relaxed and a verbalization of
confident nak nga rumwaren
Nursing Intervention
Nursing Interventions

Rationale

1. Encourage verbalization of positive or

negative feelings about actual or
perceived changed.

To decrease anxiety of the patient

2. Inform patient that hair loss is usually

temporary.

To decrease anxiety of the patient

3. Encourage use of wig or cap

To compensate with the hair loss

4. Refer patient to support groups

comprised of individuals with similar
alterations

To lay the patient in similar situations that

offers different type of support which is
perceived as helpful

5. Monitor weight daily

To ensure effectiveness of interventions

6. Monitor daily food intake; have patient

keep food diary as indicated.

To
identify
nutritional
strengths
and
deficiencies that will serve as a guide in
rendering interventions

7. Encourage patient to eat high-calorie,

nutrient-rich diet, with adequate fluid
intake, use of supplements and
frequent or smaller meals spaced

To maintaining adequate caloric and protein

intake.

throughout
the
contraindicated)

day

(if

not

8. Refer to dietitian or nutritional support

team.

Provides for specific dietary plan to meet

individual needs and reduce problems
associated with protein, calorie malnutrition
and micronutrient deficiencies.

Nursing Evaluation
After 5 days of rendering interventions, the patient was able to express positive feelings
about self as manifested by mingling with others, relaxed and a verbalization of confident nak
nga rumwaren
Nursing Diagnosis
Risk for infection related to bone marrow suppression secondary to chemotherapeutic agent
Nursing Inference
Cisplatin can kill both cancerous cells and other normal cells in the body. The normal
cells in the body that are most at risk for being killed by chemotherapy are those that are
growing at a fast rate. Since blood cells are dividing at a rapid rate, they are sometimes
destroyed by chemotherapy decreasing the production of blood cells,including WBC, leaving
people susceptible to infection.
Nursing Goal
After 2-3 hours of rendering interventions, the nurse will be able to minimize exposure to
microorganisms to the patient.
Nursing Interventions
Nursing Interventions

Rationale

1. Monitor changes or abnormalities in

CBC and vital signs (increased WBC,
increased body temp., increased pulse)

To render immediate action

2. Wash hands before and after handling

the patient

To prevent contamination of pathogens

3. Maintain asepsis for dressing changes,

and wound care, catheter care, etc.

To prevent transmitting of pathogens

4. Limit visitors

To reduce the risk of increase number of

microorganisms
in
the
patients
environment

5. Administer antibiotic as ordered

To prevent infection

6. Encourage a low-microbial diet (e.g.

cooked foods, no unwashed fresh fruits
and vegetables)

To reduce the risk of infection

Nursing Evaluation
After 3 hours of rendering interventions, the nurse was able to minimize exposure to
microorganisms to the patient.