• Standard of care = CHOP

(cyclophosphamide,
doxorubicin, vincristine,
prednisone)
• 21-day basis
• 6-8 cycles
• Hyper-CVAD
(cyclophosphamide, vincristine,
doxorubicin (Adriamycin),
dexamethasone)
• Course A: CVAD
• Course B: methotrexate,
cytarabine
• Smaller doses, more
frequently – minimize side
effects
 Trade & Generic Name Therapeutic Side Effects/ Nursing Considerations for this patient
Category
Cyclophosphamide (CPM) Alkylating agent, antineoplastic Marked leukopenia 8-15 days after initiation. Nausea, vomiting
(beginning about 6 hours after administration, lasting about 4
hours), alopecia. Obtain CBC weekly during therapy or until
maintenance dose is established. Monitor serum creatinine, BUN,
urine output, serum uric acid, electrolytes, WBC, hematologic
toxicity (fever, sore throat, signs of local infection, unusual
bleeding/bruising. Encourage copious fluid intake and frequent
voiding.
Dexamethasone Corticosteroid Insomnia, facial edema, moderate abdominal distention,
indigestion, increased appetite, nervousness, facial flushing,
diaphoresis. Monitor I&O, daily weight, serum glucose, Monitor for
edema. Monitor pattern of bowel activity. Evaluate food tolerance.
Must taper off gradually under medical supervision.
(Doxo) Antineoplastic Complete alopecia, nausea, vomiting, stomatitis, esophagitis,
reddish urine. Monitor for stomatitis. Observe IV site for infiltration,
Doxorubicin
vein irritation. Assess dermal creases, nail beds for
hyperpigmentation.

Leucovorin (LCV) Folic acid antagonist, antidote When combined with chemo agents: diarrhea, stomatitis, nausea,
vomiting, lethargy, malaise, fatigue, alopecia, anorexia. Monitor for
vomiting. Assess CBC with differential (also electrolytes, hepatic
function tests).

Pharmacology Reference:
Kizior, R., & Hodgson, B. (2015). Saunders Nursing Drug Handbook. Elsevier.
 1. Disturbed Body Image 2.Risk for Infection 3. Impaired Skin Integrity

Pt Initials: KC
Age: 9 y.o.
Medical diagnoses: Stage 3 ALCL,
chemotherapy, hx of asthma,
eczema

4. Risk for Impaired Gas Exchange 5. Risk for Nausea 6. Risk for Caregiver Strain

1. Disturbed Body Image r/t loss
of hair from chemotherapy
Supporting Data: verbal
preoccupation of hair, use of head
wrap, preoccupation on braiding
hair of toy dolls
Labs: (for chemo) CBC, AST (36
U/L), ALT (39 U/L)
Meds: (chemo) cyclophosamide
(CPM), dexamethasone, doxo,
leucovorin (Rescue)
2. Risk for Infection with IVAD,
cancer, receiving chemo meds
(locally and systemically)
Supporting Data: invasive IVAD,
chemo treatment (may suppress
immune system)
Labs: (for chemo) CBC, AST (36
U/L), ALT (39 U/L)
Meds: (chemo) cyclophosamide
(CPM), dexamethasone,
doxorubicin, leucovorin (Rescue),
Carafate (side effect of chemo
drug, ulcer)
3. Impaired Skin Integrity r/t dry
skin, eczema, possible pruritus
Supporting Data: possible
pruritus from chemo meds, hx of
eczema, presence of small dry
patches on skin
Labs: albumin (3.9 g/dL)
(nutritional status and healing)
Meds:
(antihistamine/ eczema)
hydroxyzine, triamcinolone

4. Risk for Impaired Gas
Exchange r/t asthma
Supporting Data: hx of asthma
Labs: hemoglobin level, peak flow
meter, pulse ox (O2 sat)
Meds: (respiratory) albuterol,
singulair, claritin
6. Risk for Caregiver Strain
5. Risk for Nausea r/t chemotherapy
Supporting Data:
side effects
grandmother has custody of
child. Grandmother was at
Supporting Data: side effects of
bedside, but left for an hour
chemo drugs
or so to pick up the patient’s 7
year old brother from school.
Labs: electrolytes (bicarbonate,
Patient displayed annoyance
potassium, sodium), monitor I&O
as grandmother left.
Bickering between the patient
Meds:
and grandmother occurred
(GI meds) ondansetron, Ativan,
before the grandmother’s
Benadryl
departure.
 Patient verbalizes positive outlook, including knowledge
Disturbed Body Image of possible hair growth after chemo treatment
completion, by end of hospitalization

Remain free of signs of redness from tape (locally)

Risk for Infection surrounding IVAD and free of increased temperature
throughout hospitalization (systemically)

Patient maintains skin integrity as evidenced by absence

Impaired Skin Integrity of redness and irritation at the end of each day of
hospitalization

Risk for Impaired Gas Exchange
Risk for Nausea
Risk for Caregiver Role Strain
Patient maintains optimal gas exchange as
evidenced by O2 sat >95% throughout
hospitalization
Client verbalizes decreased nausea and
reduction in number of episodes of vomiting
in 24 hours
Caregiver verbalizes positive feelings about
care, recipient, and their relationship by end
of hospitalization
Anaplastic Large Cell Lymphoma. Retrieved from
http://www.lymphoma.org/site/pp.asp?c=bkLTKaOQLmK8E&b=6300143
Getting the Facts. Retrieved from http://www.lymphoma.org/atf/cf/%7B0363cdd6-51b5-427b-
be48-e6af871acec9%7D/ANAPLASTIC10.PDF
Kizior, R., & Hodgson, B. (2015). Saunders Nursing Drug Handbook. Elsevier.
Lymphoma Facts. Retrieved from http://www.lymphomafacts.org/atf/cf/%7B72077738-DE58-
41DC-A481-2EB061EAEFA1%7D/Lymphoma_Facts.pdf
Sposito, A. P., Silva-Rodrigues, F. M., Sparapani, V. C., Pfeifer, L. I., de Lima, R. G., &
Nascimento, L. C. (2015). Coping Strategies Used by Hospitalized Children With Cancer
Undergoing Chemotherapy. Journal Of Nursing Scholarship, 47(2), 143-151. doi: 10.
1111/jnu.12126