Educational use only. Drug cards are AI-assisted study material for NCLEX preparation.
Chemotherapy — general nursing principles
Mechanism of action
Cytotoxic chemotherapy agents kill rapidly dividing cells through DNA damage, mitotic spindle disruption, antimetabolite incorporation, or alkylation. The trade-off: they hit cancer cells AND every other rapidly dividing tissue — bone marrow, GI mucosa, hair follicles, gonads. Targeted therapies and immunotherapies have different mechanisms but share many supportive-care principles.
Adverse effects
Life-threatening / NCLEX-tested
- Severe bone marrow suppression — neutropenic fever is a life-threatening emergency
- Tumor lysis syndrome — high uric acid, K+, phosphate, low calcium → AKI; prevent with hydration ± allopurinol/rasburicase
- Severe nausea, vomiting, mucositis, diarrhea
- Cardiotoxicity (anthracyclines like doxorubicin), pulmonary toxicity (bleomycin), neurotoxicity (vincristine, platinum agents), nephrotoxicity (cisplatin), hemorrhagic cystitis (cyclophosphamide — give mesna)
- Extravasation of vesicants (doxorubicin, vincristine) → severe tissue necrosis
- Secondary malignancies, infertility
- Severe immunosuppression with risk of opportunistic infection
Side effects
Common — what to teach
- Alopecia (hair regrows; reassure, offer scalp cooling where available)
- Fatigue (often the most disabling symptom)
- Taste changes, anorexia, weight loss
- Mild peripheral neuropathy
- Skin and nail changes
- Cognitive complaints ("chemo brain")
Food & drug interactions
Live vaccines are contraindicated during and immediately after most regimens. NSAIDs and anticoagulants compound bleeding risk during thrombocytopenia. Many chemo agents are CYP3A4 substrates — review interactions on every course. Avoid grapefruit. Strict isolation precautions for caregivers around body fluids during the active excretion window (typically 48 hours after IV chemo).
Nursing implications
Assessment, monitoring, patient teaching
- Nurse certification: only chemotherapy-certified nurses should hand-administer cytotoxic agents (ONS/ONCC chemo provider card)
- Personal protective equipment: chemo-rated gown, double gloves, eye/face protection; closed-system transfer devices (CSTDs) when available
- Verify two patient identifiers, drug, dose, route, schedule, lab parameters (ANC, platelets), height/weight/BSA, and consent — independent two-nurse verification on every dose
- Vesicant infusions: central line preferred; check blood return every 5 minutes during peripheral push; STOP infusion at any sign of infiltration and follow extravasation protocol (cold or warm compress depending on agent; antidote per drug)
- Monitor CBC, CMP, electrolytes, uric acid before each cycle; teach patients to call for fever (≥ 38.0 °C / 100.4 °F)
- Tumor lysis prophylaxis: aggressive IV hydration, allopurinol or rasburicase, monitor electrolytes and renal function for the first 5–7 days after high-bulk regimens
- Antiemetic regimen tailored to emetogenic potential (5-HT3 + dexamethasone + NK1 antagonist for high-risk regimens)
- Counsel on neutropenic precautions, mouth care for mucositis, fertility preservation discussion, and contraception during and for months after treatment (teratogenicity)
When to hold / contraindications
- ANC below regimen-specific threshold (commonly < 1.5 × 10⁹/L for cytotoxic chemo)
- Platelet count below regimen-specific threshold (commonly < 100 × 10⁹/L)
- Any active major infection — treat first
- Significant organ dysfunction (LFTs, creatinine, ejection fraction) per regimen
- Active extravasation — stop, start protocol, do not restart at the same site
- Pregnancy (most regimens are teratogenic; discuss in detail before starting)
Memory anchor
Chemotherapy hits "the four fasts" — bone marrow, GI mucosa, hair follicles, germ cells. ANC, platelets, fever-call rule (≥ 38 °C → call), and tumor-lysis hydration are the daily lookouts.
Practice Chemotherapy questions
Test your recall on real NCLEX-style pharmacology questions — with full rationales and an AI Coach for the parts you miss.