Oncology Nursing
Chemotherapy and radiation safety, side effects, emergencies and screening
Handling chemotherapy safely
- Two pairs of chemo-tested gloves, impermeable gown, eye and face protection if splashing is possible.
- Closed-system transfer devices; spill kit available; dispose in hazardous waste.
- Body fluids may contain drug for ~48 h: gloves for handling them.
- Extravasation of a vesicant: stop the infusion, leave the catheter in, aspirate, follow the antidote protocol (e.g., dexrazoxane for anthracyclines; warm vs. cold packs depend on the drug), notify.
Side effects and care
- Neutropenia: blood counts lowest (nadir) ~7–14 days after chemo. Fever ≥100.4°F (38°C) = emergency: cultures and antibiotics within 1 hour.
- Low platelets: bleeding precautions.
- Nausea: give antiemetics before chemo (ondansetron, NK1 blockers, dexamethasone, olanzapine).
- Mouth sores: soft brush, saline or baking soda rinses, no alcohol mouthwash, soft bland foods.
- Fatigue (gentle exercise helps), hair loss, taste changes, neuropathy.
- Immunotherapy (checkpoint inhibitors): immune side effects (colitis, pneumonitis, hepatitis, thyroid problems): report diarrhea or cough early.
Radiation therapy
External beam
Patient is not radioactive. Skin: mild soap, lukewarm water, pat dry; don't wash off markings; no lotions, powders or deodorant on the area before treatment unless approved; avoid sun and heat.
Sealed implant (brachytherapy)
Patient emits radiation while it's in place: private room; limit time, keep distance (≥6 ft when possible), use shielding; no pregnant visitors or children. A dislodged implant: long-handled forceps into a lead container: never by hand.
Unsealed (e.g., radioactive iodine)
Body fluids are radioactive for days: flush twice, separate utensils and laundry, distance from others, as instructed.
Oncologic emergencies
| Tumor lysis syndrome | ↑ K⁺, ↑ uric acid, ↑ phosphate, ↓ calcium after treatment starts → hydration, allopurinol or rasburicase, cardiac monitoring |
| Hypercalcemia | Confusion, constipation, thirst → IV fluids, zoledronic acid or denosumab, calcitonin |
| Spinal cord compression | New back pain → weakness, bowel or bladder changes → steroids, imaging, radiation: emergency |
| Superior vena cava syndrome | Swelling of face, neck and arms, distended neck veins, dyspnea → raise HOB |
| Cardiac tamponade, SIADH, sepsis | See relevant pages |
Screening (USPSTF)
| Breast | Mammogram every 2 years, ages 40–74 (2024) |
| Cervical | 21–29: Pap every 3 yr. 30–65: HPV test every 5 yr, co-test every 5 yr, or Pap every 3 yr |
| Colorectal | Ages 45–75 |
| Lung | Yearly low-dose CT, ages 50–80, ≥20 pack-years, smoking now or quit within 15 years |
| Prostate | PSA: individual decision, ages 55–69 |