Chapter 11
Oncology: Nursing management in cancer care
243
Continues on following page
Nursing interventions
i. Each day: change drinking water,
denture cleaning fluids and
respiratory equipment containing
water.
5. Assess intravenous sites every day for
evidence of infection:
a. Change peripheral short-term
intravenous sites every 72 hours.
b. Cleanse skin with an alcohol wipe
(70% w/w ethyl alcohol or 60%
v/v isopropyl alcohol) or povidone-
iodine before arterial puncture or
venipuncture.
c. Change central venous catheter
dressings every 48 hours.
d. Change all solutions and infusion
sets every 48 hours.
e. Use evidence-based guidelines
for care of peripheral and central
venous access devices.
6. Avoid intramuscular injections.
7. Avoid insertion of urinary catheters;
if catheters are necessary, use strict
aseptic technique.
8. Teach patient or family member to
administer granulocyte (or granulocyte-
macrophage) colony-stimulating factor
when prescribed.
9. Advise patient to avoid exposure
to animal excreta; discuss dental
procedures with physician; and avoid
vaginal or rectal manipulation during
sexual contact during period of
neutropenia (Marrs, 2006; Zitella et al.,
2006).
Rationale
i. Stagnant water is a source of
infection.
5. Nosocomial staphylococcal
septicaemia is closely associated with
intravenous catheters.
a. Incidence of infection is increased
when catheter is in place
.
72 hours.
b. An alcohol wipe and povidone-
iodine is effective against many
Gram-positive and Gram-negative
pathogens.
c. Allows observation of site and
removes source of contamination.
d. Once introduced into the system,
microorganisms are capable of
growing in infusion sets despite
replacement of container and high
flow rates.
e. Nursing research determines best
practice.
6. Reduces risk for skin abscesses.
7. Rates of infection greatly increase
after urinary catheterisation.
8. Granulocyte colony-stimulating factor
decreases the duration of neutropenia
and the potential for infection.
9. Minimises exposure to potential
sources of infection and disruption of
skin integrity.
Expected outcomes
Plan of Nurs ing Care
Care of patient with cancer
(
continued
)
CHART
11-4
Nursing interventions
1. In erythematous areas:
a. Avoid the use of soaps, cosmetics,
perfumes, powders, lotions and
ointments, deodorants.
b. Use only lukewarm water to bathe
the area.
c. Avoid rubbing or scratching the
area.
d. Avoid shaving the area with a
straight-edged razor.
e. Avoid applying hot-water bottles,
heating pads, ice and adhesive tape
to the area.
f. Avoid exposing the area to sunlight
or cold weather.
Rationale
1. Care to the affected areas must focus
on preventing further skin irritation,
drying and damage.
Expected outcomes
• Avoids use of soaps, powders and
other cosmetics on site of radiation
therapy.
• States rationale for special care of
skin.
• Exhibits minimal change in skin.
• Avoids trauma to affected skin
region (avoids shaving, constricting
and irritating clothing, extremes of
temperature, and use of adhesive
tape).
• Reports change in skin promptly.
• Demonstrates proper care of blistered
or open areas.
Nursing problem:
Impaired skin integrity: erythematous and wet desquamation reactions to radiation therapy
Goal:
Maintenance of skin integrity
