Page 920 - Saunders Comprehensive Review For NCLEX-RN

E. Fatigue and nutrition

1. Assist the parents and child in selecting a well-
balanced diet.
2. Provide small meals that require little chewing and are
not irritating to the oral mucosa.
3. If the child cannot take oral feedings, parenteral
nutrition or enteral feedings may be prescribed.
4. Assist the child in self-care and mobility activities.
5. Allow adequate rest periods during care.
6. Do not perform nursing care activities unless they are
essential.
F. Chemotherapy
1. Monitor for severe bone marrow suppression;

during the period of greatest bone marrow
suppression (the nadir), blood cell counts are
extremely low.
2. Monitor for infection and bleeding.

3. Protect the child from life-threatening

infections.
4. Monitor for nausea, vomiting, and alteration in bowel
function.
5. Administer stool softeners as prescribed and if needed
to prevent straining if constipation occurs.
6. Provide rectal hygiene gently as needed.
7. Administer antiemetics before beginning
chemotherapy as prescribed.
8. Monitor for signs of dehydration.
9. Monitor for signs of hemorrhagic cystitis.
10. Monitor for signs of peripheral neuropathy.
11. Assess oral mucous membranes for mucositis;
administer frequent mouth rinses per agency
procedure and as prescribed to promote healing or
prevent infection (local oral anesthetics may also be
prescribed).
12. Instruct the parents and child in the signs and
symptoms to watch for after chemotherapy and when
to notify the primary health care provider (PHCP).
13. Inform the parents and child that hair loss may occur
from chemotherapy (hair regrows in about 3 to 6
months and may be a slightly different color or
texture).
14. Instruct the parents and child about the care of a
central venous access device, as necessary (see
Chapter 69).

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