The oncology clinical nurse specialist (CNS) is asked to develop a staff development program for

registered nurses who will be administering chemotherapeutic agents. Because the nurses will
be administering a variety of chemotherapeutic drugs to oncology patients, the CNS plans on
presenting an overview of agents, classifications, and special precautions related to the safe
handling and administration of these drugs.

1. What does the CNS describe as the goals of chemotherapy?

The goals of chemotherapy are:

 To eliminate cancer cells until they are no longer detected in your body.
 To relieve symptoms of advanced cancer
 To slow or stop the growth of rapidly dividing cancer cells in the body.
 To destroy cancer cells and slowing the growth of cancer cells
 To ease cancer symptoms  that are causing pain or pressure.

2. How should the CNS respond to the following question: “Why do patients require
rounds of chemotherapeutic drugs, including different drugs and varying intervals?”

The length of chemotherapy treatment is determined by a variety of factors.  These include

the type of cancer, the extent of cancer, the types of drugs that are given, as well as the
expected toxicities of the drugs and the amount of time necessary to recover from these
toxicities.  Many chemotherapy treatment schedules (including the type and length of
chemotherapy treatment) have been determined through clinical trials that compared them
and determined which had the most benefit and was most well tolerated. Most chemotherapy
treatments are given in repeating cycles. The length of a cycle depends on the treatment being
given. Most cycles range from 2 to 6 weeks. The number of treatment doses scheduled within
each cycle also varies depending on the drugs being given. Cancer patients are given different
types and combination of chemo drugs based on the type and stage of cancer. Cycles are
planned in a way that allows the drugs to effectively attack the cancer, while also providing
time for normal cells to rest and recover from damage. Chemo is given in a series of treatment
periods known as chemo-cycles. During a cycle chemo is given several times in pre-decided
intervals. The schedule used for specific patients with specific cancers varies greatly. Sessions
may be held every other day or may be divided by weeks. The interval between two chemo
treatments helps the patient to recover from side effects of chemo drugs and produce new
healthy cells.

3. In teaching about the administration of chemotherapeutic agents, what signs of

extravasation should the nurse include?
 Extravasation is the inadvertent instillation or leakage of vesicant material into the
perivascular and subcutaneous spaces during medication administration.  Extravasation results
in local reactions ranging from local irritation to severe tissue necrosis of the skin, surrounding
vasculature, and supporting structures. Extravasation is the inadvertent leaking of an IV fluid
into the subcutaneous tissue. Tissue damage can range from mild discomfort to severe tissue
destruction. Extravasation during administration chemotherapeutic agents is suspected if one
or more of the following signs is observed during or immediately after the injection. The signs
and symptoms may include no blood return from the IV catheter, resistance to flow of IV fluids,
and swelling, pain, or redness at the insertion site. If induration, swelling or leakage is observed
at the injection site. If resistance is felt on syringe plunger during administration. Tissue
necrosis is possible. The damage related to a vesicant extravasation may take weeks to become
fully apparent

4. What clinical manifestations of myelosuppression, secondary to chemotherapy

administration, should the CNS include in this program?

Myelosuppression, or also known as bone marrow suppression are typically occurs 7 to 14

days following the administration of chemotherapy. Myelosuppression in patients receiving
chemotherapy for CRC may manifest as neutropenia, thrombocytopenia, or anemia. It is a
common side effect of chemotherapy that is characterized by a decrease in blood cell
production. Clinical manifestations of myelosuppression secondary to chemotherapy
administration include:
1. A decrease in red blood cells, this type of myelosupprssion is called anemia.
2. A drop in a specific type of white blood cells known as neutrophils, this type of
myelosuppression is called neutropenia.
3. A drop in platelet count, this type of myelosuppression is called thrombocytopenia. The
patient should be monitored for any signs of bleeding and/or infection, including fever. If you
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