Activity 22.2: Reflective practice

Consider the fact that cytotoxic drugs have most effect on the rapidly dividing cells in the body. The rapidly dividing cells are those of the bone marrow, gastrointestinal tract, skin and hair. What side effects will a person experience because of this? And what nursing interventions can help patients manage those side effects?

Bone marrow effects of chemotherapy include neutropenia (low neutrophils), anaemia (low red cells so less circulating haemoglobin) and a risk of bleeding from thrombocytopenia (low platelets). Collectively, this is referred to as ‘pancytopenia’.

To minimise the risks of infection, patients are advised the following:

  • Avoid crowded places and any ill people
  • Check their temperature if they feel unwell
  • Do not share food, drink cups, utensils or other personal items such as toothbrushes
  • Cook food well to kill any germs
  • Carefully wash raw fruits and vegetables
  • Protect skin from direct contact with pet bodily waster by wearing household vinyl gloves
  • Use gloves for gardening
  • Brush teeth with a soft toothbrush
  • Try to keep all household surfaces clean
  • Get the ‘flu vaccine

Skin and hair effects include alopecia and nails can show vertical lines or look bruised.

Effects on the gastrointestinal tract include mucositis, nausea and vomiting and diarrhoea.

Patients’ platelet count and haemoglobin levels are monitored closely when having chemotherapy.