Cancer Care, Immunological Disorders, and Infection Control

Cancer Care: The Nurse's Role in Medical-Surgical Settings

Cancer is one of the most common diagnoses nurses encounter in adult medical-surgical units. Your role spans assessment, patient education, symptom management, and rapid recognition of life-threatening complications. Two major treatment modalities you will support are chemotherapy and radiation therapy.

Side Effects of Chemotherapy

Chemotherapy drugs target rapidly dividing cells — which means cancer cells are affected, but so are healthy cells in the bone marrow, gastrointestinal tract, hair follicles, and mucous membranes. Key side effects and your nursing priorities include:

• Neutropenia: A drop in neutrophil count leaves patients highly vulnerable to infection. Monitor for fever (often the only sign of infection in an immunocompromised patient), institute neutropenic precautions when the absolute neutrophil count (ANC) falls below the threshold defined by your facility's policy, and report any temperature elevation promptly.
• Mucositis: Painful inflammation and ulceration of the oral and gastrointestinal mucosa. Perform oral assessments every shift, encourage gentle mouth rinses as ordered, and assess the patient's ability to eat and swallow safely.
• Nausea and vomiting: Administer antiemetics as scheduled — not just when nausea is severe. Monitor fluid and electrolyte balance and document intake and output carefully.
• Fatigue: Teach patients to prioritize activities, schedule rest periods, and report worsening fatigue, which can signal anemia or infection.
• Alopecia: Hair loss is usually temporary but can be emotionally distressing. Provide compassionate support and information about wigs, head coverings, and expected hair regrowth timelines.

Side Effects of Radiation Therapy

Radiation affects tissues within the treatment field. Local skin reactions (redness, dryness, peeling) are common; instruct patients to keep the skin clean, avoid harsh soaps and sun exposure in treated areas, and not remove skin markings without guidance. Fatigue is nearly universal. Depending on the site, patients may experience mucositis, dysphagia, diarrhea, or cystitis.

Oncological Emergencies

Rapid recognition and escalation are essential. Three emergencies you must know:

1. Septic Shock

Neutropenic patients who develop infection can deteriorate into septic shock rapidly. Signs include fever or hypothermia, tachycardia, hypotension, and altered mental status. Intervene immediately: notify the provider, obtain blood cultures before antibiotics are started, initiate IV access, and prepare for urgent fluid resuscitation and broad-spectrum antibiotic administration per order.

2. Tumor Lysis Syndrome (TLS)

When cancer cells die rapidly — often after chemotherapy — they release potassium, phosphate, and uric acid into the bloodstream. This causes hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia, which can lead to dangerous cardiac arrhythmias and acute kidney injury. Monitor lab values closely, maintain adequate hydration as ordered, and report abnormal electrolytes immediately.

3. Spinal Cord Compression

Tumors can press on the spinal cord, causing back pain (often the first symptom), weakness, numbness, or loss of bowel and bladder control. This is a medical emergency requiring immediate notification of the provider. Permanent paralysis can result if treatment is delayed.

Infection Control: Transmission-Based Precautions

All patient care begins with Standard Precautions — treating all blood, body fluids, non-intact skin, and mucous membranes as potentially infectious. Hand hygiene is the single most effective infection prevention measure.

When the route of transmission is known or suspected, Transmission-Based Precautions are added:

• Contact Precautions: For pathogens spread by direct or indirect contact (e.g., MRSA, C. difficile, wound infections). Wear gloves and a gown upon room entry. Dedicate equipment to the patient when possible.
• Droplet Precautions: For pathogens spread by large respiratory droplets (e.g., influenza, pertussis). Wear a surgical mask upon room entry; keep the patient in a private room or cohort with similar patients.
• Airborne Precautions: For pathogens spread by small airborne particles that can travel long distances (e.g., tuberculosis, measles, varicella). A fitted N95 respirator (or higher) is required, and the patient must be placed in an airborne infection isolation room (AIIR) — a negative-pressure room with the door kept closed.

Donning and Doffing PPE

Proper donning (putting on) and doffing (removing) sequences are critical to prevent self-contamination. The most contaminated item — the gown and gloves — are removed first during doffing. Hand hygiene is performed before donning and at each step of doffing. Errors in sequence during doffing are a common cause of healthcare-associated infections.

Neutropenic Precautions (Protective Isolation)

Patients with very low ANCs require protection from the environment. Key interventions include:

• Private room
• Strict hand hygiene by all staff and visitors
• Restricting visitors with active illness
• Avoiding raw or undercooked foods (low-microbial diet per facility policy)
• No fresh flowers or potted plants (which harbor mold and bacteria)
• Daily assessment of all potential infection sites (IV sites, mucous membranes, skin folds)

Patient and family education is essential: teach the signs of infection and when to call for help immediately.

Safety Priorities

Always perform hand hygiene before and after patient contact. Never bypass isolation precautions, even briefly. Confirm the correct precaution level is posted before entering any room. In cancer care, report any fever in a neutropenic patient as an emergency until proven otherwise.