1 of 34

Management of Common Side Effects

Unit 1 Lesson 5

Contact info: info@nursesinternational.org

2 of 34

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 34

Introduction

Pediatric cancer treatment can cause various side effects that require careful management

Nursing assessment and intervention are important to help reduce the impact of these side effects

Age-appropriate education and open communication with patients and caregivers are essential

Contact info: info@nursesinternational.org

4 of 34

Student Learning Outcomes

At the end of this lesson, students will be able to:

Identify the common side effects of cancer treatment in pediatric patients

Describe the causes of side effects

Discuss the nursing assessment and treatment

Contact info: info@nursesinternational.org

5 of 34

Common Side Effects

Fevers
Skin concerns
Nausea and vomiting
Diarrhea and constipation
Fatigue
Knowledge deficit

Contact info: info@nursesinternational.org

6 of 34

Fevers

Increased body temperature above normal range

Criteria for fever

Oral temperature ≥38.3°C (101°F) or
≥38.0°C (100.4°F) for >1 hour

Causes

Chemotherapy-induced neutropenia
Infections

(St. Jude Children's Research Hospital,2023; Children's Hospital of Orange County, n.d.)

Contact info: info@nursesinternational.org

7 of 34

Nursing Management of Fevers

Monitor vital signs
Assess for signs of infection
Consider blood cultures before antibiotics
Administer antipyretics as prescribed
Encourage rest and hydration
Educate caregivers on when to seek medical attention

(St. Jude Children's Research Hospital,2023; Children's Hospital of Orange County, n.d.)

Contact info: info@nursesinternational.org

8 of 34

Case Study

A 6-year-old patient undergoing chemotherapy presents with a temperature of 38.5°C (101.3°F) for the past 2 hours. What should the nurse do next?

A. Administer antipyretics as prescribed, assess for infection and notify the HCT

B. Fever is a common side effect of chemotherapy and usually resolves itself

C. Immediately start broad-spectrum antibiotics

D. Discharge the patient and advise the caregivers how to monitor the fever at home

Contact info: info@nursesinternational.org

9 of 34

Skin Concerns

Indications

Visible skin changes
Patient-reported discomfort
Impaired quality of life

Causes

Chemotherapy
Radiation therapy
Targeted therapies

(American Cancer Society, 2017)

Various skin issues:

rashes
dryness
itching
pigmentation changes

Contact info: info@nursesinternational.org

10 of 34

Nursing Management of Skin Concerns

Assess skin integrity
Monitor for changes
Recommend gentle, fragrance-free skincare products
Encourage sunscreen use and protective clothing
Administer topical treatments or oral antihistamines as prescribed
Stress the need for cleanliness and good hygiene

(American Cancer Society, 2017; AAD, n.d.)

Contact info: info@nursesinternational.org

11 of 34

Critical Thinking Question

A pediatric patient receiving radiation therapy complains of itchy, dry skin in the treatment area. What should the nurse recommend?

A. Applying gentle, fragrance-free moisturizers to the affected area

B. Use of exfoliates to remove the dry skin

C. Expose the affected area to direct sunlight for Vitamin D

D. Ask the health cafe team to reduce the amount of radiation

Contact info: info@nursesinternational.org

12 of 34

Mucositis (Mouth, Gum, and Throat Sores)

Causes

Chemotherapy
Radiation therapy to the head and neck area

(Children's Hospital of Orange County, n.d.; National Cancer Institute, 2019)

Inflammation and ulceration of mucous membranes in the digestive tract

Indications

Pain
Redness
Swelling, or
Sores in the mouth, gums, or throat

Contact info: info@nursesinternational.org

13 of 34

Nursing Management of Mucositis

Assess severity using a validated scale (e.g., WHO Oral Mucositis Scale)
Encourage good oral hygiene practices
Administer pain relief medications as prescribed
Recommend soft, non-spicy, and non-acidic foods
Provide cryotherapy or low-level laser therapy as directed

(Children's Hospital of Orange County, n.d.; National Cancer Institute, 2019)

Contact info: info@nursesinternational.org

14 of 34

What Would the Nurse Do?

A 10-year-old patient undergoing chemotherapy reports pain and difficulty swallowing due to mouth sores. What interventions should the nurse prioritize?

A. Explain that this is a common side effect of chemotherapy and will subside after the treatment

B. Discourage the patient from br ushing their teeth too frequently to avoid irritating the sores

C. Rinse mouth with a diluted solution of water and lemon juice

D.Assess the severity of mucositis using a validated scale

Contact info: info@nursesinternational.org

15 of 34

Radiation Dermatitis (Skin Irritation)

Skin reaction caused by radiation therapy

Indications

Redness
Swelling
Itching
Peeling
Skin ulcers in the treatment area

Causes

Radiation therapy

(Children's Hospital of Orange County, n.d.)

Contact info: info@nursesinternational.org

16 of 34

Nursing Management of Radiation Dermatitis

Assess severity using a validated scale (e.g., RTOG scale)
Encourage gentle skin care practices
Recommend loose-fitting, soft clothing
Apply moisturizers or barrier creams as directed
Administer topical or systemic medications as prescribed

(Children's Hospital of Orange County, n.d.)

Contact info: info@nursesinternational.org

17 of 34

Nausea and Vomiting

Discomfort or unease in the stomach, urge to vomit
Indications

Client-reported nausea
Retching, or
Vomiting episodes

Causes

Stimulation of the vomiting center in the brain due to chemotherapy

(Yale Medicine, n.d.)

Contact info: info@nursesinternational.org

18 of 34

Nursing Management of Nausea and Vomiting

Administer antiemetic medications as prescribed
Encourage small, frequent meals
Avoid strong odors
Provide non-pharmacological interventions (relaxation techniques, distraction)
Educate age-appropriate children about why this is happening

(Yale Medicine, n.d.)

Contact info: info@nursesinternational.org

19 of 34

Case Study

An 8-year-old patient receiving chemotherapy experiences frequent episodes of nausea and vomiting. What should the nurse include in the patient's care plan?

A. Administer antiemetic medications as prescribed and encourage small, frequent meals�B. Withhold solid foods and offer clear liquids until the nausea subsides�C. Offer a variety of preferred foods to encourage the patient to eat�D. Encourage physical activity to distract the patient from nausea

Contact info: info@nursesinternational.org

20 of 34

Diarrhea

Frequent, loose, or watery bowel movements

Symptoms

Increase in stool frequency
Loose or watery stools
Abdominal cramps

Causes

Chemotherapy's effects on the gastrointestinal tract

(KidsHealth, 2018)

Contact info: info@nursesinternational.org

21 of 34

Nursing Management of Diarrhea

Monitor hydration status and electrolyte balance

Administer antidiarrheal medications as prescribed

Encourage a low-fiber, bland diet

Provide protective creams to prevent rectal sores

Educate patients and caregivers on proper toilet habits

(KidsHealth, 2018)

Contact info: info@nursesinternational.org

22 of 34

Critical Thinking Question

A 3-year-old patient undergoing chemotherapy has experienced a significant increase in loose, watery stools over the past 24 hours. What is the most appropriate nursing intervention?

A. Monitor hydration status and electrolyte balance

B. Encourage a high-fiber diet to promote bowel regularity

C. Administer laxatives to prevent constipation

D. Restrict fluid intake to minimize stool output

Contact info: info@nursesinternational.org

23 of 34

Constipation

Difficulty passing hard stool or infrequent bowel movements

Symptoms

Decreased stool frequency
Hard or lumpy stools
Straining during bowel movements

Causes

Chemotherapy's effects on the gastrointestinal tract
Medications
Decreased activity
Diet changes

(KidsHealth, 2018)

Contact info: info@nursesinternational.org

24 of 34

Nursing Management of Constipation

Monitor hydration status and electrolyte balance

Encourage regular physical activity and adequate fluid intake

Administer stool softeners or laxatives as prescribed

Educate patients and caregivers on proper toilet habits

(KidsHealth, 2018)

Contact info: info@nursesinternational.org

25 of 34

Fatigue

A persistent feeling of tiredness, weakness, and lack of energy

Symptoms

Client-reported fatigue
Decreased physical function, or
Impaired quality of life

Causes

Cumulative effects of therapy
Anemia
Emotional stress

(American Cancer Society, 2017)

Contact info: info@nursesinternational.org

26 of 34

Nursing Management of Fatigue

Assess severity and impact of fatigue on daily activities

Encourage regular rest periods and energy conservation techniques

Address contributing factors (pain, sleep disturbances, nutritional deficiencies)

Suggest play and pastime activities that do not require exertion

(American Cancer Society, 2017)

Contact info: info@nursesinternational.org

27 of 34

What Would the Nurse Do?

A 12-year-old patient reports persistent fatigue that interferes with their daily activities. What should the nurse include in the patient's care plan?

A. Encourage the patient to participate in strenuous exercise to build endurance�B. Inform the child and parents that fatigue is an expected side effect of treatment�C. Restrict the patient's rest periods to ensure the child will sleep the entire night

D.Assess the severity and impact of fatigue on daily activities

Contact info: info@nursesinternational.org

Answer: D

Explanation: When addressing fatigue in pediatric cancer patients, the nurse should assess the severity and impact of fatigue on daily activities, encourage regular rest periods and energy conservation techniques, address contributing factors (pain, sleep disturbances, nutritional deficiencies), and suggest play and pastime activities that do not require exertion. The nurse should also educate age-appropriate children about why fatigue is happening and that it is not usually permanent.Correct Answer: A. Assess the severity and impact of fatigue on daily activities.�Rationale: Assessing the severity and impact of fatigue allows the nurse to understand how it affects the patient's daily life and to develop an appropriate care plan. Encouraging strenuous exercise may worsen fatigue. Informing the child and parents that fatigue is expected does not address the need for assessment and intervention. Restricting rest periods is unlikely to be beneficial and may exacerbate fatigue.

28 of 34

Knowledge Deficit

A lack of understanding or knowledge regarding cancer treatment and side effects

Symptoms

Client or family saying they do not understand
Misconceptions
Asks questions about disease process or treatment
Non-adherence (not doing what they were instructed to do)

Causes

Lack of understanding about cancer treatment and its side effects

(St. Jude Children's Research Hospital, 2023)

Contact info: info@nursesinternational.org

29 of 34

Nursing Management of Knowledge Deficit

Assess client's and caregiver's understanding of the treatment plan and side effects
Provide age-appropriate education and resources

Picture books
Puzzles
Diagrams

Encourage open communication to address concerns or misconceptions
Collaborate with the multidisciplinary team to ensure consistent information
Use the teach-back technique to ensure understanding

(St. Jude Children's Research Hospital, 2023)

Contact info: info@nursesinternational.org

30 of 34

Critical Thinking Question

The parents of a 5-year-old patient express confusion and misconceptions about their child's cancer treatment plan. What is the most appropriate nursing intervention?

A. Use correct medical terminology to ensure the family understands

B. Limit the amount of information provided to avoid overwhelming the family

C. Direct the family to the reatment schedule

D.Provide age-appropriate education resources, such as picture books and diagrams

Contact info: info@nursesinternational.org

31 of 34

Red Flags: South Africa

Frequent missed or cancelled appointments

May indicate financial problems, transportation issues, or limited healthcare facilities.

Use of traditional medicine or alternative therapies alongside conventional cancer treatment.
Limited access to mental health services and support groups may impact the emotional well-being of pediatric cancer patients and their families.
In some communities, cancer may be associated with stigma or misconceptions, leading to delayed diagnosis or treatment avoidance.

Contact info: info@nursesinternational.org

32 of 34

References

American Academy of Dermatology Association (AAD). (n.d.). How to Relieve Itchy Skin. https://www.aad.org/public/everyday-care/itchy-skin/itch-relief/relieve-itchy-skin

American Cancer Society. (2017). Late Effects of Childhood Cancer Treatment. https://www.cancer.org/cancer/survivorship/children-with-cancer/late-effects-of-cancer-treatment.html

Children's Hospital of Orange County. (n.d.). Side Effects of Chemotherapy and Radiation in Children. https://www.choc.org/health-topics/side-effects-of-chemotherapy-and-radiation-in-children

Contact info: info@nursesinternational.org

33 of 34

References

KidsHealth. (2018). Late Effects of Cancer and Cancer Treatment. https://kidshealth.org/en/parents/late-effects.html

National Cancer Institute. (2019). Oral complications of chemotherapy and head/neck radiation (PDQ®)–Patient version. https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq

St. Jude Children's Research Hospital. (2023). Side Effects. https://together.stjude.org/en-us/diagnosis-treatment/side-effects.html

Yale Medicine. (n.d.). Pediatric Chemotherapy. https://www.yalemedicine.org/conditions/pediatric-chemotherapy

Contact info: info@nursesinternational.org

34 of 34

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org