Teach the patient and significant others about the course of the disease, the treatment options, and how to recognize complications. Explain that the patient or parents need to notify the physician if any of the following occur: fever, chills, cough, sore throat, increased bleeding or bruising, new onset of bone or abdominal pain. Discuss the patient's home environment to limit the risk of exposure to infections. Encourage the patient to avoid close contact with family pets because dogs, cats, and birds carry infections. Animal licks, bites, and scratches are sources of infection. The patient should not clean birdcages, litter boxes, or fish tanks. Additional sources of bacteria in the home include water in humidifiers, standing water in flower vases, and water in fish tanks. Encourage the patient to have air filters in furnaces and air conditioners changed weekly. Explain that raw fruits, vegetables, and uncooked meat carry bacteria and should be avoided. If the patient becomes injured, encourage the patient or significant others to apply pressure, use ice, and report excessive bleeding. Teach the patient to avoid blowing or picking the nose or straining at bowel movements to limit the risk of bleeding.
Explain the proper administration and potential side effects of any medications. Teach the patient how to manage pain with the prescribed analgesics and other side effects specific to each chemotherapeutic agent. Explain that the chemotherapy may cause weight loss, even anorexia. Encourage the patient to eat a diet high in calories and protein and to drink at least 2000 mL of fluids per day. If the chemotherapy leads to anorexia, encourage the patient to eat frequent, small meals several times a day. Arrange for a dietary consultation if needed before discharge. If the patient has oral lesions, teach the patient to use a soft toothbrush or cloth and to avoid hot, spicy foods and commercial mouthwashes, which can irritate mouth ulcers. Encourage the patient to take frequent rest periods during the day and to space activities with rest.
Urge the patient to maintain a realistic but positive attitude. The return to an independent lifestyle is possible with the efforts of a competent healthcare team and the patient's cooperation. Provide a list of referral agencies as appropriate, such as the American Cancer Society, hospice, and support groups.
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