Nursing · Adult clinical nursing
A fever after chemotherapy is an emergency, and the patient carries almost all the information
Cancer is among the leading causes of death worldwide and a substantial share of people will be diagnosed during their lives — but most of them are not on a cancer ward. They arrive at emergency departments with fever, at medical wards with breathlessness, at surgical wards for unrelated operations, and at community services for everything. So this is knowledge generalists need. A large fraction of cancer is preventable, several of the commonest are caused by infections that can be vaccinated against, and several are highly curable when found early and largely incurable once spread — which makes taking a vague symptom seriously one of the highest-value acts in the subject. And the treatment is decided in a clinic while what the person actually lives through is managed by nurses: sickness, mouth ulcers, exhaustion, fear, money running out, hair gone, and the complications that kill within hours.
Cancer is among the leading causes of death worldwide and a substantial proportion of people will be diagnosed with it during their lives. Whatever ward a nurse works on, a share of the patients there either have cancer, are being investigated for it, or have survived it.
People with cancer present to emergency departments with fever, to medical wards with breathlessness, to surgical wards for unrelated operations, and to community services for everything. The specialist knowledge is needed by generalists, which is the argument for this manual existing.
Tobacco, infection, alcohol, weight, and sun exposure account for a large fraction of cancers worldwide, and several of the commonest are caused by infections that can be vaccinated against. Prevention is not a separate subject from treatment; it is the part with the largest possible effect.
Several common cancers are highly curable when found while still confined and largely incurable once spread. That single fact is why screening, and why taking a vague symptom seriously, carries more weight in this subject than almost anything done in a treatment room.
The treatment is decided in a clinic and delivered over months, and what the person actually lives through — sickness, mouth ulcers, exhaustion, fear, money running out, hair gone — is managed by nurses. So is the recognition of the complications that kill.
Normal cells divide when instructed and stop when instructed. Cancer arises when accumulated damage to the controlling genes removes those limits, so the cells keep dividing, ignore signals to die, and invade the tissue around them.
One genetic change is almost never enough; cancer usually requires several accumulated over years, which explains why most cancers occur with increasing age and why exposure long ago can cause disease now. It also explains why removing an exposure still helps.
A benign growth enlarges locally and does not invade or spread, though it can still cause serious harm by pressing on something important. Malignant means it invades surrounding tissue and can travel, and that capacity to travel is what makes it lethal.
Cancers arising in different tissues behave differently, respond to different treatments and carry different outlooks, so the word cancer describes a category rather than a condition. Two patients with the same word on their notes may have almost nothing in common.
Cancers of blood-forming and lymphatic tissue present as fatigue, infection, bruising, night sweats, weight loss and swollen glands rather than as a mass. Somebody looking for a lump will miss them entirely.
Cancer extends directly into neighbouring tissue, travels through lymphatic channels to lymph nodes, and travels in the blood to distant organs. Knowing those three routes explains why lymph nodes are examined and removed and why particular organs are scanned.
Different cancers spread to characteristic places — bone, liver, lung and brain being the commonest destinations. That is why a person with a cancer history who develops back pain, jaundice, breathlessness or headache is investigated rather than reassured.
A cancer that began in the breast and has reached the bone is still breast cancer and is treated as such. Patients frequently understand it as having developed a second disease, and correcting that gently changes how they understand their treatment.
Cancer confined to its origin is usually treated with the intention of cure. Once it has spread widely, treatment usually aims to control it and to preserve life and comfort, and the aim being different is something the patient must actually be told in words.
A growing mass obstructs a bowel, a bile duct, an airway or a ureter, or presses on the spinal cord or a major vein. A large share of the emergencies in this subject are mechanical consequences of something growing in a confined space.
Smoking causes a large share of cancer deaths and is implicated in cancers well beyond the lung — bladder, kidney, pancreas, mouth, throat and more. Nothing else available to a nurse in a brief conversation has the same potential effect.
Several common cancers are caused by chronic infection, including cervical cancer, liver cancer and some stomach cancers. Vaccination and treatment of those infections prevent cancer directly, which makes immunisation programmes cancer prevention.
Alcohol causes cancer at several sites, raised body weight is linked to many, and inactivity contributes. These are diffuse, unglamorous risks that together account for a great deal, and they are the ones patients least expect to hear.
Ultraviolet exposure causes skin cancer, and a long list of occupational and environmental exposures cause specific cancers in people who were frequently never told. Asking what somebody has worked with for thirty years is a real clinical question.
A minority of cancers run strongly in families through inherited genetic faults, and identifying those families allows surveillance or preventive action. Several cancers in close relatives, at young ages, is the pattern that should prompt asking further.
Screening tests apparently well people to find cancer or pre-cancer early enough to change the outcome. It only makes sense where the disease is common enough, the test is good enough, and treating it early actually helps.
Cervical screening prevents cancer rather than merely detecting it, by finding changes before they become malignant. Breast and bowel screening find cancers at curable stages. These three account for most of the benefit worldwide.
An abnormal screening result means further tests are needed, not that cancer is present, and a great deal of avoidable terror comes from people not being told that clearly. Explaining it at the moment of the letter is genuinely valuable work.
Uptake is lowest among poorer people, people who speak a different language, people with disabilities and those with the worst access to care — which is to say among those at highest risk. Improving attendance is a bigger win than improving the test.
Screening finds some abnormalities that would never have caused harm, leading to treatment nobody needed, and it misses some cancers. An honest account of both is what allows somebody to make a real choice rather than comply with an instruction.
Any new lump that persists, grows, or is hard and fixed warrants assessment, and the commonest reason for delay is the person deciding it is probably nothing. Most lumps are indeed nothing, which is exactly why the ones that matter are dismissed.
Blood in urine, in stool, coughed up, from the vagina between periods or after the menopause, or from a nipple. All of these have benign causes and all require explanation rather than assumption, and postmenopausal bleeding in particular is never normal.
A cough for weeks, a hoarse voice, altered bowel habit, difficulty swallowing, indigestion that is new and persistent, a sore that does not heal, a mole that has changed. The pattern is persistence and change rather than severity.
Losing weight without trying, particularly with fatigue or night sweats, is a serious symptom that is regularly welcomed by the patient and overlooked by everybody else. Asking whether weight loss was intended takes one sentence.
Fear, cost, distance, not wanting to waste anybody's time, family responsibilities, and previous experiences of being dismissed. A nurse who understands why somebody waited eight months is better placed to make sure the next person does not.
Scans show a mass; only examining cells or tissue establishes what it is. That is why a biopsy is necessary before treatment, and why a patient who has had a scan does not yet have a diagnosis however certain everybody sounds.
Imaging shows where it is and whether it has spread, blood tests show organ function and sometimes markers, and the biopsy identifies the type. Explaining which question each test answers reduces the sense of endless unexplained procedures.
Patients consistently describe the period between suspicion and diagnosis as harder than treatment. Telling somebody when they will hear, by what means, and who to contact if they do not, is the single most useful intervention during it.
Patients assume that not being contacted means nothing was found, and results have been lost that way. A system where somebody is told the result either way, and knows they will be, prevents a specific and serious kind of harm.
An urgent referral is understood as a diagnosis. Saying plainly that most people referred urgently do not turn out to have cancer, while still taking it seriously, is honest and it helps.
Staging describes the size of the tumour, whether lymph nodes are involved, and whether it has spread to distant organs. Almost every decision about treatment and every statement about outlook follows from it.
Early stage disease is usually treated to cure, late stage usually to control. Patients and their families frequently do not know which of those is being attempted, and that is the most important thing they could know.
Grade describes how abnormal the cells look and how fast they are likely to behave, which is separate from how far the disease has spread. A small, high-grade cancer and a large, low-grade one are different problems.
Many cancers are tested for particular features that predict response to specific treatments, which is why treatment sometimes waits for results that seem to take a long time. Explaining that the delay is buying a better-targeted treatment helps.
Survival statistics describe what happened to large numbers of people diagnosed years ago and treated with what was available then. They do not predict an individual, and offering them as though they did causes avoidable despair.
Beginning by asking what they understand so far reveals whether they are expecting this, what words they use, and what they most fear. It also prevents delivering a diagnosis to somebody who was told it yesterday and did not absorb it.
People differ enormously in how much detail they want and when, and both extremes are legitimate. Asking, rather than deciding on their behalf, is the difference between information and assault.
Once the word cancer is said, very little that follows is retained. That is why the important information is repeated at a later conversation, written down, and given to somebody who was in the room with them.
The instinct to fill a silence with reassurance or with facts removes the space the person needs. Sitting quietly, and not leaving, is a skilled response rather than an absence of one.
In many families and cultures information is managed collectively, and in some the patient is expected not to be told directly. Navigating that while preserving the patient's own right to know what they want to know requires care rather than a rule.
Cancer surgery aims to remove the tumour with a rim of normal tissue around it, because cancer extends microscopically beyond what can be seen. Whether that margin was clear is one of the most important results afterwards.
Nodes are examined to establish whether the disease has spread, which determines what treatment follows. Removing many nodes can cause lasting swelling of the limb, which is why fewer are taken where that is possible.
Lymph fluid that cannot drain causes a swollen, heavy limb that is prone to infection and is largely irreversible once established. Prevention advice, skin care and early reporting of swelling actually matter, and are frequently given once and never again.
Cancer patients undergoing surgery are frequently older, malnourished, anaemic and immunosuppressed by other treatment, so the ordinary risks are higher. Nutrition and correcting anaemia before an operation are real interventions.
An operation may remove a breast, leave a stoma, alter a voice or change how somebody eats. Preparing for that, and arranging to be seen by whoever teaches the new skill, is part of the surgery rather than something afterwards.
Chemotherapy damages cells that are dividing rapidly, which is why it works on cancer and why it also harms bone marrow, the lining of the gut and mouth, and hair follicles. Every major side effect follows from that one mechanism.
Treatment is spaced to allow normal tissues, particularly bone marrow, to recover between doses. That is also why blood counts are checked before each cycle and why treatment is sometimes delayed, which patients experience as a setback rather than as safety.
It may be given to cure, to shrink a tumour before surgery, to reduce the chance of recurrence after surgery, or to control advanced disease. These are entirely different situations and the patient should know which one applies to them.
Several agents with different mechanisms are usually combined, because cancer cells resistant to one may not be resistant to another. It also means the side effect profile is the sum of several, which is why regimens differ so much in tolerability.
A cancer that responded may stop responding as resistant cells are selected out, which is why treatment is changed rather than continued. Explaining that in advance prevents a change of treatment being understood as a personal failure.
Many are toxic, irritant or carcinogenic, so preparation, administration, spill management and disposal follow specific procedures and use specific protective equipment. This protects the nurse, and it is not optional or excessive.
Staff who are pregnant, breastfeeding or trying to conceive have particular precautions regarding handling these agents. Knowing the local policy, and feeling able to say so without difficulty, is a legitimate expectation.
Some agents cause severe tissue destruction if they leak out of a vein, producing ulceration that may need surgery. Any pain, burning, swelling or resistance during an infusion means stopping immediately rather than flushing and continuing.
Wrong agent, wrong dose, wrong route and wrong patient in this field cause death rather than inconvenience, and some agents are fatal if given by the wrong route. This is why independent checking exists, and why being interrupted during it is a safety issue.
Some agents cause reactions during administration — flushing, breathlessness, rash, back pain, a fall in blood pressure. Recognising it, stopping the infusion and summoning help is why somebody stays nearby during the early part of a first dose.
Chemotherapy suppresses the white cells that fight bacteria, so an infection can progress to overwhelming sepsis within hours with very few visible signs. This is the emergency every nurse in every setting must recognise, not only those in cancer services.
In somebody who has had chemotherapy recently, a fever is treated as an emergency requiring immediate assessment and antibiotics without waiting for a source to be found or for blood results. Hours matter, and so does not sending them to wait.
Without white cells there may be no pus, no redness, no crackles and no obvious focus, because the visible signs of infection are largely produced by the white cells that are missing. A well-looking patient with a fever is still an emergency.
Some patients become septic without a fever, presenting as shivering, confusion, a fast pulse, low blood pressure or simply feeling dreadful. A recently treated patient who says something is wrong is believed and assessed.
People receiving chemotherapy need to know, in writing, that a fever or feeling unwell means contacting the service immediately, day or night, and who to call. A patient who waited until morning because they did not want to trouble anybody is a system failure.
Anti-sickness treatment given before chemotherapy and continued on schedule works far better than treatment given once vomiting has started. A patient told to take it only if needed will suffer unnecessarily, and that instruction is given surprisingly often.
After a bad experience, some people become nauseated before treatment even begins, triggered by the sight or smell of the unit. It is a learned response, it is not imaginary, and preventing sickness on the first cycle prevents it entirely.
Some agents cause sickness days afterwards, when the patient is at home and has run out of tablets. Asking about the days after, rather than only the day of treatment, finds this.
Persistent vomiting causes dehydration, kidney injury and salt disturbance, and in somebody already unwell that escalates quickly. Being unable to keep fluids down is a reason to come in rather than to persevere.
Small frequent amounts, cold or bland food, avoiding cooking smells, ginger, fresh air, and not lying flat immediately after eating. These are not a substitute for treatment and they matter to the person living through it.
Chemotherapy and radiotherapy damage the lining of the mouth, producing ulceration that makes eating, drinking and swallowing tablets painful. It also becomes a route for infection, which is why mouth care is a clinical intervention rather than hygiene.
Regular gentle cleaning, a soft brush, avoiding alcohol-based rinses and dry irritating foods, and starting before soreness begins. Prevention here directly affects whether somebody can complete their treatment.
Damage to the gut lining causes diarrhoea with dehydration risk, while several anti-sickness agents and pain treatments cause constipation severe enough to require admission. Both need asking about specifically, because neither is volunteered.
Dryness, rashes, sensitivity to sunlight, discoloured or lifting nails, and painful palms and soles with certain agents. Knowing these in advance turns a frightening development into an expected one, and some need reporting promptly.
Any break in the skin or mouth lining in an immunosuppressed person is a route for serious infection. That reframes a cracked lip, a torn cuticle or a pressure area as something more than a minor problem.
Losing hair makes an invisible illness visible to everybody, removes control over who knows, and is consistently rated among the most distressing effects. Treating it as a minor cosmetic matter tells the patient their distress is unreasonable.
Eyebrows, eyelashes and body hair are also lost, which changes the face in a way people are not prepared for. Saying so in advance, rather than letting them discover it, is the point.
Cutting hair short before it falls, arranging a wig or covering beforehand, and deciding who to tell gives back some control. Most of the value is in doing it early.
Hair usually returns, sometimes a different colour or texture, and the wait feels much longer than it is described as being. An honest timeframe is better than a vague reassurance.
Weight gain or loss, scars, a stoma, swelling, early menopause, changed skin. Asking how somebody feels about how they look is a question rarely asked and frequently welcomed.
Radiation damages the genetic material of cells in a targeted area, given in small daily fractions over weeks so that normal tissue recovers between treatments. The side effects are therefore local to the area treated, which is the key to anticipating them.
Radiation to the pelvis causes bowel and bladder symptoms, to the chest causes swallowing difficulty and cough, to the head causes mouth and taste changes and hair loss in that area. Knowing the field tells you what to expect.
The skin becomes red, dry, sore and sometimes breaks down. It is cared for with gentle washing, avoiding friction, perfumed products and sun, and following the specific local advice, which differs between centres.
Tiredness builds through a course and continues for weeks after it finishes, and is frequently worse than patients were led to expect. Daily travel to appointments for six weeks adds substantially to it.
Patients and families frequently believe they are dangerous to be near, particularly to children, after external radiotherapy. They are not, and saying so plainly resolves real distress. Internal sources are a different situation with specific precautions.
Newer treatments act on particular features of cancer cells or on particular signals they depend on, which is why the cancer is tested first and why they only work in people whose cancer carries that feature. This is why treatment is personalised.
These agents cause rashes, diarrhoea, blood pressure changes, wound healing problems and specific organ effects rather than the classic pattern of chemotherapy. A nurse expecting low blood counts and hair loss will not recognise them.
Some treatments work by removing the brakes on the immune system, which can then attack normal organs — bowel, liver, skin, lungs, and hormone glands. These effects can appear months after treatment and can be severe.
Because an immune effect can involve almost any organ, a new symptom in somebody on these treatments is reported rather than attributed to something else. Diarrhoea in particular is taken seriously rather than managed at home.
Many of these are oral treatments taken at home, which shifts monitoring, adherence and side effect recognition onto the patient. They are as hazardous as an infusion and are frequently treated by everybody as ordinary medicine.
Cancer in the spine can compress the cord, causing back pain, leg weakness, numbness and bladder or bowel disturbance. Function lost is frequently not recovered, so this is recognised and treated within hours rather than days.
A tumour in the chest can obstruct the large vein returning blood from the head and arms, producing facial and arm swelling, distended veins, breathlessness and headache worse on lying down or bending. It is urgent.
Cancer can raise blood calcium, causing thirst, constipation, nausea, confusion and drowsiness, and it is easily mistaken for disease progression or for the effect of pain treatment. It is treatable, and missing it costs somebody weeks of clarity.
When a treatment destroys a large volume of cancer rapidly, the contents released can damage the kidneys and disturb the heart's rhythm. Patients at risk are identified beforehand, hydrated, and monitored closely.
Cancer raises the risk of clots substantially, and low platelets from treatment raise the risk of bleeding, sometimes in the same patient. A swollen calf, sudden breathlessness, or unexplained bruising all require prompt attention.
Most cancer pain can be well controlled with available treatments used properly, and the commonest reasons it is not are underprescribing, irregular dosing, and fear of dependence held by patients, families and staff alike.
Pain that is present most of the time is treated with regular doses so that it does not return, with additional doses available for breakthrough. Waiting until pain is severe means chasing it rather than controlling it.
Patients hide pain because they fear becoming addicted or because they believe strong treatment means the end is near. Both beliefs are extremely common, both are addressable in a short conversation, and both cause real suffering.
Bone pain, nerve pain from a tumour pressing on a nerve, and pain from a swollen organ respond to different approaches, so describing the character of the pain guides treatment more than its score does.
Radiotherapy to a painful bone deposit, a nerve block, positioning, a cushion, treating the constipation, and reducing fear all reduce pain measurably. A plan consisting only of tablets is an incomplete plan.
Advanced cancer causes a wasting process in which muscle is lost regardless of intake, so it is not solved by encouraging somebody to eat more, and pressing them to do so causes conflict and guilt in families.
Food tastes metallic, wrong, or of nothing, and favourite foods become intolerable. Suggesting cold food, stronger flavours, small amounts often, and whatever they can actually face is more useful than a balanced meal plan.
Families express love by feeding, so refusal of food is experienced as refusal of care and becomes a source of real distress. Naming that out loud, with both of them present, relieves more than any supplement.
Difficulty swallowing from a tumour, a sore mouth or treatment to the throat is a mechanical problem needing assessment rather than encouragement, and the risk of food entering the lungs is real.
Activity within tolerance maintains muscle, appetite, mood and independence through treatment, and the instinct to rest completely accelerates decline. Modest, regular movement is a genuine recommendation rather than an aspiration.
Chemotherapy lowers white cells, causing infection risk; red cells, causing anaemia with fatigue and breathlessness; and platelets, causing bruising and bleeding. Knowing which is low tells you what to watch for.
Counts typically fall to their lowest around a week to two after treatment and then recover, which is when patients are most vulnerable and most likely to be at home. Telling them when to be most careful is specific and useful.
Fatigue, breathlessness and dizziness from a low red cell count limit what somebody can do, and correcting it changes their week. It is frequently tolerated longer than it needs to be.
Giving the wrong blood kills, which is why identity checking at the bedside is done rigorously every time and why reactions are watched for during the early minutes. Familiarity is the enemy of this check.
With very low platelets, a soft toothbrush, no sharp razors, avoiding constipation and straining, and reporting nosebleeds, gum bleeding or new bruising. Simple, specific, and rarely explained in enough detail.
Many treatments damage small veins or are needed over long periods, so a line into a large central vein is placed. It spares the patient repeated cannulation and makes blood sampling possible without further needles.
A line is a direct route into the bloodstream, and infection through it in an immunosuppressed patient is life-threatening. Hand hygiene, cleaning the hub and not using it unnecessarily are the interventions that prevent it.
In a patient with a central line, fever raises the possibility of line infection and samples are usually taken from the line as well as peripherally. The line is not removed reflexively, but the possibility is actively considered.
A line that will not flush, leaks, or has a visible split is not forced. Forcing a blocked line can dislodge a clot or rupture the catheter, and both have serious consequences.
Patients manage lines at home — keeping the dressing dry, protecting it, recognising problems. What they are taught, and whether they were watched doing it rather than told, determines whether it lasts.
Chemotherapy and radiotherapy can cause permanent infertility and early menopause, and options to preserve fertility exist but must be arranged before treatment starts. A conversation not had in that window cannot be had later.
Younger patients, and particularly those who are unwell or frightened, are often not asked, and afterwards it is a specific and lasting grief. Raising it, even briefly, even when the answer is no, is part of the care.
Pregnancy during treatment carries serious risks to a fetus, so contraception is necessary even where fertility seems unlikely, and the necessity is regularly not explained. Assumptions about who needs this conversation are frequently wrong.
Pain, dryness, loss of desire, erectile difficulty, altered body image and fear of causing harm all affect intimacy, and almost nobody raises it. A single matter-of-fact question gives permission for a conversation the person wanted.
Treatment-induced menopause arrives abruptly rather than gradually, with intense symptoms and accelerated bone loss, in somebody who was not expecting it for twenty years. It deserves its own explanation and its own management.
Childhood cancers are mostly different diseases from adult ones, and many are highly curable with intensive treatment. That changes the whole tone: the treatment is aggressive because cure is genuinely expected.
Childhood cancer survival differs dramatically between wealthy and poorer countries, largely because of late presentation, abandonment of treatment for cost or distance reasons, and lack of supportive care. Most of that gap is not about drugs.
Children cope better with honest, age-appropriate information than with being protected from it, and they invariably know something serious is happening. What they imagine is usually worse than what is true.
Siblings, income, schooling, and the parents' relationship all take the strain, frequently for years. Asking about the siblings is one of the most appreciated questions a nurse can ask.
Children cured of cancer carry lifelong risks from the treatment — to growth, fertility, heart, hearing, learning and second cancers. Long-term follow-up is part of the cure, and it is where many are lost.
Recognising that further anti-cancer treatment will not help, and saying so, is frequently postponed until the patient is too unwell to use the time. An earlier honest conversation gives somebody choices they would otherwise never get.
Patients hear that nothing more can be done and understand themselves to be abandoned. The distinction between stopping treatment aimed at the cancer and continuing everything aimed at the person has to be made explicitly and repeatedly.
Being at home, attending a wedding, avoiding hospital, being able to think clearly, seeing a particular person. Without asking, the plan gets built around numbers rather than around the remaining life.
Pain, breathlessness, sickness, agitation and constipation are treated as vigorously at this stage as at any other, and frequently more so. The idea that treatment has stopped is precisely what causes symptoms to go unmanaged.
Hope for cure becomes hope for time, for comfort, for being at home, for a good death. Somebody who is told there is no hope has been told something untrue as well as cruel.
Cancer treatment causes financial catastrophe for families in much of the world, through direct costs, travel, and lost income of both patient and carer. That is a clinical problem, because it determines whether treatment is completed.
People who stop attending are recorded as having abandoned treatment when in fact they ran out of money or could not make the journey. Asking directly about cost and travel, early and without judgement, is what allows it to be addressed.
Many treatments described in textbooks are unavailable in most of the world, and pain relief in particular is inaccessible in many countries where strong analgesia is tightly restricted. Writing as though it were universal misleads the reader.
Good outcomes are achievable with limited resources through early presentation, basic surgery, available treatments used well, and careful supportive care. That is a more useful thing to teach than an unattainable standard.
A patient promised treatment that cannot be delivered loses trust in everything else. Naming honestly what is and is not possible, and helping them plan around it, preserves the relationship their care depends on.
People finishing treatment expect relief and frequently experience fear, exhaustion and loss of purpose instead, having lost the structure of appointments and the sense of actively fighting. Warning them of that in advance helps considerably.
Every ache becomes a recurrence, and the weeks before a follow-up scan are their own ordeal. It is close to universal, it is not a sign of poor coping, and saying that it is normal relieves a great deal.
Fatigue, nerve damage with numb painful hands and feet, swollen limbs, early menopause, altered bowels, reduced fertility and difficulty concentrating can last for years. Survivors are frequently told they are lucky and left with these unaddressed.
Returning to work, to relationships and to ordinary responsibility is harder than expected and is where practical support is thinnest. Phased return, honest conversations with employers and realistic expectations are the useful help.
Detecting recurrence, and managing the consequences of treatment. The second is what most survivors actually need and what is most often omitted from the appointment.
Fever in a patient who has had recent chemotherapy is the single most examined item in this subject. Also spinal cord compression, extravasation, raised calcium, transfusion checking, and breaking bad news.
Waiting for a source or for blood results before treating fever after chemotherapy; expecting the usual signs of infection in somebody with no white cells; flushing a line when an infusion is painful; attributing confusion to progression rather than checking calcium; telling a patient nothing more can be done.
Fever after chemotherapy is an emergency treated immediately. Stop an infusion that hurts. Prevent sickness rather than treat it. Give regular analgesia rather than waiting for severe pain. Ask what matters to the person.
Ask whether weight loss was intended. Ask about the days after treatment, not just the day of it. Ask about cost and travel. Ask about fertility before treatment starts. Ask about the siblings.
In this subject the patient carries almost all the information — how the treatment is affecting them, whether they can afford it, what they are frightened of, what they want. None of it arrives unless somebody asks.
Written in plain sentences on purpose. Nursing is studied in a second language by a large share of the students who will read this, and a sentence that has to be decoded twice is a sentence that teaches less.
These are the twelve questions written with this SUNYRA nursing manual, to check what it teaches. They are not past papers and were not written to any one examination's pattern; an examination tag means only that the examination's published blueprint covers this subject. Difficulty was not graded in the source, so every question is marked medium.
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