Reference — Pediatrics
Pediatric Chemotherapy Care Reference
The shared nursing bundle behind every childhood cancer — leukemia, Wilms, neuroblastoma, bone tumors. Protect against infection and bleeding, know the drug toxicities, guard the central line, and prevent tumor lysis.
Educational use only. Protocols, thresholds, and hazardous-drug handling are specialized and require specific training and PPE — follow oncology orders and your facility’s pediatric oncology protocols. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Neutropenic Precautions & Febrile Neutropenia
Fever in a neutropenic child is an emergency — cultures and broad-spectrum IV antibiotics within about 1 hour. The usual inflammation may be absent, so a single fever counts.
Precautions per protocol: meticulous hand hygiene, private room (protective environment for high risk), screen visitors for illness, no rectal temps/suppositories/enemas, avoid fresh flowers/live plants and raw or undercooked foods where restricted, strict oral and skin care, and no live vaccines during treatment. Think ANC, not total WBC.
Bleeding Precautions (Thrombocytopenia)
No IM injections or rectal medications; soft toothbrush or sponge, no flossing if very low; no NSAIDs or aspirin; avoid contact play and falls; apply pressure to puncture sites; electric razor for teens. Watch for petechiae, bruising, epistaxis, and occult bleeding (urine, stool, neuro change). Transfuse platelets per threshold.
Common Drug Toxicities
| Drug | Key toxicity | Nursing note |
|---|---|---|
| Vincristine | Peripheral neuropathy, constipation/ileus, SIADH; vesicant | Bowel regimen; assess gait/reflexes; FATAL if given intrathecally |
| Methotrexate | Mucositis, myelosuppression, hepatotoxicity, nephrotoxicity (high-dose) | Leucovorin rescue; hydration and urine alkalinization; oral care |
| Anthracyclines (doxorubicin, daunorubicin) | Cardiotoxicity (cumulative), vesicant, red urine | Baseline/serial cardiac function; warn about harmless red urine |
| Cyclophosphamide | Hemorrhagic cystitis, myelosuppression | Hydration ± mesna; monitor for hematuria |
| Corticosteroids (prednisone/dexamethasone) | Mood/behavior changes, appetite/weight gain, hyperglycemia, immunosuppression | Don't stop abruptly; support family through behavior swings |
| Asparaginase | Allergic/anaphylactic reactions, pancreatitis, coagulation effects | Observe after dosing; emergency meds ready |
Vincristine is FATAL if administered intrathecally — it is for IV use only; intrathecal chemo is a different drug (e.g., methotrexate/cytarabine).
Central Line & Tumor Lysis
Central line: sterile technique, assess the site for infection, secure to prevent dislodgement, and teach the family signs of line infection — it is the lifeline and a top infection source.
Tumor lysis syndrome: around induction, prevent with aggressive hydration and allopurinol/rasburicase; monitor for ↑potassium, ↑phosphate, ↑uric acid, ↓calcium and renal function — report early shifts before arrhythmia or AKI.
NCLEX Pearls
- ✦Febrile neutropenia = emergency: cultures + broad-spectrum antibiotics within ~1 hour; think ANC, not total WBC.
- ✦No rectal temps/suppositories/enemas and no IM injections in the neutropenic/thrombocytopenic child.
- ✦Vincristine: neuropathy + constipation, and FATAL intrathecally (IV only).
- ✦Anthracyclines are cardiotoxic (cumulative) and turn urine red (harmless); methotrexate needs leucovorin rescue and good oral care.
- ✦TLS: ↑K⁺, ↑phosphate, ↑uric acid, ↓Ca²⁺ — hydrate, allopurinol/rasburicase, watch kidneys and heart.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · CDC / ACIP (immunization schedule). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →