Preadministration Assessment

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The extent of the preadministration assessment depends on the type of malignancy and the patient's general physical condition. The initial assessment of the patient scheduled for chemotherapy may include:

• The type and location of the neoplastic lesion (as stated on the patient's chart)

• The stage of the disease, for example, early, metasta-tic, terminal

The patient's general physical condition The patient's emotional response to the disease

• The anxiety or fears the patient may have regarding chemotherapy treatments

• Previous or concurrent treatments (if any), such as surgery, radiation therapy, other antineoplastic drugs

• Other current nonmalignant disease or disorder, for example, congestive heart failure or peptic ulcer, that may or may not be related to the malignant disease

The patient's knowledge or understanding of the proposed chemotherapy regimen Other factors, such as the patient's age, financial problems that may be associated with a long-term illness, family cooperation and interest in the patient, and the adequacy of health insurance coverage (which may be of great concern to the patient)

Immediately before administering the first dose of an antineoplastic drug, the nurse takes the patient's vital signs. The nurse obtains a current weight because the dose of some antineoplastic drugs is based on the patient's weight in kilograms or pounds. The dosages of some antineoplastic drugs also may be based on body surface measurements and are stated as a specific amount of drug per square meter (m2) of body surface. Additional physical assessments may be necessary for certain antineoplastic drugs.

A few antineoplastic drugs require treatment measures before administration. An example of preadministration treatment is hydration of the patient with 1 to 2 liters of IV fluid infused before administration of cisplatin (Platinol) or administration of an antiemetic before the administration of mechlorethamine. These measures are ordered by the primary health care provider and, in some instances, may vary slightly from the manufacturer's recommendations.

When an antineoplastic drug has a depressing effect on the bone marrow, laboratory tests, such as a complete blood count, are ordered to determine the effect of

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