When a patient returns home following surgery or is receiving cancer treatments on an outpatient basis, it is important to have a clear plan in place for feeding and basic care at home.

When a patient returns home following surgery or is receiving cancer treatments on an outpatient basis, it is important to have a clear plan in place for feeding and basic care at home. Everyday tasks, like feeding, medication administration, and monitoring for physical changes and the presence of infection, need to be performed consistently.

Feeding Care

Some patients are able to return home but still require nutrition to be administered through a feeding tube. This is called “enteral feeding” and occurs through a “nasogastric tube.” One-on-one instruction from a nurse will be important to help patients and caregivers learn how to manage the responsibility. “In addition to written instructions given to a caregiver about how to manage a feeding tube, an opportunity to actually do the skills with a nurse before the patient is discharged  home will be most helpful,” saysCristina C. Hendrix, DNS, GNP-BC, associate professor at Duke University School of Nursing in Durham, North Carolina.

Nasogastric tubes require maintenance, such as periodic replacement of the dressing that holds the tube in place, and daily cleansing of the tube site. The tube itself will need to be changed periodically, as well, but this will be done by a nurse. The “feed” itself should be stored and handled carefully to avoid contamination or spoiling. Above all, hand-washing is paramount to reducing the risk of infection or illness.

Also, although you will not be using your mouth for eating or drinking as much, it is still important to care for your mouth, teeth, and gums to prevent infection.

Specific instructions on your feeding regimen and technique and care of your tube will be provided by your nurse. Make sure you and your caregiver feel comfortable with the instructions, and know how to contact someone who can answer any questions at a later time should you need assistance.  

Medication Management

Managing cancer medications can be complex and even overwhelming for caregivers. Often multiple medications must be taken, each with a different schedule and dosage, and some perhaps even limitations (e.g., take with food; take on an empty stomach; do not take with juice).

SusanChildress, RN, MSN, OCN, director of nursing at Huntsman Cancer Institute at the University of Utah in Salt Lake City,says that above all, patients should keep a detailed list of all medications and diligently follow the directions on all medication dosages. “Oncology patients take a lot of medications and there is a high probability of drug interaction. Make sure your physician knows about all the medications you are taking, including over-the-counter medications and herbal supplements,” she says. “Keep a list on you at all times.” 

Some medications require special handling and storage. But even more importantly, says Childress, family members and visitors, including children and grandchildren, should be factored into medication safety. “Make sure the medications are not within reach of children, and dispose of all medications immediately if they are discontinued,” Childress adds.  “I know it’s tempting to hold on to medications, just in case, but getting medications confused or ingested by a child is a huge risk.”

Aweekly pillbox may serve as a helpful aid in medication management. “This allows patients to sort out medications in advance,” says Hendrix.  “Another helpful approach is to write down on a piece of paper the medications that are taken in the morning, lunch, and evening.”

At-Home Injections

According to Hendrix, a nurse or other health care professional can easily teach patients and caregivers how to give subcutaneous injections.  She says the most frequent uses of subcutaneous injections are for insulin and enoxaparin (Lovenox, a blood thinner). “The skills necessary for giving subcutaneous shots can be demonstrated by a nurse using an orange fruit,” she says. “Return demonstration of skills by caregivers is necessary until the caregiver has successfully demonstrated the task.”

“In addition to these skills,” she adds, “proper disposal of needles should be discussed.” Used needles or other “sharps” (for example, syringes, auto injectors, infusion sets, connection needles or sets, lancets) should not be disposed of in the regular trash or recycling receptacles, and should not be flushed down the toilet. The FDA recently launched a new Web site to educate patients and caregivers on the safe and proper disposal of needles and other sharps. 

Infection Control

One of the most common concerns for cancer patients is the risk of infection. Often their resistance to infectious agents is lower. “This may be related to their cancer or the treatment they are receiving,” says Childress. “They should tell family and friends to stay away when they are sick.” 

During particularly vulnerable periods during treatment and recovery, it may be wise to keep young children away as much as possible, as they are often carriers of germs. Frequent hand washing, says Childress, is the best thing everyone can do, including the patient, caregivers, and visitors.

Monitoring for Emergency Situations

Patients undergoing cancer treatment may be more susceptible to other medical problems. Fever and infection are probably the most emergent symptoms for these patients. The signs of infection are frequently general body malaise, fever, and chills.  “Chemotherapy or radiation may also suppress the immune system, so symptoms such as abdominal pain, nausea, vomiting, or anything suggesting pneumonia or urinary tract infection should also be considered serious,” says Mark Melrose, DO, FACEP of Urgent Care Manhattan in New York. 

Dr. Melrose says any of these signs and symptoms should be reported as soon as possible to the patient’s supervising physician or oncologist, who can then advise the patient on the urgency of the issue and the possible need for further evaluation and care. Additionally, he advises that patients should be cognizant of changes in the way they are feeling.

“Make sure you call your doctor as soon as possible when you notice a change in your usual state of health,” Dr. Melrose cautions. “Waiting until the evening or weekend, hoping your symptoms will go away, always guarantees that your doctor won’t be available and increases the likelihood of a trip to the ER, which is never a pleasant choice.”