Oncology / Infusion | NursingWorksheets.com

Oncology / Infusion

Chemo protocols, reaction monitoring, lab thresholds, and central line care.

For educational use only. Always verify with clinical judgment and facility protocols.

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Date: ___________Shift: ___________Nurse: ___________

NursingWorksheets.com — Oncology / Infusion

PATIENT 1

Name:

Rm: ____

Age: ____

Allergies:

Code: ____

MD:

Dx:

VITALS

Vital signs monitoring grid
	0700	0900	1100	1300	1500	1700
HR
BP
RR
Temp
SpO2
Pain

CHEMO PROTOCOL

Regimen:

Cycle / Day:

BSA (m²):

PRE-MEDICATIONS

Pre-medication administration record
Drug	Dose	Time	Given

REACTION MONITORING

Infusion reaction monitoring log
Time	VS	Symptoms

LAB THRESHOLDS

ANC: ____ Hold: ____

Platelets: ____ Hold: ____

Cr/GFR: ____ Hold: ____

LFTs: ____ Hold: ____

CENTRAL LINE / PORT CARE

MEDICATIONS

Medication administration record
Drug / Dose / Route	Time	Given	Notes

LABS

Na:

K:

BUN:

Cr:

Glu:

WBC:

Hgb:

Plt:

Other:

IV ACCESS

Site/Gauge:

Fluid/Rate:

Date:

I&O

INTAKE

PO:

IV:

Blood:

Other:

Total:

OUTPUT

Urine:

Drain:

Emesis:

Other:

Total:

ASSESSMENT

PLAN / TASKS

NOTES

PATIENT 2

Name:

Rm: ____

Age: ____

Allergies:

Code: ____

MD:

Dx:

VITALS

Vital signs monitoring grid
	0700	0900	1100	1300	1500	1700
HR
BP
RR
Temp
SpO2
Pain

CHEMO PROTOCOL

Regimen:

Cycle / Day:

BSA (m²):

PRE-MEDICATIONS

Pre-medication administration record
Drug	Dose	Time	Given

REACTION MONITORING

Infusion reaction monitoring log
Time	VS	Symptoms

LAB THRESHOLDS

ANC: ____ Hold: ____

Platelets: ____ Hold: ____

Cr/GFR: ____ Hold: ____

LFTs: ____ Hold: ____

CENTRAL LINE / PORT CARE

MEDICATIONS

Medication administration record
Drug / Dose / Route	Time	Given	Notes

LABS

Na:

K:

BUN:

Cr:

Glu:

WBC:

Hgb:

Plt:

Other:

IV ACCESS

Site/Gauge:

Fluid/Rate:

Date:

I&O

INTAKE

PO:

IV:

Blood:

Other:

Total:

OUTPUT

Urine:

Drain:

Emesis:

Other:

Total:

ASSESSMENT

PLAN / TASKS

NOTES

For educational use only. Always verify with clinical judgment and facility protocols.

Date: ___________Shift: ___________Nurse: ___________

NursingWorksheets.com — Oncology / Infusion

PATIENT 3

Name:

Rm: ____

Age: ____

Allergies:

Code: ____

MD:

Dx:

VITALS

Vital signs monitoring grid
	0700	0900	1100	1300	1500	1700
HR
BP
RR
Temp
SpO2
Pain

CHEMO PROTOCOL

Regimen:

Cycle / Day:

BSA (m²):

PRE-MEDICATIONS

Pre-medication administration record
Drug	Dose	Time	Given

REACTION MONITORING

Infusion reaction monitoring log
Time	VS	Symptoms

LAB THRESHOLDS

ANC: ____ Hold: ____

Platelets: ____ Hold: ____

Cr/GFR: ____ Hold: ____

LFTs: ____ Hold: ____

CENTRAL LINE / PORT CARE

MEDICATIONS

Medication administration record
Drug / Dose / Route	Time	Given	Notes

LABS

Na:

K:

BUN:

Cr:

Glu:

WBC:

Hgb:

Plt:

Other:

IV ACCESS

Site/Gauge:

Fluid/Rate:

Date:

I&O

INTAKE

PO:

IV:

Blood:

Other:

Total:

OUTPUT

Urine:

Drain:

Emesis:

Other:

Total:

ASSESSMENT

PLAN / TASKS

NOTES

For educational use only. Always verify with clinical judgment and facility protocols.