A nurse is caring for a 55-year-old female client who underwent debulking surgery for stage IIIC ovarian cancer 3 days ago. The client is scheduled to begin chemotherapy with carboplatin and paclitaxel. Which nursing intervention should be the priority before initiating chemotherapy?
The client reports feeling anxious about starting chemotherapy and asks about potential side effects. Her current vital signs are stable, and laboratory results show WBC 6,500/mm³, hemoglobin 10.2 g/dL, and platelet count 180,000/mm³.
1Assess baseline neurological function and document findings✓ 정답
3Obtain informed consent for chemotherapy treatment
4Review dietary restrictions and nutritional guidelines
해설
Assessing baseline neurological function is the priority before carboplatin/paclitaxel chemotherapy due to high risk of paclitaxel-induced peripheral neuropathy. Obtaining consent, antiemetics, and dietary review are important but not initial priorities for neurotoxicity monitoring.
Understanding the Priority: Baseline Assessment Before Neurotoxic Chemotherapy
This question requires you to prioritize a nursing action before initiating a chemotherapy regimen that includes paclitaxel, a taxane agent. While all the listed interventions are important components of pre-chemotherapy care, the key is to identify which one is most critical to perform before the first dose is administered, based on the specific toxicity profile of the prescribed drugs and the need to establish a reference point for future assessments.
The correct answer is to assess baseline neurological function and document findings. This is the priority because paclitaxel is a well-known neurotoxic agent that frequently causes chemotherapy-induced peripheral neuropathy (CIPN). The provided research consistently highlights the significant burden of this specific adverse event.
A study on patients receiving taxane-based chemotherapy identified the core symptom network, with numbness and tingling in the hands and feet being central features of the patient experience [3]. This underscores that neurological symptoms are not just a possible side effect but a primary driver of symptom distress during taxane treatment. Another study specifically investigated the influencing factors of paclitaxel-induced peripheral neuropathy (PIPN), confirming its high incidence and the need for careful monitoring [4]. Without a thorough, documented baseline neurological assessment—including sensory, motor, and deep tendon reflex function—it becomes impossible to objectively determine if a patient’s report of tingling or numbness after the first or second cycle is a new, treatment-emergent toxicity or a pre-existing condition. This distinction is crucial for grading the toxicity, deciding on dose modifications, and implementing early interventions.
The evidence also points toward symptom management strategies that are built upon this initial assessment. For instance, a randomized controlled trial demonstrated that a walking exercise program, guided by the Theory of Unpleasant Symptoms, was effective in alleviating peripheral neuropathy and arthralgia-myalgia in patients receiving paclitaxel [1]. This non-pharmacological intervention is most effective when started early, but its initiation depends entirely on first identifying the patient’s baseline status. You cannot measure the effectiveness of an intervention to reduce CIPN if you do not know the patient’s starting point.
While the other options are important, they do not take precedence over this safety-critical baseline assessment:
- Administering prophylactic antiemetics is a standard part of pre-chemotherapy care for carboplatin and paclitaxel, but it is typically done immediately before infusion, not necessarily as the priority nursing action days in advance.
- Obtaining informed consent is a provider-level responsibility. The nurse's role is to witness the signature and verify the patient’s understanding, but the initial consent process should have been completed before this point.
- Reviewing dietary guidelines is important for managing fatigue and nausea but is not the most time-sensitive or safety-critical action related to the unique toxicity of the prescribed agents.
The patient’s current laboratory values show a WBC of 6,500/mm³ and a platelet count of 180,000/mm³, which are within normal limits and do not present a barrier to proceeding with chemotherapy. The mild anemia (hemoglobin 10.2 g/dL) is an expected finding in a postoperative patient with advanced ovarian cancer and is not a contraindication. Therefore, the nurse’s priority is to establish the neurological foundation upon which all subsequent toxicity monitoring and management will be built. A comprehensive baseline assessment is the cornerstone of safe paclitaxel administration, enabling the early detection and management of CIPN, a complex symptom cluster that significantly impacts a patient’s quality of life and functional status [2,3].
References (research sources)
[1]
The impact of walking exercise guided by the theory of unpleasant symptoms on peripheral neuropathy and arthralgia-myalgia in breast cancer patients undergoing paclitaxel treatment: A randomized controlled trial.RCT/clinical trialOzdemir D, Arslan S. (2025) · DOI: 10.1016/j.ejon.2025.102974
[3]
Symptom clusters and network analysis in lung cancer patients receiving taxane-based chemotherapy: a comprehensive assessment using the CIPNAT multi-scale tool.Research articleLi T, Sun Q, Zhang M, Liu Z, Yao L, Wu Y, Ding M. (2026) · DOI: 10.1007/s00520-026-10540-1
[4]
Influencing factors of acute severe to very severe peripheral neuropathy induced by albumin-bound paclitaxel.Research articleHuang Y, Feng L, Hu J, Zeng F. (2025) · DOI: 10.1080/1120009x.2025.2547144
Pre-Chemotherapy Nursing Priority for PaclitaxelEstablishing a Neurological Baseline
Before initiating paclitaxel, a neurotoxic taxane, the priority nursing action is a thorough baseline neurological assessment. This includes evaluating sensation, motor strength, and deep tendon reflexes to document the patient's pre-treatment status.
The documented baseline serves as the critical reference point for detecting chemotherapy-induced peripheral neuropathy (CIPN), a common dose-limiting toxicity. Early signs often include numbness and tingling in the hands and feet.
Caution
Do not confuse this with other pre-treatment tasks. While antiemetics and education are important, they are secondary to the safety measure of establishing a neurological reference point. Missing this step can lead to failure in recognizing early, irreversible nerve damage.
Chemotherapy-Induced Peripheral Neuropathy (CIPN) — A common, dose-limiting side effect of neurotoxic chemotherapy agents like taxanes, causing sensory and motor nerve damage.
Paclitaxel — A taxane chemotherapeutic agent that stabilizes microtubules, leading to cell cycle arrest and a high risk of peripheral neuropathy.
Baseline Neurological Assessment — A comprehensive pre-treatment evaluation of sensory, motor, and reflex functions to establish a reference point for detecting future deficits.