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Cancer Treatment

Patient Symptom Record for Chemo Treatment - Post-Op

Cycle 4: 4 weeks (Sep 20 - Oct 17)

 [Choose cycle: 1 2 3 4] 

Again, I did not keep track of data. Cycle 2 was pretty much the trendsetter. The only difference is the use of Zofran to treat nausea.

September 2004

Day of Cycle Date Ch Nausea Vomiting Diet Fatigue Mouth Sores Diarrhea Constipation Fever Anxiety Coping Pain Level Hand & Foot
Skin Changes
1 20 *                        
2 21 *                        
3 22 *                        
4 23 *                        
5 24 *                        
6 25 -                        
7 26 -                        
8 27 -                        
9 28 -                        
10 29 -                        
11 30 -                        

October 2004
Day of Cycle Date RT Nausea Vomiting Diet Fatigue Mouth Sores Diarrhea Constipation Fever Anxiety Coping Pain Level Hand & Foot
Skin Changes
12 1 -                        
13 2 -                        
14 3 -                        
15 4 -                        
16 5 -                        
17 6 -                        
18 7 -                        
19 8 -                        
20 9 -                        
21 10 -                        
22 11 -                        
23 12 -                        
24 13 -                        
25 14 -                        
26 15 -                        
27 16 -                        
28 17 -                        
 

Notes

  • Nausea managed with Zofran.

Explanation of codes

Symptom Code Explanation
Nausea 0 no change
  1 can eat/drink reasonable amounts
  2 50% or less than normal fluid intake - but can eat
  3 no significant intake - cannot eat/drink
Vomiting 0 no vomiting
  1 vomited once in 24 hours
  2 vomited 2-5 times in 24 hours
  3 vomited 6-10 times in 24 hours
  4 vomited more than 10 times in 24 hours
Diet 0 regular diet
  1 fluids & some solids
  2 fluids only
  3 no intake
Fatigue/
Tiredness		 0 no change, usual activity
  1 mild: able to continue normal activity
  2 change in normal activity (bed rest less than 50% waking hours)
  3 in bed/chair more than 50% of waking hours
  4 bed ridden or unable to care for oneself
Mouth Sores 0 none
  1 painless ulcers, mild redness/soreness
  2 painful, red, swollen ulcers - can eat/drink
  3 painful, red, swollen ulcers - can not eat/drink
Diarrhea 0 none
  1 increase of 2-3 bowel movements/day over normal
  2 increase of 4-6 bowel movements/day or stools during night
  3 increase of 7-9 bowel movements/day
  4 increase of 10 or more bowel movements/day
Constipation 0 none
  1 no bowel movement in 2 days
  2 no bowel movement in 3 days
  3 no bowel movement in 4 days
Fever 0 normal temperature (37°C or 98.6°F)
  1 temperature (37.1-37.9°C or 98.7-100.3°F)
  2 temperature (38.0-40°C or 100.4-104°F)
  3 temperature higher than 40°C or 104°F
Anxiety   0  1  2  3  4  5  6  7  8  9  10
no anxiety -------------- worst
Coping   0  1  2  3  4  5  6  7  8  9  10
no difficulty ----------- difficulty coping
Pain Level   0  1  2  3  4  5  6  7  8  9  10
no pain ----------------- worst
Hand & Foot
Skin Changes		 0 none
  1 skin changes (redness/cracking)
  2 skin changes with pain but normal function
  3 skin changes with pain & interferes with function

Red areas indicate you should contact CCI for further help.

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