RADIOTHERAPY
other body parts.
RADIATION THERAPY
 Is a local treatment modality for
cancer and it is the destruction of
cancer cells by ionizing radiation
 Purpose: is to destroy malignant
cells which are more sensitive to
radiation than are normal cells
without permanent damage to
adjacent body tissues
 Radiation may be used to cure
cancer, as in thyroid carcinomas,
localized cancers of the head and
neck, and cancers of the cervix.
 Radiation therapy may also be used
to control cancer when a tumor
cannot be removed surgically or
when local nodal metastasis is
present.
Used in three ways:
 Neoadjuvant (prior to local definitive
treatment) radiation therapy, with or
without chemotherapy
 Radiation therapy may be given
prophylactically
 Palliative radiation therapy
METHODS OF DELIVERING RADIATION
THERAPY
HOW IS RADIATION THERAPY USED
Radiation therapy is used two different
ways.
To cure cancer:
• Destroy tumors that have not spread to
Reduce the risk that cancer will return after
surgery or chemotherapy.
To reduce symptoms:
• Shrink tumors affecting quality of life, like
a lung tumor that is causing shortness of
breath,
Alleviate pain by reducing the size of a
tumor.
Types of Radiation Therapy
Externally (Teletherapy, DXT) – external
beam radiation therapy (EBRT)
 Delivers radiation using a linear
accelerator
Internally ( Brachytherapy or Seed
implants)
 Involves placing radioactive sources
inside the patient.
EXTERNAL BEAM RADIATION THERAPY
 This is administered through a high –
energy X-ray or gamma x-ray
machine
 The major advantage of high-energy
radiation is its skin – sparing effect.
 EBRT is the most commonly used
form of radiation therapy
Specialized Types of External Beam
Radiation Therapy (EBRT)

Intensity Modulated Radiation Therapy
(IMRT)
 A specialized form of 3D-CRT
 Radiation is broken into many
“beamlets” and the intensity of each
can be adjusted individually
Proton Beam Therapy
 Uses protons rather than x-rays to
treat certain types of cancer.
 Allows doctors to better focus the
dose on the tumor with the
potential to reduce the dose to
nearby healthy tissue
Neutron Beam Therapy
A specialized form of radiation therapy that
can be used to treat certain tumors that are
very difficult to kill using conventional
radiation therapy.
Stereotactic Radiotherapy
 Sometimes called stereotactic
radiosurgery
 This technique allows the radiation
oncologist to precisely focus beams
of radiation to destroy certain
tumors, sometimes in only one
treatment
 Stereotactic radiosurgery (SRS) is a
non-surgical radiation therapy used
to treat functional abnormalities and
small tumors of the brain.
 It can deliver precisely-
targeted radiation in fewer high-
dose treatments than
traditional therapy, which can help
preserve healthy tissue.
Systems which produce different
types of radiation for external beam
therapy include:
A) orthovoltage x-ray machines,
B) Cobalt-60 machines,
C) linear accelerators,
D) proton beam machines, and
E) neutron beam machines.
INTERNAL RADIATION THERAPY
 Places radioactive material into
tumor or surrounding tissue
 Also called Brachytherapy – brachy
Greek for “short distance”
 Radiation sources placed close to
the tumor so large doses can hit the
cancer cells
THE MAJOR TYPES OF INTERNAL
RADIATION THERAPY
 A. SEALED SOURCE –
(brachytherapy) the radioisotope is
placed within or near the tumor.*
 - is used for both intracavitary and
interstitial therapy
INTRACAVITY RT is used to treat
cancers of the uterus and cervix. The
radioisotope is placed in the body
cavity, generally for 24 to 72 hours.
In an INTERSTITIAL THERAPY, the
radioisotope is placed in needles,
beads, seeds, ribbons, or catheters,
which are then implanted directly into
the tumor
B. UNSEALED SOURCE –
The radioisotopes may be
administered intravenously, orally or by
instillation directly into the body cavity.
 the radioisotope circulates through
the client’s body. *
PRINCIPLES OF RADIATION
PROTECTION – DTS
 D – istance
 The greater the distance from the
radiation source, the less the
exposure dose of ionizing rays.
 Maintain a distance of at least 3
feet when not performing nursing
procedures.
 Performed in closed proximity such
as checking placement of the
implant & performing nursing
procedures
T – ime
 Limit contact with the client for 5
minutes each time, a total of 30
minutes per 8-hour shift
 Organize care to limit the amount of
time spent in direct contact with
the patient
 Spend less time with the patient
without sacrificing the quality of
care given
S – hielding
Use lead shield during contact with
client
 Pregnant staff should not be
assigned to clients receiving
internal RT
 The film badge should not be
shared, should not be worn other
than at work, & should be returned
according to the agency’s protocol
Staff members caring for the client with
internal RT should wear radiation
dosimeter badge while in the client’s
room.
 If the client with cancer of the
cervix has radioisotope implant into
the uterus, the following nursing
interventions should be
implemented.
1. Client’s back is turned towards the
door.
2. Encourage the client to turn to sides
at regular intervals
3. The client should be on complete
bed rest.
4. The client should be given enema
before the procedure.
5. The client should be given low fiber
diet to inhibit defecation during the
procedure until the device is removed
in 2-3 days.
6. The client should have a Foley
catheter in place during the procedure.
7. Have long forceps and lead container
readily available.
8. Foods are served on disposable
plates and utensils.
9. Trash and linens are kept in the
client’s room and are not removed until
the client is ready for discharge.
10. The client is also instructed to rinse
the sink with copious amount of water
after tooth brushing and to flush the
toilet several times after each use.
11. Anyone entering the room wears a
new pair of booties each time to
prevent tracking the radioisotope out
into the hallway.
12. Caregivers should wear gloves
when handling body fluids
13. Any emesis (vomiting), especially
that occurs shortly after ingestion of
oral radioisotope, should be covered
with absorbent pads, and the radiation
safety officer should be called
immediately.
TEACHING GUIDELINES REGARDING
EXTERNAL RADIATION THERAPY
1. It is painless
2. Lie very still on a special table while
the intervention is being given and
you may be placed in a special
position to maximize tumor
irradiation.
3. Each treatment usually lasts for few
minutes. You may hear sounds of
the machine being operated, and
the machine may move during the
therapy.
4. As a safety precaution for the
therapy personnel, you will remain
alone in the treatment room while the
machine is in operation.
5. The technologist will be right outside
your room observing you through a
window or by a closed – circuit TV. You
may communicate.
6. There is no residual radioactivity
after radiation therapy. Safety
precautions are necessary only during
the time you are actually receiving
irradiation. You may resume normal
activities of daily living.
CLIENT EDUCATION ON SKIN CARE IN
EXTERNAL RADIATION THERAPY
Skin Care within The Treatment Area
includes the following:
 Keep your skin dry.
 Do not wash the treatment area
until you are instructed to do so.
When permitted, wash the treated
skin gently with mild soap, rinse
well, and pat dry. Use warm water
or cool water, not hot water.
 Do not remove the lines or ink
marks (markings) placed on your
skin
 Avoid using powders, lotions,
creams, alcohol and deodorants on
the treated skin.
 Wear loose – fitting clothing to
avoid friction over the treatment
area.
 Do not apply tape to the treatment
area if dressings are applied.
 Shave with an electric razor. Do not
use pre-shave or after-shave
lotions.
 Protect your skin from exposure to
direct sunlight, chlorinated
swimming pools, and temperature
extremes*
 Consult your radiation therapist or
nurse about specific measures for
individual skin reactions.
NURSING INTERVENTIONS FOR SIDE
EFFECTS OF RADIATION THERAPY
1. SKIN REACTIONS
 erythema, dry/moist
desquamation
 atrophy, telangiectasia,
depigmentation, necrotic/ulcerative
lesions.
 NURSING INTERVENTIONS:
 Observe for early signs of
skin reaction and report to
the physician.
 Keep area dry.
Depigmentation telangiectasia
 Washing area with water, no soap
and pat dry (do not rub). Mild soap
is permitted.
 Do not apply ointments, powders or
lotion to the area. Cornstarch may
be used.
 Do not apply heat; avoid direct
sunshine or cold on the area.
 Use soft cotton fabrics for clothing.
To prevent skin irritation.
 Do not erase markings on the skin.
These serve as guide for areas of
irradiation.
2. INFECTION
 this is due to bone marrow
suppression
 NURSING INTERVENTIONS:
 Monitor blood counts
weekly, especially WBC
 Good personal hygiene,
nutrition, adequate rest
 Teach the client signs of
infection to report to
physician
3. HEMORRHAGE
 Platelets are vulnerable to
radiation.
 NURSING INTERVENTIONS:
 Monitor platelet count
 Avoid physical trauma or use
of aspirin( ASA)
 Teach signs of hemorrhage
to report (e.g., gum
 bleeding, nose bleeding,
black stools)
8. Social isolation is also
 Monitor stool and skin for experienced by the client due to
signs of hemorrhage fear of contaminating others with
radiation.
 Use direct pressure over
injection sites until bleeding
stops.
4. FATIGUE
 result of high metabolic demands
for tissue repair and toxic waste
removal
 plenty of rest and good nutrition

5. WEIGHT LOSS
 anorexia, pain, and effect of cancer

CHEMOTHERAPY
6. STOMATITIS AND XEROSTOMIA
 The use of chemicals as a systemic
(DRY MOUTH)
therapy for cancer.
 Ulceration of oral mucous
 Antineoplastic agents are used in an
membrane occurs
attempt to destroy tumor cells by
 NURSING INTERVENTIONS: interfering with cellular functions,
including replication.
 Administers analgesics
before meals, as prescribed  Chemotherapy is used primarily to
treat systemic disease rather than
 Bland diet, avoid smoking
localized lesions that are amenable
and alcohol
to surgery or radiation.
 Good oral hygiene with
Chemotherapy may be combined
saline rinses every 2 hours
with surgery, radiation therapy, or
 Sugarless lemon drops or both:
mint to increase salivation
 to reduce tumor size preoperatively
7. Diarrhea, nausea and vomiting, (neoadjuvant),
headache, alopecia (hair loss) and
cystitis, may also occur.
 to destroy any remaining tumor cells  Mucous membrane, blood cells, hair
postoperatively (adjuvant), or follicles, skin cells are rapidly
dividing cells.
 to treat some forms of leukemia or
lymphoma (primary).  Side effects of chemotherapy tend to
occur in these structures.
 Has fraction cell – kill. Only a certain
 GOALS:
no. of cancer cells are killed with
 CURE each course of chemotherapy.
Therefore, chemotherapy must be
 CONTROL
given in a series.
 PALLIATION OF
 May be cell – cycle specific (CCS) or
MANIFESTATIONS
cell –cycle non-specific (CCNS).
 CCS chemotherapy may
 CHEMOTHERAPY is a systemic destroy cancer cells at
intervention. It is recommended specific stage of cell division.
when:
 CCNS chemotherapy may destroy
 disease is widespread cancer cells at any stage of cell
dIvision.
 risk of undetectable disease
is high Chemotherapy Drugs

 Tumor cannot be resected  Interfere with cancer cell’s ability to

and is resistant to RT divide and reproduce.

 The OBJECTIVE of CHEMOTHERAPY  A single drug or a combination of

drugs is used
 To destroy all malignant
tumor cells without excessive
destruction of normal cells
CHEMOTHERAPY HAS THE
FOLLOWING CHARACTERISTICS
 It affects both normal and cancer
cells.
 The rapidly dividing cells, both the
normal and cancer cells are
vulnerable to destruction by
chemotherapy by disrupting cell
function and division.

ANTIMETABOLITES
 Chemotherapy drugs that interfere
with DNA and RNA growth.
 They are cell-cycle specific
 Ex: capecitabine, gemcitabine,
pemetrexed
ANTHRACYCLINES
 Are anti-tumor antibiotics that
interfere with enzymes necessary for
DNA replication.
 They are cell-cycle non-specific
 Ex: bleomycin, doxorubicin,
mitomycin-C
PLANT ALKALOIDS
 Are derived from certain types of
plants found in nature, and inhibit or
prevent mitosis.
 Cell-cycle specific
 Ex: taxanes, docetaxel, paclitaxel
ROUTES OF ADMINISTRATION OF
CHEMOTHERAPY
1. Oral Chemotherapy Medications
(Taken by Mouth)
 come in a variety of oral forms (pills,
tablets, capsules, liquid)
 Oral chemo medications
 Sub-lingual chemo medications.
2. Subcutaneous Injection of
Chemotherapy Treatments
 are commonly used for some types
of biologic response modifiers and
chemotherapy support drugs.
3. Intra-Muscular Chemotherapy
Injections
 Intra-muscular injection is a popular
method for anti- nausea medications
because it bypasses an already
irritated stomach.
4. Intravenous Chemotherapy
Treatments
 This is the most common method of
chemotherapy administration, since
most chemo drugs are easily
absorbed through the blood stream.
 IV push chemo
 An infusion of chemo
 A continuous infusion of chemo
Intravenous medications are given
directly into the blood stream
through a variety of methods.
a. An angiocatheter may be placed in a
vein in the arm or hand and then
removed after the chemo
medication is given
b. b. PICC line. Can be inserted and
used for six weeks to a few months
before it is discontinued.
c. Non-tunneled catheters. Non-
tunneled catheters are inserted
directly through the skin into the
jugular or subclavian vein and travel
through the vessel to the superior
vena cava vessel at entrance of the
right atrium of the heart
d. Tunneled Catheters.
are placed through the skin in the
middle of the chest. They are
tunneled through the subcutaneous
tissue and inserted into the superior
vena cava vessel at entrance of the
right atrium of the heart.
e. Port-a-cath.
 The port-a-cath is placed under the
skin on the chest.
4. Intraventricular/Intrathecal
Chemotherapy Treatments
 is used when drugs need to reach
the cerebrospinal fluid (CSF), the
fluid that is in the brain and spinal
cord.
There are two ways chemotherapy
can be given to the CSF:
1. Lumbar puncture (Intrathecal).
Chemotherapy can be given through
a lumbar puncture (spinal tap).
2. Ommaya reservoir
(Intraventricular).
 It is placed into the subcutaneous
tissue (the layer of tissue between
the skin and the muscle) on the
scalp.
 This procedure is used most
commonly in acute leukemias but
can be used in other situations as
well.
5. Intraperitoneal Chemotherapy
Treatments
 can be given directly into the
abdominal cavity.
 is done for cancer in the intra
abdominal area, e.g., ovarian cancer.
5. Intra-Arterial Chemotherapy
Treatments
 Intra-arterial infusions enable major
organs or tumor sites to receive
maximal exposure with limited
serum levels of medications.
7. Intravesicular Chemotherapy
Treatments
Intravesicular medications are given
with the use of a urinary catheter
directly into the bladder.
 8. Intrapleural Chemotherapy
Treatments
Chemotherapy can be given into the
pleural.
 Intrapleural chemotherapy is used
to control malignant pleural
effusions
 Topical Chemotherapy Treatments
Some chemotherapy creams are applied
directly to the skin in certain cases of
skin cancer.
 The cream is then absorbed through
the skin directly into the cancerous
lesion. The use of topical
preparations is very limited in cancer
treatments
CONTRAINDICATIONS TO
CHEMOTHERAPY
1. INFECTION
2. RECENT SURGERY
3. IMPAIRED RENAL/HEPATIC
FUNCTION
4. RECENT RADIATION THERAPY
5. PREGNANCY
6. BONE MARROW DEPRESSION
SAFE HANDLING OF
CHEMOTHERAPEUTIC AGENTS
1. Wear mask, eye shield, gloves and
back –closing gown.
2. Skin contact with drug must be
washed immediately with soap and
water. Eyes must be flushed
immediately with copious amount of
water.
3. Sterile / alcohol – wet cotton
pledgets should be used, wrapped
around the neck of the ampule or
vial when breaking and withdrawing
the drug.
4. Expel air bubbles on wet cotton.
5. Vent vials to reduce internal
pressure after mixing.
6. Wipe external surface of syringes
and IV bottles.
7. Avoid self - inoculation by needle
stab.
8. Clearly label the hanging IV bottle
with “ANTINEOPLASTIC
CHEMOTHERAPY”
9. Contaminated needles and
syringes must be disposed in a
clearly marked special container,
“leak – proof”, puncture – proof”
10. Dispose half – empty ampules,
vials, IV bottles by putting into
plastic bag, seal and then into
another plastic bag or box, clearly
marked before placing for removal.
Label as “HAZARDOUS WASTE.”
11. Hand washing should be done
before and after removal of gloves.
12. Only trained personnel should be
involved in use of drugs (preferably,
chemotherapy certified nurses).
13. Ideally, preparation of
chemotherapeutic drugs should be
in laminar flow conditions with
filtered air to prevent contamination
with microorganisms
NURSING INTERVENTIONS FOR
CHEMOTHERAPY SIDE -EFFECTS
NURSING INTERVENTIONS FOR
CHEMOTHERAPY SIDE -EFFECTS
1. G.I. SYSTEM – nausea and vomiting,
diarrhea, constipation
 Administer antiemetic to relieve
nausea and vomiting
 Replace fluid – electrolyte losses,
low – fiber diet to relieve diarrhea
 Increase fluid intake and fibers in
diet to prevent / relieve constipation
2. INTEGUMENTARY SYSTEM
 PRURITUS, URTICARIA & SYSTEMIC
SIGNS
 Provide good skin care
 STOMATITIS (ORAL MUCOSITIS)
 Provide good oral hygiene
  Avoid hot and spicy food
 ALOPECIA
 Reassure that it is temporary
 Encourage to wear wigs, hats
or head scarf
 SKIN PIGMENTATION
 Inform that it is temporary
 NAIL CHANGES
 Reassure that nails may grow
normally after chemotherapy
3. HEMATOPOIETIC SYSTEM
 Anemia
 Provide frequent rest
periods
 Neutropenia
 Protect from infection
 Avoid people with infection
 Report fever, chills,
diaphoresis, heat, pain,
erythema, or exudates on
any body surface
 Thrombocytopenia
 Protect from trauma
 Avoid ASA
 Nadir - It is the time after
chemotherapy administration when
WBC or platelet count is at the
lowest point. It occurs within 7 to 14
days after drug administration.
4. GENITO – URINARY SYSTEM
 Hemorrhagic cystitis
 Provide 2-3 liters of fluids per
day
 Urine color changes
 Reassure that it is harmless
5. Reproductive system
 Premature menopause or
amenorrhea
 Reassure that menstruation
resumes after chemotherapy
ADVERSE REACTIONS TO
CHEMOTHERAPY ARE AS FOLLOWS:
1. Hypersensitivity reaction
a. Dyspnea
b. Chest tightness or pain
c. Pruritus (itching)
d. Urticaria (wheals)
e. Tachycardia
f. g. Anxiety
h. Agitation
i. Inability to speak
j. abdominal pain
k. nausea
l. hypotension
m. cloudy mental status
n. flushed appearance
o. cyanosis
 If anaphylactic reaction occurs, the
following nursing interventions are
implemented:
a. Stop the drug administration
b. Maintain IV access with 0.9%
NS (NaCl)
c. Keep an open airway.
d. Keep client in modified
Trendelenburg position
(supine with legs elevated at
20-30’), unless
contraindicated.
 2. Extravasation
 Vessicant chemotherapeutic agents
can cause or form a blister and cause
tissue destruction. Eg., Adriamycin
(Doxurubicin), Oncovin (Vincristine).
 Irritant drugs can produce venous
pain at the site and along the vein
 Pain, erythema, swelling and lack of
blood return indicate an
extravasation.
NURSING INTERVENTIONS FOR
EXTRAVASATION include the following:
Nursing Management of
Cancer
Maintaining Tissue Integrity
Some of the most frequently encountered
disturbances of tissue integrity include
stomatitis, skin and tissue reactions to
radiation therapy, alopecia, and malignant
skin lesions.
Managing Stomatitis
 Assess oral cavity daily.
 Instruct patient to report oral
burning, pain, areas of redness,
open lesions on the lips, pain
associated with swallowing, or
decreased tolerance to temperature
extremes of food.
 Encourage and assist in oral hygiene.
  For mild stomatitis, use normal advise that hair loss may occur on
saline mouth rinses and a soft body parts other than the head.
toothbrush or toothette, remove
 Explore potential impact of hair loss
dentures except for meals (make
on self-image, interpersonal
sure dentures fit properly), apply
relationships, and sexuality.
water-soluble lip lubricant, and avoid
foods that are spicy or hard to chew  Prevent or minimize hair loss
and those with extremes of
 Suggest ways to assist in coping with
temperature.
hair loss (eg, purchase wig or
 For severe stomatitis, obtain tissue hairpiece before hair loss; wear head
samples for culture and sensitivity coverings).
tests, assess gag reflex and ability to
 Explain that hair growth usually
chew and swallow
begins again once therapy is
 Help patient minimize discomfort by completed.
using prescribed topical anesthetic,
administering prescribed systemic
analgesics, and performing
appropriate mouth care.

Managing Malignant Skin Lesions

Managing Radiation-Associated Skin
 Carefully assess and cleanse the
Impairments
skin, reducing superficial bacteria,
 Provide careful skin care by avoiding controlling bleeding, reducing odor,
the use of soaps, cosmetics, protecting skin from pain and
perfumes, powders, lotions and further trauma, and relieving pain.
ointments, and deodorants.
 Assist and guide the patient and
 Instruct the patient to avoid rubbing family regarding care for these skin
or scratching the area, exposing the lesions at home; refer for home care
area to sunlight or cold weather, or as indicated.
wearing tight clothing over the area.
Promoting Nutrition
 If wet desquamation occurs, do not
 Teach the patient to avoid
disrupt any blisters that have
unpleasant sights, odors, and sounds
formed, report blistering, and use
in the environment during mealtime.
prescribed ointments
 Suggest foods that are preferred and
Addressing Alopecia
well tolerated by the patient,
 Discuss potential hair loss and preferably high-calorie and high-
regrowth with patient and family; protein foods.
  Encourage adequate fluid intake, but  Assure patient that you know that
limit fluids at mealtime. pain is real and will assist him or her
in reducing it.
 Suggest smaller, more frequent
meals.  Help patient and family play an
active role in managing pain.
 Promote relaxed, quiet environment
during mealtime with increased  Provide education and support to
social interaction as desired. correct fears and misconceptions
about opioid use.
 Encourage nutritional supplements
and high-protein foods between  Encourage strategies of pain relief
meals. that patient has used successfully in
previous pain experience.
 Encourage frequent oral hygiene and
provide pain relief measures to  Teach patient new strategies to
make meals more pleasant. relieve pain and discomfort:
distraction, imagery, relaxation,
 Provide control of nausea and
cutaneous stimulation, etc.
vomiting.
 Patients with cancer may have other
sources of pain, such as arthritis or
 For collaborative management, migraine headaches, that are
provide enteral tube feedings of unrelated to the underlying cancer
commercial liquid diets, elemental or its treatment.
diets, or blenderize foods as
prescribed.
 Administer appetite stimulants as
prescribed by physician.
 Encourage family and friends not to
nag or cajole patient about eating.
 Decrease anxiety by encouraging
verbalization of fears and concerns,
use of relaxation techniques, and
imagery at mealtime.
Relieving Pain
 Use a multidisciplinary team
approach to determine optimal
 The nurse assesses the patient for
management of pain for optimal
the source and site of pain as well as
quality of life.
those factors that influence the
 patient’s perception and experience
of pain, such as fear and
apprehension, fatigue, anger, and
social isolation.
 Pain assessment scales are useful for
assessing the patient’s pain before
and after pain-relieving
interventions are instituted to assess
the effectiveness of interventions.
 The nurse assists the patient and
family to take an active role in
managing pain.
 The nurse provides education and
support to correct fears and
misconceptions about opioid use.
Inadequate pain management leads
to a diminished quality of life
characterized by distress, suffering,
anxiety, fear, immobility, isolation,
and depression.

Decreasing Fatigue
 Help patient and family to
understand that fatigue is usually an
expected and temporary side effect
 of the cancer process and
treatments.
 Help patient to rearrange daily
schedule and organize activities to
conserve energy expenditure
 Encourage patient and family to plan
to reallocate responsibilities, such as
childcare, cleaning, and preparing
meals.
 Encourage adequate protein and
calorie intake; assess for fluid and
electrolyte disturbances.
 Encourage regular, light exercise,
which may decrease fatigue and
facilitate coping.
 Encourage use of relaxation
techniques and mental imagery.
 Address factors that contribute to
fatigue and implement
pharmacologic and
nonpharmacologic strategies to
manage pain.
 Administer blood products as
prescribed.
Improving Body Image and Self-Esteem
 Assess patient’s feelings about body
image and level of self-esteem.
Encourage patient to verbalize
concerns.
 Identify potential threats to patient’s
self-esteem
 Encourage continued participation in
activities and decision making.
 Assist patient in self-care when
fatigue, lethargy, nausea, vomiting,
and other symptoms prevent
independence.
 Assist patient in selecting and using
cosmetics, scarves, hair pieces, and
clothing that increase his or her
sense of attractiveness.
 Encourage patient and partner to
share concerns about altered
sexuality and sexual function and to
explore alternatives to their usual
sexual expression.
 Refer patient to collaborating
specialists as needed.
Assisting in Grieving
 Encourage verbalization of fears,
concerns, negative feelings, and
questions regarding disease,
treatment, and future implications.
 Encourage active participation of
patient or family in care and
treatment decisions.
 Visit family frequently to establish
and maintain relationships and
physical closeness.
 Involve spiritual advisor as desired
by the patient and family.
 Allow for progression through the
grieving process at the individual
pace of the patient and family.
  Advise professional counseling as  Assess frequently for infection and
indicated for patient or family to inflammation throughout the course
alleviate pathologic grieving. of the disease.
 If patient enters the terminal phase  Prevent septicemia and septic shock,
of disease, assist patient and family or detect and report for prompt
to acknowledge and cope with their treatment.
reactions and feelings.
 Monitor for signs and symptoms of
 Maintain contact with the surviving septic shock
family members after death of the
 Instruct patient and family about
patient.
signs of septicemia, methods for
preventing infection, and actions to
take if infection or septicemia
Monitoring and Managing Potential
occurs.
Complications
Managing Infection Managing Bleeding and Hemorrhage
 Assess patient for evidence of  Monitor platelet count and assess
infection for bleeding
Report fever (≥38.3°C [101°F] or ≥38°C  Instruct patient and family about
[100.4°F] for greater than 1 hour), chills, ways to minimize bleeding
diaphoresis, swelling, heat, pain, erythema,
 Initiate measures to minimize
exudate on any body surfaces.
bleeding
 Discuss with patient and family
 When platelet count is less than
about placing patient in private
20,000/mm3, institute bed rest with
room if absolute WBC count is less
padded side rails, avoidance of
than 1,000/mm3 and the
strenuous activity, and platelet
importance of patient avoiding
transfusions as prescribed.
contact with people who have
known or recent infection or recent
vaccination.
 Instruct all personnel in careful hand
Promoting Home- and Community-
hygiene before and after entering
Based Care
room.
Teaching Patients Self-Care
 Avoid rectal or vaginal procedures
 Provide information needed by
(rectal temperatures, examinations,
patient and family to address the
suppositories, vaginal tampons) and
most immediate care needs likely to
intramuscular injections.
be encountered at home.
Managing Septic Shock
  Verbally review, and reinforce with  Assess adequacy of pain
written information, the side effects management and the effectiveness
of treatments and changes in the of other strategies to prevent or
patient’s status that should be manage side effects of treatment.
reported.
 Discuss strategies to deal with side
 Help coordinate patient care by
effects of treatment with patient and
maintaining close communication
family.
with all health care providers
 Identify learning needs on the basis involved in the patient’s care.
of the priorities identified by patient
 Make referrals and coordinate
and family as well as on the
available community resources.
complexity of home care.
 Instruct patient and family and
provide ongoing support that allows Nursing Management Related to Treatment
them to feel comfortable and Cancer Surgery
proficient in managing treatments at
home.
 Complete a thorough preoperative
 Refer for home care nursing to
assessment for all factors that may
provide care and support for
affect patients undergoing surgery.
patients receiving advanced
technical care.  Assist patient and family in dealing
with the possible changes and
 Provide follow-up visits and phone
outcomes resulting from surgery
calls to patient and family, and
evaluate patient progress and  Explain and clarify information the
ongoing needs. physician has provided about the
results of diagnostic testing and
surgical procedures, if asked.

Continuing Care
 Communicate frequently with the
physician and other health care
team members to ensure that the
 Refer patient for home care
information provided is consistent.
 Assess changes in the patient’s
 After surgery, assess patient’s
physical status and report relevant
responses to the surgery and
changes to the physician.
monitor for complications such as
 infection, bleeding,
thrombophlebitis, wound
dehiscence, fluid and electrolyte
imbalance, and organ dysfunction.
 Provide for patient comfort.
 Provide postoperative teaching that
addresses wound care, activity,
nutrition, and medications.
 Initiate plans for discharge, follow-
up care, and treatment as early as
possible to ensure continuity of care.
 Encourage patient and family to use
community resources such as the
American Cancer Society for support
and information.
Bone Marrow Transplantation
 Before BMT, perform nutritional
assessments and extensive physical
examinations and ensure that organ
function tests, as well as
psychological evaluations, are
completed as ordered.
 Ensure that patient’s social support
systems and financial and insurance
resources are evaluated.
 Reinforce information for informed
consent.
 Provide patient teaching about the
procedure and pre-transplantation
and post transplantation care.

During the treatment phase, closely
monitor for signs of acute toxicities (eg,
nausea, diarrhea, mucositis, and
hemorrhagic cystitis), and give constant
attention to patient.
 During the bone marrow infusions or
stem cell reinfusions, monitor vital
signs and blood oxygen saturation,
assess for adverse effects
 Because of the high risk for dying
from sepsis and bleeding, support
patient with blood products and
hemopoietic growth factors and
protect from infection.
 Assess for early graft-versus-host
disease (GVHD) effects on the skin,
liver, and GI tract as well as GI
complications
 Monitor for pulmonary
complications, such as pulmonary
edema, and interstitial and other
pneumonias, which often complicate
recovery after BMT.
Provide ongoing psychosocial patient
assessment, including the stressors affecting
patients at each phase of the
transplantation experience.
Hyperthermia
 Explain to patient and family about
the procedure, its goals, and its
effects.
 Assess the patient for adverse
effects, and make efforts to reduce
their occurrence and severity.
 Provide local skin care at the site of
the implanted hyperthermic probes.