Teaching during radiation therapy

Nutrition Rest Skin care

Redmarking vs. tatoo

Nursing Diagnosis - RT
Knowledge deficit Impaired skin integrity Fatigue
Other pertinent Nsg. Diagnoses
Nutrition Infection Impaired mucous membranes Diarrhea

Interventions for Fatigue R/T Radiation Therapy

Recognize that fatigue is compounded by things Assess impact on life / ADLs Assess labs Incorporate rest periods Reduce activity to level Mild exercise

Care of Pts with Implants

Pvt room & Pvt bath Keep door closed as much as possible Wear a badge Wear lead apron Limit visitors to hr per day & must stay six feet from pt Save all dressings and linens until source is removed

Chemotherapy
Action depends on type of Tx

Common Side Effects of Chemotherapy

1. N/V (60%) constipation, diarrhea, stomatitis 2. Alopecia 3. Myelosuppression resulting in neutropenia, thrombocytopenia, and anemia 4. Renal cells are sensitive to chemo agents resulting in increased uric acid secretion indocin allopurinol 5. Cardiomyopathy with heart failure can result.

Risk for Infection

1. Assess CBC leukopenia and a decrease in WBCs <2900 mm3 2. Temp assess for fever greater than 101 oncologic emergency 3. Avoid unnecessary injections 4. Avoid fresh fruits,plants and flowers 5. Antibiotics

Risk for Infection cont.

6. Teach risk s/s 7. Promote good hygiene, especially skin & mouth 8. Strict hand washing 9. Follow protocols for care of VAD 10. Limit ill family / friends 11. Private room

Risk for Injury: bleeding

1. Assess bleeding potential 2. Assess petechiae, hgb/hct, prolonged bleeding from invasive procedures, change in LOC 3. Decrease bleeding potential by soft toothbrush, electric razor, minimize injections, blood draws. 4. Assess OTC meds ASA, NSAIDS 5. Educate the patient and family 6. Anticipate platelet transfusion for < 20,000

Impaired gas exchange R/T anemia

1. Assess for fatigue, dyspnea, headache etc. 2. Anticipate blood transfusion if symptomatic. Concerned @ hgb 8. 3. Anticipate administration Epogen/Procrit- stimulates the bone marrow to release RBCs. 4. Maximize oxygen.

Management of blood related deficiencies

Transfusions Procrit, Epogen
H&H, RBCs

Neupogen
WBCs

Platelets

Nausea R/T effects of chemotherapy

1. 2. 3. 4. 5. Assess nausea Adjust oral and fluid intake If nutrition is compromised dietary consult Emphasize high calorie, high protein Anticipate enteral / parenteral feedings

Altered nutrition: less than requirements R/T nausea, anorexia, stomatitis

1. Treat nausea ondansetron,dolastron 2. Small meals 3. If nutrition is compromised, seek Oral care including management of stomatitis, remove dentures, offer rinse 4. Routine weights - dietary consult 5. Assess albumin levels, Fe 6. Anticipate enteral / parenteral feeding. Lipids and TPN is not uncommon 7. Up as much as possible
Bone mets hypercalcemia

Fatigue
1. 2. 3. 4. 5. 6. 7. Balance activities throughout the day Schedule rest periods. Avoid being in bed all day Reassignment of home duties and roles Blood or blood products, Epogen. Recognize own limits of intolerance Assess oxygenation.

Pain
One of the most feared effects of cancer. Collaborative management of pain. Adjunct drugs antiemetics, antidepressents, anxiolytics. Organized pain assessment method Understand pharmacology of drugs being used, tolerance may develop and larger doses may be required.

Pain Nursing Diagnosis

Analgesic
Mild to moderate use NSAIDS & adjuvants (Elavil, Prednisone) Severe narcotics, oral (MS Contin, Oxycontin) patches (Fentanyl / Durgesic) suppository, SL MSO4, PCA

Non Invasive
Relaxation massage