Neoplasms #1 (2)

Question 1

Safety precautions for the patient recieving external beam radiation

Answer 1

• Personnel not permited in treatment room (distance)
• patient is NOT radioactive
• individualized lead blocks or other shielding blocks are used to protect the patient’s vital organs from the radiation (shielding)

Question 2

Safety Precautions for the patient recieving internal sealed radiation

Answer 2

• only sealed source is radioactive, not patients and his/her body fluids
• initiate precautions of time, distance, shielding
• prevent dislodgement of radiation source if placed in body cavity

Question 3

Internal unsealed radiation

Answer 3

• patient and his/her body fluids considered radioactive for a period of time, which is determined by the energy of the radionuclide and it’s 1/2 life
• initiate precautions time, distance, shielding

Question 4

Dosimeters

Answer 4

radiation monitoring devices which measure radiation exposure. do not offer protection from radiation.

Guidelines for use:

• do not share or exchange
• wear on front of body between collar and waist
• readings per institutional time schedule (usually monthly)

Question 5

Radiation safety officer

Answer 5

• develops and implements propor radiation safety procedures to help assist health care works to keep their doses ALARA. ensure policy adherence per federal/state guidelines. must be notified of any incident in which worker and/or patient safety may be compromised

Question 6

External Source Radiation Nursing Diagnosis

Answer 6

Knowledge Deficient: self-care r/t lack of exposure

• States interventions for anticipated side-effects
• Demonstrates proper skin care

1. Description of experience (equipment, positioning, sensations, sounds, duration, no staff permitted inside treatment room during dose delivery)
2. Not radioactive
3. Interventions for anticipated side-effects
4. Avoid using any topical skin care products on the day of treatment. skin should be without any skin care products at least two hours before treatment
5. do not wash off ink marking used to delineate area (tattooing now often used to delineate area and therefore washing not a concern)

Question 7

Internal Sealed Source Nursing Diagnosis

Answer 7

Knowledge Deficient: self-care r/t lack of exposure

• States interventions for anticipated side effects
• Discusses feelings related to radiation safety precautions

1. Implant radioactive only. patient and body fluids not radioactive
2. private room will be used
3. nurse will spend limited time with patient (recommended 20-30 minutes/shift)
4. how to cope during periods of precautions
5. interventions for anticipated side effects
6. prevent dislodgement of implant
7. children and pregnant visitors not allows
8. vistors remain 6 feet from ct. behind shield. may only visit 10-30 minutes per day
9. once implant is removed and placed in safe storage, no further radiation safety measures are necessary

Question 8

Recommended time with patient with internal sealed source radiation

Answer 8

20-30 minutes per shift

Question 9

Preventing dislogement of implant with gynecologic implants

Answer 9

• Strict bed rest (foley often placed) - be sure to initiate strategies to prevent complications of immobility
• HOB elevated <40 degrees
• Log-roll when turning side to side
• Keep items within reach of patient
• Pre-treatment bowel preparation regimen (enema often given pre-insertion)

Question 10

Unsealed source radiation nursing diagnosis

Answer 10

Knowledge Deficient: self-care r/t lack of exposure

• States interventions for anticipated side-effects
• Discusses feelings r/t radiation safety precautions

1. Blood and body fluids radioactive: double flushing for excretions (care providers to wash hands with gloves on after flushing, remove gloves, wash again)
2. Disposable eating utensils and trays will be used
3. Private room; staff will gown and glove, and utilize shoe covers
4. nurse will spend limited time with patient
5. linen saved in tightly closed bags for 10-40 days before washing
6. interventions for anticipated side-effects
7. visitation policy restricted 15-30 minutes per day. children and pregnant visitors not allowed.
8. increase fluids 3-4 liters/day for 48 hours to remove agent from body

Question 11

Erythema

Answer 11

redness

Question 12

Dry desqumation

Answer 12

dry, flaky, or scaly skin due to damage of sweat and sebaceous glands

Question 13

Moist desquamation

Answer 13

blistering, peeling, and sloughing of skin

Question 14

What is the most sensitve layer of skin to radiation?

Answer 14

epidermis

Question 15

Skin reactions radiotherapy

Answer 15

may occur 1-4 weeks after inital treatment and may persist for 2-4 weeks after completion of treatment. 85-90% of those who receive RT will develip a skin reaction

Question 16

Chemotherapy Side-Effects

Answer 16

• Systemic treatment that can cause a multitude of side-effects due to its effect on rapidly dividing cells
• Different classes of chemotherapies have their own individual side-effect profile. Common side-effects may include nausea, vomiting, diarrhea, mucositis, and alopecia
• Fatigue is a universal side-effect of all chemotherapy treatments

Question 17

Radiation Side-Effects

Answer 17

• Side effects are local in nature (only related to the area irradiated)
• The exception is fatigue which is the one universal systemic side-effect

Question 18

Alopecia side effect/nursing diagnosis

Answer 18

Disturbed body image

Knowledge deficient (self-care)

• Brush and comb hair gently
• use gentle shampoo and wash hair only when necessary
• avoid hair dye, permanents, hair dryers, electric curling devices, and constricting clips or bands
• cut hair short prior to loss
• may wear a wig, hat, or scarf. begin doing this before hair loss begins
• protect scalp from cold and sun

Question 19

Nausea and Vomiting Side effect/Nursing diagnosis

Answer 19

Risk for Imbalance nutrition, less than body requirements

Nausea

Risk for deficient fluid volume

Knowledge deficient (self-care)

• Assess N/V on 0-10 scale
• offter small, frequent meals
• encourage high calorie, high protein foods
• bland, lukewarm, non-gas forming foods best tolerated
• ensure anti-emetics administered pre-treatment when chemo or RT expected to cause N
• administer anti-emetics around the clock for 24-48 hours following chemo which is expected to cause N
• N/V may need to be treated with multiple anti-emetics from different classifications to effectively alleviate symptom
• Teach signs and symptoms of dehydration to report

Question 20

Mucositis side effect/nursing diagnosis

Answer 20

Risk for imbalanced nutrition, less than body requirements

Impaired oral mucous membrane

Knowledge deficient (self-care)

• Use soft bristle toothbrush after each meal and at bedtime
• rinse mouth four times/day with saline or 1 tsp baking soda dissolved in 2 cups H20
• Avoid commerical mouthwashes, alcohol, tobacco, and irriating foods
• Use topical anesthetics and/or systemic pain medication for pain relief
• Encourage fluids and soft or liquid high calorie high protein foods
• Teach signs and symptoms to report (signs of fungal infections, inability to eat/drink)

Question 21

Diarrhea side effect/nursing diagnosis

Answer 21

Diarrhea

Risk for imparied skin integrity

Risk for deficient fluid volume

Knowledge deficient (self-care)

• assess number, amount and consistency of stool
• administer antidiarrheal medications as ordered
• maintain fluid intake by encouraging 2500 mL (or more) per day
• avoid greasy, spicy, fried foods, and dairy product
• encourage low residue, low-roughage, low-fat diet
• BRAT diet helpful (bananas, rice, apples (peeled), and dry toast
• teach/provide perianal skin care followed by moisture barrier creams
• administer anti-diarrheal medications as ordered
• teach signs and symptoms of dehydration to report

Question 22

Knowledge Deficient (skin care) r/t lack of exposure

Answer 22

Do:

1. Gently clean skin in treatment area wiht a mild soap
2. Rinse well with lukewarm water and pat dry
3. Use mild deodorant only on intact skin.
4. Wear loose, non-constricting clothing over treatment area.
5. Keep the treatment area free of all ointments, creams, lotions, deodorants or powders on the day of treatment.
6. May use plain, non-scented, lanolin-free, water based moisturizing cream if no skin breakdown is present.
7. Inspect treatment area every day and report any changes or problems to the nurse
8. Use an electric razor if necessary

Don’t:

1. Do not remove ink or port marking from your skin until directed to by staff.
2. Don’t apply fricition to the affected area
3. Avoid pressure or injury to the area, do not use adhesive tape, scrub or shave area
4. Do not expose the area to extremes of temperature
5. Avoid exposure to the sun, hot tubs, heating pads, or ice bags
6. Do not treat skin changes in the treatment area without discussing plans with the nurse