patient care Flashcards
who is responsible for assessing patients on a daily basis
radiation oncology nurses and radiation therapistss
standards for patient care
- assessment
- diagnosis
- outcome identification
- planning
- implementation
- evaluation
define evidence based practice (EBP)
solving clinical problems and delivering care based on the best current evidence, applied with clinical expertise and an appreciation of patient’s values and expectations
strongest evidence that can be used for EBP is
meta-analysis of multiple controlled clinical studies
the most radioactive cells are
rapidly dividing cells
how rapid do acute responding tissues demonstrate the effects of radiation
within hours to days
how rapidly to sub-acute responding tissues demonstrate the effects of radiation
within weeks to months
how rapidly do late responding tissues demonstrate the effects of radiation
within months to years
what factors influence cells radiation sensitivity
- cell cycle phase
- presence of oxygen enhances radiation damage
- differentiation- poorly differentiated cells are more sensitive
- proliferative capacity
- repair capacity- greater repair, more sensitive
- tumor size- larger tumor- poorly oxygenated center-less sensitive
- fractionation
- quality of radiation
which cell cycle phase is the most sensitive to radiation
late G2 and M
cell cycle that is the least sensitive to radiation
S phase
most common complications of radiation therapy
fatigue skin reactions pain distress sexual dysfunction weight loss (nutrition wise)
at what dose does a patient experience temporary hair loss
30 Gy
at what dose does a patient experience permanent hair loss
55 Gy
at what dose does a patient experience basal cell loss
20-25 Gy (2-3 weeks)
what causes skin erythmea
histamine is released from cells damaged by radiation
can occur within a couple of weeks
at what dose can it cause skin erythema
30-40 Gy
flaking of skin, superficial, sweat and sebaceous glands are damaged
dry desquamation
blistering and sloughing, damage to hair follicles and sweat glands, necrosis can occur
moist desquamation
at what dose can desquamation occur
45-60 Gy
risk factors for skin reaction
- electrons (superficial dose deposition)
- bolus
- skin folds
- lack of aeration (air)
- wound sites
- tangential fields- higher dose, thinner areas
- POP
- skin thickness
- previous exposure to radiation
- number of oxygenated cells
- general skin conditions
- moist areas of body cause friction
- nutritional status
- chemo
- medical conditions: lupus, scleroderma
what is necrosis
tissue death
at what dose can necrosis occur
> 55 Gy
when can necrosis occur
within 6 months to 2 years post treatment
necrosis is revirsible
false
common side effects of head and neck irradiation
loss of taste
dysphagia
xerostomia
what is dysphagia
difficult swallowing
what is xerostomia
dry mouth
at what dose does patient have loss of taste
30 Gy for temporary, 60 Gy for permanent
when does dysphagia occur
2-3 weeks post treatment
dose tolerance for small bowel
45 Gy
what happens when you exceed dose tolerance for small bowel
- malabsorption
- diarrhea
- dehydration
why does CNS treatment cause nausea
brain’s receptors are affected by radiation and may cause the patient to feel nauseated, vomiting can occur
what side effect is heachade
CNS
side effects to CNS
headache nausea vomiting changes in mental status weakness seizures speech problems
oxygenation and repair capacity refer to
factors influencing cell’s radiation sensitivity
a patient is beginning gynecological radiation therapy with extensive treatment of abdominal nodes. which of the following side effects might she experience
- pericarditis
- nausea
- xerostomia
- dysphagia
nausea
a patient undergoing treatment for endometrial cancer complains of diarrhea and dehydration. she also gradually lost weight. what can you surmise about her treatment and/or diet
her small bowel may have exceeded 45 Gy
this fractionation scheme is intended to decrease late effects
hyperfractionation
