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Patient Care > Radiation Therapy Side Effects and Management > Flashcards

Radiation Therapy Side Effects and Management Flashcards

1
Q

Typical H&N Pathologies

A
  1. Basal or squamous cell carcinomas of the skin
  2. Squamous or adenocarcinoma of oral cavity, oropharynx, nasal cavity, paranasal sinuses, nasopharynx, larynx, hypopharynx, and salivary glands
  3. Lymphomas involving neck nodes
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2
Q

Assessment of H&N: What is mucositis?

A

irritation of mucous membrane

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3
Q

Assessment of H&N: What is stomatitis?

A

sores in the mouth, interior lips and buccal lining

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4
Q

Assessment of H&N: What is esophagitis?

A

pain that is exacerbated by swallowing

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5
Q

Assessment of H&N: What is xerostomia?

A

dryness of the mouth or throat

(usually seen when salivary glands are in the radiation field)

(starts as thick, ropy saliva which is difficult to swallow and may progress into complete mouth drynes)

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6
Q

What 3 functionalities of H&N are assessed?

A
  1. Respiration/Airway – is patient able to maintain viable airway? Characteristics of secretions, cough effort, work of breathing
  2. Speech – voice character and quality
  3. Swallowing – what food or liquid has patient been able to take? Diet adjustments? Adequacy (weight)?
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7
Q

What 2 things of the Integumentary System is assessed?

A
  1. Dry desquamation – skin care regimen? associated symptoms?
    1. tepid water and pat dry
    2. moisturizer
    3. pruritis (topical steroidal)
  2. Moist desquamation – skin care regimen? pain? presence of infection?
    1. soak with cold wet washcloth or apply ice to help debride wound
    2. dressings to keep wound from drying out or become infected
    3. NO tape
    4. Vaseline gauze
    5. Telfa
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8
Q

Evaluation of Integumentary system: How long till skin wounds heal?

A

Will not see wound healing until several weeks after treatment, main goal is providing supportive care

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9
Q

Interventions of H&N patients

A
  • Proper oral care
  • Suctioning
  • Frequent mouth care
  • Pain control
  • Diet changes
  • Supplemental nutrition
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10
Q

H&N Interventions: Altered Nutrition

A
  • Introduce oral, parenteral, or enteral nutritional supplements for patients with impaired nutrition = 10% body weight loss
  • Assist patient identifying foods that they can eat (soft, thick, low-salt, low-acidic & avoid favorite foods)
  • Cryotherapy is useful (during chemo, not RT)
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11
Q

H&N Intervention: Pain Control

A
  1. Fentanyl patches (change every 3 days)
  2. Narcotics/Opioids (liquid form for difficult swallowing)
  3. Stomatitis Cocktail
  4. Viscous lidocaine (lidocaine shot)
  5. Carafate (thick coating to protect esophagus)
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12
Q

What 5 things are assessed when receiving radiation to the chest?

A
  1. Typical pathologies
  2. Lung cancer
  3. Esophageal cancer
  4. Lymphoma receiving mantle radiation
  5. Metastatic sites
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13
Q

What is “Normal Respiratory Patterns”?

A

How a patient’s respiratory quality, work of breathing, rate, SaO2

Normal adult respiration rate = 12-20/minute

Infant/children breathe at faster rate 20-40/minute

Respirations should be nonlabored and should not involve the use of accessory muscles

Normal SaO2 > 94%

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14
Q

Chest patient interventions: Pain

A

Related to Esophagus

Medications:

  1. Carafate
  2. Fentanyl patch
  3. Viscous lidocaine
  4. Stomatitis cocktail
  5. Norco

Alter diet: soft foods, no sharp edges (avoid scrapping esophagus), low acidity, low salt

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15
Q

What 7 typical pathologies are assessed for patients receiving radiation to the Abdomen?

A
  1. Pancreas cancer
  2. Cancer of the bile duct
  3. Stomach cancer
  4. Extended field endometrial/cervix
  5. Wilm’s tumor (pediatric)
  6. Neuroblastoma (pediatric)
  7. Metastatic sites
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16
Q

Assessing nausea for abdominal patients

A
  • Is patient experiencing any nausea or vomiting? If so, what is the pattern?
  • How many episodes of emesis in 24 hours?
  • What is the quality and consistency of the patient’s stools? How many episodes of diarrhea in 24 hours?
  • What is patient’s nutritional status?
17
Q

Assessing abdominal patients

A
  • Is patient experiencing any pain?
  • What other therapies is the patient receiving and what role are these therapies playing in symptom causation?
18
Q

What are Cystopenias?

A

Low white, red, or platelet values

19
Q

Cytopenia: Neutropenia

A

ANC < 1000 (WBC 4.3 - 10.8)

  • Consider starting Neupogen/Neulasta
20
Q

Cytopenia: Anemia

A

Normal hemoglobin 12-16

  • Consider blood transfusion < 8.0 or Procrit
21
Q

Cytopenia: Thrombocytopenia

A

Severe defined by < 25,000

Normal is 150,000-350,000

Institute bleeding precautions

Consider platelet transfusion

22
Q

Interventions for abdominal patients: Diarrhea

A
  • Mild diarrhea (3 or fewer liquid stools/day) begin low fiber diet, consider Immodium AD
  • Persistent to moderate diarrhea, start Limotil
  • For severe, consider tincture of opium
  • Evaluate for dehydration: orthostasis, dry mucous membranes, dizziness, poor skin turgor
  • Proper perineal care to reduce anal skin breakdown
  • Therapy break if severe, uncontrolled

Prolonged diarrhea can lead to hypokalemia

  • Normal serum potassium s 3.5-5.0
  • IV/oral potassium supplementation may be needed
  • Early sign is muscle cramping
23
Q

Interventions for abdominal patients: Fluid Volume Deficiency (Dehydration)

A
  • Caused by prolonged diarrhea/emesis, low intake
  • Classically characterized by orthostasis: drop un systolic pressure > 20 mmHg or pulse increase of 20 bpm or more with position changes
  • Increase PO fluids if patient is able
    • minimum of 64 ounces of fluid + 8 ounces/each loose stool
  • IV fluids usually required
  • Consider break from therapy if severe
24
Q

Interventions for abdominal patients: Nausea

A
  • Prolonged nausea can lead to decreased oral intake, weight loss, alteration in nutrition
  • Frequent emesis quickly leads to fluid volume deficiency, hypokalemia, hyponatremia
  • Prophylaxis or therapeutic antiemetics should be considered
25
Q

Pharmacologic interventions for Nausea and Vomiting

A
  • Zofran** mostly used
  • Compazine
  • Ativan (treats anxiety)
  • Reglan (antiacid and slows motility of stomach)
  • Decadron (steroid)
  • Scopolamine (patch)
26
Q

Evaluation of Diarrhea/Fluid Volume Deficit interventions

A

Blood pressure and pulse return to baseline

  • Adult = 120/80 with pulse of 60-100 bpm
  • Children = depend on body size

Good skin turgor

Moist mucous membranes

No dizziness with ambulation/position change

27
Q

What are 5 typical pathologies when assessing patients receiving Pelvic radiation?

A
  1. Cervical cancer
  2. Endometrial cancer
  3. Rectal cancer
  4. Anal cancer
  5. Prostate cancer
28
Q

Assessing pelvic patients

A
  • Has the patient experienced any change in stool patterns?
  • Is patient experiencing any dysuria, hematuria, nocturia, or frequency?
  • For females: any vaginal bleeding or discharge?
29
Q

Interventions for pelvic patients: Altered Urinary Patterns

A
  • Radiation results in urethral irritation – as urine passes, salt contents burn. Encourage increased PO fluid to dilute urine
  • Urinary tract infections
  • Pyridium for comfort. If UTI, start ABX
  • Decrease fluid intake one hour prior to bedtime if nocturia is problematic
  • Flomax to decrease frequency
  • For severe swelling or tumor impinging on bladder/urethra straight or indwelling catheters is only option for elimination
30
Q

Evaluation of Altered Urinary Patterns/Pain

A
  • Patient emptying bladder on regular basis with adequate urine stream
  • Patient reports increased comfort with urination
31
Q

Interventions for pelvic patients: Impaired Skin Integrity

A
  • Many patients will experience proctitis
  • Keep stools soft, formed
  • Hard stools or frequent diarrhea will hasten proctitis
  • Find bowel regimen that works for patient
  • Immodium, Lomotil vs. Sennokot-S Colace
32
Q

Interventions for pelvic patients

A

Essential to instruct patient to practice good perineal care in order to avoid infection

  • Baby wipes instead of toilet tissue
  • Moisturizing lotions (aquaphor)
  • Squirt bottles
  • Sitz baths

Comfort measures:

  • Immediate release pain meds taken where urge to move bowels (and stool softener)
  • Topical lidocaine or cryotherapy
  • Proctofoam/Proctocream
  • Anusol HC suppositories
33
Q

Evaluation of Impaired Skin Integrity

A
  • Patient expresses increased comfort with bowel movements
  • Patient can verbalize methods to help decrease acute anal discomfort
  • Patient remains free of infection
34
Q

Interventions for pelvic patients: Sexual Dysfunction

A
  • Men may experience difficulties maintaining erections
  • Disease-related or as side effect of radiation or hormonal therapies
  • Women will experience vaginal tenderness and dryness
  • May continue intercourse till uncomfortable
  • Post radiation will have vaginal stenosis, encourage frequent intercourse, dilator
  • Persistent vaginal dryness, encourage lubricants, Replens, HRT or Premarin Cream
35
Q

Evaluation of Sexual Dysfunction interventions

A

Patient expresses sexual satisfaction

Patient does not have pain with sexual intercourse

Patient Care (8 decks)

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