Test 2 Flashcards
Written procedures posted at every machine
Required by some state regulatory agencies
Know where emergency offs and circuits are
Emergency procedures
Where machine is controlled
Monitor and control linac
Audio and visual
Control console
4 states of operational status
Stand-by
Preparatory
Ready
Beam on
Machine in “napping” state
Has time delay before it turns on
Keeps electronics warm
Stand-by
Shows programmable operational status; record and verify
Preparatory
Confirmed program information
Ready
Turn key and hear “chirping” sound
Beam on
Displayed before or during treatment
Designed to protect patient, employees, and equipment
Interlocks
____ Gy (_____ cGy) can be given in 0.3 seconds at 4000 Gy/min if machine set for wrong beam energy
2 Gy (200 cGy)
8 examples of interlocks
Beam energy Beam symmetry, flatness Dose rate, typical dose Mechanical hazards Carousel rotation for different treatment Bending magnet not steering correctly (BMAG) Foil fault Dose/MU 1.2
11 new technologies
Conformal therapy Multileaf collimation (MLC) Dynamic wedge collimator Electronic portal imaging (EPID) On board imagers (OBIs) Stereotactic radiation therapy IMRT Tomotherapy Image guided radiation therapy (IGRT) Electronic arcs Flattening-field free (FFF)
Took place of cerrobend blocks; 52-160 leaves made of tungsten
Usually rounded on edges so they don’t break if they hit leading to penumbra at end/tip of leaf
Multileaf collimation (MLC)
Older; gets more conformal to tumor volume because peripheral dose decreases, tightens everything up to tumor volume
More angles = les dose per field; more beams
Field shape and beam angle change while gantry moves around patient
Allowed by IGRT
“Forward planning” process
Conformal therapy/3D-CRT
Flat panel MV receptor across from gantry that gives image; demonstrate poor image quality/contrast
Electronic portal imaging (EPID)
kV images on lateral sides of machine, correlates with interaction
Can recreate cone beam CT every 1 degree
Flat panel detector
Offers better detailed image
On board imagers (OBIs)
High dose per fraction for hard to reach areas (brain); long prep time, precise
External 3D frame halo: bolts drilled into head and fastened to apparatus that prevents head movement
Planning can take 3-8 hours
Fiducials track movement
Brain tumors, anterior or venous malformations (AVM), etc.
Stereotactic radiation therapy
Beam arrangements are tested by trial and error until satisfactory dose distribution is produced
“Forward planning” process
IMRT develops treatment plans using this treatment planning; radiation oncologist selects dose parameters for normal tissues and the target volume and computer “back calculates” the desired dose distribution and beam arrangements
“Inverse treatment planning”
How much dose is being received within lines
Isodose lines
Beams in different planes
Non-coplanar
Smaller MLC’s used for SBRT/SRS to conform the dose to very small treatment volumes receiving larger or single fraction doses
Micro-/mini-MLCs
Curved to match beam divergence; took place of cerrobend blocks
Dynamic wedge collimator
3 major components of the linac
Drivestand
Gantry
Couch
Collimation: bimodal (open or shut), static
Similar to CT but 6 MV
Very conformal but limited
Tomotherapy
Similar to tomo arcing around
More arcs = more time, patient has to stay still the whole time
Electronic/rapid arcs
2 types of IGRT
Exac trac
CT overlay
Uses infrared tracking to see reference position
Exac trac
Makes sure patient is perfectly aligned and if there are any shifts to be made
CT overlay
Changing planning right there
Adapted planning
Real-time MRI with Co-60
Viewray
Computers used to assist therapist in the verification of treatment parameters allow incorrect setup parameters to be corrected before machine is turned on
Computer-assisted setup and recording of patient data reduces erros
Patient information comes from treatment planning computer to machine
Record and verify
2 classes of hazards defined by the FDA
Class I
Class II
Accident causes death or injury
Class I
Accident if risk of serious injury low (operator error, linac error, etc.)
Class II
Dmax depth for superficial and orthovoltage
0.0 cm
Dmax depth for Cesium 137 and Radium 226
0.1 cm
Dmax depth for Cobalt 60
0.5 cm
Dmax depth for 4 MV
1.0 cm
Dmax depth for 6 MV
1.5 cm
Dmax depth for 10 MV
2.5 cm
Dmax depth for 15 MV
3.0 cm
Dmax depth for 18 MV
3-3.5 cm
Dmax depth for 20 MV
3.5 cm
Dmax depth for 25 MV
5.0 cm
Traditional and SI unit of Cobalt 60
Traditional: Ci
SI: Bq
Most sources have an activity of ____-____ Ci
750-9000 Ci
To compensate for the reduction in beam output of Co-60 each month (1%), a correction factor of about ___% per month must be applied to the output
1%
Electronic equilibrium
Dmax
Shielding for Co-60
Cerrobend melts at a much lower point than lead and is therefore easier and safer to use (cadmium)
5 methods to expose the Co-60 source
Air pressure (piston) Rotating wheel Mercury reservoir Chain driven Moving jaws
Number of HVLs formula
(1/2)^n = percent transmitted
Ratio of cerrobend to lead
12:1
2 advisory agencies that don’t set regulations for radiation safety procedures
International Commission on Radiological Protection (ICRP)
National Council on Radiation Protection and Measurements (NCRP)
Agency that sets regulations for radiation safety procedures
Nuclear Regulatory Commission (NRC)
States that enter into agreement with NRC to assume responsibility of enforcing regulations for ionizing radiation
Agreement states
3 times full calibration must be done
Sources replaced
5% deviation during QA or spot check
Any major repairs that require removal or restoration of major components
5 things full calibration includes
Radiation field-light coincidence
Timer accuracy
Distance measuring devices (ODIs, etc.)
Uniformity of radiation field and dependence based on useful beam
Exposure and dose rate for +/-3% accuracy for multiple field sizes
Average leakage and leakage for 1 reading at 1 m
Average = 2 or less mR/hr at 1 m
1 reading at 1 m = 10 or less mR/hr
Max permissible leakage in “on” position
0.1% or less of useful beam 1 m from source
Filter paper wiped on collimator edges twice a year with long forceps should read less than 0.005 microcurie
Wipe test
18-24 in bar to push source back into machine; first 7 in red = pretty safe, 2nd 7 in yellow = source back in housing
T-bar
Why dose Co-60 have very high penumbra?
Large source size
Increasing energy _______ penumbra; by over 10 MV penumbra _______ again because of Compton
Increases
Occurs with straight blocks because of divergence
Transmission penumbra
Transmission + geometric penumbra
Physical penumbra
Penumbra formula
P = S(SSD+d-SDD)/SDD
Increasing SSD and distance from source ______ penumbra; increasing SDD _______ penumbra
Increases, decreases
Who insures radiation therapists?
Hospital
Discipline dealing with what’s good and bad, moral duty and obligation
Set of moral principles or values
Theory or system of moral values
Principles of conduct governing an individual or group
Foundation of law
Ethics
Fidelity to conscience; person’s concept of right or wrong as it relates to conscience
Morality
Loyalty, faithfulness
Fidelity
Sum of rules and regulations by which society is governed in any formal and legally binding manner
Legal concepts
Foundation of which is ethics, primarily concerned with the good of a society as a functioning unit; exist so we can all live and coexist in formal and legal binding manner we’re governed by
Doesn’t consider the professional and patient to be on equal terms; greater legal burden/duties are imposed on the healthcare provider
Laws
Application of ethics to the bioethical sciences, medicine, nursing, and healthcare
Bioethics
7 principles of bioethics
Autonomy Beneficence Confidentiality Justice Nonmaleficence Role fidelity Veracity
Patients are independent actors whose freedom to control themselves is to be respected without interference from others
Autonomy
Healthcare professionals act in the best interest of patients, even when it might be inconvenient or sacrifices must be made
Beneficence
Principle that relates to the knowledge that information received by a patient to a healthcare provider or learned in the course of a healthcare provider performing their duty, is private and should be held in confidence
Confidentiality
Fairness and equity maintained among individuals
Justice
Directs professionals to avoid harmful acts to patients
Nonmaleficence
Principle that reminds professionals that they must be faithful to their role in healthcare environment
Role fidelity
Truthfulness specific within healthcare aspect
Veracity
3 groups of ethical theories
Teleology/consequentialism
Deontology/nonconsequentialism
Virtue ethics
2 forms of teleology/consequentialism
Egoism
Utilitarianism
Evaluate good versus bad way person can provide greatest good for most people; ends justify the means
Teleology/consequentialism
Best long-term interests of an individual are promoted; in evaluating an act/action for its moral value, it must produce a greater ratio of good over bad for the individual
Egoism
Ethical behaviors should be geared toward performing acts that produce the greatest ratio of good to bad
Utilitarianism
Uses formal rules for right and wrong for solving problems; duty and right actions to be taken
Deontology/nonconsequentialism
Practical wisdom for emotional and intellectual problem solving; practical reasoning and consideration of consequences
Virtue ethics
Ways of viewing relationship with patient; use all of these to build a relationship with patient
Models for ethical decision making
5 models for ethical decision making
Engineering/analytical Priestly Collegial Contractual Covenant
Dehumanizing approach identifies caregivers as scientist dealing only in facts and doesn’t consider the human aspect of the patient/disease
Engineering/analytical model
Provides caregiver with godlike attitude forcing patient to do whatever caregiver says regardless of pain
Priestly model
Presents a more cooperative method of pursuing healthcare for both provider and patient; consideration
Takes the extra time to get acquainted with patient
Collegial model
Maintains a business relationship where information and responsibility are shared; informed consent
Contractual model
Recognizes areas of healthcare not always covered by a contract; deals with an understanding between patient and healthcare provider that’s often based on traditional values and goals
Go above and beyond to make sure patient gets best treatment; caregiver makes more decisions
Ex: give patient dietary needs, maybe even dietician if necessary
Covenant model
Be truthful and give factual information to patient; patient must be competent
Written; must be done before touching patient
Informed consent
4 things the patient must be informed of to give informed consent
The nature of the procedure, treatment, or disease
The expectations of the recommended treatment and the likelihood of success
Reasonable alternatives available and the probable outcome in the absence of treatment
The particular known risks that are material to the informed decision about whether to accept or reject medical recommendations
Document from American Hospital Association (AHA) that explains expectations when in hospital (confidentiality,etc.)
Patient Care Partnership
7 stages of grief cycle
Shock Denial Anger Bargaining Depression Testing Acceptance (DABDA)
Initial reaction to hearing news of bad event
Shock
Pretending what is, isn’t
Denial
Outward demonstration of pent-up emotion and frustration
Anger
Trying to find a way out of the situation
Bargaining
Realization of facts
Depression
Searching for realistic resolutions
Testing
Coping with the situation and finding a way forward
Acceptance
Allows the competent adult to provide direction to healthcare providers concerning their choice of treatment under certain conditions should the individual no longer be competent by reason of illness or other infirmity to make those decision
Takes legal obligation from physician/hospital
Executes patient’s wishes (ex: resuscitation)
Living will
Joint Commission requires every hospital to have a no code policy
Do-not-resuscitate (DNR)
5 things that must be done before executing a living will
Individual demonstrates competency at the time
What done if they code
Pain medications (religion)
Relieves hospital and physician of legal responsibility
Signature has to be witnessed by two disinterested individuals who aren’t related, mentioned in will, or have no claim on the estate
Represents an intermediate station for patients with terminal illness between life and death
Daily care to make sure patient is comfortable in passing
Physical, moral, and emotional support
Improve and make patients life as tolerable as possible for little time they have left
Patients may enter on their own or may be referred by family, physicians, hospital-affiliated continuing care coordinators and social workers, visiting nurses, friends, or clergy
Life expectancy of 6 months or less
Most families prefer homecare
Hospice
Law that governs non-criminal activity, relationships between individuals
Civil laws
Type of civil law, wrongful act committed against a person
Allows compensation to be paid to an individual damaged or injured by another
Tort
2 types of torts
Intentional
Unintentional
Willful acts meant to be done
Intentional tort
Those acts that aren’t intentionally harmful but still result in damage to property or injury to person
Ex: failure of healthcare provider to provide properly for the safety of a patient or failure to properly educate a patient, resulting in harm
Unintentional tort
7 intentional torts
Assault Battery False imprisonment Libel Slander Invasion of privacy Negligence
Threat of touching in an injurious way
Assault
Actual act of harmful, unconsented, or unwarranted contact with an individual
Battery
Intentional confinement without authorization by a person who physically constricts another with force, threat of force, or confining clothing or structures
False imprisonment
Written defamation of character
Libel
Oral defamation of character
Slander
Charges may result if confidentiality of information hasn’t been maintained or the patient’s body has been improperly and unnecessarily exposed or touched
Invasion of privacy
Neglect or omission of reasonable care or caution
Negligence
Failure to follow appropriate standards of care
Medical negligence/malpractice
4 legal doctrines
Doctrine of Personal Liability
Doctrine of Respondeat Superior
Doctrine of Res Ipsa Loquitur/”the thing speaks for itself”
Doctrine of Foreseeability
Persons are liable for their own negligent conduct; law doesn’t permit wrongdoers to avoid liability for their own actions, even though someone else may also be held liable for the wrongful conduct
Therapists can be held responsible for their own negligent actions
Doctrine of Personal Liability
An employer is responsible for negligent acts of employees that occur while they’re carrying out the orders or serving the interests of the employer; certified, come from accredited program, etc.
Doctrine of Respondeat Superior
Requires the defendant to explain the events and convince the court that no negligence was involved; the Standards of Practice for Radiation Therapists may be used by either the defense of the prosecution to support or refute negligent behavior
Doctrine of Res Ipsa Loquitur/”the thing speaks for itself”
Principle of law that holds an individual liable for all natural and proximate consequences of negligent acts to another individual to whom a duty is owed
The negligent acts should or could have been reasonably foreseen under the circumstances
Injury suffered must be related to the foreseeable injury
Doctrine of Foreseeability
Believed to be the key element in loss prevention from adverse medical incidents and links every quality improvement program with measurable outcomes
Tolerances, determine effectiveness with consideration to patient’s safety
Risk management
Any happening that isn’t consistant with the routine operation of the hospital or the routine care of a particular patient
Incident
7 rationales for and documentation of treatment
Written patient history, radiographic results
Patient progress
Notes from weekly treatment visits
Blood counts, weights
Treatment indicators/responses
Why patient’s being treated the way they are
Written and included in patient’s chart
Kept separate/in department from patient’s individual medical records
Patient’s name and hospital ID number on each page
Should be legible and in pen
If mistake made, cross it out with one line and initial and date it
QA: ID, consent, diagnostic dictations, etc.
Radiation therapy chart
Consolidate, organize, and document an individual’s healthcare experience
Demonstrates why patient’s being treated
Medical records
Computer-hosted medical record provides collection and storage of information and facilitation of the patient encounter by providing the clinician with the most relevant information for the specific task at hand
Electronic medical record (EMR)
Focuses on total/overall health of patient, cross the lifetime of individuals; provides complete and accurate information and easier/better access to their information and gives patient empowerment (have access and can share as needed)
Electronic health record (EHR)
Assembly of tasks performed to accomplish a goal, can be very simple or complex
Workflow
Online management of the entire order tracking and documentation process from order entry to return of results and is a standard workflow component of an electronic chart
Computerized physician online order entry (CPOE)
4 input methods
Keyboard and mouse
Speech/voice recognition systems
Peripheral devices
Direct communication
4 peripheral devices
Barcodes
Biometric devices: fingerprint/retinal scanners
Cameras and scanners
Electronic completion devices: signature pads
Provides overall viewpoint/picture of health in certain country; took charge of publishing mortality classifications (1950s)
World Health Organization (WHO)
Set up standards to code and tabulate mortality and morbidity data
Made easy to calculate statistics (ex: cell type, classifying diseases, cause of death, level of pain)
International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD)
Step-by-step process for how something should be done
Finite set of instructions used by computers to compute a desired result (ex: diagnosis code and tumor size, node, and metastatic state data can calculate disease stage which saves clinician time)
Can compare medications and patient allergies; can be simple or complex
Treatment-planning computers
Algorithm
Stores and transfers images
Picture Archiving and Communication System (PACS)
Refers to graphic, textual, and auditory information the program presents to the user and the input methods the user employs to control the program; what is seen, usability of system
User interface
2 interfaces
Proprietary
Standards-based/open systems development
Developed and owned by private or commercial entities; for sale/not free, widely used in radiation oncology (ex: Varian linac)
Drawback: duplication of effort with solving of common problems in unique ways
Proprietary interfaces
Developed by national and international committees accredited by organizations such as the American National Standards Institute (ANSI) or International Standards Organization (ISO)
Standards-based interfaces/open systems development
2 examples of standards-based interfaces/open systems development
Health Level 7 (HL7)
Digital Imaging and Communications in Medicine (DICOM)
Defines comprehensive framework and standards for the exchange, integration sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery, and evaluation of healthcare services
Enable sharing of patient information useful across entire healthcare facility
Health Level 7 (HL7)
20 standards specific to imaging and transferring this information, used for PACS
Produced by National Electrical Manufacturers Association (NEMA) and the ACR
Describes each type or information that may be transferred
Digital Imaging and Communications in Medicine (DICOM) 3
Each type or information that may be transferred
Information Object Definitions (IOD)
6 IODS
Radiation therapy (RT) image RT dose RT structure set RT plan RT beams and RT brachytherapy RT treatment summary
Conventional and virtual simulation images, DRRs, and portal images
Radiation therapy (RT) image
Dose distributions, isodose lines, dose-volume histograms (DVH)
RT dose
Plot of target or normal structure volume as function of dose
Dose-volume histograms (DVH)
Volumetric contours drawn from CT images
RT structure set
Text information that describes treatment plans, including prescriptions and fractionation, beam definitions, and so forth
RT plan
Treatment session reports for external beam or brachytherapy may be used as part of a record and verify (V&R) system
RT beams and RT brachytherapy
Cumulative summary information may be used after treatment to send information to a hospital EMR
RT treatment summary
A system of independent, interconnected computers or terminals communicating with one another over a shared medium, consisting of hardware and communication protocols; requires special hardware, including cards within the computers and particular cables
Network
Most common protocol
Ethernet
Formed to improve computerized systems in radiation oncology; provides a platform for the radiation oncology team, administrators, and industry representatives to address these issues and develop solutions that ensure the clinic delivers the most optimal care
Integrating the Healthcare Enterprise for Radiation Oncology (IHE-RO)
3 networks
Local area network (LAN)
Wireless local area network (WLAN)
Wide area network (WAN)
A network geographically confined to an area in which a common communication service may be used (ex: home, school, office, etc.); can implement EMR software
Local area network (LAN)
Allows users to connect to a local area network via a wireless connection
Wireless local area network (WLAN)
Uses telephone, T1 lines, T3 lines (T1 moves more data than T3, both expensive) or internet for larger geographic areas or multiple LANs
Wide area network (WAN)
Allows one to have applications and data stored off-site and maintained by this
Users access this information through secure and private internet connections; makes charts available from any internet connection
Implements EMR software
Provides server that can house a lot of information as opposed to a system and can be accessed anywhere with secure systems
Application service providers (ASPs)
Most common method of restricting access
Passwords
Require security precautions to not only restrict access but also keep records of who is accessing information
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Organization, analysis, management, and use of information in healthcare
Medical informatics
Combines all the EMR information with scientific evidence, helps define clinical care for the patient
Evidence-based care
Reduce disease and promote health through communities
National public health agencies
3 national public health agencies
National Institutes of Health (NIH)
Food and Drug Administration (FDA)
Centers for Disease Control and Prevention (CDC)
Provide research to combat disease
National Institutes of Health (NIH)
Ensure safety of food, cosmetics, pharmaceuticals, biological products, and medical devices (linacs)
Food and Drug Administration (FDA)
Work with states and other partners to help observe disease, surveillance
Bioterrorism
Implement disease-prevention strategies and maintain national health statistics
Main purpose: provide and increase security if health within nation
Centers for Disease Control and Prevention (CDC)
Information system designed for the collection, management, and analysis of data on people with the diagnosis of cancer
Cancer registry
Data-gathering process in cancer registry
Abstracting
3 classifications of cancer registries
Health care institution registry/hospital-based
Central registries
Special purpose registries
Focuses on all patients who are diagnosed or treated for cancer within a specific center
Don’t distinguish where patient is from and institution must follow everyone who passes through its doors
Tracking required by law to be passed up to a state or central agency
Health care institution registry/hospital-based
Compilations of all the healthcare institution registries that are then broken down by specific geographic areas
Show larger scale trends than individual cancer centerq
Central registries
Maintain data regarding a particular type of cancer, can be established if initial data at institutional or central level point toward potential trends
Special purpose registries
Boost
Cone down (CD)
Anatomical site to be treated/diagnosis, total dose (TD), daily or by-daily (BID) fractions, number of fractions/c, schedule of treatment, treatment technique/modality (photons, electrons, etc.), beam energy, port size/field size, angles/entry of angles or number of arcs, beam modifiers (block, wedges, bolus, etc.), patient position, signature and date by physician
Prescription
Time over which TD is delivered
Protractions
Date of treatment, treatment number, elapsed days (ED), daily dose, total dose, portal films, cumulative dose (CD)
Dated and signed by therapist
Can keep critical structures dose; helps keep track of changes (ex: boost, change in tumor size)
Daily treatment record
Most common charting error
Addition and transcribing
Portal films done on a minimum ______ basis
Weekly
2 errors
Systemic
Random inherent variations in daily setup such as positioning, movement, etc.
Variation in the translation of the treatment setup from simulation to treatment unit
Systemic error
Take first exposure with 1-2 MU and open up collimation to take second exposure with less MUs or use OBI (kV) to see blocked field and organs behind it
Double-exposure film
Calculations must be checked _____
Twice
2 verbal cues
Cognitive
Affective
Composed of the actual facts and words contained in the message; ex: ointment
Cognitive
Express feelings, emotions, attitudes, and behavior rather than words; can be more difficult
Affective
Over ____ communication is transmitted nonverbally
2/3
Identifying with the feelings, thoughts, or experiences of another person
Empathy
Verbal counterpart to occasional head nodding/nonverbal cues such as “yes, uh huh, and I see” and indicate the healthcare provider is listening to and understanding the patient
Minimal verbal responses
Healthcare provider is listening to an understanding the patient’s concerns and perspectives; workers can reflect the specific content or implied feelings of their nonverbal communication they feel has been omitted or emphasized
Reflecting
Verbal statement that’s interchangeable with a patient’s statement
Paraphrasing
Open-ended statement used to obtain more information
Probing
Used to obtain more information about vague, ambiguous, or conflicting statements
Clarifying
Therapists are genuinely confused about their perceptions of the patient’s verbal or nonverbal behavior or have a hunch something should be examined; verbal and nonverbal cues not adding up
Checking out
Therapist adds something to the patient’s statement or tries to help the patient understand underlying feelings
Interpreting
Therapist shares objective and factual information; ex: low blood cell count
Informing
Therapists making the patient aware that their observations aren’t consistent with the patient’s words; response must be done with respect to the patient and extreme tact so that a defensive response isn’t elicited
Confronting
Therapist condenses and puts in order the information communicated
Summarizing
Loss of appetite resulting in weight loss
Anorexia
Complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass; affects 1/2-2/3 of cancer patients
Cachexia
Cachexia causes issues with GI tract (irritated, sore, etc.) and is treated with IV fluids with glucose, amino acids, nutrients, vitamins, etc.
Hyperalimentation
3 types of malnutrition
Marasmus
Kwashiorkor
Combination
Calorie malnutrition causes fat and muscle to deplete in body resulting in weight loss of 7-10%
Marasmus
Protein malnutrition but have enough carbohydrates and fats characterized by retarded growth, muscles waste away, can see depigmentation in skin and hair, edema (ascites), and depressed immune system
Kwashiorkor
Most life threatening malnutrition characterized by weight loss of 10% or more
Depletes all protein in body and immune system deteriorates
Common in children
Combination
6 dimensions to consider in assessing and managing the experience of cancer pain
Physiologic Sensory Affective Cognitive Behavioral Sociocultural
Organic cause of pain
Physiologic
Pain intensity, location and quality
Sensory
Depression and anxiety
Affective
Pain influences thought process and patient views themself in a different, usually negative way
Cognitive
Usually bad pain-related behaviors such as self medication-intake and dependence and lowered activity levels; irritable
Behavioral
Cultural background, being raised in certain culture/religion affects how patient deals with pain (ex: no medication)
Females and geriatrics vocalize pain more than others
Sociocultural
Assesses functional performance
Karnofsky scale
Decrease in the peripheral red blood cells
Anemia
Decrease in the white blood cells
Leukopenia
Reduction in the number of circulating platelets
Thrombocytopenia
Dynamic process directed toward the goal of enabling persons to function at their maximum level within their physical, mental, emotional, social and economic potential; need to consider the side effects of radiation
Rehabilitation
The perceived loss of self-esteem resulting in a cluster of affective behavioral (change in appetite, sleep disturbances, lack of energy, withdrawal, and dependency) and cognitive responses (decreased ability to concentrate, indecisiveness, and suicidal ideas)
Depression
Depression criteria: ___ or more symptoms present for ___ or more weeks
5 or more symptoms present for 2 or more weeks
9 criteria for depression
Depressed mood Diminished interest or pleasure Significant weight loss when not dieting or weight gain Insomnia or hypersomnia Psychometer agitation or retardation Loss of energy or fatigue Feelings of worthlessness Diminished ability to think Suicidal
Holistic approach to patient care; encompasses a sense of fulfillment and connection with a power greater than oneself and a person’s need to find satisfactory answers to questions that revolve around the meaning of life, illness, and death
Spiritual assesment
Key concept and an essential ingredient in the religious and spiritual aspects of care and a major component in the healing process
Giving realistic support is a powerful gift oncology caregivers can offer to patient
Can help physically, emotionally, and physiologically
Hope
