NCLEX-RN: Oncology Nursing

Oncology Nursing: Radiation Therapy

Focus topic: Oncology Nursing

Definition: Use of high energy moving through space or medium to interrupt cellular growth at a local level.

A. Indications.

  • Used to treat solid tumors—ionizing radiation transfers energy to molecules present in cancer cell.
  • Different tissues have different radiosensitivities—rapidly dividing tissues (testes, ovaries, lymphoid tissues, and bone marrow) are more sensitive.

B. Types of ionizing radiation.

  • Electromagnetic—radiation in wave form.
    a. X-rays—linear accelerators deposit maximum dose 5 cm or more below the skin.
    b. Electrons—delivered by machines.
    c. Gamma rays—delivered by machines that contain radioactive sources (cobalt-60, cesium-137) or radioactive substances (seeds, threads, or liquids).
  • Particulate—radiation in the form of heavy particles.
    a. Beta particles—high-speed electrons (phosphorus-32; strontium-90).
    b. Protons, neutrons, and alpha particles accelerate subatomic particles through the body tissue.

C. Newest option in radiation is intensity-modulated radiation therapy (IMRT).

  • Delivers a high dose of radiation to the tumor, but spares vital, healthy tissue around it.
  • Method targets large or small tumors; type of beam can mold to tumor shape.
  • Therapy is administered by Peacock system.
    a. Conventional radiation delivers single, large beams of uniform intensity.
    b. IMRT bombards tumor with small beams of different intensity from all sides.
  • Heralded as greatest breakthrough in cancer management in 25 years.

Oncology Nursing: External Radiation

Focus topic: Oncology Nursing
A. Teletherapy—external source of radiation. (Machine is a distance from client.) Most common type of treatment.
B. Types.

  • Natural radioactive source—gamma rays delivered via machine to lesion.
  • Machine is the linear accelerator—high-voltage electric current delivers electrons to client.

C. Side effects: fatigue—major systemic effect; headache; nausea and vomiting; skin irritation or injury; scaling, erythema; dryness.

Oncology Nursing: Implementation

Focus topic: Oncology Nursing
A. Offer psychological support and teaching.

  • What to expect from treatment.
  • Explanation of radiotherapy room.
  • Possible side effects and ways to minimize them.

B. Promote diet: high protein, high carbohydrate, fat free, and low residue.

  • Foods to avoid: tough, fibrous meat; poultry; shrimp; all cheeses (except soft); coarse bread; raw vegetables; irritating spices.
  • Foods allowed: soft-cooked eggs, ground meat, pureed vegetables, milk, cooked cereal.
  • Increase fluids.
  • Diet supplement to increase calorie and fluid intake.
  • Do not eat several hours before treatment.

C. Administer medications.

  • Compazine (prochlorperazine)—nausea.
  • Lomotil (diphenoxylate/atropine)—diarrhea.

D. Provide skin care—radiodermatitis occurs 3–6 weeks after start of treatment.

  • Avoid creams, lotions, perfumes to irradiated areas unless directed to apply by physician. Aloe vera cream or gel may be recommended.
  • Wash with lukewarm water, pat dry (some physicians allow mild soap).
  • Avoid exposure to sunlight or artificial heat such as heating pad.

E. Observe for “wet” reaction.

  • Weeping of skin due to loss of upper layer.
  • Promote rest after therapy.
  • Cleanse area with warm water and pat dry bid.
  • Apply antibiotic lotion or steroid cream if ordered.
  • Expose site to air.

Oncology Nursing: Internal Radiation/Brachytherapy

Focus topic: Oncology Nursing
A. Implantation of radioactive substance within the tumor or close to it.
B. Types.

  • Unsealed sources: isotopes (131I and 32P).
    a. Liquid and administered orally.
    b. Half-life generally short but varies with isotope.
    c. Precautions important during high-risk period (usually first 4 days).
  • Sealed sources: radium needles, radon seeds, and 137Cs.
    a. Radioactive substance encased in metal capsule placed in body cavity.
    b. Delivers radiation directly to tumor.
    c. Even though implant is sealed, special precautions are instituted.

C. Side effects.

  • Occur when normal cells are damaged.
  • Acute side effects occur during or shortly after radiation therapy; chronic effects occur months or years following therapy.
  • Common side effects from radiation therapy: alopecia, mouth dryness, mucositis, esophagitis, nausea and vomiting, diarrhea, cystitis, erythema, and dry and wet desquamation.
  • Factors influencing degree of side effects.
    a. Body site irradiated.
    b. Radiation dose—the higher the dose given, the more potential side effects.
    c. Extent of body area treated (larger area, more potential for side effects).
    d. Method of radiation therapy.
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Oncology Nursing: Implementation

Focus topic: Oncology Nursing
A. Maintain bed rest when radiation source in place.

  • Restrict movement to prevent dislodging radiation source.
  • Do not turn or position client except on back (when cesium needle in tongue or cervix).

B. Administer range-of-motion exercises qid.
C. Take vital signs every 4 hours (report temperature over 100°F or 37.8°C).
D. Observe for untoward effects: dehydration or paralytic ileus (if cervical implant).
E. Observe and report skin eruption, discharge, abnormal bleeding; teach client to avoid using lotions, ointments, and powder.
F. Provide clear liquid diet (low residue is sometimes ordered) and force fluids.
G. Insert Teflon Foley catheter (radiation decomposes rubber) to avoid necessity of bedpan.
H. Observe frequently for dislodging of radiation source (especially linen and dressings). Dislodgement can be a major problem.

  • Avoid direct contact around implant site.
  • When radiation source falls out, do not touch with hands. Pick up source with foot-long applicator.
  • Put source in lead container and call physician.
  • If unable to locate source, call physician immediately and bar visitors from room.

I. After source is removed, give the following care.

  • Administer Betadine (povidone iodine) douche if cervical implant.
  • Give Fleet (oral sodium phosphate) enema.
  • Client may be out of bed.
  • Avoid direct sunlight to radiation areas.
  • Administer cream to relieve dryness or itching.

J. Instruct that client may resume sexual intercourse within 7 to 10 days.
K. Notify physician if nausea, vomiting, diarrhea, frequent urination or bowel movements, or temperature above 100°F or 37.8°C is present.

Oncology Nursing: Safety Measures

Focus topic: Oncology Nursing
A. Implement radiation safety measures. (See Radiation Safety Measures box.)
B. Follow special principles of time, distance, and shielding.

  • Minimize time.
    a. Radiation exposure proportional to amount of time spent with client.
    b. Plan care to be delivered in shortest amount of time to meet goals—be efficient with time.
    c. Review procedures before beginning them.
  • Maximize distance.
    a. Intensity of radiation is related to distance from client.
    b. Duration of safe exposure increases as distance is increased; work as far away from source as possible.
  • Utilize shielding.
    a. Use lead shields or other equipment to reduce transmission of radiation.
    b. Store radioactive material in lead-shielded container when not in use.

C. Follow radiation precautions for isotope implant.

  • All body secretions considered contaminated—use special techniques for disposal.
  • If client vomits within first 4 hours—everything vomitus touches is considered contaminated.
  • Use disposable gown, dishes, etc.
  • Limit contact with hospital personnel and visitors. Visitors must limit exposure to 1 hour/ day and keep a distance from the client.

Oncology Nursing

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