NURSING MANAGEMENT OF PATIENTS WITH ONCOLOGICAL CONDONS 25s

.Geta short, stylish haircut before beginning radiation prepare for change n

for
to
appearance.
will cover
Athis doctor
cost.
a
prescription for a wig becausesome insurance companies

3.Once radiation treatments begin, use a mild shampoo and comb it carefully, without
tugging
4. Use a hairdryer only if necessary, and keep it on a low heat
setting
5. Avoid hair dyes, rollers, curling irons, and perms.
6. Sleep on a satin pillowcase to prevent friction between hair and scalp.
7. Consider scarves, turbans, or wigs.
8. If considering a wig, see a wig stylist before radiation treatment begins so that the

stylist can wig to your natural hair color and texture.

match a

Nausea/Vomiting: Sometimes radiation therapy causes nausea and/or vomiting

area. Nausea and vomiting can
especially when the radiation is delivered to the abdominal
happen immediately after radiation, can be delayed, or can occur in anticipation of receiving

treatment. These suggestions may help you cope with nausea:

1. Eat small meals and eat often.
2. Eat and drink slowly.
3. Avoid foods that are fried or high in fat.
4. Drink cool liquids between meals.
5. Eat foods that have only a mild aroma and that can be served cool or at room temperature.

6. Stick to any special diet that your doctor or dietitian gives you.
diet (broth and juices) or bland foods
7. For a severely upset stomach, try a clear liquid
dry toast and gelatin.
easy to digest, such
as
that are

prescribe an antiemetic.
8. If nausea and vomiting persist, your physician can

delivered to the abdominal area can cause diu.nea,

Diarrhea: Radiation treatment that is
which usually begins in the third or fourth week of therapy. These tips may help you manage
diarrhea:
1. As soon as diarrhea starts, switch to a clear liquid diet.
2. Avoid foods that are high in fiber o r c a n
cause cramps or a gassy feeling (raw vegetables,
coffee, beans, cabbage, and spicy food).
3. Eat snmall, frequent meals.
4. Avoid dairy products. because
in potassium, such as bananas, potatoes, and apricots,
5. Eat foods that are high
diarrhea causes potassium loss.

is a c o m m o n factor with cancer

and its treatment.
Loss of Appetite: Loss of
appetite These suggestions
contribute to a loss of appetite.
Nausea, vomiting, and depression can intake:
maintain your nutritional
may help you be more
Several smaller meals throughout the day might
1. Eat whenever you are hungry.
meals.
appropriate than three larger
 NURSING-

SURGICAL
MEDICAL
Coursein
Concise
V
brachytherapy art
Method of Administration

Common radioactive isotopes used in

Rays Emitted

Radiation Source Half-Life

Interstitial and intracavitary

Interstitial (seeds, needles)

Radium (Ra) 1622Y a, B and y
Interstitial and intracavitary
a and B
Radon 4 days Machine and Interstitial

33 Yrs i and y
Cesium (Cs)
and y
5 Yrs
Cobalt (Co) B and y
Intracavitary

3 Days
Cold (Au
I n t e r s t i t i a l

and y Systemic therapy (Mouth)

Iridium (Ir 74 Days
B and 7 V, and intracavitary
lodine ( ) 8 Days By
mouth,

Phosphorus ("P) 14Days

Methods of Administration for Brachytherapy one of two ways, each

delivered in
radiation is usually
Brachytherapy: Internal
.Sealed Both methods use
sealed implans is in the
of which is described below: source
In interstitial
radiation therapy, the radioactive into tissue at or
or inserted
a) Interstitial Implant: catheter is implanted
needle, seed, wire, ribbon or
Orm
of
near the tumor site. the radiation
or intraluminal radiation therapy,
In intracavitary The
D) Intracavitary Implant: and held in place with an applicator.
into body cavity
source implanted directly
is is complete.
and applicator is removed when treatment
radioactive s o u r c e

radiation therapy or unsealed

brachytherapy uses
Unsealed Brachytherapy: Systemic be taken by
2. iodine 131 and strontium 89. The materials may
radioactive materials such as
the body, delivering
into thebody. The substance travels throughout
mouth or injected
radiation.

RADIATIO SAFETY
The most in radiation safety are:
important factors
1. Time: Minimize time spent in close proximity to patient. Radiation exposure is directiy
related to the time spent within the specifie distance of the radioactive source.
2. Shielding: Lead shielding can provide additional safety from radiation.
3. Distance: Maximize the distance from the radionctive material. The amount of radiation
decreases according to inverse law. According to inverse square law, exposure decreases
as the distance from the radioactive source increases.

Exposure
(Distance)
NURSING MANAGEMENT OF PATIENTS WITH ONCcoLOGICAL cONDITIONS
y.
ASSIist the patient in carrying out activities of daily living if patient feels tatigue &
weakness.
10.
Fatient should be taught about precautions that has to be taken when implant get
dislodged.
instruct the patient to eat a balanced diet. Patient should take small meals frequently.
12. Patient should wear
loose and soft ciothes over treated area.
15. Instruct the patient to avoid sun exposure during treatment and for at least 1 year after

radiation therapy.

CHECK YOUR PROGRESS

1. Define following
terms-
a) Radiation therapy b) Teletherapy
c)Brachytherapy d) Electromagnetic Radiation
e) Intracavitary Implant Mucositis
g Xerostomia h) Myelosuppression
2. Write short notes on-
a) External radiation therapy
b) Internal radiation therapy
c) Radiation safety
3. Fill in the blanks -

a) Teletherapy is a radiation technique in which the radiation source is . t o the person.

b) Gamma rays are produced b y . isotopes and release radiation energy as they break
down.
C *onnnnenno.oseo USes radioactive materials such as iodine 131 and strontium 89.
d) Radiation exposure is directly related to the.. spent within the specific distance of
the radioactive source
4. Write the management of the following radiation side effects
a) Skin Reaction b) Mucositis
c) Dry Mouth d) Alopecia
e) Nausea and vomiting
5. Describe the nursing management of patient undergoing radiotherapy

SURGICAL INTERVENTIONS
Cancer surgery- an operation to repair or remove part of body to diagnose or tred
cancer-is considered oldest of the cancer treatment. The main goal of the cancer surger
is the cancer by removing the entire
to cure leaving disease free margins.
tumor, Therea
many reasons to perform a surgical intervention for someone with cancer: diagnosis an
staging, cure, palliation, reconstruction and prevention. Cancer surgery may be on
treatment, or it may be supplemented with other treatments, such as radiation, chemotherap
hormone therapy and biological therapy.
 MEDICAL SURGICAL NURSING
26 PU Concise Course in
ensure tnat you get
E a t often. hour c a n more
Taking just a few bites of food every

protein and calories.

S. Have a calm, relaxed mealtime.
Add
variety
your menu. to
music,
candles, a n d
riends.

and appealing ambiance with

or
alm
blood c o u n t s (Myelosuppression): Blood
counts, or the numDer blood cells in
LOw Low blood cous t y u s e changes n
can be affected by radiation therapy. anu F a u e n t s describe a s o e

on,
the radiation therapy period,
P Or rest patterns during
sense ot tiredness and fatigue.
Possible Side Effects with Radiation to the Chest
ue-causes difficulty breathing. Fibrosis
Lung fibrosis: Lung fibrosis-scarring of the lung r treatment for Hodgkin's lymphoma
a significant long-term (late) complication atter treatment ror I1Ougkins lymphoma
this d e c r e a s e in lung function
can be the lungs. However,
Oner cancers requiring radiation to
a to over time and is thought to be reversiDie.
Ppedrs improve radiation
ot to the middle
cOmplications: Heart disease is also a late complication
eat

mediastinum. The risk of heart d1sease increases with higher

ot the torso, called the
POruon doses and larger field sizes.
radiation Radiation Therapy
Fossible Long-Term Side Effects of
econdary cancer:
A second cancer can be induced by treatmient, 1ncluding radiation,
cancer
tor Hodgkin's
chemotherapy. reatment
T
or the combination of radiation and i n c i d e n c e of second cancers.
chemotherapy, higher
young age
at a will ultimately result in a
ymphoma hormone) is one of

ypothyroidism: Hypothyroidism (abnormally

low levels of thyroid
in
patients where
the more frequently complications of radiation therapy
encountered late
of patients receiving
radiation field includes the neck.
This may occur in up to one-third
the received r a d i a t i o n therapy to be
tor patients who have
radiation therapy. It is important
and symptoms of hypothyroidism
occur
very late and
tested on a regular basis because signs

are subtle.
UNDERGoING RADIATION THERAPY
NURSING MANAGEMENT OF POATIENT
of radiotherapy.
1. the
Reassure clearing all the fears about the effects
patient by and
like
equipment to be used, duration of procedure
2.
Explain the procedure
if immobilization of any
patientpart
to body is required and side effects of radiotherapy.

If is used for radiotherapy, patient should be informed about restriction

3. radio-implant
of movements of & relatives.
patient
4. Assess patient's skin, nutritional status and general well-being of patient
to rule out side effects.
5. Oral mucosa & skin of the patient assessed frequently
6. Skin is protected from radiation. Advice the patient to avoid use of lotions, powders
o n area used for radiation.
and o i n t m e n t
7. Advice the patient not to remove the marking of skin that is used to specify the area to

radiations.
has to be main tained gently by using soft brush.
8. Oral hygiene
 NURSING MANAGEMENT OE PATIENTSWTH ONCOLOGICALCONDITIONS 23
Side Effects of Radiation
Therapy and Their Management
Most Common Side Effects of Radiation
Therapy
Skin Reaction: A common side of effect radiation therapy 15 severe
ne o0ay being treated. Skin reaction can range from mild redness and dryness to severe nd drvness
peeling. There are effective topical medications for treatment of radiation-induce
minimize skin irritation during
d n as well as a number of precautions that may
radiation therapy, such as:
1. Keep the treated area dry and free from irritation.
2. Wash the skin in the treatment area only with mild soaps.
3. Use a mild shampoo, such as baby shampoo, if the head is being treated.
4. When using a towel, pat the area dry instead of rubbing.
5. If you must shave in the treated area, use an electric razor to prevent cuts.

6. Avoid using shaving lotions or scented creams.

7. Do not use perfumes, deodorants, or makeup in the treated area.

8. Avoid using heating pads or ice packs on the skin in the treated area.

9. Wear loose-fitting clothing that does not rub the skin in the treated area.
such as wool, corduroy, and starched
10. Avoid harsh fabrics over the treatment area,

cloth.
sunscreen.
11. Avoid exposure in the treated area.
sun Wear protective clothing and use a

treated
12. Do not use adhesive tape, including Band-Aids or paper tape, on the area.

Fatigue: is a feeling of tiredness, weariness, weakness, or exhaustion, profound or a

Fatigue
effects of radiation therapy. Fatigue is
lack of energy and is one of the most c o m m o n side
after treatment. The feeling of fatigue should wear
typically more severe two to four hours
may help you
off several weeks after the end of radiation therapy. The following suggestions
manage fatigue resulting from
radiation therapy:
1. Limit your activities, if possible.
2. Exercise each day to maintain your strength.
3. Prepare meals ahead of time and freeze them.
4. Use convenience foods that are ready to eat.

5. Accept offers of help from friends and relatives

6. Drink three litres of fluid cach day to prevent the buildup of cellular waste products.
7. Increase rest by getting more sleep at night and taking naps during the day.
to eat even when you are tired. Sometimes a little food will increase energy.
8. Try
to the Head and Neck
Side Effects Associated with Radiation Therapy
mucositis.
Mucositis: Radiation therapy that is delivered to the head and neck area may cause
the mouth and throat, the mucous membranes.
Mucositis is inflammation of the lining of
the head and neck, chest, abdomen, or
When radiation is administered directly to or near
to the mucosal lining of entire GI tract. Here are
anal-rectal regions, it may cause damage
some suggestions:
 SURGICAL NUbe
PUConcise
Course in MEDICAL URSING
swallow.
and
1. Choose soft foods that are easy to chew fruits and
foods
foods that
that are
such as citrus spicy, salty
. Avoid foods that irritate the mouth,
or dry. into small pieces.
tender. Cut foods
oods until they are soft
and e a s i e r to swallow.
it
OK to make
tood with butter, thin gravies,
or sauces
ix
o r food processor.
5. Puree food in a blender
6. Use a straw to drink liquids. food can
irritate a tender mo
mouth.
because hot
.Eat foods cold or at room temperature
mouth and t h r o a t long enough to aeat
to numb
tablets/sprays
8. Use anesthetic dispersible
meals.
therapy that is delivered to the head and neck
Mouth): Radiation condition caused k
Xerostomia (Dry Xerostomia is a chronic dry-mouth by
also result in xerostomia. mouth can be
diticult, but these tips may
area may with a dry
to the salivary glands. Coping
damage
help: such as lemonade, to nelp mouth produce
sweet/tart foods or beverages,
1. Try consuming
saliva.
gum; this may
also help produce more
sugar-free hard candy/popsicles/chew
2
Suck
saliva.
on

swallow.
Eat soft and pureed foods that are easier to
3.
balm/ointment.
4. Keep lips moist with lip and easier to
to make them moist
gravies, and salad dressings
5. Eat foods with sauces,
swallow. easier.
water every few minutes to
make swallowing and talking
6. Sip or cancer itself may cause a
s e n s e of taste and/or smell: Radiation therapy
Changed complete.
treatment is Foods may have
change of taste or smell that typically goes away once make food taste
a bitter or metallic taste, or simply less taste. These suggestions may help to
better:
unpleasant taste; choose foods that look and smell good
1. Stop eating foods that cause an

to you.

2. Serve foods at room temperature.

3. Try using small amounts of flavorful seasonings.
4. Try tart foods, such as oranges or lemons that may have more taste.

5. Marinate meat, chicken, or fish in sweet sauces.

6. If red meat tastes or smells strange, switch to chicken, turkey, eggs, or dairy products.

Less Common Side Effects of Radiation Therapy

Hair Loss: Radiation therapy causes hair loss (Alopecia) only in the area being treated. Hair
loss typically begins 2 to 4 weeks after treatment begins. Hair loss caused by radiaton i
temporary. Regrowth typically begins 6 to 8 weeks after the end of radiation. The best way
to deal with hair loss is to prepare for it before it happens. Consider the following ups To
coping with hair loss:
 SURGICAL NURSING
20 CourseIn MEDICAL
PV Conclse
RADIATION THERAPY of
Radiation therapy (also called radiotherapy, x-ray therapy, or irradiation) 1s the use

D nype
Drtain of en
type of O (called
energy radiotherapy,
calledionizing * to K ce
radiation) d (the "target tissue") by
aulation therapy injures or destroys cells in the area Dem cells to continue to grOw
aamaging their genetic material, making it impossibe or
and divide.
as many cancer
or to damage
he possible,
aim of radiotherapy is to cure cancer, where
Where cure is not possible,
cells as possible, while limiting harm tonearby healthy tissue. impr
e aim is the relief of symptoms (palliation) of cancer, thereby
well-being
TYPES OF RADIATION THERAPY
deliver the radiation.
are different types of radiation and different ways to
nere
Kadiation may come from a machine outside the body (external
radiation), may be placed
materials that
nside the body (internal radiation), or may use unsealed radioactive g
throughout the body (systemic radiation therapy).
is
Radiation Therapy: External beam radiation, also called teletherapy,
1. External
administered by a machine at a certain distance from the specific area of the body. TeletheraPy
is in which the radiation source is
a
radiation technique external to the person. epenamg
on the amount of energy x-rays can be used to destroy cancer cells at the surface or deeper
in the body.
External radiation therapy is used to treat most types of cancer, including cancer of the
bladder, brain, breast, cervix, larynx, lung, prostate, and vagina. In addition, external
radiation may be used to relieve pain or ease other problems when cancer spreads to other
parts of the body from the primary site.

sOURCES OF ENERGY FOR EXTERNAL RADIATION THERAPY

a. Electromagnetic Radiation: X-rays or gamma rays, which are both forms of

electromagnetic radiation. Xrays created by machines called linear accelerators.

are
Camma rays are produced when isotopes of certain elements (such as iridium and cobalt
60) release radiation energy as they break down.
b. Particulate Radiation: Particle beams use
fast-moving subatomic particles instead of
photons. This of
type radiation may be called particle beam radiation therapy or particulate
radiation. Particle beams are created by linear accelerators,
synchrotrons, betatron and
cyclotrons, which produce and accelerate the particles required for this type of radiation
therapy. Particle beam therapy uses electrons, neutrons, heavy ions (such as protons
and helium); and pi-mesons (also called
pions), which are small, negatively charged
particles produced by an accelerator and a system of magnets.
NURSING MANAGEMENT OF PATIENTS WITH ONCOLOGICAL CONDITIONS21

Specialized Methods of External Beam Radiation

to the
in use or under study improve
A number of refinements and techniques are

effectiveness of external radiation therapy

1. Intraoperative Radiation Therapy

2. Stereotactic Radiosurgery
3. Stereotactic Radiotherapy
Three-dimensional (3-D) Conformal
Radiation Therapy
4.
(IMRT)
5. Intensity-Modulated
Radiation Therapy

therapy, also called brachytherapy,

Internal radiation
2. Internal Radiation
Therapy: placed directly
(radiation sources)
which the specific radioisotopes
radiation technique in holder called an
is a sealed in a small
The radiation source is usually
the tumor. catheters, ribbons,
into or near tubes called
form of thin wires, plastic
be in the
implant. Implants may compartments.
cavities or interstitial
capsules, or sceds into body for a few days. The
stays in
the hospital
For internal radiation therapy, the patient radiation is highest during
Because the level of
or permanent. have visitors only for a
be temporary
implant may not be able to have
visitors or may
amount
the hospital stay, patients
may in the body. The
there is no radioactivity
a n implant
is removed, leaves the
short time. Once sate level betore the patient
down to a few
radiation in a permanent
implant goes tew minutes or
left in place a
of
be removed atter just a or even
implants may toT a few days
hospital. High-dose
sometimes
remain longer,
L o w - d o s e implants usually
hours. their radioactivity
quickly.
lose
Permanent implants
permanently.