Radiation Therapy Side Effects and Management Flashcards
(35 cards)
Typical H&N Pathologies
- Basal or squamous cell carcinomas of the skin
- Squamous or adenocarcinoma of oral cavity, oropharynx, nasal cavity, paranasal sinuses, nasopharynx, larynx, hypopharynx, and salivary glands
- Lymphomas involving neck nodes
Assessment of H&N: What is mucositis?
irritation of mucous membrane
Assessment of H&N: What is stomatitis?
sores in the mouth, interior lips and buccal lining
Assessment of H&N: What is esophagitis?
pain that is exacerbated by swallowing
Assessment of H&N: What is xerostomia?
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)
What 3 functionalities of H&N are assessed?
- Respiration/Airway – is patient able to maintain viable airway? Characteristics of secretions, cough effort, work of breathing
- Speech – voice character and quality
- Swallowing – what food or liquid has patient been able to take? Diet adjustments? Adequacy (weight)?
What 2 things of the Integumentary System is assessed?
-
Dry desquamation – skin care regimen? associated symptoms?
- tepid water and pat dry
- moisturizer
- pruritis (topical steroidal)
-
Moist desquamation – skin care regimen? pain? presence of infection?
- soak with cold wet washcloth or apply ice to help debride wound
- dressings to keep wound from drying out or become infected
- NO tape
- Vaseline gauze
- Telfa
Evaluation of Integumentary system: How long till skin wounds heal?
Will not see wound healing until several weeks after treatment, main goal is providing supportive care
Interventions of H&N patients
- Proper oral care
- Suctioning
- Frequent mouth care
- Pain control
- Diet changes
- Supplemental nutrition
H&N Interventions: Altered Nutrition
- 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)
H&N Intervention: Pain Control
- Fentanyl patches (change every 3 days)
- Narcotics/Opioids (liquid form for difficult swallowing)
- Stomatitis Cocktail
- Viscous lidocaine (lidocaine shot)
- Carafate (thick coating to protect esophagus)
What 5 things are assessed when receiving radiation to the chest?
- Typical pathologies
- Lung cancer
- Esophageal cancer
- Lymphoma receiving mantle radiation
- Metastatic sites
What is “Normal Respiratory Patterns”?
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%
Chest patient interventions: Pain
Related to Esophagus
Medications:
- Carafate
- Fentanyl patch
- Viscous lidocaine
- Stomatitis cocktail
- Norco
Alter diet: soft foods, no sharp edges (avoid scrapping esophagus), low acidity, low salt
What 7 typical pathologies are assessed for patients receiving radiation to the Abdomen?
- Pancreas cancer
- Cancer of the bile duct
- Stomach cancer
- Extended field endometrial/cervix
- Wilm’s tumor (pediatric)
- Neuroblastoma (pediatric)
- Metastatic sites
Assessing nausea for abdominal patients
- 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?
Assessing abdominal patients
- Is patient experiencing any pain?
- What other therapies is the patient receiving and what role are these therapies playing in symptom causation?
What are Cystopenias?
Low white, red, or platelet values
Cytopenia: Neutropenia
ANC < 1000 (WBC 4.3 - 10.8)
- Consider starting Neupogen/Neulasta
Cytopenia: Anemia
Normal hemoglobin 12-16
- Consider blood transfusion < 8.0 or Procrit
Cytopenia: Thrombocytopenia
Severe defined by < 25,000
Normal is 150,000-350,000
Institute bleeding precautions
Consider platelet transfusion
Interventions for abdominal patients: Diarrhea
- 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
Interventions for abdominal patients: Fluid Volume Deficiency (Dehydration)
- 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
Interventions for abdominal patients: Nausea
- 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
