Side effects

5 rights of drug administration

1. right pt

2. right med

3. right dose

4. right time

5. right route

Diarrhea interventions non pharmaceutical

• increase fluid

• BRAT diet

• cook veg and fruit

• decrease fiber

• no caffiene, spicy, sweet

Diarrhea intervention pharmaceutical

lomotil or OTC immodium

high fiber foods

grain: whole wheat

fruit: fresh and dried

veg: broccoli

nuts: all

Diarrhea etiology? pattern?

• villi become short/flat, decreasing absorption

• 3rd week of tx

• last 8-12 weeks post RT

Cystitis intervention non pharmaceutical

• urine test for UTI

• no smoking and alcohol

• no spicy and caffiene

cystitis intervention pharmaceutical

• Pyridium (pain)

• urodine

• urispas ( treat muscle spasms)

pattern of cystitis

• damage occurs at 15-30Gy

• goes away after 3 months

etiology of cystitis

obstruction /swelling, inflammation

Nausea/vomiting intervention

• increase protein and caloric intake

• small frequent meals

• avoid odor

• gravol

Etiology/pattern of nausea and vomiting

• cells damaged in rads produce waste and release transmitters that stimulate vomiting center in medula

• 1-2 weeks post tx start

Lymphedema interventions

• avoid lifting

• keep clean/ avoid cuts

• keep an eye out for infection

• elevate arm

• arm excercises

Lymphedema etiology

surgery

What are late effects of lung radiation

• pulmonary fibrosis

• pneumonitis

Flow rate and O2 concentration for partial rebreather

6-10L/min 60-90%

Flow rate and O2 concentration for venteri mask

4-10L/mi 24-50%

Flow rate and O2 concentration for nasal canula

2-6L/min 24-45%

Flow rate and O2 concentration for face mask

5-8L/min 40-60%

Flow rate and O2 concentration for nonrebreather

15L/min 95-100%

dyspnea intervention

• get help to do things

• lean forward to breath

• use a fan

• raise head when sleeping

• alert team if sputum change

• avoid OTC cough medicine

etiology of dyspnea

• COPD

• surgery

• chemo

• rads

Dyspnea definition

SOB

Dysphagia interventions

• increase protein and caloric intake

• easy chew foodpatter

• liquid tylenol for pain

pattern of dysphagia

• within 3 weeks after RT start

• can continue 2-4 weeks post tx and up to 6 months

dysgeusia interventions

• experiment with spices, textures

• metallic- try cooking/eating without metal utensil

signs and symptoms and pattern of dysgeusia

• bitter/ salty taste impacted first and sweet last

• 1-2 weeks post tx start

• can return in few months and up to 1 year

etiology of dysgeusia

• damaged taste bug

• damaged olfactory cells

• reduced saliva

candidiasis intervention

• monitor pt for infection

• anti-fungal medication

what is candidiasis

• thrush

• fungal infection

mucositis intervention (prevention, trauma, nutrition)

• high protein and caloric intake

• oral hygiene

• avoid smoking, alcohol, hot an cold foods, spicy and citris, hard and crunchy

• blend food

mucositis intervention (pain management)

• liquid lidocaine

• analgesics

• may be advised against to use OTC pain due to chemo

pattern of mucositis

• usually 1 week after tx start (10Gy)

• heals 3 weeks post RT

• can last 6-8 weeks

late signs of mucositis

• ulceration

• bleeding

• pain

early signs of mucositis

• xerostomia

• inflammation of membranes

• pain/burning

• whitish//yellow membrane

mucositis etiology

• cells in basal layer of mucus membrane become damaged

• inflammation or ulceration

xerostomia interventions (nutrition)

• sweet/sour foods

• salagen (saliva replacement)

• suck on sugarless candies

xerostomia interventions (infection and trauma)

• maintain oral hygiene

  • mouthwash (biotene)

• avoid alcohol, spicy/dry foods

• keep kips moist

xerostomia etiology

damaged salivary glands/vasculature results in decreased saliva

increased ICP intervention

• ensure pt is taking all meds at correct times

• dex

when can increased ICP begin

after 1 tx or 1-2 weeks after start tx

signs/ symptoms of increased ICP

• headaches

• nausea/vomiting

• changes in balance

• changes in vision

• decreased consciousness

• seizures

etiology of ICP

• waste products produced from cells within brain causing inflammatory response

• tumor bulk

alopecia intervention

• mild baby shampoo

• wash gently

• avoid irritants ( chemicals, heat)

when does permament hair loss start

4000cGy

when does temporary hair loss start

2000-4000cGY

intervention for bone marrow suppression

monitor infection, blood levels

term for decreased WBC

neutropenia

term for decreased platelet

thrombocytopenia

term for decreased RBC

anemai

serious risk of infection when WBC is

<500mm3

moderate risk of infection when WBC is

500-1000/mm3

etiology and pattern of bone marrow suppression

when over 25% of bone marrow is dosed over 30Gy

hyperpigmentation definition

• increased melanocytes

• dark area on skin

hypopigmentation definition

• decreased melanocytes

• 1-5 yrs post tx

moist desquamation intervention

• nonadherent dressing

• similar to dry erythema

• flamazine

dry erythema interventions

• mild soap

• lukewarm water

• stop moisturizer if skin break

• loose clothing

pruritis intervention

• no scratching

• cool balms ( to decrease swelling

• hydrocortisone

what comes first- moist or dry desquamation

dry. comes 1-2 weeks after RT start, moist is 2-3 weeks

what dose do erythema start

2000cGy

what dose do dry desquamations start

3000cGy

what dose do moist desquamation start

4000cGy

RTOG skin toxicity grade 0

no symptoms

RTOG skin toxicity grade 1

dull erthema, dry desquamation, decrease sweat

RTOG skin toxicity grade 2

bright erythema, patchy moist desquamation, moderate edema

RTOG skin toxicity grade 3

moist desquamation outside fields, pitting edema

RTOG skin toxicity grade 4

ulceration, bleeding, necrosis

fatigue intervention

• rest more often

• stress management