Part 1: Nursing/Patient Care + General Side Effects of RTT

True or False: RTT may NOT legally diagnose patient

True. This duty belongs to the physician.

True or False: RTT may legally interpret images

False. They may not. This duty belongs to the physician.

True or False: RTT may legally reveal test results to patients

False: They may not. This duty belongs to the physician.

True or False: RTT may NOT legally prescribe drugs to patients

True. This duty belongs to the physician.

True or False: RTT may admit or discharge patients from the hospital

False. This duty belongs to the physician.

True or False: RTTs may legally order tests

False. This duty belongs to the physician.

True or False: Not all hospitals have comprehensive supportive care

True

What is the first thing you should do when retrieving a patient for treatment?

Be sure to properly check the patient’s ID

What is one benefit of waiting rooms?

Provide community & support

List some of the problems with waiting rooms:

1. Lack of modesty- main reason (e.g. Patient changes into a gown and then has to go back to main waiting room → Fix: second gown-waiting area)

2. Misinformation

3. Side effects talk, scaring other patients

What are the 3 general side effects of RTT

That can occur no matter the treatment site

1. Skin Reaction

2. Anorexia

3. Fatigue

General Side Effects of RTT: I. SKIN REACTION

I. SKIN REACTION

def. outer surface & leading to outer surface, also includes glandular tissues

term. epithelial cells

Why are epithelial cells really affected by radiation?

Epithelial cells have a rapid rate of reproduction

Radiation affects fast reproducing cells

Name the 3 categories of sensitive skin areas:

2 epic interviews

What is an acute reaction?

short term

Name the 3 stages of acute skin reaction

1. simple erythema (aka erythema)

2. dry desquamation

3. moist desquamation

4. (Some list necrosis as a 4th stage)

What stage(s) of acute skin reaction are most patients in

simple erythema or dry desquamation

What causes the moistness in moist desquamation?

Buildup of serous fluid

What is a late effect?

permanent/ semi-permanent

occur some time after treatment is finished

List the late effects of radiation on the skin

1. fibrosis/ atrophy (can cause edema)

2. telangiectasia

3. necrosis

extra:

tanned appearance

term. fibrosis/atrophy

skin becomes thick and leathery

Fibrosis can result in:

impairment of lymph drainage resulting in edema

term. telangiectasia

def. bluish, purple lesions due to destruction of capillaries

True or False: Necrosis is a common late effect of radiation on the skin

False. It is rather rare

Commonly overlooked skin reactions

1. Upper back erythematous rxns for AP/PA chest (lung, esophagus CA)

2. Treating thru clothes creates bolus effect

Skin care for Severe Skin Reactions (Moist Desquamation)

1. Cleanse area with: ½ Hydrogen Peroxide, ½ Saline (mix immediately prior to use)

2. Gauze dressings for wound area

3. Area may need to be cultured for infection (i.e. take bacteria culture)

Suggestions to all patients to minimize skin reactions:

(What would you recommend to patients with skin reactions or to help prevent skin reactions)

Weather stuff

1. Avoid extreme temperatures (hot or cold)

2. Avoid sun

3. Avoid swimming in chlorinated pools or ocean water

Shower Stuff

1. Use electric razor

2. Use mild soaps

3. Pat skin dry when coming out the shower, don’t rub

4. Wear breathable cotton

5. Avoid tight fitting clothes

6. Avoid deodorant

7. Avoid cosmetics

Ointments

1. Put ointments/ lotions AFTER treatments (specially talc)

2. Corticosteroid creams

3. Aquaphor

4. Aloe Vera

5. Cornstarch & water paste

6. Plain yogurt in infected areas

General Side Effects of RTT: II. ANOREXIA

II. ANOREXIA

What are the 3 general causes of anorexia

1. Pathophysiological process of cancer (fyi: cancer produces chemicals that decrease appetite. H/N cancers= side effects that cause difficulty eating)

2. Effects & Side Effects of treatment

3. Psychosocial impact of cancer (FYI: anxiety or shame decreases appetite)

PEP: cheerleaders

Other specific causes of anorexia:

1. fatigue

2. alterations in sense of taste

3. dry mouth

4. pain

5. stress/ anxiety

PS (its a) FAD

Lingual Taste Sensations:

1. Tip

2. Sides (Towards Tip)

3. Sides (Towards Back)

4. Back

`

1. Sweet

2. Sour

3. Salty

4. Bitter

`

General Side Effects of RTT: III. Fatigue

III. Fatigue

What is the most common radiation therapy side effect experienced?

Fatigue

General Advice when to deal with fatigue

1. Encourage pt to maintain a normal lifestyle as much as possible

2. Remind patient fatigue is NOT a sign of disease coming back

Possible Causes of Fatigue

1. Destruction of cells as a result of treatment & subsequent release of waste products into the bloodstream

2. Increase in BMR due to tumor having increase need for nutrients

BMR stand for

Basal Metabolic Rate (i.e metabolism)

When does fatigue typically occur:

When does it start?

When does it go away?

• Peaks 2 weeks into tx

• Disappears 2 weeks AFTER tx finishes

Interventions for Fatigue:

Prescription

Procrit (injection)

What does procrit do?

Boosts your body’s ability to make RBCs (red blood cells)

its pro RBC critters

General advice to patients concerned with fatigue

Lifestyle:

1. Conserve energy BUT maintain lifestyle (pace activities)

2. seek help with housekeeping/ chores

3. Help patient maintain adequate patterns of sleep, rest, exercise

Eat/ Drink:

1. force fluids: 3L/Day (UNLESS CONTRAINDICATED) to promote excretion of tumor waste products

2. Maintain good nutrition

Talk to patient:

1. Educate patient on possible causes of fatigue, explain they are only temporary

2. Help patient develop coping skills to alleviate stress

Medications:

1. Administer medicine to control pain and other symptoms

2. If prescribed, transfuse packed RBCs to improve erythrocyte count