patient care semester 1

Most common side effect and symptom of cancer treatment is

Fatigue

Fatigue decreases

Self-care ability and the ability to recover it affects all areas of life

What symptom of cancer treatment do patients consider considered to be the most difficult?

Fatigue

Dental extractions should done prior or after therapy

Prior to avoid osteoradionecrosis

Acute side effects of head and neck

Mucositis, dysphasia xerostomia

Are tastebuds radio sensitive

True

Late side effects of head and neck

Osteoradionecrosis, mucosal fibrosis, infection, hypothyroidism

Definition of fatigue

Overwhelming exhaustion, lack of energy, difficulty, concentrating, emotional distress, depression

The patient’s most affected by fatigue are

Lung, head/neck, concurrent, chemo, patients, brain sono syndrome

Most skin reactions happen where and why?

In skin folds because it creates a bullet and there is moisture

What treatment modality is associated with less severe skin reactions

IMRT

Factors that contribute to fatigue

Age/performance status, type insight of treatment, pre-treatment, fatigue, quality of sleep, treatment, trips, blood counts

Factors to help manage fatigue

Exercise, delegating tasks, stress management, allowing patients to talk about it, forewarning patients

Most severe skin reactions happened to patients who are receiving treatment to the

Breast, head/neck, genital area

Skin reactions tend to peak when

Towards the end of treatment and worsen after completion

Most skin reactions are healed within

Four weeks

What are the two layers of the skin and what is the most sensitive?

Epidermis and dermis

The epidermis is the most sensitive because it is the superficial layer

What is the most common skin reaction?

Skin erythema

What are the two phases of skin erythema?

The first peak happens within 10 days with doses as low as 1.5 gray

The second peak happens 20 days into treatment

How to manage skin erythema

Gentle washing, pat skin, dry, mild soap, loose, cotton, clothing, moisturizer, no deodorant/perfume, no razors, avoid sun

What dose does dry desquamation happen and what is it?

Dry and flaky skin typically occurs at doses above 20 gray

What is moist desquamation and what dose does it typically occur at?

Weeping blistering raw and pus typically occurs above 30 gray

Acute radiation doses above two gray results in

Skin erythema

Skin reactions order

Mild erythema, dry desquamation, moist desquamation, necrosis

What increases skin reactions?

Bolus, tangible fields, parallel, opposed fields, electron treatment

What age group are more likely to have skin cancer?

Older people because they have an impaired ability to heal

What is another word for breathlessness?

Dyspnea

What is SVC syndrome?

Obstruction of blood flow to the SVC

What are common symptoms of SVC syndrome?

Trouble breathing, coughing, edema to the face, neck, and upper body or arms

What is plural effusion?

Fluid accumulation around the lungs prevents it from expanding normally giving a sensation of shortness of breath

What are the two most common side effects of the head and neck?

Mucositis and dysphasia

Osteoradionecrosis

Most liberating toxicity complication presents as Jo swelling, trimmer, and mouth pain after being treated for head and neck cancer

Trismus

Lock jaw, difficulty opening the mouth

What is the most dose limiting side effect for head and neck cancer patients?

Mucositis

Proctitus

Inflammation of the rectum

What are some side effects of stomach cancer patients?

Nausea and vomiting

Patient receiving treatment to the prostate/abdomen area will face

Proctitis

Karnofsky performance status scale is

A behavioral scale ranking 0 to 100 zero means dead 100 means normal

Can breathlessness be a side effect of panic attack attacks and anxiety

Yes

Palliative treatment is to relieve pain, not cure. It is usually reserved for patients with.

Metastasis

Out of all the treatment areas patients being treated in what would be the least likely to experience fatigue

The extremities because there is no major organs nearby

When we are assessing pain, are we looking at race?

No

Can radiation be used to treat bone metastasis

Yes

What drug class is Benadryl a part of

Antihistamine

Organizations that certified hospitals

JCAHO

Are clam shells used to shield testes from the primary beam

No, they are used to shield from internal scatter

What is the most Radio sensitive TD 5/5

Sperm

Osteopenia

Reduced bone density

Acute pain

Lasts less than 3-6 months

The body can restore and repair itself

Interpreted by society as a sign of personal or moral defect above and beyond any physical deformity, placing the person outside some socially acceptable standard for human attributes or performance

Stigma

Which of the following is not required to be included in the patient’s health record

Patient’s phone number

Head and neck side effects

Mucositis, xerostomia, dysphasia

Types of feeding tubes

NG tube, which is placed through the nose and down the esophagus into the stomach

PEG tube, which is the most common and is placed endoscopically through a Vitola created between the stomach and the interior abdominal wall

Chronic pain

Pain lasting more than 12 weeks

The body may have the inability to restore/repaired itself

True or false freaky therapy has less side effects than EBRT for men for erectile dysfunction

True

Dyspareunia

Pain during sec

What can help with vaginal stenosis, adhesions, dysparenia

Vaginal dilators

Most damaged to the reproductive organs during radiation comes from

Low doses of scattered internal radiation

oligospermia happens at less than what gray

1

About 0.15-0.5

Temporary sterility for males is what gray

0.5-6 gray

Temporary sterility for females is

1.5 gray-2

What is more sensitive to radiation sperm or ovaries?

Sperm

Physical death

Occurs when the vital organs no longer function

Emotional death

Absence of feeling

Physiological or social death

A loss of social identity a loss of social connectedness

What are the five stages of grief?

Denial, anger, bargaining, depression, acceptance

How is the denial stage described?

It’s the first stage in the grieving process, patients act like nothing is wrong and do not acknowledge that anything is wrong

This is a common defense mechanism and gives you time to absorb the news and begin to process it

How is the anger stage of grief described?

Second stage of grief where patients resist their feelings of loss and they may lash out at family members or themselves. They blame others to gain control.

What is the bargaining stage of grief?

The third stage of grieving the patients and family members postpone accepting the reality of the situation. They are open to suggestions and alternative medical treatment during this stage. It may also feel remorseful for their previous anger.

There is a lot of of what if and if only statement

What is the depression stage of grieving?

This is the fourth stage where the patient/family realized the loss is a permanent reality and become very aware of the force of its impact on their lives

Typically feelings of depression and loneliness where they become withdrawn

What is the acceptance stage of grief?

The final stage where the patient’s/family begin dealing with the loss and except that they have a terminal illness and begin to deal with their pain and awareness of mortality

What patients receive hospice care

This care is offered and provided for patients during their last phase of life where there is no active or curative treatment being given

What is palliative care for?

Can be offered and provided at any stage of an illness and can be provided while the patient is receiving active treatment

Which Care team coordinates most of the care for the patient

Hospice care

Who recommends hospice care?

The physician when a patient is not expected to live more than six months

What does DNR stand for and what does it mean?

Do not resuscitate it means requests to not have CPR if your heart stops or if you stop breathing

What are the four stages of adapting to changes in body image?

Impact of diagnosis, morning, defect, reconstruction

What is the impact of diagnosis?

Resulting in shock rather than anger which may be directed at a healthcare professional or the family

What is morning body image?

Yearning to return to the previous self may manifest through denial

What is the defect of body image?

Adaptive response, seeking information and trying out different coping strategies

What is the reconstruction of body image?

Recognize the implications of the body image change, and accepts the use of AIDS and can plan for the future

Cachexia definition

Weakness and wasting away from the body due to severe chronic illness is more than just weight loss

Alopecia

The loss of hair

When can alopecia become permanent?

With a dose of 4500 CGy

Examples of permanent changes to the body

Amputations, scars, infertility

Examples of temporary changes

hair loss, weight loss/weight gain

Mucositis

When your mouth is inflamed and sore

xerostomia

Resulting from reduced or absent saliva flow

Dysphasia

Difficulty swallowing

Clinically significant weight loss is defined as

10% or more pre-diagnosis weight loss

Anorexia

Lack or loss of appetite for food

What percentage of cancer patients are malnourished?

85%

How many cancer patients are hospitalized from malnourishment

2/3

What is TD 5/5

Represents the radiation dose that would result in 5% risk of severe complications within five years after irradiation

Which patients are at higher risk for infertility

Younger patients

Why are younger patients more vulnerable to radiation for infertility?

Their ovaries have more follicles

Radiation can cause what to the reproductive system

Infertility or premature ovarian failure

Total dose and what can have an effect on infertility

Fractionation it matters how it’s delivered

What is the fractionation effect?

Ovarian tissue has a low alpha/beta ratio, which means it’s more sensitive to larger doses per fraction

How can we limit the harmful effects of infertility?

Shield ovaries, use IMRT/proton therapy to reduce scatter, consider ovarian transposition, which means move ovaries out of the field