Give staff inservice on treating radiation patients
Give staff inservice on treating radiation patients
Oncology nurse explains what to expect
Home care nurses sometimes are asked to care for patients who are undergoing radiation treatment for cancer. Caring for these patients requires some knowledge about how radiation treatment affects skin, the senses, and various parts of the body. That’s why the Center of Living, Home Health and Hospice in Asheboro, NC, asked a nurse who specializes in radiation treatment to teach an inservice on the topic.
"The nurse explained situations that could happen to a patient because of radiation and how nurses should respond, and when they should call for help," says Anneal Lamb, a social worker and director of the center, a nonprofit agency that serves a rural area in central North Carolina.
The agency’s nurses greatly appreciated the inservice, saying they thought it was very helpful, says Cheryl Cheston, RN, BSN, OCN, a radiation therapy nurse supervisor for Moses Cone Health System in Greensboro, NC. The 500-bed hospital is part of a health system that includes two hospitals and a cancer institute.
"One of the big things is for nurses to be knowledgeable about radiation treatment to dispel the myths and to make sure they know what to tell the patient," Cheston says.
She covered the various types of radiation treatment in the inservice, dividing side effects by area of the body. "Side effects associated with radiation therapy are site-specific. Whatever they’re treated in is the area where you’ll see side effects occur."
Cheston lists the areas, as follows:
• Chest and breast
The most obvious side effects are skin reactions, including redness; dryness; itchiness; hyperpigmentation, which may be permanent; and moist or dry peel, where the epidermal layer of skin sheers off at the treatment area. With breast cancer patients, there may be some shortness of breath and a cough, although radiation therapists try to prevent damage by protecting the lungs during radiation.
"The basic premise of radiation therapy is to give the best treatment to this cancer, but protecting any adjacent or underlying structures that don’t need radiation and to try to protect as much normal skin as possible," Cheston says.
Other potential side effects are soreness and swelling in the breast, which may last six months to one year, and a permanent thickening of breast tissue.
Chest cancer patients may develop a dry, hacking cough during treatment. They may have some irritation to their esophagus, which may feel like indigestion or a lump in the throat when swallowing.
"Some people can experience nausea, if the treatment is low in the chest," Cheston says. Also, if a patient has indigestion, over-the-counter antacids like Mylanta and Tums may not work. Home care nurses need to make sure patients undergoing radiation treatment do not put any creams, lotions, powders, or deodorants in the treatment field, because these products will make the area absorb a greater dose of radiation, she says. Also, they should avoid using any creams containing metals, such as zinc oxide ointment.
"If you’re cleansing the area, use normal saline, sterile water, and basic skin care," Cheston says. "If the skin is not broken down, then you can use normal water from the faucet with a mild soap, like a baby soap."
Also, home care nurses need to remember not to wipe off the patient’s radiation marks because those are used to set up the radiation field. If they’re wiped off, the radiation therapists must spend another hour or two marking the patient.
Patients also should eat only soft foods that are bite-size and use oxygen if needed.
• Head and neck
Patients who have cancer in the throat or base of tongue may undergo radiation treatments to their head or neck. "They can get an extremely bad sore throat," Cheston says. "If the salivary gland is in the radiation field, then they can get a dry mouth where they have a cotton mouth, and saliva will thicken and make them feel [nauseated]."
Unfortunately, the saliva problem may be permanent. "The dry mouth is the most awful thing," she says. "You can’t chew your food properly with a dry mouth because you’re always having to take sips of liquid to get a bite of food down." This can be disheartening to patients, who may need a therapist to help them learn new ways to eat.
Patients also may experience difficulty or pain in swallowing, changes in taste, skin reactions on the neck, and hoarse or whispered speech. For example, patients may find that food tastes strange, and sometimes their normal ability to taste does not return.
Typically, patients are given nutritional consults, and their weights are checked regularly. Plus, they are screened by a dentist, Cheston says. However, home care nurses could help by making sure the patient is eating soft foods and foods with gravy, and avoiding spicy and coarse foods. It’s a good idea for the patient to take a nutritional supplement and avoid all tobacco and alcohol use. Also, some patients may have all of their teeth removed before treatment to avoid radiation burns. Others may need to have a fluoride treatment every evening before bedtime.
Some of the more extreme side effects include a worsening of neurological symptoms, such as confusion, ataxia, headaches, and blurred vision. Patients may have nausea and vomiting, and hair loss may be permanent. "If we’re treating someone with a brain tumor, then they can get a skin reaction, especially if we’re doing the whole brain," Cheston says. "The scalp can get extremely itchy and sore, and all the hair can fall out."
Other tips on managing patients undergoing this type of radiation treatment include having them avoid commercial mouthwash and possibly having them use feeding tubes for up to four months after treatment.
• Abdomen
The biggest side effect is nausea. "Every patient is different, but we typically don’t see nausea until a week or two into treatment," Cheston says. Other side effects are diarrhea and small bowel obstruction from adhesions.
Patients should take a medication for nausea, typically 30 minutes to an hour before their treatment. Also, they need to watch for any increase in abdominal pain, liquid diarrhea, severe nausea, or uncontrolled vomiting. "If a patient is throwing up blood or anything like that, then they need to call the doctor pronto," she says.
She also advises patients not to eat one or two hours before treatment and to wait for an hour or two after treatment to eat. They should eat a bland diet with small frequent meals and avoid foods that are high in fat and fiber, including all fried foods and raw fruits and vegetables. They should drink cool liquids or eat foods served at room temperature.
• Pelvis
Patients treated with radiation in this region may experience nausea, diarrhea, increased frequency of urination, and burning with urination. Men may become impotent, and sexual desire generally decreases in both men and women. There may be some rectal irritation, such as proctitis or a flare-up of hemorrhoids.
"These are acute, early side effects, and they are usually temporary and dissipate after the radiation stops," Cheston says.
Patients also may experience some skin irritation, which will dissipate after the treatment stops. Women may have vaginal narrowing and shortening, which is permanent, and they may experience vaginal dryness, itching, or burning.
Usually patients’ diarrhea and nausea will go away, but for some patients with abdominal cancer or prostrate/rectal cancers, there will be a prolonged problem with diarrhea even after radiation treatment ends.
Nurses can give patients these tips to follow while undergoing radiation treatment of the pelvic area:
— Avoid caffeinated drinks.
— Avoid heavy spices.
— Drink at least eight ounces of liquid per day, such as cranberry juice and water.
— Eat white potatoes, which may shrink hemorrhoidal tissue.
Cheston suggests home care nurses caring for patients undergoing radiation treatment should pay close attention to any skin reactions. They also should make sure patients do not use hot pads, hot tubs, or powders. "They could use Aqua 4, a natural care gel that is an aloe vera and water mix. It’s a cool gel, very soothing, that keeps skin soft and doesn’t have as much dryness and itchiness."
If patients are experiencing nausea, the nurse could suggest they eat cold foods; potatoes with no butter; bland foods like pastas, rice, grits, cream of wheat; and liquids or Jell-O. They should stay away from milk products.
Sometimes, the best care a nurse can provide these patients is emotional support. "Make suggestions such as support groups," Cheston says. "And listen to what the patient has to say and really pay attention. Don’t do something else while the patient is talking with you."
The patient may need the nurse’s full attention and, perhaps, a hug. The nurse can help patients attend more to the positive. "Empathize with them, but change their focus and redirect them to something positive, if you can," Cheston says.
Sources
• Cheryl Cheston, RN, BSN, OCN, Radiation Therapy Nurse Supervisor, Moses Cone Health System, 1200 N. Elm St., Greensboro, NC 27401. Phone: (336) 832-8143.
• Anneal Lamb, Social Worker, Director of Hospice Division and Networking for Humanity, Center of Living, Home Health and Hospice, P.O. Box 9, Asheboro, NC 27204-0009. Phone: (336) 672-9300. Fax: (336) 672-0868.
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