Teaching presentation

1. Radiation Therapy
By Samantha Brezinski, Jennifer Page, Christina Pawlowski

2. Objectives
● Students will define radiation therapy and understand how and why it is used.
● Students will understand the side effects of radiation therapy and how to manage
them in a presenting patient.
● Students will be able to teach a patient about the effects of radiation and how to
prevent complications.
● Students will demonstrate knowledge through NCLEX style questions and a case
study.

3. Introduction: What is radiation therapy?
● Also know as radiotherapy
● Involves the use of radionuclides, discrete gamma ray sources, or ionizing radiation beams to treat cancer
locally (effects of treatment are only seen on the cells and tissues in its path).
● Intended to destroy cancer cells in a targeted area and minimally damage surrounding healthy cells
● Used to cure, control, and palliate cancer
● Given as a series of separated doses: usually small doses of therapy are given per day for a set time period
to maximize destruction of cancer cells while simultaneously reducing injury to normal tissue.
If total body irradiation (TBI) is used:
● All body areas are affected. May take days, weeks, or months to see systemic effects.

4. Introduction: Who does it affect?
Radiation is a type of cancer treatment, so any cancer patient may be considered for
the therapy. Risk factors for developing cancer include:
● Prolonged exposure to carcinogens
● Declining immune function
● Advancing age
● Genetic predisposition
● Patients with AIDS
● Very old or very young patients
● Diets high in animal fats, nitrites, red meat, and low in fiber.
● Those who have a history of smoking or drinking alcohol.

5. Introduction: Delivery methods and devices
Method is chosen based on the shape, size, and location of the tumor, as well as the patient’s health status.
● Teletherapy is a method of radiation therapy delivered from a source outside of the patient.
○ The patient is not radioactive or hazardous to others.
● Brachytherapy is close therapy, in which the radiation source comes into direct, continuous contact with
the tumor for an allotted amount of time.
○ gives a high dose of radiation to the tumor while limiting the amount of radiation to normal tissue
○ Radiation remains inside the patient, and they are hazardous to others, until isotopes are eliminated
by the body.
○ These wastes are hazardous: follow hospital policy for disposal.
Regardless of which treatment is used, the ideal radiation dose is one that kills the most cancer cells while
having the least damage on regular tissue!

6. Side Effects
Adverse effects vary depending on the tissue that is being targeted, but two common side effects are:
● Altered taste (especially red meat, tastes metallic)
● Fatigue
Other possible side effects include:
● Alopecia and radiodermatitis of the scalp
● Xerostomia (dry mouth)
● Cerebral edema
● Ear and external auditory canal irritation
● Oral mucositis
● Oral candidiasis (oral thrush)
● Nausea and vomiting
● Oral herpes
● Esophagitis and pharyngitis
● Dental caries
● Skin reactions
● Acute xerostomia (dry mouth)

7. Self-care: Preventing infection
A certain degree of bone marrow suppression occurs regardless of the treatment, so prevention of infection is in
patients receiving radiation therapy is important:
● Avoid crowds and gatherings with people who may have an infection.
● Do not share personal bathroom supplies, like toothpaste or toothbrushes, and clean toothbrush once per week.
● Bathe daily, but take care to wash radiation sites softly with hands rather than a washcloth.
● Wash your hands thoroughly and frequently with antimicrobial soap.
● Follow the cancer center's instructions for eating fresh or raw foods.
● Avoid drinking liquids that have been standing at room temperature for an hour or longer.
● Take your temperature at least once a day and whenever you do not feel well.
● Take all prescribed drugs.
● Report any of these indications of infection to your physician immediately:
○ Temperature greater than 100° F (37.8° C)
○ Persistent cough (with or without sputum)
○ Pus or foul-smelling drainage from any open skin area or normal body opening
○ Presence of a boil or abscess
○ Urine that is cloudy or foul smelling or that causes burning on urination

8. Self care: Preventing bleeding
● Use an electric shaver on irradiated areas and a soft toothbrush that is washed weekly.
● Visit the dentist frequently, but consult health care provider if dental work needs to be done.
● Do not take aspirin or aspirin-containing products.
● Do not participate in contact sports, and especially avoid contact to radiated skin.
● Avoid very hot food or hard foods that could damage the mouth (especially cautious of cheese on pizza!).
● Monitor skin and mouth daily for bruises or swelling.
● Notify health care provider if:
○ You are injured, burned, or if persistent bleeding occurs
○ See blood in your vomit, urine, or bowel movement
● It is generally safe to have sex during therapy, but use a condom and avoid trauma.
● Take a stool softener to promote comfortable bowel movements, unless you have diarrhea.
● Do not use enemas or suppositories to promote bowel movements.
● Do not wear tight clothing or shoes that rub or would cause blisters.

9. Skin Care
The skin in the path of radiation may become dry and even break down. Teach the patient to:
● Wash the irradiated area gently each day with mild soap, using hand rather than washcloth.
● Do not remove ink or dye marks that mark the radiation site.
● Use a clean, soft towel to pat skin dry after washing.
● Wear soft clothing over radiation site and avoid belts or buckles (anything that can rub the skin).
● Only use skin care products prescribed by physician.
● It is essential to avoid exposing irradiated skin to sunlight:
○ Wear soft clothing that covers the area.
○ Go outdoors before 10 am or after 7 pm when the sun is less damaging to skin.
○ When outside, stay under umbrellas or awnings, avoiding direct sunlight for at least one year after
treatment has ended.

10. Nursing diagnoses
Activity Intolerance r/t fatigue from possible anemia
Disturbed Body Image r/t change in appearance, hair loss
Diarrhea r/t irradiation effects
Fatigue r/t malnutrition from lack of appetite, nausea, and vomiting
Deficient Knowledge r/t what to expect with radiation therapy
Nausea r/t side effects of radiation
Imbalanced Nutrition: less than body requirements r/t anorexia, nausea, vomiting, irradiation of areas of pharynx and esophagus
Impaired Oral Mucous Membrane r/t irradiation effects
Ineffective Protection r/t suppression of bone marrow
Risk for Powerlessness r/t medical treatment and possible side effects
Risk for compromised Resilience r/t radiation treatment
Risk for impaired Skin Integrity: r/t irradiation effects
Risk for Spiritual Distress r/t radiation treatment, prognosis

11. ● Ensure the patient has a private room, especially with a private bathroom.
● Make sure a sign on the door reads “Caution: Radioactive Material.”
● Keep the door to the patient's room closed.
● A dosimeter film badge can measure an individual’s exposure to radiation.Anyone caring for the patient
should wear a badge to calculate exposure.
● When providing care, wear a lead apron and do not turn back to patient.
● Pregnant women, children 16 years old and younger, and women attempting to conceive should not
interact with the patient.
● Visitors must stay 6 feet from the patient and may only visit for 30 minutes per day.
● If the implant is dislodged, do not touch it with bare hands. Pick it up with tongs and place in a lead
container.
● Dressings and bed linens should stay in the room until the radioactive source is removed. Then they can
be removed according to usual protocol.
Nursing interventions for patient with sealed implants

12. Lab and Diagnostic Tests
Lab tests are done after radiation therapy is completed to look for signs of cancer or
treatment side effects.
● Complete blood count (CBC) test, liver and kidney function tests, blood tumor
markers
Imaging tests may be done if exams, symptoms, or tests suggest recurrence.
● X-ray, ultrasound, CT scan, PET scan, MRI scan, bone scan, and/or a biopsy

13. NCLEX questions
Which action by a nursing assistant (NA) caring for a patient with a temporary
radioactive cervical implant indicates that the RN should intervene? (Select all that
apply).
a. The NA places the patient's bedding in the laundry container in the hallway.
b. The NA flushes the toilet once after emptying the patient's bedpan.
c. The NA stands by the patient's bed for an hour talking with the patient.
d. The NA gives the patient an alcohol-containing mouthwash for oral care.

14. NCLEX questions
A patient is beginning external beam radiation therapy to the right axilla after a
lumpectomy for breast cancer. Which of the following should the nurse include in
client teaching?
a. Use a heating pad under the right arm.
b. Immobilize the right arm.
c. Place ice on the area after each treatment.
d. Apply deodorant only under the left arm.

15. NCLEX questions
A patient receiving radiation therapy for lung cancer is having difficulty sleeping. The
nurse should:
a. Suggest the patient stop watching T.V. before bed.
b. Assess the patient’s usual sleep patterns, amount of sleep, and bedtime rituals.
c. Tell the patient sleeplessness is expected with radiation therapy.
d. Suggest that the patient stop drinking coffee until therapy is complete.

16. NCLEX questions
The nurse who is caring for a patient receiving external beam radiation therapy for
treatment of lung cancer should assess the client for which of the following?
a. Diarrhea.
b. Improved energy level.
c. Dysphagia
d. Normal white blood cell count.

17. NCLEX questions
When caring for a patient with an internal radiation implant, the nurse should observe
with principles? (Select all that apply)
a. Limiting the time with the patient to 1 hour per shift.
b. Keeping pregnant women out of the patient's room.
c. Placing the patient in a private room with a private bath.
d. Wearing a lead shield when providing direct patient care
e. Removing the dosimeter film badge when entering the patient’s room
f. Allowing individuals younger than 16 years old in the room as long as they are 6
feet away from the patient.

18. Case Study
J.S. is a 70 year old caucasian male being treated for lung cancer. He has a history of
smoking a pack of cigarettes per day, but quit at age 50 when he lost his job at a steel
mill and has not smoked since. He is undergoing radiation therapy to the chest and has
experienced physical and emotional changes since starting the treatment. He has lost
chest hair, but scrubs the area vigorously each day to prevent infection. His wife is
concerned because he no longer enjoys eating his favorite meal, steak and potatoes,
and he seems to be too tired to play with his grandkids when they visit each week. His
wife tells the nurse that they are planning a trip to the bahamas in 6 months because
she believes her husband just needs to get away, enjoy the weather, try new food and
relax. The nurse uses the opportunity to teach the couple about radiation therapy.

19. Case Study
● What risk factors did J.S. display for acquiring his lung cancer?
● As the nurse, what would you tell J.S. and his wife about his side effects? Are they
normal or abnormal? Should they be worried?
● What behaviors that the couple display are cause for concern? What should the
nurse correct?
● What referrals could the nurse make for J.S. to teach him more about radiation
and help him cope with lifestyle changes?

20. References
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Bauer, C., Laszewski, P., & Magnan, M. (2015). Promoting Adherence to Skin Care Practices Among Patients Receiving
Radiation Therapy. Clinical Journal of Oncology Nursing CJON, 19(2), 196-203. doi:10.1188/15.cjon.196-203
General Principles of Radiation Therapy. (n.d.). Retrieved April 25, 2016, from
http://emedicine.medscape.com/article/846797-overview#a3
Ignatavicius, Donna, Workman, M. L. (2016). Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8th Edition.
[VitalSource Bookshelf Online]. Retrieved from https://pageburstls.elsevier.com/#/books/9781455772551/
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doi:10.4103/0973-1075.156507
Radiation Therapy Guide | Drugs.com. (n.d.). Retrieved May 01, 2016, from
http://www.drugs.com/health-guide/radiation-therapy.html