Unit One Care of Client with Cancer RADIATION. This Class Radiation (Chpt 16) Definition Sources of radiation Uses of radiation principles of radiation.

Unit One Care of Client with Unit One Care of Client with CancerCancer

RADIATIONRADIATION

This ClassThis Class

Radiation (Chpt 16)Radiation (Chpt 16)DefinitionDefinition Sources of radiationSources of radiation Uses of radiation principles of radiation Uses of radiation principles of radiation

protectionprotection Types of radiation therapyTypes of radiation therapy Care of clients receiving radiation therapyCare of clients receiving radiation therapy Side effects & symptom managementSide effects & symptom management

Class ObjectivesClass Objectives

Describe radiation as a modality for cancer Describe radiation as a modality for cancer treatment, and the uses of radiotherapytreatment, and the uses of radiotherapy

Identify factors affecting cell response to Identify factors affecting cell response to radiotherapy.radiotherapy.

Discuss the principles of radiation protectionDiscuss the principles of radiation protection Describe the types of radiation therapy and Describe the types of radiation therapy and

related nursing care.related nursing care. Discuss side-effects of radiation therapy and Discuss side-effects of radiation therapy and

nursing care nursing care

RADIOTHERAPY:RADIOTHERAPY: One way to stop the ca One way to stop the ca

from growing is to from growing is to interfere interfere with the ca with the ca

cell’s cell’s ability to multiply.ability to multiply. Radiation at high Radiation at high dosages, causes dosages, causes

changes in the ca cell’s changes in the ca cell’s that stops the cell’s that stops the cell’s

ability to multiply and ability to multiply and eventually kills the ca eventually kills the ca

cell. In some cases cell. In some cases destroys ca cell in destroys ca cell in others slows down others slows down

growth.growth.

RadiotherapyRadiotherapy RADIOTHERAPYRADIOTHERAPY is the treatment of is the treatment of

neoplastic disease using neoplastic disease using HIGH ENERGY IONIZING RAYS (x-rays or gamma rays) to KILL CANCER CELLS.THESE MAY BE GENERATED BY RADIOACTIVE SOURCES OR LINEAR ACCELERATORS. THE HIGHER THE ENERGY OF THE PHOTON THE DEEPER IT CAN PENETRATE THE BODY BEFORE LOSING ITS EFFECT.

Radiation deters the proliferation of Radiation deters the proliferation of malignant cells by decreasing the rate of malignant cells by decreasing the rate of mitosis or impairing DNA synthesis.mitosis or impairing DNA synthesis.

Gamma & X-raysGamma & X-raysHigh Energy Ionizing

Terms to RecognizeTerms to Recognize Becquerel Becquerel (Bq):(Bq): unit of measure for the amount of unit of measure for the amount of

of a radioactive nuclide in a particular energy state . of a radioactive nuclide in a particular energy state . One Bq= one nuclear disintegration per second One Bq= one nuclear disintegration per second

Gray (Gy)Gray (Gy) Unit of radiation dose (one joule per kg). Unit of radiation dose (one joule per kg). One Gy= 100 centigray (cGy) equals 100rad (1 rad= One Gy= 100 centigray (cGy) equals 100rad (1 rad= 1cGy)1cGy)

Rad (r)Rad (r) Acronym for radiation absorbed doseAcronym for radiation absorbed dose Roentgen (R) Roentgen (R) Unit of exposure to ionized radiationUnit of exposure to ionized radiation Sievert (Sv)Sievert (Sv) The unit of dose equivalent to ionizing The unit of dose equivalent to ionizing

radiation is = one joule per kg. (used in radiation radiation is = one joule per kg. (used in radiation safety re occupational exposure)safety re occupational exposure)

Action Action of Radiationof Radiation

Prevents the reproduction of cells as Prevents the reproduction of cells as breaks DNA strandsbreaks DNA strands

CellsCells most sensitivemost sensitive to radiationto radiation M & G2M & G2 phases &phases & least sensitiveleast sensitive in in S phaseS phase

Cells that are rapidly dividing cells and Cells that are rapidly dividing cells and undifferentiated are more sensitive to undifferentiated are more sensitive to radiation.radiation.

RadiationRadiation SOURCES SOURCES

COLBALT 60COLBALT 60 CESIUM 137CESIUM 137 IODINE 131IODINE 131 IRIDIUM 192IRIDIUM 192 RADIUM 226RADIUM 226 RADON 222RADON 222 STRONTIUM 90STRONTIUM 90

Important to Know!Important to Know!

RATE AT WHICH RATE AT WHICH RADIOTHERAPY RADIOTHERAPY DELIVEREDDELIVERED NOTED AS MILLION ELECTRON NOTED AS MILLION ELECTRON VOLTS ( CURRENTLY 2- 40 MEV’S USED)VOLTS ( CURRENTLY 2- 40 MEV’S USED)

LINEAR ACCELERATORSLINEAR ACCELERATORS DEVELOPED DEVELOPED ALLOWING DEEPER PENETRATION AND ALLOWING DEEPER PENETRATION AND LESS SUPERFICIAL TISSUE DAMAGELESS SUPERFICIAL TISSUE DAMAGE

ThreeThreeGoals of RadiotherapyGoals of Radiotherapy

CurativeCurative Control: Control:

AdjuvantAdjuvant

Pre/Post OperativePre/Post Operative

IntraoperativeIntraoperative PalliationPalliation

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http://www.youtube.com/watch?http://www.youtube.com/watch?v=lZ9cGVaxOes&feature=relmfuv=lZ9cGVaxOes&feature=relmfu

Radiation Protection: PrinciplesRadiation Protection: Principles

ALARA PRINCIPLE: TIME:TIME: longer time of exposure, greater longer time of exposure, greater

amt. of rad. absorbedamt. of rad. absorbed DISTANCEDISTANCE :intensity of rad. decreases :intensity of rad. decreases

as distance from source increases. as distance from source increases.

SHIELDINGSHIELDING:: % of rad. penetration % of rad. penetration decreases as the shield thickness decreases as the shield thickness increases. increases.

ALARA PrincipleALARA PrincipleThe physical protection against external radiation is based on the following three principles:

-distance from the source of radiation (distance),

-limitation of the time of irradiation (time),

-absorption of radiation (shielding).

TimeTime Minimize time spent in close proximity Minimize time spent in close proximity

to the client. Radiation exposure is to the client. Radiation exposure is directly related to the time spent within directly related to the time spent within a specific distance of rad. Souce. Care a specific distance of rad. Souce. Care giver should not exceed 1/2 to 1 hour giver should not exceed 1/2 to 1 hour exposure per shift.exposure per shift. Organize care prior to entering room.Organize care prior to entering room. Assemble all equipment prior to room Assemble all equipment prior to room

entryentry In room place supplies/equipment In room place supplies/equipment

within easy quick access.within easy quick access. Post time guidelines on doorPost time guidelines on door..

DistanceDistance The amount radiation decreases Doubling The amount radiation decreases Doubling

the distance from the rad source the distance from the rad source Quarters Quarters the amt. of radiation received!the amt. of radiation received!

If the exposure at 1 meter from the Rad. If the exposure at 1 meter from the Rad. Source is X, the exposure at 2m is ¼ of x, Source is X, the exposure at 2m is ¼ of x, and at 4m, one sixteenth.and at 4m, one sixteenth.

Interventions:Interventions: Teach client self-care & rationale for isolationTeach client self-care & rationale for isolation Limit client care by individual caregiverLimit client care by individual caregiver Use communication devices outside room Use communication devices outside room

when possiblewhen possible

ShieldingShielding

When used properly, lead shielding can When used properly, lead shielding can provide added protection from radiation. provide added protection from radiation.

In practice, nurses find lead shielding in be In practice, nurses find lead shielding in be cumbersome to work with.cumbersome to work with.

Improper use leads to a false sense of Improper use leads to a false sense of security, and impedes rapid care.security, and impedes rapid care.

Nurses wear a film badgeNurses wear a film badge NB pregnant nurses should not care for NB pregnant nurses should not care for

radiation clients.radiation clients.

Types of Radiation Therapy

External Beam or Teletherapy

most common type of radiation

using machines (linear accelerator)

client is not radioactive Internal radiation or Brachytherapy

implants (temporary/permanent)

client is radioacive

TeletherapyTeletherapy

Delivering radiation from a source a Delivering radiation from a source a distance from the targetdistance from the target

Radiation department administersRadiation department administers Advantage skin sparring effect giving max Advantage skin sparring effect giving max

rad to tumor not the skin. rad to tumor not the skin. Client monitored via TV or intercom Client monitored via TV or intercom Treatment approx. 10 mins. Treatment approx. 10 mins. Not painful client feels heat or tingling.Not painful client feels heat or tingling.

BrachytherapyBrachytherapy

Delivers a high dose of radiation to a Delivers a high dose of radiation to a localized arealocalized area

The specific radioisotope is chosen on the The specific radioisotope is chosen on the basis of its half-lifebasis of its half-life

May be implanted by means of needles, May be implanted by means of needles, seeds, beads, or catheters into body seeds, beads, or catheters into body cavities (vagina, abdomen, prostate, cavities (vagina, abdomen, prostate, pleural space).pleural space).

May be given orally or IV (thyroid cancer)May be given orally or IV (thyroid cancer)

Brachytherapy uses sealed radioactive sources, which places the radiation source near or in the tumour for a Brachytherapy uses sealed radioactive sources, which places the radiation source near or in the tumour for a calculated period of time. This form of Radiation Therapy is most commonly used to treat some forms of skin calculated period of time. This form of Radiation Therapy is most commonly used to treat some forms of skin cancer, prostate cancer and gynaecological malignancies. At the completion of each treatment, the radiation cancer, prostate cancer and gynaecological malignancies. At the completion of each treatment, the radiation source is removed. This means that source is removed. This means that you will not be radioactiveyou will not be radioactive, and there is no need to alienate yourself , and there is no need to alienate yourself from others. The number of treatments you require varies, depending on your diagnosis and treatment site.  from others. The number of treatments you require varies, depending on your diagnosis and treatment site.  You will be advised ahead of time on how many treatments you will have.You will be advised ahead of time on how many treatments you will have.

Brachytherapy: Sealed Brachytherapy: Sealed PROSTATE BRACHYTHERAPY

BrachytherapyBrachytherapy may be sealed or unsealed:

SEALED:SEALED:

InterstitialInterstitial

IntercavityIntercavity

UNSEALED:UNSEALED:

Systemic (IV, oral)Systemic (IV, oral)

Types of Radiation:Types of Radiation:

External:External:Beam radiationBeam radiationTeletherapyTeletherapy GAMMA RAYSGAMMA RAYS::penetrate deeplypenetrate deeply BETA RAYS: BETA RAYS: surface penetrationsurface penetration

Internal:Internal:ImplantedImplantedBrachytherapyBrachytherapy SEALED:SEALED:

InterstitialInterstitialIntercavityIntercavity

UNSEALED:UNSEALED:

Systemic (IV, oral)Systemic (IV, oral)

BrachytherapyBrachytherapy SEALEDSEALED

Emits low energyEmits low energy

Continuous Continuous

Interstitial & intracavity Interstitial & intracavity implantsimplants

Ex. Seeds Ex. Seeds APPLICATORSAPPLICATORS

CLIENT EMITS

RADIATION but NONE IN EXCRETA

UNSEALEDUNSEALED

Injected, instilled or oral.Injected, instilled or oral.

SystemicallySystemically

EX. EX. II131 131

CLIENT AND EXCRETA are RADIOACTIVE

Sealed Brachytherapy:Sealed Brachytherapy:

Intracavity:Intracavity: Radioisotopes (cesium or radium) put in applicator & Radioisotopes (cesium or radium) put in applicator &

placed in body cavity for a specific amount of time (24-placed in body cavity for a specific amount of time (24-72hours)72hours)

When treatment completed applicator & radioactive When treatment completed applicator & radioactive material removedmaterial removed

treats ca uterus & cervixtreats ca uterus & cervixInterstitial:Interstitial: Placed needles, beads, seeds, ribbons or catheters Placed needles, beads, seeds, ribbons or catheters

placed directly into tumor (breast, prostrate)placed directly into tumor (breast, prostrate) Radioisotopes iridium,cesium, gold, radonRadioisotopes iridium,cesium, gold, radon Can be temporary or permanent placementCan be temporary or permanent placement treats Prostrate cancertreats Prostrate cancer

Brachytherapy for prostate cancerBrachytherapy for prostate cancer

Brachytherapy for prostate Brachytherapy for prostate cancer. Lithotomy cancer. Lithotomy positioning and graphic positioning and graphic representation of how representation of how

brachytherapy occursbrachytherapy occurs

Needle insertion of radioactive Needle insertion of radioactive implantsimplants..

BRACHYTHERAPYInterstitial seed implantation

Emits low energyEmits low energy

ContinuousContinuous

EX: EX: SEEDS SEEDS in this in this case for 1 year.case for 1 year.

Watch for symptoms of Watch for symptoms of irritation or problems irritation or problems voiding (swelling)voiding (swelling)

Radioactive seeds implanted in prostate

Nursing Care of the Client with Sealed Implant

Private room with bathroom

Radioactive material sign

Wear dosimeter No pregnant staff Visitors limited to 30

mins per day Visitors are restricted

and must remain at 6 feet distance

All dressings & linens saved until implant removed

LEAD CONTAINER & LONG HANDLED FORCEPS,LEAD GLOVES KEPT IN ROOM IN EVENT OF DISLODGEMENT

REMEMBER ALARA TIME DISTANCE SHEILDING

Nursing Care of Client with UNSEALED Implant

Presents potential Presents potential contamination hazard/ all contamination hazard/ all articles in room are articles in room are considered contaminatedconsidered contaminated

After d/c articles are After d/c articles are discarded but taken to discarded but taken to protected area ‘til protected area ‘til detectable radioactivity detectable radioactivity decaysdecays

Rubber gloves worn with Rubber gloves worn with direct caredirect care

No pregnant staffNo pregnant staff

Articles in room phone, Articles in room phone, call light, floors covered call light, floors covered plasticplastic

disposable plastic /paper disposable plastic /paper used for dietary trays & used for dietary trays & utensilsutensils

pts. Flush toilet several pts. Flush toilet several times times

Keep linen & gowns kept Keep linen & gowns kept in separate isolation bagsin separate isolation bags

Loss of Radioactive Material:

Considered an emergencyConsidered an emergency Search initiated by radiation staffSearch initiated by radiation staff Nothing moves from the room while Nothing moves from the room while

client has radioactive material in placeclient has radioactive material in place If found radioactive material use forceps If found radioactive material use forceps

& gloves& gloves Notify Atomic Energy CanadaNotify Atomic Energy Canada

Factors affecting cell response to Radiotherapy:

Histological type of cellHistological type of cell Oxygen effectOxygen effect Type of radiotherapy usedType of radiotherapy used Rate at which radiotherapy is deliveredRate at which radiotherapy is delivered

Rate of Delivery of Radiation: Rate of Delivery of Radiation: TeletherapyTeletherapy

FRACTIONATIONFRACTIONATION- - administering radiation in administering radiation in divided doses rather than single doses to divided doses rather than single doses to minimize side effects by allowing normal minimize side effects by allowing normal cells time to recover.cells time to recover.

Dividing total dose radiation into smaller Dividing total dose radiation into smaller frequent doses.frequent doses.

Fractionation allows normal cells time to repair.Fractionation allows normal cells time to repair. Increases chance of getting the cells in the Increases chance of getting the cells in the

vulnerable G2 & M phases.vulnerable G2 & M phases.

CELL / TISSUE RADIOSENSITIVITY

HIGH

MODERATE

LOW

RESISTANT

LYMPHATIC

SKIN

HEART

MUSCLE

G.I. EPITHELIUM

KIDNEY

BRAIN

MATURE BONE

CARTILAGE MUCOUS

MEMBRANES

LIVER PERIPHERAL NERVES

CONNECTIVE TISSUE

GONADS

LUNG

Chemical Modifiers:Chemical Modifiers:

Compounds used to increase the Compounds used to increase the radiosensitivity of tumor cells or protect radiosensitivity of tumor cells or protect normal cells from the effects of normal cells from the effects of radiotherapyradiotherapy..

Types Chemical Modifiers:Types Chemical Modifiers:

RADIOSENSITIZERS - RADIOSENSITIZERS - INCREASE CELLINCREASE CELL

KILLKILL

RADIOPROTECTORSRADIOPROTECTORS- - PROTECT CELLS PROTECT CELLS

Radioprotector: Radioprotector: Protects cells Protects cells from radiationfrom radiation

Pilocarpine (Salagen)Pilocarpine (Salagen) administered administered orally decreases xerostomia from orally decreases xerostomia from salivary gland dysfunction related salivary gland dysfunction related to head/neck radiation.to head/neck radiation.

decreases chance of mucositis, decreases chance of mucositis, fungi, infections and ulcers of fungi, infections and ulcers of mouthmouth

Important!Important!

PilocarpinePilocarpine

Factors influencing degree & occurrence of side effects Radiotherapy:

Body site irradiatedBody site irradiated DosageDosage Extent of body area treatedExtent of body area treated Method of radiation deliveryMethod of radiation delivery Age of clientAge of client General health of clientGeneral health of client Previous surgeries & chemotherapyPrevious surgeries & chemotherapy Radiosensitivity of tissue/organ treated.Radiosensitivity of tissue/organ treated.

Phases of Radiation Injury:Phases of Radiation Injury:

Early (acute): occurs within weeks and resolve 4-6 weeks post radiation. Usually temporary and effect tissue with rapidly dividing cells (skin, mucous membranes)

Late Phase: may occur months/years later and usually result from damage to the micro-circulation. Affect any/all tissues especially: lymph, thyroid, pituitary, breast, brain, bone, cartilage, pancreas and bile ducts.

SYMPTOM MANAGEMENT IN RADIATION ONCOLOGY

Symptom ManagementSymptom Management Nausea & vomitingNausea & vomiting DiarrheaDiarrhea XerostomiaXerostomia Ocular symptoms ( edema, dryness, photophia)Ocular symptoms ( edema, dryness, photophia) Oral mucositisOral mucositis AlopeciaAlopecia HyperthermiaHyperthermia HeadacheHeadache CystitisCystitis EsophagitisEsophagitis

Skin ReactionsSkin Reactions

Acute or ChronicAcute or Chronic : Acute:Acute: begin about 2 weeks after start of begin about 2 weeks after start of

treatment and resolve over next 3-4 treatment and resolve over next 3-4 weeks. Reactions include erythema, dry weeks. Reactions include erythema, dry desquamation, wet desquamationdesquamation, wet desquamation

Chronic:Chronic: may occur years later and may occur years later and include atrophy, pigment changes, fibrosis include atrophy, pigment changes, fibrosis and telangiectasia.and telangiectasia.

Dry desquamationDry desquamation

Begins within 7-10 days Begins within 7-10 days of treatmentof treatment

Erythema that may Erythema that may progress to dry, itchy skinprogress to dry, itchy skin

May be scaling, flaking, May be scaling, flaking, peelingpeeling

Result of partial loss of Result of partial loss of the epidermal basal cell the epidermal basal cell layer.layer.

Wet desquamationWet desquamation

Result of complete destruction of Result of complete destruction of the basal cell layerthe basal cell layer

Blister, vesicles, and serous oozingBlister, vesicles, and serous oozing Pain may occur if nerve endings Pain may occur if nerve endings

are exposedare exposed Occurs more often in areas of Occurs more often in areas of

friction & moisture (skin fold, groins)friction & moisture (skin fold, groins) Increased risk of infection (may Increased risk of infection (may

require break in treatment)require break in treatment)

General Skin Care Radiation Client

Wash daily with water or mild scent-free soap soap (not dove as has creams added)

Use hand to wash Rinse soap well If tatooing used so not to worry re washing

simulation marks Pat skin dry No powders, ungs, creams unless ordered by

Oncologist

Skin CareSkin Care cont’dcont’d

Wear soft clothing over radiation site (cotton) Avoid belts, straps & tight clothing Avoid sun exposure Shave with electric razor Do not use tape over site

Skin ChangesSkin Changes RecommendationsRecommendations

Little or no skin changes – just Little or no skin changes – just starting treatmentstarting treatment

Cornstarch dusting in treatment Cornstarch dusting in treatment area will prevent rubbing/irritation area will prevent rubbing/irritation from clothes. Do not use in moist from clothes. Do not use in moist or open areas.or open areas.

Slight redness, slight warmth, mild Slight redness, slight warmth, mild itchinessitchiness

Stop cornstarchStop cornstarchUse pure Aloe Vera to moisten Use pure Aloe Vera to moisten skin and help with the itchinessskin and help with the itchiness

Dry desquamationDry desquamation Stop aloe vera gelStop aloe vera gelUse 1% hydrocortisone cream Use 1% hydrocortisone cream twice dailytwice daily

Moist desquamationMoist desquamation Stop hydrocortisone creamStop hydrocortisone creamIntra-site gel or flamazineIntra-site gel or flamazineSaline compresses may be usedSaline compresses may be used

(Radiation therapy, Biotherapy and Gene Therapy, CCNS 2004)

AlopeciaAlopecia

May occur within the treatment fieldMay occur within the treatment field Extent depends upon area of treatment Extent depends upon area of treatment

and dose of XRTand dose of XRT Often patchy in appearanceOften patchy in appearance Usually begins 2 weeks after start of XRTUsually begins 2 weeks after start of XRT Usually temporary, but may be permanentUsually temporary, but may be permanent Regrowth usually begins 3-6monthsRegrowth usually begins 3-6months

MucositisMucositis

Inflammation of the mucosal lining of the Inflammation of the mucosal lining of the G.I. tractG.I. tract

If oral cavity - stomatitisIf oral cavity - stomatitis If esophagus – esophagitisIf esophagus – esophagitis Common in patients receiving XRT to Common in patients receiving XRT to

head & neckhead & neck Severity depends on dose, size of field, Severity depends on dose, size of field,

and fractionation schedule of XRTand fractionation schedule of XRT

MucositisMucositis

Symptoms include:Symptoms include: Soreness or burning in mouth or throatSoreness or burning in mouth or throat Difficulty swallowingDifficulty swallowing Sensation of having”lump in throat”Sensation of having”lump in throat” Redness, tenderness, or ulcerations in the Redness, tenderness, or ulcerations in the

mouthmouth

Assessment of mucositisAssessment of mucositis

HistoryHistory

- Oral symptoms- Oral symptoms- Food and fluid intakeFood and fluid intake- Difficulty swallowingDifficulty swallowing

Assessment of mucositis (cont’d)Assessment of mucositis (cont’d)

PhysicalPhysical- Assess oral cavity for redness, Assess oral cavity for redness,

inflammation, ulcers, infectioninflammation, ulcers, infection

InvestigationsInvestigations

Swab lesions if candida or herpes suspectedSwab lesions if candida or herpes suspected

General InterventionsGeneral Interventions

Scrupulous oral careScrupulous oral care Soft tooth brushSoft tooth brush No commercial mouthwashes – use No commercial mouthwashes – use

normal saline, club soda, or baking soda normal saline, club soda, or baking soda solutionsolution

No lemon and glycerin mouth swabsNo lemon and glycerin mouth swabs Consider pain relief mouthwashConsider pain relief mouthwash Soft, bland dietSoft, bland diet

XerostomiaXerostomia

Dryness in the mouth caused by lack of Dryness in the mouth caused by lack of normal secretion of salivanormal secretion of saliva

Salivary glands very sensitive to XRTSalivary glands very sensitive to XRT Severity related to doseSeverity related to dose May be permanent with higher dosesMay be permanent with higher doses

XerostomiaXerostomia

Lack of moisture to mucosa causes Lack of moisture to mucosa causes irritation to the mucosa, fissures may irritation to the mucosa, fissures may develop on the corners of the mouthdevelop on the corners of the mouth

Xerostomia promotes accumulation of Xerostomia promotes accumulation of bacteria and plaque increasing bacteria and plaque increasing susceptibility to infection, dental caries, susceptibility to infection, dental caries, and peridontal diseaseand peridontal disease

Xerostomia InterventionsXerostomia Interventions

Good oral hygieneGood oral hygiene Frequent sips water, sugarless gum, avoid dry Frequent sips water, sugarless gum, avoid dry

foods, liquids with mealsfoods, liquids with meals Avoid alcohol and smokingAvoid alcohol and smoking HumidifierHumidifier Artificial saliva i.e. Moistir ac meals, hs, & prnArtificial saliva i.e. Moistir ac meals, hs, & prn Pilocarpine for radiation induced xerostomiaPilocarpine for radiation induced xerostomia

DiarrheaDiarrhea

Passage of frequent (more than 3/24hrs), Passage of frequent (more than 3/24hrs), loose, watery stoolloose, watery stool

Can lead to dehydration, malabsorption, Can lead to dehydration, malabsorption, fatique, hemorrhoids, and perianal skin fatique, hemorrhoids, and perianal skin breakdownbreakdown

Caused by irritation/inflammation of the Caused by irritation/inflammation of the bowel liningbowel lining

Risk for DiarrheaRisk for Diarrhea

Higher in patients undergoing chemo or Higher in patients undergoing chemo or XRT to abdomen or pelvisXRT to abdomen or pelvis

With XRT usually develops 10-15 days With XRT usually develops 10-15 days into treatment into treatment

Lasts 2-3 weeks after treatmentLasts 2-3 weeks after treatment

Assessment of DiarrheaAssessment of Diarrhea

History - onset, pattern, number of History - onset, pattern, number of B.M.’s/24 hrs.B.M.’s/24 hrs.

Physical – vital signs, abdominal Physical – vital signs, abdominal assess.,hydration statusassess.,hydration status

Psychological – anxiety, stressPsychological – anxiety, stress Investigations – serum electrolytes, Investigations – serum electrolytes,

creatinine & urea, stool cultures & stool for creatinine & urea, stool cultures & stool for c. difficilec. difficile

InterventionsInterventions

Radiation induced diarrhea usually Radiation induced diarrhea usually managed initially with dietary changesmanaged initially with dietary changes

- Small freq. mealsSmall freq. meals- Drink 8-10 glasses of fluidsDrink 8-10 glasses of fluids- Low fat, low fiber dietLow fat, low fiber diet- Avoid gas producing foodsAvoid gas producing foods- Avoid caffeinated beveragesAvoid caffeinated beverages

Interventions cont’dInterventions cont’d

Loperamide – if patient has more than 3 Loperamide – if patient has more than 3 watery B.M.’s per daywatery B.M.’s per day

Protect peri-anal area form skin Protect peri-anal area form skin breakdownbreakdown

- Keep area clean and dryKeep area clean and dry- Sitz bathes several times a day can ease Sitz bathes several times a day can ease

discomfortdiscomfort

Other complications radiation Other complications radiation treatmenttreatment

Cystitis (usually occurs 1-2 weeks post Cystitis (usually occurs 1-2 weeks post XRT and subsides 2 weeks after XRT XRT and subsides 2 weeks after XRT completecomplete

Lhermitte’s syndrome – after spinal cord Lhermitte’s syndrome – after spinal cord radiationradiation

Vaginal stenosis – after XRT to pelvisVaginal stenosis – after XRT to pelvis Radiation pneumonitis – after XRT to Radiation pneumonitis – after XRT to

lungslungs