Med-Surg Immune System, part 10: Chemotherapy, Radiation, Malnutrition, Mucositis

by Cathy Parkes October 07, 2020

In this video

Chemotherapy

  • Nursing precautions around patients undergoing chemotherapy

Internal Radiation

  • Nursing precautions around patients undergoing brachytherapy

External Radiation

  • Patient teaching for patients undergoing external radiation therapy

Common cancer treatment complications 

  • Malnutrition
    • Nursing care for malnutrition
    • Patient teaching for malnutrition
  • Mucositis
    • Nursing care for mucositis
    • Patient teaching for mucositis

Full Transcript

Alright. In this video, we are going to talk about nursing care and patient teaching associated with cancer treatment. So in this specific video, we'll be talking about chemotherapy, internal radiation, external radiation, as well as malnutrition and mucositis.

So let's first talk about chemotherapy. If you are taking care of a patient who is undergoing chemotherapy, you need to make sure you're wearing the appropriate PPE that is required. So you should check with your facility policy. But typically this involves special gowns and special gloves.

In addition, when you are bagging up linens in the room, you want to make sure you double-bag these linens with an impervious bag on the outside. So by impervious, I mean something where substances aren't going to leak through. Basically, it's going to hold everything in and nothing's going to leak out.

Then you want to definitely follow spill-management guidelines. So chemotherapy spills do happen. You need to be prepared for that occurrence and know what those guidelines are and just follow your facility policy with that.

And then you want to make sure to double flush toilets and use a splash guard prior to flushing.

Okay, if your patient is getting internal radiation, so that is something called brachytherapy. This is where they put a radioactive substance either on or very close to the cancer internally. So if your patient has that internal radiation, you need to take steps to protect yourself.

So you always want to keep the door closed to the patient's room.

You want to have a warning sign on the door so that anybody who comes through understands that the patient has internal radiation going on.

You want to limit visitors to 30 minutes, and you want to make sure they stay at least six feet away from the patient.

And then when you are caring for the patient, you need to make sure you are wearing a lead apron as well as a dosimeter film badge, which will help to track how much radiation exposure you're getting.

And then you always want to face the patient so that that lead apron can do its job and protect you.

Alright. Now, let's talk about patient teaching for external radiation. So there's definitely some important points that you'll need to reinforce with your patient.

First of all, the area that will be undergoing radiation will be marked. And it's really important that your patient not wash off these markings.

In addition, they should be very gentle with the skin over the area that's going to receive radiation. So they should clean it with gentle soap and pat it dry. They should not apply any lotions, powders, or ointments over the area unless specifically prescribed by the provider.

So my mom just finished up her radiation therapy for breast cancer, and it went well. Her provider did have her actually put on Aquaphor ointment over the area, but in some cases, your provider may not want you to do that. So you never want to put anything on the area unless you check with the provider first.

In addition, you want to advise the patient to wear loose and soft clothing, because that area's going to be very, very sensitive.

And they should also avoid sun and heat exposure to the area that will be receiving radiation.

Alright. Now, let's talk about some of the nursing care and patient teaching we need to do for common complications of chemotherapy.

One such complication is malnutrition. Chemotherapy can cause nausea and vomiting, which can definitely lead to malnutrition.

So as a nurse, we're going to want to provide an antiemetic about 30 minutes prior to chemotherapy. And a common antiemetic that we use in the hospital is ondansetron, which is Zofran.

We can also give the patient an appetite stimulant. So one such medication that does that is called megestrol. And the way I remember this medication is, with megestrol, it will encourage the patient to ingest more food.

Alright. So in terms of patient teaching. We want to encourage the patient to avoid drinking liquids with their meals because we don't want them to fill up on liquids.

We really want them to focus on consuming a high-calorie, high-protein, nutrient-dense diet.

And then we can also advise them that room temperature or cooler foods are sometimes easier to get down when you're feeling nauseous.

And then in some cases, if they're still not eating enough, we may need to use supplements to help make sure they get enough calories and nutrients.

Okay, another common and awful complication with chemotherapy is something called mucositis. This is where the mucosal membranes in the mouth become inflamed, irritated, and ulcerated. Very, very painful.

So we want to make sure that we are providing meticulous oral care for our patient before and after meals.

We also want to do some important teaching, including letting the patient know that they should avoid any mouthwash that contains glycerine or alcohol.

They should also rinse their mouth with a saline solution twice a day.

And they should use a soft toothbrush and then avoid foods that can cause more pain and damage to that mucosa.

So if the patient was to eat some crackers or chips, those have sharp edges and they're hard. And that would not feel good on their mouth.

So scrambled eggs would be a much better choice because they're soft, they're nutrient-dense, and it will just be much easier on their mouth.

Okay, so I'm going to stop here. We will talk about more complications and how we care for those complications in my next video!


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