Nursing Responsibilities for

Patients receiving Radiotherapy

and Chemotherapy

Marlon Rey Anacleto,RN,MAN

Radioactive
Materials

Types of Radiotherapy
External

where the radiation

comes from a
machine outside the
body.

Internal

where the radiation

comes from
implants or liquids
placed inside the
body.

Types of Radiotherapy

Types of Radiotherapy
Who are the members of the radiation team?
OncologistDiagnosis and treatments

NurseNursing care (pre-radiation, during

radiation and post-radiation)
PhysicsCalculation on the amount of dose in
radiation
RadiologistProviding radiation regarding the
physicians order

Pre-Radiation
Preparation of knowledge on radiotherapy by
assessing and giving information
What is radiotherapy?
How much expenses for radiation?
How long for the radiation?
What will be complications?
Preparation of patient (body)
Laboratory testsCBC, Electrolytes, Blood chemistry

Post Therapy
How to take care the treated area?
Keep the skin dry
Do not remove the ink marks
Avoid using powder, lotions, creams, alcohol, and
deodorant
Wear loose-fitting cloths
Shave with an electric razor only
Protect the skin from direct sunlight, chorine, and
extreme temperature

Side Effects
Fatigue
Anorexia
Mucositis
Xerostomia
Alopecia

Skin reaction
Nausea & Vomiting
Esophagitis
&Dysphagia
Diarrhea
Cystitis
Bone marrow
depression

Fatigue
Factors contributing to fatigue:
Surgery/Chemotherapy Pain
Medications

Malnutrition

Anemia

Normal lifestyle
Nursing Care
Assessing contributing factors, and
encouraging patient to rest and limit daily
activities.

Anorexia
Factors contributing to anorexia
Waste products of tissue destruction, anemia, inactivity,
medications, and psychological problems.

Nursing Care
* Eat small, frequent meals * Change diet and
environment * Stimulate appetite * Eat
nutritious and high protein snacks * Avoid fatty
or greasy foods * Take nutritional supplements

Mucositis/Stomatitis
A patchy, white membrane become confluent and
may bleed if disturbed.

Nursing Care
* Avoid irritantsalcohol, tobacco, spicy, acid
foods or hot drinks* Eat soft or liquid diet *
Mouth care with saline or water frequently

Xerostomia
Xerostomia is associated with the dry mouth that
results from radiation to salivary glands.
It includes alterations in taste

Nursing Care
* Moisten foods * Use artificial saliva * Make
foods easier to eat * Avoid dry foods * Soak
foods in coffee, milk or warm drinks * Mouth
care with saline frequently

Alopecia
Alopecia is described as the loss
of hair that can occur with the
radiation of the brain
Nursing Care
* Gently brush and comb, infrequently
shampoo * Avoid the use of hair coloring
and chemical * Give psychological support
for change of body image * Give advice for
using wig if necessary

Skin Reactions
Skin reactions include:
erythema, dry and moist desquamation
Nursing Care
* Prevent increasing irritation and avoid scratch * Not
to use any perfumed soap, ointments or deodorant
* Use baby powder or maize starch* Wear loosecloths and cotton made rather synthetic materials*
Open to fresh air but not direct to sunlight* Teach
patients about skin careskin emulsion creamfor
dry, and pain management and antibiotic spray for
moist desquamation

Nausea & Vomiting

Xerostomia is associated with the dry mouth that
results from radiation to salivary glands
It includes alterations in taste
Nursing Care
*Offer ice chips* Eat small, frequent meals *
Eat salty foods, add salt in foods * Drink
clear or cool beverages * Avoid overly
sweet, greasy or high fat foods * Rest with
the head elevated after eating * Mouth care
* Take antiemetic medications if necessary.

Electrolytes imbalance
Electrolyte imbalance is commonly caused by loss

of body fluids through prolonged vomiting,

diarrhea, sweating, or high fever. All of these may
be side effects of chemotherapy treatment.
The kidneys play a critical role in regulating

electrolytes. They control the levels of chloride in

your blood and flush out potassium, magnesium
and sodium. Therefore, a disturbance in blood
levels of these electrolytes may be related to
kidney function.

Esophagitis & Dysphagia

Firstly recognize difficulty in swallowing solids and
make swallowing painful resulting in decrease in
intake foods and fluids.
Nursing Care
* Eat high-calorie, high-protein diet * Drink
plenty of liquids * Eat soft and liquid foods *
Blenderlize solid foods

Diarrhea
Can occur if the areas of the abdomen and pelvis
are treated.

Nursing Care
* Drink plenty of fluids to avoid dehydration *
Avoid milk or dairy products * Avoid foods
high in fiber * Avoid high fat, spicy, and gas
forming foods * Electrolyte replacement-potassium

Cystitis
Cystitis and urethritis result from radiation to the
pelvic and bladder areas.
Nursing Care
* Urine examination * Drink plenty of fluid*
Observe infectious signsfever, difficulty of
voiding* Avoid moisture in the area treated
* Take antibiotic as prescribed

Bone Marrow Suppression

Can occur if the areas of the abdomen and pelvis are
treated.
Nursing Care

Examine blood counts weekly. CBC

* Observe signs and symptoms of bleeding, and

infection, anemia,

* Teach patients to look for these signs

* Transfuse blood components as necessary

* Give health education on nutritious foodsegg

Observe for signs and symptoms

of TLS
Tumor Lysis Syndrome:When cancer cells are
killed by therapy, they may spill their inner
(intracellular) contents, which accumulate in the
body faster than can be eliminated. These excess
intracellular contents cause the metabolic and
electrolyte disturbances that result in tumor lysis
syndrome (TLS). TLS can result in life-threatening
complications if not managed appropriately. If TLS
is untreated, its progression may cause acute
kidney failure, cardiac arrhythmias, seizures, loss
of muscle control or death.

S/S

Nausea and vomiting

Joint discomfort

Shortness of breath

Irregular heartbeat

Lethargy

Cloudy urine

Other patients feel no symptoms of TLS in its early stages, but

have abnormal laboratory results. Laboratory results indicative
of TLS show high potassium, uric acid and phosphorous levels
and low calcium levels in the blood.

Nurses Roles
Provision of nursing care
Emotional support
Monitoring/ Coordination
Health education
Follow up/ Referral system
Promotion of quality of life

Chemotherapy
is the use of cytotoxic drugs in the treatment of
cancer. It is one of the four modalitiessurgery, radiation therapy, chemotherapy
and biotherapy- that provide cure, control, or
palliation. Chemotherapy is systemic as
opposed to localized therapy such as surgery
& radiation therapy.
Paul Erlich, considered to be the father of
chemotherapy.

Chemotherapy in 5 ways
1. Adjuvant therapy- A course of chemotherapy used in conjunction
with another treatment modality.
2. Neo-adjuvant chemotherapy- Administration of chemotherapy to
shrink the tumor prior to surgical removal of the tumor.
3. Primary therapy- The treatment of patients with localized cancer for
which there is an alternative but less than completely effective treatment.
4. Induction chemotherapy- The drug therapy is given as the primary
treatment for patients with cancer for which no alternative treatment
exists.
5. Combination chemotherapy- Administration of two or more
chemotherapeutic agents in the treatment of cancer, allowing each
medication to enhance the action of the other or act synergistically with it.
e.g. MOPP regimen for Hodgkins disease.

ROLE OF A NURSE
Prior to chemotherapy administration
1 Review- The chemotherapy drugs prescription
which should have:
-Name of anti-neoplastic agent.
-Dosage
-Route of administration
-Date and time that each agent to be administered.
2. Accurately identify the client
3.Medications to be administered in conjunction with
the chemotherapy e.g antiemetics, sedatives etc.

ROLE OF A NURSE
4.. Assess the clients condition including

- Most recent report of blood counts including

hemoglobin ,hematocrit, white blood cells and
platelets.
-Presence of any complicating condition which
could contraindicate chemotherapeutic agent
administration i.e. infection, severe stomatitis ,
decreased deep tendon reflexes, or bleeding .
-Physical status
-Level of anxiety
-Psychological status.

5. Prepare for potential complications

Review the policy and have medication and supplies
available for immediate intervention the event of
extravasation.
Review the procedure and have medication available
for possible anaphylaxis

6.Assure accurate preparation of the agent

-Accuracy of dosage calculation
-Expiry date of the drug to be checked
-Procedure for correct reconstitution and
-Recommended procedures for administration

7.Assess patients understanding of the

chemotherapeutic agents and administration
procedures.

*Aseptic technique should be followed.

*Personal protective equipment includes disposable surgical
gloves, long sleeves gown and elastic or knit cuffs.
*Protective eye goggles
*To minimize exposure
-Wash hands before and after drug handling.
-Limit access to drug preparation area
*Keep labeled drug spill kit near preparation area.
*Apply gloves before drug handling.
*Open drug vials/ ampoules away from body.
*Place absorbent pad on work surface.
*Wrap alcohol wipe around neck of ampoule
before opening.
*Cover tip of needle with sterilize gauge when
expelling air from syringe.
*Label all chemotherapeutic drugs.
*Clean up any spill immediately

Drug administration
1. Routei) Oral - Emphasize the importance of compliance by the
patient with prescribed schedule. Drugs with emetic potential
should be taken with meals.
Assure that chemotherapeutic agents are stored as directed by
the manufacturer (refrigerate, avoid exposure to direct
light,etc).
ii) Intramuscular and subcutaenous Chemotherapeutic
agents that can be administered I/M or subcutaneously are few
in number. Non-vesicants like L-asperaginase, bleomycin,
cyclophosphamide, methotraxate. Cyta arabine,and some
hormonal agents are given I/M & /Or subcutaneously.

-Use the smallest gauge needle possible for the

viscosity of the medication.
-Change the needle after withdrawing the agent
from a
vial or ampoule.
-Select a site with adequate muscle and/or SC tissue.
iii) Intravenous It is the most common method of
administration of cancer chemotherapy. May be
given through central venous catheters or peripheral
access. Absorption is more reliable. This route is
required for administration of vesicants and it also
reduces the need of repeated injection. Because
the I/V provides direct access to the circulatory
system, the potential for infection and life
threatening sepsis is a serious complication of
IV chemotherapy.

Intrathecal- Infusion of medication can be given through an

Ommaya reservoir, implantable pump and /or usually through
lumbar puncture.
a) Wear protective equipment (gloves, gown and
eyewear).
b) Inform the patient that chemotherapeutic drugs are harmful
to normal cells and that protective measures used by
personnel
minimize their exposure to these drugs.
c) Administer drugs in a safe and unhurried
environment.

d)Place a plastic backed absorbent pad under the tubing during

administration to catch any leakage.
Do not dispose of any supplies or unused drugs in patient care
areas.
Documentation
Record
-chemotherapeutic drugs, dose, route ,and time
-Premedications, postmedications, prehydration and
other infusions and supplies used for chemotherapy
regimen.
-Any complaints by the patient of discomfort and
symptoms experienced before, during, and after
chemotherapeutic infusion.

Disposal of supplies and unused drugs

a)Do not clip or recap needles or break syringes.
b)Place all supplies used intact in a leak
proof ,puncture proof, appropriate labeled
container.
c)Place all unused drugs in containers in a leak
proof, puncture proof, appropriately labeled
container.
d)Dispose of containers filled with
chemotherapeutic supplies and unused drugs in
accordance with regulations of hazardous wastes