Cancer Treatment Nursing Safety

Overview

• Topic: Nursing care and patient teaching for cancer treatments and complications.
• Treatments discussed: chemotherapy, internal (brachytherapy) and external radiation.
• Complications discussed: malnutrition and mucositis.
• Focus: PPE, safety procedures, patient education, and symptom management.

Chemotherapy: Nursing Safety and Procedures

• Follow facility policy for handling cytotoxic agents and waste.
• Use appropriate PPE: special gowns and special chemotherapy-rated gloves.
• Double-bag soiled linens; outer bag must be impervious to prevent leaks.
• Know and follow spill-management protocols for chemotherapy spills.
• Double-flush toilets and use a splash guard after patients’ toileting to prevent exposure.

Internal Radiation (Brachytherapy): Safety Measures

• Definition: radioactive source placed on or very near tumor inside the body.
• Room precautions:
  • Keep patient room door closed.
  • Post radiation warning sign on the door.
• Visitor guidance:
  • Limit visitors to 30 minutes.
  • Maintain at least 6 feet distance from patient.
• Staff protection:
  • Wear lead apron and dosimeter film badge to monitor exposure.
  • Face the patient when providing care so the lead apron protects properly.

External Radiation: Patient Teaching and Skin Care

• Markings:
  • Radiation fields are marked; instruct patients not to wash off markings.
• Skin care over radiation site:
  • Clean gently with mild soap; pat dry.
  • Do not apply lotions, powders, or ointments unless prescribed by provider.
  • Wear loose, soft clothing to reduce irritation.
  • Avoid sun and heat exposure to the treated area.
• Reinforce checking with provider before using any topical product.

Malnutrition From Chemotherapy: Nursing Care and Teaching

• Cause: chemotherapy-induced nausea and vomiting can lead to inadequate intake.
• Nursing interventions:
  • Administer antiemetic about 30 minutes prior to chemotherapy (e.g., ondansetron/Zofran).
  • Consider appetite stimulants if needed (e.g., megestrol) to increase intake.
• Patient teaching:
  • Avoid drinking liquids with meals to prevent early satiety from fluids.
  • Emphasize high-calorie, high-protein, nutrient-dense foods.
  • Recommend room-temperature or cooler foods if nausea is present.
  • Use oral nutritional supplements when oral intake remains insufficient.

Mucositis: Nursing Care and Teaching

• Definition: inflammation, irritation, and ulceration of oral mucosa from chemotherapy; very painful.
• Nursing care:
  • Provide meticulous oral care before and after meals.
  • Encourage regular oral assessments for ulcers, bleeding, or infection.
• Patient teaching and precautions:
  • Avoid mouthwashes that contain glycerine or alcohol.
  • Rinse mouth with saline solution twice daily.
  • Use a soft toothbrush to minimize trauma.
  • Avoid hard, sharp, or abrasive foods (e.g., crackers, chips).
  • Recommend soft, nutrient-dense foods (e.g., scrambled eggs) that are easier to swallow and gentler on mucosa.

Key Terms and Definitions

Action Items / Next Steps

• Verify facility-specific PPE and spill-management policies for chemotherapy handling.
• Ensure staff training on brachytherapy room precautions and dosimeter use.
• Provide written patient education on skin care for external radiation, including what to avoid.
• Standardize pre-chemotherapy antiemetic timing and prescriptions for appetite support when indicated.
• Implement oral care protocols for patients at risk of mucositis, including saline rinses and soft toothbrush availability.