Radiation Side Effects

Front 1

radiation side effects are related to...

Back 1

1) the area being treatment

2) the dose delivered

3) the time line of presentation (acute or chronic)

Front 2

what are the therapist's responsibilities?

Back 2

1) evaluate

2) knowledge of disease side effects

3) knowledge of treatment side effects

Front 3

acute side effects

-definition

-examples

Back 3

short term reaction that occur during treatment and subside after treatment is completed

ex. dysphagia, esophagitis, erythema

Front 4

chronic side effects

-definition

-examples

Back 4

long term effects that appear months to years after treatment is completed

ex. fibrosis of the lungs

irritation of bronchus

Front 5

side effect complications

occur when...

-examples

Back 5

tolerance dose is exceeded of an organ

ex. pneumonitis, myelopathy

can occur under tolerance dose

Front 6

TD 5/5

Back 6

5 percent risk at 5 years

Front 7

most common treatment side effects

Back 7

fatigue

appetite loss

myelosuppression

skin changes

Front 8

fatigue

-definition

Back 8

total lack of energy that is not relieved by sleep

Front 9

signs of fatigue

Back 9

exhaustion

weakness

whole body tiredness

difficulty concentrating

difficulty sleeping

lack of motivation

Irritability

decrease of interest in activities

Front 10

how does the disease cause fatigue?

Back 10

the mechanism is unknown

but some theories are:

-lack of exercise

-anemia

-depression

Front 11

how does treatment cause fatigue?

Back 11

mechanism is unknown

but some theories are:

-bone marrow is in the treatment field

-normal tissue is damaged

-increased stress

Front 12

other underlying problems associated with fatigue

Back 12

anemia

neutropenia

patients are put on hold

infection

dehydration

pain

nausea

diarrhea

Front 13

underlying problems for fatigue

how do you treat anemia?

Back 13

blood transfusion

medication: epogen/procrit

Front 14

underlying problems for fatigue

how do you treat neutropenia?

Back 14

medication: neupogen

Front 15

normal RBC count

Back 15

men: 4.5-6.0 trillion/liter

women: 4.3 - 5.5 trillion/liter

Front 16

normal platelet count

Back 16

150,000-440,000 mm^3

Front 17

normal hemoglobin count

Back 17

men: 14-18 gr/dl

women: 12-16 gr/dl

Front 18

normal WBC count

Back 18

5-11 billion/liter

Front 19

how to treat underlying problems from fatigue

Back 19

promote well being and restfulness by

-increase sleep/rest

-nutrition - eat a well balanced diet, and drink (8) 8oz of fluid a day

psychotherapy/counseling

Front 20

how much should you drink per day?

Back 20

8 - 8oz of fluid

Front 21

loss of appetite during treatment - good or bad

Back 21

bad, it is important not to lose weight during treatment

Front 22

ways to keep your weight up

Back 22

cut food into small pieces

eat small meals several times a day

drink a lot of fluids

add creams/butter

nutritional supplements

Front 23

myelosuppression

-define

Back 23

decrease in the number of circulating blood cells, white/red/platelets

Front 24

what are the different kinds of cells that decrease with myelosuppression?

Back 24

leukocytopenia - WBC

-granulocytopenia

-neutropenia

thrombocytopenia - platelets

anemia - RBC

Front 25

what causes myelosuppression when treating cancer?

Back 25

-bone marrow is an active organ and is affected quickly

-chemotherapy

-radiation therapy - site dependent, effects occur 1-2 weeks after beginning of treatment and recover 2-3 weeks later

-combination of rt and chemo

Front 26

cause of myelosuppression

-what is not effected when treating with radiation therapy?

Back 26

circulating blood cells (site dependent)

Front 27

lifespan of RBC

Back 27

100-120 days

Front 28

lifespan of WBC

Back 28

11-16 days

Front 29

lifespan of platelets

Back 29

5-9 days

Front 30

causes of myelosuppression

-side effects of radiation therapy are dependent on...

-counts typically fall ____________ compared to chemotherapy

Back 30

side effects are dependent on the amount of bone marrow in the field

counts typically fall slower than chemotherapy

Front 31

how to prevent infection in patients with myelosuppression

Back 31

-handwashing

-avoid invasive procedures

-good nutrition

-transfusions

-medications to promote hemogenesis

Front 32

skin

-what is special about it?

-name the layers

Back 32

it is the largest organ in the body

two layers: epidermis, dermis

Front 33

epidermis

-define

Back 33

outer layer of the skin

Front 34

dermis

-define

Back 34

contains specialized cells and structures, where all the stuff is

Front 35

hypodermis/subcutaneous

Back 35

deepest layer of the skin consists of a network of collagen and fat cells. It conserves the body's heat and protects the body from injury by acting as a shock absorber

Front 36

the layers of the epidermis

Back 36

stratum corneum

stratum granulosum

stratum spinosum

stratum basale

Front 37

function of the skin

Back 37

acts as a barrier from infection

prevents loss of body fluids

reserves body temperature

cosmesis

immunity

Front 38

dermatitis

Back 38

inflammation of the skin

Front 39

erythema

Back 39

redness of the skin

Front 40

hyperpigmentation

Back 40

patches of skin that become darker in color than surrounding skin

Front 41

pruritis

Back 41

itchy skin

Front 42

desquamation

Back 42

shedding of the outer most membrane of the tissue

Front 43

prophylactic skin care

Back 43

loose or soft clothing

avoid deodorants

avoid lotions

Front 44

reaction assessment for erythema

Back 44

location

size

color

discomfort

Front 45

erythema

-definition

-caused by

-dose

Back 45

abnormal redness of the skin

caused by congestion of the capillaries

dose: 3000-4000 cGy

Front 46

clinical presentation of dry desquamation

Back 46

partial loss of the epidermal basal layer

dryness, itching, scaling, flaking, and peeling

hyperpigmentation

Front 47

when a patient has erythema/dry desquamation, you should promote...

Back 47

cleanliness

comfort

reduce inflammation

prevent trauma to area

Front 48

dose of dry and moist desquamation

Back 48

4,500-6000 cGy

Front 49

things to do to manage erythema/dry desquamation

Back 49

use mild unscented soaps (dove/neutrogena, ivory)

tepid water

mild shampoos

cornstarch

moisturizing creams (not oil based)

corticosteroid creams (hydrocortisone)

Front 50

clinical presentation of moist desquamation

Back 50

complete destruction of the basal cell layer

blister or vesical formation

nerve exposure and pain

serous drainage

Front 51

reaction assessment for moist desquamation

Back 51

location

size

wound base

exudate

odor

discomfort

Front 52

how would you care for moist desquamation

Back 52

promote cleanliness

manage pain

maintain principles of moist healing

promote rapid re-epithelization

prevent infection

Front 53

precautions for moist desquamation

-if area becomes moist,

Back 53

discontinue use of any lotions/creams/powders

Front 54

discourage the use of this kind of plant during treatment

Back 54

aloe vera

Front 55

what would you use to manage moist desquamation

Back 55

saline or astringent compresses

tepid water

hydrocolloid dressings

nonadherent dressings

air out area

Front 56

define astringent

Back 56

a substance that contracts the tissues or canals of the body thereby diminishing discharges, as of mucus or blood

Front 57

example of an astringent compress

Back 57

dombero soak

Front 58

types of hydrocolloid dressing

Back 58

tegaderm, duoderm, vigilon

Front 59

type of nonadherent dressing

Back 59

telfa pads

Front 60

benefits of using hydrocolloid dressing

Back 60

it has gel forming agents

it can adhere to a moist or dry surface

it does not cause trauma on removal

Front 61

Brain

-intracranial pressure causes

Back 61

disease

-primary or secondary tumor

surgery

RT

rapid weaning from certain meds (steroids)

Front 62

signs of intracranial pressure

Back 62

headache

neurologic changes

nausea/vomiting

Front 63

how to treat intracranial pressure

Back 63

corticosteroid

-decadron

Front 64

side effects of decadron

Back 64

they are almost always reversible

-difficulty sleeping

-fluid retention

-heartburn

-increase blood sugar

Front 65

acute side effects of Brain treatment

Back 65

edema

dermatitis

alopecia

Front 66

dose for alopecia

Back 66

2000-4000 cGy

Front 67

Brain

-how to manage edema

Back 67

anti-inflammatories

-corticosteroids - decadron

seizure medication

-dilantin/tegretol

Front 68

Brain

chronic side effects

Back 68

cataract formation-500 cgy

visual changes - retinopathy/optic chiasm

alopecia

neurophysiologic

radiation necrosis

Front 69

cataract formation dose

Back 69

500 cGy

reversible

Front 70

head and neck

mucositis/stomasitis

Back 70

inflammation of the mucous membrane

Front 71

Head and neck

-taste changes happen at what dose

-occurs how many weeks into treatment

Back 71

3000-4000 cGy

1-2 weeks

Front 72

head and neck

-mucositis/stomatitis - what cells are sensitive

-occurs how many weeks into treatment

-increase risk of...

Back 72

epithelial cells are extremely radiosensitive

occurs 2-3 weeks into treatment

increases risk of fungal infection (candida albicans)

Front 73

head and neck

-xerostomia- what is sensitive to RT

-duration

Back 73

salivary glands are extremely sensitive to RT

may be permanent

Front 74

head and neck

-hoarseness/laryngitis - what happens to the vocal cords

Back 74

vocal cords become edematous

Front 75

head and neck

-dental caries define

-how to manage

Back 75

dental caries is tooth decay

manage by using prophylactic fluoride treatment

Front 76

head and neck

-otitis define

-can cause

Back 76

inflammation of the ear

can cause hearing problems

Front 77

medications for soothing and numbing the mouth

Back 77

baking soda gargle

antacids

benxylox

Front 78

artificial saliva aids

Back 78

salagen

Front 79

antifungal medication

Back 79

diflucan

nystatin

Front 80

how to manage head and neck side effects, promote...

Back 80

good hydration

good nutrition

prohylactic dental care

humidifier

avoid irritants such as smoking/alcohol and spicy foods

Front 81

thorax treatment side effects

Back 81

esophagitis

xerostomia

dysphagia

lung fibrosis

pericarditis

Front 82

thorax

-radiation pneumonitis - when does it occur

Back 82

acute, within 6 months of treatment

Front 83

thorax

-define lung fibrosis

-acute or chronic

Back 83

scarring of the lungs

chronic/permanent

Front 84

thorax

-define pericarditis

-when does it occur

Back 84

inflammation of the lining of the heart

occurs 4-12 months after treatment

Front 85

thorax

-cancer - who are at risk

-what kind of cancers are they at risk for

Back 85

younger people under 20

risk for hodgkin's mantle and left breast cancer

Front 86

breast cancer side effects

Back 86

skin reactions

-erythema

-edema

-hyperpigmentation

-pruritis

-desquamation

lymphedema

-disease

-RT

-surgery

pericarditis

Front 87

breast

- factors affecting skin reactions

Back 87

large pendulous breast

-superclavicle fold

-inframammary fold

recent chemotherapy

concurrent chemotherapy

Front 88

breast

-ways to prevent skin reactions

Back 88

patient position and IMRT

Front 89

which types of cancers are affected by lymph flow

Back 89

breast and sarcomas especially

Front 90

lymphedema define

-signs

Back 90

accumulation of lymph fluid in interstitial tissue

-swelling

-skin tightening

Front 91

if you have lymphedema, what precautions must you take

Back 91

avoid infections

protect limb from cuts

manicure nails carefully

avoid taking blood pressure on effected side

avoid burns

Front 92

breast

-types of moisturizing creams

Back 92

aloe vera and eurcerin

Front 93

abdomen

-symptoms

Back 93

appetite changes

nausea/vomiting

fatigue

Front 94

abdomen

-what chemicals are released and causes vomiting

Back 94

chemical neurotransmitter, Serotonin is released in the blood

Front 95

abdomen

-nausea and vomiting dose

Back 95

1000-3000 cGy

Front 96

meds to treat abdomen treatment

Back 96

antiemetics

-compazine/thorazine/zofran/kytril

-proophylactic treatment

antihistamines

-benadryl

steroids

-mainly given with chemotherapy

treat anxiety

-education

meds: ativan

Front 97

abdomen

-diet

Back 97

avoid greasy foods

avoid solid foods immediately after tx

drink plenty of fluids

eat crackers/hard candy

avoid cooking meals with strong odor

eat small meals

avoid hot spicy foods

eat carbs

Front 98

pelvis

symptoms

Back 98

anal skin irritation

fibrosis

diarrhea

Front 99

pelvis

-how to care for anal skin irritation

Back 99

creams

soft cleansing wipes

sitz bath

Front 100

pelvis

diarrhea

-dose

- stools/day that require hospitalization, and stools/day where diarrhea is diagnosed

-when lining is damaged...

-clinical side effects are:

Back 100

-dose 2000-5000 cGy

-diarrhea diagnosed at 3 stools in 24 hrs

-hospitalized at 7 stools/day

-when lining is damaged, fluids and nutrients have difficulty getting across intestinal wall

-clinical side effects is: fluid loss, fecal inconinence, severe perianal irritation

Front 101

pelvis

how to manage diarrhea

Back 101

increase fluids to at least 8-8 oz glasses a day

have a low residue diet like applesause, rice, bananas, dry toast

Front 102

pelvis

-low residue diet items

Back 102

veggies

-squash

-green and yellow beans

-spinach, eggplant, potatoes, carrots

fruits

-no pulp juice, canned fruit

bread

oils, butter

Front 103

pelvis

-high residue diet items

Back 103

raw veggies

raw fruits

whole grains, wheat

popcorn, nuts, coconut

Front 104

pelvis

medication to control diarrhea

Back 104

lomotil/imodium AD

Front 105

what do you use when you have vaginal fibrosis

Back 105

vaginal dilators