Question

4.) One patient has Hodgkin's disease. One patient has Non-Hodgkin's Disease. Draw two columns and compare/contrast the two illnesses. 5) What is extravasation, and what should the nurse do about it? 6) Describe 3 topics of patient education for the patient receiving radiation therapy.

Answer 1

Compare and contrast between Hodgkin's disease and non Hodgkin's disease:-

Both Hodgkin and non-Hodgkin lymphoma are malignancies of a family of white blood cells known as lymphocytes, which help the body fight off infections and other diseases.

Hodgkin's disease	non Hodgkin's disease
1.Hodgkin lymphoma is marked by the presence of Reed-Sternberg cells.	1.Non Hodgkin's lymphoma, by contrast, can be derived from B cells or T cells and can arise in the lymph nodes as well as other organs.
2.Hodgkin lymphomas are more likely to arise in the upper portion of the body (the neck, underarms, or chest).	2.Non-Hodgkin lymphoma can arise in lymph nodes throughout the body, but can also arise in normal organs. Patients with either type can have symptoms such as weight loss, fevers, and night sweats.
3.Hodgkin lymphoma tends to progress in an orderly fashion, moving from one group of lymph nodes to the next, and is often diagnosed before it reaches an advanced stage.	3.Most patients with non-Hodgkin lymphoma are diagnosed at a more advanced stage.
4.Hodgkin lymphoma is considered one of the most treatable cancers, with more than 90 percent of patients surviving more than five years.	4.Survival rates for patients with non-Hodgkin lymphoma tend to be lower, but for certain types of the disease, the survival rates are similar to those of patients with Hodgkin lymphoma.
5.Hodgkin lymphoma most often occurs in people ages 15 to 24 and in people over 60.	5.The median age of patients with non-Hodgkin lymphoma is 60, but it occurs in all age groups.

2.) Extravasation:-   Extravasation is the process by which any liquid (fluid or drug) accidentally leaks into the surrounding tissue. In terms of cancer therapy, extravasation refers to the inadvertent infiltration of chemotherapy into the subcutaneous or subdermal tissues surrounding the intravenous or intra-arterial administration site.

Extravasated drugs are classified according to their potential for causing damage as ‘vesicant’, ‘irritant’ and ‘nonvesicant’

PREVENTION of Extravasation:-

Most extravasations can be prevented with the systematic implementation of careful, standardized, evidence-based administration techniques.

In order to minimize the risk of extravasation, the staff involved in the infusion and management of cytotoxic drugs must be trained to implement several preventive protocols.

Preventive protocols to minimize the risk of extravasation:-

(1.)‘Site of insertion’:- Identification of the most appropriate cannulation site should be undertaken before insertion. If venous access continually proves difficult, placement of a central venous access device should be considered. The following are among the conditions of the cannulation site:

(a)Large veins in the forearm are recommended for peripheral administration.

(b)Cannulation should be avoided over joints.

(c)The inner wrist and the lower extremities should not be used.

(d)Veins in the anticubital fossa or on the dorsum of the hand, particularly for vesicant drugs, are not recommended.

(e)Avoid cannulation where lymphoedema is present.

(f)Cannulation on the side of a mastectomy is still a matter of discussion.

‘(2.)Cannula’:- Preventive measures related to the type of cannula include:

(a)Winged steel infusion devices (‘butterfly’ needles) must not be used for infusion of vesicant drugs as the needle can be easily displaced or puncture the venous wall.

(b)Flexible cannulae should be used.

(c)For infusion of vesicant drugs of longer duration (e.g. 12–24 hours) the central venous access is highly recommended.

(3.)Procedures’:-

(a)After cannulation, check for blood flow. Then, flush with 10-ml normal saline and check for signs of extravasation.

(b)Flushing with 10–20 ml of saline solution between different drug infusions is recommended.

(c)A blood return (flashback) should always be obtained before drugs are administered and checked regularly throughout the bolus infusion.

(d)Continue monitoring of the cannula insertion site and check regularly for the appearance of symptoms such as swelling, pain or redness sluggish infusion rate. This is highly recommended during infusion of all drugs.

(e)Bolus dosages of vesicant drugs may be administered concurrently with a fast-running infusion of compatible i.v. fluid.

3. Answer:-patient receiving radio therapy guidelines:-

radiotherapy is a well-established, safe and effective form of treatment. Millions of patients are treated safely with radiotherapy every year to cure or control symptoms of cancers such as head and neck, brain, breast, cervical, prostate and skin cancer. Radiotherapy also is an effective treatment for some benign diseases. However, radiotherapy, like other cancer treatments, has the potential for side effects.

Some side effects of radiation therapy, like fatigue and skin problems, can happen no matter what part of the body is being treated.

(1)Fatigue from Cancer Therapy:-It is not unusual to feel tired while you are receiving cancer therapy. Remember that fatigue is a temporary side effect of treatment, and it is different from ordinary tiredness. Also, the fatigue you may experience depends on many factors and varies from person to person. This type of fatigue may not be relieved by rest or sleep.

Please ask your nurse to review this information with you and to answer any questions you may have. Keep your nurse and doctor informed about your energy level or feelings of fatigue.

Helpful Hints for Managing Fatigue:-

(a)Pace your activities for the day. Be sure to include periods of rest between energy-draining activities.

(b)Set realistic goals. Increase or decrease activities as needed.

(c)Don’t be afraid to ask for help with chores.

(d)Look for ways to save your energy. Try shorter or easier versions of activities. For example, sit while you fold the laundry and limit trips up and down the stairs.

(e)Allow time for naps or rest periods.

(f)Save time for activities you enjoy. Plan them as part of your day. This helps to decrease stress. Stress can drain your energy.

(g)Plan a short period of light activity each day, such as a walk or a stroll. Being inactive may actually increase fatigue.

(h)Eat a balanced diet. Drink at least eight glasses of fluids daily, unless your doctor has restricted the amount of fluids you can drink due to another medical condition. Avoid foods and beverages that contain caffeine, especially in the evening.

Things to Report to Your Nurse or Doctor:-Tell your nurse or doctor if you experience any of the following symptoms:

(1.)Dizziness

(2.)Weakness

(3.)Headaches

(4.)Ringing in your ears

(5.)A sudden increase in fatigue

(6.)Any new or unusual symptoms

Things to Report Immediately Call immediately if you have any of the following symptoms:

(a)Shortness of breath

(b)Chest pain

(c)Fainting.

2.Low Platelet Count (Thrombocytopenia):-Platelet count is the number of platelets in the blood. A normal platelet count ranges from 150,000 to 350,000. If the number of platelets is too low, excessive bleeding can occur. The medical name for a low platelet count is thrombocytopenia (throm-bo-sigh-toe-PEE-nee-uh).

Causes of a Low Platelet Count:-

Some things can affect how well the bone marrow can produce platelets. When not enough platelets are made, the platelet count in your blood is too low. Chemotherapy and some radiation therapy can cause this temporarily. These cancer treatments can slow the production of platelets in the bone marrow. Another cause of a low platelet count is cancer of the bone marrow. Other conditions can result in a low platelet count as well.

Things toDo for a low Platelet Count:-

For a low platelet count below 50,000, you must take precautions. Follow the guidelines below to help prevent or stop bleeding.

(a)Do not take any medicine, including over-the-counter drugs, without your doctor’s approval. It is very important to avoid aspirin and other drugs that contain aspirin. If you are not sure about a medicine, ask your doctor.

(b)Use a soft-bristle tooth brush. Do not use dental floss.

(c)Do not have dental work without your doctor’s approval. If you must have dental work, tell your dentist that you have a low platelet count.

(d)Do not do heavy lifting, contact sports, or strenuous exercise.

(e)Do not walk in bare feet.

(f)If you feel weak and unsteady, have someone help you when walking.

(g)Avoid cutting your nails. Use an emery board to care for your nails.

(h)When shaving, do not use a razor blade. Use an electric razor instead.

(i)Be careful when using household tools, such as knives and scissors.

3. Radiation Therapy to the Head and Neck:-

The following guidelines will help you take an active part in your radiation therapy.

(a)Temporary Skin Changes:-

Temporary skin changes may occur in the treated area. Usually these changes include redness, dryness, scaling, and itchiness.

These skin changes usually occur 1 to 2 weeks after treatment begins and may last 1 to 2 weeks after your last treatment.

During this time:

(I)Men may shave, but only with electric shavers. Do not use pre-shave or after-shave lotions.

(Ii)Women should not apply makeup to the treated area.

(III) Moisturizers may be applied to the treated area as needed. Do not use moisturizers within 2 hours before your radiation treatment.

(Iv) Wear soft, loose-fitting shirts with open collars to prevent skin irritation.

(b)Permanent Skin Changes:-

Permanent skin changes include increased sensitivity to summer and winter temperatures. Apply PABA-free sunscreens routinely to the treatment site whenever you are outdoors for more than 10 minutes, summer or winter. Use a sunscreen with a minimum sun protection factor (SPF) of 30.

(3.)Mouth Care:-

You will need to take special care of your teeth and mouth while you are receiving radiation treatments.

(I) if you have your natural teeth, you need to schedule a checkup with your dentist before your radiation treatment planning begins. Special fluoride treatments are necessary. Tell your dentist to call this radiation center to speak to your doctor or nurse if you receive dental care before or during treatment.

(Ii)Use a toothbrush with soft bristles. If you have any soreness or tenderness in your mouth, using a soft sponge to clean your mouth and teeth may be helpful. Your nurse can give you the names of appropriate products to use.

(Iii)Gently floss your teeth daily with unwaxed dental floss.

(Iv)if you wear partial or full dentures, you may want to keep them in only while you are eating.

(V)Examine your mouth and gums every day. Tell your nurse if you notice any red or white spots or if your mouth becomes sore.

4.)Mouth and Throat Dryness:-

Your mouth and throat will feel dry and your saliva and mucus may become thick. This usually occurs 1 to 2 weeks after the start of your radiation treatments. It may last for several months after your radiation therapy has ended.

(a)Eat and drink frequently to maintain moisture in your mouth. You may want to try artificial saliva. Ask your nurse to tell you about this product.

(b)Use a water bottle or travel cup to drink from throughout the day.

(C)Do not smoke or chew tobacco.

(d)Do not drink alcoholic beverages.

(e)Use a cool-air humidifier at home. Clean the humidifier and change the water every day.

Things to Report to Your Nurse or Doctor:-

Tell your nurse or doctor if you have any of the following symptoms:

(a) Inability to eat your usual diet.

(b)Sores in your mouth or on your lips.

(c)Red, swollen, or tender areas of skin.

(d)Any new or unusual symptoms.