I. Pre-radiotherapy care
1.Psychological care, targeted to do a good job of diversion.
2.Advise patients to quit smoking and alcohol, avoid spicy and sour food, and avoid overcooked and hard food to avoid damage to mucosa.
3.Explain to the patient the importance of protecting the skin of the irradiated field and the method before irradiation.
(1) Avoid stimulation of the irradiated field skin by mechanical substances to avoid damage to the skin. The patient’s underwear should be soft, wide and moisture-absorbent (silk or cotton fabrics). If the head and neck irradiation can be used soft and smooth silk scarf to protect the skin of the neck. Niu Po, Department of Radiotherapy, Henan Provincial People’s Hospital
(2) Keep the skin of the irradiated field clean and dry to prevent ulceration and infection. Especially the skin under the breast, under the axilla and perineum. When it is hot and sweaty, use warm water and soft towel to gently dip and wash, avoid using soap and coarse towel to wipe.
(3) Avoid local hot and cold stimulation to avoid damage to the skin.
(4) Avoid direct light, wear a hat or umbrella when going out in summer.
(5) Do not use your fingers to directly touch or peel the dried and peeling scabs with your hands to avoid damaging the skin and prolonging the healing time.
(6) Do not use metal-containing ointment or zinc oxide tape on the radiation site, as it will produce two rays and aggravate the skin reaction.
Second, care during radiotherapy
(1) Always keep the lines of the irradiated field clear, if you find that they are not clear, you should ask the physician to draw them clearly in time, do not draw them yourself to avoid misalignment.
2. Do not move your position during irradiation to avoid missing the tumor while irradiating the normal tissue.
3. Before and after half an hour of irradiation, ask the patient not to eat as much as possible, so as not to cause conditioned anorexia.
4.Rest quietly for 30-60 minutes after each radiotherapy to reduce radiation reaction.
5.Encourage patients to drink more water, 2000-4000ml daily, to facilitate toxin excretion.
6.Patients should develop good hygiene habits in general, and rinse the mouth after meals to remove food residues in the mouth and reduce oral mucosal reactions.
7, dietary guidance patients should choose high calorie, high protein, high vitamin, low fat, digestible light food. At the same time, ginseng, red dates and rice kernel can also be used to help improve the immune function of the body.
Third, post-radiotherapy reaction care
1.Gastrointestinal reaction care.
(1) Keep the mouth clean during radiotherapy, gargle with 5% boric acid solution four times a day (after three meals and before going to bed), and if pseudomembranes appear, gargle with 1.5% hydrogen peroxide solution instead.
(2) Avoid too cold and too hot food.
(3) If oral mucosal ulcers appear, apply ulcer compound locally.
(4) Dry mouth can be used to nourish yin and produce fluid with maitake or honeysuckle tea.
(5) Nasopharyngeal and maxillary sinus irrigation is required for nasopharyngeal or maxillary sinus irradiation.
2. Skin reaction care.
(1) First degree reaction.
After a few days of irradiation, the skin appears erythematous, with burning and tingling sensation, continue irradiation, the skin can become dark red, later there is flaking, called dry peeling. Treatment: Local disinfectant talcum powder and camphor powder can be puffed.
(2) Degree II reaction.
The skin can appear highly congested, edema, blister formation, with exudate, called wet reaction. Treatment: If the skin is not ruptured and there is no inflammation, expose the trauma and apply 2% nail violet or recovery cream several times a day. If there is blister and exudate, apply cold wet compress with 3% boric acid solution for 1-3 days, and after the exudate is absorbed, use exposure therapy.
(3) Grade III reaction.
Ulcer necrosis and damage to the dermis. By surgical treatment: cut out the necrotic tissue and rinse the wound for drug change.
3.Bone marrow suppression care :
(1) For patients with extensive irradiation, blood should be checked once a week. If the white blood cell is lower than 3*109/L, report to the doctor, suspend radiotherapy and give symptomatic treatment.
(2) If the white blood cell count is lower than 1*109/L, then protective isolation measures should be taken, a single ward, masks and hats should be worn in and out of the ward, and the ward should be irradiated with ultraviolet light twice a day to keep the patient’s bedding and clothing clean.
4. Radiation esophagitis care.
(1) Ask the patient to eat a soft diet.
(2) For severe obstruction with dysphagia, use 20% mannitol 250ml + gentamicin 160,000u + dexamethasone 15mg, 20ml/time, 3 times daily orally to reduce esophageal edema and inflammatory reaction.
(3) For those with severe swallowing pain, 1% procaine can be given orally before meals, while 1% neomycin 20ml can be given orally after each meal to flush the esophagus.
(4) In middle and advanced ulcerated esophageal cancer, the mucosa is prone to necrosis causing perforation. The nature of pain, the presence of choking and cough and the change of pulse should be closely observed so that the doctor can be notified in time for treatment.
5.Care of radiation pneumonia.
(1) Ask the patient to rest in bed.
(2) Pay attention to keep warm and prevent cold.
6. Care for radiation proctitis and cystitis.
(1) Reduce the stimulation of the rectum and avoid constipation.
(2) Supply adequate nutrition and water to prevent infection. If necessary, give 30ml of rice soup + 5 drops of tincture of opium orally, or use a small amount of tin type dispersion to retain the enema to protect the intestinal mucosa.
(3) In case of radioactive cystitis, drink more water and rest to play the role of flushing the bladder.
7.Care for acute radiation reaction in brain tissue.
(1) Closely observe body temperature, pulse, respiration, blood pressure, consciousness, pupils, and limb activity, and report abnormalities to the doctor in a timely manner.
(2) Do a good job of coma convulsion and paralysis care to prevent brain failure and asphyxia from occurring.