In Intracavitary implant, the applicators are specially designed to deliver the radiation

according to the tumor site. Patients treated with intracavitary applicators receive 3 to 6
treatments, delivered on an out-patient basis.
Preparation for Intracavitary Implants
On the evening before an applicator insertion, the patient is requested to have a light dinner
(broth, jello) and not to eat or drink after midnight. A little water is permissible to take
medications. The patient performs a Fleet enema the night before and the morning of the
insertion. At the clinic, the patient lies supine (on the back) on the padded treatment couch in
the treatment position with feet in stirrups. The nurse will administer conscious sedation to relax
the patient, if necessary. Local anesthetic may also be given at the beginning of the insertion.
The nurses gently wash the perineal and genital area. Sterile drapes are placed around the
vaginal area. Catheters are inserted into the bladder and rectum for the introduction of contrast
liquid. This contrast is necessary to visualize the bladder and rectum on radiographs so that
radiation doses to these structures can be calculated.
I. Nursing Diagnosis
Impaired skin integrity related to disruption of skin surface as manifested by presence of
erythema, darkening of the skin and moist desquamation.
Nursing Inference
Radiation essentially damages the mitotic ability of clonogenic or stem cells within the basal
layer, thus preventing the process of repopulation and weakening the integrity of the skin.
Radiotherapy repeatedly impairs cell division within the basal layer, and so the degree to which
a skin reaction develops is dependent on the survival of actively proliferating basal cells in the
epidermis. Moist desquamation occurs when clonogenic cells in the basal layer are sterilised,
thus rendering cells unable to repopulate in time to replace the damaged tissue. Consequently,
the epidermis becomes broken. Thus disruption of skin surface.
Nursing Goal
After 3-4 weeks of rendering nursing interventions, the patient will display timely healing of skin
lesions without complication.
Nursing Interventions
Assess skin frequently for side effects of
radiation therapy; note breakdown and
delayed
wound
healing.
Emphasize
importance of reporting open areas to
caregiver.
Assess skin and IV site and vein for erythema,
edema, tenderness; weltlike patches, itching
and burning; or swelling, burning, soreness;
blisters progressing to ulceration or tissue
necrosis.
Bathe with lukewarm water and mild soap.
Encourage patient to avoid vigorous rubbing
and scratching and to pat skin dry instead of

Rationale
A reddening or tanning effect (radiation
reaction) may develop within the field of
radiation. moist desquamation (blistering),
ulceration, hair loss, loss of dermis and sweat
glands may also be noted.
Presence of phlebitis, vein flare or
extravasation
requires
immediate
discontinuation of antineoplastic agent and
medical intervention.
Maintains cleanliness without irritating the skin.
Helps prevent skin friction and trauma to
sensitive tissues.

rubbing.
Turn or reposition frequently.
Review skin care protocol for patient receiving
radiation therapy: Avoid rubbing or use of
soap, lotions, creams, ointments, powders or
deodorants on area;

Avoid applying heat or attempting to wash off

marks or tattoos placed on skin to identify area
of irradiation;
Recommend wearing soft, loose cotton
clothing; have female patient avoid wearing
bra if it creates pressure;
Wash skin immediately with soap and water if
antineoplastic
agents
are
spilled
on
unprotected skin (patient or caregiver).
Review expected dermatologic side effects
seen
with
radiatiotherapy
(rash,
hyperpigmentation, and peeling of skin on
palms).
Inform patient that if alopecia occurs, hair
could grow back after completion of
chemotherapy, but may or may not grow back
after radiation therapy.
Apply ice pack or warm compresses per
protocol

Promotes circulation and prevents undue

pressure on skin and tissues.
Designed to minimize trauma to area of
radiation therapy. Can potentiate or otherwise
interfere with radiation delivery. May actually
increase irritation and reaction. Skin is very
sensitive during and after treatment, and all
irritation should be avoided to prevent dermal
injury.
Helps
control
dampness
or
pruritus.
Maintenance care is required until skin and
tissues have regenerated and are back to
normal.
Protects skin from ultraviolet rays and reduces
risk of recall reactions.
Dilutes drug to reduce risk of skin irritation and
chemical burn.
Anticipatory guidance helps decrease concern
if side effects do occur.
Anticipatory guidance may help in preparation
for baldness. Men are often as sensitive to hair
loss as women. Radiations effect on hair
follicles may be permanent, depending on rad
dosage.
Ice restricts blood flow, keeping drug localized,
while heat enhances dispersion of neoplastic
drug or antidote, minimizing tissue damage.

Nursing Evaluation
After 3-4 weeks of rendering nursing interventions, the patient displayed timely healing of skin
lesions without complication.

II. Nursing Diagnosis

Imbalanced nutrition less than body requirement related to diarrhea secondary to damaged
intestinal mucosa as manifested by nausea and vomitting, weight loss and decrease skin turgor.
Nursing Inference
Radiation therapy can cause diarrhea; when treatments kill non target, healthy cells in the
mucosal lining of the intestines, absorption of GI fluids and nutritional content of food is
disrupted, contributing to diarrhea. Damaged intestinal mucosa also release prostaglandins and
disrupt absorption of bile salts, hastening intestinal peristalsis and the movement of fluids and
fecal matter through the intestines

Nursing Goal
After 2-3 days of rendering nursing interventions, the patient will display adequate fluid balance
and demonstrate progressive weight gain as evidenced by moist mucous membranes, good
skin turgor and stable vital signs.

Nursing Interventions
Assess skin turgor and moisture of mucous
membranes. Note reports of thirst.
Monitor I&O and specific gravity; include all
output sources, (emesis, diarrhea, draining
wounds. Calculate 24-hr balance).
Weigh as indicated.
Monitor vital signs. Evaluate peripheral
pulses, capillary refill.
Encourage increased fluid intake to 3000 mL
per day as individually appropriate or
tolerated.
Observe for bleeding tendencies (oozing
from mucous membranes, puncture sites);
presence of ecchymosis or petechiae.
Minimize venipunctures (combine IV starts
with blood draws). Encourage patient to
consider central venous catheter placement.
Avoid trauma and apply pressure to
puncture sites.
Provide IV fluids as indicated.
Monitor
laboratory
studies
electrolytes, serum albumin).

(CBC,

Rationale
Indirect indicators of hydration status and
degree of deficit.
Continued negative fluid balance, decreasing
renal output and concentration of urine suggest
developing dehydration and need for increased
fluid replacement.
Sensitive measurement of fluctuations in fluid
balance.
Reflects adequacy of circulating volume.
Assists in maintenance of fluid requirements
and reduces risk of harmful side effects.
Early identification of problems (which may
occur as a result of cancer or therapies) allows
for prompt intervention.
Reduces potential for hemorrhage and infection
associated with repeated venous puncture.
Reduces potential for bleeding and hematoma
formation.
Given for general hydration and to dilute
antineoplastic drugs and reduce adverse side
effects (nausea and vomiting, or nephrotoxicity).
Provides information about level of hydration
and corresponding deficits.

Nursing Evaluation
After 2-3 days of rendering nursing interventions, the patient displayed adequate fluid balance
and demonstrated progressive weight gain as evidenced by moist mucous membranes, good
skin turgor and stable vital signs.

III. Nursing Diagnosis

Disturbed Body Image related to hair loss as manifested by feeling of hopelessness,
preoccupation with change in body part and fear of rejection.
Nursing Inference
A disturbance or alteration in the attitude of person has about the actual or perceived structure
or function of allor part of the body. This attitude is dynamic and altered through interaction with
other persons and situations and is influenced byage and developmental level.
Nursing Goal
After 3-4 weeks of rendering nursing intervention, the patient will be able to verbalize
understanding of body changes, relief of anxiety and adaptation to actual body image.
Nursing Interventions
Acknowledge
and accept expressionof
feelings of frustration, grief, hostility.Note
withdrawn behavior and use of denial.

Rationale
Acceptance of this feeling as a normal
response to what has occurred facilitates
resolution. It is not helpful of possible to push
patient ready to deal with situation. Denial
maybe prolonged and be an adaptive
mechanism because patient is not ready to
cope with personal problems.
Enhance trust and rapport betweenpatient and
nurse.

Be realistic and positive during treatments in

health teaching and setting goals within
limitations.
Provide hope within parameters of individual Promotes positive attitude and provides
situation, do not give false reassurance.
opportunity to set goals and plan for future
based on reality.
Help the client select and use wig.
To minimize body changes or enhance
appearance.
Give positive reinforcement of progress and Words
of encouragement
can
support
encourage endeavors toward attainment development of positive coping behaviors.
of rehabilitation goals.
Encourage family interaction with each other Maintain open lines of communication and
and with rehabilitation team.
provides on ongoing support for patient and
family.
Provide support group for significant others. Promotes ventilation of feelings and allow for
Give information about how so can be helpful more helpful responses to patient.
to patient.
Role play social situation of concern to patient. Prepares patient for reactions of others and
anticipates ways to deal with them.

Encourage patient to look at affected body To begin to incorporate changes in body

part.
image.
Nursing Evaluation
After 3-4 weeks of rendering nursing intervention, the patient was able to verbalize
understanding of body changes, relief of anxiety and adaptation to actual body image.