Radiation, internal
Internal radiation, also known as brachytherapy, involves placing a radiation source into a specific area of the body or onto a body surface. The radiation source may be administered locally or systemically.
If delivered locally, either the interstitial or intracavitary approach may be used. In the interstitial approach, radioactive substances are sealed in applicators (such as molds, needles, beads, seeds, or ribbons) and implanted directly in the tumor or surrounding tissue or placed on top of a body surface. In the intracavitary approach, unsealed radioactive substances are temporarily delivered into a hollow body cavity (such as the vagina, abdomen, or pleura).
A new method for delivering intracavitary radiation is performed with a machine called a remote afterloader. Radiation is delivered at very high doses to a specific area each day over the course of 3 to 5 days.
Several new approaches are being evaluated to determine their effectiveness. One approach is intraoperative radiation, in which a large dose of external radiation is directed at the tumor and surrounding tissue during surgery. Another technique is hyperthermia, in which body tissue is exposed to high temperatures. This method may be administered locally, regionally, or to the whole body.
Recently, radiolabeled antibodies have been used to deliver doses of radiation directly to the cancer site. After injection, the antibodies actively seek out the cancer cells and destroy them by the action of the radiation. This approach may help lessen the risk of radiation damage to healthy cells.
Internal radiation also can be delivered systemically, using radioactive materials in solutions or colloidal suspensions that are given orally or I.V. Systemic applications are used for primary and metastatic thyroid cancer.
Procedure
In the interstitial or intracavitary approach, the physician usually inserts the applicator for the radioactive source in the operating room with the patient under anesthesia. Then, to minimize exposure of hospital personnel, he places the radioactive source in the applicator after the patient returns to his room.
If the radioactive source isn’t permanent, it’s usually left in place for 24 to 72 hours and then removed in the patient’s room. If a remote afterloader is used, the patient is treated in an inpatient or outpatient department, supplanting the need for hospitalization and isolation because the radioactive source is only in place for a few minutes.
If the patient receives internal radiation involving I.V. or oral administration of a radioactive solution or suspension, or intracavitary instillation of a radioactive suspension (usually by paracentesis or thoracentesis), the radioactive substance is administered in the radiation therapy department. Following intracavitary instillation of a suspension, the patient lies on a flat surface and is rotated every 15 minutes for 2 to 3 hours to distribute the suspension.
Complications
A radiation reaction may occur with any type of internal radiation and may cause nausea, vomiting, malaise, diarrhea, anorexia, elevated temperature and, possibly, dehydration. Other complications stem from the death of local healthy cells that are exposed to the radioactive source. These complications include localized skin burns, hemorrhage due to destruction of bone marrow, and neurologic dysfunction.
Key nursing diagnoses and patient outcomes
Fear related to having a radioactive substance placed internally. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
identify and express his fears
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