2. 1 Psychological nursing and health education guide most patients lack knowledge and understanding of "radiotherapy". Before treatment, patients and their families should be briefly introduced to the purpose, effect, superiority, course of treatment, precautions, possible adverse reactions and common treatment knowledge. And sign the informed consent form of radiotherapy, and distribute the booklet "Guide to Radiotherapy Common Sense" for them to read, so that they can have a certain understanding and psychology. During the treatment period, the patients were regularly publicized and educated about tumor prevention and treatment knowledge, and personalized nursing was carried out. Teach relevant nursing knowledge, introduce cured cases, enhance their anti-cancer confidence, and make them actively cooperate with treatment and nursing.
2.2 Nutrition and Dietary Care In vitro intracavitary radiotherapy for cervical cancer, the rectum is the most vulnerable organ, with different degrees of abdominal pain, diarrhea and abdominal distension. Therefore, it is advisable to eat a diet with high protein, high vitamins, less residue and low fiber, and avoid foods that are easy to produce gas such as sugar, beans and carbonated drinks, and avoid spicy and irritating foods. For patients with severe diarrhea, radiotherapy should be suspended, signs of dehydration and electrolyte disorder should be found in time, and water, electrolyte and nutrition should be supplemented in time by eating fruits, drinking drinks, broth or intravenous rehydration.
2.3 Care of Irradiated Skin Irradiated skin may appear redness, dryness, itching, peeling or ulceration. Before radiotherapy, the importance of protecting irradiated skin to prevent skin reaction should be explained to patients. Tell them to keep the lines of the wild lines clear and wear cotton, soft, wide and breathable underwear to avoid rubbing against rough clothes. Irradiated fields can be lightly soaked with warm water and soft towels, and soap scrubbing or hot water bathing is prohibited. It is forbidden to use irritating disinfectants such as iodine and alcohol. Don't scratch the local skin, and don't peel it by hand to prevent skin damage and infection. Keep vulva and groin clean and dry.
2.4 Nursing care of vaginal irrigation
2.4.65438+ Therefore, vaginal irrigation is an essential nursing measure for patients with cervical cancer after external radiotherapy and before intracavitary radiotherapy. The purpose of vaginal irrigation is to remove necrotic and exfoliated tissues, reduce infection, promote local blood circulation, improve the nutritional status of tissues, avoid vaginal adhesion, and facilitate the absorption and regression of inflammation; At the same time, it can remove the necrotic tissue after radiotherapy, improve the sensitivity of radiotherapy and prevent pelvic peritonitis [2].
2.4.2 Irrigation method: Health education should be conducted before radiotherapy to inform each patient of the role of vaginal irrigation and its influence on radiotherapy, so that they can actively accept and actively cooperate with irrigation. General patients in our department use 1∶5000 potassium permanganate solution to wash 1 time every day, and patients with excessive secretion and strong smell wash their vagina twice a day; Patients with massive bleeding are not allowed to wash. When washing, the action should be gentle, the washing pressure should not be too high, the temperature should be appropriate, and the disinfection and isolation system and aseptic technology should be strictly implemented to prevent cross-infection.
2.5 Nursing care of intracavitary radiotherapy
2.5. 1 Before radiotherapy, make routine preparations before gynecological surgery. Before radiotherapy, the vulva and vagina should be washed with 1∶5000 potassium permanganate solution, which should be sufficient and thorough to reduce the chance of pelvic infection and prevent vaginal adhesion.
2.5.2 Pay attention to the patient's urination after radiotherapy (1), and those who have difficulty urinating for more than 4 hours need catheterization; (2) Observe whether there is bleeding or oozing in the vagina. If the patient is found to be pale, bleeding heavily, or even fainting, he should stay in bed immediately and fill the vagina with gelatin sponge or iodoform gauze; If necessary, use hemostasis, infusion and blood transfusion to prepare for rescue; (3) Observe body temperature and abdominal pain, and pay attention to prevent pelvic inflammatory disease; (4) Insist on vaginal irrigation 1 time every day to remove necrotic tumor tissue and improve the sensitivity of radiotherapy.
2.6 Prevention and nursing of radiation proctitis is one of the early complications of radiotherapy for cervical cancer. Reducing the dose of vaginal point A irradiation can significantly reduce the incidence of proctitis and cystitis [3]. Radiation proctitis can be divided into mild, moderate and severe according to its severity. The incidence varies with different treatment methods and total radiation dose, which is about 10% ~ 20% [4]. Preventive and nursing measures: (65,438+0) The patient has intestinal irritation symptoms such as abdominal pain, diarrhea and acute diarrhea, and even bloody stool due to rectal congestion and ulcer. We should cooperate with the doctor to make an individualized radiotherapy plan and move the uterus forward through appropriate adjustment. Maintaining rectal emptying during endovascular treatment is beneficial to vaginal tamponade and reducing rectal radiation dose. (2) For acute proctitis, radiotherapy should be stopped immediately, and the protective agent of digestive tract mucosa: oral smecta, 3 times a day, or retention enema every night; Frequent diarrhea, oral administration of Yimengting can inhibit intestinal peristalsis and prolong the retention time of intestinal contents. (3) closely observe the nature of stool and abdominal pain to prevent water and electrolyte disorder; To understand the degree of anemia, a small amount of blood transfusion should be given many times to those with severe anemia, and the whole body support treatment should be strengthened.
2.7 Prevention and Nursing of Radioactive Cystitis Radiotherapy can cause congestion, edema, ulcer and bleeding of bladder mucosa, and patients have frequent urination, urgency, dysuria, hematuria and dysuria. Radiation cystitis is the most common complication of advanced radiation urinary system, which is characterized by recurrent hematuria and can cause severe anemia. In addition to anti-inflammatory, hemostasis, spasmolysis and anemia correction, local hemostasis is feasible, and cystostomy is performed if necessary. In short, the treatment is difficult, and its incidence is 2% ~ 10% [4]. Preventive and nursing measures: (1) Patients are required to empty urine before pelvic radiotherapy; During intracavitary radiotherapy, gauze should be filled in vagina to increase the distance between radioactive source and bladder and reduce bladder involvement. (2) Conservative treatment is the main treatment for mild to moderate acute radiation cystitis: instruct patients to drink water 1000 ~ 2000 ml every day, apply anti-infection, hemostasis and symptomatic treatment in time to reduce bladder irritation; Pay attention to the cleanliness of vulva and urethral orifice after each urination to prevent retrograde infection. Transfusion of new blood for patients with severe bleeding to correct anemia and improve their general condition. (3) For patients with severe radiation cystitis who have repeated gross hematuria, use gentamicin 240,000 U dexamethasone 5mg epinephrine 1mg saline 50ml for bladder perfusion according to the doctor's advice, and instruct the patients to perfuse after exhausting urine, turn over frequently, and change their body position, so that the liquid can fully contact the inner wall of the bladder, diminish inflammation and stop bleeding, and promote epithelial tissue repair and mucosal healing.
2.8 Prevention and nursing of adverse reactions of radiotherapy in hematopoietic system can cause various changes in patients' blood system, mainly due to the inhibition of radiation on bone marrow hematopoietic function, which is related to the dose, frequency and irradiation area of contact radiotherapy; The sensitization of adjuvant chemotherapy is also related to the side effects of anticancer drugs. Therefore, radiotherapy patients should have routine blood examination 1 time every week, and be treated in time according to different symptoms, such as taking vitamins, promoting blood circulation and removing blood stasis, and compound Ejiao slurry. If necessary, blood components and white blood cells should be provided.
2.9 Discharge Guidance Make a guidance plan before discharge: (1) Keep the vagina clean, teach patients the method of vaginal irrigation, the appropriate temperature of the irrigation solution, the depth of the irrigation head in the vagina, and rotate the irrigation head for irrigation; (2) Eat reasonably and pay attention to nutrition; (3) Avoid heavy physical labor and have a proper rest; (4) sexual life guidance to maintain the quality of life; (5) Regular follow-up.