Patient Care and Assessment
Patient Care and Assessment covers the person on the table: assessing and documenting side effects, educating patients, managing devices, and escalating red flags. Questions are scenario-based and reward triage judgment over memorized drug lists.
Acute toxicity by site
- Skin follows RTOG/EORTC grading: dry desquamation is grade 2, moist desquamation in a skin fold is grade 3. Use gentle washing, water-based moisturizer, and non-adherent dressings.
- Head and neck: mucositis, xerostomia, dysgeusia, dysphagia. Saline and bicarbonate rinses, analgesia per order, weekly weight tracking, fluoride trays after treatment.
- Pelvis: cystitis, diarrhea, proctitis. Hydration, fiber adjustment, antidiarrheals as ordered.
- Thorax: esophagitis, cough, fatigue. New focal symptoms raise concern for pneumonitis and require physician review.
Assessment and escalation
- At each weekly visit ask, look, and document: weight, pain score, toxicity grade, and medication changes.
- Escalate immediately for fever with neutropenia, new neurological deficit suggesting cord compression, facial swelling with distended neck veins suggesting SVC syndrome, stridor, or uncontrolled pain.
- Screen for pregnancy before CT simulation and before fluoroscopic procedures; ask about contrast allergy and renal function before contrast.
Worked example
A larynx patient at fraction 18 reports 2/10 odynophagia, has lost 3 kg (4 percent of body weight), and shows patchy moist desquamation in the neck crease. The skin is grade 3 and the dysphagia grade 2. Report both to the radiation oncologist, request a dietitian consult, start the prescribed topical dressing regimen, and schedule weekly weight checks rather than waiting for the next routine visit. Document the grades and the actions taken.
Traps
- Giving skin-care advice that contradicts departmental protocol or the physician order, especially metal-containing creams that raise surface dose.
- Reassuring a patient with red-flag symptoms instead of escalating.
- Documenting only the physician assessment, not your own findings.
- Assuming the physician covered consent or that a caregiver absorbed the instructions.