Patient Care and Management
Patient care and management tests whether you can prepare, support, and monitor patients through simulation and treatment while recognizing when to escalate. It covers consent, communication, immobilization, skin and mucosal toxicity, nutrition, anxiety, and documentation.
Core practice
Confirm identity with two identifiers and check the prescription, site, and side. Consent must be informed and voluntary; the radiographer can support the process but cannot coerce. Assess pain, mobility, swallowing, breathlessness, claustrophobia, continence, and cognitive status before positioning. Explain what the patient will see, hear, and feel, including machine movement and the need to lie still. Use immobilization that is reproducible and comfortable; padding and arm supports reduce set-up variation. Document baseline skin condition, allergies, and devices.
Toxicity and supportive care
Radiation dermatitis ranges from erythema to dry then moist desquamation. Wash gently with lukewarm water and a mild non-perfumed cleanser if departmental protocol allows; avoid friction, heat, and adhesive tape in the treated field. Do not apply creams immediately before treatment unless the protocol specifies. Mucositis, dysphagia, nausea, diarrhoea, cystitis, and fatigue need proactive assessment and referral. Nutritional decline in head and neck or oesophageal treatment may require dietitian input and consideration of enteral feeding.
Worked example
A patient with head and neck cancer becomes panicky when the thermoplastic mask is fitted. The radiographer stops, explains the mask's purpose, demonstrates it on a model, and allows the patient to hold and smell it. They practice brief mask placement with the patient's hand raised as a stop signal, then escalate to the radiation oncologist for anxiolysis if needed. Rushing the fit risks a poor mask, motion, and a repeat CT. The reasoning is to preserve safety and reproducibility while respecting consent.
Traps
Never promise that treatment is side-effect free. Do not assume all redness needs a cream; some products increase bolus or skin reaction. Do not use the same instructions for every site: skin folds, perineum, and breast need different care. Avoid describing a mask as just a mask to a claustrophobic patient. Record conversations and escalations; a verbal reassurance without documentation is weak evidence.