Nurses play a vital role in the treatment and management of gynaecological cancer. They provide specialist care at all stages of the process. Areas involving this specialist care include:
- immediate post-operative care on the ward;
- radiation therapy nursing;
- chemotherapy nursing;
- home nursing; and
- palliative care nursing.
Some knowledge and skills in the following areas may be needed in the nursing care of gynaecological oncology patients.
Stomal Therapy
As some patients may need to have bowel surgery, colostomies, or ileostomies, stomal therapy is an important area of consideration. As this surgery also often involves extensive wounds, the appropriate knowledge of wound care and wound care products is required.
Invasive Monitoring And Procedures
Patients may required Central Venous Pressure / Arterial Line Monitoring. Knowledge of the use of portacaths, PICC's, central lines to deliver intravenous fluids and medications; and non invasive sequential compression devices is also required.
Chemotherapy and Radiation Therapy
Knowledge of the appropriate routes, doses and reactions is required.
Infection Control.
Nurses must be aware of standard infection control precautions.
It is essential to understand the difference between external beam and internal radiation therapy. External is generally more simple than internal as it does not require the use of applicators. Usually, the patient need simply undress, receive treatment, redress and go home.
The peak period for side effects differs between internal and external therapy. There are some cases where iridium patients have not peaked until 12 months after the cessation of treatment.
Internal
Internal [caesium] or [irridium] involves the use of catheters, hardware (metal rods) or plastic catheters sutured into the vulval area. Staff need to be aware of this equipment.
The vulval area must be kept clean during internal radiation therapy, and peri toilets are needed.
If the tumour is bulky, it may begin to shrink after a few treatments. If this happens, there is a risk that the catheters can dislodge or move. In this instance, the physicist needs to be notified, as the treatment fields may have changed. [Caesium] is given for up to 72 hours. If the applicator dislodges, the sezium source could be sitting in the bed which is a danger to staff and the patient. This problem can be partly alleviated by the use of blind end catheters. [Caesium] can cause atrophy so dilators are required.
Catherine Nicholas – In-Hospital Nursing
Registered Nurse
Royal Women's Hospital
Gail Powell – In-Hospital Nursing
Registered Nurse
Royal Women's Hospital
Carol Parker – Radiation Therapy Nursing
Registered Nurse, MN (Oncology)
Clinical Nurse Consultant Qld Radium Institute
Bronwyn Scharf – Radiation Therapy Nursing
Registered Nurse Qld Radium Institute.
Lesley McLeod – Palliative Care Nursing
Registered Nurse, M Primary Healthcare, GradDip
Palliative Care Nursing Clinical Nurse Consultant Karuna Hospice Service