Pre‐procedure

ActionRationale

1. 1.Show
   Ensure written consent has been obtained, checking the patient is prepared to go ahead with the procedure.
   To ensure consent has been obtained. To ensure the patient fully understands and agrees to the treatment planned and is offered the opportunity to ask any questions or mention any concerns they may still have (Faithfull and Wells [17], E).
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   Ensure thorough nursing assessment of the patient has been undertaken by nursing staff.
   To ensure the patient is suitable and will comply with treatment restrictions (Gosselin and Waring [23], E).
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   Ensure full pre‐operative medical assessment has been undertaken including baseline blood tests (FBC, clotting, U&E and LFT), ECG and chest X‐ray.
   To ensure the patient is fit for treatment. E
4. 4.Show
   Administer antidiarrhoeal drugs the night before treatment. The patient should be monitored and if necessary treatment provided for radiation‐induced enteritis.
   To prevent bowel action during treatment which may then dislodge applicators during treatment. E

Procedure

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   Nurse the patient on a pressure‐relieving mattress or with a foam wedge under her buttocks or a pillow under her knees to alter position.
   To promote comfort and to relieve backache because rolling is not encouraged and in some areas is not permitted. E
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   Ensure the plastic transfer tubes are supported securely in the bed bracket, leaving slight slack.
   To enable the patient to change position slightly without putting traction on the applicators. E
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   Limit the frequency and duration of interruptions to treatment. Visitors are discouraged unless the patient is markedly distressed.
   To prevent unnecessary prolongation of treatment time. E
4. 8.Show
   Check the patient's physical and psychological condition 2‐hourly:

   • Temperature, pulse and vaginal loss.
   • Contents of catheter drainage bag.
   • Assist the patient to adjust her position.
   To monitor for haemorrhage, shock or other post‐operative complications. E

   To ensure urine is draining freely. E

   To promote comfort and relieve prolonged pressure on any one area. To maintain skin integrity and prevent friction. E
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   Check position of applicators. Marking the position of the applicators on the patient's legs can assist in the checking of their position.
   To ensure no movement of the applicators has occurred. E
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   Administer prescribed analgesia, antiemetics, antidiarrhoeal and sedative agents as appropriate, observing and evaluating effect.
   To promote the patient's comfort and well‐being. E
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   Encourage fluid intake as soon as the patient is able to drink.
   To ensure adequate hydration and reduce the risk of urinary tract infection and dehydration (Beetz [3], R1a).
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   Encourage a light, low‐residue diet to be taken, appropriate for consuming easily in a lying down position.
   To maintain nutritional needs whilst reducing stimulation of a bowel action. E

Post‐procedure

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   Perform accurate documentation.
   To ensure accurate record keeping (NMC [51], C).