Chapter 24: Radionuclide therapy
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Post‐procedural considerations
Ongoing care
Mouth care
The patient may have difficulty in swallowing due to soreness and oedema and may be at risk of localized mouth infection (Ionising Radiations Regulations [34]) so frequent mouth care using a sterile saline solution as a mouthwash is important. Any rinsed solution should be collected in a disposable bowl to check for a dislodged source. Nurses should ensure that the patient has paper tissues and a bowl, crushed ice to suck and/or soluble aspirin as a mouthwash. Corticosteroids may also be prescribed to help reduce oedema.
A soft, puréed or liquid diet, avoiding spicy and/or hot foods, must be provided to maintain nutritional levels and reduce the complexity of eating when implants are present and further exacerbation of local reactions or soreness from the implants. This will also reduce the risk of the patient biting into the source or their tongue. Carbonated water can also alleviate dryness caused by the treatment.
Writing equipment must be provided for the patient to reduce the need for oral communication. Talking can increase soreness and pain, and potentially alter the distribution of the sources. The sources should be checked at regular intervals, for example at the beginning of each shift, to ensure they have not become dislodged. The patient should be confined to their room and only leave when necessary, for example to visit the X‐ray department. This is to minimize the risk of radiation exposure to other people on the ward.
Discharge of the patient
The patient is usually discharged the day after the removal of the implant; they should be warned about the painful local reaction that they may experience from cell breakdown and cell death induced by the radiation. In order to minimize the risk of infection or soreness, the patient should be taught oral hygiene care and to observe the mouth for any infection (Hoskin and Coyle [28], UKOMiC [70]).
