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  /Title (rtt-306-patient-care-2.pdf)
  /Creator (Cheatography)
  /Author (kissoo07 (kissoo07))
  /Subject (RTT 306 Patient Care 2 Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{RTT 306 Patient Care 2 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{kissoo07 (kissoo07)} via \textcolor{DarkBackground}{\uline{cheatography.com/118072/cs/21835/}}}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 26th February, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Taking Care of You}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Stress}} - produced by events that are perceived as demands on time, energy, or resources w/ threat that not enough time, energy, or resources available for full obligation; Vit C, Complex B Vits, Mg lost through stress \newline % Row Count 5 (+ 5)
{\bf{Fight or Flight}} - physiologic reaction to real or imagined threat arising from fear \& anger \newline % Row Count 7 (+ 2)
{\bf{Burnout}} - emotional exhaustion/fatigue, depersonalization, ↓ personal accomplishment \newline % Row Count 9 (+ 2)
{\bf{Language}}  \newline % Row Count 10 (+ 1)
                   1. Out of Control Lang. = I must, I have to, It's unfair \newline % Row Count 12 (+ 2)
                   2. In Control Lang. = I can, I decided, I choose% Row Count 14 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Patient Education \& Supportive Care}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Informed Consent}}  \newline % Row Count 1 (+ 1)
The patient MUST: \newline % Row Count 2 (+ 1)
1. have the ability/capacity to make the decision \newline % Row Count 3 (+ 1)
2. comprehend all info being given \newline % Row Count 4 (+ 1)
3. give consent voluntarily w/out being forced, persuaded, threatened  \newline % Row Count 6 (+ 2)
4. be given info about tx, procedure, benefits/risks of having/not having tx, stats of benefits/risks occuring/not occuring \newline % Row Count 9 (+ 3)
{\bf{Types of Patient Edu.}} \newline % Row Count 10 (+ 1)
1. Pamphlets \newline % Row Count 11 (+ 1)
2. Group teaching \newline % Row Count 12 (+ 1)
3. Video \newline % Row Count 13 (+ 1)
4. Internet \newline % Row Count 14 (+ 1)
5. Books \newline % Row Count 15 (+ 1)
{\bf{Patient Edu. About Tx. Room}} \newline % Row Count 16 (+ 1)
1. Length of tx. \newline % Row Count 17 (+ 1)
2. How patient will feel during tx.  \newline % Row Count 18 (+ 1)
3. Emphasize fact that they must remain still and breathe normally (unless DIBH) \newline % Row Count 20 (+ 2)
4. Explain role of each therapist in the room \newline % Row Count 21 (+ 1)
{\bf{Body Language}} \newline % Row Count 22 (+ 1)
1. Make eye contact and get on same level as patient \newline % Row Count 24 (+ 2)
2. Pause \& listen for understanding/?s \newline % Row Count 25 (+ 1)
3. Have open body language \newline % Row Count 26 (+ 1)
4. Show empathy \newline % Row Count 27 (+ 1)
{\bf{Most Likely To...}} \newline % Row Count 28 (+ 1)
Receive info about tx. - younger patients \newline % Row Count 29 (+ 1)
See nurse \& seek support - younger females \newline % Row Count 30 (+ 1)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Patient Education \& Supportive Care (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Experience more stress - men% Row Count 1 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Normal Values}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Hematocrit (Hct)}} - volume \% of RBCs in blood  \newline % Row Count 1 (+ 1)
M: 45 - 52\%  \newline % Row Count 2 (+ 1)
F: 37 - 48\% \newline % Row Count 3 (+ 1)
{\bf{Hemoglobin (Hgb)}} - protein in RBCs carrying O2 from lungs to tissues of body \& CO2 back to lungs \newline % Row Count 6 (+ 3)
M: 13.5 - 17.5 g/dL \newline % Row Count 7 (+ 1)
F: 12 - 15.5 g/dL \newline % Row Count 8 (+ 1)
Ch: 12 - 14 g/dL   \newline % Row Count 9 (+ 1)
{\bf{Erythrocytes (RBCs)}} \newline % Row Count 10 (+ 1)
M: 4.7 - 6.1 million cells/µL \newline % Row Count 11 (+ 1)
F: 4.2 - 5.4 million cells/µL  \newline % Row Count 12 (+ 1)
{\bf{Leukocytes (WBCs)}} \newline % Row Count 13 (+ 1)
Adults: 5,000 - 10,000 cells/µL \newline % Row Count 14 (+ 1)
{\bf{Platelets}} \newline % Row Count 15 (+ 1)
Adults: 200,000 - 500,000 platelets/µL \newline % Row Count 16 (+ 1)
The following values are for adults: \newline % Row Count 17 (+ 1)
{\bf{Temperature}} \newline % Row Count 18 (+ 1)
Oral: 96.8° - 98.6° F or 36° - 37° C \newline % Row Count 19 (+ 1)
{\bf{Pulse}}  \newline % Row Count 20 (+ 1)
60 - 100 beats/min \newline % Row Count 21 (+ 1)
{\bf{Respiration }} \newline % Row Count 22 (+ 1)
12 - 18 breaths/min \newline % Row Count 23 (+ 1)
{\bf{BP}} \newline % Row Count 24 (+ 1)
Systolic - pressure in arteries during ❤ contraction; top \# \newline % Row Count 26 (+ 2)
90 - 120 mmHg \newline % Row Count 27 (+ 1)
Diastolic - pressure in arteries during ❤ relaxation; bottom \# \newline % Row Count 29 (+ 2)
60 - 80 mmHg% Row Count 30 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Psychosocial Issues}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Psychosocial}} - involves both psychological \& social aspects of life \newline % Row Count 2 (+ 2)
{\bf{Situations where patients need additional support}} \newline % Row Count 4 (+ 2)
1. Deciding whether or not to have tx. \newline % Row Count 5 (+ 1)
2. Undergoing 1st tx. \newline % Row Count 6 (+ 1)
3. Coping with experience of tx. \newline % Row Count 7 (+ 1)
4. Coping with inconvenience of tx.  \newline % Row Count 8 (+ 1)
5. Dealing with long term considerations \newline % Row Count 9 (+ 1)
{\bf{Patient Centered Care}} \newline % Row Count 10 (+ 1)
1. Assessment (QLI, FLIC, FACT) \newline % Row Count 11 (+ 1)
2. Involvement in decision making \newline % Row Count 12 (+ 1)
3, Info provision \newline % Row Count 13 (+ 1)
4. Patient friendly resources \newline % Row Count 14 (+ 1)
5. Holistic approach to care \newline % Row Count 15 (+ 1)
{\bf{Domains of Patient Transition at EOT}} \newline % Row Count 16 (+ 1)
1. Psychological - cont. emotional distress, withdrawal from support \newline % Row Count 18 (+ 2)
2. Physical - marks, scars, pain, difficulty sleeping \newline % Row Count 20 (+ 2)
3. Social - ?ing where they fit in w/ friends/family/society \newline % Row Count 22 (+ 2)
4. Spiritual - ?ing their spirituality \newline % Row Count 23 (+ 1)
{\bf{Grief vs Depression}} \newline % Row Count 24 (+ 1)
{\bf{G:}} somatic distress, ↓ usual patterns of behavior, agitation, sleep/appetite disturbances ↓  concentration, social withdrawal \newline % Row Count 27 (+ 3)
{\bf{D:}} same + helplessness, hopelessness, worthlessness, guilt, suicidal thoughts \newline % Row Count 29 (+ 2)
{\bf{G:}} assoc. w/ disease progression \newline % Row Count 30 (+ 1)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Psychosocial Issues (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{D:}} ↑ prevalence in patients w/ advanced disease \newline % Row Count 2 (+ 2)
{\bf{G:}} patients retain capacity for pleasure \newline % Row Count 3 (+ 1)
{\bf{D:}} patients enjoy nothing \newline % Row Count 4 (+ 1)
{\bf{G:}} comes in waves \newline % Row Count 5 (+ 1)
{\bf{D:}} constant \newline % Row Count 6 (+ 1)
{\bf{G:}} passive wishes for death to come quickly  \newline % Row Count 7 (+ 1)
{\bf{D:}} intense/persistent suicidal thoughts \newline % Row Count 8 (+ 1)
{\bf{G:}} able to look forward to future \newline % Row Count 9 (+ 1)
{\bf{D:}} no sense of positive future \newline % Row Count 10 (+ 1)
{\bf{Resentment}} - experience of negative emotion felt due to real/imagined wrong done \newline % Row Count 12 (+ 2)
{\bf{Anger}} - emotional response related to one's psychosocial interpretation of event% Row Count 14 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Death \& Dying}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Dying with Dignity}} \newline % Row Count 1 (+ 1)
- option for qualifying terminally ill adults to request and receivve prescription med that will end their life \newline % Row Count 4 (+ 3)
- legal in CA, CO, VT, HI, NJ, ME, OR, WA, DC \newline % Row Count 5 (+ 1)
{\bf{Stages of Grieving}} \newline % Row Count 6 (+ 1)
1. Denial \newline % Row Count 7 (+ 1)
2. Anger \newline % Row Count 8 (+ 1)
3. Bargaining \newline % Row Count 9 (+ 1)
4. Depression \newline % Row Count 10 (+ 1)
5. Acceptance \newline % Row Count 11 (+ 1)
*In no particular order \newline % Row Count 12 (+ 1)
*Not every individual goes through every stage \newline % Row Count 13 (+ 1)
{\bf{Physical Signs/Symptoms in Last 48 hrs.}} \newline % Row Count 14 (+ 1)
1. Noisy/moist breathing \newline % Row Count 15 (+ 1)
2. Urinary dysfunction \newline % Row Count 16 (+ 1)
3. Pain \newline % Row Count 17 (+ 1)
4. Restlessness/agitation \newline % Row Count 18 (+ 1)
5. Dyspnea (difficulty breathing) \newline % Row Count 19 (+ 1)
6. Nausea/vomiting \newline % Row Count 20 (+ 1)
7. Sweating \newline % Row Count 21 (+ 1)
8. Confusion \newline % Row Count 22 (+ 1)
{\bf{Palliative Care}} - relieving symptoms w/out affecting disease process, chance of improving QOL, may be given at same time as curative tx. \newline % Row Count 25 (+ 3)
{\bf{Hospice}}- tx. doesn't offer hope, death expected \newline % Row Count 27 (+ 2)
{\bf{Autonomy}} \newline % Row Count 28 (+ 1)
Each person entitled to determine own destiny UNLESS: \newline % Row Count 30 (+ 2)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Death \& Dying (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{1. Decision may cause harm to others or oneself \newline % Row Count 1 (+ 1)
2. Patient is incompetent to make the decision \newline % Row Count 2 (+ 1)
3. "Physician' privilege" \newline % Row Count 3 (+ 1)
{\bf{DNR}} = Do Not Resuscitate  \newline % Row Count 4 (+ 1)
{\bf{Advanced Directive}} - document that outlines one's medical desires \& requests if they are in a situation where they can't make a decision \newline % Row Count 7 (+ 3)
{\bf{Durable Power of Attorney (DPOA)}} - states the person whom the patient has chosen to make a decision in place of them if the patient is unable to do so, aka Health Care Proxy% Row Count 11 (+ 4)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Body Image}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{RESOURCE}} - \{\{link="http://lookgoodfeelbetter.org"\}\}link text\{\{/link\}\} : Look Good Feel Better \newline % Row Count 2 (+ 2)
{\bf{Factors}} - visibility, pain, location of tumor, prosthetics, control \newline % Row Count 4 (+ 2)
{\bf{Alopecia}} - hair loss \newline % Row Count 5 (+ 1)
{\bf{Cachexia}} - weakness and wasting of the body due to severe chronic illness \newline % Row Count 7 (+ 2)
{\bf{Potential Side Effects of RT on Body Image}} \newline % Row Count 8 (+ 1)
1. {\bf{Bone Mets}}: pain relief/improvement of mobility  \newline % Row Count 10 (+ 2)
2. {\bf{Malignant Cord Compression}} - improvement/prevention in further deterioration in function \newline % Row Count 12 (+ 2)
3. {\bf{SVC Obstruction/Facial Tumors}} - improvement in cosmetics \& symptoms/reduction in edema/tumor shrinkage \newline % Row Count 15 (+ 3)
4. {\bf{Esophageal Obstruction}} - relief of obstruction/improvement in eating ability \newline % Row Count 17 (+ 2)
5. {\bf{Discharging/Fungating Wounds}} - allleviatiation of discharge/tumor shrinkage \newline % Row Count 19 (+ 2)
6. {\bf{Hemoptysis (bleeding of airway; coughing up blood)/Hematuria (blood in urine)/Rectal Bleeding}} - control of bleeding  \newline % Row Count 22 (+ 3)
{\bf{Stages of Adapting to Body Image}} \newline % Row Count 23 (+ 1)
1. {\bf{Impact of Diagnosis}}- shock rather than anger; may be directed towards health professional or family \newline % Row Count 26 (+ 3)
2. {\bf{Mourning}}- yearning to return to previous self \newline % Row Count 28 (+ 2)
3. {\bf{Defect}}- seeking info or trying different coping strategies \newline % Row Count 30 (+ 2)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Body Image (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{4. {\bf{Reconstruction}}- accepts the use of aids; able to plan for the future% Row Count 2 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Sexuality}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Potential Effects of Rad on Sexual Organs}} \newline % Row Count 1 (+ 1)
{\bf{M}}: pelvic fibrosis, sympathetic nerve injury, ↓ semen volume, ↓ testosterone, ↓ penile BP, fibrosis of cavernosal arteries \newline % Row Count 4 (+ 3)
{\bf{F}}: pelvic fibrosis, atrophy of vaginal wall, ↓ tissue elasticity, ↓ vaginal lubrication, scarring, ulceration, obliteration of small blood vessels \newline % Row Count 8 (+ 4)
{\bf{Fertility Preservation}} \newline % Row Count 9 (+ 1)
1. {\bf{Ovarian/testicular shielding}} - may maintain function but small chance \newline % Row Count 11 (+ 2)
2. {\bf{Laparascopic Ovarian Transposition}} - effective method for maintaining reproductive function \& ↓ need for hormone replacement therapy \newline % Row Count 14 (+ 3)
3. {\bf{Testicular Transposition}} - for fields restricted to inguinal pelvis \newline % Row Count 16 (+ 2)
4. {\bf{Embryo Cryopreservation}} - for use in in-vitro, may take 4-6 weeks to collect viable oocytes; for patients of reproductive age \newline % Row Count 19 (+ 3)
5.{\bf{Cryopreservation of Sperm}} - intracytoplasmic sperm injection (ICSI) requires few sperm for successful fertilization \newline % Row Count 22 (+ 3)
{\bf{ALARM}}- baseline assessment to determine sexual function before tx. \newline % Row Count 24 (+ 2)
{\bf{A}}ctivity, {\bf{L}}ibido, {\bf{A}}rousal, {\bf{R}}esolution, {\bf{M}}edical History% Row Count 26 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{x{1.4931 cm} x{3.4839 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Sexuality}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Rad Dose (Gy)}} & {\bf{Effect on Ovarian Function}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
0.6 & None \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
1.5 & No lasting damage for young F  Some steril. risk for F \textgreater{}40 \tn 
% Row Count 6 (+ 3)
% Row 3
\SetRowColor{white}
2.5 - 5 & 30 - 40\% steril. risk for F 15-40 \textgreater{}90\% steril risk for F \textgreater{}40 \tn 
% Row Count 9 (+ 3)
% Row 4
\SetRowColor{LightBackground}
5 - 8 & 50 - 70\% steril. risk for F 15 - 40 \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
\textgreater{}8 & 100\% risk of permanent steril. \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Ovaries}} produce {\bf{oocytes}} (fetus = 6 million, birth = 2 million, puberty = 100,000) \& secrete {\bf{steroid hormones}} for sexual function \& sexual maturity \newline  \newline Tolerance of ovary ↓ w/ ↑ age, ↑ dose per fraction, ↑ total dose \newline  \newline {\bf{Possible solutions}}:  \newline 1. Vaginal dilator for stenosis, adhesions, dyspareunia (pain due to penetration) \newline 2. Lubrication for dryness \newline 3. Diff sex positions for ↓ elasticity or scarring}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{1.4931 cm} x{3.4839 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Sexuality}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Rad Dose (Gy)}} & {\bf{Effect on Spermatogenesis }} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\textless{}0.1 & None \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
0.1 - 0.3 & Temp oligospermia w/ full recovery by 12 mos. \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
0.3 - 0.5 & Temp oligo/azoospermia 4 - 12 mos. after RT w/ full recovery by 48 mos. \tn 
% Row Count 8 (+ 3)
% Row 4
\SetRowColor{LightBackground}
0.5 - 1 & \textgreater{}90\% temp OS/AS 3 - 17 mos. w/ recovery 8 - 26 mos \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
1 - 2 & 100\% AS 1-2 mos. w/ return of sperm counts 11 - 30 mos. \tn 
% Row Count 12 (+ 2)
% Row 6
\SetRowColor{LightBackground}
3 - 4 & 100\% AS w/ no recovery up to 40 mos. \tn 
% Row Count 14 (+ 2)
% Row 7
\SetRowColor{white}
12 & Permanent AS w/ ↓ testicular size and ↓ testosterone production \tn 
% Row Count 17 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Testes}} produce {\bf{spermatozoa}} for reproduction \& {\bf{testosterone}} (secreted by {\bf{Leydig cells}}) for sexual function \& maturity  \newline  \newline {\bf{Possible solutions}} - pharm. drugs, penile implants, vacuum device for erectile dysfunction \newline  \newline {\bf{Oligospermia (OS)}} = LOW sperm count \newline {\bf{Azoospermia (AS)}} = NO sperm count}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Human Diversity}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Diversity}} - differing from one another; made up of distinct characteristics, qualities, or elements \newline % Row Count 3 (+ 3)
{\bf{Globalization}} - process of interaction \& integration among people, companies, and govts. of different nations; driven by international trade and investment \newline % Row Count 7 (+ 4)
{\bf{Cultural Diversity}} \newline % Row Count 8 (+ 1)
1. {\bf{Communication}}- can help avoid offending people; be aware of who's around you and the basic norms of their culture to be able to provide better patient centered care \newline % Row Count 12 (+ 4)
2. {\bf{Space}} - distance extending in all directions; know personal/cultural boundaries \newline % Row Count 14 (+ 2)
3. {\bf{Time}} -  cultures have different time orientations; ex: someone may have a certain time of day they pray so we have to try and accommodate \newline % Row Count 17 (+ 3)
4. {\bf{Environmental Control}}- ability of people to control nature; differences in health practices and definitions of health and illness vary in each culture \newline % Row Count 21 (+ 4)
5. {\bf{Biologic Variations}}- certain people are susceptible to certain diseases; differences in nutritional preferences; ethnically/racially related characteristics \newline % Row Count 25 (+ 4)
6. {\bf{Social Organizations}}- enculturation; some hiring practices support diversity to provide better cultural understanding of different populations \newline % Row Count 28 (+ 3)
{\bf{Cultural Sensitivity}} \newline % Row Count 29 (+ 1)
{\bf{Values}} - est. early in childhood through unconscious process of socialization; foundation of beliefs \newline % Row Count 32 (+ 3)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Human Diversity (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Beliefs}} - knowledge, opinions, and faith about life are built on individual vaues \newline % Row Count 2 (+ 2)
{\bf{Customs}} - Dietary habits, religious practices, communication patterns, family structure, health practices \newline % Row Count 5 (+ 3)
{\bf{Cultural Competency}}- possessing a set of attributes that enable effective interactions in a cross-cultural or multicultural environment \newline % Row Count 8 (+ 3)
1. Valuing diversity \newline % Row Count 9 (+ 1)
2. Having the capacity for cultural assessment \newline % Row Count 10 (+ 1)
3. Having consciousness of the dynamics of cross-cultural interactions  \newline % Row Count 12 (+ 2)
4. Institutionalizing cultural knowledge  \newline % Row Count 13 (+ 1)
5. Developing adaptations of service delivery that reflect an understanding of a multicultural environment  \newline % Row Count 16 (+ 3)
{\bf{Civil Rights Act of 1964}}- prohibits discrimination on the basis of race, color, and national origin; requires health care organizations and providers who receive federal funding to make interpreter services available to patients who have limited proficiency in English \newline % Row Count 22 (+ 6)
{\bf{Vienna Declaration for Human Rights}}- protects those with disabilities and its values include: \newline % Row Count 24 (+ 2)
1. Dignity \newline % Row Count 25 (+ 1)
2. Autonomy  \newline % Row Count 26 (+ 1)
3. Equality  \newline % Row Count 27 (+ 1)
4. Solidarity  \newline % Row Count 28 (+ 1)
{\bf{Types of Interpreters}} \newline % Row Count 29 (+ 1)
1. Telephone \newline % Row Count 30 (+ 1)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Human Diversity (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{2. Video Conferencing \newline % Row Count 1 (+ 1)
3. Voice Activated Software \newline % Row Count 2 (+ 1)
4. Family/friends (be cautious) \newline % Row Count 3 (+ 1)
{\bf{Discrimination}} \newline % Row Count 4 (+ 1)
1. Age \newline % Row Count 5 (+ 1)
2. Ethnicity or national Origin \newline % Row Count 6 (+ 1)
3. Race \newline % Row Count 7 (+ 1)
4. Gender or sexual orientation \newline % Row Count 8 (+ 1)
5. Mental/physical ability \newline % Row Count 9 (+ 1)
{\bf{Ethnicity}}- an individual's distinctive racial, national, religious, linguistic, or cultural heritage \newline % Row Count 12 (+ 3)
{\bf{Ethnocentrism}}- viewing norms/values of one's culture as the only acceptable norms/values  and using that idea as a standard to judge all other cultures \newline % Row Count 16 (+ 4)
{\bf{Racism}}- believing one race or culture is superior to others and using that idea to discriminate races that are considered to be inferior  \newline % Row Count 19 (+ 3)
{\bf{Assimilation}}-an individual who moves further away from their true identity (culture, religion, language, etc.) and slowly "fits in" with the majority of society (whatever is considered to be "normal"); can happen consciously or subconsciously \newline % Row Count 25 (+ 6)
{\bf{English Only}} \newline % Row Count 26 (+ 1)
Requiring to speak only English at the workplace is legal if organization shows it's a business necessity \newline % Row Count 29 (+ 3)
1. To enable supervisors who speak only English to properly monitor job performance \newline % Row Count 31 (+ 2)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Human Diversity (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{2. To promote safety in emergency situations \newline % Row Count 1 (+ 1)
3. To promote efficiency when multi-lingual speakers collaborate on work projects with English only speakers \newline % Row Count 4 (+ 3)
4. To promote customer relations when speaking with English speaking customers \newline % Row Count 6 (+ 2)
Issues: provides a means for national origin discrimination, everyone learns at a different pace and it takes time to be become proficient in a language, patients may become ill before learning the language% Row Count 11 (+ 5)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Fatigue}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Fatigue}} - characterized by overwhelming exhaustion, lack of energy, difficulty concentrating, emotional distress, depression \newline % Row Count 3 (+ 3)
Most common symptom and side effect of cancer tx. (75-100\% of patients affected) but direct cause unknown \newline % Row Count 6 (+ 3)
{\bf{Indirect causes}}  \newline % Row Count 7 (+ 1)
1. Need for extra energy to repair/heal body tissue damaged by tx. \newline % Row Count 9 (+ 2)
2. Buildup of toxic substances that are left in the body after cells are killed by tx. \newline % Row Count 11 (+ 2)
3. Effect of biologic therapy on immune system \newline % Row Count 12 (+ 1)
4. Changes in the body's sleep cycle \newline % Row Count 13 (+ 1)
{\bf{Factors that contribute}}- anemia, hormone levels that are too low or too high, trouble breathing or getting enough O2, infection, pain, stress. loss of appetite or not getting enough calories and nutrients, dehydration, changes in how well the body uses food for energy, weight loss, loss of muscles/strength, meds that cause drowsiness. problems getting enough sleep, being less active, other medical conditions \newline % Row Count 22 (+ 9)
{\bf{Risk Factors}} \newline % Row Count 23 (+ 1)
1. Age/performance status \newline % Row Count 24 (+ 1)
2. Type/site of tx. (volume, dose, normal tissue damage) \newline % Row Count 26 (+ 2)
3. Pre-tx fatigue, commute to tx. \newline % Row Count 27 (+ 1)
4. Blood counts \newline % Row Count 28 (+ 1)
{\bf{Patients most affected by fatigue}}   \newline % Row Count 29 (+ 1)
1. {\bf{Lung patients}}- breathing, coughing, infection, if tumor close to mediastinum then issues with swallowing    \newline % Row Count 32 (+ 3)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Fatigue (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{2. {\bf{Head and Neck patients}} - weight loss from not eating enough because everything  hurts   \newline % Row Count 2 (+ 2)
3. {\bf{Concurrent chemo patients}} - both the radiation and chemo effects together are the  most difficult to deal with   \newline % Row Count 5 (+ 3)
4. {\bf{Brain patients}} - sleep issues  \newline % Row Count 6 (+ 1)
{\bf{Why it's important}} \newline % Row Count 7 (+ 1)
↓ QOL for patient, ↓ self-care ability, ↓ ability to recover, ↑ feeling of ill health  \newline % Row Count 9 (+ 2)
{\bf{Managing Fatigue}} \newline % Row Count 10 (+ 1)
1. Warn patients so they are prepared and educated  \newline % Row Count 12 (+ 2)
2. Allow patients to talk about it \newline % Row Count 13 (+ 1)
3. Recommend exercise if possible \newline % Row Count 14 (+ 1)
4. Stress management techniques \newline % Row Count 15 (+ 1)
5. Psychological counseling \newline % Row Count 16 (+ 1)
6. Sleep% Row Count 17 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Skin Reactions}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Most likely to occur in the following rad tx. areas}}: \newline % Row Count 2 (+ 2)
1. Breast \newline % Row Count 3 (+ 1)
2. Head and Neck \newline % Row Count 4 (+ 1)
3. Perineal  \newline % Row Count 5 (+ 1)
4. Where skin folds rub together \newline % Row Count 6 (+ 1)
Tend to peak towards EOT, usually worsen after tx. completed \newline % Row Count 8 (+ 2)
Most reactions heal within {\bf{4 weeks}} after EOT \newline % Row Count 9 (+ 1)
{\bf{Main Layers of Skin}} \newline % Row Count 10 (+ 1)
1. Epidermis (superficial)  \newline % Row Count 11 (+ 1)
          - {\bf{Most sensitive to rad}} \newline % Row Count 12 (+ 1)
          - Basal layer rapidly divides; when cells of this layer die off, repopulation of epidermis is disrupted so {\bf{degree to which basal layer is affected = degree of skin reaction}} \newline % Row Count 16 (+ 4)
2. Dermis (deep) \newline % Row Count 17 (+ 1)
{\bf{RTOG}} used to assess skin reactions (scoring is 0-4) \newline % Row Count 19 (+ 2)
Adv: accurate estimate of area of skin affected and of severity of skin reaction \newline % Row Count 21 (+ 2)
{\bf{Risk Factors}}- Moist areas of the body, skin folds, nutrition, age, ethnicity, overall skin condition, dose, energy, fractionation, bolus \newline % Row Count 24 (+ 3)
{\bf{Erythema}} \newline % Row Count 25 (+ 1)
{\emph{Clinical Presentation}}- red, inflamed, sometimes shiny, skin feels   hot/itchy/uncomfortable \newline % Row Count 27 (+ 2)
Expected at 1.5 Gy and higher, usually after {\bf{20-25 Gy}} \newline % Row Count 29 (+ 2)
{\emph{Skin Care Recommendations}}- Gentle washing with mild soap, pat skin dry, loose cotton   clothing, no \seqsplit{moisturizer/perfume/deodorant/makeup/razors/sun} in the area   of treatment, hydrocortisone, aloe vera without alcohol, benadryl cream   \newline % Row Count 34 (+ 5)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Skin Reactions (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Dry Desquamation}} \newline % Row Count 1 (+ 1)
{\emph{Clinical Presentation}} - dry and flaky skin, usually itchy   \newline % Row Count 3 (+ 2)
Expected at {\bf{40+ Gy }} \newline % Row Count 4 (+ 1)
{\emph{Skin Care Recommendations}}- Gentle washing with mild soap, pat skin dry, loose   cotton clothing, avoid friction, topical steroids usually help   \newline % Row Count 7 (+ 3)
{\bf{Moist Desquamation}} \newline % Row Count 8 (+ 1)
{\emph{Clinical Presentation}}- blister/vesicle formation, serous drainage, pain,   exposure of dermal layer  \newline % Row Count 11 (+ 3)
Expected at {\bf{50+ Gy}} \newline % Row Count 12 (+ 1)
{\emph{Skin Care Recommendations}}- silver sulfadiazine cream (antibacterial), hydrogel % Row Count 14 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Nutrition (NOT DONE YET)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Anorexia}}- lack/loss of appetite for food \newline % Row Count 1 (+ 1)
{\emph{Symptoms}} \newline % Row Count 2 (+ 1)
1. Fatigue \newline % Row Count 3 (+ 1)
2. Dry mouth, esophagities, nausea, vomiting \newline % Row Count 4 (+ 1)
3. Presence of pain/infection \newline % Row Count 5 (+ 1)
4. Presence of stress, anxiety, depression \newline % Row Count 6 (+ 1)
5. Change in lifestyle patterns \newline % Row Count 7 (+ 1)
{\emph{Advice to patients}} \newline % Row Count 8 (+ 1)
1. Eat small meals at frequent intervals \newline % Row Count 9 (+ 1)
2. Adjust their protein/calorie intake \newline % Row Count 10 (+ 1)
3. Avoid drinking fluids with meals so they do not feel full faster \newline % Row Count 12 (+ 2)
4. Remove unpleasant smells \newline % Row Count 13 (+ 1)
5. Use nutritional supplements \newline % Row Count 14 (+ 1)
{\bf{Early satiety}}- inability to eat a full meal or feeling full after only a small amount of food \newline % Row Count 16 (+ 2)
{\bf{Late Tumor Burden}}-  \newline % Row Count 17 (+ 1)
Larger tumor burden = more difficult to restore energy  \newline % Row Count 19 (+ 2)
{\bf{Esophagitis}} - inflammation of the esophagus \newline % Row Count 20 (+ 1)
{\bf{Marasmus}}- severe undernourishment (usually occurs in children) \newline % Row Count 22 (+ 2)
{\bf{Cachexia}}- wasting away of the body due to severe chronic illness \newline % Row Count 24 (+ 2)
{\bf{Dysphagia}}- difficulty swallowing \newline % Row Count 25 (+ 1)
{\bf{Clinically Significant Weight Loss}} \newline % Row Count 26 (+ 1)
{\bf{Factors Affecting Nutritional Status}} \newline % Row Count 27 (+ 1)
1. {\bf{Pre Existing condition(s)}} - diabetes, liver/renal disease, poor housing \newline % Row Count 29 (+ 2)
2. {\bf{Surgery Related Factors}} - chewing/swallowing for H\&N, early satiety for stomach \newline % Row Count 31 (+ 2)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Nutrition (NOT DONE YET) (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{3. {\bf{Cancer Related Factors}} - weight loss, anorexia, early satiety, altered body image \newline % Row Count 2 (+ 2)
{\bf{Side Effects}}% Row Count 3 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{General Therapist Recommendations}} \newline 1. Drink plenty of fluids \newline 2. Avoid raw fruits/veggies \newline 3. Reduce alcohol consumption \newline 4. Avoid tobacco products \newline 5. Avoid extremely hot/cold foods}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{3.38436 cm} x{1.59264 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Tolerance Doses 5/5}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Site}} & {\bf{TD 5/5 (Gy)}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Testes & 1 \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Ovaries & 2 - 3 \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
Bone Marrow & 2.5 \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Growing Cartilage & 10 \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
Lens & 10 \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
Whole Lung & 17.5 \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
Whole Kidney & 23 \tn 
% Row Count 9 (+ 1)
% Row 8
\SetRowColor{LightBackground}
Whole Liver & 30 \tn 
% Row Count 10 (+ 1)
% Row 9
\SetRowColor{white}
Salivary Glands & 32 \tn 
% Row Count 11 (+ 1)
% Row 10
\SetRowColor{LightBackground}
Whole Intestine & 40 \tn 
% Row Count 12 (+ 1)
% Row 11
\SetRowColor{white}
Whole Heart & 40 \tn 
% Row Count 13 (+ 1)
% Row 12
\SetRowColor{LightBackground}
Whole Brain & 45 \tn 
% Row Count 14 (+ 1)
% Row 13
\SetRowColor{white}
Retina & 45 \tn 
% Row Count 15 (+ 1)
% Row 14
\SetRowColor{LightBackground}
20 cm Spinal Cord & 45 \tn 
% Row Count 16 (+ 1)
% Row 15
\SetRowColor{white}
1/3 Lung & 45 \tn 
% Row Count 17 (+ 1)
% Row 16
\SetRowColor{LightBackground}
1/3 Liver & 50 \tn 
% Row Count 18 (+ 1)
% Row 17
\SetRowColor{white}
1/2 Intestine & 50 \tn 
% Row Count 19 (+ 1)
% Row 18
\SetRowColor{LightBackground}
1/2 Kidney & 50 \tn 
% Row Count 20 (+ 1)
% Row 19
\SetRowColor{white}
5 -10 cm Spinal Cord & 50 \tn 
% Row Count 21 (+ 1)
% Row 20
\SetRowColor{LightBackground}
Whole Stomach & 50 \tn 
% Row Count 22 (+ 1)
% Row 21
\SetRowColor{white}
Whole Lymph Node & 50 \tn 
% Row Count 23 (+ 1)
% Row 22
\SetRowColor{LightBackground}
Optic Chiasm & 50 \tn 
% Row Count 24 (+ 1)
% Row 23
\SetRowColor{white}
Cornea & 50 \tn 
% Row Count 25 (+ 1)
% Row 24
\SetRowColor{LightBackground}
Whole Esophagus & 55 \tn 
% Row Count 26 (+ 1)
% Row 25
\SetRowColor{white}
100 cm\textasciicircum{}2\textasciicircum{} Skin & 55 \tn 
% Row Count 27 (+ 1)
% Row 26
\SetRowColor{LightBackground}
1/3 Stomach & 60 \tn 
% Row Count 28 (+ 1)
% Row 27
\SetRowColor{white}
1/3 Brain & 60 \tn 
% Row Count 29 (+ 1)
% Row 28
\SetRowColor{LightBackground}
1/3 Heart & 60 \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{3.38436 cm} x{1.59264 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Tolerance Doses 5/5 (cont)}}  \tn
% Row 29
\SetRowColor{LightBackground}
1/3 Esophagus & 60 \tn 
% Row Count 1 (+ 1)
% Row 30
\SetRowColor{white}
10 cm\textasciicircum{}2\textasciicircum{} Adult Bone & 60 \tn 
% Row Count 2 (+ 1)
% Row 31
\SetRowColor{LightBackground}
50 cm\textasciicircum{}2\textasciicircum{} Oral Cavity \& Pharynx & 60 \tn 
% Row Count 4 (+ 2)
% Row 32
\SetRowColor{white}
Rectum & 60 \tn 
% Row Count 5 (+ 1)
% Row 33
\SetRowColor{LightBackground}
Mature Cartilage & 60 \tn 
% Row Count 6 (+ 1)
% Row 34
\SetRowColor{white}
Adult Muscle & 60 \tn 
% Row Count 7 (+ 1)
% Row 35
\SetRowColor{LightBackground}
2/3 Bladder & 65 \tn 
% Row Count 8 (+ 1)
% Row 36
\SetRowColor{white}
10 cm Ureters & 70 \tn 
% Row Count 9 (+ 1)
% Row 37
\SetRowColor{LightBackground}
1/3 Bladder & 80 \tn 
% Row Count 10 (+ 1)
% Row 38
\SetRowColor{white}
10cm\textasciicircum{}2\textasciicircum{} Large Arteries and Veins & 80 \tn 
% Row Count 12 (+ 2)
% Row 39
\SetRowColor{LightBackground}
Vagina & 90 \tn 
% Row Count 13 (+ 1)
% Row 40
\SetRowColor{white}
Uterus & 100 \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}