A patient of cervical cancer is having internal radium implant. In which of the following position should place the client to prevent dislodgement of device?

1. A

   Place the client in supine position

2. B

   Place the client in Trenlenburg's position

3. C

   Place the client in Prone position

4. D

   Place the client in semi-fowler position

Appeared in: NORCET 3 - 2022 (Shift-2)

Explanation

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• The supine position immobilizes the pelvis, which is essential to prevent any movement that could shift the radium implant from its precise therapeutic location.
• Lying flat on the back minimizes the effect of gravity on the pelvic region, which could otherwise cause the applicator to slide downwards and become dislodged.
• Strict bed rest in the supine position is a fundamental safety protocol to ensure the radiation is delivered accurately to the cancerous tissue while minimizing exposure to adjacent healthy organs like the bladder and rectum.

Why Other Options Were Wrong

• Option B: This position, with the head lower than the feet, would cause a significant shift in the pelvic organs due to gravity, creating a high risk of dislodging the implant.
• Option C: Lying on the abdomen places direct pressure on the pelvis and the implant itself, which could easily cause it to move out of position and would be very uncomfortable for the patient.
• Option D: Elevating the head of the bed increases the downward pull of gravity on the implant, significantly increasing the risk of it sliding out of place. Patients in this position can also slide down in bed, further risking displacement.

Related Visual

• Visual 1: Diagram: A patient in the supine position with an intracavitary applicator for cervical brachytherapy, highlighting the need for pelvic stability.
• Visual 2: Infographic: The principles of radiation safety (Time, Distance, Shielding) for nurses caring for patients with internal implants.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Nursing care and positioning for patients with internal radiation (brachytherapy) to guide bedside assessment, documentation, and the next nursing action.
• Proper positioning is critical for the effectiveness of brachytherapy; a dislodged implant can lead to under-treatment of the cancer and radiation damage to healthy tissues like the bladder and rectum.
• Nurses must enforce strict bed rest and educate the patient on the importance of not changing position without assistance to prevent complications.
• What if? If the patient must be turned for skin care, a log-rolling technique with minimal hip flexion is used, typically by two nurses, to maintain spinal alignment and prevent pelvic movement.

How to Approach the Question

• Identify the clinical goal: The question asks how to prevent dislodgement of an internal radium implant.
• Recall the core principle of brachytherapy: The radiation source must remain in a precise, fixed position to be effective and safe.
• Analyze the forces at play: Consider gravity and pressure. The goal is to choose a position that minimizes both.
• Evaluate each option based on its effect on pelvic stability: Supine (flat, stable), Trendelenburg (head down, causes organ shift), Prone (on stomach, causes direct pressure), and Semi-Fowler (head up, gravity pulls implant down).
• Conclude that the supine position offers the greatest stability and is the safest choice to prevent movement of the implant.

Concept Tested & Keywords

• Concept Tested: Nursing care and positioning for patients with internal radiation (brachytherapy).
• Stem keywords: cervical cancer, internal radium implant, prevent dislodgement, position
• Lead-in keywords: which of the following position
• Negative lead-in flag: false

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Q3kEo87wOIElkSO2u1GOGl

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