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 provides the greatest stability for the pelvis, minimizing movement that could dislodge the intracavitary radiation implant.
• Lying flat counteracts the force of gravity that could otherwise pull the heavy implant out of the cervix, which is a risk in more upright positions.
• Patients undergoing low-dose-rate brachytherapy, which can last for several days, require strict immobility to ensure the applicator remains in the precise location for effective treatment.
• This position facilitates strict bed rest, which is a cornerstone of care for preventing complications like implant displacement.

Why Other Options Were Wrong

• Option B: Trendelenburg's position (feet elevated) would cause an undesirable shift of pelvic and abdominal organs, potentially misaligning the applicator relative to the tumor and surrounding structures.
• Option C: The prone position (lying on the stomach) is completely contraindicated. It would place direct pressure on the abdomen and the implant, causing discomfort and a high risk of displacement.
• Option D: Semi-Fowler's position, which involves elevating the head of the bed 30-45 degrees, increases the angle of the hips. This creates a downward gravitational force that significantly increases the risk of the implant sliding out of the cervix.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Patient positioning and nursing care for internal radiation therapy (brachytherapy) to guide bedside assessment, documentation, and the next nursing action.
• Proper positioning is a critical nursing responsibility that directly impacts both treatment efficacy and patient safety during brachytherapy.
• Failure to maintain the correct position can lead to under-dosing the tumor (reducing the chance of cure) and over-exposing healthy tissues like the bladder and rectum, causing long-term complications.
• Radiation safety for staff and visitors is paramount. A dislodged implant creates a radiation hazard. Nurses must know the emergency protocol: do not touch with bare hands, use long-handled forceps, place in a lead container, and notify the radiation oncology team immediately.

How to Approach the Question

• First, identify the core of the question: finding the safest position to prevent an object from falling out of the cervix.
• Consider the object: a radium implant is a physical device with weight, placed in the cervix/uterus.
• Analyze the goal: to prevent dislodgement. This means you need the most stable, secure position.
• Evaluate each option based on physics and anatomy:
• Supine: Flat, stable, neutral gravity on the implant.
• Trendelenburg: Tilts the whole pelvis, shifts organs, not stable.

Concept Tested & Keywords

• Concept Tested: Patient positioning and nursing care for internal radiation therapy (brachytherapy).
• Stem keywords: cervical cancer, internal radium implant, prevent dislodgement, position
• Lead-in keywords: In which of the following position

Question ID

Q3kEo87wOIElkSO2u1GOGl

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 75-77

E6 Gynecology Williams p. 197-228