A nurse is developing a plan of care to prevent skin breakdown for a client with a spinal cord injury and paralysis. Which of the following nursing actions are appropriate? (Select all that apply.)

Choice A reason:
Using chemotherapy instead of radiation may not be a viable option as the treatment plan is based on the type and stage of cancer. Chemotherapy can also affect fertility, so it is not a direct solution to the concern of infertility.

Choice B reason:
Fertility medications during treatment might help preserve fertility, but they do not address the direct impact of radiation on reproductive organs. Additionally, the use of such medications should be discussed with an oncologist and a fertility specialist.

Choice C reason:
Radiation shielding techniques involve using protective shields to limit radiation exposure to the reproductive organs. This can help reduce the risk of infertility caused by radiation, especially when the pelvic area is involved in the treatment.

Choice D reason:
Surgical interventions to remove the cancer may be part of the treatment plan, but they do not directly address the concern of radiation-induced infertility. Surgery can also result in infertility, depending on the organs involved and the extent of the procedure.

Choice A reason:
Using an antibiotic ointment is not typically recommended as a preventive measure for skin integrity during radiation therapy. Antibiotic ointments are used to treat bacterial infections, and their use should be directed by a healthcare provider if an infection is present or there is skin breakdown.

Choice B reason:
It is important not to apply heat to the area of irradiation as heat can increase skin irritation and the risk of burns in the treated area. Patients undergoing radiation therapy are advised to avoid heat sources, including heating pads, hot water bottles, and direct sunlight, to prevent further damage to the skin.

Choice C reason:
Lubricating the skin with hypoallergenic lotion can help maintain skin integrity by keeping it moisturized. However, it is crucial to use lotions that are free of metals, alcohol, perfumes, and dyes, as these can react with radiation and cause skin irritation. Lotions should be applied after radiation therapy sessions and not immediately before treatment.

Choice D reason:
The instruction not to wash the area of irradiation is incorrect. It is essential to keep the skin clean to reduce the risk of infection. Patients should gently wash the irradiated area with lukewarm water and mild soap, and pat the area dry with a soft towel. They should avoid scrubbing or using harsh soaps that can irritate the skin.