# Situation: A 60-year-old man who smokes and drinks alcohol daily undergoes total laryngectomy with a permanent tracheostoma for cancer of the larynx. Four weeks after surgery, he begins external beam radiation to the neck. Which instruction about the skin in the treatment field is correct?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629841  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 60-year-old man who smokes and drinks alcohol daily undergoes total laryngectomy with a permanent tracheostoma for cancer of the larynx.

Four weeks after surgery, he begins external beam radiation to the neck. Which instruction about the skin in the treatment field is correct?

## 보기

1. Apply an ice pack when the skin feels warm
2. Wash gently with lukewarm water and mild soap **✔ 정답**
3. Scrub off the ink markings after each treatment
4. Leave the area unwashed until the course is finished

**정답: 2**

## 해설

Skin in the radiation field is washed gently with lukewarm water and mild soap and patted dry. The client avoids heat, ice, tape, perfumed products, scratching, and sun on the area, and does not remove skin markings, which guide treatment.

## 심화 해설

Radiation skin care after total laryngectomy

The correct instruction is to wash gently with lukewarm water and mild soap. Radiation damages the rapidly dividing basal cells of the epidermis, producing a reaction that resembles a burn. Keeping the skin clean reduces bacterial load and removes exudate without adding friction, which lowers the risk of secondary infection and moist desquamation. Gentle washing with lukewarm water and mild soap is a recommended supportive care intervention for acute radiation dermatitis.

Key point! The skin in the treatment field should be patted dry rather than rubbed, and the client should avoid any product that adds chemical or thermal irritation.

Why the other options are incorrect

| Option | Why it is wrong | Mechanism or risk |
| --- | --- | --- |
| 1. Apply an ice pack when the skin feels warm | Cold is a form of thermal stress on already injured skin | Ice causes vasoconstriction and can worsen tissue hypoxia; extreme temperature changes increase pain and may mask progressive skin breakdown |
| 3. Scrub off the ink markings after each treatment | Markings guide daily field placement and must remain intact | Scrubbing creates friction and mechanical trauma; removing markings would compromise accurate radiation delivery |
| 4. Leave the area unwashed until the course is finished | Accumulated sweat, debris, and exudate increase infection risk | Unwashed skin promotes bacterial colonization and can intensify pruritus, odor, and moist desquamation |

What the guidelines support

The MASCC consensus process identified gentle washing with water and mild soap as one of the interventions reaching at least 75% agreement for clinical use in acute radiation dermatitis . The systematic review underlying those recommendations included 235 original studies, with 149 randomized controlled trials, and found consistent support for basic skin hygiene as part of prevention and management . The ESTRO RTT committee similarly emphasizes practical skin care that avoids friction, heat, and harsh chemicals while preserving treatment markings . A comparison of clinical practice guidelines published between 2010 and 2021 also shows that washing the irradiated skin gently is a standard recommendation across organizations, although specific product choices vary .

The core principle is to minimize mechanical, chemical, and thermal irritation while maintaining skin integrity and accurate treatment field markings. For a client with a permanent tracheostoma, this skin care also protects the peristomal area from additional breakdown during radiation.

Watch out! Avoid heat, ice, tape, perfumed products, scratching, and direct sun on the treated area. Do not remove the ink markings; they are essential for reproducible radiation delivery.

## 임상 시나리오

Radiation Skin Care After LaryngectomyGentle cleansing reduces infection risk without adding trauma
Wash the treatment field gently with lukewarm water and mild soap, then pat dry without rubbing. Keeping skin clean lowers bacterial load and removes exudate, reducing risk of moist desquamation.

Avoid heat, ice, tape, perfumed products, scratching, and sun exposure on the treated area. Do not remove ink markings; they guide daily radiation field placement.

CautionIce packs cause vasoconstriction and worsen tissue hypoxia on already injured skin. Scrubbing markings creates friction trauma and compromises accurate radiation delivery.

## 핵심 개념

- **Radiation dermatitis** — Acute skin reaction from radiation damaging basal cells of the epidermis, resembling a burn
- **Moist desquamation** — Loss of epidermis with weeping or exudate, a complication of severe radiation skin reaction
- **Treatment field markings** — Ink marks on skin used to guide accurate daily radiation beam placement
- **Permanent tracheostoma** — Surgically created opening in the trachea after total laryngectomy for breathing

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