Podcast
Questions and Answers
What is an essential part of preventing infection and promoting nutrition intake in patients undergoing cancer treatment?
What is an essential part of preventing infection and promoting nutrition intake in patients undergoing cancer treatment?
Oral assessment and careful intervention to keep the oral cavity moist, clean, and free of debris
What is recommended for patients with xerostomia?
What is recommended for patients with xerostomia?
Saliva substitutes and drinking small amounts of water frequently
Why is it essential to refer a patient to a dentist before starting cancer treatment?
Why is it essential to refer a patient to a dentist before starting cancer treatment?
To address any necessary dental work and prevent oral complications
How often should patients perform oral care?
How often should patients perform oral care?
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What is an effective cleansing agent for oral care?
What is an effective cleansing agent for oral care?
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Why is it important to involve a dietitian in patient care before cancer treatment starts?
Why is it important to involve a dietitian in patient care before cancer treatment starts?
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What type of foods are recommended for patients experiencing anorexia during cancer treatment?
What type of foods are recommended for patients experiencing anorexia during cancer treatment?
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Why is it important to monitor patients for dehydration during cancer treatment?
Why is it important to monitor patients for dehydration during cancer treatment?
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Why may a patient need enteral or parenteral nutrition?
Why may a patient need enteral or parenteral nutrition?
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How does anorexia affect the patient?
How does anorexia affect the patient?
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What is radiation?
What is radiation?
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What is simulation in radiation therapy?
What is simulation in radiation therapy?
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What is the difference between internal and external radiation?
What is the difference between internal and external radiation?
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What is brachytherapy?
What is brachytherapy?
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Why is it important to manage symptoms that interfere with appetite?
Why is it important to manage symptoms that interfere with appetite?
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What is the goal of nutrition therapy in patients with anorexia?
What is the goal of nutrition therapy in patients with anorexia?
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What can be done to prevent nausea and vomiting in patients undergoing radiation therapy?
What can be done to prevent nausea and vomiting in patients undergoing radiation therapy?
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How would you manage diarrhea in patients undergoing chemotherapy?
How would you manage diarrhea in patients undergoing chemotherapy?
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What should be avoided in the diet of patients undergoing chemotherapy?
What should be avoided in the diet of patients undergoing chemotherapy?
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Why should milk products be avoided in patients undergoing radiation therapy?
Why should milk products be avoided in patients undergoing radiation therapy?
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What should be inspected in patients experiencing rectal irritation?
What should be inspected in patients experiencing rectal irritation?
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Why are patients diagnosed with head and neck cancer who receive radiation at high risk for?
Why are patients diagnosed with head and neck cancer who receive radiation at high risk for?
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What should patients keep to record episodes and aggravating and alleviating factors of diarrhea?
What should patients keep to record episodes and aggravating and alleviating factors of diarrhea?
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What may be used for painful skin irritations in patients experiencing diarrhea?
What may be used for painful skin irritations in patients experiencing diarrhea?
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What is the purpose of using WBC growth factors in cancer treatment?
What is the purpose of using WBC growth factors in cancer treatment?
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Why is it important to avoid invasive procedures in patients with thrombocytopenia?
Why is it important to avoid invasive procedures in patients with thrombocytopenia?
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What is the general threshold for platelet transfusions in patients with thrombocytopenia?
What is the general threshold for platelet transfusions in patients with thrombocytopenia?
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How can nurses help patients manage fatigue during chemotherapy?
How can nurses help patients manage fatigue during chemotherapy?
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Why is it important to prevent nausea and vomiting in patients undergoing chemotherapy?
Why is it important to prevent nausea and vomiting in patients undergoing chemotherapy?
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What is a recommended form of exercise for patients with fatigue during chemotherapy?
What is a recommended form of exercise for patients with fatigue during chemotherapy?
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Why is it important to address anemia in patients undergoing radiation therapy or chemotherapy?
Why is it important to address anemia in patients undergoing radiation therapy or chemotherapy?
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How can patients with anemia benefit from RBC growth factors?
How can patients with anemia benefit from RBC growth factors?
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What is the primary responsibility of the nurse in preparing a patient for Gamma Knife technology?
What is the primary responsibility of the nurse in preparing a patient for Gamma Knife technology?
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What is the nurse's role in protecting the patient and others during Gamma Knife technology?
What is the nurse's role in protecting the patient and others during Gamma Knife technology?
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How does the nurse care for the effects of radiation on the skin?
How does the nurse care for the effects of radiation on the skin?
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What is the difference between dry and wet desquamation?
What is the difference between dry and wet desquamation?
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What is the nurse's role in monitoring and supporting patients undergoing radiation therapy?
What is the nurse's role in monitoring and supporting patients undergoing radiation therapy?
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Why is it important for the nurse to provide education on recognizing signs and symptoms of complications after radiation therapy?
Why is it important for the nurse to provide education on recognizing signs and symptoms of complications after radiation therapy?
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What is the nurse's role in post-treatment care after a Gamma Knife procedure?
What is the nurse's role in post-treatment care after a Gamma Knife procedure?
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Why is it essential for the nurse to educate patients on managing common side effects of radiation therapy?
Why is it essential for the nurse to educate patients on managing common side effects of radiation therapy?
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What are the initial steps to take when extravasation is suspected in a patient receiving intravenous therapy?
What are the initial steps to take when extravasation is suspected in a patient receiving intravenous therapy?
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What is the primary goal of radiation therapy in cancer treatment?
What is the primary goal of radiation therapy in cancer treatment?
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Why is it essential to assess patient symptoms and the injection site after an extravasation incident?
Why is it essential to assess patient symptoms and the injection site after an extravasation incident?
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What is the importance of involving a dietitian in patient care before cancer treatment starts?
What is the importance of involving a dietitian in patient care before cancer treatment starts?
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How can nurses help patients manage fatigue during chemotherapy?
How can nurses help patients manage fatigue during chemotherapy?
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What is the importance of providing education on recognizing signs and symptoms of complications after radiation therapy?
What is the importance of providing education on recognizing signs and symptoms of complications after radiation therapy?
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What is the role of the nurse in caring for the effects of radiation on the skin?
What is the role of the nurse in caring for the effects of radiation on the skin?
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Why is it essential to address anemia in patients undergoing radiation therapy or chemotherapy?
Why is it essential to address anemia in patients undergoing radiation therapy or chemotherapy?
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What is the essential aspect of spiritual ministry in nursing, and how can it be demonstrated in patient care?
What is the essential aspect of spiritual ministry in nursing, and how can it be demonstrated in patient care?
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What is the significance of cultural sensitivity in patient communication, and how can nurses incorporate it into their practice?
What is the significance of cultural sensitivity in patient communication, and how can nurses incorporate it into their practice?
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How do therapeutic relationships between nurses and patients contribute to holistic healing, and what are the essential elements of these relationships?
How do therapeutic relationships between nurses and patients contribute to holistic healing, and what are the essential elements of these relationships?
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What is the role of diagnostic procedures in cancer diagnosis, and how do nurses support patients during these procedures?
What is the role of diagnostic procedures in cancer diagnosis, and how do nurses support patients during these procedures?
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How do nurses provide holistic care to patients undergoing cancer treatment, and what are the key aspects of this care?
How do nurses provide holistic care to patients undergoing cancer treatment, and what are the key aspects of this care?
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What is the significance of patient education in cancer care, and how do nurses facilitate patient understanding of their treatment and care?
What is the significance of patient education in cancer care, and how do nurses facilitate patient understanding of their treatment and care?
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How do nurses demonstrate empathy and compassion in patient care, and what are the benefits of these traits in therapeutic relationships?
How do nurses demonstrate empathy and compassion in patient care, and what are the benefits of these traits in therapeutic relationships?
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What is the role of nurses in promoting cultural sensitivity and addressing health disparities in cancer care?
What is the role of nurses in promoting cultural sensitivity and addressing health disparities in cancer care?
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How can nurses demonstrate compassion and empathy towards patients with cultural differences and physical problems?
How can nurses demonstrate compassion and empathy towards patients with cultural differences and physical problems?
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What is the importance of considering patients with difficult behaviors as a different culture?
What is the importance of considering patients with difficult behaviors as a different culture?
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How does nursing involve both art and science?
How does nursing involve both art and science?
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What is the significance of building a trusting relationship with patients in nursing practice?
What is the significance of building a trusting relationship with patients in nursing practice?
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How can nurses ensure cultural sensitivity in their practice?
How can nurses ensure cultural sensitivity in their practice?
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What is the significance of compassion in building a trusting relationship with patients, regardless of their physical problems or cultural differences?
What is the significance of compassion in building a trusting relationship with patients, regardless of their physical problems or cultural differences?
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What is the role of non-verbal communication in nursing practice?
What is the role of non-verbal communication in nursing practice?
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How can nurses promote holistic healing in their practice?
How can nurses promote holistic healing in their practice?
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How does considering difficult patients as a different culture promote cultural sensitivity in nursing?
How does considering difficult patients as a different culture promote cultural sensitivity in nursing?
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What is the significance of active listening in therapeutic relationships?
What is the significance of active listening in therapeutic relationships?
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In what ways does nursing go beyond being a science, and become an art?
In what ways does nursing go beyond being a science, and become an art?
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Why is it essential for nurses to be compassionate when dealing with patients who have embarrassing diagnostic procedures?
Why is it essential for nurses to be compassionate when dealing with patients who have embarrassing diagnostic procedures?
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How does a nurse's ability to see themselves in their patients' shoes promote holistic healing?
How does a nurse's ability to see themselves in their patients' shoes promote holistic healing?
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What role do nurses play in supporting patients who have limited family support or resources?
What role do nurses play in supporting patients who have limited family support or resources?
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How can effective communication improve patient outcomes, particularly for those with complex needs?
How can effective communication improve patient outcomes, particularly for those with complex needs?
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What is the value of considering each patient as an individual with unique needs, rather than just a diagnosis or condition?
What is the value of considering each patient as an individual with unique needs, rather than just a diagnosis or condition?
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What is the purpose of debulking surgery in cancer treatment?
What is the purpose of debulking surgery in cancer treatment?
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What is the goal of supportive and palliative care in cancer treatment?
What is the goal of supportive and palliative care in cancer treatment?
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What is the difference between curative and supportive care in cancer treatment?
What is the difference between curative and supportive care in cancer treatment?
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What is the role of calendula ointment and topical hyaluronic acid cream in radiation dermatitis?
What is the role of calendula ointment and topical hyaluronic acid cream in radiation dermatitis?
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What is the significance of wet desquamation in radiation therapy?
What is the significance of wet desquamation in radiation therapy?
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What is the importance of agency protocols in radiation oncology?
What is the importance of agency protocols in radiation oncology?
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What is the role of nurses in managing radiation dermatitis?
What is the role of nurses in managing radiation dermatitis?
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What is the impact of cancer treatment on the overall death rate and number of cancer survivors?
What is the impact of cancer treatment on the overall death rate and number of cancer survivors?
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How can nurses demonstrate compassion and empathy towards patients from diverse cultural backgrounds, and what are the benefits of such approach?
How can nurses demonstrate compassion and empathy towards patients from diverse cultural backgrounds, and what are the benefits of such approach?
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What is the role of therapeutic relationships in holistic healing, and how can nurses foster such relationships with their patients?
What is the role of therapeutic relationships in holistic healing, and how can nurses foster such relationships with their patients?
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How can nurses effectively communicate with patients who have language barriers, and what are the implications of ineffective communication?
How can nurses effectively communicate with patients who have language barriers, and what are the implications of ineffective communication?
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What is the significance of considering patients' cultural backgrounds in diagnostic procedures, and how can nurses incorporate this into their practice?
What is the significance of considering patients' cultural backgrounds in diagnostic procedures, and how can nurses incorporate this into their practice?
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How can nurses develop a patient-centered approach to care, and what are the benefits of such an approach?
How can nurses develop a patient-centered approach to care, and what are the benefits of such an approach?
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What is the significance of compassion in building a trusting relationship with patients, especially those with cultural differences?
What is the significance of compassion in building a trusting relationship with patients, especially those with cultural differences?
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What is the importance of empathy in patient communication, and how can nurses demonstrate empathy in their practice?
What is the importance of empathy in patient communication, and how can nurses demonstrate empathy in their practice?
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How can nurses promote holistic healing in their patients, and what are the benefits of such an approach?
How can nurses promote holistic healing in their patients, and what are the benefits of such an approach?
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How can considering patients with difficulties as a different culture enhance therapeutic relationships?
How can considering patients with difficulties as a different culture enhance therapeutic relationships?
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What is the role of spiritual ministry in nursing, and how can nurses incorporate it into their practice?
What is the role of spiritual ministry in nursing, and how can nurses incorporate it into their practice?
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In what ways can nurses demonstrate compassion in their care, particularly for patients who may not have family support?
In what ways can nurses demonstrate compassion in their care, particularly for patients who may not have family support?
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How does nursing as an art, rather than a science, enable nurses to provide more personalized care to patients?
How does nursing as an art, rather than a science, enable nurses to provide more personalized care to patients?
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What is the importance of considering the patient's perspective and experiences in providing holistic care?
What is the importance of considering the patient's perspective and experiences in providing holistic care?
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In what ways can diagnostic procedures be embarrassing or distressing for patients, and how can nurses mitigate these effects?
In what ways can diagnostic procedures be embarrassing or distressing for patients, and how can nurses mitigate these effects?
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How can nurses incorporate cultural sensitivity into their communication with patients from diverse backgrounds?
How can nurses incorporate cultural sensitivity into their communication with patients from diverse backgrounds?
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What is the role of spirituality in holistic care, and how can nurses incorporate it into their practice?
What is the role of spirituality in holistic care, and how can nurses incorporate it into their practice?
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How can nurses demonstrate cultural sensitivity in patient communication, and what is the significance of this approach in nursing?
How can nurses demonstrate cultural sensitivity in patient communication, and what is the significance of this approach in nursing?
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What is the essential aspect of spiritual ministry in nursing, and how can it be demonstrated in patient care?
What is the essential aspect of spiritual ministry in nursing, and how can it be demonstrated in patient care?
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What is the role of the nurse in caring for the effects of radiation on the skin, and how can they provide education on managing common side effects of radiation therapy?
What is the role of the nurse in caring for the effects of radiation on the skin, and how can they provide education on managing common side effects of radiation therapy?
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What is the significance of therapeutic relationships in nursing, and how can nurses establish trust with their patients?
What is the significance of therapeutic relationships in nursing, and how can nurses establish trust with their patients?
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How can nurses incorporate holistic healing into their practice, and what are the benefits of this approach?
How can nurses incorporate holistic healing into their practice, and what are the benefits of this approach?
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What is the role of the nurse in preparing a patient for diagnostic procedures, and what education should be provided to the patient?
What is the role of the nurse in preparing a patient for diagnostic procedures, and what education should be provided to the patient?
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What is the significance of patient communication in nursing, and how can nurses ensure effective communication?
What is the significance of patient communication in nursing, and how can nurses ensure effective communication?
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What is the role of the nurse in patient education, and how can they address the patient's questions and concerns?
What is the role of the nurse in patient education, and how can they address the patient's questions and concerns?
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What is the primary goal of radiation therapy in cancer treatment?
What is the primary goal of radiation therapy in cancer treatment?
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What should be done immediately when extravasation is suspected in a patient receiving intravenous therapy?
What should be done immediately when extravasation is suspected in a patient receiving intravenous therapy?
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Why is it essential to address anemia in patients undergoing radiation therapy or chemotherapy?
Why is it essential to address anemia in patients undergoing radiation therapy or chemotherapy?
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How can nurses help patients manage fatigue during chemotherapy?
How can nurses help patients manage fatigue during chemotherapy?
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What is the significance of cultural sensitivity in patient communication, and how can nurses incorporate it into their practice?
What is the significance of cultural sensitivity in patient communication, and how can nurses incorporate it into their practice?
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What is the role of the nurse in caring for the effects of radiation on the skin?
What is the role of the nurse in caring for the effects of radiation on the skin?
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Why is it essential for the nurse to provide education on recognizing signs and symptoms of complications after radiation therapy?
Why is it essential for the nurse to provide education on recognizing signs and symptoms of complications after radiation therapy?
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What is the essential aspect of spiritual ministry in nursing, and how can it be demonstrated in patient care?
What is the essential aspect of spiritual ministry in nursing, and how can it be demonstrated in patient care?
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What is the purpose of debulking surgery in cancer treatment, and how does it make subsequent treatments more effective?
What is the purpose of debulking surgery in cancer treatment, and how does it make subsequent treatments more effective?
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How does a nurse promote supportive care and palliation of symptoms when cure or control of cancer is no longer possible?
How does a nurse promote supportive care and palliation of symptoms when cure or control of cancer is no longer possible?
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What is the difference between dry and wet desquamation, and how does a nurse care for each?
What is the difference between dry and wet desquamation, and how does a nurse care for each?
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What is the role of the nurse in caring for a patient receiving radiation therapy, and why is education on recognizing signs and symptoms of complications essential?
What is the role of the nurse in caring for a patient receiving radiation therapy, and why is education on recognizing signs and symptoms of complications essential?
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How does a nurse address the holistic needs of a patient undergoing cancer treatment, incorporating cultural sensitivity and spiritual ministry into care?
How does a nurse address the holistic needs of a patient undergoing cancer treatment, incorporating cultural sensitivity and spiritual ministry into care?
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What is the primary goal of radiation therapy in cancer treatment, and how does a nurse educate patients on managing side effects?
What is the primary goal of radiation therapy in cancer treatment, and how does a nurse educate patients on managing side effects?
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Why is it essential for nurses to provide individualized care and communication tailored to each patient's unique needs and cultural background?
Why is it essential for nurses to provide individualized care and communication tailored to each patient's unique needs and cultural background?
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How do nurses promote therapeutic relationships with patients undergoing cancer treatment, and what is the significance of empathy and emotional support?
How do nurses promote therapeutic relationships with patients undergoing cancer treatment, and what is the significance of empathy and emotional support?
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Study Notes
Oral Care for Patients with Cancer
- Patients should use fluoride supplements as recommended by their dentist to prevent infection and promote nutrition intake.
- Saliva substitutes may help patients with xerostomia.
- Oral assessment and careful intervention are essential to keep the oral cavity moist, clean, and free of debris.
- Implement standard oral care protocols to address prevention and management of mucositis.
- Routinely assess the oral cavity, mucous membranes, characteristics of saliva, and ability to swallow.
Anorexia in Cancer Patients
- Anorexia is a common side effect of cancer and cancer treatment.
- Involve a dietitian in patient care before cancer treatment starts.
- Monitor patients during and after treatment to ensure that weight loss does not become excessive.
- Observe for dehydration and manage other symptoms that interfere with appetite.
- Most patients tolerate small, frequent meals of high-protein, high-calorie foods best.
- Nutrition supplements can be helpful.
- The patient may need enteral (EN) or parenteral nutrition (PN) if they are severely malnourished.
Care of the Patient Receiving Radiation
- Radiation is high-energy waves that cause ions to be produced in cells, breaking bonds in DNA leading to cell death.
- Simulation defines treatment fields, which are filmed and marked out on the skin.
- Internal radiation (brachytherapy) is delivered directly into the tumor, allowing for minimal exposure to surrounding healthy tissues.
- External radiation (external beam radiation therapy) is the most common form of radiation treatment delivery.
- Prophylactic antiemetic and anti-anxiety medication should be given 1 hour before treatment.
- Assess patients who have nausea and vomiting for signs and symptoms of dehydration and metabolic alkalosis.
- Treatment includes antiemetic drugs, diet adjustments, and non-drug interventions.
Managing Radiation-Induced Diarrhea
- Recommend a diet low in fiber and residue before chemotherapy known to cause diarrhea.
- Avoid fried, fatty, or highly seasoned foods, and foods that are gas-producing.
- Lukewarm sitz baths may ease discomfort and cleanse the rectal area if rectal irritation develops.
- Inspect the perianal area for evidence of skin breakdown.
- Systemic analgesia may be used for painful skin irritations.
Managing Fatigue and GI Effects of Chemotherapy
- Help patients recognize that fatigue is common and teach them energy conservation strategies.
- Encourage patients to be more active during periods when they typically feel better.
- Patients may need to rest before activity and have others help with work or home tasks.
- Maintaining exercise and activity within tolerable limits is often helpful in managing fatigue.
Nursing Responsibilities for Patients Receiving Radiation
- Preparation and education: Explain the procedure to the patient and family, including possible side effects and needed safety precautions.
- Safety: Follow safety protocols to protect the patient, themselves, and possible visitors.
- Post-treatment care: Distribute care and patient education after the implant is removed if applicable.
- Monitoring and support: Monitor patient skin for adverse reactions and provide support for managing common side effects.
Care for the Effects of Radiation on the Skin
- Protect radiated skin from temperature extremes.
- Avoid constricting garments, rubbing, harsh chemicals, and deodorants.
- Lubricate dry skin with a non-irritating lotion emollient that contains no metal, alcohol, perfume, or additives.
- Dry reactions are uncomfortable and cause pruritus, while wet desquamation is a severe reaction that requires prompt intervention.
Importance of Compassion in Nursing
- Compassion is essential in nursing, regardless of a patient's physical problems or cultural differences
- Showing kindness and making an effort to make the patient comfortable can display compassion through actions, not just verbal communication
- Compassion can help build a trusting relationship with the patient and allow them to be more vulnerable
Nursing as an Art
- Nursing is an art, not just a science, because it requires compassion and mercy for others
- Nursing involves understanding patients in ways that aren't just verbal, but also through physical cues and explanation of actions
- Every patient is an individual, and no two patients fit the same plan of care, even if they have the same condition
Cancer and the Nursing Process
- There are currently over 16.9 million cancer survivors in the United States, with some being cancer-free and others still receiving treatment
- Survival statistics vary by type and stage of cancer
- Radiation therapy aims to get rid of cancer cells by damaging their genes, preventing growth and multiplication
- Radiation can cure patients, reduce pain, and alleviate symptoms
Managing Extravasation
- Steps to safely manage a patient with extravasation include stopping the infusion, not flushing the line, disconnecting IV tubing, and attempting to aspirate residual medication
- A cold compress is recommended, and the site should be assessed, along with the patient's symptoms
Radiation Therapy
- Radiation therapy involves using x-rays to kill cancer cells by damaging their genes
- The goal of radiation therapy is to cure patients or reduce pain and symptoms
Skin Care for Radiation Dermatitis
- Calendula ointment and topical hyaluronic acid cream are effective for managing radiation dermatitis
- Skin care for moist desquamation includes keeping tissues clean with normal saline compresses or modified Burow's solution soaks
- Protecting the skin from further damage with moisture vapor-permeable dressings or Vaseline petrolatum gauze is essential
Surgical Interventions for Cancer
- Debulking surgery involves removing as much of the tumor as possible, making chemotherapy and/or radiation therapy more effective
- Curative surgeries include radical neck dissection, mastectomy, thyroidectomy, nephrectomy, hysterectomy, and oophorectomy
- Supportive and palliative care involves maximizing bodily function or facilitating cancer treatment when cure or control is no longer possible
Importance of Compassion in Nursing
- Compassion is essential in nursing, regardless of a patient's physical problems or cultural differences
- Showing kindness and making an effort to make the patient comfortable can display compassion through actions, not just verbal communication
- Compassion can help build a trusting relationship with the patient and allow them to be more vulnerable
Nursing as an Art
- Nursing is an art, not just a science, because it requires compassion and mercy for others
- Nursing involves understanding patients in ways that aren't just verbal, but also through physical cues and explanation of actions
- Every patient is an individual, and no two patients fit the same plan of care, even if they have the same condition
Cancer and the Nursing Process
- There are currently over 16.9 million cancer survivors in the United States, with some being cancer-free and others still receiving treatment
- Survival statistics vary by type and stage of cancer
- Radiation therapy aims to get rid of cancer cells by damaging their genes, preventing growth and multiplication
- Radiation can cure patients, reduce pain, and alleviate symptoms
Managing Extravasation
- Steps to safely manage a patient with extravasation include stopping the infusion, not flushing the line, disconnecting IV tubing, and attempting to aspirate residual medication
- A cold compress is recommended, and the site should be assessed, along with the patient's symptoms
Radiation Therapy
- Radiation therapy involves using x-rays to kill cancer cells by damaging their genes
- The goal of radiation therapy is to cure patients or reduce pain and symptoms
Skin Care for Radiation Dermatitis
- Calendula ointment and topical hyaluronic acid cream are effective for managing radiation dermatitis
- Skin care for moist desquamation includes keeping tissues clean with normal saline compresses or modified Burow's solution soaks
- Protecting the skin from further damage with moisture vapor-permeable dressings or Vaseline petrolatum gauze is essential
Surgical Interventions for Cancer
- Debulking surgery involves removing as much of the tumor as possible, making chemotherapy and/or radiation therapy more effective
- Curative surgeries include radical neck dissection, mastectomy, thyroidectomy, nephrectomy, hysterectomy, and oophorectomy
- Supportive and palliative care involves maximizing bodily function or facilitating cancer treatment when cure or control is no longer possible
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Description
Learn about the importance of oral health and hygiene, including the use of fluoride supplements, saliva substitutes, and oral care protocols to prevent infection and promote nutrition intake.