CLINICAL SPECIALITY-II MEDICAL SURGICAL NURSING- ONCOLOGY NURSING, M.Sc. Nursing

Placement : II Year Hours of Instruction

Theory : 150 hours

Practicals : 950 hours

Total : 1100 hours

Course Description
This course is designed to assist students in developing expertise and indepth
understanding in the field of oncology Nursing. It will help students to
develop advanced skills for nursing intervention in various oncological
conditions. It will enable the student to function as oncology nurse
practitioner/specialist and provide quality care. It will further enable the
student to function as educator, manager, and researcher in the field of
oncology nursing

Objectives


1. Explain the prevention, screening and early detection of cancer
2. Describe the epidemiology, etiology, pathophysiology and diagnostic
assessment of oncological disorders of various body systems
3. Describe the psychosocial effects of cancer on patients and families.
4. Demonstrate skill in administering/assisting in various treatment
modalities used for patients with cancer
5. Apply nursing process in providing holistic care to patients with
cancer.
6. Apply specific concepts of pain management
7. Appreciate the care of death and dying patients and value of
bereavement support.
8. Describe the philosophy, concept and various dimensions of palliative
care
9. Appreciate the role of alternative systems of medicine in care of cancer
patients
10. Appreciate the legal & ethical issues relevant to oncology nursing
11. Recognize and manage Oncological emergencies
12. Counsel the patients with cancer and their families
13. Incorporate evidence based nursing practice and identify the areas of
research in the field of oncology nursing
14. Recognize the role of oncology nurse practitioner as a member of
oncology team
15. Collaborate with other agencies and utilize resources in caring for
cancer patients.
16. Teach and supervise nurses and allied health workers.
17. Design a layout and develop standards for management of oncology
units/hospitals and nursing care.

Content outline
Unit Hours.
Content
I 4 Introduction


􀂉 Epidemiology-Incidence, Prevalence – Global, National, State and
Local
􀂉 Disease burden, concept of cancer, risk factors
􀂉 Historical perspectives
􀂉 Trends and issues
􀂉 Principles of cancer management
􀂉 Roles and responsibilities of oncology nurse

II 5 The Nature of Cancer


􀂉 Normal cell biology
􀂉 The Immune system
􀂉 Pathological and pathophysiological changes in tissues
• Biology of the cancer cell
• Clone formation Transformation
• Tumor stem lines
• Structure of a solid tumor
• Products produced by the tumor
• Systemic effects of tumor growth

III 4 Etiology of Cancer


􀂉 Carcinogenesis,
􀂉 Theories of cancer causation
􀂉 Risk factors
􀂉 Carcinogens – genetic factors, chemical carcinogens, radiation,
viruses, Immune system failure, rapid tissue proliferation
􀂉 Hormone changes, diet, emotional factors.

IV 10 Diagnostic Evaluation


􀂉 Health assessment: History taking, physical examination,
􀂉 Staging and grading of tumors,
􀂉 TNM Classification
􀂉 Common diagnostic tests
• Blood investigation: Haemetological, Bio-chemical, Tumor
markers, Hormonal assay
• Cytology:Fine needle aspiration cytology(FNAC)
• Histopathology: Biopsy
• Radiological assessment: MRI, Ultrasound, Computed
tomography, Mammography, Positron emission
tomography(PET), Radio nuclide imaging, Functional
metabolism imaging
• Endoscopies
Nurses responsibilities in diagnostic measures

Unit Hours.
Content
V 10 Levels of prevention and care


􀂉 Primary prevention – Guidelines for cancer detection, general
measures, Warning signs of cancer,
􀂉 Self examination-Oral, Breast, Testicular
􀂉 Secondary prevention – early diagnosis.
􀂉 Screening
􀂉 Tertiary prevention – disability limitation,
􀂉 Rehabilitation :Mobility , Speech, Bowel and bladder, Ostomies etc
􀂉 Patient and family education,
􀂉 Discharge instruction, follow-up care and use of community
resources.

VI 25 Cancer Treatment Modalities and Nurse’s Role


􀂉 Surgery
• Principles of surgical oncology
• Current surgical strategy,
• Determining surgical risk
• Special surgical techniques
• Pre-intra-postoperative nursing care
• Acute and chronic surgical complications
• Future directions and advances
􀂉 Chemotherapy
• Principles and classification of chemotherapeutics
• Pharmacology of antineoplastic drugs- Mechanism of action,
Absorption, protein binding, Bio-transformation, excretion,
common side effects, drug toxicity
• Calculating drug doses,
• Therapeutic response to chemotherapy-Tumor variables, drug
resistance,
• Safety precautions
􀂉 Radiation Therapy
• Physics of radiotherapy
• Types of ionizing rays
• Radiation equipments:Linear accelerator, cobalt,
Implants,Isotopes,
• Types of therapies: Oral, Brachy therapy, tele therapy, selectron
therapy
• Effects of radiation on the body tissue,
• Radiation biology – cell damage hypoxic cells, alteration of
tumor kinetics.
• Approaches to radiation therapy –
• External radiotherapy
• Internal radiotherapy – unsealed,
• Sealed sources.
• Effectiveness of radiotherapy-Radiosensitivity, treatment effects
• Complications of radiotherapy
• Radiation safety: Standards of Bhaba Atomic Research
Centre(BARC)
􀂉 Bone Marrow Transplantation /Stem Cell Transplantation
• Types, indications, transplantation procedure, complications
and nursing managment
• Types and donor sources
• Preparation and care of donor and recipient
• Bone marrow bank
• Legal and ethical issues
􀂉 Immunotherapy (Biotherapy)
• Concepts and principles
• Classification of agents
• Treatment and applications
􀂉 Gene Therapy
• Current Concepts and practices
􀂉 Alternative and Complementary Therapies
• Current practices

VII 10 􀂉 Pain management:- Theories, types and􀂉 Assessment of pain


• Nature of cancer pain
• Pathophysiology of pain
• Pain threshold
• Principles of cancer pain control
• Pharmacological: Opioid and non-opioid analgesic therapy
• Patient controlled analgesia(PCA)
• Other invasive techniques of pain control
• Recent developments in Cancer pain
􀂉 Non- Pharmacological pain relief technique-
• Complementary therapies(Music, massage, meditation,
relaxation techniques, biofeed back etc)
• Psychological intervention in pain control
• Alternative system of medicines
Role of nurse

VIII 5 Palliative care


􀂉 Definition and scope, philosophy
􀂉 Concept and elements of palliative care
􀂉 Global and Indian perspective of palliative care
􀂉 Quality of life issues
􀂉 Communication skill
􀂉 Nursing perspective of palliative care and its elements
􀂉 Home care
􀂉 Hospice care
Role of nurse in palliative care

Unit Hours.
Content
IX 2 􀂉 Infection control:


• Process of infection, risk of hospitalization, nosocomial
infections- prevention and control of infection in acute, long
term care facility and community based care
• Standard safety measures

X 30 Nursing Care of Patients With Specific Malignant Disorders


􀂉 Malignancies of G.I. system-oral, oesophagus, stomach, rectal,
liver & pancreas, care of ostomies/stoma
􀂉 Respiratory malignancies
􀂉 Genito urinary system malignancies- prostate Bladder, renal
testicular malignancies,
􀂉 Gynecological malignancies-cervix, uterus, ovary
􀂉 Hematological malignancies-Lymphomas, Leukemias.
􀂉 Malignancies of musculoskeletal system
􀂉 Endocrine malignancies
􀂉 Skin
􀂉 Head and Neck -brain tumors
􀂉 Other malignancies – Breast cancer, AIDS related Malignancies
(Kaposi's Sarcoma)

XI 10 Paediatric malignancies


􀂉 Leukemia, Lymphoma, Neuro- blastoma
􀂉 Wilm’s tumor, Soft tissue sarcoma, Retinoblastoma
􀂉 Nursing Management of children with Paediatric Malignancies

XII 15 Nursing Management of Physiological Conditions and Symptoms
Of Cancer Patient


􀂉 Nutrition: - effects of cancer on nutritional Status and its
consequences:-Anemia, Cachexia, Xerostomia, mucositis,
Dysphagia , nausea and vomiting, constipation, diarrhoea,
electrolyte imbalances, taste alterations
􀂉 Impaired mobility: Decubitus ulcer, pathologic fractures,
thrombophlebitis, pulmonary embolism, contractures, footdrop
Other symptoms
􀂉 Dyspepsia & hiccup, dyspnoea
􀂉 intestinal obstruction,
􀂉 Fungating wounds
􀂉 Anxiety & depression, insomnia
􀂉 Lymph edema
Impact of cancer on sexuality:
􀂉 Effects of radiotherapy/ chemotherapy/surgery on sexuality of the
cancer patient
􀂉 Nursing management of cancer patients experiencing sexual
dysfunction
􀂉 Sexual counseling

Unit Hours.
Content
XIII 10 Cancer Emergencies


􀂉 Disseminated intravascular coagulation(DIC),
􀂉 Malignant pleural effusion
􀂉 Neoplastic cardiac tamponade and septic shock spinal cord
compression
􀂉 Superior venacava syndrome
􀂉 Metabolic emergency: hyper and hypo calcemia
􀂉 Surgical emergency
􀂉 Urological emergency
􀂉 Hemorrhage
􀂉 Organ obstruction
􀂉 Brain metastasis
􀂉 Nurses role in managing oncologic emergencies

XIV 8 Psycho-Social Aspects of Nursing Care


􀂉 Psychological responses of patients with cancer
􀂉 Psychosocial assessment –
􀂉 Crisis intervention, coping mechanisms
􀂉 Stress management, spiritual/cultural care and needs
􀂉 Counseling: individual and family
􀂉 Maximizing quality of life of patient and family
Ethical, moral and legal issues-
􀂉 End of life care
􀂉 Grief and grieving process
􀂉 Bereavement support
􀂉 Care of Nurses who care for the dying.

XV 2 Layout and Design of an oncology institution/ ward, OPD,


chemotherapy unit, Bone marrow transplantation unit, Pain
clinic etc
􀂉 Practice Standards of oncology nursing
• Policies and Procedures
􀂉 Establishing Standing orders and Protocols
Quality Assurance Programme in oncology units
􀂉 Nursing audit

Clinical Experience


S.No.           Deptt./ Unit                No. of Week Total Hours
1 Medical Oncology ward 6 180 Hours
2 Surgical Oncology ward 6 180 Hours
3 Bone marrow transplantation Unit 2 60 Hours
4 Operation Theatre 2 60 Hours
5 Radiotherapy Unit 2 60 Hours
6 Chemotherapy Unit 4 120 Hours
7 Out patient department and pain clinic 2 60 Hours
8 Pediatric Oncology ward 2 60 Hours
9 Palliative Care ward 2 60 Hours
10 Community oncology 2 60 Hours
11 Hospice 1 30 Hours
12 Other field visits 1 30 Hours
Total 32 Weeks 960 Hours

Procedures Observed


1. CT Scan
2. MRI
3. PET Scan(Positron Emission Tomography)
4. Ultra sound
5. Mammography
6. Radio Nuclide Imaging
7. Bone Scan
8. Thyroid Function Test
9. Functional and Metabolic Imaging
10. Transportation of radioactive materials
11. Others

Procedures Assisted


1. IV cannulation – Open method
2. Chemotherapy
3. Radiotherapy – Brachytherapy – Low Density Radiation, High Density
Radiation.
4. Interstitial implantation
5. Bio-therapy and Gene therapy
6. Teletherapy – Treatment planning
7. Bone marrow aspiration and biopsy
8. Biopsy – tissue
9. FNAC – Fine Needle Aspiration Cytology and biopsy