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Specialized Role:Oncology Nurse
1. SPECIALIZED ROLE : ONCOLOGY NURSE
Manjunathan C.,
RN RPN., M.Sc.(N)., M.Sc.,(CP)., PhD.,(ON),
AGM-Nursing I Operations I JCI Coordinator,
Apollo CBCC Cancer Care,
Apollo Hospitals International Ltd.
Goals of Cancer Treatment,
Expected Complications:
“Hands of Specialized Nurses Role”
2. • What am I going to Learn Today????
1. Definition
2. Goals of Cancer treatment
3. Complications –
* Chemotherapy
* Radiation Therapy
* Surgical therapy
* Bone marrow Transplantation/Stem Cell Transplantation
4. Role of specialized Nurse
20. Acute Toxicities
Busulfan
seizures, pulmonary fibrosis
Calci-neurin inhibitors
seizures, renal failure
Cyclophosphamide
cardiomyopathy, neuropathy, SIADH
Toxicities may happen in all the phases of Bone Marrow Transplantation
Toxicitites in conditioning Phase are:
Drug & Metabolic Disturbances
23. Role of Nurse
Isolation
Periodic assessment and Investigations
Care of lines, tubes and drains
Mouth Care, Nostrils, axilla & Groin care
Neutropenic Diet
Sterlization of articles
& Room Cleaning
Medication
Management
Immunocompromized
/ Neutropenia-Special
Care
24. Role of bedside RN- Isolation
• Positive pressure
• HEPA filter
• PPEs
• Visitor Restriction
• Aseptic Precautions
25. Cont...
• Hand Hygiene: Hand wash before and after using toilet.
• Hand washing to be done while entering the unit
• Advice Health professional to wear mask and to avoid encoutering
patients when they have a cold or URI
• Advice patient to wear mask when they walk in the corridor
• Protect client from others with infections and those who have recently
been vaccinated (a person may have a subclinical infection after a
vaccination)
26. Role of bedside RN- Periodic Assessment and
Investigation
• Hemodynamic stabilization
• Investigation:
– Complete Blood Count (with Differential)
-White cells, haemoglobin, platelets
– Biochemistry
-Electrolytes, urea, creatinine, Liver function
– Microbiology
-Blood cultures (peripheral and all central line lumens)
-Oral ulcers or sores –send swabs ( Viral Cx and fungal Cx )
-Exit site swabs
-Wound swabs
-Urine Cultures
-Stool Cultures
– Radiology
-Chest Xray
27. Role of bedside RN- Care of Lines & Tubes
Central line dressing once in two/three days
Frequent flushing of line
Minimal use of lines
Avoid invasive procedures (e.g. urinary catheterizations, arterial and
venous punctures, injections) whenever possible; if such procedures are
necessary, perform them using sterile technique
Change intravenous insertion sites/tubings according to hospital policy
• Anchor catheters/tubings (e.g. urinary, intravenous) securely in order to
reduce trauma to the tissues and the risk for introduction of pathogens
associated with the in-and-out movement of the tubing
• Maintain a closed system for drains (e.g. urinary catheter) and
intravenous infusions whenever possible
28. Role of bedside RN- Care of Mouth,
Nostrils, Axilla and Groins
Rinse mouth with chlorhexidine/ cephasole solution thrice a day
Sitz bath twice a day
Neosporin powder in the groin and axilla
Candid mouth paint for the tongue
Fusidin ointment for nostrils
Zinc oxide to prevent excoriation
Avoid Clipping Nails
Preventing constipation: Initiate measures to prevent constipation &
prevent damage to the bowel mucosa from hard stool
Avoid unnecessary rectal invasion (e.g. temperature taking, enemas,
suppositories, rectal tube) to prevent trauma to rectal mucosa and
possible abscess formation
29. Role of bedside RN
- Medication Management
• Antibacterial, antiviral and antifungal systemically
• < 7 days of neutropenia
~ response rates to initial antimicrobial therapy was 95%, compared to
only 32% in patients with more than 14 days of
Immunocompromized / neutropenia ( <.001)
~ patients with intermediate durations of neutropenia between 7 and 14
days had response rates of 79%
1988,Rubin and colleagues
30. Role of bedside RN- Immunocompromized
/ Neutropenic Diet
• Avoid raw and undercooked meat
• Double boiled Foods
• Preservatives should not be used: Tinned foods, cheese etc
• Outdated products should not be consumed.
• In patients with periodontitis and stomatitis, a soft or full liquid diet is
indicated.
• Maintain a fluid intake of at least 2500 ml/day unless contraindicated
• Avoid spicy and acidic foods
• Eat only fruits and vegetables that can be washed or cooked.
• Eat only meat that is fully cooked.
• Avoid drinking unpasteurized milk or other unpasteurized beverages.
31. Role of bedside RN- Sterlization & Cleaning
• Autoclave
– RN Scrub
– Patient gowns
– Pillow cover
– Bed spread
– Linens
• Regular room cleaning : Advice cleaning of the room when patient is not
in the room
• Deep Cleaning when required
• Before using equipments (stethoscope, infusion pumps, etc.) from this
room for other patients clean them thoroughly with 70% Alcohol.
• Advice not to use sharp play material and have all items sterilized
32. Role of IC Nurse
• Daily surveillance
• Coordination with HIC committee members and other Medical team
Operations team-
• Auditing practices
Deep cleaning
Nursing practices
• Maintaining schedule of Air vent cleaning, HEPA filter validation /
change
• Coordination with Biomedical Engineers on Room Pressure
• Educating Bedside nurses on Reverse barrier techniques
• Conducting link nurses meeting with supervisors and other important
• Tracking Quality Indicators
33. Best Infection Control Practices-Mandate
for Oncology
Ventilation
Construction
Isolation
Hand
Hygiene
EquipmentPlants
Play
Areas &
Toys
Health
Care
Workers
Visitors
34. Cont...
Patient Skin
Care
Oral & Dental
Care
Prevention of
Bacterial Infection
Related to
Intravascular
Catheter
Drug-Resistant
Organisms
Specific
Nosocomical
Infections
Legionellosis
Community
Respiratory
Virus Infection
Mycobacteriu
m
Tuberculosis
Infection
Control
Surveillance
Ref: Clare A. Dykewicz-Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
35. Cont..,
Toxicities result from profound from during Recovery Phase are;
Marrow suppression
Infectious
Hematologic
Thrombotic microangiopathies
–Hemolytic uremic syndrome
–Risks: female graft, older recipient, viral/fungal infections,
calcineurin inhibitors
Lung injuries
–carmustine, cyclophosphamide, busulfan, melphalan, total
body irradiation
36. Cont..,
Cytokine storm
- Increased risk with rapid engrftment
–capillary leak, oxygen desaturation,
–Differences with GM-CSF vs G-CSF?
Sinusoidal occlusive syndrome (SOS, veno-occlusive
disease [VOD])
–Risks: cyclophosphamide or busulfan; prior
gemtuzumab ozogamicin; allogeneic SCT
Acute graft versus host
–skin rash, diarrhea, elevated transaminases
37. Certainly My role is Important
• Rehab-Care• Survivor
Care
• Supportive
Care
• Symptom
Management
Patient
Assessment
Patient
Education
Coordinati
on of Care
Direct
Patient
Care
38. Major Role-Onco Nurse
Leadership
within the MDT
& wider cancer
team
Innovation, project
management and
change
management
In-depth
knowledge of a
tumor area
Excellent decision
making abilities
Empathy for
patients & their
families
Advanced
communication &
advocacy skills
Ability to assess
patients’ holistic
needs
Acting as a key
worker across
the whole care
pathway
Advanced/
clinical
diagnostic skills
39. No More Slow….
When you become more
slow to accept, adapt and
adopt an advanced
Technologies in the
system
Then we will be????
40.
41. -
Take home message!!!
Don’t wish it were easier, wish
You were Better,
Don’t wish for fewer problems
Wish for more Skills
Don’t wish for less challenges,
Wish for more Wisdom
- Carl Shoaf
42. “We have two jobs: Our job and
the job of improving our job”.
THANK YOU
AnyFurtherqueriesreachme @:
manjunathan1801@gmail.com
