Selected complications of allogeneic bone marrow transplantation

Veno-occlusive disease in hematopoietic stem cell transplantation recipients

Veno-occlusive disease (VOD) is a potentially fatal complication of hematopoietic stem cell transplantation that affects the liver, as well as other organs. Although mild cases resolve on their own, severe cases of VOD carry a high mortality rate. The diagnosis usually is clinically based, with nonspecific signs such as weight gain, ascites, hepatomegaly, right upper quadrant abdominal pain, and elevated serum bilirubin. Although studies are ongoing, no U.S. Food and Drug Administration-approved treatments for VOD exist to date. Therefore, supportive care is a critical part of the treatment plan. Oncology nurses should be familiar with the risk factors and clinical signs of VOD so that patients can be monitored closely for its occurrence. Accurate and timely recognition of VOD is crucial for appropriate treatment.

Hematopoietic stem cell transplantation: implications for critical care nurses

Hematopoietic stem cell transplantation (HSCT) is being used increasingly in the treatment of malignant and nonmalignant diseases. The treatment modality has been proven effective but is not without risks. Studies consistently have identified the need for advanced supportive care (e.g., multiple organ dysfunction, vasopressor use, mechanical ventilation) as a negative prognostic indicator in patients who have received HSCT. Among patients who have received HSCT, 15%-40% require critical care monitoring or advanced support. Nurses on intensive care units can positively impact outcomes for transplant recipients when they possess the specialized skills to recognize and promptly intervene when transplant-related complications arise. This article will provide a basic overview of the HSCT process and outline the complications that may necessitate transfer to a higher level of care for specialized skills and equipment in the intensive care setting.

[Self-care in hospital discharge planning after bone-marrow transplantation: a case report]

The purpose of this work was to construct an instrument that would enable the characterization of therapeutic self-care needs of an individual submitted to bone marrow transplantation (BMT) by reflecting on nursing interventions in the planning of hospital discharge based on Orem's self-care theory. The inclusion criteria consisted in the selection of allogenic clients who had been submitted to BMT and presented chronic myeloid leukemia. Data analysis enabled the evaluation of modified self-care requirements and nursing interventions were included in the support-education system and in the partly compensatory system. The instrument must be refined, but its use can be suggested as a support for the elaboration of the planning of hospital discharge for BMT patients.

Myelodysplastic syndromes

OBJECTIVES

To provide a framework of information from which the nurse can collaborate with the health care team to plan, coordinate, and deliver care to persons with myelodysplastic syndromes (MDS) and their families.

DATA SOURCES

Research studies, book chapters, and review articles pertaining to the classification, pathogenesis, manifestations, diagnosis, treatment, and prognosis of MDS.

CONCLUSIONS

The MDS are a group of hematologic disorders characterized by ineffective hematopoiesis, peripheral blood cytopenias, and a propensity to transform into acute myelogenous leukemia. The primary treatment is supportive care; however, chemotherapy, bone marrow transplant, and hematopoietic growth factors are also used.

IMPLICATIONS FOR NURSING PRACTICE

Assessment, education, emotional support, monitoring of complications, and provision of help to the patient with fatigue to prioritize activities and plan periods of rest are important supportive care measures.

Bone marrow transplantation: issues for critical care nurses

Bone marrow transplantation (BMT) is becoming a wide used therapeutic modality in the field of cancer care. Offering long-term disease-free survival in more than half of some patients with previously fatal diseases, this therapy has challenged clinicians to reevaluate critical care management strategies for such patients. Critical illness occurs in approximately one third of allogeneic transplants, necessitating that critical care nurses be familiar with this therapy and its reported complications. Critical care nurses are an integral part of producing the reported cure and remission rates, despite significant complications. In this article, the authors outline the common critical care problems of this patient population. The chronologic format enables the practitioner to correlate and differentiate key characteristics of potential complications. A case study, with clinical symptoms representing several potential etiologies, demonstrates the application of these concepts. Through the use of nursing knowledge of the unique needs of these patients, there is the potential to continue to improve patient outcomes.