Bone Marrow Transplantation

Nutritional issues in patients with severe neutropenia

OBJECTIVES

To provide information on the assessment and management of the nutritional needs of patients with severe neutropenia.

DATA SOURCES

Textbook chapters, research articles, and review articles.

CONCLUSIONS

Malnutrition is a common result of high-dose chemotherapy treatment. Clinical outcomes are directly related to careful assessment, early intervention, and ongoing evaluation and monitoring in the severely neutropenic population.

IMPLICATIONS FOR NURSING PRACTICE

Early assessment, management, and psychological support are essential in meeting the needs of this patient population.

Anxiety, needs, and coping in family members of the bone marrow transplant patient

There is an imperative need in cancer nursing to recognize that family members of the patient undergoing bone marrow transplantation are unique in the outside stressors with which they must cope. These families have a multitude of needs to be addressed for them to be able to decrease their anxiety and be able to offer the emotional support the bone marrow transplant patient requires. The stressors, needs, and coping mechanisms of the cancer family, that may affect their outward behavior toward the patient and nursing staff, are outlined here. From this information, nursing interventions can be designed to help families decrease their anxiety and increase coping capabilities.

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.

Allogeneic bone marrow transplantation

From highly investigational to standardized therapy, allogeneic BMT has established its role in the treatment of selected diseases. Continued refinements in bone marrow transplantation will increase the number of potential candidates, reduce associated risks, and improve disease-free survival rates. With further exploration into its efficacy, allogeneic BMT will bring new challenges and opportunities for patients, families, and health care providers.

Selected complications of allogeneic bone marrow transplantation

Patients receiving allogeneic bone marrow transplant experience multiple complications. Specifically, infection, renal complications, VOD, and GVHD can produce life-threatening toxicity. Many of the treatments cause further compromise of major organs. Astute nursing assessment and prompt interventions can decrease the severity experienced by the patient. Each of these complications requires ongoing study to develop new therapies for management.

Issues for designing marrow transplant programs

Centers that design a creative and effective BMT program can be viable in this era of limited health care dollars. Ongoing evaluation of cost and outcome is of critical importance to the center, patients, insurers, and health care policy makers. The program design, operational design, staffing and education needs, and economic considerations are important components of a marrow transplant program.