Sometimes, transplants are needed when high doses of chemo or radiation have destroyed too many blood cells, and the transplant is used as a “rescue” treatment 2 Types: Stem Cell Transplant _bone_______ marrow transplant Stem cells from the blood or bone marrow can come from the client a matched __donor___________ or from an identical sibling or twin.
Stem cells are given into a vein (similar to blood transfusion). Over time they settle in the bone marrow and hopefully produce healthy blood cells. Complications of transplants: Infection Graft vs Host Disease (GVHD: the graft rejects or “attacks” the host Early signs of rejection 1) _abdominal________________ pain or cramps, nausea, vomiting, and diarrhea 2) Jaundice or other liver problems 3) Dark (tea-colored) urine 4) Skin rash, itching, and redness GVHD is treated with anti-rejection drugs and steroids G. Major Side Effects of Cancer and/or Treatment for Cancer 1. Fatigue – Plan and pace patient care. Not relieved by rest 2. Infection is the # _1____ cause of death related to cancer a. Infection Prevention (neutropenic precautions) Private room, wash hands, have their _own_____ supplies in room (b/p, stethoscope) Limit visitors / nurses in the room Change dressings and IV tubing _daily_________ Cough and deep breathe No _fresh_______ flowers or __potted___________ plants Avoid crowds Do not share toiletries Bathe warm moist areas usually twice daily (groin and under the arms) Wash hands after touching a pet, shaking hands with people Avoid __raw_____ fruits and vegetables Only drink _fresh_________ water b. Nursing Considerations Assess for slight increase in temperature which could mean _sepsis_______. Instruct client to come to hospital or clinica for an oral temperature of _100.4_______ or greater Monitor absolute neutrophil count.
4. Neutropenia: A decrease in the number of neutrophils (mature WBCs) in the blood. ANC = absolute neutrophil count. The ANC shows how many WBCs are neutrophils and can show how well the patient can handle an infection. Normal ANC (absolute neutrophil count): 2200 to 7700 cells/mm3 a. Nadir: The __lowest_______________ point. 7-14 days after chemo Neutrophils are the 1 st line of defense inside the body to protect us from _infection______________ Neutropenia + Infection = Sepsis, Septic shock, and ___death__________ b. Risk factors for Neutropenia The very old and the very young Advanced metastatic disease Malnourishment Vitamin __B12____ and folic acid deficiencies can cause neutropenia Impaired tissue integrity (wounds, ulcers, ostomies) Presence of other disease (comorbidities such as COPD, HIV/AIDS) Hematologic malignancies Lymphomas, __leukemias________, and myelomas Can be a side effect of cancer treatment (ex. Chemo/radiation) c. Neutropenia Treatment Prophylactic antibiotics Implement Neutropenic Precautions (see previous on handout and all the general ways to prevent infection in addition to: Vital signs a minimum of every _four hours____________ Private room with door closed and sign posted Antimicrobial soap for handwashing instead of regular soap No invasive procedures: No IM _injections_____ or ___rectal__ meds or rectal exam.
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