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Nursing Care for a Client Receiving a Bone Marrow Transplant

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Mary Goodwin

on 1 February 2015

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Transcript of Nursing Care for a Client Receiving a Bone Marrow Transplant

The Types of Bone Marrow Transplants
One to three days after treatments are complete, 'administration' of the bone marrow is done. The collected bone marrow is thawed and re-administered to the patient intravenously. The stem cells reconstitute the patients hematopoietic system.

The day of administration is numbered as day 0.
Between 10-28 days after the transplant, the bone marrow goes through a stage called 'engraftment'. This is when the stem cells reach the bone marrow and begin to make new bone marrow. Patients continue to stay in hospital under isolation during this time to prevent infection. Patients can be discharged once their nutrition, blood work,and GI system (no nausea, vomiting or diarreha) has returned to normal levels.
Nursing Care for a Client Receiving a Bone Marrow Transplant
Harvesting the Bone Marrow
Once a donor match has been made, the donor's stem cells are collected from the bone marrow in a procedure called 'harvesting'. A needle is inserted into the bone marrow and the marrow is aspirated. Bone marrow is harvested from either the iliac crest or sternum. Usually multiple needle sticks are required to collect an adequate amount of stem cells. The collection is then filtered to remove any fat cells or bone fragments.The sample is then made suitable for storage by adding preservatives before freezing.
Preparative Therapy
Bone Marrow Transplants (BMT)
With this type of BMT, the transplant comes from a donor. Often family members are found to be the best match. High doses of chemotherapy with or without radiation are administered, then the bone marrow is transplanted to "rescue" the host. This type is most commonly used in leukemia patients.
BMT allows for large doses of chemotherapy (with or without radiation) to be administered to clients where tumours are resistant to the standard doses of treatment. Once these treatments are complete, a bone marrow transplant is used to replace the client's bone marrow.
The Goal of a BMT is to cure a client's malignant or nonmalignant disease.
(Lewis et al., 2010)
Allogeneic, Autologous & Syngeneic
(American Cancer Society, 2015)
(Lewis et al., 2010)
Patients will receive their own bone marrow. The bone marrow is removed and stored before they are given high doses of chemotherapy or radiation. Once receiving one or both of these treatments, their own bone marrow is reintroduced.
(Lewis et al., 2010)
Syngeneic bone marrow transplants are where the donor is an identical twin. Stem cells are harvested from one twin and infused into the other.
(Lewis et al., 2010
(American Cancer Society, 2014)
(Lewis et al., 2010)
(American Cancer Society, 2014)

Once the bone marrow is harvested the patient will receive high doses of chemotherapy with or without radiation. This will prepare the patient's bone marrow for the transplant and remove any remaining cancer cells. The bone marrow is destroyed during this process, thus making room for new bone marrow.
(Lewis et al., 2010)
Post Transplant
(American Cancer Society, 2014)
Viral, bacterial, and fungal infections. Patients are at high risk for infection until engraftment due to their critically low white blood cell count.

Graft-verse-host disease:
most common for allogeneic bone marrow transplants. The T-cells from the donor attack many of the recipient's organs and cause tissue rejection.

Other Complications:
malnutrition, diarrhea, nausea, vomiting, dehydration, bleeding, anemia, pain, renal injury, lung damage, cardiac damage, graft failure, graft rejection and many more...
(Budde et al., 2014)
(American Cancer Society, 2014)
(Lewis et al., 2010)

American Cancer Society. (2008). Title of the web article. Retrieved from http://www.whatever.com

Budde, H., Kolb, S., Salinas Tejedor, L., Wulf, G., Reichardt, H. M., Riggert, J., & Legler, T. J. (2014).
Modified Extracorporeal Photopheresis with Cells from a Healthy Donor for Acute Graft-versus-Host Disease in a Mouse Model
. Plos ONE, 9(8), 1-9. doi:10.1371/journal.pone.0105896

Kee, J.(2010).
Laboratory and Diagnostic Tests
. Upper Saddle River New Jersey, United States of America: Pearson

Lewis, S., Heitkemper, M., Dirksen, S., O'Brian, P. & Bucher, L. 2010.
Medical-Surgical Nursing in Canada: Assessment and management of clinical problems.
Toronto, Canada. Mosby Elsevier.

Potter & Perry. (2010).
Canadian Fundamentals of Nursing.
Toronto, Canada. Mosby Elsevier.
Nurse's Role
Before, during and after the bone marrow transplant the nurse has many key roles including frequent assessments of the patient's vitals. Temperature, blood pressure and heart rate can be the first signs of infection.It is crucial that the nurse reports any abnormal vital signs to the physician immediately.

Drawing blood work such as complete blood count and blood cultures and obtaining urine cultures are other roles for the nurse.

Maintaining contact precautions to prevent infection and adequate hand hygiene needs to be done by the nurse. The nurse must also make sure visitors do the same.

Assisting with ADLs, planning for rest periods and encouraging nutrition intake are also important nursing tasks.
(Kee, 2010)
(Lewis et al., 2010)
Health Teaching
The most important health teaching point for families and the patient is infection control. Frequent hand hygiene, maintaining contact precautions (depending on the agency policies) and refraining from visiting while experiencing flu-like symptoms are of key importance.

Health teaching for the patient includes the signs and symptoms of infection (fever, chills and diaphoresis) and to notify the nurse of these symptoms.

Health teaching for the family and patient include the importance of adequate oral intake maintain proper nutrition and hydration.

When the patient is ready for discharge, health teaching includes infection control practices at home. Separating soiled from unsoiled linens in the wash and using disinfectants when appropriate.
(Lewis, et al., 2010)
(Potter & Perry, 2010)
Being in the hospital for 30 or more days can be very taxing on both the patient and their family. These effects are exacerbated for the patient while they are under isolation. The daily support they would normally have at their own home such as telephone calls, emails, texts, video calls and drop ins from family and friends are no longer part of their daily routine. Depression is a common by-product of bone marrow transplants. With proper infection control health teaching, and support from the nurse, patients can safely have visitors while in hospital.
(Lewis et al., 2010)
(Potter & Perry, 2010)
NURS 2016



DUE: FEBRUARY 2nd, 2015
Image Retrieved from: www.independent.co.uk
Harvesting stem cells from the bone marrow.
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