Nursing care during bone marrow transplant is crucial component during patient’s admission in the unit. Following points must be kept in mind while handling a transplant patient.
Medication During Bone Marrow Transplant:
Medications plays and important role in preventing infection during bone marrow transplant. The main medications used are antivirals, anti -bacterial, anti-fungal and anti- rejection immunosuppressive medication in allogeneic bone marrow transplant.
Safe Handling of Central line :
Central lines are recommended for transplant phase to give chemotherapy medicine other medications and to transfuse blood, blood products also to infuse stem cells or bone marrow. Central line care is very important when patient become neutropenic having zero white blood counts or having very compromised immunity.
Mishandling of central line catheter leads to serious complications during transplant. Infected catheter may lead to complications such as endocarditis that is infection of the layer covering the heart and CLABSI. This can lead to life-threatening conditions even death.
Maintaining patient’s personal hygiene: (Nursing care considerations)
Personal hygiene is very necessary to prevent patient from infections.
Management of neutropenia fever 🙁 Nursing care considerations)
when patient’s immunity is compromised patient becomes at high risk for catching infections especially central line associated blood stream infections. Moreover, if patient gets fever must consider following measures.
- Send blood cultures to identify any blood stream infection.
- Must send urine Routine examination and urine culture
- Chest X-ray to rule out hospital acquired pneumonia
- Give anti pyritic to treat/ lower fever
- Hydrate patient to recover insensible loss and prevent dehydration.
- Start antibiotics as per your hospital formulary recommendations.
Keeping Patient in Isolation:
keep patient in a room with heap- filtration device. As, patients with compromised immunity are at higher risk of getting infection from air so, air of room should be filtered and clean. The isolation is called neutropenia isolation. Patient should not be visited by many visitors or a person having fever or any other contagious disease.
Daily monitoring of electrolytes, liver function test and complete blood count is necessary to monitor daily status of patient. Moreover, laboratory indicates the condition of internal body organ and also indicates effects of medications on organs. Deranged or altered electrolytes levels must be replaced.
Preventing constipation: Encourage patient to take fluids and keep them active by doing walk to prevent constipation. Severe constipation leads to gastrointestinal disturbances such as gas and bloating, decrease appetite and perianal muscles irritations and tears in case of very hard stool.
Pain management: During bone marrow transplant patients may experience abdominal cramps due to diarrhea or mucositis /oral ulcer pain. controlling pain is very necessary in bone marrow transplant. Such pains are relieved by pain killers starting from lower intensity to higher intensity.
Mouth care: Mouth care is very important during bone marrow transplant especially when patients count become very low. Good mouth care prevents mouth ulcers. Medications used for routine mouth care are a mouthwash containing anti-fungal in it, Nilstat oral drops any antiseptic gel. Furthermore, some studies suggest honey as a good remedy for mouth ulcers.
Control of bleeding: There could be risk of bleeding during bone marrow transplant as patient’s platelet count becomes very low during neutropenia phase.
Prevent from fall: Patients become very weak during transplant due to low intake and low hemoglobin which could lead to low blood pressure which may result into fall. Patients need extra ordinary care during ambulation.
Hair Fall Management:
Due to high dose chemotherapy and total body irradiation patient experience hair falls. Patient with long hair must be trimmed to avoid getting hair into eyes, and mouth or ears due to excessive fall.
Management of diarrhea: In bone marrow transplant patient get high dose chemotherapy which may cause severe loose motion and vomit. Loose motions must tested for any pathogens especially clostridium\ diffecile and other gut pathogens. Patient with severe diarrhea should be resuscitated with intravenous fluids to prevent dehydration. Moreover electrolytes should be replaced according to their normal ranges. Moreover, any detected pathogen must be treated with antibiotics.
Diet and Nutrition:
Patients become very selective regarding diet. Moreover, it is necessary to maintain patient’s nutrition to bring the body back to its normal condition as chemotherapy hits all systems of the body. Due to which patients become very weak and lethargic. However, nutrition could be maintained by giving fluids containing high calories such as shakes and ice creams. If in case of decrease oral intake due to mucositis or oral ulcers total parental nutrition could be given via central catheter to fulfil patient’s nutritional requirements.
Important drugs and their levels: some important medicines are given to patient throughout transplant process to prevent graft versus host disease such as tacrolimus and cyclosporine. Moreover, the blood levels of these medicines are very important to prevent GVHD. However, trough level is taken before 30 minutes. if the cyclosporine is given intravenous blood sample to monitor the drug level should be taken from peripheral vein. As when it is given through central line it internally coats the line and when blood is drawn the coated drug become concentrated. This gives false results usually very high levels.
As chemotherapy given in the conditioning phase hits and finishes patient whole bone marrow and affects peripheral blood components .this includes platelets and red blood cells that results in need of packed blood transfusion and platelet transfusion.
Infection Control Precautions:
As, patients during transplant are at very high risk for getting infection.to Prevent patients from infection need to control visitors ,avoiding visiting a person having any sign of infections such as coughing ,flu and fever. Moreover, patient should have a special diet known as neutropenia diet. Patients should be avoided raw vegetable and some fruits which could not be peeled off. Frozen food should be avoided and fresh fruits should be encouraged. Drinking water should be boiled water or mineral water. Patient’s room should be with hepa filtration plant to purify the room air.
Maintaining a Good Hydration:
As, due to fever, diarrhea, decreased oral intake and some medications patients become dehydrated so, hydration is needed to keep kidneys well-functioning. Hence care of patient during bone marrow transplant is very crucial part of transplant. maintaining patient’s diet; hygiene and hydration are key components of transplant.