Nursing Management in Bone Marrow Transplantation

Nursing care of patients undergoing BMT is complex and demands a high level of skill. Transplantation nursing can be extremely rewarding yet extremely stressful. The success of BMT is greatly influenced by nursing care throughout the transplantation process.
 

IMPLEMENTING PRETRANSPLANTATION CARE
All patients must undergo extensive pretransplantation evaluations to assess the current clinical status of the disease. Nutritional assessments, extensive physical examinations and organ function tests, and psychological evaluations are conducted. Blood work includes assessing past antigen exposure (for example, to hepatitis
virus, cytomegalovirus, herpes simplex virus, HIV, and syphilis). The patient’s social support systems and financial and insurance resources are also evaluated. Informed consent and patient teaching about the procedure and pretransplantation and posttransplantation care are vital.

PROVIDING CARE DURING TREATMENT
Skilled nursing care is required during the treatment phase of BMT when high-dose chemotherapy (conditioning regimen) and total body irradiation are administered. The acute toxicities of nausea, diarrhea, mucositis, and hemorrhagic cystitis require close monitoring and constant attention by the nurse. Nursing management during the bone marrow or stem cell infusions consists of monitoring the patient’s vital signs and bloodoxygen saturation; assessing for adverse effects, such as fever, chills, shortness of breath, chest pain, cutaneous reactions, nausea, vomiting, hypotension or hypertension, tachycardia, anxiety, and taste
changes; and providing ongoing support and patient teaching. 

Throughout the period of bone marrow aplasia until engraftment of the new marrow occurs, patients are at high risk for dying of sepsis and bleeding. Patients require support with blood products and hemopoietic growth factors. Potential infection may be
bacterial, viral, fungal, or protozoan in origin. Renal complications arise from the nephrotoxic chemotherapy agents used in the conditioning regimen or those used to treat infection (amphotericin B, aminoglycosides). Tumor lysis syndrome and acute tubular necrosis are also risks after BMT. 

GVHD requires skillful nursing assessment to detect early effects on the skin, liver, and gastrointestinal tract. VOD resulting from the conditioning regimens used in BMT can result in fluid retention, jaundice, abdominal pain, ascites, tender and enlarged liver, and encephalopathy. Pulmonary complications, such as pulmonary edema, interstitial pneumonia, and other pneumonias, often complicate the recovery after BMT. (Medical and Surgical Nursing; Brunner & Suddarth10th Edition)

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