Rol de enfermería en el cuidado de la zona dadora en el paciente quemado / Role of the nurse in the care of the donor skin zone of the burned patient

La cobertura de una quemadura, con un injerto cutáneo de espesor parcial, constituye el tratamiento qurúrgico de eleción para las quemaduras de tipo AB, o B. Para ello es necesario tener una zona dadora o donante, que permita ir recuperando la piel dañada, con la mayor celeridad posible, debido a la inestabilidad del gran quemado. Una zona donante es el área intacta de piel de la que se ha extraído, con una cuchilla protegida (navaja) o con un dermátomo eléctrico, una lámina que se denomina auto injerto y puede ser de espesor total (epidermis y dermis completa). Los sitios donantes son heridas desarrolladas quirúrgicamente y pueden considerarse estériles. La cobertura de elección, es una lámina de piel porcina liofilizada e hidratada con solución fisiológica que se aplica en quirófano, protegida con gasa furacinada de 10 x 10, áposito espiriforme y venda.

Leading change: Retrospective evaluation of a nurse-led initiative in vascular access options for autologous stem cell transplant recipients ranging from Hickman catheters to peripherally inserted central catheters.

Central venous access is essential for patients undergoing autologous hematopoietic stem cell transplantation (ASCT). Traditionally, tunneled silastic catheters have been inserted in these patients. However, changes in resource allocation, resulting in reduced surgery and surgeon time and decreasing toxicity associated with ASCT, have caused changes in venous access needs and options. This led the advanced practice nurse in the transplant program to evaluate other central access devices, which resulted in the introduction of peripherally inserted central catheters (PICCs) for this patient population. This study reports the results of a retrospective analysis comparing efficacy and complication profiles between 50 patients with the traditional Hickman catheter and 70 patients with PICCs.

Toe-to-hand transplantation surgery.

This article discusses toe-to-hand transplantation. The purpose of this article is to familiarize nurses with this procedure. In many cases, the actions taken initially and postoperatively may have a direct effect on the success or failure of the surgery. Two different procedures are discussed. The first procedure is replantation or revascularization of amputated digits in which time is of the essence and is usually performed right after the initial injury. The second procedure is the toe-to-hand transfer, which is an elective procedure in which there is less emphasis on time. This procedure occurs a few months after the initial accident.

Measurement of nursing care time of specific interventions on a hematology-oncology unit related to diagnostic categories.

The aim of this study was to develop a tool that can aid nurse managers in planning nurse staffing levels and assessing workload in hematology-oncology wards. A task-oriented method based on a time-and-motion study was used. Three general nursing procedures and 7 specific oncologic and hematologic activities were clocked. It was checked in the charts of the patient, for each day of the admission, how often selected nursing procedures were performed. Then total amount of time needed for each patient was calculated. Data from 29 admissions to the ward were analyzed and divided into 5 categories based upon the treatment performed during that admission. The categories chosen were: autologous stem cell transplantation, allogeneic stem cell transplantation, graft versus host reaction, leukemia treatment, and chemotherapy for solid neoplasm. The results obtained are an estimate of the different daily workload that is required for these categories of patients in selected nursing procedures.

The changing treatment paradigm in patients with newly diagnosed multiple myeloma: implications for nursing.

PURPOSE/OBJECTIVES: To review the changing treatment paradigm for newly diagnosed multiple myeloma and its implications for nursing. DATA SOURCES: Journal articles, textbooks, published research data. DATA SYNTHESIS: The treatment approaches to newly diagnosed multiple myeloma are varied, and no consensus exists about the best choice of induction therapy prior to high-dose chemotherapy with autologous stem cell transplantation. Novel therapies that have shown strong clinical activity in patients with relapsed or refractory myeloma currently are being explored as first-line therapy with associated higher incidence of serious complications. CONCLUSIONS: Novel approaches in the treatment of newly diagnosed multiple myeloma may lead to better overall patient survival. Research is ongoing to find ways to improve progression-free and overall survival in patients with multiple myeloma. IMPLICATIONS FOR NURSING: Oncology nurses play vital roles in the assessment and monitoring of serious complications associated with various therapies for patients with newly diagnosed multiple myeloma. Key responsibilities include safe and effective administration of complex chemotherapeutic regimens, management of side effects, patient and family education, and coordination of a multidisciplinary approach.

Autologous stem cells derived from the peripheral blood compared to standard bone marrow transplant; time to engraftment: a systematic review.

Lymphoma patients who require high dose chemotherapy are 'rescued' by reinfusion of stem cells to repopulate their bone marrow and minimise the risk of fatal infections or haemorrhage. This review evaluated the evidence for the use of stem cells derived from the peripheral blood to speed the engraftment of neutrophil and platelets when compared to standard bone marrow transplant. A systematic search of the Cochrane Library, Medline and Embase was carried out to identify randomised controlled trials comparing haematological recovery following these two interventions which met predetermined inclusion and exclusion criteria. Four studies were critically appraised and found to follow heterogenous protocols but were otherwise of satisfactory quality. All four studies demonstrated an advantage of peripheral blood stem cell transplantation over bone marrow transplantation in terms of neutrophil recovery and three out of four demonstrated the same trend for platelet engraftment. In sum, there is evidence to support the use of peripheral blood stem cell transplantation for this population of lymphoma patients. Nurses can share this information confidently with patients and other staff. However, a more extensive review of studies which have investigated the association between extended neutrophil and platelet recovery and length of hospitalisation, number of septic neutropenic episodes and cost reduction is needed to give a fuller picture of the effects for treatment.

Fatigue and depression in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation.

PURPOSE/OBJECTIVES: To describe the patterns of depression and fatigue, including its dimensions, and the relationship between these two variables in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation (PBSCT). DESIGN: Prospective, descriptive, correlational, repeated measures. SETTING: Midwestern university National Cancer Institute-designated clinical cancer center. SAMPLE: 27 patients with lymphoma aged 19 to 71 undergoing autologous PBSCT. METHODS: The revised Piper Fatigue Scale was used to measure fatigue and its dimensions. The Center for Epidemiologic Studies' Depression Scale was used to measure depression on selected days at baseline and during chemotherapy and recovery. MAIN RESEARCH VARIABLES: Fatigue and its four dimensions (behavioral/severity, sensory, cognitive/mood, and affective meaning) and depression. FINDINGS: Total fatigue, fatigues four dimension scores, and depression scores changed significantly over time, with the highest scores at day + 7 after transplant. Total fatigue and the four dimension scores were highly and positively correlated with depression, with the highest correlation reported between the affective fatigue dimension and depression. CONCLUSIONS: The findings support the importance of assessing fatigue and depression in patients undergoing autologous PBSCT at baseline, during chemotherapy, and throughout recovery. IMPLICATIONS FOR NURSING: Routine clinical assessment with close observation around day +7 after transplant and patient education about the patterns of fatigue and depression will help the healthcare team to intervene at the appropriate time and may help patients to better manage these symptoms.

Osteochondral autotransfer--newer treatment for chondral defects.

Osteoarthritis is believed to be accelerated by full thickness defects of articular cartilage. This article describes emerging therapies, including mosaicplasty autologous (i.e., the patient's own) graft and autologous chondrocyte implantation techniques. Patients with chondral defects caused by a variety of possible pathologies experience positive implications, including return to normal function and delaying the onset of osteoarthritis.

The lived experience of seven people treated with autologous bone marrow/peripheral blood stem cell transplant.

Autologous bone marrow or peripheral blood stem cell transplant are recent treatments to offer hope of a cure or prolonged remission for certain types of cancer. Current literature predominantly has either a biomedical focus or deals with survivorship issues. The ways in which survivors perceive this treatment option is important in providing nurses with a deeper insight and understanding with which to inform nursing practice. Using methods consistent with hermeneutic phenomenology, seven people who survived this treatment were invited to participate in sharing their stories in individual audiotaped interviews. Themes that emerged from their stories include changing concepts of self, the significance of relationships, being different from the past and temporality.

Cardiac explantation and autotransplantation.

Cardiac explantation and autotransplantation is a procedure by which the heart is removed from the chest and replaced. Explantation of the heart for tumor removal has been documented six times in the literature; however, with this aggressive approach, the median patient survival rate is only eight months. This article presents a case study in which this procedure was used to treat a patient with malignant fibrous histiocytoma.

Autologous stem cell transplant: an overview.

Autologous stem cell transplantation increasingly is used as a treatment modality for selected hematologic and solid tumors. Autologous stem cell transplant comprises either autologous bone marrow transplant (ABMT) or peripheral blood stem cell transplant (PBSCT). ABMT and PBSCT enable patients to receive potentially lethal doses of chemotherapy or radiation therapy and rescue them with a viable source of new blood cells. Supportive measures, including blood product, growth factor, and antibiotic administration, and the expanded clinical expertise of ambulatory and home care nurses have allowed an increasing portion of this process to be performed outside of an acute care setting. The shift of care to an ambulatory or home setting will become the standard, rather than the exception, in the near future. A brief review of major implications for nurses is delineated.

Peripheral blood stem cell transplantation.

Peripheral blood stem cell (PBSC) transplantation is a promising new therapy in the treatment of malignancies. It is being used to supplement and in place of bone marrow transplantation to restore hematopoiesis after myeloablative therapy. PBSCs are collected through apheresis, generally after a course of myelosuppressive therapy to prime the progenitor cells. Problems that potentially could arise during PBSC collection include citrate toxicity, hypovolemia, and thrombocytopenia. PBSC infusion is similar to the infusion of bone marrow. Engraftment following PBSC transplantation progresses rapidly, resulting in shorter hospital stays. The future of PBSC therapy looks promising, but much still has to be learned about this innovative treatment.

Autologous bone marrow transplantation. A review of the principles and complications.

High-dose chemotherapy and autologous bone marrow transplantation (ABMT) is now used routinely in an attempt to cure patients with poor-prognosis malignant diseases. This aggressive and intensive treatment requires a highly trained health-care team. Nurses specializing in the care of these patients are essential to maintain patient well-being and ensure a good outcome. High-dose therapy leads to myelosuppression and tissue damage, and the resultant infections, bleeding, and organ toxicities are frequently either unusual or more severe than those seen with conventional-dose antineoplastic therapies. Organ toxicities can affect both short-term and long-term functional status. Disabling or even fatal consequences of treatment can occur during the transplant or months or years later. A specialized knowledge base and an understanding of the way this therapy affects the patient is required not only for the acute inpatient period, but also for the long term. A team approach to these complex patients with a central role for the nurse clinician will lead to optimal patient care.

Assessment of the autologous bone marrow transplant patient according to Orem's self care model.

Autologous bone marrow transplantation (ABMT) is an increasingly effective treatment option for both hematologic malignancies and solid tumors. The dose-limiting toxicity of bone marrow suppression after intensive chemotherapy and/or radiation therapy can be minimized by reinfusing the patient's stored marrow. However, the ABMT procedure involves a period of profound neutropenia before the reinfused marrow engrafts and it also carries a significant risk of major organ toxicities. Common adverse effects of the procedure include mucositis, pneumonitis, renal failure, and veno-occlusive disease of the liver. In this article, Orem's Self-Care Model is used as a framework for assessing ABMT patients with the goal of recognizing developing complications early.

The Ross procedure: aortic valve replacement using autologous pulmonary valve.

The use of pulmonary autologous valve in aortic valve replacement pioneered by Dr. Donald Ross in 1967 has been employed in young patients for more than two decades with impressive results. This procedure is recommended for young patients with isolated aortic disease who are expected to have a longer life span. Because of its lack of tissue degenerative changes, the autologous pulmonary valve has the potential to function longer than other biologic valves and mechanical valves while exhibiting the same inherent hemodynamic advantages. The assessment of the long-term performance of the pulmonary autograft in the aortic position suggests that the pulmonary autologous valve is the best choice for isolated aortic valve replacement in young patients.