Cuidados de enfermagem com pacientes submetidos a transplante de células-tronco hematopoiética / Cuidados de enfermería de pacientes sometidos a trasplante de células madre hematopoyética / Nursing care for patients undergoing hematopoietic stem cell transplantation

Resumo Objetivo: Mapear estudos de enfermagem que contemplem os cuidados de enfermagem com pacientes submetidos ao transplante de células-tronco hematopoiética. Métodos: Revisão de escopo, cuja busca foi realizada nas bases MEDLINE, CINAHL e LILACS, no período de junho a agosto de 2019, em português, inglês e espanhol. Foram selecionadas 18 publicações que contemplavam a temática. Resultados: Os cuidados de enfermagem estiveram relacionados às fases do transplante, a saber: condicionamento, infusão, pega e pós-transplante. Conclusão: O conhecimento específico do cuidado de enfermagem com o paciente submetido ao transplante de células-tronco hematopoiética permite ao enfermeiro o reconhecimento de complicações dessa clientela, favorecendo intervenções precoces e visando ao restabelecimento do indivíduo, contribuindo, assim, para uma assistência de enfermagem baseada em evidências.

Resumen Objetivo: Mapear estudios de enfermería que contemplen los cuidados de enfermería de pacientes sometidos al trasplante de células madre hematopoyética. Métodos: Revisión de alcance, cuya búsqueda fue realizada en las bases MEDLINE, CINAHL y LILACS, en el período de junio a agosto de 2019, en portugués, inglés y español. Fueron seleccionadas 18 publicaciones que contemplaban la temática. Resultados: Los cuidados de enfermería estuvieron relacionados con las fases del trasplante, a saber: acondicionamiento, infusión, injerto y postrasplante. Conclusión: El conocimiento específico sobre los cuidados de enfermería de pacientes sometidos al trasplante de células madre hematopoyética permite al enfermero reconocer las complicaciones de esta clientela, favorece intervenciones precoces en busca de la recuperación del individuo y, de esta forma, contribuye para una atención de enfermería basada en evidencias.

Abstract Objective: To map nursing studies that address nursing care for patients submitted to hematopoietic stem cell transplantation. Methods: Scoping review, whose search was carried out in the MEDLINE, CINAHL and LILACS bases, from June to August 2019, in Portuguese, English and Spanish. We selected 18 publications on the theme. Results: The nursing care was related to the phases of the transplantation, namely: conditioning, infusion, harvest, and post-transplantation. Conclusion: The specific knowledge of nursing care for patients submitted to hematopoietic stem cell transplantation allows the nurse to recognize complications of this clientele, favoring early interventions and aiming to restore the patient, thus contributing to evidence-based nursing care.

The Roles of Nurses in Hematopoietic Cell Transplantation for the Treatment of Leukemia in Older Adults.

OBJECTIVE: To review and summarize nurses' roles in the care of the older adult undergoing an allogeneic hematopoietic cell transplant (HCT) for the treatment of leukemia. DATA SOURCES: Published literature indexed in PubMed, CINAHL, textbooks, and clinical expertise. CONCLUSION: Nurses are a vital component of the highly specialized care delivered before, during, and after an allogeneic HCT. IMPLICATIONS FOR NURSING PRACTICE: Nurses who are prepared for the complex HCT care trajectory will be able to optimally meet the complex needs of the older adult patient and their caregiver(s).

Palliative care of hematopoietic cell transplant recipients and families.

OBJECTIVES: To provide support for the early integration of palliative care into the care of hematopoietic cell transplant (HCT) recipients and families with the goal of improving care. DATA SOURCES: Journal articles and on-line databases. CONCLUSION: Early integration of palliative care for HCT recipients at high risk for complex symptom clusters, non-relapse mortality, or relapse offers an opportunity to clarify goals of care, advanced care planning, and improving the quality of care for both recipients and families. IMPLICATIONS FOR NURSING PRACTICE: The palliative care service can support the HCT nurse in providing complex care to HCT recipients who are faced with significant side effects, toxicities, and complications of transplant.

Incidence and severity of oral mucositis in patients undergoing haematopoietic SCT--results of a multicentre study.

Oral mucositis (OM) is a common side effect experienced during haematopoietic SCT (HSCT), and it can have a significant impact on the quality of life of patients. A descriptive nurse-led study was undertaken in 19-member centres of the Italian national transplant group (GITMO) evaluating incidence, severity and duration of OM in patients undergoing HSCT. Data from 1841 patients between 2002 and 2006 was analyzed. Initial medical history and oral cavity assessment was performed. Assessment was repeated on the day of transplant, then daily, using the WHO (World Health Organisation) oral toxicity scale. A total of 71% of the patients evaluated developed mucositis and 21.6% developed severe mucositis. Duration of OM in most cases lasted for 10-14 days and resolved along with marrow reconstitution. Oral mucostitis is a frequent side effect in patients undergoing HSCT. The onset of severe mucositis seems to be related to the conditioning regimen used. This database provides a descriptive overview of the incidence and severity of mucositis and has encouraged participating centres to adopt routine evaluation and measurement of the oral cavity. The assessment tools are still used in some centres, providing a basis for further collaborative research projects.

Acute complications of stem cell transplant.

OBJECTIVES: To provide a comprehensive review of the acute complications that occur during the first 100 days post stem cell transplant (SCT). DATA SOURCES: Research studies, book chapters, websites, and articles. CONCLUSION: Even though the outcomes for SCT continue to improve, the complications seen in the first 100 days post transplant are a significant cause of mortality. Astute nursing assessment with resultant early intervention improves treatment-related mortality. IMPLICATIONS FOR NURSING PRACTICE: Because SCT patients are seen in every oncology care setting, knowledge of these acute complications is essential to helping the nurse care for and educate SCT recipients.

Hepatic sinusoidal obstruction syndrome in patients undergoing hematopoietic stem cell transplant.

PURPOSE/OBJECTIVES: To provide a comprehensive review of hepatic sinusoidal obstruction syndrome (HSOS) in patients receiving a hematopoietic stem cell transplant and to describe the implications for nursing care. DATA SOURCES: Published research articles, reviews, case reports, and books. DATA SYNTHESIS: Disagreement exists regarding the precise cause of HSOS. Prevention and treatment strategies have emerged based on these causative theories. Few published resources are available for nursing assessment and intervention specific to HSOS, although symptom management strategies derived from other disease etiologies can be used successfully. CONCLUSIONS: HSOS is a complex consequence of myeloablative chemoradiotherapy. Although the overall incidence is declining, research continues to explore better methods for prophylaxis and develop more efficacious treatment options. IMPLICATIONS FOR NURSING: Nurses caring for patients receiving a hematopoietic stem cell transplant must comprehend the proposed etiologies for HSOS and be familiar with the manifestations of the syndrome. Symptom management requires a thorough understanding of affected organ systems.

Hematopoietic stem cell transplantation: implications for critical care nurses.

Hematopoietic stem cell transplantation (HSCT) is being used increasingly in the treatment of malignant and nonmalignant diseases. The treatment modality has been proven effective but is not without risks. Studies consistently have identified the need for advanced supportive care (e.g., multiple organ dysfunction, vasopressor use, mechanical ventilation) as a negative prognostic indicator in patients who have received HSCT. Among patients who have received HSCT, 15%-40% require critical care monitoring or advanced support. Nurses on intensive care units can positively impact outcomes for transplant recipients when they possess the specialized skills to recognize and promptly intervene when transplant-related complications arise. This article will provide a basic overview of the HSCT process and outline the complications that may necessitate transfer to a higher level of care for specialized skills and equipment in the intensive care setting.

Immune reconstitution: the foundation for safe living after an allogeneic hematopoietic stem cell transplantation.

With increasing frequency, oncology nurses are providing long-term care to hematopoietic stem cell transplantation (HSCT) recipients in nontransplantation settings. This may be a result of more patients receiving HSCTs, recipients living longer, and recipients' desire to return to their hometowns as soon as possible. Although critical to patients' initial recovery after HSCT, immune reconstitution also must remain a priority of oncology nursing care long beyond the date of discharge from a transplantation center. As patients resume their normal lives, oncology nurses need to be diligent in assessment and education to facilitate the ultimate goal, a safe life after HSCT. This article provides concise details about the short- and long-term immunologic effects of HSCT and focuses on the long-standing threat of opportunistic infections that can persist months and years after HSCT.

Hematopoietic cell transplantation in non-Hodgkin's lymphoma.

OBJECTIVE: To explore the role and outcomes using hematopoietic cell transplantation (HCT) as a treatment option with aggressive, follicular, mantle, T-cell, and HIV related non-Hodgkin's lymphoma (NHL). DATA SOURCES: Research and review articles and textbooks. CONCLUSION: High-dose chemotherapy and/or radiation therapy followed by HCT has been used to overcome resistance to standard-dose therapy and has been explored over the past 40 years and has shown long-term survival of approximately 10% to 50% in patients with relapsed or refractory lymphoma. IMPLICATIONS FOR NURSING PRACTICE: Nursing plays a significant role in the assessment and management of patients throughout the course of HCT.

[Nursing diagnosis for allogeneic bone marrow transplantation patient: case study]. / Diagnósticos de enfermagem de paciente submetido à transplante de medula óssea alogênico: estudo de caso.

This case study aims at presenting the follow-up of a patient who underwent allogeneic bone marrow transplantation and the experience of the nursing team of the Centro de Transplante de Medula Ossea (Bone Marrow Transplantation Center) at the Hospital de Clínicas de Porto Alegre, Brazil, during the development of the systematization of the nurse practice emphasizing the period of elaboration of the nursing diagnosis. Twenty-six diagnosis established in this case are discussed and put together in the format of a table to allow the reader to have a view of their initial and ending periods, during the in-patient treatment time.

Hematopoietic cell transplantation in the treatment of leukemia.

OBJECTIVES: To review the current evidence regarding the role and benefits of hematopoietic cell transplantation (HCT) in leukemia. DATA SOURCES: Review articles, original articles, internet web sites, and books. CONCLUSION: HCT is a potentially curative treatment modality for patients with hematologic malignancies such as leukemia. IMPLICATIONS FOR NURSING PRACTICE: Nurses working with patients undergoing HCT need awareness of the type of leukemia, source of the hematopoietic cell product, type of preparative regimen used, and the complications of the procedure will enable nurses to educate and intervene with patients and their family members throughout the transplant trajectory.

Hematopoietic stem cell transplantation: a glimpse of the past and a view of the future.

Hematopoietic stem cell transplantation (HSCT) is still the only definitive treatment for some malignant and nonmalignant diseases. The amount of knowledge that has been gained regarding this treatment is enormous. Research and development has been focused on minimizing transplant-related toxicity and disease recurrence. Early experiences of bone marrow administration to patients include marrow given by mouth, by intramuscular injection, intramedullary, and by intravenous route. Radiation injury in humans was a major stimulus for research in bone marrow transplantation. Early research was done on animals and then logically applied to humans. Over the last four decades, there was key progress made in the development of conditioning regimens, the selection of patients, the selection of donors, and prevention and treatment of complications associated with the HSCT procedure. It is believed that the recent and future advances of HSCT will make the transplant process less complex and more successful. In the 21st century, there will be marked improvements scientifically, technologically, and clinically in the HSCT procedure. If the current rate of research, clinical development, and dedication continues, HSCT should be even more rewarding and exciting for all clinicians who care for these patients and families.