Hey, Those Are My Cells!

(Note: This is similar, or a predecessor, to two published posts I had on TheONC. Oncology's Best Kept Secret & SCID: The Bubble Boy Illness)

Bone marrow, or stem cell, transplant (BMT or SCT) is a relatively new concept. It is done for many reasons, in my life it's done mostly for multiple myeloma and leukemia patients. However, I have a friend with a nine month old who is having a SCT from cord blood because he is suffering from Severe Combined Immuno-Deficiency, or SCID. The hope for him, as well as for the patients I see more often getting these transplants, is that chemotherapy will wipe out the "bad" bone marrow and the stem cells will replace it with "good" cells. 

This process is obviously not without huge risks. There are the well known side effects of chemo that patients have to look forward to as well as the increased potential threat of infection due to literally having no immune system for a short period of time.

These patients get the strictest education about what to expect and the rules that will be followed before, during, and after transplant. Because of the high risk of infection, they are usually started on a prophylactic antibiotic, antiviral, and antifungal. They are also made to exercise before and after in a way to preserve energy (sounds counter-intuitive, I know) and promote healing. Also, nutrition is focused on heavily - both to make sure they are eating and to make sure the food they are eating is safe for consumption (no fresh fruits & veggies, everything cooked to and eaten at proper temperature, etc.). 

There's so much more to talk about on this topic, hopefully at a later date. Does your facility provide BMT/SCT? Do they follow similar procedures, or how are they different?

Why do we educate patients?

Part of nursing education focuses on the importance of educating patients. One of the first things I was taught at both jobs I've had since graduation immediately stress the importance of educating patients and documenting it as done. However, I don't feel I ever really fully grasped the importance of proper education until recently. 

I had a patient who had started his chemotherapy regimen the day I had him. The day girls got the consent signed and gave him his Avastin, Oxaliplatin, a 5-FU push and then started a 46 hour hang on 5-FU. I took over care for this patient about 15 minutes into the 5-FU hang. We went through our normal tasks and I asked if I could get him anything. He said, "A fresh water would be nice." I got him this and he politely asked if there was ice, because it wasn't very cold. I told him that because of the Oxaliplatin he shouldn't have anything cold to drink. This was shocking news to him - his entire diet for now consists of yogurt, ice cream, and refrigerated Ensures. 

We spent the rest of our interactions throughout the night talking about why he couldn't have cold stuff, I promised him room temperature Ensures, and he asked several appropriate questions. The one I didn't have an answer to was, "How long do I have to wait until I can have cold stuff again?" I didn't know; I asked my colleagues and no one knew. Thanks to Google and American Cancer Society, I found our answer. 

I feel a lot of nurses go through the motions, share as little as possible, and only answer questions (which patients don't always know the right ones to ask), and don't properly educate. I'm sure I'm guilty of this as well, but I do, at least, always make sure my patients understand their medications - what they're for and the important side effects or things to avoid while on it. I wonder, how do you educate your patients? Do you think we are lacking in this area as nurses? (Why?)