Mr. F. is a 62-year-old man with acute myelogenous leukemia diagnosed 15 months

Question

Mr. F. is a 62-year-old man with acute myelogenous leukemia diagnosed 15 months ago. He received two cycles of induction (high doses) chemotherapy, which resulted in disease remission. He received additional chemotherapy (reduced intensity) over the next 4 months, and underwent an allogeneic peripheral blood stem cell transplant (identical-matched donor; his sister). He was started on standard immunosuppressive drugs to prevent graft-versus-host disease (GVHD). Forty-three days after his transplant, Mr. F. was diagnosed with stage 1 acute GVHD (skin changes on arms and palms of hands). During a routine follow-up visit, Mr. F. complains of mucositis and xerostomia, photosensitivity, dry and irritated eyes, joint pain, a rash on his arms, and an 8-lb weight loss since his last visit 1 month ago.

Questions:

What risk factors are associated with developing chronic GVHD?
What are possible signs and symptoms of chronic GVHD?
What is the priority of care for the patient experiencing chronic GVHD?
What are key nursing interventions for the patient with chronic GVHD?

Explanation / Answer

In GVHD ,the donated bone marrow cells views the recipient body as foreign,and the donated blood cells /bone marrow attack the body.

Risk factors:

Signs and symptoms:

Care of patient:

After a transplant,the recipient usually takes drugs that supress the immune system.This helps reduce the chances of severity in GVHD.Medication should be followed as prescribed by the clinician without fail.AS gastro intestinal tract and abdomen swelling occurs,one should take care while intake of diet.Use oil based creams and lotions as nail and skin rashes are common.Hydrate first and then moisturise the patient as they undergo dehydration.High SPF creams to be used when they step outside.

Nursing interventions:

Psychosocial support and proffessional counseling can be helpful in coping up the body of the patient as well as stress treatment by nurses.The nurses to have knowledge about assessment criteria for chronic GVHD.Systemic treatment,infection prevention,relief of discomfort all these alteration must be determined by nurse.

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