Bone Marrow/Stem Cell Transplant Unit - What to expect?

SteffersRN87, BSN, RN · Nov 25, 2009

Are you interested in oncology or where you just placed there? I love hem/onc and BMT. You are correct with the diagnoses that you will encounter. You may also see some solid tumors receiving transplants. There may be some hematological disorders. Here is what to expect and maybe some things to familiarize yourself with. Good luck! I hope you enjoy as much as I do!

Diagnoses:

ALL

AML

APL

CLL

CML

Myelodysplastic Syndrome (MDS)

Hodgkin's Disease

Non-Hodgkin's Lymphoma (many subtypes)

Waldenstrom's Macroglobulinemia

Multiple Myeloma

Myelofibrosis

Myeloproliferative Disorders / Polycythemia Vera

Aplastic Anemia

ITP & TTP

Sickle Cell Disease

*The most comm you will encounter are the leukemias and lymphomas, multiple myeloma, and MDS*

Things we routinely do in BMT world:

central line care

administration of blood & blood products

electrolyte replacements

administration of chemotherapy & biotherapy

give lots of meds for pain & nausea

give lots of antibiotics

transplants

apheresis (if that is a part of the unit)

Things we look for:

infection & fever (huge)

oral mucositis, nausea or vomiting, dehydration, or diarrhea

toxicities from chemo

graft vs. host complications

Things to Know:

-Usually, we let our hemoglobins drop to 8.5 and platelets to 20 before transfusion. All patients receive Tylenol & Benadryl as pre-meds to prevent reaction. All blood and blood products must be filtered, irradiated, and CMV safe or negative.

-The WBC count will drop more than you have ever seen. Look up how to calculate an ANC.

-We replace potassium, magnesium, and phosphorous around the clock.

-We give lots of pain and nausea meds to help minimize side effects of the disease and treatment.

Anything else, let me know!

JennRN113 · Nov 25, 2009

Thanks for the feedback! Lots of helpful info. I wasn't looking to be on an oncology floor, I was placed there. I am on an FNP track. Will I be seeing children as well? I am finishing up my peds rotation right now and cared for a 2yo with leukemia, so some of what you mentioned already sounds a bit familiar to me. I don't think the children on our floor get their cancer treatments on the unit, however. So I was hoping to get an opportunity to work with some children on bone marrow/stem cell, as well as adults.

blondy2061h, MSN, RN · Nov 25, 2009

I wrote a lengthy post about it here. My unit is similar to Steffers's unit in a lot of ways, but different also. We typically let hgbs drop to 8 and plts to 10 before transfusion. We almost never give Tylenol (fear of preventing a fever- which will lead to infections being caught latter and suppress the patient's only natural defense against infection). We also don't premedicate for transfusions unless the patient has a history of reactions. We replace phosphorus, potassium, magnesium and calcium routinely. Other than that, everything she said is exactly the same as what I do.

KeLsRN · Nov 25, 2009

I'm on a hem/onc floor as a new grad, and have floated to our adjoining BMT floor. It seems like a great place for a new nurse to start out at, because you see such a variety of conditions. Some patients are incredibly heave, some are just in for treatment and are pretty independent. Emotionally, you also see a lot of variety, as some people are at the end of life and some are curable. You also get a lot of electrolyte replacement, blood/platelet transfusions, interesting surgical cases, and experience with chemotherapy infusions.

Good luck!

KeLsRN · Nov 25, 2009

Oh, and we don't work with peds cases- our floor is adult only.

SteffersRN87, BSN, RN · Nov 25, 2009

We are strictly adults... But some of our "adults" are 18 to 21... The pediatric hospital in our area does not like to treatment "children" 18 to 21...