Preventing crises in the patient with cancer.

Despite what the title of this presentation implied, no magic pills are available that can be given to prevent patients from getting very sick or falling off that thin line between physical compensation and critical illness. A large part of the prevention of crises comes from redefining the nature of what you view as a crisis and being prepared for the worst possible scenario. The reality is that some patients will develop complications, most of which will be reversible with early interventions. No matter what we do, some patients cannot and will not survive a complication. Your role is pivotal in recognizing high-risk patients, guiding discussions regarding treatment preferences, assisting in defining the treatability of specific complications, and providing care directed at the appropriate therapeutic goals.

Opportunistic fungal infections in the critically ill.

Opportunistic fungal infections are increasingly common in acute care and now represent 10% to 15% of all nosocomial infections. Few references and clinical resources are readily available for nurses in planning care for these patients (as opposed to bacterial diseases, which are better known). Nurses must recognize patients at high risk for fungal infections and develop more detailed assessment plans that include orifice and breath sound assessments. They also must be familiar with antifungal therapies and the specialized nursing care required to administer them safely and with the best bioavailability.

Sepsis.

OBJECTIVES: To review infection and sepsis in patients with cancer and to provide an overview of controversies and research-based practices of infectious complications and management strategies. DATA SOURCES: Research studies, review articles, web sites, and consensus documents. CONCLUSIONS: Traditional assumptions about infection and its optimal management are redefined by research regarding transfusion and catheter-related infections, prophylactic antibiotic administration, use of growth factors, and antimicrobial therapy regimens. IMPLICATIONS FOR NURSING PRACTICE: Infection is still the most common source of morbidity and mortality among cancer patients. The importance of recognizing high-risk patients, implementing infection prevention practices, and prompt intervention for infection symptoms has been established.

Intestinal obstruction.

Intestinal obstruction, a disorder that afflicts both children and adults, is associated with significant morbidity. Early recognition and appropriate management can prevent life-threatening complications; however, considerable controversies exist regarding the ideal method of diagnosis and treatment. This article provides a comprehensive overview of risk factors for small and large bowel obstruction. The pathophysiologic process is related to the clinical findings. A summary of diagnostic methods with an evaluation of their relative merit is presented. Preventive, and medical, surgical, and palliative therapies are described, with an emphasis on the actions that an advanced practice nurse can implement.

Hypothyroidism in cancer patients.

Hypothyroidism as a manifestation of malignancy, as a comorbid disorder in cancer patients, and its treatment are of significant importance to the advanced practice nurse. Considering that the incidence of hypothyroidism reaches 50% to 80% in some cancer patient populations, it is of concern that this problem is rarely addressed in standard oncology texts and journals. This article addresses the unique relationship of hypothyroidism to cancer patients and the important role of the advanced practice nurse in assessing and managing this complex disorder.

Critical care of the patient with hematologic malignancy.

Patients with leukemia, lymphoma, or multiple myeloma are prone to critical illness because of the diffuse nature of their disease and the disruption of protective mechanisms. Despite high morbidity rates, a number of these patients have an excellent probability of long-term remission if supported through a crisis. Complications that cause critical illness can be categorized as related to disease or those caused by therapy. Those with unique features or management strategies for the hematologic malignancy patient and are included in this discussion include: leukostasis, disseminated intravascular coagulation, tumor lysis syndrome, respiratory failure, and typhlitis. A case study of an acutely ill, newly diagnosed patient with several of these oncologic emergencies is used to exemplify typical clinical finds and management strategies.

Issues and trends in critical care of patients with cancer.

The specialty of critical care oncology has emerged as a result of changes in treatment of malignancies and technologic critical care developments. In this article, the author provides the experienced critical care nurse with an overview of the practice of critical care oncology and the unique needs of these patients. Methods for predicting critical illnesses in specialized cancer populations are provided. Also included is a summary of universal cancer care issues such as bone marrow suppression, venous access, chronic pain, and nutrition disorders that cross all specialty areas. This article serves as a basis and resource for practicing critical care nurses and includes background information for the other articles included in this journal issue.

Bone marrow transplantation: issues for critical care nurses.

Bone marrow transplantation (BMT) is becoming a wide used therapeutic modality in the field of cancer care. Offering long-term disease-free survival in more than half of some patients with previously fatal diseases, this therapy has challenged clinicians to reevaluate critical care management strategies for such patients. Critical illness occurs in approximately one third of allogeneic transplants, necessitating that critical care nurses be familiar with this therapy and its reported complications. Critical care nurses are an integral part of producing the reported cure and remission rates, despite significant complications. In this article, the authors outline the common critical care problems of this patient population. The chronologic format enables the practitioner to correlate and differentiate key characteristics of potential complications. A case study, with clinical symptoms representing several potential etiologies, demonstrates the application of these concepts. Through the use of nursing knowledge of the unique needs of these patients, there is the potential to continue to improve patient outcomes.

Cancer critical care: past, present, and future.

Utilization of critical care interventions for cancer patients has increased because of new hopes for cure or long-term remission, increased ability to treat certain complications, and consumer demand. Cancer therapies are more aggressive causing increased organ toxicity, prolonged aplasia, and a variety of complications that may be life threatening. Public awareness and knowledge that cancer no longer means death has permitted cancer patients to partake of critical care technology. The nurse plays a key role in anticipating and predicting critical complications.

Creating critical care oncology beds.

The emergence of specialized oncology practices such as bone marrow transplantation has resulted in a higher incidence of critical complications and complex needs, which has led many oncology units to develop new strategies to care for the patients in the oncology unit. Designated oncology intensive care unit (ICU) beds and a dedicated trained staff is one method of delivery; other institutions transfer patients to existing ICUs, and some have equipped the entire oncology unit for critical care interventions. It is necessary to evaluate key issues when providing critical care to patients with cancer.

Disorders of hemostasis in sepsis.

Sepsis is noted for producing disruptions in hemostasis. The patient-related risk factors, clinical presentation, and management strategies are dependent upon the presiding disorder. Platelet deficiency and dysfunction, hepatic protein disorders, and disseminated intravascular coagulation are the most common clinical problems. Nursing care focuses on prevention, early recognition, and supportive care for the thrombotic or bleeding patient. An overview of the disorders of hemostasis in sepsis and nursing care of these patients are described in this article.