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Nursing staff on the MTU are the cornerstone of your care. The MTU is considered a critical care unit with an outpatient treatment room, an outpatient exam room, and 8 inpatient beds. Nursing staff are on the MTU floor 24/7 to triage questions. The nursing staff consists of the nurse manager, the clinical nurse coordinator, inpatient nursing staff, and outpatient nursing staff.
Below is important information that patients and caregivers will learn in the Nursing Care Class. It is provided here since the classes are taught on a rotating basis and may not be taught to you during the first few weeks you arrive to the MTU.…
Care Class - Nurses Session
Introduction
The care class instructor will:
- Provide handouts
- Explain why the MTU has classes
- Explain patient & family expectations
- Describe some resources
- Family support group
- Psychology
- Social worker
- Chaplains
Role of the Support Person – inpatient setting
- Promote interaction between the patient and family, friends & support system
- Advocate for patient & provide information about his/her preferences or needs
- Attend daily rounds: Mon & Wed 8:30am, Tues, Thurs & Fri 9:30am. Weekends vary between 8:30-10:00am
- Fill out daily counts calendar
- Encourage patient to exercise (walk in hallway, ride stationary bike, etc.)
- Provide clean clothes each day
- Learn Hickman catheter dressing change & flushing of the line
- Learn how to operate IV pump for home IV infusions
Role of the Support Person – outpatient setting
- Get the patient to appointments on time
- Help the patient keep track of doses and timing of medications
- Keep track of the patient's food & fluid intake
- Keep track of the patient's needs, signs & symptoms
- Have the patient take their temperature at least twice a day
- Administered home IV infusions if needed
- Stay healthy: sleep right, eat right & exercise
- Remind patient to wear sunscreen
Hickman Catheter
- Refer to Right Atrial Catheter Booklet
- If the catheter breaks, clamp the line above the break & immediately call the MTU
- If the catheter falls out, the cuff is exposed, you can't flush the line, the patient develops pain or swelling in arm or catheter area, or develops a fever (temp >100.4), call the MTU
Symptom Management
Nausea/Vomiting
Let the MTU staff know if anti-nausea medication is not working
Take anti-nausea medications on a schedule; for example, 30 minutes before meals or taking pills
Diarrhea
Report color, frequency, & consistency of stool
Report abdominal pain or cramping
Encourage patient to drink plenty of fluids
Decreased Appetite
Refer to Dietitian's materials
Most patients, when first discharged from the hospital, will still need TPN and/or hydration. The nursing staff will teach patients & caregivers to administer home TPN or hydration safely.
Neurological changes
Medications may cause changes in a patient's behavior. You should know that:
Steroids may cause mood swings, crying, inappropriate laughter or anger
Pain medications may cause confusion, hallucinations & the inability to concentrate
Anti-nausea medications may cause sleepiness, uneasiness or jitters
GVHD medications may cause short-term memory loss, sensory loss or tremors
In addition, changes in blood chemistry may cause numbness, tingling & altered sensation. Encourage the patient to tell someone if this occurs.
Fatigue & Weakness
Try to keep the patient active during the day
Encourage the patient to sit in a chair & walk
Encourage the patient to use the stairs when he/she is strong enough
Although activity is important, let the patient take it slow & praise him/her for any activity
IMPORTANT: Don't let a very active patient do push-ups, pull-ups, sit-ups or run stairs. These exercises can make a patient's Hickman catheter come out.
Boredom & Diversions
Develop a plan to help ward off boredom. Some ideas: models, computers, Scrabble, card games, crafts, phone calls, reading – the best reading material may be short stories or articles – day trips, videos (MTU has a VCR/DVD player), music (each inpatient room contains a radio, tape deck & CD player) and walks with family.
Fever
Thermometer use at the apartments:
- Make sure you have a working thermometer (if you do not, please let the outpatient nurses know – they will provide you with one)
- Call if the patient's temperature is 100.5 or greater
Observation – observe the patient for:
- Increased tiredness
- Looking or feeling flushed
- Feeling cold
- Shaking chills
- If the patient has shaking chills, call the BMTU. DO NOT let the patient take Tylenol before they are seen by a nurse or doctor.
Environment
Car and apartment air conditioning may be used with precautions. Turn on the air conditioning & allow it to run for several minutes before letting the patient into that area. Air conditioners may put an excess amount of dust into the air when initially turned on.
Clean fans may be used if desired.
Immunizations
Patient will not be immunized until at least 1 year after transplant
Children & other relatives of transplant patient should receive the killed virus Salk vaccine, not the life oral Sabin vaccine for polio.
Children who are over the age of one, who are not sick, may visit a patient
Family members should get flu shots annually
Sex
Before intercourse, make sure that:
- The patient has a platelet count of at least 50K
- The patient has Agrans above 500
- The patient or partner uses a condom
- The female patient uses lubricant
EMERGENCIES
Definite Emergencies – these include:
a. Unconsciousness. If a patient is unconscious:
i. Check to see if the patient is breathing
ii. Try to rouse the patient. If you can't, call 911
iii. If you know CPR & the patient isn't breathing, start CPR
b. Seizures
i. Place the patient on his/her side
ii. Try to protect the patient from injury
iii. Keep your fingers & all utensils away from the patient's mouth
c. Severe chest pain
d. Sudden, severe bleeding
e. Choking. If the patient is choking on a piece of food & can't speak, perform the Heimlich maneuver. If you can't dislodge the food, call 911.
f. Inability to get up after a fall
If any of these emergencies occurs, call 911. Give the operator:
Name
Address
Description of the emergency
If you’re alone with the patient, stay with him/her until the ambulance arrives, then call the MTU. Tell the ambulance driver to take the patient to the Seattle VA. Tell the driver that the patient will be a direct admit to the MTU.
Potentially dangerous situations:
Dizziness/lightheadedness
If you're afraid the patient will fall, call the MTU to arrange transportation to the unit.
Discourage the patient from changing positions quickly. Have the patient sit on the side of his/her bed for a few minutes before standing up.
Don't let the patient walk without assistance
Call the MTU & come in for evaluation
Less severe bleeding (nose, urine, stool, sputum, vomit)
Nosebleeds
- Apply pressure over the patient's nostrils or on the bridge of his/her nose.
- Apply ice to the patient's forehead of the back of his/her neck. Frozen vegetables work well as an ice bag.
- Shortness of breath. If a patient has trouble breathing:
Loosen clothing around the patient's neck
Try to put the patient in an upright position
For any of these problems, call the MTU (206) 764-2199 and ask whether or not you should bring the patient to the unit for evaluation.
Patient Education for Pain
When you talk to your doctor or nurse about pain, they will ask you some of the following questions: Your answers will help them to understand more about your pain and help them make a plan to treat your pain effectively.
- Where is your pain, how long does it last, how often does it occur?
- Can you describe the pain?
- What brings on the pain?
- What relieves the pain or makes it worse?
There are many factors that influence your pain and your perception of pain:
- Fear and anxiety which causes muscle tension and thereby increases pain
- Cultural beliefsIsolation
- Immobility can cause pressure and stiffness increasing pain
- Depression sometimes treating underlying depression will decrease the level of pain
Pain Management:
There are many pain management therapies. You should try to use more than one in your treatment plan. The goal of the treatment should be to decrease the level of pain to permit optimal bodily function (so that you are able to carry out you daily activities such as walking, bathing and getting dressed).
- Pain medications can be taken by mouth even for severe pain. There are also pain medications that are in the form of a patch. If you are on a pain patch then your Doctor has probably ordered medications for breakthrough pain too. Pain medications work more effectively when they are taken before the pain becomes severe. If you are going to be away from home make sure that you bring your pain medications with you so the pain does not become severe.
- Emotional support- talking to friends and relatives.
- Comfort Measures using ice/heat, changing your position, massaging the affected area.
- Complementary Measures: distraction, imagery, deep breathing, muscle tensing/relaxation, acupuncture.
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