Myelosuppression associated with antineoplastic therapy may lead to neutropenia, anemia, or both, resulting in an increased risk for infection, fatigue, diminished quality of life, and reduced survival. Neutropenia can result in dose reductions and treatment delays. Hematopoietic growth factors have been used effectively as supportive therapy to reduce antineoplastic therapy-associated neutropenia and anemia. This article discusses management of neutropenia and anemia secondary to antineoplastic therapy, new medications, and nursing considerations.
Background Children with leukemia are at risk of developing life threatening opportunistic pulmonary infections. The role of bronchoalveolar lavage (BAL) and lung biopsy (BX) in the management of these patients is controversial. In this study, we evaluate the yield and safety of BAL and BX in children with leukemia. Procedure We reviewed the records of all children with leukemia who underwent either BAL or BX between 1997 and 2007 at the St Jude Children’s Research Hospital. Results A total of 64 patients were included, of whom 35 (55%) had BX and 29 (45%) had BAL. Positive results were obtained in 69% of BAL cohort and in 46% of BX cohort. Both procedures resulted in change in antimicrobial coverage (77% in lung biopsy, 83% in BAL). Pulmonary hemorrhage occurred in 2 patients, and transient hypoxia was the most frequent complication. All resolved without negatively impacting the clinical course. Conclusion Both BAL and BX are safe and useful in the management of children with leukemia and pulmonary disease.
March 5Y8. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, Clinical Nurse Specialists: Leaders in Clinical Excellence, demonstrated the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.One hundred three abstracts were submitted; 58 were selected for either podium or poster presentations. Again this year, there is a CNS student poster session. The abstracts addressed CNS practice in the 3 spheres emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include new research in diabetes care, designing CNS practice for specialty settings, strategies for maintaining clinical excellence, doctoral education choices for CNSs, building a healthy work environment through CNSYnurse manager partnerships, developing a CNS ladder for career advancement, and many new and thoughtful ideas for supporting CNS education and certification. Collectively, the abstracts represented the breadth, depth, and richness of the CNS's contribution to the well-being of the nursing profession, individuals, families, communities, and society.The conference abstracts are published so that we may share new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We Purpose: This presentation will discuss a methodological approach to ensuring that didactic and clinical expectations of clinical nurse specialist (CNS) students are truly reflective of current practice in complex organizations. Curricular review and enhancement using CNS stakeholders can help generate quality patient outcomes.Significance: The CNS works in an increasingly complex organizational culture and is responsible for patient safety and quality patient outcomes. Clinical nurse specialist curricula and clinical experiences must be complete and inclusive in the education and preparation of CNS students for practice environments.Design: Clinical nurse specialist educators must respond to many different factors in the designing curricula and must deliver an educational product which actually prepares CNS graduates for practice in complex organizational systems. The clarity of CNS practice is strongly enhanced by linking authentic practice elements to the CNS educational experience.Methods: The graduate faculty of the CNS program at Armstrong Atlantic State University initiated a curriculum revision project. The goal was to authenticate, through discussions with CNS key stakeholders, the inclusion of patient safety, organizational complexity, and quality patient outcomes while meeting the published criteria from the accrediting bodies. In addition to program faculty, 13 practi...
2153 Patients with hematological malignancies are at risk of developing life threatening opportunistic pulmonary infections. The value of bronchoalveolar lavage (BAL) and lung biopsy (BX) in the management of these patients is debatable. While some believe these procedures are relatively safe and often provide valuable information that can guide management in these patients, others question the benefit of the procedures or are concerned about the potential complications of the procedures. We reviewed the St Jude experience with bronchoalveolar lavage and lung biopsy in children with leukemia to assess the benefit and safety of these 2 procedures. Review of medical records from January 1, 1997 through December 31, 2007 identified 183 potential episodes of BAL or BX in patients with leukemia who were younger than 22 years at time of procedure. In 30 patients who had multiple procedures, only the initial procedure was included. A total of 64 patients were included, 36 (56.3%) of which had lung biopsy and 28 (43.7%) who had BAL. (See Table 1 for Demographics). There was a trend of better yield with BAL as compared to BX (67% versus 44%, p=0.079). Better BAL yield was observed in: males versus females (88% versus 42%, p=0.017), ALL versus AML (79% versus 44%, p=0.097), non-neutropenic versus neutropenic children (90% versus 56%, p=0.098). Both procedures resulted in change in antimicrobial coverage (78% in lung biopsy, 89% in BAL). Although both procedures were relatively safe, patients with BX had more complications as compared to BAL. Bx resulted in new oxygen need in 4 patients, increased oxygen need in 1 patient, intubation in 2 patients, and bleeding in 1 patient. BAL resulted in new oxygen need in 2 patients and increase in need in 7 patients, but no intubation or bleeding was related to this procedure. In summary, BAL and BX have a reasonable safety profile and contributed to the management of pulmonary infections in children with leukemia. Compared to BX, BAL was associated with higher yields and less complications. Table 1. Demographics Variable BAL (28) BX (36) Sex M/F 16/12 19/17 Mean Age 11 years 11 years ALL patients 19 12 AML patients 9 24 Neutropenia (ANC≤500) 18 21 Intubated prior to procedure 13 4 Disclosures: No relevant conflicts of interest to declare.
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