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oncology (stem cell unit)
Student
Institution Affiliation
Instructor
Course
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Introduction
This week at MD Anderson Cancer Center in the G18 Stem Cell Unit, I faced a clinical
incident during my clinical rotation. A 55-year-old female patient who came for multiple
myeloma treatment through a stem cell transplant had a sudden onset of acute respiratory
distress. The case called for an urgent and integrated approach to medical care.
Background
This patient and I had built a friendly rapport because I had been assigned to her for the
past three days. My understanding of respiratory physiology, oncology, and critical care from my
nursing practice helped me deal with this clinical situation, given my prior encounters with
respiratory distress in immunocompromised patients. My assignment was to closely observe any
signs of distress in the patient and her family and act immediately while providing patient's
support to the patient. It created an impression of need and duty towards her to protect her from
harm and make her feel comfortable.
Noticing
Firstly, I pointed out a raised respiratory rate, usage of accessory muscles, and dyspnea in
the patient. She was even getting a low oxygen saturation level, although she was on
supplemental oxygen. Whenever I was around her, she appeared anxious and pale and sometimes
even had blue lips, showing seriousness.
Interpreting
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She may have had a respiratory infection, pulmonary oedema or some complication
resulting from her treatment. My considerations were about the procedural options, such as
changing her oxygen support, providing a bronchodilator, and preparing her for mechanical
ventilation. This was similar to other cases of respiratory distress I had encountered, but her
immunocompromised status and the post-transplant context made it more challenging. I collected
her past and present clinical data on recent laboratory tests and spoke to the respiratory therapist
and my tutor to get additional data.
Responding
The goal was to stabilize the patient's respiratory condition and decrease her discomfort.
To address her respiratory distress, I adjusted her oxygen rate, administered the prescribed
bronchodilators, and started using non-invasive positive pressure ventilation as directed by the
doctor (MacLeod et al., 2021). I also assured the patient that everything was okay to calm her
down as much as possible. The main concern was addressing her acute conditions while keeping
her calm and informed.
Reflection-in-Action
The patient's respiratory rate slowly increased after interventions, and the oxygen levels
were maintained. During the examination, the relations seemed satisfied with the response time
and were assured about her state. I also kept observing her and provided necessary interventions
in her care.
Reflection-on-Action and Clinical Learning
Three ways my nursing care skills expanded:
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1. Increased efficiency in identifying acute respiratory distress and suitable, comprehensive
interventions in immunocompromised patients.
2. Integrated patient care and coordination within interdisciplinary teams to provide efficient
and effective treatment.
3. Particular competencies in providing patient and family education about anxiety and
explaining various interventions.
Three things I might do differently:
1. Implement NIPPV early by involving the respiratory therapist at the onset of the patient's
intervention.
2. Offer relaxation and breathing techniques earlier to calm the patient down to a manageable
level (Brownstone et al., 2021).
3. Aim at patients' vital signs more often during the critical periods after transplantation to
notice changes.
Additional knowledge and skills required:
1. Special training focusing on both general and stem cell transplant-related respiratory
complications.
2. To Increase awareness of the pharmacological management options for the development of
acute respiratory distress in those receiving cancer therapy.
3. To properly familiarize myself with the current standards of practice and protocols for
handling respiratory emergencies in immunocompromised patients.
Changes in values or feelings
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As a result, this episode underscored the importance of early identification of signs of
respiratory distress and prompt intervention. It only increased my compassion for patients who
undergo such procedures and stressed the importance of treating the whole person physically and
emotionally. It emphasized the importance of collaboration between different fields and the
ongoing process of attendant learning to care for the patients adequately.
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References
Brownstone, N., Myers, B., & Howard, J. (2021). Psychological Tools to Assist Your Practice:
Progressive Muscle Relaxation, Deep Abdominal Breathing, Mindfulness, and Guided
Imagery.AEssential Psychiatry for the Aesthetic Practitioner, 189-199.
https://doi.org/10.1002/9781119680116.ch18
MacLeod, M., Papi, A., Contoli, M., Beghé, B., Celli, B. R., Wedzicha, J. A., & Fabbri, L. M.
(2021). Chronic obstructive pulmonary disease exacerbation fundamentals: Diagnosis,
treatment, prevention and disease impact.ARespirology,A26(6), 532-551.
https://doi.org/10.1111/resp.14041
