Nurses' Role in Decreasing Cardiopulmonary Damage in a Setting of Necessary Cardiopulmonary Toxic Therapy

Topic Significance & Study Purpose/Background/Rationale

Transplant physicians study t-cell modulated therapy, novel immunosuppressive therapies, and cell selection during mobilization—the very construct of transplantation.  Traditionally nurses focus on symptom-management.  The concept of nurse-driven symptom management should be expanded.  Transplant nurses are in an excellent position to broaden their scope and significantly impact patient outcomes by protecting patients from untoward cardiac and pulmonary effects. 

Methods, Intervention, & Analysis

During transplantation, chemotherapeutic agents, radiation, immunosuppressive medications, antiemetic medications and antibody therapies can damage the cardiovascular and/or pulmonary systems. In fact, Chow et. al. found increased frequency of cardiovascular hospitalizations and mortality among transplant recipients (Annals of Internal Medicine, 2011).  While some heart and lung functional loss is unavoidable due to essential therapies, some cardiopulmonary injuries are preventable. Nurses have a paramount role in preventing patients from worsening to critical care status as well as safeguarding patients from short-term mortality and long-term morbidity.  The severity and frequency of some untoward cardiac and pulmonary effects can be avoided with more informed management.

Findings & Interpretation and Discussion & Implications

This discussion will review common therapies that damage the cardiovascular and pulmonary systems.  For instance, radiation can cause pneumonitis, and tacrolimus can prolong a QTc on an ECG.  However, normal saline is a therapy as well.  During certain induction and conditioning regimens as well as hypotensive events, fluids are administered liberally and often without diagnostics in place.  Many patients with transient hypotension are transferred to a higher level of care due to fluid volume overload.  This example is but one area where nurses can improve care. Acute and long-term signs and symptoms will be explored with an emphasis on pathophysiology and diagnostics. Stroke volume research from fluid volume recipients will be briefly presented (Aim 3 of USCOM Feasibility Study, 2014).  Finally, interventions will be reviewed.  In short, the unavoidable cardiopulmonary side effects will be separated from preventable ones.