Introduction Nutrition is important during recovery time. Hence

Introduction

Hematopoietic
stem cell transplant (HSCT) is a procedure frequently used for hematological
malignancies such as leukemia, myeloma, lymphoma and primary immune deficiency
(Chabner, Longo & Harrison., 2014). Hematopoietic stem cell which is
obtained from bone marrow, peripheral blood or umbilical cord blood and it is
infused through intravenous infusion to restore hematopoietic function
(Biagioli et al., 2016). According to Lynora J. Metoyer, approximately 50,000
transplants performed worldwide annually. HSCT patients are more vulnerable
patients among the cancer population (Cooke et al., 2011). HSCT patients
require a dedicated full time care giver for 24hours a day and they serves
important role in caring patients following HSCT (Laudenslager et al., 2015).
It is the care givers responsibility is to identify and respond to changes in patient’s
condition, assist in patient’s activities of daily living, emotional support, administering
medications and transportation to appointments (Cooke et al., 2011).  Therefore care giver education is most
significant element.  We can use one to
one method, handouts and videos to educate the caregiver (Buchsel &
Yarbro., 2005). Care givers role will evolve in Physical Well-Being, Social
Well-Being and Psychological Well-Being (Cooke, Grant
and Gemmill, 2012).  In this essay the
author will discuss about roles of family caregiver post HSCT discharge.

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Role
of care giver

Care
giving requires as substantial time commitment. Care givers are expected to care
for everything from performing physical care such as monitoring vital signs to
evade infections as infection is one of the major risk factor (Cooke et al.,
2011). Keep the home environment clean and tidy to prevent infection and not to
allow patient to do house-keeping. Do not keep plants or fresh flowers where
patient is staying (Beattie & Lebel., 2011). Nutrition is important during
recovery time. Hence it is important to have a balanced diet to improve immune
system. Often patient’s experienced difficulty to maintain a good electrolyte
balance due to vomiting, diarrhea, chemotherapy and poor appetite (Kurtin, Lilleby &
Spong., 2013). Therefore care giver should help to prepare meals for patients.
To allow only well cooked food, well washed fruits and vegetables and not to
allow raw uncooked food, alcohol, raw grain products, unwashed raw vegetables
or herbs (Kurtin, Lilleby & Spong, 2013). Monitor intake and output to prevent
dehydration or fluid retention and to prevent electrolyte imbalance (Cooke,
Grant & Gemmill., 2012). Maintaining patient’s personal hygiene by using
mild soap and shampoo and apply mild moisturizer and applying sun screen
lotion. Maintaining good hand hygiene at all times. To encourage patient to
wear foot wear at all times. Monitor skin for abnormalities such as dry skin, rashes,
redness, swelling and bruises (Metoyer, DNP,FNP., 2013). Provide oral care and
monitor oral cavity for dryness, swelling or inflammation, painful cum,
stiffness of jaw, swallowing difficulties or ulcers (Cooke, Grant & Gemmill.,
2012). Assist patients with the administration of medications and monitoring
compliance and keeping record of medications taken (Kurtin, Lilleby &
Spong., 2013). Care for Venous Access Device (VAD) by ensuring that the line is
covered with plastic wrap while shower, to change dressing immediately if the
dressing is wet. Monitor the surrounding skin for any abnormalities such as
rashes, skin redness and inflammation (Schmit-Pokorny et al., 2003). Arranging
transport and accompanying for follow up appointments (Cooke, Grant &
Gemmill, 2012). To recognize new symptoms and any changes like
fever-Temperature 38 degree Celsius, shortness of breath, hematuria, Signs of infection
around your central line, such as pain, redness, swelling, or pus, aware what
to do in an emergency situation (Kurtin, Lilleby & Spong,, 2013). Communicating
with health care team and obtaining information, (Grant, Cooke & Gemmill., 2012). Encourage patient to do
simple exercise daily. For example walking and avoid vigorous exercise or
activities (Beattie & Lebel., 2011). Help patient to avoid crowded places
and minimize the visitors and should be brief. Protect patient from visitors who
are sick. Educate visitors about hand hygiene too (Cooke et al., 2011). Reducing
the patient’s risk of falls at Home by Make sure all the rugs are secured.
Encourage patient to wear nonslip slippers or shoes. Ensure that pathway at
home is cleared and not cluttered (Kurtin, Lilleby & Spong,, 2013). Communicate with
patient about her views and emotional state. Provide emotional support by
giving encouragement throughout and at the challenging times and helping
patient’s to maintain their self-identity (Cooke et al., 2011). This will help
the caregiver to improve her relationship with patient (Beattie & Lebel.,
2011). 

Graft-versus-Host Disease (GVHD) results
from the reaction of T-cells in the Graft to cells in the Host and graft cell
will try to reject the cells in the host (Hughes-Jones et al., 2009). The cells
that are most commonly involved skin, gastro intestinal tract and liver. The clinical features
are maculopapular rashes, frequent Watery diarrhea and abdominal cramping (Chabner,
Longo & Harrison., 2014). Thus it is important for caregiver to identify
the symptoms to notify health care team immediately.

Caregiver may feel overwhelmed by the
responsibilities at times. Caregiver also needs to take care
of themselves as well. It is important that caregiver should maintain a
positive attitude and flexible approach, while providing care to HSCT patients.
They may ask other family members to help in patient care and they can join
caregiver support groups. (Applebaum et al., 2016)

Conclusion

Caregivers are very important to reduce
poor outcomes and reduce the preventable errors of post HSCT patients at home
after discharge.  A competent caregiver need
to arrange transport and accompany patient for medical appointments, communicate
with health care team, Monitor Medication compliance and keeping
record of medications, Assist with Basic Needs, Prepare Meals, Housekeeping,
Monitor
Performance, Help with daily activities, Assist with physical therapy and
recognize new symptoms and any changes. Furthermore, the caregiver needs to
take care of them selves.