Question

Ms. Miller is a 62-year-old female with past medical history of leukemia and undergoes a hematopoietic stem cell transplantation. Graft-versus-host disease is one of the complications that can occur. 1. Using your own words, describe to the patient and family what graft-versus-host disease is. Click here to enter text. 2. Differentiate between acute and chronic GVHD. Click here to enter text. 3. Describe the treatment regimen for GVHD. Click here to enter text. 4. There can be different clinical manifestations based on organ system. Describe clinical manifestations for three different systems and nursing priorities for each.

Answer 1

1.Graft versus host disease refers to the recipient cells attacked by the transplanted tissue of the donar. In simple the transplanted tissue when makes new cells (wbc) recognises the host cell as antigen and attacks it.

2.Differences between Acute and chronic graft vs host disease

Acute	Chronic
occurs in less than 100 days	occurs after 100 days
affects gastrointestinal system (stomach,intestine) skin,liver Treatable for symptoms Has increased risk of morbidity and mortality	it affects skin ,stomach,intestine,esophagus,oral cavity, liver,respiratory system,connective tissues, exocrine glamds Incresed risk of skin cancer Often irreversible Permanent loss of function

3.Treatment

The main line of standard treatment is the administration of intravenous glucocorticoid

Cyclosporin for six months are effective

The other drugs which are used is alemtuzumab,sirolimus,pentostatin

Symptomatic treatment for skin infections and joint pain with topical applications

4.The clinical manifestation

Gastrointestinal :abdominal pain,dry mouth, mouth ulcer,abdominal pain , nausea ,diarrhoea

• Assess the pain level and administer analgesics
• Maintain good oral hygiene to prevent dryness and mouth ulcers
• Maintain adequate hydration in case of altered bowel pattern

Skin:rashes,jaundice

• Monitor the patients skin ,laboratory vales of Sr.Bilirubin
• Prevent any harsh treatment on the skin or skin care yo prevent damage of skin and risk for infection
• topical medication to treat rashes

Eyes:photophobia,bleeding conjuctiva,lagophthalmus

• Periodic examination of vision level
• Tear drops can be used to prevent dryness
• Avoiding excess direct light
• Wearing dark glasses to prevent glare

Weight loss

• Monitor daily weight
• Provide a nutritional diet
• Treat ulcers in the mouth which can be the cause for decreased nutrient intake