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Opportunistic fungal infections are increasingly common in acute care and now represent 10% to 15% of all nosocomial infections. Few references and clinical resources are readily available for nurses in planning care for these patients (as opposed to bacterial diseases, which are better known). Nurses must recognize patients at high risk for fungal infections and develop more detailed assessment plans that include orifice and breath sound assessments. They also must be familiar with antifungal therapies and the specialized nursing care required to administer them safely and with the best bioavailability.

Patients with leukemia, lymphoma, or multiple myeloma are prone to critical illness because of the diffuse nature of their disease and the disruption of protective mechanisms. Despite high morbidity rates, a number of these patients have an excellent probability of long-term remission if supported through a crisis. Complications that cause critical illness can be categorized as related to disease or those caused by therapy. Those with unique features or management strategies for the hematologic malignancy patient and are included in this discussion include: leukostasis, disseminated intravascular coagulation, tumor lysis syndrome, respiratory failure, and typhlitis. A case study of an acutely ill, newly diagnosed patient with several of these oncologic emergencies is used to exemplify typical clinical finds and management strategies.

The specialty of critical care oncology has emerged as a result of changes in treatment of malignancies and technologic critical care developments. In this article, the author provides the experienced critical care nurse with an overview of the practice of critical care oncology and the unique needs of these patients. Methods for predicting critical illnesses in specialized cancer populations are provided. Also included is a summary of universal cancer care issues such as bone marrow suppression, venous access, chronic pain, and nutrition disorders that cross all specialty areas. This article serves as a basis and resource for practicing critical care nurses and includes background information for the other articles included in this journal issue.

Bone marrow transplantation (BMT) is becoming a wide used therapeutic modality in the field of cancer care. Offering long-term disease-free survival in more than half of some patients with previously fatal diseases, this therapy has challenged clinicians to reevaluate critical care management strategies for such patients. Critical illness occurs in approximately one third of allogeneic transplants, necessitating that critical care nurses be familiar with this therapy and its reported complications. Critical care nurses are an integral part of producing the reported cure and remission rates, despite significant complications. In this article, the authors outline the common critical care problems of this patient population. The chronologic format enables the practitioner to correlate and differentiate key characteristics of potential complications. A case study, with clinical symptoms representing several potential etiologies, demonstrates the application of these concepts. Through the use of nursing knowledge of the unique needs of these patients, there is the potential to continue to improve patient outcomes.

Utilization of critical care interventions for cancer patients has increased because of new hopes for cure or long-term remission, increased ability to treat certain complications, and consumer demand. Cancer therapies are more aggressive causing increased organ toxicity, prolonged aplasia, and a variety of complications that may be life threatening. Public awareness and knowledge that cancer no longer means death has permitted cancer patients to partake of critical care technology. The nurse plays a key role in anticipating and predicting critical complications.