Educational Neutropenia power point_by_Angela_DeJong
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Chemotherapyinduced Neutropenia By Angela De Jong, RN 7/28/2010
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Transcript of Educational Neutropenia power point_by_Angela_DeJong
Chemotherapy-‐induced Neutropenia
By Angela De Jong, RN 7/28/2010
What is Neutropenia?
l A decrease in the number of white blood cells, especially neutrophils. l Neutrophils account for 50-‐70% of circulaJng white blood cells. l Neutrophils serve as the primary defense against infecJons. l Neutrophils work by destroying bacteria in the blood.
l Neutrophils have a life span of only 7-‐12 hours
Grades of Neutropenia
l There are 4 grades, based upon the absolute neutrophil count (ANC) l 0, is when the ANC is greater than 2,000 l 1, ANC of 1,500-‐1,900 l 2, ANC of 1,000-‐1,400 l 3, ANC of 500-‐900 l 4, ANC less than 500
Absolute Neutrophil Count l Polys (also named as segs or neutrophils) + bands → to decimal point
l MulJple above with total WBC (white blood count) which is ∆ to thousands
l = ANC or absolute neutrophil count
l Example: Polys = 31% (.31) + bands= 10% (.10) = .41
l WBC = 3.3 (3300)
l .41 x 3300 = 1353 ANC PaJent is moderately neutropenic!!!
Risk Factors
l Decreased renal funcJon
l Advanced age
l Receiving chemotherapy, especially mulJ-‐agent therapies or high-‐dose therapies
l Immunocompromized system prior to chemotherapy treatment
l Liver dysfuncJons (increased bilirubin)
l COPD
Risk Factors
l Cardiovascular disease
l Diabetes mellitus
l Current acJve infecJons
l Open wounds
l Recent surgery
Cancer (diseases related) Risk Factors
l Tumor type
l Bone marrow involvement with tumor
l Advanced cancer
PaJent Complaints in the Order of Severity
l Affects my family or partner.
l Loss of hair.
l Constant Jredness.
l Affects my work and/or home duJes.
l Affects my social acJviJes.
l Loss of sexual feeling.
(Cancer Nursing PracJce, 2010, box 1)
Medical Treatment
l Broad spectrum anJbioJcs l Piperacillin-‐tazobactam l Gentamicin l Vancomycin l Clindamycin l Ciprofloxacin
Medical Treatment
l Broad spectrum anJbioJcs conJnued l Amoxicillin-‐clavulanate l Cegazidime l Cefepime l Imipenen-‐cilastaJn l Meropenem
Medical Treatment ConJnued
l AnJfungals l NystaJn (quesJonable efficacy) l Magic mouth wash (quesJonable efficacy) l Fluconazole l Ketoconazole l Itraconazole
l White blood cells growth factors l Neupogen l Neulasta
Medical Treatment ConJnued
l White cell transfusion
l CorJcosteroid therapy
l IV immune globulin
PaJent Self Care Treatment
l Hand hygiene using soap and water or an anJsepJc hand saniJzer
l Use a mask with a HEPA filter while out in the environment
l Avoid contaminaJon from animals feces, saliva, urine, or pet scratches
l Avoid sexual intercourse during neutropenic phase
l No shaving with razors
l Avoid use of suppositories and tampons
Nursing ResponsibiliJes; Assessment l Administer ordered broad spectrum anJbioJc (i.e. Cefepime) within 1 hour of neutropenic assessment and diagnosis
l Monitor vital signs every 4 hours, or more frequently if needed
l Monitor white blood cells daily
l Ausculate lungs daily
l Inspect all sites associated with high risk for infecJon (body orifices, IV sites, wound, etc.) daily
Nursing ResponsibiliJes: Assessment
l Note medicaJons that mask signs and symptoms of infecJon (i.e., steroids, anJpyreJcs).
l Observe for signs and symptoms of infecJon: l Oral temperature of 100.4 for > 1hour l Single temperature of >100.5 l Chills l White patches in mouth l Redness
Nursing ResponsibiliJes; Assessment
l Observe for signs and symptoms of infecJon, conJnued: l Cough, producJve sputum l SOB l Changes in character/color of body fluids l Urinary feq/burning l Flu-‐like symptoms
Nursing ResponsibiliJes; Assessment
l Observe for signs and symptoms of infecJon, conJnued: l Rash l Swelling l Heat l Pain of body area
Nursing Treatment
l Hand washing with soap and water or anJsepJc wash
l Private room
l Avoid contact with persons who have infecJons, especially upper respiratory infecJons
l Wear masks in public during neutropenic phase
l Washing fresh fruits and vegetables thoroughly
l EliminaJng fresh flowers and plants from being brought into the paJent’s room
l SupporJve care
Nursing Teaching
l Instruct the paJent and their family; l Normal range and funcJon about white blood cells (WBC) l DefiniJon and causes of neutropenia l To noJfy their physician if they have a temperature >100.4 degrees F l Avoid crowded areas and persons with recent or current infecJons l Shower/bathe daily l PracJce meJculous oral hygiene ager each meal and at bedJme
Nursing Teaching
l Instruct the paJent and their family; l Inspect skin for open, painful, or inflamed areas and noJfy physician if present
l Wash hands thoroughly before eaJng and ager bowel and bladder eliminaJon
l Wash all raw fruits and vegetables before eaJng l Do not share eaJng utensils l Do not use suppositories l Do not take rectal temperatures
Nursing Teaching
l Instruct the paJent and their family; l Do not use vaginal tampons l Wash perineum with soap and water ager eliminaJon l Prevent consJpaJon by using stool sogeners or laxaJves as needed l Avoid pet/animal excreta l Do not receive life vaccinaJons (i.e. nasal flu sprays, polio)
References
l AAHS AdministraJon Policies. (2005). Care of the neutropenic paJent. Retrieved July 1, 2010, from Hqps://apps.aahs.org
l Cancer Nursing PracJce. (2010). Effects of chemotherapy-‐induced neutropenia on quality of life. Retrieved June 20, 2010, from EBSCOhost database. hqp://web.ebscohost.com.ezproxy.apollolibrary.com/ehost/pdfviewer/pdfviewer?vid=6&hid=8&sid=1ad65d20-‐28e3-‐45ea-‐a4a2-‐22d5be58ab10%40sessionmgr13
l Cancerconnect.com. (n.d.). Low white blood counts (neutropenia). Retrieved July 28, 2010, from hqp://news.cancerconnect.com/neutropenia/
l Caring.com. (2010). BoosJng white blood cell counts. Retrieved July 28, 2010, from hqp://www.caring.com/arJcles/boosJng-‐white-‐blood-‐cell-‐count
l Flores, I., Ershler, W. 2010. Managing neutropenia in older paJents with cancer receiving chemotherapy in a community setng. Retrieved June 20, 2010, from ProQuest database. hqp://proquest.umi.com.ezproxy.apollolibrary.com/pqdweb?index=0&did=1961185111&SrchMode=1&sid=4&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1277055889&clientId=13118
References
l Hudock, S. Juergens, R. (2010). Evidence-‐based management of chemotherapy-‐induced febrile neutropenia. Pp. 1.
l Neutropenia Support AssociaJon Inc. (2010). Treatment for Severe Chronic Neutropenia. Retrieved July 28, 2010, from hqp://www.neutropenia.ca/about/treatment.html
l Oncology Nursing Society (ONS). (2006). PEP up your pracJce!
l Stoppler, M. (2010). Neutropenia. Retrieved June 20, 2010, from hqp://www.medicinenet.com/neutropenia/arJcle.htm
