[Daisies]

I have a pt. that I have been taking care of and she has small cell tonsil cancer. She is on Neutropenic Precautions. I would like to know more about what Neutropenic Precautions is and how I can best care for my patient!? Can anyone help?

[Emmanuel Goldstein]

It really depends on your facility's protocols.

The most important thing is strict handwashing (surprise surprise) in and out. Infected staff and visitors should stay away. Many hospitals still require a special diet (with no fresh or uncooked foods) and no fresh flowers or live plants, although not all do.

No rectal meds, temps, enemas, etc. Use stool softeners to prevent straining. Good pulmonary toilet. Monitor all invasive lines, wounds, etc., for s/s infection (remember, there won't be purulent drainage when there are not enough white cells to form pus).

With a neutropenic patient, you want to monitor their VS at least every four hours. Watch for fever and BP trends; also be aware of subnormal temps in these patients.

If they develop chills and rigors, their temp is spiking rapidly. Be sure to take it again once the chills stop, as this is when it's at its peak; but notify the doc when they rigor, regardless. They're going to need pan-cultures and antibiotics.

I can't say this emphatically enough--- when a neutropenic patient becomes septic, they crash hard and fast. I've seen patients go from 'fine' to coding within minutes. So you must stay on top of this. Always suspect sepsis with neutropenic fever. A fever in a neutropenic patient is an emergency, and you always treat it as such. Never ignore a fever. Ever.

Here's a good tutorial on neutropenia:

http://www.realnurseed.com/t1000.htm

http://www.cancer.org/downloads/CRI/Fever-2006.pdf

[pagandeva2000]

Also, they mention that patients should not consume fresh fruit and vegetables because of the bacteria, no free standing water or fresh flowers in the area, for the same reasons.

[StacieRN]

Additionally:

Depending on policy at your facility, pt may need to be on bottled water only. If that is the case - no ice (ice machines possible source of bacteria.)

Limit sticks. Make sure pt has soft toothbrush or switch to toothettes. No straws (may cause gums to bleed and introduce bacteria.) No alcohol based mouthwashes.

Absolutely no children around.

If antibiotics are ordered on a neutropenic pt, always consider these orders STAT.

No visitors (or staff members) that have had a live vaccine in the last month.

No tampons.

And no blue cheese dressing (it contains live mold)

[Emmanuel Goldstein]

Originally Posted by StacieRN

Depending on policy at your facility, pt may need to be on bottled water only. If that is the case - no ice (ice machines possible source of bacteria.)

I've only worked a couple of places with that policy. I think it's a good idea--- ever looked closely at that ice machine and the drains? Ick. I think they're just plain nasty for patients in general.

If antibiotics are ordered on a neutropenic pt, always consider these orders STAT.

As in yesterday.

[General E. Speaking, RN]

no ground black pepper- I think you can have pre-packaged pepper but not freshly ground???

[Tampagirl]

One of the facilities that I've been to put these patients on reverse isolation. So you still have to wear a gown, gloves, and mask but it's because you can get them sick. Everything mentiones above was also in effect.

[earle58]

and of course, assess pt's pulm, gu, surgical, iv sites, for s/s infection.

leslie

[GrumpyRN63]

all of above plus excellent oral care w/ mouth rinses, watch for thrush/mucositis

[Emmanuel Goldstein]

Originally Posted by kriso

no ground black pepper- I think you can have pre-packaged pepper but not freshly ground???

http://www.pubmedcentral.nih.gov/art...gi?artid=87582

The prevalence of thermotolerant fungi on non-heat-sterilizable food was determined. Aspergillus spp. were noted in 100% of pepper and regular tea samples, 12 to 66% of fruits, 27% of herbal teas, and 20% of freeze-dried soup samples. All soft cheese samples were contaminated by Geotrichum and yeast (Candida norvegensis) but Candida albicans was never identified.

Several types of foods were selected from those served in three hematology wards of St. Louis Hospital, Paris, France. At least 15 individual samples of each food were taken at random from the kitchens of the wards, the central kitchen, or the hospital pharmacy, where foods were usually stored. Food included regular tea (bags), herbal tea (bags), chocolate (powder), freeze-dried coffee, chicory, freeze-dried soup (bags), salt (bags), ground pepper (bags), caster sugar (bags), fresh bread, sandwich loaves, rusks, ketchup, mustard, vinegar sauce, cereals, potato crisps, aperitif biscuits, sweet biscuits, sponge cakes, cheeses (soft cheeses [Saint Nectaire and Cantal], processed cheese, and cream cheese), fruits (apple, apricot, banana, kiwi, lemon, melon, orange, and peach), and fruit juices (apple, cocktail, grape, and pineapple). Apart from fruits, all foods were individually wrapped.

Ew.