evergreener 659 Views
Joined: Mar 23, '06;
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Here is some information I found from reading my texts and visiting other discussions on this site. I tried to summarize the important aspects of caring for a neutropenic pt with professional literature. There is more info to come, but I wanted to make sure I hit the big points. Thanks in advance for reading it...I hope you learn something new from it.
I Prevent Infection
a) WASH HANDS!!!!! (thoroughly and constantly!)
b) Know pts neutrophil status to determine need for additional
(Neutropenia is defined as <1,500-2,000 (Tabers, 2005), but severe
neutropenia is <500 cells/mm3 (Lehne, 2004).)
c) Implement contact precautions/reverse isolation
(I have read that there is no evidence to suggest that these precautions have
been successful and that some hospitals choose not to use them to save $
and to make pt more comfortable (I guess so the pt doesn't feel like E.T.--in
the final scene). Anyone experience this at their hospital? I think its mostly in
d) Restrict diet to avoid possibly contaminated foods (salads & fresh
(again, no evidence found that suggests this is helpful. I also see pts getting
fruit juices still...would this matter? I found that 95% of juices are
pasteurized, but often not labeled. See this link for more info:
II Report signs of infection and follow treatment protocol
a) Fevers >100.4 are reported in neutropenic pts (is this pretty standard?)
b) Start antibiotics immediately if fever is >100.4 (I saw on other postings that Vanco is used...is that normally the case? What other antibiotics are common? I assume the docs prescribe broad-spectrums. Also, what do you culture if you don't know where the infection is?)
My pharmacology book suggests IV Cefriaxone plus amikacin for initial empiric therapy (Lehne, 2004)...does anyone follow this suggestion in their practice?
III Neupogen if necessary to increase WBC
a) usually not given to Leukemia pts (because it proliferates the
cancerous cells of the bone marrow) However, I did read that in pts with
acute myelogenous leukemia, neupogen has been given to stimulate division
of cancer cells, thereby making them more sensitive to chemotherapeutic
agents (Lehne, 2004). This goes back to getting those cells out of the Go
phase and into the active cell cycle to kill 'em off!
b) can cause resp depression (I saw this in my Mosby's Drug Guide for
Nurses (2005) and I looked it up in my Pharmacology text book but this one
did not mention resp depression as an adverse effect. I want to know the
pharmacology behind the respiratory depression. Does anyone know
why this drug would cause it? I cannot make the connection.)
c) very expensive $1800-2800 per treatment...Yikes! (As nurses, do you
see this drug equally prescribed to pts in need...or just to the ones with
good insurance coverage?)
IV Other things to be aware of in the neutropenic pt
a) thrombocytopenia goes along c the neutropenia r/t bone marrow
suppression, so don't give aspirin or other anticoagulants, and assess for
bleeding, take extra precautions to avoid bruising, etc.
b) anemia may also be present
c) remember psychosocial needs too!
The information I have found from 2000 and 2003 says that the studies show no conclusive evidence that these diets help prevent mortality in neutropenic pts. I cannot find recent research either.
I will keep hunting...please let me know if you find anything either. I am writing a paper on this for nursing school.
I have recently started working on an oncology unit and have noticed that only certain people wear masks when entering the neutropenic pts room. I am wondering if there is an intermediate protocol between normal procedures and complete reverse isolation. What is your hospital's policy for contact with neutropenic patients?
Also, neutropenic pts cannot have fresh fruit or salads...I find it very ironic that after eating a big hospital cafeteria salad yesterday on lunch, I came home with a cramping abdomen and later an unpleasant episode with emesis. I think I could contribute to some evidence-based practice!
My final question: Does anyone know of any evidence-based practice r/t the diet and contact precautions with neutropenic pts?
(I promise to share the research I find too...I just have to post a question for a paper assignment. ) Thanks.
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