neutropenia: sepsis dx, on abx temp spike. ?Call?

[gentle]

Hello everyone,

I hope the title gives enough info to peak the curiosity enough for responses.

This past weekend, I was at work. Neutropenic patient with dx of sepsis. Saturday was day 3 of admission. Patient on 2 iv abx, but still spiked temp of 101.2F on my shift. I was concerned. I didn't know what to do, so I requested the ID MD phone number to place the call. wbc 0.2 anc 0.

the attending was adamant that i shouldn't be soo concerned. the patient didn't look septic and was not symptomatic for being septic. This is true, however, we are not the usual unit for onc patients and to me it is reasonable to question whether we are headed the right direction with the abx currently being used. is this incorrect thinking on my part? should i have just read the progress notes and stated patient so and so has an elevated temp but other vs are stable. all the while thinking, pt not on ivf to assist compensation for potential septic shock.? hope that makes sense.

anyway, i was later encouraged that i should have read the progress notes to see that patient was actually improving, which is true, i admit. i'll be chalking this one up to remember to read the progress notes. or at least try to read the notes and ask for interpretation when needed.

on the other hand, i don't think we have many policies for onc patients and i also think i did the best that i could under the circumstances. at any rate, the patient is safe and secure on my watch.

[silver888stein]

what is your usual cut-off hemoglobin levels before giving any chemotherapy?

[globalRN]

i am not sure what 101 F is but if the patient is spiking 38.5 or more and is neutropenic. warrants blood cultures being drawn for sure and a review of treatment plan.

Day 3 of antibiotics, patient should be improving and shouldn't really be spiking 38.5 or more. day 3, the results of first set of blood cultures should be back and be a guide for antibiotic tx as well.

i imagine the patient was on something like pip/taz+ aminoglycoside, or ceftazidime + something else?

i think u did the right thing, nothing is worse than a significant temp on a high risk patient which is blown off or not addressed appropriately. better safe than dead(patient that is)

[gentle]

i am not sure what 101 F is but if the patient is spiking 38.5 or more and is neutropenic. warrants blood cultures being drawn for sure and a review of treatment plan.

Day 3 of antibiotics, patient should be improving and shouldn't really be spiking 38.5 or more. day 3, the results of first set of blood cultures should be back and be a guide for antibiotic tx as well.

i imagine the patient was on something like pip/taz+ aminoglycoside, or ceftazidime + something else?

i think u did the right thing, nothing is worse than a significant temp on a high risk patient which is blown off or not addressed appropriately. better safe than dead(patient that is)

You are absolutely right!!!! Thank you.

I verified that I did the right thing by calling our sister hospitals' onc nurses, on Thursday of last week. Sure enough they said the same thing that you are writing. Sooo, in the end, I did the right thing. Thanks for your support.

[iluvivt, BSN, RN]

Just remember that one of the primary responsibilities of a nurse is assessment and data collection. You did just that ...you assessed the patient ...collected the data...and the last step of the process is interpretation of the data. You determined that there was a significant change in the patient's condition (temp spike) and you reported it to the MD and documented it as such. Good job!!!!