3. FEBRILE NEUTROPENIA
Febrile neutropenia is one of the common
oncological emergencies.
It is mainly seen on patients who take
chemotherapy
Nurses should specifically trained in the recognition
and management of neutropenic sepsis, so that
rapid assessment and administration of first line
antibiotics can be achieved.
03/06/2019
3
mathewvmaths@yahoo.co.in
4. EPIDEMIOLOGY
The highest rate of febrile neutropenia is seen on
patients with haematological malignancies ,which
accounts above 80 %.
10%–50% of patients with solid tumors are also
prone to get febrile neutropenia.
It commonly develops after first few cycles of
chemotherapy.
03/06/2019
4
mathewvmaths@yahoo.co.in
5. EPIDEMIOLOGY
Considered primary cause of mortality in 36% of
cancer patients
Considered secondary cause of mortality in 68% of
cancer patients.
It is the most common cause of mortality &
morbidity in cancer patients.
03/06/2019
5
mathewvmaths@yahoo.co.in
6. FEBRILE NEUTROPENIA
03/06/20196
Febrile neutropenia (FN) is defined as an oral
temperature >38.3°C (101F) or two consecutive readings
of >38.0°C(100.4F) for 2 hrs. and an absolute neutrophil
count (ANC) <500cells/mm3, or expected to fall below
500cells/mm3 in next 48 hrs.
IDSA - Infectious Diseases Society of America
mathewvmaths@yahoo.co.in
7. WHAT IS FEBRILE NEUTROPENIA?
Febrile neutropenia (FN) is defined as
An oral temperature
>38.3°C (101F) or
two consecutive readings of >38.0°C(100.4F) for 2 hrs.
&
An absolute neutrophil count (ANC)
<500cells/mm3, or
expected to fall below 500cells/mm3 in next 48 hrs.
(Definition by IDSA - Infectious Diseases Society of
America)
03/06/2019
7
mathewvmaths@yahoo.co.in
9. WHAT IS NEUTROPENIA?
03/06/20199
Neutropenia means low neutrophil count.
Neutropenia is a condition ,where the
patient’s ANC is < 1500 cells/mm3.
mathewvmaths@yahoo.co.in
10. WHAT IS ANC AND HOW TO CALCULATE
ANC ?
03/06/201910
ANC (Absolute neutrophil count) – is the total number
of neutrophils present in the blood, which include both
mature neutrophils ( segs or segmented cells) and bands
(immature neutrophils).
Formula
ANC = (% of mature Neutrophils + % of Bands) X Total WBC)
Unit of ANC is cells per microliter. One microliter is
equal to one cubic millimeter of blood.
Normal range of ANC is > 1500 cells/mm3.
mathewvmaths@yahoo.co.in
11. TYPES OF NEUTROPENIA
Type ANC Count
Mild Neutropenia 1000-1500 cells/mm3
Moderate Neutropenia 500-999 cells/mm3
Severe Neutropenia <500 cells/mm3
Profound Neutropenia <100 cells/mm3
03/06/2019
11
mathewvmaths@yahoo.co.in
16. INITIAL EVALUATION
Blood cultures
For bacterial and fungal organisms
Peripheral blood, and Central catheter lumen.
Sputum microscopy and culture
Chest radiograph: baseline and with symptoms –
CT of the chest
Urine cultures: symptoms or catheter in place.
Cerebrospinal fluid
Joint fluid: if local infection suspected.
03/06/2019
16
mathewvmaths@yahoo.co.in
17. INITIAL EVALUATION
Diarrheal stools: cultures, ova/parasites, C difficile
toxin assays .
Cutaneous lesions: (aspirate / biopsy / wash )
culture.
CBC, LFTs, RFTs, electrolyte panel: at baseline and
every 3-4 days, as necessary.
Drainage sites: stain and culture (bacteremia, AFB,
fungi, viruses).
03/06/2019
17
mathewvmaths@yahoo.co.in
18. CLINICAL FEATURES
Fever
Irritability
Hot or cold shivers,
sweating
Warm forehead with
flushed or pale face
Rapid heart rate
Skin rash
Vomiting
Abdominal pain
A sore which does not
heal
Mouth ulcers
Pain on swallowing
Coughing
Diarrhea
Change in level of
consciousness
Painful or frequent
urination
03/06/2019
18
mathewvmaths@yahoo.co.in
22. INDICATIONS OF VANCOMYCIN
Clinically suspected serious catheter-related
infection
Known colonization with MRSA or pcn/ceph-
resistant pneumococci
Hypotension or other cardiovascular impairment
Soft-tissue infection
Severe mucositiS
03/06/2019
22
mathewvmaths@yahoo.co.in
28. NURSING INTERVENTIONS
03/06/201928
The goal is to prevent infectious complication or
detect infection at the earliest possible stage and
promptly intervene.
mathewvmaths@yahoo.co.in
29. PATIENT AND FAMILY EDUCATION
03/06/201929
Explanation of the function of while blood
cells
Meaning of nadir
Instructions for temperature taking
Signs and symptoms of infection (e.g.
fever, malaise, those related to specific
organs such as cough, urinary frequency
with or without dysuria, etc.)
Hygiene practices emphasizing hand
washing
mathewvmaths@yahoo.co.in
30. PATIENT AND FAMILY EDUCATION
03/06/201930
Identification and assessment of high‐risk
areas for infection (chest, urinary tract, skin)
Care of access devices (e.g. Hartman line,
urinary catheter)
Avoidance of exposure to persons with
communicable or infectious illnesses, stay
away from crowds and animals
Maintain nutritional status by a balanced diet
Specific directions for access to healthcare
systems (clinic or emergency)
mathewvmaths@yahoo.co.in