Febrile neutropenia -Nursing ppt

FEBRILE NEUTROPENIA
Mathew Varghese V
MSN(RAK),FHNP (CMC Vellore),
CPEPC
Nursing officer
AIIMS Delhi
03/06/2019
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mathewvmaths@yahoo.co.in

03/06/2019
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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.
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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.
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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.
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FEBRILE NEUTROPENIA
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 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

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)
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NEUTROPHILS
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WHAT IS NEUTROPENIA?
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 Neutropenia means low neutrophil count.
 Neutropenia is a condition ,where the
patient’s ANC is < 1500 cells/mm3.

WHAT IS ANC AND HOW TO CALCULATE
ANC ?
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 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.

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
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ETIOLOGICAL AGENTS
Bacteria
Fungus
Virus
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INITIAL EVALUATION
 Detailed history .
 Comprehensive physical examination
 Search for potential sites of infection
 (skin, nail, oropharynx, gastrointestinal and
respiratory tracts, perianal and genital regions,
vascular access and biopsy sites).
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CLINICAL EXAMINATION
O
S
C
A
R
Oral inspection
Skin integrity
Catheter site
Anal region inspection
Routine vital signs
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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.
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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).
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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
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MASCC RISK-INDEX SCORE
MULTINATIONAL ASSOCIATION FOR SUPPORTIVE CANCER CARE
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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
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COMPLICATION
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NURSING INTERVENTIONS
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 The goal is to prevent infectious complication or
detect infection at the earliest possible stage and
promptly intervene.

PATIENT AND FAMILY EDUCATION
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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

PATIENT AND FAMILY EDUCATION
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 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)

THANK YOU
03/06/2019mathewvmaths@yahoo.co.in31

Febrile neutropenia -Nursing ppt

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