Febrile neutropenia -Nursing ppt
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Febrile neutropenia is a common oncological emergency seen in patients undergoing chemotherapy. It is defined as a fever over 38.3°C along with a low absolute neutrophil count under 500 cells/mm3. The highest risk is in patients with hematological malignancies undergoing chemotherapy, where febrile neutropenia is a leading cause of mortality. Nurses play an important role in early recognition of infection and rapid administration of first-line antibiotics to treat potential neutropenic sepsis.
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Febrile neutropenia -Nursing ppt
- 1. FEBRILE NEUTROPENIA Mathew Varghese V MSN(RAK),FHNP (CMC Vellore), CPEPC Nursing officer AIIMS Delhi 03/06/2019 1 mathewvmaths@yahoo.co.in
- 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
- 14. 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). 03/06/2019 14 mathewvmaths@yahoo.co.in
- 15. CLINICAL EXAMINATION O S C A R Oral inspection Skin integrity Catheter site Anal region inspection Routine vital signs 03/06/201915 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
- 20. MASCC RISK-INDEX SCORE MULTINATIONAL ASSOCIATION FOR SUPPORTIVE CANCER CARE 03/06/2019 20 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