Care of the Oncology Patient Stacy Ravert RN, BSN, OCN

The Many Faces of Oncology

Client Background Variety of diagnosis Multiple needs Chemotherapy disease management end of life care

Neutropenia Defined as an absolute neutrophil count (ANC) of less than 500 Calculated by the following formula ANC = % polys+ % Bands x WBC 100

Significance of Neutropenia During neutropenia a clients immune system is weak Client is the most vulnerable to infections Infection is the common cause of mortality and morbidity

Nursing Responsibilities Identify Patients at risk Monitor Assign to a private room Teaches patients, family and staff on hand washing Avoids assigning staff with documented infections or suspected infections

Nursing Responsibilities continued Instructs visitors to check in with the nurse Instructs patients that children under 1 years of age cannot visit Minimized/postpones all invasive procedures if possible Prohibits contact with staff/visitors with known or suspected transmissible illness Provides mask when leaving room

Nursing Responsibilities Continued Avoids stagnant water sources (water pitchers) Avoids soil (plants in soil) Offers low bacterial diet when ordered by physician Removes neutropenic precaution when ANC is greater than 500

Questions

Case Study Andrew Blake is a 24 year old male who was diagnosed with Acute Myologenous Leukemia 14 days ago. He has been hospitalized since his diagnosis. He received chemotherapy 8 days ago. You are working dayshift. Your report from nightshift is as follows:

Case Study Continued He slept throughout the night. He currently has D51/2 NS with 20 KCL running at 125cc/hr through a double lumen Hickman catheter. Both lumen were flushed that morning, and both injection caps were changed. A CBC and CMP were both drawn. He is voiding per urinal, independent, and is on a regular diet. His lab results are not back yet. He was afebrile throughout the night and his vital signs are stable.

Case Study Continued You verify allergies in the computer (he has none), and find that his lab results are back as follows: WBC 500 Hgb 10 HCT 24.9 Plt 13,000 Neutrophils 35 Bands 1

Case Study Continued What is the ANC? You go into the room to assess the patient. He is alert and orientated to person, place, time and situation Lungs are CTA bilaterally, respiratory rate is 16 Heart rate is regular at 88bpm, BP 126/78, Peripheral Pulses are positive, no edema, temperature is 37.7 Abdomen is soft and non-tender, Bowel tones positive x4 He has voided 350cc of clear yellow urine in the urinal without complaints of burning or frequency. ANC is 180 ([{35+1}/100]*500)

Case Study When you go in at 1130 to do your noon assessment you find the same patient as follows: He is unaware of where he is, and having a difficult time staying wake, pulling at his Hickman. He is diaphoretic. His lungs are coarse and diminished in the bases. His respiratory rate is 22. His blood pressure is 90/68, heart rate is tachycardic at 124, peripheral pulses are present. His temperature is now 39.4, and he is having shaking chills. What do you do?

Case Study Continued Call the physician and get order for: Blood culture Urine culture Antibiotics (usually start with ceftazadime) Pack Red Blood Cells Platlets After you get the above orders what do you do? Obtain cultures then start the antibiotics

Questions