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

2. The Many Faces of Oncology

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

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

5. 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

6. 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

7. 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

8. 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

9. Questions

10. 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:

11. 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.

12. 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

13. 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)

14. 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?

15. 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

16. Questions