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HemOnc > Neutropenic Fever > Flashcards

Neutropenic Fever Flashcards

1
Q

first WBC to arrive to site of injury

A

neutrophil

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2
Q

WBC that can attack up to 1-2 dozen BACTERIA

A

neutrophil

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3
Q

Fever = (2)

A
  1. single oral temp > 38.3C / 101F

2. temp of >38 / 100.4F on 2 occasions separated by 1 hr

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4
Q

neutropenia =

A

ANC < 1500 cells / microL

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5
Q

severe neutropenia

A

ANC < 500 cells or expected w/in 48 hrs

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6
Q

profound neutropenia

A

ANC < 100 cells / mm3

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7
Q

ANC =

A

total WBC X % neutrophils

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8
Q

the more lobes (2-4)/bands

A

the more immature the neutophil–the more acute the infection–Left-shift–bandemia

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9
Q

neutropenic fever =

A

fever in someone w/ neutropenia

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10
Q

ANC

A

absolute neutrophil count

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11
Q

Neutropenia causes (2)

A
  1. ^ utilization (sepsis)

2. v production (bone marrow) –leukemia, drugs (CHEMO), HIV

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12
Q

Neutropenic fever management

A

a medical emergency–> immediate ER eval

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13
Q

Before antibiotics most neutropenic fever pt’s _____

A

died

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14
Q

Neutropenic Fever initial eval

A
  1. ENSURE HEMODYNAMIC STABILITY
  2. History
  3. review of histories
  4. Focused Exam
  5. lines or in-dwelling hardware
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15
Q

Splenectomy think (3) w/ neutropenic fever pt’s – Tx accordingly

A
  1. Strep pneumo
  2. N. meningitidis
  3. H. influenzae
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16
Q

for Neutropenic Fever–stay away from ____ _____!

A

rectal exam!

17
Q

skin exam w/ neutropenic fever may find (2)

A
  1. petechiae

2. vesicels

18
Q

neutropenic Fever Labs (4)

A
  1. CBC
  2. culture anything possible
  3. chest xray *, CT, MRI
  4. LP if meningitis is suspected (platelets!)
19
Q

Neutropenic fever Tx (3) broad

A
  1. assess Low vs. High risk
  2. obtain cultures
  3. Begin empiric antibiotic therapy
20
Q

*complete initial eval and tx within ______ of onset of neutropenic fever

A

1 hour–abx w/in 1 hour!

21
Q

neutropenic fever low risk pt’s (8)

A
  1. adult
  2. ANC > 500
  3. peak temp <39C 102F
  4. no chemo
  5. no malignancy
  6. normal chemistires
  7. Normal CXR
  8. No indwelling cath or line
22
Q

score over ____ = low risk on MASCC sheet

A

21

23
Q

High risk pt’s w/ neutropenic fever (11)

A
  1. child/elderly >60 yo
  2. malignancy
  3. ANC<100
  4. concurrent chemo and radiotherapy
  5. DM, poor nutrition
  6. delayed surgical healing or open wounds
  7. significant mucositis
  8. unstable (HTN, oliguric, hypoxic)
  9. Chronic CS
  10. indwelling line
  11. recent hospitalization for infxn
24
Q

Tx for low risk pts (4)

A
  1. oral cipro plus augmentin
  2. For PCN allergy – oral cipro + clindamycin
  3. minimum 4 hr observation in ER before discharge
  4. F/U w/in 24-48 hrs
25
Q

Fungal Neutropenic fever etiologies (2)

A
  1. candiada

2. aspergillus

26
Q

Tx for high risk N.F. pts

A
  1. admit for inpatient
  2. Gegin monotherapy (anti-pseudomonal)–cephalosporins
  3. carbapenem–imipenem
  4. anti-pseudomonal PCN
27
Q

further Tx for high risk N.F. pts if evidence of pneumonia

A

add aminoglycoside (tx’s Klebsiella)

28
Q

Treatment for N.F. if abdominal sx’s present

A

Metronidazole – suspect C. Diff

29
Q

If catheter-related infection related to NF tx w/

A

vancomycin– for MRSA–assume it is pen resistant then move off vanco when culture returns if pen sensitive

30
Q

for sever mucositis related NF

A

tx w/ vanco – for S. viridans

31
Q

If high risk NF pt is vanco resistant tx w/ (3)

A
  1. linezolid
  2. daptomycin
  3. quinopristin (dalfopristin)
32
Q

PCN allergy:

  1. non-anaphylactic tx:
  2. anaphylactic tx:
A
  1. cefepime

2. Aztreonam +/- aminoglycoside or fluoroquinolone

33
Q

when to stop ABX in NF pt if afebrile by day 3, cultures negative, AND if low risk pt

A

after 7 days if ANC remains > 500 for 48 hrs

34
Q

If temp > 3 days, continue ABX until pt fever free AND

A

ANC > 500 X 5 days

35
Q

ABX tx if ANC remains <500

A

minimum of 2 weeks of ABX therapy

36
Q

when fever > 4-7 dyas and pt anticipated to remain neutropenic for > 7 days consider

A

fungal infx–> Tx w/ Amphotericin B, Itraconazole

37
Q

Viral neutropenic fever think (3) Tx.

A
  1. HSV
  2. varicella
  3. CMV
    - -anivirals generally aren’t indicated unless vesicle can be cultured
38
Q

Gram - neutropenic fever etiologies (4)

A
  1. E. coli
  2. Klebsiella species
  3. Pseudomonas aeruginosa
  4. Enterobacter species
39
Q

Gram + NF etiologies (6)

A
  1. S. aureus
  2. S. epidermidis
  3. Enterococcus faecalis
  4. Corynebacterium species
  5. S. PNEUMONIAE
  6. S pyogenes

HemOnc (7 decks)

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