NS case Flashcards
1
Q
- 52 year old woman with breast cancer calls chemo unit feeling generally unwell - temp is 38.6
- is this normal?
A
no - temps >38.0 (x2) or >38.5 or <35 require medical assessment in a chemo patient
2
Q
- she underwent cycle 2 of FEC (5-fluorouracil, epirubicin, cyclophosphamide) chemo 12 days before - when are neutrophil levels most commonly lower in chemo patients?
A
days 7-14 of chemo
BUT
can also be low up to 6 weeks after
3
Q
- she is admitted to the oncology ward for assessment and management - what would be key to as in her history?
A
systemic inquiry for signs of infection anorexia lethargy malaise sweats
4
Q
- her history reveals dysuria, increased urinary frequency, lethally, anorexia, and vommiting twice - where does this suggest the source of infection is?
A
urinary tract source
5
Q
5. comment on the following found on examination: HR - 125 Temp - 38.8 BP - 85/40 RR - 18 O2 sats - 99% on air
A
HR - tachycardic Temp - febrile BP - low ?hypovolaemic RR - normal O2 sats - normal
Tach + febrile + hypo
= ?sepsis
6
Q
- on further examination she had cool peripheries, cap refill time of 4 seconds and suprapubic tenderness on abdominal exam. What investigations might you carry out?
A
FBC, UE, LFTs, CRP, Bone profile, blood cultures +/-clotting urine dipstick + culture CXR throat swab ECG
7
Q
- she is a septic patient who is also neutropenic so should therefore be treated as an oncological emergency - what are your first lines of treatment?
A
DON’T WAIT FOR BLOOD TEST RESULTS
- urgent IV access and aggressive fluid resuscitations - 3-4L in first few hours
- urgent IV AB
- paracetamol
- antiemetics
- catheterise (also helps with monitoring)
- regular observations (response to therapy, deterioration)
8
Q
- her blood come back showing neutrophils of 0.6 and CRP 130 - comment on these figures
A
neutrophils - high (1.5)
CRP - high (<4)
9
Q
- her urine dipstick is positive for nitrites and leucocytes - how might this help with her treamtent?
A
can be sent for MC+S to guide antibiotic choice and use
10
Q
- for how long should she be on IV AB?
A
minimum of 3 days
11
Q
- when might you swap the AB regimen?
A
switch from stage 1 to 2 if patient is worsening or not improving after 48 hours
switch to oral after 3 days if bloods improving and patient apyrxial for 48hrs
12
Q
- what alternative treatment can be given if neutrophils are slow to improve?
A
GCSF - granulocyte colony stimulating factor
13
Q
- how will her chemotherapy treatment be affected by NS?
A
may need next cycle of chemo delayed or dose reduced with addition of prophylactic GCSF
