Wk 1 The Nursing Care Considerations And Management Flashcards
What are the investigations done for a patient with a diagnosis of leukaemia?
Blood tests:
- Full blood count (FBC)
- Liver function test (LFTs)
- Urea and electrolytes
- Peripheral blood film (to check the size and shape of the blood cells)
Biopsies
- Bone marrow biopsy
- Lymph nodes biopsy
Scans
- CT, MRI, PET, X-Ray, Ultrasound
Genetic testing aka (cytogenetic, molecular testing)
- knowing the particular gene change helps to predict the treatment that might work best & its prognosis
Immunephenotyping aka flow cytometry
- this considers the protein on the surface of cells to see if there are any abnormal cells
General health and infection screening
- Such as HIV or Hep B and C
What are the nursing managements of chemotherapy patients?
Cytotoxic chemotherapy does not differentiate between malignant and normal cells, hence it has side effects which should be managed
All patients should have FBC, VSE, LFT’s taken a day or 2 before the next cycle of chemotherapy to ensure the bone marrow has recovered.
-Maintain a strict input and output chart
-Perform mouth and skin care
-Weight patients daily
When does danger time known as the Nadir occur?
Danger time known as the nadir occurs between 5-10 days post chemotherapy for most regimes.
Why does the Nadir occur?
This is caused by the depression of the bone marrow.
When are blood transfusions required?
Blood transfusions is usually indicated if HB <100 gram/litre and the patient is symptomatic
Why is a platelet transfusion required?
A platelet transfusion is required due to thrombocytopenia
When is a platelet transfusion required?
When the platelet count is less than 50 x 109 per litre and the patient is haemorrhaging
How are the side effects of chemotherapy managed?
Through the administration of:
Analgesics
Antiemetic
Antipyretics
Antihistamine
Antidiarrheal medications
What is Febrile Neutropenia?
It’s a medical condition characterised by a fever and a significant decrease in neutrophils, a type of white blood cell essential for fighting infections.
It is a common and potentially life threatening complication in pt undergoing chemotherapy or those with a weakened immune system.
What is a complication of Neutropenia?
Neutropenic Sepsis is a potentially life-threatening complication of neutropenia. It is defined as a temperate greater than 38c or any symptoms and/or signs of Sepsis, in a person with an absolute neutrophil count of 0.5 x 10 (9) /L or lower.
What are the causes of Neutropenic Sepsis?
Cytotoxic chemotherapy
Immunosuppressive drugs
Stem cell transplantation
Infections
Bone marrow disorder
Nutrition deficiencies
What is the nursing assessment of neutropenia?
Check for the presence of venous access device and signs of infection
History - ask the pt or carer about any known causes or risk factors for neutropenia, any recent fever, known cancers and the duration of the cancer treatment, possible risk factors for infection, and recent travels. - this helps to make an informed treatment decision
Undertake a physiological assessment to establish a baseline for treatment
Head to toe assessment of pt’s skin for rashes or wounds
What is the nursing management of neutropenia?
- Escalate to a senior clinician/ ST3
- Give oxygen therapy to people to maintain oxygen saturation above 94% unless contraindicated
- Obtain intravenous access and take blood test and microbiology samples
- Collect urine sample for analysis
- Administer prescribed intravenous broad spectrum antibiotic
- Give intravenous fluid bolus to restore tissue perfusion
- Closely monitor pt including urine output and clinical conditions
What is the patient education on discharge for Neutropenic Sepsis?
Educate on strategies for infection prevention, such as the importance of good personal and oral hygiene, handwashing, ensuring foods are well-cooked, and wearing protective gloves for cleaning and gardening, for example.
• Provide advice on the nature of sepsis, what to expect during recovery after sepsis, and sources of information and support.
• Provide information on how and when to seek specialist advice on any symptoms or concerns, and when to seek emergency care.
• Advise having access to a thermometer to check temperature accurately at home, and the importance of monitoring for symptoms and body temperature, especially if unwell.
• Educate on the need to adhere to medication plan.
What is the patient education for chemotherapy patients?
Chemotherapy is excreted in all body fluids and can stay in the system for 48 hours.
• Eat small frequent nutritious meal
• Use of gloves when handling body fluids and maintaining hand hygiene
• Wear disposable pads if incontinent
• Utilise the cancer support community
• Patients are advised not to become pregnant or inseminate for one year after completion. Barrier contraception is advised.
• Sperm and egg storage are offered if appropriate
