Care of the Oncology Patient

Stacy Ravert RN, BSN, OCN

The Many Faces of Oncology

Client Background

• Variety of diagnosis• Multiple needs

– Chemotherapy– Diagnosis – 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 WBC100

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.

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?

Questions