As society continues to age, cancer is becoming more and more prominent. The number of new cases continues to rise each year. Some of these cases can be contributed to just older age whereas some are from improving cancer screenings. At some point in your nursing career you will take care of a patient who had cancer, currently has cancer, or will develop cancer.
Depending on what area you work in, you might encounter a patient with cancer for a multitude of reasons. You may have to manage a side effect from the drugs, care for them during an oncologic emergency, or be present during the end of life care. Regardless of your setting, it is important that you understand how to care for a neutropenic patient and what your hospital's policies are on immunocompromised patients.
When a patient is classified as immunocompromised they have a reduction in their white blood cells (WBC). Most chemotherapies work by killing rapidly dividing cells. Cancer cells rapidly divide, but so do blood/bone marrow cells. WBCs are part of our immune system and help fight infection and protect our bodies from foreign invaders. WBCs are actually comprised of five different cells each with its own job.
In terms of neutropenia, a low neutrophil count increases the chance of an infection. Neutrophils make up the largest number of WBCs and are made in the bone marrow.
They are our first line of defense in an infection. Neutrophils digest bacterial organisms and debris. They have a half-life of seven to eight hours in circulation. There are levels of neutropenia, but the lower the ANC (absolute neutrophil count), the higher the risk of getting an infection. ANC represents the number of mature WBCs in circulation using a simple, mathematical calculation.
When a patient is neutropenic, the usual signs of infection may not be present because of a lack of a sufficient number of neutrophils needed to produce common infectious signs. Here are some simple signs you should look out for and alert the medical provider immediately:
- Temperature > 100.4°F (38°C)
- Shaking chills
- Cough, Sore throat
- Burning with urination
- New lower back pain
- Blood in urine
- Diarrhea (worsening)
- Rash
- Redness, soreness around central line catheter or a wound
In the case that your patient is developing an infection, a common workup should include:
- History review for recent travel or illness exposure
- Timing of last chemotherapy
- Current medications
- Prior infections
As a nurse, you may see the following orders for your patient:
- Blood cultures- typically two sets
- CBC, CMP
- Urine culture
- Chest x-ray
- Site-specific cultures
- Broad-Spectrum antibiotics (Cefepime, Ceftazidime, Imipenem, Piperacillin/tazobactam
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