 |
|
 |
 |
| |
|
|
| |
| Neutropenic Precautions and the Risk of Immunosuppression |
 |
by Cassie Ruhnke RN BSN - June 24, 2010
|
A diagnosis of cancer comes with a myriad of life changes. Specifically, a known criminal into the world of newly threatened homeostasis is chemotherapy. With the exceptions of specific tumor binding/monoclonal antibody therapies, chemotherapy reacts completely as predicted, and we must educated our patients so they maintain their health and safety during their immunosuppression, which includes the neutropenia.
Chemotherapy, as a rule, has a notorious habit of damaging the fast growing cells without differentiating cancer versus healthy cells. This bombastic attack on our normal cellular makeup can cause such cellular level damage that the warnings are there such as the chemo can actually put you at increase risk for leukemia or lymphoma or another secondary cancer. This may not be a consideration to an already distressed pt starting initial treatment, but years later it can leave them in a cold sweat in the middle of the night.
One of the most devastating things to occur is the decrease in the white blood cell count of the patient. The neutropenia can be anywhere from mild/moderate to so severe that the counts can be as low as 0.0-0.1 mcL. This puts the pt at risk for severe risk for infection, neutropenic fever, even hospitalization. The pt has threats not only from others, but is also a threat to themselves. This is a huge issue, considering the multitude of patients that we treat.
The young adult to family age person who is being treated for a cancer diagnosis with chemotherapy, who has neutropenia has risk factors that are specific to their own group. Young children are continually bringing in new infectious agents to the environment which the patient needs to try and fight off. Friends and family are also carriers of diseases from school aged children, and poorer hand washing in these groups is also a concern.
If patients in these groups are in school, there is a whole new exposure risk. Prevention is key in this area as is clarification on how that is done by simple and repetitive education. Also, fatigue is a major issue as well which can beat down an already decreased immune system and put the patient at greater risk for acquiring infections.
Also, the elderly client brings to the table their own special risks to obtaining chemotherapy. Their group has a higher risk for immunosuppression, neutropenia, infection. With that comes a higher risk of hospitalization and secondary acquired infections (pneumonia) and nosocomial infections. These can be extremely dangerous and with this population can result in long term hospitalization, and depending on status and when this is caught, even death in some of this patient population.
The last population that we need to watch for is the infant population. This group is a group that typically is more sustainable with the infectious process than the other groups after neutropenia hits them. The concern is really the other issues such as dehydration, electrolyte imbalances, again, if inpatient then nosocomial infections. This group is dependent on the parent(s) and so education is the first line of defense we have to monitor this group.
Due to the immunosuppression, risk from exposure, patient’s own behavioral patterns, and the support systems they have at home and that they feel they have in the Oncologist office. These things all intervene with how a patient will respond to the adverse effects from the chemotherapy and the immunosuppression.
Now, there are two medications that we are utilizing regularly for prevention of neutropenia for patients. The first medication is Neulasta. Neulasta is a long acting sub q injectable drug that over stimulates bone marrow to produce white blood cells and prevent neutropenia in chemotherapy regimens that are every 3-4 weeks. Neulasta is administered 24 hours post treatment.
There is also the shorter, daily injection medication called neupogen that is given in 2 different doses, this is for shorter chemotherapy regimen schedules. This also helps to prevent the neutropenia that occurs with the chemotherapy. These are great medications, but they do not come without their own side effects.
The overstimulation of bone marrow typically occurs in the iliac crests, the sternum, and the femurs. Due to the stimulation that occurs, Neulasta has been accounting for more pain issues than neupogen. The pain can be mild to severe, with the need of Hydrocodone for pain management. It is better for a patient to be prepared for pain issues, than be shocked when it comes and not have anything available to them.
Education is also extremely important with these medications. A lot of patients are concerned when after the first injection with neulasta, they have severe chest soreness. Warning them that this can occur, that it is sternal pain, that it is bilateral, goes away with hydrocodone or recommended pain medication, and that it does not travel, and there are no breathing issues. Educating is the first priority of our job. We need to overeducated and make sure pain meds are in place. Nurses need to be proactive with our patients.
Obviously blood counts must be watched as well. There can still be neutropenia, especially common with neupogen. This is especially important around the patient’s nadir period. There is also the chance that there can be incorrect overstimulation of the white blood cells which need to be monitored. It is imperative that CBC’s and neutrophils need to be monitored. Neulasta provides no guarantee on anything. Nursing judgment is always the best.
Education is still the most important. Proper hand washing, infection prevention, signs and symptoms to monitor for, and to call when these symptoms develop a.s.a.p. so that they can be caught early stage. Wash veggies, do not eat unpasteurized eggs or cheeses, do not drink unpasteurized milk, and eat no raw foods. Hand out sheets with the number to call during the day and after hours is a great reference for the patients as well.
With all of these things that we do as nurses on a daily basis, to be more aware and put into practice, we can help these patients and families become educated on what immunosuppression is, how neutropenia effects not just the pt, but the whole family, and how everyone can work together to prevent serious issues that can occur from neutropenia. Together as support systems for the patients, we can decrease the hospitalizations, provide excellent care for our patients, and get these patients through treatment without some devastating issue.
Cassie is an eleven year cancer nurse with inpatient and outpatient experience as well as case management and managed care experience. She has also utilized the skills and compassion that it takes to be an oncology RN to work as an inpatient hospice RN. Cassie has a true love of nursing and her patients.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
RECOMMEND THIS ARTICLE
You must be logged in
to recommend articles
|
 |
|
|
| Ethel |
on 19 Apr 2011 at 11:54 pm |
|
| I want you to take my story to heart. I went to the Cancer Treatment Center in Philadelphia and had 4 chemotherapy and 25 radiation treatments. I was given neulasta and neupogen and the pain was managed very well with claritin (an antihistamine) and ibuprofen daily. I do not want you to suffer any more... Add this to your medications after every shot. |
|
|
|
|
| |
|
|
 |
 |
|
 |
 |
 |
|
