Otterbein University Digital Commons @ Otterbein

Nursing Student Class Projects (Formerly MSN) Student Research & Creative Work

7-25-2018

Neutropenic Sepsis in the

Nicole Melchiorre Otterbein University, [email protected]

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Recommended Citation Melchiorre, Nicole, "Neutropenic Sepsis in the Intensive Care Unit" (2018). Nursing Student Class Projects (Formerly MSN). 332. https://digitalcommons.otterbein.edu/stu_msn/332

This Project is brought to you for free and open access by the Student Research & Creative Work at Digital Commons @ Otterbein. It has been accepted for inclusion in Nursing Student Class Projects (Formerly MSN) by an authorized administrator of Digital Commons @ Otterbein. For more information, please contact [email protected]. Neutropenic Sepsis in the Intensive Care Unit Nicole Melchiorre RN, BSN Oerbein University, Westerville, Ohio References What is Sepsis in the Underlying Signs & Implicaons of Nursing Care Neutropenic Paent? Pathophysiology Significance of Pathophysiology Best, J. T, Anderson, F., Rioux, L. Symptoms (2013). Implementaon of an Evidence-Based Order Set to Impact • It is imperave praconers are • Neutropenic Sepsis is a • An organism or microcrobe • Dunkley and McLeod (2015) Inial Anbioc Time Intervals in highly suspicious when caring for • Hypotension describe the three hour care Adult Febrile . Oncology complication and oncological enters the bloodstreams, colonizes, • Neutropenic paents face greater complicaons and poorer this paent populaon. and reproduces in a host. The bundle as a part of nursing Nursing Forum, 38(6), 661-668. emergency that results from prognosis in sepsis. According to Kruse, et al (2016) paents intervenon. This includes • Altered Mental Status body’s inflammatory response Dunkley, S., & McLeod, A. (2015). cancer and treatment of cancer. with neutropenic sepsis, prognosis of the inial insult, is • Dunkley and McLeod (2015) obtaining blood cultures prior Neutropenic sepsis: assessment, iniates in the presence of According to Vioral& Wentley determined primarily by the severity of mulple organ encourages praconers to to administraon of anbiocs, pathophysiology,and nursing care. • infecon. When the localized reflect that counts are administraon of broad Brish Journal of Neuroscience (2015), neutropenic sepsis dysfuncon. inflammatory response cannot lowest 5-7 days aer spectrum anbiocs, Nursing, 11(2), 79-87. remains the leading cause of manage the infecon, sepsis occurs administraon administraon of 30ml/kg Kim, M., Ahn, S., Kim, W. Y., Sohn, C. • Tachycardia crystalloid for sepsis induced death in oncology patients. (Vioral & Wentley, 2015). • Clong abnormalies and coagulopathies can further be and it is the nadir me period H., Seo, D. W., Lee, Y. S., & Lim, K. S. that neutropenic paents are at hypotension and/or lactate complicated in the neturopenic seng causing DIC and (2017). Predicve performance of the highest risk for infecon. greater than 4, and measuring quick Sequenal Organ Failure • Sepsis occurs due to • Tachypnea • According to Dunkley and decreased perfusion to the ssues. Oncology paents have lactate levels. Assessment Score as a screening tool overwhelming infecon McLeod (2015), there may be a baseline coagulopathies related to chemotherapy treatment, • Best, et al (2013), supports for sepsis, mortality, and intensive • Increased Lactate delay of local inflammatory current pracce of standardized • Maintaining adequate care unit admission in paents with (bacterial, viral, or fungal) being that should be considered, and potenally exaggerated in perfusion with a mean arterial present and the body’s immune levels, acidosis. response and absence of pyrexia order sets in the sepsis treatment febrile neutropenia. Supporve Care due to the lack of sepsis. protocol. Early administraon of pressure (MAP) of 65 or greater in Cancer, 25(5), 1557-1562. is necessary to adequately response is inadequate (Vioral & present in the oncological paent. anbiocs, fluid resuscitaon, Kruse, J. M., Jenning, T., Rademacher, • Oliguria and anuria obtaining blood, urine, and stool perfusion organs. Hypotension S., Arnold, R., Schmi, C. A., Jorres, Wentley, 2015). • According to Dunkley and McLeod (2015), The release of must be promptly managed cultures, and stabilizaon of vital A., & Oppert, A. (2016). Neutropenic • Infecon also smulates the cytokines into the blood stream, leads to leakage of fluid from with fluids and vasopressors if sepsis in the ICU: outcome predictors • Neutropenic Sepsis has been • Hypoxia signs are all shown to improve release of cytokines, triggering a circulaon into intersal ssues, decreased intravascular outcomes and decrease necessary to prevent further in a two-phase model and deined in the National Institute damage. Strict intake and number of responses such as volume, hypotension, hypoxia, and lacc acidosis. mortality. microbiology findings. Crical Care of Health (NIH) as a neutrophil • Cold, clammy, cyanoc vasodilaon, increased capillary output measurement is crucial Research & Pracce, 9(2), 1-9. as well. count of <0.5 x10/L and either a permeability, and clot formaon. • Wells, et al (2015), stresses the Vioral, A., & Wentley, D. (2015). skin Managing oncology neutropenia and importance of connued temperature higher than 38 (Dunkley and McLeod, 2015). • Control blood glucose levels. sepsis in the intensive care unit. educaon of providers caring for Insulin resistance can occur Crical Care Nursing Quarterly, 38(2), degrees Celsius or other signs • Bounding pulses neutropenic paents as well as • The complement system is a part related to stress in the crically 165-174. or symptoms consistent with the paents and families ill paent. This along with of the innate immune system, with themselves. Early recognion is Wells, T., Thomas, C., Wa, D., clinically signiicant sepsis administraon of steroids Fountain, V., Tomlinson, M., & three purposes: recruitment of instrumental. contribute to hyperglycemia, Hilman, S. (2015). Improvements in (Wells, et al. 2-15). inflammatory cell to infected area, requiring insulin administraon the management of neutropenic mark pathogens by covering the • Paent’s may require and close monitoring of blood sepsis: lessons learned from a district • As a RN in the Medical bacterial membrane, and destroy mechanical venlaon in the glucose levels (Dunkley & crically ill period of sepsis hospital. Clinical Medicine, 15(6), Intensive Care Unit at the James pathogens (Dunkley and McLeod, McLeod, 2015). 526-530. management in order to control

Cancer Hospital, sepsis in the 2015). However, in sepsis, the hypoxia and dyspnea. Dyspnea neutropenic patient is the most complement system can be may occur as a compensatory Conclusion

overacve, leading to mechanism related to metabolic commonly seen diagnosis. acidosis (Dunkley & McLeod, Infecon is the most common complicaons such as DIC and Educating the care providers at mulsystem organ failure. 2015). complicaon in paents the bedside on early receiving chemotherapy • Transfusion Red Blood Cells to intervention and proper sepsis • According to Dunkley and treatment, with neutropenia maintain hemoglobin greater being the primary risk factor intervention is instrumental in McLeod (2015), the inflammatory than 7. ( Kruse, et al, 2016). Early improving outcomes for these response disrupts normal recognion and intervenon patients. coagulaon, causing excessive • Consider corcosteroids if are necessary to decrease platelet plugs and fibrin in hemodynamic instability mortality and improve overall microvasculature in conjuncon connues despite fluid outcomes. Acknowledging with a deficit of clong factors resuscitaon and vasopressor neutropenic sepsis as an support. Hydrocorsone 200mg/ oncological emergency while leading to coagulopathies. daily is the recommended dose understanding the (Dunkley & McLeod, 2015). pathophysiology of the disease allows paents to receive opmal care.