Otterbein University Digital Commons @ Otterbein
Nursing Student Class Projects (Formerly MSN) Student Research & Creative Work
7-25-2018
Neutropenic Sepsis in the Intensive Care Unit
Nicole Melchiorre Otterbein University, [email protected]
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Part of the Nursing Commons
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 O erbein University, Westerville, Ohio References What is Sepsis in the Underlying Signs & Implica ons of Nursing Care Neutropenic Pa ent? Pathophysiology Significance of Pathophysiology Best, J. T, Anderson, F., Rioux, L. Symptoms (2013). Implementa on of an Evidence-Based Order Set to Impact • It is impera ve prac oners are • Neutropenic Sepsis is a • An organism or microcrobe • Dunkley and McLeod (2015) Ini al An bio c Time Intervals in highly suspicious when caring for • Hypotension describe the three hour care Adult Febrile Neutropenia. Oncology complication and oncological enters the bloodstreams, colonizes, • Neutropenic pa ents face greater complica ons and poorer this pa ent popula on. 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) pa ents interven on. 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 ini al insult, is • Dunkley and McLeod (2015) obtaining blood cultures prior Neutropenic sepsis: assessment, ini ates in the presence of According to Vioral& Wentley determined primarily by the severity of mul ple organ encourages prac oners to to administra on of an bio cs, pathophysiology,and nursing care. • Fever infec on. When the localized reflect that neutrophil counts are administra on of broad Bri sh Journal of Neuroscience (2015), neutropenic sepsis dysfunc on. inflammatory response cannot lowest 5-7 days a er spectrum an bio cs, Nursing, 11(2), 79-87. remains the leading cause of manage the infec on, sepsis occurs chemotherapy administra on administra on of 30ml/kg Kim, M., Ahn, S., Kim, W. Y., Sohn, C. • Tachycardia crystalloid for sepsis induced death in oncology patients. (Vioral & Wentley, 2015). • Clo ng abnormali es and coagulopathies can further be and it is the nadir me period H., Seo, D. W., Lee, Y. S., & Lim, K. S. that neutropenic pa ents are at hypotension and/or lactate complicated in the neturopenic se ng causing DIC and (2017). Predic ve performance of the highest risk for infec on. greater than 4, and measuring quick Sequen al Organ Failure • Sepsis occurs due to • Tachypnea • According to Dunkley and decreased perfusion to the ssues. Oncology pa ents have lactate levels. Assessment Score as a screening tool overwhelming infec on 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 prac ce of standardized • Maintaining adequate care unit admission in pa ents with (bacterial, viral, or fungal) being that should be considered, and poten ally 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. Suppor ve Care due to the lack of neutrophils sepsis. protocol. Early administra on 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 pa ent. an bio cs, fluid resuscita on, 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 stabiliza on of vital A., & Oppert, A. (2016). Neutropenic • Infec on also s mulates 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 circula on into inters al ssues, decreased intravascular outcomes and decrease necessary to prevent further in a two-phase model and de ined in the National Institute damage. Strict intake and number of responses such as volume, hypotension, hypoxia, and lac c acidosis. mortality. microbiology findings. Cri cal Care of Health (NIH) as a neutrophil • Cold, clammy, cyano c vasodila on, increased capillary output measurement is crucial Research & Prac ce, 9(2), 1-9. as well. count of <0.5 x10/L and either a permeability, and clot forma on. • Wells, et al (2015), stresses the Vioral, A., & Wentley, D. (2015). skin Managing oncology neutropenia and importance of con nued temperature higher than 38 (Dunkley and McLeod, 2015). • Control blood glucose levels. sepsis in the intensive care unit. educa on of providers caring for Insulin resistance can occur Cri cal Care Nursing Quarterly, 38(2), degrees Celsius or other signs • Bounding pulses neutropenic pa ents as well as • The complement system is a part related to stress in the cri cally 165-174. or symptoms consistent with the pa ents and families ill pa ent. This along with of the innate immune system, with themselves. Early recogni on is Wells, T., Thomas, C., Wa , D., clinically signi icant sepsis administra on 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 administra on the management of neutropenic mark pathogens by covering the • Pa ent’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 ven la on in the glucose levels (Dunkley & cri cally 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
overac ve, leading to mechanism related to metabolic commonly seen diagnosis. acidosis (Dunkley & McLeod, Infec on is the most common complica ons such as DIC and Educating the care providers at mul system organ failure. 2015). complica on in pa ents 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 recogni on and interven on patients. coagula on, causing excessive • Consider cor costeroids if are necessary to decrease platelet plugs and fibrin in hemodynamic instability mortality and improve overall microvasculature in conjunc on con nues despite fluid outcomes. Acknowledging with a deficit of clo ng factors resuscita on and vasopressor neutropenic sepsis as an support. Hydrocor sone 200mg/ oncological emergency while leading to coagulopathies. daily is the recommended dose understanding the (Dunkley & McLeod, 2015). pathophysiology of the disease allows pa ents to receive op mal care.