Chemotherapy

Induced
Neutropenia
LAMYA ALSHAMMARI
Outlines
Scenario
Nursing health history
Physical assessment
Pathophysiology, management and complications
Laboratory result
Medications
Nursing care plan
Patient education
References
 Scenario
years old male diagnosed of Ewing Sarcoma, on 50
chemotherapy and radiotherapy, received his last chemo
session last week. Presented to Accident and Emergency
complaining of three days history of sore throat,
constipation for three days and hx of mild difficulty
. swallowing that has been improved
 Nursing health history
Biographic data  Past medical/surgical history
• Gender: Male • Dyslipidemia
• History of long standing on and off
•Nationality: Saudi constipation
•Age: 50y/o • Bilateral inguinal hernia around 10 years
ago
•Medical diagnosis: Ewing Sarcoma • Hemorrhoidectomy 3 years ago

Chief complain
• three days history of sore throat, mild difficulty swallowing and constipation for three days.
 Physical Assessment
General appearance
Patient was conscious and oriented, lying flat on bed not in distress with patent IV cannula at the left ACF G22.
Anthropometric measurement
•Height : 178cm
•Weight : 80kg
•BMI : 25.25
Vital signs
RBS O2 saturation Blood pressure Respiratory pulse Temperature
rate
81mg/dl 98% 116/81 mmHg 19 b/m 99 b/m 37.3 c
Integumentary system

Skin is intact, pale, cold and dry .

Black, clean and dry hair .
No pressure ulcer or edema .
Head, eyes, ears, mouth, throat, nose and
sinuses
Head in midline
Pupils are 2mm and equal in size .
Congested posterior pharyngeal wall and whitish patches
all over the soft palate .
Stomatitis (fungal infection)
 Reparatory system
Intact airway, both lungs appears clear on chest X-ray
Breathing effectively on room air with saturation of 98%
and respiratory rate of 19 breaths per minute .
Cardiovascular system
Equal strength bilaterally peripheral pulses.
S1+S2+0
Capillary refill less than 2sec
Gastrointestinal system
Soft, lax and not tenderness abdomen .
Decreased bowel sound due to constipation .
Genitourinary system

Patient able to void freely with

clear yellow urine
Neuromuscular system
Glasgow coma scale :

Total Motor Verbal Eyes

15 6 5 4

Patient is conscious, oriented to person, place

and time .
 Pathophysiology, management and
complications

Chemotherapy Induced
Neutropenia
 Chemotherapy Induced Neutropenia
is toxicity in patients with cancer treated with chemotherapy.
Neutropenia is a condition characterized by abnormally low blood
levels of infection-fighting neutrophils, a specific kind of white
blood cell.

Neutropenia is a common complication that occurs during

treatment with chemotherapy in oncology patients. Some patients
are at higher risk of developing neutropenia, based on type of
cancer as well as type of treatment. Neutropenia can lead to serious
complications, including infections and sepsis. Ensuring patient
safety is important in decreasing morbidity and mortality.
Neutropenia can be prevented and treated pharmacologically. Once
patients are neutropenic, precautions should be taken to minimize
risk of infection. These precautions increase patient safety during
times of neutropenia.
 Who is at a higher risk for chemotherapy induced
?neutropenia

Patients receiving chemotherapy that decreases the number of white blood cells
Patients who already have a low white blood cell count, or who have previously received
chemotherapy or radiation treatment
Patients age 70 and older who may be at risk of more severe infection and longer
hospitalizations
Patients with other conditions affecting their immune system
 Management
 routine complete blood count (CBC) checked
 chemotherapy dose modification (dose interval delays)
  initiation of primary prophylaxis with  granulocyte colony-stimulating factor (G-CSF)
 white blood cell boosters that can stimulate white blood cell production and help protect
against infection caused by strong chemotherapy, and may help allow full-dose
chemotherapy on schedule.
complications
 febrile neutropenia
Increase the risk of life-threatening infections.
 increased morbidity and early mortality
Disrupt delivery of cancer treatment, resulting in a change to the planned dose and time
Laboratory results
RefRange Result Test name

HIGH <0.05 0.06 Procalcitonin

NORMAL 0.4-2.0 0.72 Lactic acid

LOW 2.0-7.5 0.32 NEU

LOW 4-11 0.288 WBC

LOW 140-450 69.4 PLT

LOW 13-18 8.32 HGB

LOW 0-20 5 ESR

Laboratory results
RefRange Result Test name

LOW 15-37 10.9 AST

LOW 136-145 131.63 Sodium

neg>=5 67.0 CRP

 Medication
Side effects action classification Route, dose, frequency Drug name
bone pain, chest pain, Used to treat CIN by Recombinant human SC, 300MCG/ML, OD FILGRASTIM
cough, dizziness, Stimulates the granulocyte colony
dyspnea, epistaxis, production of stimulating factor
fatigue fever, nausea, neutrophils in the
neutropenia, pain, bone marrow
rash, and
thrombocytopenia.
Rash, diarrhea, nausea, Treat infection caused Board-spectrum IV, 2GM, Q0 CEFTRIAXONE
upset stomach and by susceptible cephalosporin
headach organisms antibiotic
Headache, hunger, To treat infection Fluoroquinolone PO, 500MG, OD LEVOFLOXACIN TAB
sweating, tachycardia antibiotic
and dizziness
Side effects action classification Route, dose, Drug name
frequency
Chills, weakness, Slowing growth of Triazoles antifungal PO, 150MG, OD FLUCONAZOLE CAP
swelling, light the fungi that cause QAM
colored stool. Yellow infection
eye and skin
Allergic reaction Pain management Analgesic PO, 500MG, OD PARCETMOL TAB
that cause rash and medication used to Q8PM
swelling, reduce mild to
hypotension moderate pain
Tooth and throat Decrease infection Antimicrobial BID MOUTH WASH
irritation, dryness of in the mouth CHILORHEXIDINE
the mouth, GLUCONATE 1%
unpleasant taste,
tongue swelling and
 Nursing Care Plan
Acute pain
Infection
Assessment Nursing Goal  Nursing Rational  Evaluation
diagnosis interventions
Subjective data: Acute pain After 1 hour of  Assess pain score,  To establish  Goal is met
Patient said (I related to nursing onset, duration,     baseline data. after 1 hour
have throat pain) stomatitis interventions quality patient is
decrease pain as
Objective data: evidence patient  Monitor V/S. To establish   Comfortable
 Discomfort. comfort.    baseline data.
 Signs of
infection  Established  To have a good
rapport. nurse-patient
relationship.

 Administer  To relive pain

medication and manage
(analgesic and infection
antibiotics) as
Evaluation Rational Nursing Goal Nursing diagnosis Assessment
intervention
After appropriate Prevent infection Infection related to Objective data:
nursing A well-organized  Inspect the from worsening neutropenia
intervention : assessment should status of the oral
be performed of mucosa; include
The infection will listed sites using a the: Tongue,  Congested
be prevented from tongue blade to Lips, Mucous posterior
worsening show areas of the membranes, pharyngeal wall
oral cavity. Gums, Saliva and whitish
and Teeth patches all over
the soft palate .
Stomatitis (fungal
 Antibiotic will  IV antibiotic infection)
help eliminate
infection and  NEU (0.32)
prevent its  Procalcitonin
spread. (0.06)
 ESR (5)
Assessment Nursing Goal Nursing  Rational Evaluation 
diagnosis interventions
 Monitor patient’s  Dehydration p
fluid status to redisposes
determine if patients to
adequate. impaired oral
mucous
membranes.
 Patient education
Patients was discharge and educated to immediately report fever, chills, SOB and change in mental health occur.

Next GCSF dose after 2 days

Follow up with oncology center and OPD appointment

Take medications as prescribed

good hand hygiene, good oral care/hygiene, avoidance of plants and flowers, follow a neutropenic diet, and

monitoring for fever.

References
Ralph, S. S., & Taylor, C. M. (2013). Sparks and Taylor's Nursing Diagnosis Pocket Guide. Lippincott Williams & Wilkins.

Skidmore-Roth, L. (2015). Mosby's Drug Guide for Nursing Students. (11th ed.). Elsevier Health Sciences.

Dinan MA, Hirsch BR, Lyman GH. Management of chemotherapy-induced neutropenia: measuring quality, cost, and value. J Natl Compr
Canc Netw. 2015 Jan;13(1):e1-7. doi: 10.6004/jnccn.2015.0014. PMID: 25583775.

Lyman GH, Lyman CH, Agboola O. Risk models for predicting chemotherapy-induced neutropenia. Oncologist. 2005 Jun-Jul;10(6):427-
37. doi: 10.1634/theoncologist.10-6-427. PMID: 15967836.

Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management.
Cancer. 2004 Jan 15;100(2):228-37. doi: 10.1002/cncr.11882. Erratum in: Cancer. 2004 May 1;100(9):1993-4. PMID: 14716755.