Nursing management of common oncological emergencies.

This article examines three of the most common oncological emergencies. It considers the underlying pathophysiology of these conditions and the symptoms. The role of the nurse in identifying these conditions and expediting timely care to reduce patient morbidity and mortality is discussed.

Care of immunocompromised patients in hospital.

Infection presents a significant risk for immunocompromised patients. To reduce this risk, various precautions can be implemented and these may affect patients' quality of life. Such precautions are controversial, with varying practices being adopted by different hospitals. This article aims to enhance nurses' knowledge about the current evidence on the interventions designed to reduce the rate of infection in immunocompromised patients who are in hospital.

Nurses reclaiming ownership of their practice: implementation of an evidence-based practice model and process.

This article describes a new model and process to implement evidence-based practice. This model builds on concepts from the Iowa Model of Evidence-Based Practice, the Stetler model, and Rosswurm and Larrabee's model. The new model focuses on the centrality and involvement of staff nurses in making evidence-based practice clinical changes. Two figures illustrate the model and the implementation process. A detailed case study based on the model is included. Barriers identified in the literature review are addressed in the case study. Implementation of this model creates opportunities for staff nurses to recognize ownership of their practice and their role in changing the practice setting to a culture of evidence-based practice.

Nursing care, education and support for patients with neutropenia.

Neutropenia is reduced white blood cell count. It is a side effect of cytotoxic chemotherapy for cancer and haematological patients. This article aims to help nursing students and qualified nurses who are novices in caring for neutropenic patients to become familiar with the usual body defences against infection; understand how the body's ability to fight infection is affected by neutropenia; recognise potential sources of infection; and support the patient who is at risk of infection as a result of neutropenia.

Nurses' knowledge and care practices for infection prevention in neutropenic patients.

BACKGROUND: Neutropenia-associated infections can prolong hospitalization, increase re-admission, mortality and morbidity rates. AIM: To determine nurses' knowledge and infection control care practices in neutropenic patients. DESIGN: This descriptive study was conducted between January 2012 and May 2012, at oncology adult inpatient units of a university hospital in Turkey. Sample consisted of 51 staff nurses. METHODS: Data were collected by a form included sociodemographic characteristics, neutropenia knowledge questions, and infection control care practices. Each nurse was observed by researcher three times for infection control care practices. RESULTS: The mean score of nurses' knowledge was 21.3 ± 2.4 (min. 17; max. 27). For all three observations hand hygiene adherence was found low both in medication preparation, administration and vital signs assessment. Sterility disrupted in almost all preparation of parenteral medications. CONCLUSIONS: Even nurses' knowledge related with neutropenia and care of neutropenic patient was found above average their infection control care practices were found insufficient.

Care of patients with neutropenia.

Neutropenia can be a significant problem in the oncology setting. Awareness of potential risks, management of neutropenia, and preventive measures guide nurses in providing comprehensive care that can make the difference between life and death.

Neutropenic sepsis.

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The article discussed the causes, signs and symptoms of neutropenic sepsis in adult patients after cancer treatment. It also explored the prevention and management of this condition.

Protocols for managing chemotherapy-induced neutropenia in clinical oncology practices.

Chemotherapy-induced neutropenia is managed in different ways in clinical practice. Chemotherapy dose reductions and delays are used more often than proactive, first-cycle use of colony-stimulating factors, but such dose modifications can result in suboptimal treatment outcomes. This article reviews how 3 oncology practices have used practice pattern studies to assess and improve their quality of care, particularly in the management of neutropenia. These practices analyzed their records for the occurrence of neutropenia and for delays or reductions in chemotherapy doses. Once baseline measurements of quality of care were established, the practices developed guidelines to optimize their management of neutropenia. The practice patterns were assessed again after the guidelines had been implemented, to determine the effect of these guidelines on clinical outcomes. All 3 practices had fewer delays and reductions of chemotherapy doses after the guidelines were used. These differences were both clinically and statistically significant. Clinical experience shows that nurses are well positioned to assess which patients may be at the greatest risk for neutropenia and its complications and therefore should be treated with colony-stimulating factors. Practice guidelines for the use of colony-stimulating factors are being developed, but broader acceptance of these guidelines is needed to support nurses' recommendations.

Neutropenia management with granulocyte colony-stimulating factors: from guidelines to nursing practice protocols.

Neutropenia, a problem that oncology nurses face in daily practice, is the major dose-limiting toxicity in patients with cancer who are treated with myelosuppressive chemotherapy. The incidence of chemotherapy dose reductions or treatment delays, which can impact overall dose intensity and compromise treatment outcomes, may be reduced by the proactive use of granulocyte colony-stimulating factor (G-CSF). National and international guidelines have been developed to promote the cost-effective use of G-CSF. Nursing care protocols for the management of chemotherapy-induced neutropenia (CIN) can be developed based on the national guidelines and modified for use by individual clinical practices. Risk assessment for CIN, which considers the prescribed chemotherapy regimen, patient risk factors, and treatment intent, should be a key component of the practice guidelines. Because most neutropenic events occur in the first cycle of chemotherapy, risk assessments should be conducted before the initiation of chemotherapy. Patients identified as at high risk for neutropenic complications should be given G-CSF in the first and subsequent cycles to allow the delivery of chemotherapy at full dose and on schedule. Nurses are instrumental in the development and implementation of neutropenia management protocols, which have the potential to markedly improve the quality of care and outcomes for patients with cancer.

Informal Caregivers' Knowledge and Practice of Caring for Neutropenic Patients.

Cooperation of informal caregivers on neutropenic patient care is very important. This descriptive study includes interviews with 100 informal caregivers of inpatients who became neutropenic at least two days previously. Data were collected through face-to-face interviews on informal caregivers' knowledge and practice of caring for patients with neutropenia. The authors found that some rules, such as washing hands and attention to personal cleaning, were known and practiced; other rules, such as having a bath every other day, were less well known. At a Glance • Caregivers should be provided with regular training and standard education programs. • Informal caregivers should be observed when engaged in their routines to assess whether their practice is appropriate in neutropenic patient caring, and nurses should check whether or not their recommendations are being applied and ensure any deficiencies are addressed. • The verbal instruction provided by nurses for caregivers does not include enough information about care for neutropenic patients.

Managing hematologic toxicities: novel therapies.

Myelosuppression associated with cancer chemotherapy may lead to neutropenia, anemia, or both, resulting in an increased risk for infection, fatigue, diminished quality of life, and reduced survival. In addition, neutropenia specifically has been shown to result in dose reductions, treatment delays, or both in subsequent chemotherapy cycles. Hematopoietic growth factors have been used effectively as supportive therapy to reduce chemotherapy-associated neutropenia and anemia. New preparations have the potential to improve treatment outcome dramatically. Results from recently reported studies indicate that patients at risk for neutropenia can be safely and effectively treated with pegfilgrastim once per chemotherapy cycle, and that those with anemia can be managed with weekly or biweekly darbepoetin alfa therapy. These new treatments have the potential to reduce the morbidity and mortality associated with opportunistic infections, decrease the requirement for potentially dangerous blood transfusions, and improve the quality of life for patients undergoing cancer chemotherapy. The longer dosing intervals offered by these new preparations may decrease healthcare expenses and enhance patient adherence.

Oncology nursing protocols: a step toward autonomy.

Many professional nurses see the lack of autonomy, an essential element in the definition of a professional, as a deterrent to achieving true professional status. Autonomy in nursing is seen in the context of self-governance, shared governance, and nurses' participation in the decision-making process with regard to patient care problems and/or responses to care. To promote staff nurses' decision-making participation and increase their responsibility and accountability on a 32-bed oncology unit, Oncology Nursing Protocols were developed and implemented.

Dietary restrictions for patients with neutropenia: a survey of institutional practices.

PURPOSE/OBJECTIVES: To describe institutional practices related to dietary restrictions for patients with neutropenia to determine whether restrictions are used and when they are implemented and discontinued. DESIGN: Descriptive survey. SAMPLE: 156 institutions belonging to the Association of Community Cancer Centers. METHODS: Mailed survey. FINDINGS: Of the institutions surveyed, 78% (n = 120) placed patients with neutropenia on restricted diets. Participating institutions responded that patients were placed on restricted diets at a variety of different white blood cell and neutrophil counts, including neutrophils < 1,000 (43%) and < 500 (46%). The majority of institutions (92%) placed patients on restricted diets once neutropenia was documented, while only 9% of institutions restricted diets when cancer treatment was initiated. Of the participating institutions, 83% (n = 96) restricted diets only when patients were neutropenic rather than throughout the duration of the chemotherapy regimen. The most commonly restricted foods were fresh fruits and juices (92%), fresh vegetables (95%), and raw eggs (74%). Few institutions restricted tap water (12%). Wine was restricted at 39% of institutions, and beer was restricted at 40% of institutions. CONCLUSIONS: The role of diet in the development of infection in patients with neutropenia is unclear. This unclear role contributes to the variation in dietary restrictions among institutions. IMPLICATIONS FOR NURSING PRACTICE: Additional research should focus on dietary factors contributing to neutropenic infections and establishing criteria for implementation of specific dietary modifications. Nursing assessment should include nutritional status and risk factors for neutropenia and bacterial translocation. Nursing protocols for neutropenic dietary restrictions should be based on research findings.

Management of neutropenic enterocolitis in the patient with cancer.

Neutropenic enterocolitis is a life-threatening condition often seen in patients experiencing prolonged periods of neutropenia from conditions such as leukemia and lymphoma and from aggressive chemotherapy regimens. Its exact pathologic process remains unclear; however, it has been proposed that direct cytotoxic damage occurs to the bowel mucosa with subsequent microbial invasion complicated by the lack of adequate neutrophil response. The damage may progress to bowel perforation and septic shock. Early recognition and management by healthcare team members are crucial for the improved prognosis of these individuals. Controversy continues to exist concerning management options and the timing of these interventions. This article outlines nursing and medical management of the patient with neutropenic enterocolitis.

Nursing protocol for the patient with neutropenia.

Although major advances in the treatment of cancer have resulted in improved survival rates, serious infections continue to be a major source of morbidity and mortality in the immunocompromised patient. Patients may experience prolonged periods of bone marrow suppression accompanied by neutropenia as a result of the underlying disease, and as a result of treatment with myelosuppressive chemotherapy, intensive radiotherapy, or both. Neutropenia is the single most important factor predisposing patients with cancer to infection. The risk of developing infection increases as neutropenia persists, and this risk is consistently greater at lower neutrophil levels. Infection in a patient with neutropenia is regarded as an emergency situation requiring immediate action; progression of localized to disseminated infection leading to sepsis may be so rapid that, if not detected early, mortality is high. In the presence of neutropenia, the manifestation of infection leading to life-threatening septicemia is altered. The usual signs and symptoms of infection may be minimal or absent, hindering early and accurate diagnosis of infection. To provide a means of early and more accurate diagnosis of infection in the patient with neutropenia, a nursing protocol has been developed that incorporates preventive interventions, guidelines for early detection of impending infection, and measures to control infection.

Influences of nutrition and stress on people at risk for neutropenia: nursing implications.

Neutropenia may be influenced by malignancy type, treatment, age extremes, inadequate nutrition, or psychological stress. Of these five factors, only nutrition and stress are amenable to nursing intervention and management. The increasing trend of providing treatment in the outpatient setting and managing the patient with neutropenia in the home challenges nurses to develop innovative methods of care. This article offers suggestions to assist nurses in the creative management of individuals at risk for neutropenia by maximizing nutrition and minimizing psychological stress. This discussion addresses the physiology of the inflammatory immune response; pathophysiology of neutropenia; factors that may influence the risk of infection, such as sustained stress, dietary fiber, antioxidant vitamins, and food-borne bacteria; and interventions that reduce the potential for neutropenic sepsis. Nursing implications that reduce the risk of neutropenic infection include patient education related to nutrition, stress management, and self-care.

Current strategies for managing myelosuppression in patients with cancer.

Myelosuppression in patients with cancer is usually the result of tumor invasion of the bone marrow, cytotoxic chemotherapy, or radiation therapy, all of which suppress bone marrow function. Anemia, thrombocytopenia, and neutropenia are the three most clinically significant complications that result from bone marrow depression. Although anemia and thrombocytopenia can produce serious clinical problems, blood-component transfusions--despite having inherent problems of their own--usually are successful in correcting or minimizing these complications. Although neutropenia is manageable in most situations, it remains a serious problem that, at its worst, can progress to life-threatening septicemia. The longer neutrophil counts remain low, the more susceptible patients become to infection by endogenous and exogenous microbial flora. Accordingly, the oncology nurse increases the frequency of patient assessment and monitoring for infection. Control measures are introduced to minimize environmental contaminants. These measures attempt to reduce the incidence of opportunistic infections that frequently occur in patients with severe or prolonged neutropenia and for which antimicrobial therapy is indicated. Implementing specific infection-control interventions and thoroughly educating the patient and his/her family help to limit the clinical problems associated with myelosuppression for most patients.

Bacterial translocation: nursing implications in the care of patients with neutropenia.

PURPOSE/OBJECTIVES: To describe bacterial translocation; the potential causes and influencing factors of bacterial translocation; the anatomy, physiology, and immunology of the small intestine; and the significance of bacterial translocation in patients with cancer. DATA SOURCES: Published articles and books, as well as clinical experience. DATA SYNTHESIS: 50% of infections in patients with cancer who are neutropenic result from endogenous sources such as the normal microbial flora of the bowel. This process called bacterial translocation may be responsible for symptoms such as fever of unknown origin in these patients. CONCLUSION: Maintaining normal bacterial ecology and mucosal integrity of the bowel can reduce the risk of bacterial translocation. IMPLICATIONS FOR NURSING PRACTICE: Care is directed at preventing constipation and maintaining integrity of the normal bowel and microbial flora by providing a low-microbial diet that contains adequate fluid and fiber and by encouraging good oral care.