--Greatest risk is native bacteria in foreign places. Worst are gram- which travel through BS-->sepsis. Pt education on sepsis is vital, because otherwise they may not know to call MD or come in.
How do you calculate ANC?
Total WBC (neutrophil% plus bands)
Transfuse when Hgb<8, <10 if getting radiation.
Blood is filtered to remove WBC (WBCs may give pt feeling of general illness like flu)
Infuse total volume over 3-4hrs.
Coordinate with radiation Tx.
Apheresed (single donor) transfusion is preferred because multiple donors ^ risk of development of platelet antibodies
Infuse as rapidly as tolerated (30-60min), but DO NOT PUSH.
Platelet count <50K is really bad.
N/V/C/D: if C, start on stool softener stat, because if thrombocytopenic, straining to stool may-->hemorrhage.
Past Hx of Type I herpes. If yes-->acyclovir. Always ask about cold sores/genital herpes.
PCA pump w morphine, esp if mouth sores present. Will get better when WBC returns to normal.
Serotonin-Antagonist agents most helpful
----No dystonia, hallucinations, sedation
----after 5 days, must switch anti emetics to another mechanism of action (Benadryl/Ativan) because serotonin receptors will be saturated and Rx will stop being effective. Will also prolong QT intervals-->TDP at high doses)
Usually caused by poor intake, but increase due to polypharm
Sepsis possible from seeding GI flora into blood stream.
Stool softeners important
Very common in elderly
Breakdown of GI mucosa
Eradication of normal flora-->growth of opportunistic flora (C. Diff)
Tx with abx.
--Ca+, Phos, Mg++
v GFR-->v drug excretion
Always assess fro preexisting renal disease because may Cx some therapies.
*Very common in adults
Pseudo-Diabetes due to v insulin production/secretion
--Monitor for SnSs of DM, especially if also on steroids.