Remember that you need to have completed six of the seven Journal Club articles presented this year in order to receive credit for clinical ladder. Your confirmation sheet can be sent inter-office mail to Melissa Luebbe c/o Pain Management. You can also flag me down anytime when you see me rounding in the units! I hope this has been an informative and enjoyable year for everyone, we will start up again in September.
Questions
- Explain two differences between Neulasta and Neupogen.
- A patient receiving chemotherapy should be advised to go to the Emergency Department for what symptoms? What would you tell this patient will be done for them once they reach the Emergency Department? These answers will require your own research, or you can call one of your brainy friends in the Infusion Center.
Discussion Question
How could you teach a neutropenic patient stay safe -while not becoming disengaged from the world?
Just For Fun
Just For Fun
Can someone blog how many Neulasta injections are given daily in the Infusion Center?
Answers and questions can be sent to melissa.luebbe@ctca-hope.com
Helping the patient feel empowered in their own care would be beneficial. There are many different recommendations for staying safe. In regard to the recommendation of handwashing, it is easy to see how crucial this action can be. Tips for not becoming disengaged would be portable hand sanitizers are very convenient, can clip on a purse or belt loop, and provide more freedom for patients. They can also request friends and family to help them in their efforts to stay healthy by encouraging handwashing and safe hygiene from visitors as well.
ReplyDeleteNicole, I like your suggestion about handwashing or the use of antibacterial hand sanitizers. This is an effective way of avoiding catching unwanted virus's. I always tell my patients also to try to avoid touching their eyes, nose, and mouth before washing their hands with soap and water. Great post!
DeleteI agree with Nicole, with the appropriate precautions, patients can stay safe while participating in an active life style. Hand hygiene is key. I would teach the patients precautions for reducing risk of injury and infection such as avoid sharp objects, clean fruits and veggies well, cook food thoroughly, avoid crowds and sick people. The patients can still enjoy their meaningful to them with family and friends; they can work and do most things that are meaningful to them.
ReplyDeleteThe best thing to tell a patient to do to protect themselves when they are neutropenic is to wash there hands often with lots of soap and water, and for convience hand sanitizers are great have with them at all times. It is also important to avoid crowds and places where people may be sick, but that they should not let that prevent them from doing essential things such as shopping, manditory travel, or Dr visits. It is in these instances the patient can wear a mask to help decrease the risk of the spread of infection. With that being said even when in places where there are crowds of people the patients most important intervention will be hand hygene.
ReplyDeleteWe can teach our patients how to maintain quality of life by washing all raw fruits and vegetables well as well as cooking food thoroughly, avoiding sick people, wearing a mask on planes, being cautious with razors and other sharp objects, bathing daily and drying thier body thoroughly, and prevention of cuts and scrapes as they are an opening for infection. Neupogen and Neulasta also help but all of these precautions will allow patients to live their lives daily.
ReplyDeleteyour emphasis on hygiene is good, and we know that skin that is clean and healthy is less prone to breakdown and infection. Less infection on the skin reduces the stress on the imune system and needs of the body
DeleteI agree with Pamela teaching patients about the importance of hygine is very important. It will help cut down the chance of infection.
DeleteWhen empowering our patients to maintain a good quality of life, there are essential items that should be included. If at all possible, Neupogen or Neulasta should be ordered after chemotherapy to reduce the severity and duration of neutropenia.
ReplyDeleteAs mentioned by all the nurses above, hand hygiene is critical to reducing the amount of microorganisms that are introduced into the body, along with daily bathing. In addition to this, oral hygiene should be emphasised to also reduce this introduction of micro- organisms.
Avoiding all persons with known cold, flu or other infections AND large crowds is advisable, however not always feasible. If possible, sending family or friends to the store for the patient and have them also assist in food preparation. Washing fresh fruits and vegetables and thoroughly cooking raw foods will also help.
We know that patients that are nutritionally healthy, have a greater chance of NOT having neutropenia, so assistance with the nutritional services is also a great benefit.
Social isolation is common during neutropenia, however, social networking with face time, and skype can help reduce this isolation.
It is that ounce of prevention that is always better than the pound of cure :)
All great points! I always learn so much from all of you!
DeleteExcellent summation of considerations Judy:-)
DeleteNeupogen and Neulasta are of course an important prevention measure. I believe as you stated above that we also need to assist them to really focus on their nutrition. This is also key as they bounce back after each cycle.
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ReplyDeleteThese are the things that should be taught to a neutropenic patient:
ReplyDeleteAlways wash your hands with soap and plenty of water. Many infections are transmitted through hands and things that you touch, such as doorknobs. Washing your hands thoroughly is the most important thing you can do to prevent infection.
Avoid people with colds or the flu.
Avoid large crowds, to reduce the likelihood of coming into contact with sick people.
Bathe daily and carefully dry your skin.
Take steps to prevent cuts or scrapes, as these provide entry points for infection:
Use an electric razor instead of a blade to avoid cuts.
Use caution with sharp objects.
Wear gloves when appropriate.
If you have a cut or scrape, keep it covered with a clean bandage until it heals.
Prevent cracks in your skin by using lotion.
Cook your food thoroughly to kill any potential microorganisms that may be on raw food.
Really, these are things that we all do in everyday life if we're not feeling well. Keeping in touch with friends and family, via phone,email, skype, etc. will help eliminate feeling disengaged
Very well said, What else can i say :) Good job Tina!
DeleteVery nice overview of neutropenic precautions Tina! Very thorough!
DeleteGreat job Tina !!!There is nothing more to add.
DeleteI would emphasize the importance of staying away from others who may be sick or large crowds. In order to not feel disengaged from the world, pt's could be encouraged to socialize via phone, social media, skipe etc. They could also have visitors if they have been screened for any active coughing, sneezing, fevers, body aches, etc. Either party could wear a mask. Interaction/visiting could also be outside in the fresh open air if weather is permitting.
ReplyDeleteI like your thinking for keeping the patient involved with friends and family without putting them at risk. Masks are also so simple yet so important.
DeleteI agree. I think that our patients who are willing to wear a mask to protect themselves are very brave. They may stand out in a crowd but are doing what they need to do to best protect themselves.
DeleteI agree with everyone elses comments. I do have to say, working in infusion we usually administer as little as 10 injections up to 30 injections a day. WOW!!!!
ReplyDeletePrevention is the key.Medications to combat infections is important but prevention is still the first line of defense for these cancer patients.Good handwashing is necessary.Avoiding large crowds also lessen the likelihood of catching something.Protecting their skin from scrapes,cut or dryness can also help prevent infection.
ReplyDeleteKnowledge is power! Teach the patient what neutropenia means and how it can affect their day to day life. Ask what they do once they go home and discuss ways of doing those activites in the safest way possible. For example, With technology on the rise, perhaps the patient could skype or teleconference gatherings they would have attended in person. This way they are still involved but at less risk for infection.
ReplyDeleteI agree, technology can go a long way in keeping someone connected while not exposing them to alot of people and potentials for infection
DeleteTechnology is a great option for these patients. It is the safest way for them to remain connected without the risk.
DeleteEveryone brought up excellent points. I was thinking that many patients return to work between their chemo treatments and this can pose an added increase in risk for infection but also may continue to allow the person to feel connected to their life and to provide normallacy. Of course hand hygiene is a major factor in reducing risk. But also being aware of vectors for infection in the environments, such as shared keyboards and writing utensils; tables in the common eating areas and bathroom door handles. Also maintaining a distance from groups of people. Perhaps during the nadir point it would be most prudent for the person to remain at home or avoid direct human contact. As mentioned above, technology has opened many doors to maintaining contract without having direct interaction.
ReplyDeleteGreat suggestions. Keeping the environmental surfaces is a great way to decrease the risk of infection. Perhaps employers can take extra precautions to clean the workplace in pts getting chemo.
DeleteJust being able to go to a store or restaurant can be tricky when trying to avoid germs. Beyond the normal handwashing and other preventatives the patient should avoid touching their face while out and use anti-bacterial wipes and gel. Maybe even having a friend or family member to handle things like opening doors, pushing the cart, or handling money while shopping. Going out when the stores are less busy may be a good option also.
ReplyDeleteI agree Melissa, shopping can be challenging and cannot always be avoided. However shopping earlier in the day on a weekday can cut down on exposure to germs. Frequent hand washing and avoiding touching their face is imparitive.
DeleteI will suggest the patient to wear a mask when going out on public. Also to do constant handwashing and sanitizing, and just daily personal hygine. Avoid friends and family who have colds or the flu, and going out when there is a smaller crowd ata restaurant or the store.
ReplyDeleteObviously patients should avoid being near those that are ill, use good personal hygiene, prevent cuts and scrapes, clean their wounds properly, and cook food thoroughly, to name a few,
ReplyDeletePatients should check their temps x2 daily, attempt to stay away from friends or relatives that appear to be ill, large crowds, wash hands frequently, report sx of possible infection, avoid cleaning up after pets, wash fruits and vegetables well, and cook or steam vegetables, pressure or burning with urination.
ReplyDeleteI'm glad you added taking your temperature. I forgot to say that. That is also a very important piece. The temperature may be a first sign that something is going on. I have had many patients call with no other symptoms than a 100.8 fever only to find out they are septic.
DeleteThe patient would be instructed if they developed a fever of 100.5 or higher, chills, or signs and symptoms of infeciton to see medical attention that day. They would also be instructed to using toothpicks, eating raw foods, avoid deli meats, cook food thoroughly, use an electric razor only, avoid crowds, avoid others that are sicks, avoid cleaning pet cages, liter boxes, and to wash hands frequently I would recommend using social media, and the telephone to prevent being disengaged from the world until this resolves. .
ReplyDeleteI agree with your recommendations and really appreciate that social media can keep our patients and families connected even when it is medically necessary for them to be avoiding others for their safety.
DeleteIn order for the neutropenic patient to carry on a normal daily routine we want to teach prevention prior to their possible drop in their counts. The patient should be instructed to avoid people with colds and flu. Avoid larged crowds to reduce contact with sick people. Instruct patients to wash hands with soap and water. Bath daily and dry gently to prevent skin tears and irritation. Avoid scrapes, cuts and use an electric razor when shaving.
ReplyDeleteI can't think of anything left to add, with the exception of prophylactic antiobiotics. I remember the days when patients were placed in reverse isolation on the general medical unit. The nurse gowned, gloved, and masked for every entry. Food was "sterile" to decrease dietary bacteria burden.
ReplyDeleteThere is not much more to add.Frequent handwashing,use of hand sanitizers,avoiding people with s/s of cold/flu,avoiding large crowds-these are the key steps to prevent infections.
ReplyDeleteI agree Margaret.
DeleteTo keep a neutropenic patient safe while not becoming disengaged form the world would be first to Teaching the patient the importance of avoiding sources of infections as written above by all the nurses and second help them to realize this is while their counts are low and remind the patient of other ways to keep in contact with other family, friends through social media. Each patient that attends the "What is Cancer" class on Thursday from 5/30 to 6/30pm in the small dining room learn the importance of watching for signs of infection and taking their temperature two times a day and to go to the ER if they have a fever of 100.5 or chills to be evaluated for infection. I advised them to let the staff know they are a cancer patient and have received chemo. .. Thanks for all the great comments from everyone!
ReplyDeleteAll of these are all excellent instructions to give patients to help prevent infections. I would like to add a few things: if a patient has a home or apartment with more than one bathroom - he/she should pick one and no one else should use it. Keep Clorox wipes available for inbetween surface cleaning. If patient has small children/infant delegate changing infants diapers to another parent or family member whenever possible. If you absolutely have to use a public restroom become a foot flusher and frequent handwasher. Patients that have strong faith may not want to risk being in a large crowded church however they can request the congregation pray for them. With with the Catholic faith they may also recieve the communion at home allowing them to keep spiritually connected too.
ReplyDeleteKelly - I agree with your added suggestions. All great examples of keeping what is important consistent - just altering a few things to keep themselves safe.
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DeleteOf course many already gave the best answers of important hand hygiene etc - along with other good examples. I think in addition - I would encourage connection with friends and family through telephone, e-mail, Facebook, etc to continue to feel engaged with the lives of their family and friends. Even though they may choose to stay away from large gatherings to stay healthier... if they make a point to stay connected in other ways such as posting pictures on Facebook and allowing their family & friends to comment positively... or make a special time for phone conversations... I think it would help with the adjustments in preventing infection.
ReplyDeleteI agree. This is an excellent way of staying engaged without actually having to go out in public.
DeleteI think everyone basically mentioned the best appropriate measures to take when one is neutropenic. Hand washing most definitely tops it all along with hand sanitizer as a convenience when your out and about in public. Avoid large crowds, cooking vegetables (any food for that matter) thoroughly is important. One can always wear a mask when they are in public and ofcourse stay away from anyone that is sick is vital, especially, when it is someone you live with. As mentioned above, you can still keep in touch with family and friends via FB, phone, email.
ReplyDeleteIn Care Management we have to discuss this with patients pretty frequently. We always tell them to have good handwashing and to encourage those around them to have good handwashing as well. We always remind patient's it is necessary to take precautions as they are immunocompromised and getting sick could be very bad for them. We do tell people to avoid large crowds but if they do want to go out maybe suggest a mask. We tell them to not have pets lick their faces as they can transmit bacteria to the patients. Of course all of this is to keep the patient safe. In today's world there are still many ways to stay connected without physically being with someone, whether these are preferred ways or not, be it through Skype or facebook, or cell phones.
ReplyDeleteProper hand washing & avoiding people with colds or the flu are important to teach oncology pts. Provide them masks especially if they are flying or going to public places. They can always use technology to keep in touch with family and friends while receiving treatment.
ReplyDeleteI tell my patient's that they do not need to be isolated and that they are allowed to be around people. The most important thing that I tell my patient is to make sure that they wash their hands and stay away from anyone who is potentially sick. For patients who have blood work weekly, I instruct the to look at their blood work and see when they hit their lowest nadir, then the next time, they can stay away from large crowds when they are at their lowest point.
ReplyDeleteThey need to be taught to avoid people with cold or the flu, to not be in a crowded area, to reduce the likelihood of coming into contact with sick people. They need to be taught to take steps to prevent cuts or scrapes as that could lead to infection. also, if they have cuts or scrape, they need to be taught to keep it covered with a clean bandage until it heals. It is especially important to teach neutropenic patients that they need to cook food thoroughly to kill any potential microorganisms that may be on raw food. Most of our patient's use air transportation and so they can be asked to wear a mask when in airports to help prevent coming in contact with sick people.
ReplyDeleteBeena, great comment about the raw food- that is not something that automatically pops into my head. Also, I liked your tip about the cuts and scrapes. Patients don't always understand why it is so important to keep on the PICC line dressing change for 24-48 hours in order for their body to heal itself.
ReplyDeleteLet patients know that there are public places they can visit. You can go to these places when fewer people are likely to be there. This is usually mid-morning or mid-afternoon on weekdays. Avoid weekend visits to public places or when they are crowded. Examples are: Places of worship (sit in the first or last pew or an uncrowded section), museums, shopping mall, grocery store, parks and playgrounds, weekday afternoon movies. Definitely avoid: crowded theaters, concerts, bars, crowded stores, aviary and pet stores, greenhouses, floral shops, conservatories, and swimming pools. The more education patients receive, the better decisions they can make about their health.
ReplyDelete