| Concerning risk factor |
a) To determine patients' lack of knowledge and information about the disease, treatment and care to be used. |
II |
| b) To assess the risk factors for FN such as advanced age, previous FN, radiation therapy and/or previous CT, associated comorbidities, previous hospitalizations, aggressive or metastatic cancer, catheter manipulation, weakened immune system, low levels of albumin, hematological diseases (leukemias, lymphomas or other bone marrow diseases). |
II |
| c) To assess issues such as psychosocial well-being, lifestyle, organic functions (kidney, liver, heart function); recovery of spinal cord activity, people recently submitted to HSCT, SIRS and hemodynamic instability. |
II |
| d) To pay attention to the handling of catheters properly, especially semi-implantable catheters (more susceptible to infection than fully implantable catheters. |
VI |
| e) To pay attention to hand and equipment hygiene, which can be channels of transmission of pathogens to cancer patients. |
II |
| f) To guide patients to avoid closed places with clusters of people and individuals with contagious diseases. |
VI |
| Concerning prevention |
a) To observe the use of G-CSFs, especially in the first cycle of CT, since it decreases the incidence, duration and severity of hospitalizations for FN or other neutropenic complications, in addition to minimizing reductions in CT doses and possible delays. Recommended for patients over 65 years of age; spinal cord infiltration; open wounds; active infections or other serious comorbidities; received extensive previous treatment or CT and combined radiation therapy, and received a CT regimen with a documented rate of FN greater than 20%. |
II |
| b) To pay attention to the proper administration of G-CSFs subcutaneously. The drug should be started 24 hours after CT and repeated every 24 hours. When G-CSF is used in patients treated with weekly CT regimens, it should be stopped 24 hours before next treatment, once G-CSF has been used in 1 cycle, it must be used in all subsequent cycles of the same form. |
VI |
| c) To continuously assess the risk factors for post-chemotherapy FN. |
IV |
| d) To guide patients and family members about the importance of hand hygiene and disinfection of materials. |
II |
| e) To carry out an outpatient nursing consultation (offer patients a tangible education, to reinforce post-CT care to prevent FN, risk of sepsis and clarify patients' doubts). |
IV |
| f) To periodically schedule laboratory tests for patients after CT to assess the immune system, explaining the need for it to continue with CT treatment. |
IV |
| g) To advise patients to use Telenursing whenever necessary (use technology to provide guidance to patients, especially those from distant regions/use appropriate communication to avoid generating errors). This feature allows professional and patient proximity, provides integration, protection and security. |
IV |
| h) To observe the occurrence and start immediate treatment for vomiting, mucositis, diarrhea, which are predisposing factors to the onset of infection, which may contribute to FN. |
IV |
| Concerning management |
a) To request the start of antibiotic therapy within 1 hour to guarantee positive effects in the treatment, avoid possible organizational problems, such as delays in filling out the prescription, problems with the system with a specific form, delays in transferring the emergency service to the inpatient unit, problems with the pharmacy process, or delay in medication administration. |
VII |
| b) To perform exam collection, if neutrophils are less than 500mm3, temperature higher than 38.0°C and patients received CT in the last 14 days. Collect blood culture and urine samples (according to the institutional protocol) and send them to the laboratory on an urgent basis and start the antibiotic. To perform exams for kidney, liver, urine culture (IN) colproculture (IN) imaging exams radiology, ultrasound, tomography. Perform culture of other sites, such as catheters. |
VI |
| c) To assess the antibiotic used, in cases of low risk (oral antibiotic therapy). In high-risk cases, patients must be hospitalized and use intravenous antibiotics. |
IV |
| d) To perform early sepsis screening, source assessment, timely administration of appropriate antibiotics and management of infusion. Fever should be recognized as an emergency and antibiotics should be used promptly to prevent sepsis, septic shock and death. |
V |
| e) To pay attention to the recombinant human G-CSF that stimulates the proliferation of bone marrow progenitor cells and their differentiation into functional blood cells, which helps in the recovery of patients with neutropenia. G-CSF can be administered to patients who are experiencing an episode of FN ("secondary prophylaxis"). Recommendations include starting treatment with CSFs 24 hours after CT administration. |
VI |
| f) To monitor nutritional status and advise patients not to eat raw foods if their neutrophil is less than 500mm3 (neutropenic patients should avoid raw foods due to the presence of bacteria in food, should avoid raw dairy products, herbs, honey, fruits and fresh vegetables, cold meats and cheeses and water from wells (so include well-cooked foods in meals). |
VI |
| g) To assess signs and symptoms, grade of FN patients is in (grade zero - 2,000mm3 or higher, grade 1 - 1,500 to 1,999mm3, grade 2 - 1,000 to 1,499mm3, grade 3 - 500 to 999mm3 and grade 4 - less than 500mm3) and monitor vital signs for 4/4 hours or whenever necessary according to patients' clinical picture using devices exclusively for patients with FN or performing disinfection of the devices to avoid cross contamination. |
VI |
| h) To perform hand hygiene, prepare the necessary materials for the procedure, rub the catheter hub with antiseptics (alcoholic chlorhexidine 0.5% or alcohol 70%). Access catheters with sterile devices only. To perform the dressing change of the fully implantable catheter every 7 days in case of transparent film and replace the dressings in cases of dirt, damp or loose. |
VI |
| Concerning specific management for pediatrics |
a) To pay attention to the dosage of antibiotics, since most are fractionated. They must be equipped with a graduated chamber and/or use of the infusion pump, which allows the infusion of medicines at the appropriate dosage and time. |
VII |
| b) To assess the child's psychosocial issues and family support (the presence of parents helps during treatment). To provide a pleasant, creative, quiet place for recovery. |
VII |
| c) To establish dialogue with children, using a language that is easy to understand and adapted to their age. Knowing how to listen to questions carefully. |
VII |
| d) To carry out the selection of appropriate equipment for children, such as equipment and extenders, micropores, splints. |
VII |
| a) To promote the continuing professional qualification to prevent and recognize possible complications related to FN such as sepsis, pneumonia, cellulite. |
IV |
| b) To emphasize the importance of hand hygiene before the preparation and administration of medications, punctures, catheter handling. |
II |
| c) To educate patients about the disease, FN and post-CT care. |
IV |
| d) To instruct patients and family members to take care at home, when checking the temperature, signs and symptoms that should be reported to a health professional (such as: fever, chills, bleeding, persistent pain even with the use of prescription drugs). |
IV |
| e) To asses patients before CT treatment (investigation and nursing diagnoses), in order to elaborate relevant interventions (perform nursing consultation periodically). |
IV |
| f) To encourage nurses to discuss the need for hematopoietic support with other members of the health team. |
V |
| g) To assess the risk of FN in order to design supportive care plans, considering the myelosuppressive potential of the treatment regimen. |
IV |
| h) To use an evidence-based approach to nursing care. |
IV |
| i) To document the results and response to treatment before the next CT cycle to be administered. |
IV |
| j) To monitor possible complications of patients, especially elderly people, children and individuals most likely to become myelosuppressed. |
IV |
