Haemato - Oncology Practice Identify and critically discuss/analyse one or two key patient issues, the care provided at the time and any factors that may have influenced the quality of the care provided…
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Based on the reports of that test, Ruth was informed that she has acute lymphatic leukemia (ALL) and will need to commence chemotherapy with Cyclophosphomide, Cytarabine and Mercaptoprine for which Hickman line was inserted and kept in situ. She received 4 cycles of chemotherapy until this admission when she got admitted for a complication, febrile neutropenia On this admission, the sixth one since her diagnosis, Ruth presented with fever. On examination, she was febrile, feeling unwell, tearful and anxious, and feeling hot and cold. Her temperature was 38.4C and heart rate 115 beats per minute. Neutrophil count was 0.3 percent, which is suggestive of severe neutropenia. Septic screen was done which included urine culture and sensitivity, stools culture and sensitivity, sputum examination and a full blood count. Chest x-ray and throat swab also was done. Intravenous fluids were commenced as per her weight and first line broad spectrum antibiotics as per hospital protocols were prescribed. Problem-1: Chemotherapy-related neutropenia Overview of the problem Ruth is diagnosed with febrile neutropenia....
Neutrophils are very important for innate immunity and comprise the first cellular component of any inflammatory response (Friese, 2006). Neutropenia is common adverse effect of cytotoxic chemotherapy (Brien et al, 2006). This condition typically occurs in the presence of other side effects and these concurrent events affect the quality of life of the patient. Other side effects include asthenia, anorexia, vomiting and dehydration. In addition to these events various precautions that are taken to minimise neutropenia also affect the quality of life. The degree of febrile neutropenia also influences the intensity of adverse events (Padilla and Ropka, 2005). The duration of chemotherapy induced neutropenia is typically 7-10 days (Friese, 2006). The blood culture of Ruth grew staphylococcus aureus. Urine and other cultures were negative. The staphyloccus aureus was resistant to vancomycin. Hence her antibiotics were changed to meropenem and gentamycin. Ruth was constantly monitored for improvement both through physical examination and laboratory tests. This is because, neutropenia is associated with significant morbidity and mortality because of the increased risk of developing infections that could be life threatening. The risk of infections correlates with drop 0f absolute neutrophil count and those with severe neutropenia (ANC < 0.5 ? 109/L) are at greatest risk of developing infections which are life threatening. In Ruth, the neutropenic count was 0.3 and she presented with only fever. More often than not, infection due to neutropenia manifests as just fever and hence presence of fever in neutropenic patients warrants close monitoring (Padilla and Ropka, 2005).
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