Sepsis in people with cancer is generally caused by gram-negative bacteria like Escherichia coli and Pseudomonas sp. In most cases, these bacteria are part of the person’s normal flora. Good hand washing and general personal hygiene practices remain key nursing strategies to prevent FN and sepsis. People at risk of developing FN or sepsis must also receive education on:6,9 signs and symptoms of FN and sepsis actions that should be taken in the event of these signs or symptoms developing minimising potential exposure to infectious sources times at which people receiving treatment for cancer will be at their greatest risk of infection. Management All persons receiving treatment for cancer who present with a fever should be managed as if they are neutropaenic, without waiting for laboratory confirmation of their neutrophil count. The key nursing priorities when dealing with FN or sepsis is prompt assessment using a septic workup as per local policy and procedures. People with symptoms of sepsis should receive antibiotics within 30 minutes of presentation. For with suspected or confirmed FN that has not yet progressed to sepsis, antibiotic therapy should, if possible, commence within one hour of presentation. Ideally, blood cultures should be collected prior to the commencement of antibiotics, in order to better identify the causative infectious agent. Subsequent therapy should be based on the clinical findings of the tests performed and may also include the administration of intravenous fluid, blood products, oxygen, and/ or vasopressors. Individuals experiencing altered mental status must also be closely monitored to ensure safety. Other supportive management strategies undertaken by nurses include: monitoring the person’s response to therapy by checking signs regularly reviewing test results as appropriate assessing for signs and symptoms of septic shock supportive management of provision of information and supportive care to reduce concerns and psychological distress. Resource links The contains a resource on the . This includes a detailing the antibiotics that should be used to treat FN and sepsis. (This is a free resource, but you must register and log in to access). You may also find the NCCN Guidelines on ) helpful. (This is a free resource, but you must register and log in to access).
Treatment of MSCC should take into consideration the person’s pre-treatment health status, including their ability to ambulate and comorbidities. Palliative radiotherapy remains the cornerstone of treatment for most people with MSCC. Urgent surgical opinion should also be sought for the person with actual or impending MSCC, as evidence has suggested that outcomes are improved with decompressive surgery to radiotherapy. People with MSCC are also often treated with corticosteroids, although there is currently limited evidence to support this practice. More than 50% of individuals with MSCC go on to develop urinary retention and faecal incontinence. Incontinence can have a major impact on QoL. Faecal incontinence is also a leading cause of admittance to a residential aged care facility. Learning activities Completed Activities Discuss the nursing implications of people receiving the following treatments for MSCC: corticosteroids radiation to the spinal cord decompressive surgery Discuss the evidence-based supportive care you could offer a person with MSCC who is suffering with bowel and bladder dysfunction. Superior vena cava syndrome Aetiology and contributing factors Superior vena cava syndrome (SCVS) is a complication that can arise in people with cancer, especially those with lung cancer or lymphoma. Approximately two to four percent of all people with lung cancer will go on to develop SVCS at some time. The superior vena cava (SVC) is responsible for the venous drainage of the head, neck, arms, and upper thorax. The SVC has thin walls, and is vulnerable to external compression by tumours arising in the lung or mediastinal area. Tumour invasion, thrombosis, or interference with the venous return can also cause obstruction of the SVC, leading to SVCS. This syndrome is defined by the constellation of symptoms that result from the obstruction of the SCV., and symptoms commonly associated with SVCS include: facial or neck swelling (in 82% of presentations) arm swelling (68%) dyspnoea (66%) cough (50%) dilated chest veins (38%).
The management of the individual undergoing a procedure to insert a CVAD involves: gaining written consent for the procedure and the sedation (if sedation is planned) preparing the person for the procedure (assessment, fasting, review of pathology, administration of products and pre-medications as required). Following catheter insertion, radiological examination (e.g. chest X-ray) should be obtained to: verify catheter placement detect adverse events provide record of placement. The anatomical placement of the catheter tip must be documented and checked prior to the initiation of any therapy through the device. Learning activities Completed Activities Refer to your local policy and procedures and the CNSA . Develop a care plan for an individual undergoing a procedure to have a CVAD inserted. Outline the rationale for the following prior to insertion of a CVAD Antibiotics Platelets Describe the information and supportive care needs of a person and their carer pre insertion of a CVAD and the nursing responses to their needs. You are caring for a person who is having a Hickman tunnelled catheter inserted. He swims daily in the local public pool and asks if he will be able to continue to do this while the Hickman catheter is insitu. What information and advice would you provide to him? Care and maintenance principles All facilities caring for people who have a CVAD should have specific evidence based policies and procedures which undergo a robust review and evaluation process. The care and maintenance of CVADs differs between facilities. Some areas of CVAD management remain contentious or unclear despite a vast amount of research and debate. These include: most appropriate skin antiseptic appropriate cleansing of needleless access caps CVAD dressing requirements, i.e type and frequency of changing securement devices flushing techniques flushing and locking solutions.