Page 209 - Critical Care Notes

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Clinical Presentation
When a patient is neutropenic, the following usual signs of infection may not be
present because of the lack of sufficient number of neutrophils needed to pro-
duce common infectious signs:
■ Local warmth
■ Local swelling
■ Shaking chills
Common presenting symptoms of neutropenia include the following:
■ Sore throat, mouth
■ Low-grade fever
■ Gingival pain and swelling
■ Skin abscess
■ Recurrent sinusitis, otitis
■ Cough
■ Shortness of breath
■ Nasal congestion
■ Diarrhea or loose stools
■ Burning during urination
■ Perirectal pain
■ Unusual redness
Diagnostic Tests
■ Blood cultures
■ CBC with manual differential
■ Antinuclear antibody (ANA)
■ Rheumatoid factor (RF)
■ Vitamin B 12 and folate levels
■ Basic metabolic panel (BMP)
■ Kidney and liver function tests
■ Urinalysis and urine culture
■ Site-specific cultures such as stool, skin, and vascular access devices
■ Skin biopsy, if new erythematous tender skin lesions are present
■ HIV testing if risk factors are present
■ Chest x-ray
Management
■ Begin treatment with broad-spectrum antibiotics within 1 hr of obtaining
cultures until an organism is identified.
■ Check temperature every 4 hr; avoid rectal temps.
■ Monitor for signs of infection.
■ Assess and monitor CBC with differential.
■ Discontinue any medications that could be the cause.
■ Use good skin care for wound and abrasions.
HEMA/
ONCO