“It’s actually the nurse who most often first identifies the subtle signs of sepsis in patients. Trust your clinical judgement,” ONS member Laura Zitella, MS, RN, ACNP-BC, AOCN®, nurse practitioner at the University of California, San Francisco, told listeners during a conversation with Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS. Zitella explained the nursing and management considerations for febrile neutropenia and what to do if it transitions into sepsis. This episode is part of a series about oncologic emergencies; the previous episodes are also linked below. You can also earn free NCPD contact hours after listening to this episode by completing the evaluation linked below.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Episode Notes

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities.
• Previous Oncology Nursing Podcast episodes on oncologic emergencies
• Clinical Journal of Oncology Nursing articles:
  • Sepsis: Symptoms, Assessment, Diagnosis, and the Hour-1 Bundle in Patients With Cancer
  • NEWS Scoring System: Use in Hematologic Malignancies and Cellular Therapeutics Patient Populations
  • Febrile Neutropenia: Decreasing Time to Antibiotic Administration in a Community Hospital Emergency Department
• ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition)
• ONS courses:
  • Oncologic Emergencies
  • Treatment and Symptom Management—Oncology RN
  • Essentials in Oncologic Emergencies for the Advanced Practice Provider
• ONS Huddle Cards™
• International Guidelines for Management of Sepsis and Septic Shock
• National Comprehensive Cancer Network guidelines on prevention and treatment of cancer-related infections
• Sepsis Alliance
• Surviving Sepsis Campaign

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From Today’s Episode

“We know that fever and neutropenia in combination needs to be treated immediately. This is a high-risk oncologic emergency. Our patients who have febrile neutropenia are at very high risk of having a severe infection or sepsis.” Timestamp (TS) 03:44

“Patients with cancer are at an increased risk for infection because of the inherent immunosuppression of the cancer itself and also the treatment.” TS 08:28

“There are some very, very basic things that patients can do [to decrease risk for infection]. The most important is good handwashing. I explain to patients that your skin is the best barrier against getting an infection. If there’s no break in the skin, then infection cannot get in. So, if your hands get contaminated and you wash them before you touch your eyes or your mouth or your nose, then that is a good way to prevent infection.” TS 11:42

“Even if a patient does everything perfect, most of the time when you’re neutropenic, the infections that develop come from endogenous organisms. So, our body is colonized with probably 10 times as many microbes as human cells, and when the immune system is suppressed, it allows these organisms sometimes to cause infection. So, it’s very important for patients to know that if they have signs of infection that they should let us know so that we can start immediate treatment to treat the infection.” TS 14:01

“If patients are higher risk or they have any organ dysfunctions, or other symptoms—like they’re unwell, nausea, vomiting, diarrhea, any symptoms like that—they should be admitted to the hospital, and we would initiate IV antibiotics.” TS 17:37

“It’s actually the nurse who’s most often the person that first identifies sepsis in patients, so I think it’s really important to trust your clinical judgement. When you look at a patient, it’s really easy to tell when something is wrong. When they’re starting to breathe too heavy or they’re a little bit off and they’re starting to get some altered mental status, or suddenly their heart rate is elevated for no reason even though they’re just lying in bed. So, nurses are really positioned and are most often the ones who first pick up on these subtle signs.” TS 27:17