Protocol for Management or Neutropenic Fever
Fever: oral temperature of ≥38.3 C (101F) – single spike or ≥ 38.0 (100.4F) for at least one hour
Neutropenia: neutrophil count <500/mm3
Signs and Symptoms
- Timing, frequency and duration of nausea/vomiting
- Date of last chemotherapy
- Medication utilized to control thus far
- Reports of dry mucous membranes, lightheaded when arising, weight loss, excessive thirst, decreased urine output, appearance of vomitus, any blood.
- Note age of patient, history of motion sickness, cigarette or alcohol use, history of nausea/vomiting with pregnancy.
Dry mucous membranes, poor skin turgor, bowel sounds – hypo or hyperactive, abdominal exam.
Basic metabolic panel
- Guidelines for BCC – Chemotherapy Induced Emesis
- Memorandum 3-26-2001
- Antiemetics by physician
- Consult with physician for all cases of severe nausea and vomiting – patient not able to tolerate any oral intake > 24 hours duration.
- Additional antiemetics, especially for breakthrough nausea/vomiting with standard approach or age less than or equal to 45 years.
a. Decadron: 4 – 8 mg BID x 3 days for delayed nausea/vomiting
b. Add rectal suppository – Phenergan 25 mg or Compazine 25 mg every 4 hours prn.
c. Change to Emend (Aprepitant) for next courses.
- Severe nausea/vomiting
a. IV Fluids – NS 1-2 liters. Add electrolytes based on lab values.
b. V Antiemetics
-Zofran 10-12 mg IV
-Decadron 8 mg. IV
-Ativan 1 mg IV prn anxiety
Reviewed: July 7, 2004, Jan. 25, 2006
Richard Elledge, M.D., Medical Director
Suzanne Perez, RN, BSN, OCN, Manager, Clinical Operations
Mari Rude, RN, ANP, AOCN, Nurse Practitioner/Care Coordinator