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Lester and Sue Smith Breast Center

Houston, Texas

The Lester and Sue Smith Breast Center's mission is to improve prevention, diagnosis and treatment of breast disease.
Lester & Sue Smith Breast Center
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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


  1. Timing, frequency and duration of nausea/vomiting
  2. Date of last chemotherapy
  3. Medication utilized to control thus far
  4. Reports of dry mucous membranes, lightheaded when arising, weight loss, excessive thirst, decreased urine output, appearance of vomitus, any blood.
  5. Note age of patient, history of motion sickness, cigarette or alcohol use, history of nausea/vomiting with pregnancy.
  6. Physical:

Dry mucous membranes, poor skin turgor, bowel sounds – hypo or hyperactive, abdominal exam.


Basic metabolic panel

Treatment Guidelines

  • Guidelines for BCC – Chemotherapy Induced Emesis
  • Memorandum 3-26-2001
  • Antiemetics by physician
  1. Consult with physician for all cases of severe nausea and vomiting – patient not able to tolerate any oral intake > 24 hours duration.
  2. 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.
  3. 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

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