Neutropenic Fever i te wa o te Chemotherapy me te maimoatanga mate pukupuku ohotata¶

Mo te tangata e whiwhi ana i te chemotherapy, te rongoa hinu wheua kua whakaritea, me te whakawhiti i nga pūtau kakau, kare he "maeke" noa te kirikaa: he whawhati tata hauora e kiia ana ko Febrile Neutropenia (Neutropenic Fever). Ka whakakorehia e te chemotherapy te wehewehenga tere o nga pūtau toto ma e mohiotia ana ko neutrophils, te kaiawhina o mua o te tinana ki nga huakita me te harore, ina koa i te waa "nadir" matapihi (\(7\text{ ki }14\text{ days}\) i muri i te whaowhia chemotherapy). Ka taka te tatau neutrophil ki te kore, tata ki te kore ranei, ka taea e nga huakita kino e noho maori ana i roto i te waha, i nga whekau, i te kiri ranei i te taha o te tauranga venous pokapū ka uru ki roto i te toto ka rua ia 20 meneti karekau e puta he nana, he whero, he maremare ranei. Ki te kore e rongoatia i te kainga mo etahi haora, ka tere haere te kirika neutropenic ki te fulminant. sepsis me te ru septic. Ko te oranga kei runga i te Golden Hour "Door-to-Antibiotic" Ture: ka tae wawe ki te tari whawhati tata no reira kei te uru nga patu paturopi whanui-a-whanui ** i roto i te 60 meneti o te whakamatautau**, a kaua rawa e huna i te kirika e piki haere ana me te acetaminophen (paracetamol) me te ibuprofen i mua i te waea atu ki te roopu oncology.

Mahia tenei inaianei¶

1. Tirohia he waha (waha) ranei te werawera taima/te wa tonu ka tono i te ture tino \(38.3°\text{C}\) (\(101.0°\text{F}\)) / \(38.0°\text{C}\) (\(100.4°\text{F}\)) ture. E ai ki te American Infectious Diseases Onc (AS) American Society of Infectious Diseases (AS) Society for Medical Oncology (ESMO), me nga aratohu UK NICE, Neutropenic Fever kua tautuhia hei:
2. He pāmahana waha kotahi \(38.3°\text{C}\) (\(101.0°\text{F}\)) teitei ake ranei, OR
3. He pāmahana waha \(38.0°\text{C}\) (\(100.4°\text{F}\)) teitei ake ranei e mau tonu ana mo te 1 haora (ka rua ranei te ine i te 1 haora i te iti rawa atu).
4. (Tuhipoka: He maha nga tarahiti UK NHS me nga pokapū mate pukupuku e whakamahi ana i te paepae panui kotahi ake ake mo te \(38.0°\text{C}\) [\(100.4°\text{F}\)] kotahi, ranei \(37.5°\text{C}\) [\(99.5°\text{C}\) [\(100.4°\text{F}\)] kotahi, ranei *\(37.5°\text{C}\) [\(99.5°\text{F}\)] i nga wa katoa'; paepae.
5. Waea atu ki to nama whawhati tata o te rohe mena he makariri/tekae te manawanui, he mangere, he rangirua, he poto te manawa, he whakaheke toto ranei. Waea 911 i Amerika me Kanata, 112 puta noa i te Kotahitanga o Europi, 999 i te United Kingdom, tirohia katoa ranei tau ohorere mehemea he wiriwiri te manawanui, he ngoikore te ahua i te wa e tu ana, he tere te ngakau (\(>100\text{ bpm}\)), he pehanga toto kei raro iho i te \(100\text{ mmHg}\), he ahua koma, he kotingotingo, he rangirua ranei, ahakoa ka panui te inemahana ** he iti noa, he iti noa ranei (\(<36.0}\text\\text\<36.0}\) \(<96.8°\text{F}\))**, i te mea ko te sepsis makariri te ahua kino rawa atu o te ru septic.
6. Mena ka mau te mate kirikaa, waea atu ki to Raina Oncology Triage 24-haora ka haere totika ki te Tari ohorere. Kaua e tatari ki nga haora tari o te ata. Me peia e te tangata te manawanui ki te hohipera, me tono ki te kaitoi mate pukupuku i runga i te waea kia waea atu i mua ki te teepu whakamatautau ruuma whawhati tata kia kua reri nga ahurea toto me nga patu paturopi whakaroto i te taenga mai.
7. Kaua e hoatu he pire whakaheke kirika (kaore he acetaminophen, paracetamol, ibuprofen, aspirin ranei) kaua rawa e whakamahi i te ine ine wera. Te ine i te pāmahana i raro i te arero (waha) i raro ranei i te ringaringa (axillary; kia mohio kei te tata te \(0.5°\text{C}\}\)0.9 i te panuitanga o te axillary. Ko te panui o raro o te \(37.8°\text{C}\) [\(100.0°\text{F}\)] he rite ki te kirikaa waha).
8. Whakanohoia he kaarei whakamarumaru N95/FFP2 ranei ki runga i te manawanui i mua i te hikoi ki roto i te rūma tatari o te Tari Ohotata. Na te mea karekau he parepare parepare a te turoro neutropenic, he kino te noho tahanga i roto i te ruuma tatari ohorere ki te taha o nga turoro maremare. Whakaatuhia to "Kari Matohi Neutropenic Neutropenic Sepsis Alert" ki te nēhi whakamatautau i te wa tonu ka tono kia tuuhia ki roto i tetahi ruma whakamatautau taratahi i taua wa tonu.
9. Tirohia mo etahi atu whawhati ohorere oncologic nui. I a koe e whakareri ana mo te kawe waka, me tere te tirotiro mo Malignant Spinal Cord Compression (mamae hou me te ngoikore o te waewae, te ngongo, te raru ranei o te kopu), Superior Vena Cava (SVC) Syndrome (tetere te kanohi/kaki me te poto o te manawa), **Tumor Lysis Syndrome, i roto i nga ra ka timata te mate o te mate pukupuku, o te pouri o te mimi. chemo), me Hypercalcemia of malignancy (te matewai nui, te mimi auau, te paura, me te rangirua).

Te whakamatautau ohorere me te rakau whakatau raruraru maimoatanga mate pukupuku¶

Whakamahia tenei mahere rerenga haumanu ki te whakamatau i nga tohu whakapeka i roto i te manawanui e rongoa ana i te mate pukupuku kaha, i roto ranei i nga wiki e 6 o te chemotherapy.

flowchart TD
    Start["Mate Matepukupuku i runga i te Chemotherapy, Immunotherapy,<br/>Rararuraru ranei ka whanake tohu mate"] --> SepsisFlags{"Hipanga 1: Tirohia te Rua Septic Omaoma / Crisis Whero Kara<br/>1. Te wiriwiri (rigors), ahakoa karekau he wera nui?<br/>2. Hipothermia: Te Pawera <36.0°C (96.8°F)?<br/>3. Te mangere, te ngenge, te rangirua, te korero pohehe ranei?<br/>4. Ka poto te manawa, te manawa tere, te mamae o te uma?<br/>5. Te whero, te nana, te mamae ranei i runga i te raina Port-a-Cath / PICC / Hickman?"}

    SepsisFlags -->|"ĀE: 1 tāpaetanga"| Call911["CRITICAL ONCOLOGIC SEPSIS / CRISIS:<br/>1. Waea atu ki 911 / 112 / 999 mo te Ambulance<br/>2. Whakapuakina 'Chemotherapy Neutropenic Sepsis Emergency'<br/>3. Whakamana 60-Minute Door-to-IV-Antibiotic Target<br/>4. Me takoto tonu (me te mea he poto te manawa); NPO"]

    SepsisFlags -->|"NO"| TempCheck{"Hipanga 2: Tirohia te Wehenga-Waha<br/>(KAUA KAUA e whakamahi i te inemahana rectal)<br/>He temp >= 38.3°C (101.0°F) KOTAHI<br/>OR >= 38.0°C (100.4°F) mo te 1 haora?"}

    TempCheck -->|"ĀE: Kua tutuki te paepae kirika"| NeutFever["NEUTROPENIC FEVER OHOHO:<br/>1. KAUA e hoatu Tylenol/paracetamol, ibuprofen, aspirin ranei<br/>2. Waea 24-haora Oncology Triage Line NOW i te wa e wehe ana<br/>3. Whakanohoia he kanohi ki te manawanui; haere ki te Tari ohorere inaianei<br/>4. Whakaatuhia te Kaari Matohi Chemo i te whakamatautauranga: tono kia wehea +<br/> Nga Ahurea Toto (Tauranga + Pikitia) & IV Antibiotic < 60 min."]

    TempCheck -->|"KORE: Karekau he kirikaa, he tohu sepsis"| OncEmerg{"Hipanga 3: Tirohia Nga Whanaketanga & Metabolic Cancer Emergency:<br/>A. Te mamae o te tuara/kaki hou + te ngoikore o te waewae, te ngongo, te rereke ranei o te kopu?<br/>B. Te kanohi tetere/kaki/ringa me te maremare/kei te kaha ake te takoto?<br/>C. Chemo o tata nei (1-7 ra) + kowhao, nausea, pouri mimi?<br/>D. Te matewai nui, te rangirua, te paura, te mamae o te wheua?"}

    OncEmerg -->|"A: Te mamae o muri + nga tohu neuro"| MSCC["TE WHAKAMAHI KAUPAPA KAUPAPA KAUPAPA:<br/>Emergency Spine MRI + High-Dose IV Dexamethasone NOW"]

    OncEmerg -->|"B: Te pupuhi o te kanohi/kaki + te pupuhi"| SVCS["HE WHAKAMAHI KAUPAPA KAUPAPA KAUPAPA (SVC) SYNDROME:<br/>Noho tika (45-90 deg); Pouaka ohorere CT + Tiaki Oncology"]

    OncEmerg -->|"C, D ranei: He raru mo te mate huka"| Metabolic["TE WHAKAMAHI I TE TUMOR LYSIS, TE HYPERCALCEMIA RANEI:<br/>Te Tari Ohotata Inaianei mo te ECG, Electrolytes, & IV Wai"]

Wāhanga 1: Te Maramatanga ki te Neutropenic Fever me te Matapihi "Nadir" Danger Window¶

1. He aha te "Te Tatau Neutrophil Absolute" (ANC) me te Chemo Nadir?¶

He maha ngā momo pūtau kei roto i ngā pūtau toto mā (leukocytes), engari ko neutrophils ngā pūtau patu huakita tuatahi. Ka tatauhia e nga taote te Te Tatau Neutrophil (ANC) ma te whakareatia te tapeke o nga tatau toto toto ma ki te paheketanga o nga neutrophils kua wehea ("segs") me nga roopu pakeke: - ANC Hauora Tika: \(1,500\text{ ki }8,000\text{ cells mo ia microliter }(\mu\text{L})\) (\(1.5\text{ ki }8.0 \times 109/\text{L}\)). - Neutropenia: ANC kei raro \(1,500\text{ cells}/\mu\text{L}\) (\(<1.5 \times 109/\text{L}\)). - Neutropenia Tino (Te Morearea kirika): ANC kei raro \(500\text{ cells}/\mu\text{L}\) (\(<0.5 \times 109/\text{L}\)), kei raro ranei i te \(1,000\text{ cells}/\mu\text{L}\) e tika ana kia taka ki raro i te \(508\) i roto i nga haora e whai ake nei. - Neutropenia Hōhonu (Tino Morearea): ANC kei raro \(100\text{ cells}/\mu\text{L}\) (\(<0.1 \times 109/\text{L}\)), he mea noa i te wa o te whakaurutanga o te reukemia whakapeka, te whakawhitinga o nga pūtau kakau.

Ahea te "Nadir" ka puta? Whai muri i te whakaurunga o te huringa chemotherapy i roto i te toto i te Ra 1, ka ora nga neutrophils kua huri haere i roto i te toto mo etahi ra, i te wa poto ka oho te wheketere hinu wheua. No reira, ka pa te tatau o nga pūtau toto ma ki tona pito toka-raro rawa (te nadir) i waenga i te Ra 7 me te Ra 14 i muri i te chemotherapy (ahakoa ka puta i nga wa katoa i roto i nga rongoaa-waha i ia ra, iraruraru, i nga mate pukupuku hematologic penei i te reukemia, lymphoma, me te myeloma maha).

2. He aha te ahua o nga mate ka kore e kitea i te mea he kore noa koe¶

I roto i te tangata he rauropi mate noa, ka kitea he mate na te mea ** miriona neutrophils e tere ana ki te waahi ka mate**, ka puta he nana kowhai matotoru, te kiri tetere whero, te mamae o te korokoro, te papapa ma ki te pouaka X-ray: - Karekau Neutrophils = Karekau he Pus me nga Tohu Tauhira: I te turoro neutropenic tino kino: - Ka mate pea te matea huakita ka puta te kore maremare, kore kohu, me te tino maramara X-ray o te uma, ka kitea he kirikaa me te manawa tere. - Ko te ** mate mimi nui (urosepsis)** ka pa pea kare he wera i te wa e mimi ana me te whakaatu kore nga ruma toto ma (pyuria) i runga i te toka mimi, he kirikaa anake. - Ko te kiri, perirectal cellulitis ranei whakamate kei te taha o te anus, i te tauranga venous pokapū ranei ka kitea he kore te nana, he whewhe rererere ranei, ka puta he mahanahana ngawari, he mawhero ngoikore, he ngawari ranei i te taha o te kirikaa. - Whakatupato mo nga Corticosteroids e huna ana i te kirika: He maha nga turoro mate pukupuku e tango i ia ra, ia wiki ranei dexamethasone, prednisone ranei (mo te pupuhi roro, lymphoma, myeloma maha, nga paanga o te taha immunotherapy, nausea ranei). Ko nga corticosteroids ka kaha te pehi i te thermostat hypothalamus o te roro. Ka taea e te manawanui e tango ana i te dexamethasone te mate neutropenic bloodstream sepsis me te pāmahana noa o te \(37.0°\text{C}\) (\(98.6°\text{F}\)). I nga turoro e mau ana i te steroids, maataki noa mo ** te wiri (he kaha), te ngenge ohorere, te rangirua ngawari, te whanoke, te tere o te ngakau i raro i te \(3\6. (\)96.8°\text{F}$)**.

3. Ko te "60-Minute Door-to-Needle Antibiotic Ture"¶

Ina uru mai nga huakita ki roto i te toto o te turoro kaore he neutrophils (he maha nga Gram-negative rodpēnei i te Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa ranei e whakawhiti ana puta noa i nga whewhe waha kua pakaruhia e te chemotherapy [mucositis] ranei te arai intestinal, ranei Grampositive rite **S. Streptococcus mai i nga catheters venous pokapū), ka piki te mate mate ki ia haora o te whakaroa. - Te Mana Whakahaere o te Hohipera o te Ao: Ko nga Aratohu mai i te ASCO, IDSA, ESMO, te Surviving Sepsis Campaign, me te UK NICE (CG151) e whakahau ana kia whakahaerehia e nga tari whawhati tata katoa te horopeta tuatahi o te empiric anti-pseudomonal intravenous beta-lactam antibiotic (pēnei i te *cefepime, piperacillin-tazobactam/m*Tazobactam] 60 meneti o te tūroro e kuhu ana i te kuaha o te hōhiper **kaore e tati kia hoki mai te hua o te tau toto toto ma (CBC) taiwhanga ki te whakapaehia te neutropenia. - He aha te mahi i roto i aua meneti 60 tuatahi: Ka tuhi tonu nga nēhi e rua nga huinga ahurea toto** (kotahi huinga ktoia i roto i ia lumen o te tuuroro kua whakatō Port-a-Cath, raina PICC, Hickman catheter ranei**, me tetahiuinga i unuhia mai i te uaua o te ringa peripheral), tuhia he Tatau Toto Katoa (CBC me te toto toto, ka whakairihia te taumata IV i muri tonu mai i te taumata o te toto (CBC me te toto rereke), ka whakairia te taumata IV. tuhi. - Te Whakatau Morearea Nui ki te Morearea Iti (Te Tohu MASCC): I te wa e rere ana te horopeta paturopi IV tuatahi, ka tatauhia e nga tohunga kaiakiko me nga taote ohorere te **Taupae Morearea mo te Tiaki Tautoko i te Matepukupuku (MASCC) ** me te CISNE score ki te whakatau mena me noho te manawanui ki roto i te ruuma wehe i roto i te ruuma (whakahaerehia te pehanga toto, te whakaheke toto, te whakaheke toto, te whakaheke toto, te mate pukupuku, te whakaheke toto, te mate pukupuku, te mate pukupuku, te mate pukupuku, te mate pukupuku. te mucositis kino ranei) ka taea ranei te whakawhiti ki te whakamaarama tino aro turukihia.

Wāhanga 2: Te Whakaaetanga i etahi atu E rima o nga mate ohorere oncologic¶

Ahakoa karekau he kirikaa te tangata mate pukupuku, ka taea e te mate pukupuku kaha me nga maimoatanga mate pukupuku hou (chemotherapy, radiation, me nga kaiwhakahaere i te waahi arataki mate) ka paheke e rima nga raru o te hanganga, o te mate kirikiri ranei e hiahia ana ki te tiaki tari ohorere:

Te tiaki i mua i te hohipera i te wa e whakarite ana mo te Tari ohorere¶

Hipanga 1: Me pehea te tango i te pāmahana tika i roto i te manawanui chemotherapy¶

1. Whakamahia he matimati-waha (i raro i te arero), tympanic (taringa), i te ine wera o te tinana (rae) ranei.
2. Mēnā ka inu noa te tūroro i te ti wera, te wai tio rānei, tatari 15 ki te 20 meneti i mua i te tango i te pāmahana ā-waha kia kore ai e hē te korero.
3. Kua Rahuitia: Kaua rawa e Whakamahia i te Wehenga Rectal.
4. Ka tukinohia e te chemotherapy nga pūtau mucosal e wehewehe tere ana e mau ana i te kopa gastrointestinal katoa mai i te waha ki te nono (mucositis). Ko te pana i te pito inemahana (he suppository, enema, he tampon ranei) ki roto i te toka ka puta he roimata mokitokito i roto i te ararewa tapawha pakarukaru, ka taea e te miriona E. coli me te huakita whekau anaerobic ki te kuhu ki roto tonu i te rerenga toto (bacteremia) me te paheketanga kino o te perirectal abscess me te kore e taea te whakahaere toto mena he iti nga pereti (thrombocytopenia).

Hipanga 2: Tirotirohia nga "Rima Huna" Nga Pae Whakauru Mate¶

I a koe e korero ana ki te nēhi oncology triage, e tatari ana ranei mo te kawe waka, tirohia enei waahi e rima (kaua rawa e kotikehia, ka paopao, ka werohia ranei tetahi mamae) ka whakaatu mai i taau e kite ana: 1. Te Pūrere Uru Waenga Waenga (Port-a-Cath, Raina PICC, Hickman Tunnelled Catheter ranei): Tirohia te kiri i runga i te tauranga o te pouaka, i te ringaringa ranei o te raina PICC me te kore e tihorea te kakahu maataata. He whero, te pupuhi, te mahana, te ngawari, te kirikiri kowhai ranei kei te taha o te ara kauhanga? I timata te kirikaa, te wiri ranei ** i roto i te 30 ki te 60 meneti i muri i te horoi, te whakamahi ranei i te tauranga**? (He tohu matarohia o te catheter lumen kua koronihia; me tango e nga kaimahi o te hohipera nga ahurea toto mai i te tauranga i mua i te whakatau me pehea te rongoa.) 2. Waha, Kapi, me te korokoro (Mucositis Waha): Tiaho te rama waea ki roto i te waha. He whewhe whero e mamae ana, he papapa rite ki te pata ma (thrush / candidiasis), he toto kao, he uaua ki te horomia wai? 3. Nga Pukahukahu me te Manawa: Tatauhia te maha o nga manawa ka tangohia e te manawanui i roto i te 60 hēkona i te okiokinga (ko te tere manawa ** kei runga ake i te 20 ki te 22 manawa ia meneti* he tohu whakatupato moata mo te sepsis me te pneumonia ahakoa karekau he mare) me te tirotiro i te oximeter pulse maihao mena kei te waatea. 4. Te Pupu me te Rohe Perirectal: Patai atu ki te manawanui mena he mamae puku o te taha matau (typhlitis) ranei te mamae, te wera, te ngawari ranei i te taha o te anus, iwi hiku ranei ina noho ana, e pahemo ana ranei (he mea huna tonu te perianal cellulitis, he puna huna o nga turoro Gram-negative me te neerobic neerobic. 5. Mimi me te Hiako: Patai atu mena he kino te mimi, he ahua kapua, he mawhero ranei, kua tino heke te reo i roto i nga haora 12 kua hipa.

Hipanga 3: Whakahaerehia te Thrombocytopenia (Nga Platelet iti) i te wa kotahi¶

Na te mea ka pehia e te chemotherapy te hinu wheua katoa, he maha nga wa ka paheke te toto ma te tangata turoro (neutropenia) (thrombocytopenia, ina koa ka heke iho nga platelets ki raro i te \(10,000\text{ ki }20,000/\mu\text{L}\)) i te wa ano: - Tirohia te kiri o nga hiu, ponawaewae, me nga ringaringa mo nga ira iti whero, papura ranei e kore e memenge ina pehia (petechiae), nga maru pouri kaore i whakamaramatia (ecchymoses), he pupuhi toto ranei kei roto i te waha (purpura maku). - Mēnā he ihu ihu te tūroro, ka toto kapia ranei i te taha o te kirika, nohoia kia anga whakamua, whakawiri tonutia te ihu o raro mo te 20 meneti (tirohia ihu ihu), me korero wawe ki te ruma whawhati tata i te mea ka hiahia wawe ratou ki te whakawhitinga platelet i te taha o o ratou patu paturopi IV.

Hipanga 4: Matohi Ohotata Motuhake mo te CAR-T Cell me nga Turoro Antibody Bispecific (CRS me ICANS)¶

Mena ka whiwhi tetahi turoro i te Car-T cell therapy (chimeric antigen receptor T-cell therapy) he bispecific T-cell engager antibody mo te reukemia, lymphoma, myeloma maha ranei i roto i nga wiki e 4 kua pahure ake nei, e rua nga take whakararu ora i te kirikaa ohorere: 1. Neutropenic Bacterial Sepsis (e hiahia ana kia tere te 60-meneti IV antibiotic), ME 2. Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS): He kaha te whakahohenga aukati e puta ai te kirikaa nui (\(>38.0°\text{C}\) ki te \(40.5°\text{C}\)), ka heke te pehanga toto, te iti o te hāora, me te huringa ohorere, te wiri o te ringa, te wiri o te kupu, te wiri, te wiri o te kupu, te wiri, te wiri, te wiri ranei. hopukina). - Mandatory Mahi: Whakaatu tonu te CAR-T / Bispecific Wallet Card i nga wa katoa i te whakamatautau ohorere; i tua atu i nga paturopi whaanui IV, ko enei turoro e hiahia ana kia tere te whakahaere i te kaiwawao kaiawhina interleukin-6 tocilizumab me/ranei corticosteroids kua rurukuhia me o raatau pokapū rongoa pūtau.

Ko te tuhinga korero tika mo 911 / 112 / 999 me te Triage ohorere¶

Ko nga rangahau e whakaatu ana ko nga turoro mate pukupuku neutropenic he maha nga wa e pa ana ki te whakaroa morearea i roto i nga waahi tatari ruuma whawhati tata ki te kore e kii te manawanui me te mema o te whanau i nga kupu haumanu "Chemotherapy Neutropenic Sepsis: 60-Minute Antibiotic Window" i te whakapiri tuatahi. Whakamahia tenei kupu tuhi mo te kupu:

• I te wa e waea ana ki 911 / 112 / 999 (mehemea he makariri, he mangere, he poto te manawa, he rangirua ranei):

  *"Kei te hiahia ahau ki te waka tūroro i [Wāhitau Tika] mo te whakapae Neutropenic Sepsis. Ko te manawanui he [Tane/wahine]-tau-tau [tane/wahine] e mahi ana i te chemotherapy mo te [Momo o te Matepukupuku], me ta ratou whaowhia chemotherapy whakamutunga i te [Rā, X nga ra i mua]. te rangirua], kua whakatōhia he [puru Port-a-Cath / ringa PICC raina].

• I te wa e piki atu ana ki te Teepu Whakamatau a te Tari Ohotata (mehemea ka tae ma runga waka):

  "Kei te mahi haumanu kaha tenei turoro (Ra [X] i muri i te whaowhia, kei roto i te matapihi nadir) a he Neutropenic Fever o [X.X°C / XXX.X°F]. Anei [tana] Oncology Neutropenic Sepsis Alert Card. I raro i nga aratohu ASCO, IDSA, me NICE, [ia/ia] e hiahia ana ki te whakamaaramatanga o te toto, te whakamarumarutanga o te toto, te whakamarumarutanga o te toto, te whakamarumaru. ** nga patu paturopi whaanui-a-whanui-a-whaa tuatahi i roto i te 60 meneti i muri i te whakamatautau."

• Mena kei runga te turoro i te Immunotherapy (Ko nga Kaipupuri Tirohanga penei i te Pembrolizumab/Keytruda, Nivolumab/Opdivo, Ipilimumab/Yervoy ranei):

  *"He Panui Nui mo te Triage: Kei te whiwhi tenei turoro i te Cancer Immunotherapy ([Ingoa o te Taauau]), ehara i te mea ko te chemotherapy tuku iho. Ko o ratou tohu he Immune-Related Adverse Event (irAE) penei i te autoimmune pneumonitis, colitis, myocarditis, adrenal crisis ranei, e hiahia ana ki te toro atu ki te mate oncology ** ki te mate o te mate pukupuku o te mate.

He aha hei hopu i roto i te 2 meneti mo te Tari ohorere Go-Bag¶

• Ko te "Chemotherapy / Immunotherapy Wallet Alert Card" (e whakaatu ana i nga tikanga mo te rongoa, te ra o te huringa whakamutunga, te tau waea/peera 24-haora, me te momo tauranga).
• Kari tautuhi Port-a-Cath, he tauranga tauranga-a-roto ranei (ka korero ki nga nēhi ohorere mena he "Power-Injectable" te tauranga pouaka mo te rereke o te matawai CT me te rahi o te ngira Huber [\(3/4\text{-inihi}\) vs. \(1\text{-inihi}\)] e pai ana ki te tauranga).
• Kirīmi matemate (lidocaine/prilocaine EMLA cream) ki te mea kua tohua: ka pania he kirīmi whakaweto kua tohua ki runga i te pouaka Port-a-Cath kua hipokina e te takai kirihou i te wa e eke ana i roto i te motoka ki te hōhipera ka mate te kiri i roto i te 30 meneti kia kore e mamae te uru ki te tauranga me te ngira Huber.
• Ko nga rongoa o naianei kei te kainga (ina koa ko nga patu paturopi prophylactic penei i te levofloxacin, trimethoprim-sulfamethoxazole ranei, nga antifungal penei i te fluconazole/posaconazole, nga patu huaketo penei i te acyclovir, nga werohanga tauwehe tupu penei i te pegfilgrastim [Neulasta] me te filgrastim [Neupogen], me te whakaheke toto).
• Kaihini waea me te maataki e waatea ana.

Te aukati mate o ia ra i te wa o te Chemotherapy Nadir (Nga ra 7 ki te 14)¶

Ahakoa karekau he whakatupato e arai i te 100 paiheneti o te kirika neutropenic (no te mea ko te nuinga o nga mate ka ahu mai i te tipu o te kunatu o te manawanui), ma te whai i enei ture e pa ana ki nga taunakitanga i nga ra iti o te tatau ka whakaitihia nga whare haumanu ka taea te aukati: 1. Te Tiaki Wha (Whakakore i te Whakauru Mucositis): Horoihia to waha kia 4 nga wa ia ra (i muri i nga kai katoa me mua o te moenga) me te wairewa parakore o **\(1/2\text{pune}\) tote me te \(1/2\text{ teaspoon}\) houra tunutunu (konutai bicarbonate) kua rewa ki te \(240\text{ mL}\)$$\()\text{ auneke}**\). Whakamahia he paraihe niho tino ngohengohe, ka karohia nga horoinga waha arumoni e whakamaroke ana, e pakaru ana te ararewa waha. 2. Te aukati i te koroke me te kawa whakaene: Ko te whakamaarama me te rongoa mate nausea (pēnei i te ondansetron/Zofran) ka tino paopao. Ko te tohe ki te haere i te kuemu pakeke ka haea te ararewa whakaeneene (anal fissure), ka hanga he tomokanga tika mo nga huakita whekau ki te kuhu ki te toto. Mauria moata to kai whakamarumaru mo te kutae-a-waha e taunakihia ana e te kaimataiwhao, te inu i te wai maha, me te kaua rawa e whakamahi i te whakapoipoi totika, i te enemas ranei. 3. Kai me te Maaku Ringa: Horoi ringa ki te hopi me te wai mahana mo te 20 hēkona i mua i te kai me muri i te whakamahi i te wharepaku. Kohuatia nga kai katoa, heihei, ika, me nga huaki kia pai te mahana o roto, kia ata horoia nga hua mata me nga huawhenua, me te karo i te miraka kore, te tipu mata, te maataitai mata/huhi, me te kai parai kua noho ki te pāmahana rūma. 4. Me mohio ki te Pegfilgrastim (Neulasta) Te mamae o te Iwi me te Kirika Pono: He maha nga turoro ka whiwhi i te werohanga whakakaha i te toto-ma (pegfilgrastim or filgrastim, G-CSF) 24 haora i muri i te chemotherapy. I te tere o te hanga i nga neutrophils hou a te hinu wheua i roto i nga ra e 2 ki te 5 e whai ake nei, he maha nga wa ka rongo nga turoro i te mamae nui o te hope, te u, me te tuara o raro (he maha nga wa ka tukuna e te loratadine [Claritin] mena ka whakaaetia e te tohunga oncologist). Heoi, kaua rawa e kiia he kirikaa \(38.0°\text{C}\) (\(100.4°\text{F}\)) teitei ake ranei "mai i te pupuhi Neulasta": tirohia tonu to paanga me te waea atu ki te oncology mo tetahi kirikaa.

Pātai auau¶

He aha te take he kino rawa te tango i te Tylenol (acetaminophen/paracetamol) te ibuprofen ranei mo te kirika ngawari, mahunga ranei i te wa o te chemotherapy?¶

Ina whakahekehia e te haumanu o ou toto toto ma (neutrophils), kaore e taea e to tinana te hanga nana, te whero, te pupuhi rohe ranei ina uru mai nga huakita, no reira ko te kirikaa ANAKE te tohu whakatupato kua timata te mate o te toto. Ko te tango i te acetaminophen, te paracetamol, te ibuprofen, te aspirini ranei ka whakaheke i to pāmahana mo etahi haora, ka huna i taua tohu whakatupato i te wa e tere haere ana nga huakita i roto i to toto. Kaua rawa e tango i nga rongoa whakaheke kirikaa i te wa o te chemotherapy me te kore e tirotiro i to paanga i te tuatahi me te whakamohiotanga mai i to roopu oncology.

He aha te panui ine wera e kiia ana he ohorere hauora i te wa o te chemotherapy?¶

E ai ki nga aratohu oncology o te ao (ASCO, IDSA, me ESMO), he ohorere kirika neutropenic ko tetahi pāmahana waha o te 38.3°C (101.0°F) teitei ake ranei, OR te pāmahana waha o te 38.0°C (100.4°F) teitei ake ranei e roa ana mo te 1 haora katoa (he maha nga whare hauora UK mo te 8. 100.4°F). I tua atu, ki te wiriwiri te tangata turoro ki te haumanu, te mangere, te mangere, te rangirua, te poto o te manawa, me te PAKAHA rereke ranei i raro i te 36.0°C (96.8°F), he ohorere tonu ahakoa kaore he panui ine wera nui.

He aha te take i aukatihia ai e nga aratohu whawhati tata te whakamahi i te inemahana whakamohoao, i te whakamaarama whakaahuru ranei i roto i te turoro chemotherapy?¶

Ko te chemotherapy he whakaheke me te whakangoikore i te kiriuhi mucous ngawari e mau ana i te toka me nga whekau i te wa kotahi ka whakaheke i nga pūtau toto ma e whawhai ana ki te mate me nga pereti toto-toto. Ko te whakauru i te inemahana whakaahuru, i te suppository, i te enema ranei ka ngawari te karawhiu, te haehae ranei i te pakitara tapawha pakarukaru, ka kuhu tika i te miriona o nga huakita whekau ki roto i te rerenga toto (ka pa te mate mate Gram-negative sepsis) me te paheketanga o te toto.

He aha te mamae o te tuara i roto i te turoro mate pukupuku e hiahia ana ki te tirotiro wawe mo te kopeketanga o te taurakira?¶

He maha nga mate pukupuku noa (ina koa te u, te prostate, te huhu, te whatukuhu, me te myeloma maha) ka horapa ki nga koiwi o te tuara. Mena ka tipu te putunga pukupuku ki roto i te hiku, ko te tohu tuatahi i roto i te 90 paiheneti o nga turoro he hou, kei te kino haere ranei te mamae o te tuara, te kaki ranei (he kino rawa atu ina takoto papa i runga i te moenga me te maremare ranei) nga ra, wiki ranei i mua i te ngoikoretanga o nga waewae, te ngongo ranei. Ko te hopu i te kopeketanga o te taurakira i te wa moata me te MRI ohorere me te IV dexamethasone nui i te wa e taea tonu ana e te manawanui te hikoi ka pupuri i to raatau kaha ki te hikoi me te pupuri i te mana o te kopu.

Kua tirohia nga puna¶

• ** American Society of Clinical Oncology (ASCO) me Infectious Diseases Society of America (IDSA, United States):** Whiowhio Management of Fever and Neutropenia in Adults Treated for malignancy: ASCO and IDSA Clinical Practice Guideline Update (Taplitz et al., Journal of Clinical Oncology) me te *IDSA Guideline Guideline Practice Practice (Taplitz et al., *Journal of Clinical Oncology) me te *IDSA. Nga Turoro Neutropenic me te mate pukupuku * (Freifeld et al.).
• National Institute for Health and Care Excellence (NICE, United Kingdom): Neutropenic Sepsis: Prevention and Management in People with Cancer (NICE Clinical Guideline CG151, the 60-minute door-to-antibiotic mandate) and Metastatic Spinal Cord Compression in Pakeke: Risk Assessment, Diagnosis and Management (NICE Guideline NG234).
• European Society for Medical Oncology (ESMO): Whakahaere o Febrile Neutropenia: ESMO Clinical Practice Guidelines (Klastersky et al., Annals of Oncology) me ESMO Guidelines on Management of Toxicities from Immunotherapy.
• ** Whatunga Matepukupuku Matawhānui o te Motu (NCCN, United States):** Nga Aratohu Mahi Haumanu a NCCN i roto i te Oncology: Te Aukati me te Maimoatanga o nga mate pukupuku e pa ana ki te mate pukupuku me te whakahaere i nga taakaha e pa ana ki te aukati i te aukati i te mate.
• Oncology Nursing Society (ONS) & UK Oncology Nursing Society (UKONS): Acute Oncology Initial Management Guidelines and 24-Hour Triage Rapid Assessment Toolkit.

Nga kaiarahi e pa ana¶

• Te whakamohiotanga o te Sepsis me te ru septic me te urupare ohorere
• Ko te mate o Cauda equina me nga haki whero o te kopeke o te taurakira
• Ko te raruraru o te adrenal me te werohanga ohorere o Addison
• Te pupuhi o te pumanawa me te thrombosis uaua hohonu (DVT)
• Te whakaheke toto i runga i te whakaheke toto, i te hemophilia ranei