# data[].attributes.body
Neutropenic Precautions

VS q 4 hrs

Weight Daily

Strict I/Os

Regular diet

Maintain central access device

Change CVAD dressing & caps Q7D

Parameters: Call MD for SBP > 160 or < 90, DBP > 90 or < 50, T > 100.4⁰F, HR >120

O₂ 2-4L PRN to Keep SpO₂ > 92%

Lab: BMP daily @ 0500

Lab: CBC daily @ 0500

Consult hematology/oncology

Updated Orders:

ABGs

Blood Cultures

Lactic Acid

Place on telemetry

# data[].attributes.body
MAR:

0900 acyclovir 400mg PO BID

0900 fluconazole 200mg PO BID

0900 ondansetron 8mg PO Q12 hrs

0900 enoxaparin 40 mg SQ daily

0900 pantoprazole 40 mg PO daily

0930 Cefipime IVPB Q12H

IVFs:

**0.9%NaCl 1000 mL bolus STAT

0.9%NaCl 10 mL flush Q12H & PRN

PRN:

oxycodone 5mg PO Q4 PRN for moderate-severe pain

Acetaminophen 650 mg PO Q4H PRN for mild pain or fever

Senna 8.6 mg PO daily PRN for constipation

Miralax 17 g PO daily PRN for constipation

# data[].attributes.body
0700:

T: 100.9F

BP: 98/62

HR: 108

RR: 26

SpO₂: 92% on RA

Weight 86 kg

# data[].attributes.body
LABS @ 0500

Na 140

K 4.0

Mg 2.0

Ca 9.8

Albumin 3.6

WBC 500

ANC 200

Cr 1.0

BUN 20

RBCs 3

Hgb 7.2

Hct 22

PLT 30

Labs @ 0900

ABGs

pH: 7.32

PCO2: 35

Bicarb: 20

Lactic Acid 2.2

Blood Cultures: Pending

# data[].attributes.attachment_link.provider_name
Society of Critical Care Medicine (SCCM)

# data[].attributes.attachment_link.title
Surviving Sepsis Campaign Guidelines 2021

# data[].attributes.attachment_link.description
Surviving Sepsis Campaign Guidelines 2021

# data[].attributes.attachment_link.description
Guidelines published in 2016 provide a revised definition of sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection. The guidelines define septic shock as sepsis with circulatory, cellular, and metabolic dysfunction that is associated with a higher risk of mortality. The measurement of serum lactate has been incorporated into the latest septic shock definition. The guidelines recommend the Sequential Organ Failure Assessment (original and quick versions) as an important tool for early diagnosis. Respiratory, gastrointestinal, genitourinary, and skin and soft tissue infections are the most common sources of sepsis. Pneumonia is the most common cause of sepsis. Although many patients with sepsis have fever, the clinical manifestation can be subtle, particularly in older patients and those who are immunocompromised. Initial evaluation of patients with suspected sepsis includes basic laboratory tests, cultures, imaging studies as indicated, and sepsis biomarkers such as procalcitonin and lactate levels. Fluid resuscitation is the priority in early management, including administering an intravenous crystalloid at 30 mL per kg within the first three hours. Antimicrobial therapy should also be initiated early. Most research indicates that antimicrobial therapy should be started within three hours of presentation. The latest guidelines recommend starting antimicrobials within one hour, but this is controversial. Vasopressor therapy is indicated if hypotension persists despite fluid administration. Future trials of sepsis management are focusing on improving long-term rates of readmission and death, physical disability, cognitive impairment, and quality of life.