Oncology & chemotherapy in the Kenntnisprüfung

Mrs S. had chemotherapy 10 days ago; her neutrophils are severely reduced. She measures 38.5 °C but feels “quite well”. What do you do?

• I measure again in an hour, because she feels well and has no signs of infection
• I give paracetamol as per the as-needed prescription and watch whether the fever falls
• I inform the doctor immediately, check vital signs and prepare blood cultures
• I re-measure rectally to confirm the value before I call the doctor

Explanation: Fever in neutropenia is an emergency: without defence cells, sepsis can develop within hours, even if the patient still feels well. The prescribed i.v. antibiotics must be started quickly. Waiting or only treating the fever loses time; rectal measurement is taboo in neutropenia because of the risk of injury.

Mr K. has beginning mucositis under chemotherapy. Which mouth care is correct?

• Soft toothbrush, frequent rinses with water or saline solution, mild food
• Alcohol-based mouthwash several times a day, to kill the germs effectively
• Let lemon swabs stimulate the mouth, so that saliva flow is promoted
• Thorough cleaning with a hard toothbrush and dental floss against deposits

Explanation: The aim is to keep the mucous membrane moist and clean without irritating it further: soft toothbrush, rinse frequently, food that is neither spicy nor acidic. Alcohol dries out and stings; lemon is acidic and irritates the sore mucosa – an outdated practice. Hard brushes cause injury.