The nurse is preparing to care for a client with acute myelogenous leukemia who is going through induction chemotherapy. The client's laboratory results are shown in the exhibit. Which intervention would be a priority for this client? Click on the exhibit button for additional information.
Laboratory results
White blood cells - 1, 100 / m * m ^ 3 * (1.1 * 10 ^ 9 / L)
Absolute neutrophil count - 400 / m * m ^ 3 * (0.4 * 10 ^ 9 / L)
Hemoglobin - 8.2 g/dL (82 g/L)
Platelets -78000 / m * m ^ 3 * (78 * 10 ^ 9 / L)
The client's laboratory results show severe neutropenia, with a reduced white blood cell count (normal 4,000-11,000/mm³ [4.0-11.0×10/L]) and reduced absolute neutrophil count (normal 2200-7700/mm³ [2.2-7.7×10%L]). Protection against infection is the most important goal for this client.
The following neutropenic precautions are indicated:
- A private room
- Strict handwashing
- Avoiding exposure to people who are sick
- Avoiding all fresh fruits, vegetables, and flowers
- Ensuring that all equipment used with the client has been disinfected
(Option 1) The client's laboratory results show moderate anemia. Blood transfusion and/or erythropoietin injections are important but not a priority. Infections in immunocompromised clients are life threatening.
(Option 2) The client's platelet count of 78,000/mm³ (78 ×109/L) is decreased but not dangerously low; therefore, it is not the highest priority intervention. Avoiding intramuscular injections and minimizing venipunctures is most important when the platelet count is below 50,000/mm³ (50 ×10/L), as these can cause prolonged bleeding.
(Option 3) This client would need SCDs for prevention of deep vein thrombosis to the legs as anticoagulants may not be used due to the risk of bleeding from low borderline platelet count. However, this is not a priority over infection prevention.
Educational objective:
Neutropenic precautions should be used to prevent infection in clients who have low white blood cell and absolute neutrophil counts and are receiving chemotherapy. Infections in these clients are life threatening.
The client's laboratory results show severe neutropenia, with a reduced white blood cell count (normal 4,000-11,000/mm³ [4.0-11.0×10/L]) and reduced absolute neutrophil count (normal 2200-7700/mm³ [2.2-7.7×10%L]). Protection against infection is the most important goal for this client.
The following neutropenic precautions are indicated:
- A private room
- Strict handwashing
- Avoiding exposure to people who are sick
- Avoiding all fresh fruits, vegetables, and flowers
- Ensuring that all equipment used with the client has been disinfected
(Option 1) The client's laboratory results show moderate anemia. Blood transfusion and/or erythropoietin injections are important but not a priority. Infections in immunocompromised clients are life threatening.
(Option 2) The client's platelet count of 78,000/mm³ (78 ×109/L) is decreased but not dangerously low; therefore, it is not the highest priority intervention. Avoiding intramuscular injections and minimizing venipunctures is most important when the platelet count is below 50,000/mm³ (50 ×10/L), as these can cause prolonged bleeding.
(Option 3) This client would need SCDs for prevention of deep vein thrombosis to the legs as anticoagulants may not be used due to the risk of bleeding from low borderline platelet count. However, this is not a priority over infection prevention.
Educational objective:
Neutropenic precautions should be used to prevent infection in clients who have low white blood cell and absolute neutrophil counts and are receiving chemotherapy. Infections in these clients are life threatening.
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