Neutropenia AL BRGSON

If you are neutropenic, Notify your nurse or healthcare provider if you have any of the following: fever >____, if u have any chills or feel ___; notice any redness, discharge or new ___ in your body; have changes in ___ or ____ movements; have a cough, sore throat, mouth sores or blisters.

100.4 feel hot discharge or new pain changes in urination or bowel movements

a neutropenic patient is predisposed to infection, so a low grade fever of > or ____ is of GREAT SIGNIFICANCE

100.4 degrees F

What is a normal neutrophil count?

4000-11,000

What is the formula for figuring out the Absolute Neutrophil Count (ANC)? what is the signifiance of this?

ANC = WBC x % neutrophils This gives you the state of neutropenia and risk for infection

A peripheral blood smear can be done to assess for immature forms of _____.

WBCs

NCLEX: Priority nursing actions when caring for a hospitalized patient with a new-onset temp of 102.2 and sever neutropenia include (Select all that apply) a. administering the prescribed antibiotic stat b. drawing peripheral and central line blood cultures c. ongoing monitoring of the patient's vital signs for septic shock d. taking a full set of vital signs and notifying the physician immediately e. administering transfusions of WBCs treated to decrease immunogenicity

a. administering the prescribed antibiotic stat b. drawing peripheral and central line blood cultures c. ongoing monitoring of the patient's vital signs for septic shock d. taking a full set of vital signs and notifying the physician immediately

NCLEX: The most important method for identifying the presence of an infection in a neutropenic patient is a. frequent temperatures b. routine blood and sputum cultures c. assessing for redness and swelling d. monitoring WBC counts

a. frequent temperatures (Rationale- An elevated temperature is of most significance in recognizing the presence of an infection in the neutropenic patient because there is no leukocytic response, and when the WBC count is depressed, the normal phagocytic mechanisms of infection are impaired, and the class signs of inflammation may not occur. Cultures are indicated if temperature is elevated but are not use to monitor for infection.)

When a febrile episodes occurs in a neutropenic patient, ____ therapy must be initiated immediately, even before the determination of a specific causative agent by culture.

broad spectrum abx (remember that you draw culture, then start broad spectrum abx, then once causative agent is determined- then you can change abx to type that treats for specific organism)

The longer you are neutropenic, the greater risk you have for developing fungal infections. Antifungal therapy should be started if a (+) culture is done or if the pt is still frebile while being treated with _____.

broad spectrum antibiotics

Doing a bone marrow aspiration and biopsy show the ____ & ____.

cellularity & cell morphology

most common reason a patient is neutropenic

chemo and immunosuppressants

Collaborative management of a patient with neutropenia includes determining the cause of the neutropenia, identifying the organism if an infection is present, THEN administering ____ therapy, Neupogen given SQ, & protective isolations which includes ____, ___, ___, & ____>

combination antibiotic therapy (remember to always get blood cultures before you start abx strict hand washing, restricting visitors, private room, HEPA filtration (FYI- these pts should have No standing water, no raw veggies/fruit except bananas, no fresh flowers, when they leave room they need to wear a mask, no IM injections for them, healthcare worker who is sick should not take care of them, electric razors, no indwelling foleys if possible, rotate IV sites & change IV tubing every 48 hrs instead of 72H, they should not garden or pick up after pets)

The major method of preventing infection in the patient with neutropenia is use of a. HEPA filtration rooms b. prophylactic antibiotics c. private, laminar airflow rooms d. strict hand washing by all person in contact with the patient

d. strict hand washing by all persons in contact with the patient (RAtionale- Despite its seeming simplicity, hand washing before, during, and after care of the patient with neutropenia is the major method to prevent transmission of harmful pathogens to the patient. HEPA filtration and LAF rooms may reduce the number of aerosolized pathogens, but they are expensive and LAF use is controversial. Antibiotics are administered when febrile episodes occur but are not use prophylactically to prevent development of resistance.)

An elderly man is already neutropenic and the nurse suspects he may have pneumonia when he shows what signs atypical of a neutropenic pneumonia?

delerium

What is the job of a correctly functioning neutrophil? What is the job of correctly functioning granulocytes?

fight infection phagocytize pathogenic microbes

single most important factor in preventing spread of infection to patient on neutropenic precautions

hand WASHING (transmission of organisms from humans most commonly occurs by direct contact with hands)

blood cell production, termed ___, occurs within the bone marrow

hematopoiesis

If the ANC is from 1000 to 1500 then the patient is at increased risk for _____. An ANC indicative of moderate risk is one of ___ to ____. An ANC indicative of severe risk is < ____.

infection 500-1000 <500

for a neutropenic patient, The faster the drop in neutrophil count, the longer the duration of neutropenia, the > incidence of ____, ____, & _____.

infection sepsis death

syndrome developed secondary to disease or treatment in which WBC <4000

leukopenia

Doing a WBC can help determine ___, the differential that is done with the WBC can help determine ____.

leukopenia neutropenia

common entry points of infection in neutropenic patients is ___, ___, ___, __, & ___

mouth throat skin perianal area pulmonary sites

syndrome developed secondary to disease or treatment in which the neutrophil count is <1000 to 1500

neutropenia

G-CSF (Neupogen/Neulasta) work to stimulate the production and function of _____. GM-CSF (Leukine/Prokine) work to stimulate the production and function of ____ & ___.

neutrophils neutrophils & Monocytes

In neutropenic patients, ____ contribute to life threatening infections like pneumonia

normal body flora contribute

A leukopenic patient does not show the typical ssx that are normally associated with inflammation ____, ____, ____ & since WBC are a major component of pus, pus is also absent in these pts.

redness heat swelling

___ are the sources of all blood cells

stem cells

neutropenic patients are more prone to developing ___ infections like Herpes simplex/zoster, candidias, staph, & ecoli

systemic infections