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Hey guys, let's take a look at the care plan for neutropenia. In this lesson, we'll briefly take a look at the pathophysiology and etiology of neutropenia. We're also going to take a look at additional things like subjective and objective data, as well as nursing interventions and rationales for each.
So neutropenia is an abnormally low count of neutrophils, which is a type of white blood cell. Neutrophils are made in the bone marrow, so anything that inhibits or disrupts this process can result in neutropenia. Neutropenia can also occur if neutrophils are destroyed, for instance, by a medication. It can be congenital or can be acquired. Congenital neutropenia can result from conditions like Kostmann’s syndrome or myelokathexis. Acquired neutropenia can result from nutritional deficiencies, infections like Hep A,B,C, HIV, and others, by medications, chemotherapy, leukemia, alcohol use disorder, and even more things. The desired outcome is to restore the neutrophil count, prevent additional destruction, and prevent infection.
Let's take a look at some of the subjective and objective data that your patient with neutropenia may present with. Remember, subjective data are going to be things that are based on your patient's opinions or feelings, and actually with neutropenia, it typically will not elicit symptoms. They might have symptoms from the actual cause of the neutropenia or subsequent infections. Many patients are unaware until labs are drawn and the diagnosis is made.
Objective data consists of an absolute neutrophil count of less than 1500 cells.
Let's take a look at some of the nursing interventions, which are important in caring for a patient with neutropenia.
Preventing infection is key. Patients with neutropenia are at an increased risk for infection already and have a decreased ability to fight infection. With this in mind, it's important to avoid any unnecessary lines, drains, tubes, and maintain appropriate care in cleaning, and discontinue lines as soon as they are no longer medically indicated. Promoting oral care is also critical as the mouth is a place that can get infected easily, especially if the patient is on antibiotics, which destroys the good bacteria. It is a great idea for any patient who is about to begin a treatment like chemo, which may cause neutropenia, to get a dental exam prior. Brushing and flossing daily is essential. Although it sounds very basic, promoting hygiene is super important as proper hygiene reduces the risk of infection, and this is our main concern with neutropenia patients.
Also, as you know, skin is super important in preventing infection therefore, if it is compromised, it can be a huge problem for a patient with neutropenia. So, prevention of ulcers and skin breakdowns is key as these patients may not be able to heal properly.
Nutrition, this is another important nursing intervention because food that is not stored or prepared properly could cause infection. Listeria, for example, is a foodborne illness that could be detrimental to a neutropenic patient. In case you were wondering, there is no evidence that a neutropenic diet benefits a patient with neutropenia. It is said that just following safe food handling guidelines set by the FDA is enough. Educate the patient on signs and symptoms of infection, and when to alert the healthcare team.
One final note guys, years ago, the standard was to put these patients in isolation, also known as neutropenic precautions, protective isolation, or reverse isolation. However, evidence now does not support this, and states that what actually puts neutropenic patients at risk are their own bodies. So, putting masks and gowns on does not reduce this risk. It simply increases costs, creates feelings of isolation, and places strain on the mental health of the patients.
Okay, guys, here is a look at the care plan for neutropenia. That's it for this lesson. We love you guys. Now, go out and be your best self today and as always, happy nursing!
So neutropenia is an abnormally low count of neutrophils, which is a type of white blood cell. Neutrophils are made in the bone marrow, so anything that inhibits or disrupts this process can result in neutropenia. Neutropenia can also occur if neutrophils are destroyed, for instance, by a medication. It can be congenital or can be acquired. Congenital neutropenia can result from conditions like Kostmann’s syndrome or myelokathexis. Acquired neutropenia can result from nutritional deficiencies, infections like Hep A,B,C, HIV, and others, by medications, chemotherapy, leukemia, alcohol use disorder, and even more things. The desired outcome is to restore the neutrophil count, prevent additional destruction, and prevent infection.
Let's take a look at some of the subjective and objective data that your patient with neutropenia may present with. Remember, subjective data are going to be things that are based on your patient's opinions or feelings, and actually with neutropenia, it typically will not elicit symptoms. They might have symptoms from the actual cause of the neutropenia or subsequent infections. Many patients are unaware until labs are drawn and the diagnosis is made.
Objective data consists of an absolute neutrophil count of less than 1500 cells.
Let's take a look at some of the nursing interventions, which are important in caring for a patient with neutropenia.
Preventing infection is key. Patients with neutropenia are at an increased risk for infection already and have a decreased ability to fight infection. With this in mind, it's important to avoid any unnecessary lines, drains, tubes, and maintain appropriate care in cleaning, and discontinue lines as soon as they are no longer medically indicated. Promoting oral care is also critical as the mouth is a place that can get infected easily, especially if the patient is on antibiotics, which destroys the good bacteria. It is a great idea for any patient who is about to begin a treatment like chemo, which may cause neutropenia, to get a dental exam prior. Brushing and flossing daily is essential. Although it sounds very basic, promoting hygiene is super important as proper hygiene reduces the risk of infection, and this is our main concern with neutropenia patients.
Also, as you know, skin is super important in preventing infection therefore, if it is compromised, it can be a huge problem for a patient with neutropenia. So, prevention of ulcers and skin breakdowns is key as these patients may not be able to heal properly.
Nutrition, this is another important nursing intervention because food that is not stored or prepared properly could cause infection. Listeria, for example, is a foodborne illness that could be detrimental to a neutropenic patient. In case you were wondering, there is no evidence that a neutropenic diet benefits a patient with neutropenia. It is said that just following safe food handling guidelines set by the FDA is enough. Educate the patient on signs and symptoms of infection, and when to alert the healthcare team.
One final note guys, years ago, the standard was to put these patients in isolation, also known as neutropenic precautions, protective isolation, or reverse isolation. However, evidence now does not support this, and states that what actually puts neutropenic patients at risk are their own bodies. So, putting masks and gowns on does not reduce this risk. It simply increases costs, creates feelings of isolation, and places strain on the mental health of the patients.
Okay, guys, here is a look at the care plan for neutropenia. That's it for this lesson. We love you guys. Now, go out and be your best self today and as always, happy nursing!
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