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Outline
Pathophysiology
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 that process can result in neutropenia. It also can result if neutrophils are destroyed (by medications, for example) Neutropenia can be congenital or acquired.
Etiology
Congenital neutropenia can result from conditions like Kostmann’s syndrome or myelokathexis.
Acquired neutropenia result from nutritional deficiencies, infections (Hep A, B, C, HIV, and more), medications, chemotherapy, leukemia, alcohol use disorder, and more.
Desired Outcome
Restore neutrophil count, prevent additional destruction, prevent infection
Neutropenia Nursing Care Plan
Subjective Data:
**Neutropenia itself will typically not elicit symptoms, but its cause or subsequent infections may, which differ. Many patients are unaware until the lab is drawn and the diagnosis is made.
Objective Data:
absolute neutrophil count < 1500 cells/mm3
Nursing Interventions and Rationales
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Prevent infection
- Patients with neutropenia are at an increased risk for infection already and will have a decreased ability to be able to fight infection appropriately, therefore it’s essential to prevent this by avoiding unnecessary lines/drains/tubes, appropriate care and cleaning, and discontinuing lines as soon as they are no longer medically indicated.
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Promote oral care
- The mouth is a place that can get infected easily, especially if a patient is on antibiotics, which destroys some of the good bacteria there. It’s ideal if someone who is about to endure treatment that may cause neutropenia (like chemo) can get a dental exam prior. Brushing and flossing regularly is essential.
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Promote hygiene
- Proper hygiene reduces the risk for infection, which is our main concern with neutropenia.
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Prevent skin breakdown
- Skin is an essential aspect of our body that prevents infection. Therefore, if it is compromised, it can be quite a problem for a patient with neutropenia. Prevent ulcers and breakdown, as they may not be able to heal properly and prevent healing and recovery.
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Promote nutrition and ensure food is prepared and stored appropriately
- Food that is not stored or prepared properly could cause infection. Listeria is a food-borne illness that could be quite detrimental to a neutropenic patient.
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Educate on signs and symptoms of infection
- Patients must know when to alert their healthcare team when/if signs and symptoms of infection present themselves when they are neutropenic, as
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**A note about “neutropenic precautions” or “protective isolation” or “reverse isolation”
- Years ago, the standard in practice for patients with neutropenia was to put the patient on isolation, however evidence does not support this practice. Please see the quote below:“Evidence does not support the use of reverse isolation in hospitals…the use of reverse isolation procedures should be discouraged as they are unlikely to be of benefit, and commonly cause anxiety and confusion for patients, families, and healthcare workers” Sheshadri and Baumann 2008.Essentially, what puts the neutropenic patient at greatest risk for infection is their own body, so putting on gowns and masks doesn’t reduce that risk. It does increase cost and makes the patient feel isolated, straining their mental health unnecessarily.
References
- NCBI – Neutropenia: etiology and pathogenesis
- Mayo Clinic – Neutropenia
- Nursing Standard – Nursing care, education and support for patients with neutropenia
- Sheshadri, S. and Baumann, M.Reverse isolation for Neutropenic Patients. Community Oncology. November 2008.
- Clinical Correlations – Neutropenic Precautions Demystified
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