Neutropenia

1. Pathophysiology Pharmacological Therapy Treats • -Involves determining cause and then identifying offending organism if infection is present • -Prophylactic, empiric, or therapeutic antibiotic therapy may be implemented (**prompt initiation of empiric broad-spectrum antibiotic therapy at any sign of infection, antibiotics w/in 1 hour if fever present) • -Typically given via IV because of the rapidly lethal effects of infection • *Third or fourth generation cephalosporin, a carbapenem, or a combination of an aminoglycoside and an antipseudomonal may be used • -Hematopoietic growth factors (Neupogen, Neulasta, Leukine) given to stimulate neutrophil production and function • -Nutritional support if caused by nutritional deficiency (cobalamin, folic acid) • -Condition associated with a neutrophil count (absolute neutrophil count [ANC]) less than 1,000 cells/uL. Severe neutropenia is associated with an ANC less than 500 cells/uL. Typically, neutrophils range from 4,000 to 11,000 cells/uL. • -It is often a result that occurs with a variety of conditions or diseases. Common drug induced causes include: antitumor antibiotics, antinflammatory drugs, chemotherapy, and immunosuppressive therapy. Hematologic disorders (leukemia, aplastic anemia), autoimmune disorders (systemic lupus erythematosus, rheumatoid arthritis), infections (viral, parasitic, etc.), hemodialysis, transfusion reaction, severe sepsis, and nutritional deficiencies are also causes of neutropenia • -When WBCs are depressed, normal phagocytic mechanisms are impaired • -The patient has little to no ability to fight infection, minor infections can easily lead to sepsis • -Mucous membranes of throat and mouth, skin, perianal area, and pulmonary system are common entry points for pathogenic organisms Medical interventions for To Diagnose Prevents/treats infection To increase neutrophils To Treat Fever To check for drug-induced cause Followed by To Treat Deficiency To determine cause Treated with Prevent Infection Neutropenia Body’s Response Manages Symptom In Response to Nursing Interventions To check for Body’s response Diagnoses Symptoms in response to Goals: Patient adheres to infection control and protection practices. Patient experiences no signs or symptoms of infection – reducing the risk of septic shock. -Institute protective environmental practices (i.e.: strict hand washing, visitor restrictions, private room if hospitalized, use of high particulate air filtration) -Avoid uncooked meats, seafood, eggs, and unwashed fruits and vegetables -Instruct visitors to wash hands on entering/exiting patient’s room -Do not perform gardening or clean up after pets (petting is fine, as long as strict hand washing is implemented) -Patient teaching to above preventative measures -Monitor patient for signs and symptoms of infection [avoid rectal temperature measurements/rectal exams] -Fever greater than or equal to 100.4 FMD must be notified immediately -Inspect skin and mucous membranes for redness, extreme warmth and/or drainage (indicates severe infection) -Quality of life should be considered and discussed with patient (r/t fatigue, malaise, decrease in function, and social isolation) Diagnosed Assessment & Diagnostic Tests • Assessment: • -Classic signs of inflammation (redness, heat, swelling) may not occur. WBCs are the major component of pus, so pus formation may not be visible. • -Complaints of sore throat, diarrhea, rectal tenderness, vaginal itching, shortness of breath, non-reproductive cough • -Low grade fever • Tests: • -White blood cell count with differential [ANC <1,000 cells/uL] • -Bone marrow aspiration and biopsy • -Review of patient’s past and current drug history • - If infection is present, serial blood cultures, sputum, throat, lesions, wounds, urine, and feces cultures may be taken and tested To increase neutrophil count Managed by Done in response to Done in response to Assess for Done in response to Done in response to

2. Key: Pharmacological therapy Pathophysiology Assessment & Diagnostic Tests Nursing Interventions Reference: Lewis, Sharon L., Margaret M. Heitkemper, Shannon Ruff Dirksen, Linda Bucher, and Ian M. Camera. Medical-surgical nursing: assessment and management of clinical problems. 8th ed. St. Louis: Mosby, 2011. Barbara Fournier