Nursing Care Plan (NCP) for Neutropenia
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Outline
Lesson Objectives for Neutropenia
- Understanding Neutropenia:
- Define neutropenia as a condition characterized by an abnormally low level of neutrophils, a type of white blood cell crucial for immune function. Understand the role of neutrophils in protecting the body from infections.
- Causes and Risk Factors:
- Explore the various causes of neutropenia, including chemotherapy, certain medications, infections, and underlying medical conditions. Identify risk factors that may predispose individuals to develop neutropenia.
- Clinical Manifestations:
- Recognize the clinical manifestations of neutropenia, such as increased susceptibility to infections, fever, and potential complications. Understand the importance of early detection and management to prevent severe infections.
- Diagnostic Approaches:
- Familiarize with diagnostic approaches for neutropenia, including complete blood count (CBC) with differential, bone marrow aspiration, and assessing the underlying cause through medical history and physical examination.
- Management and Nursing Interventions:
- Learn about the management of neutropenia, including pharmacological interventions such as granulocyte colony-stimulating factors (G-CSF), infection prevention strategies, and patient education. Understand the role of nursing interventions in supporting individuals with neutropenia.
Pathophysiology of Neutropenia
- Impaired Neutrophil Production:
- Neutropenia often results from a disruption in the production of neutrophils, which are critical for innate immune responses. Impaired production can occur in the bone marrow due to various factors.
- Increased Destruction of Neutrophils:
- Accelerated destruction of neutrophils may occur, leading to a decrease in circulating neutrophil levels. Conditions such as autoimmune disorders or medications can contribute to the destruction of these white blood cells.
- Altered Distribution and Sequestration:
- Neutrophils may be redistributed or sequestered in organs and tissues, making them less available in the bloodstream. This altered distribution can impact the body’s ability to mount an effective immune response.
- Bone Marrow Suppression:
- Conditions that suppress bone marrow function, such as chemotherapy or radiation therapy, can result in neutropenia. The bone marrow, responsible for producing blood cells, may be adversely affected, leading to a reduced neutrophil count.
- Increased Utilization in Infections:
- During infections, there is an increased demand for neutrophils at the site of infection. This heightened utilization, coupled with a compromised production or increased destruction, can contribute to neutropenia.
Etiology of Neutropenia
- Chemotherapy and Radiation Therapy:
- Treatment modalities like chemotherapy and radiation can suppress bone marrow function, leading to a decrease in neutrophil production and subsequent neutropenia.
- Medications:
- Certain medications, such as immunosuppressants, antibiotics (e.g., trimethoprim-sulfamethoxazole), and antithyroid drugs, can cause neutropenia as a side effect.
- Infections:
- Severe infections, particularly those involving the bone marrow or directly affecting neutrophils, can lead to increased destruction and utilization, contributing to neutropenia.
- Autoimmune Disorders:
- Autoimmune disorders, including rheumatoid arthritis and lupus, can result in the destruction of neutrophils by the body’s immune system, contributing to neutropenia.
- Congenital Disorders:
- Certain congenital disorders, such as cyclic neutropenia or Kostmann syndrome, can lead to chronic neutropenia due to genetic abnormalities affecting neutrophil production.
Desired Outcome for Neutropenia
- Maintained Neutrophil Levels:
- Achieve and maintain an adequate neutrophil count within the normal range to support the body’s ability to defend against infections and prevent complications.
- Prevention of Infections:
- Minimize the occurrence of infections by implementing infection prevention strategies, promoting aseptic techniques, and educating the patient on measures to reduce the risk of exposure to pathogens.
- Resolution of Underlying Cause:
- Identify and address the underlying cause of neutropenia to prevent recurrent episodes. Collaborate with the healthcare team to manage contributing factors such as medications or underlying medical conditions.
- Patient Education and Empowerment:
- Educate the patient on the importance of adherence to prescribed medications, infection prevention measures, and early recognition of signs and symptoms of infection. Empower the patient to actively participate in their care.
- Improved Quality of Life:
- Enhance the patient’s overall quality of life by managing neutropenia effectively, minimizing the impact of infections, and providing emotional support. Encourage the patient to engage in normal daily activities while maintaining precautions.
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 Assessment for Neutropenia
- Complete Blood Count (CBC):
- Monitor the patient’s CBC with differential regularly to assess neutrophil levels. Document any fluctuations or trends, and report abnormal results promptly.
- Signs and Symptoms of Infection:
- Assess for signs and symptoms of infection, such as fever, chills, increased heart rate, and changes in mental status. Promptly investigate and initiate appropriate interventions if infection is suspected.
- Medication History:
- Obtain a detailed medication history, including current medications and any recent changes. Identify medications known to cause neutropenia and collaborate with the healthcare team for potential adjustments.
- Recent Infections or Illnesses:
- Inquire about recent infections, illnesses, or hospitalizations, as these factors can contribute to neutropenia. Understanding the patient’s medical history aids in determining the underlying cause.
- Bone Marrow Aspiration:
- If indicated, assess the results of bone marrow aspiration to determine the cause of neutropenia and guide treatment decisions. Collaborate with the healthcare team for interpretation and planning.
- Education and Understanding:
- Assess the patient’s understanding of neutropenia, its causes, and the importance of adherence to prescribed medications. Identify any misconceptions or concerns that require clarification.
- Psychosocial Assessment:
- Evaluate the patient’s psychosocial well-being and coping mechanisms. Neutropenia and its management may impact the patient emotionally, so providing emotional support and addressing concerns is crucial.
- Infection Prevention Practices:
- Assess the patient’s adherence to infection prevention practices, including hand hygiene, avoiding crowds, and maintaining a clean environment. Provide education and reinforcement of these practices as needed.
Implementation for Neutropenia
- Pharmacological Interventions:
- Administer prescribed medications, such as granulocyte colony-stimulating factors (G-CSF), as directed to stimulate neutrophil production and prevent severe neutropenia. Monitor for potential side effects and report any adverse reactions.
- Infection Prevention Measures:
- Educate the patient on infection prevention strategies, including meticulous hand hygiene, avoiding crowds, and maintaining a clean living environment. Emphasize the importance of promptly reporting any signs of infection.
- Regular Monitoring and Assessments:
- Conduct regular monitoring of the patient’s complete blood count (CBC) with differential to assess neutrophil levels. Promptly report any significant changes to the healthcare team for further evaluation and adjustments to the care plan.
- Patient Education and Empowerment:
- Provide comprehensive education to the patient regarding their condition, including the underlying causes, medications, and self-care measures. Empower the patient to actively participate in managing their health and recognizing potential complications.
- Collaboration with Healthcare Team:
- Collaborate with the healthcare team, including physicians, hematologists, and infectious disease specialists, to address the underlying cause of neutropenia. Participate in interdisciplinary discussions to tailor the care plan to the patient’s specific needs.
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.
Evaluation for Neutropenia
- Neutrophil Levels:
- Regularly evaluate neutrophil levels through CBC with differential. Assess whether neutrophil counts remain within the target range or if adjustments to the treatment plan are necessary.
- Incidence of Infections:
- Monitor the patient for the occurrence of infections. Evaluate the frequency and severity of infections, if any, and assess the effectiveness of infection prevention measures in reducing the risk.
- Medication Adherence:
- Assess the patient’s adherence to prescribed medications, including G-CSF or other medications aimed at managing neutropenia. Evaluate whether the patient is consistently taking medications as directed.
- Patient Education:
- Measure the patient’s understanding of neutropenia, its causes, and the importance of infection prevention measures. Evaluate the patient’s ability to recognize early signs of infection and report them promptly.
- Quality of Life:
- Evaluate the impact of neutropenia management on the patient’s overall quality of life. Consider factors such as emotional well-being, ability to engage in daily activities, and any reported improvements or challenges.
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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Transcript
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!
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