How to best care for a neutropenic patient. Get more information on what types of patients are affected, infection prevention, diet restrictions and potential isolation for this high risk population.
Sadly 4 weeks ago my husband passed away from AML and he had severe Neutropenia for several months leading up to his death. He was in a Haemotology Ward , but we found the only time they gowned and masked etc was when they were doing chemo, I guess maybe being a specialized ward it was different . I used to cook all his meals at home and bring them in, we had strict guidelines and I installed a fridge in my car to keep the food the way I was told. My only concern I had was the hand washing and as a Palliative Care Nurse I was forever on the nurses backs to wash their hands. My other issue was, even though he was in Neutropenic Precautions, sometimes his bed wouldn't get changed for many days, so that was always my first job when I got in to visit every day.
Sadly 4 weeks ago my husband passed away from AML and he had severe Neutropenia for several months leading up to his death. He was in a Haemotology Ward , but we found the only time they gowned and masked etc was when they were doing chemo, I guess maybe being a specialized ward it was different . I used to cook all his meals at home and bring them in, we had strict guidelines and I installed a fridge in my car to keep the food the way I was told. My only concern I had was the hand washing and as a Palliative Care Nurse I was forever on the nurses backs to wash their hands. My other issue was, even though he was in Neutropenic Precautions, sometimes his bed wouldn't get changed for many days, so that was always my first job when I got in to visit every day.
I'm so sorry for your loss Annerw:(
Sadly 4 weeks ago my husband passed away from AML and he had severe Neutropenia for several months leading up to his death. He was in a Haemotology Ward , but we found the only time they gowned and masked etc was when they were doing chemo, I guess maybe being a specialized ward it was different . I used to cook all his meals at home and bring them in, we had strict guidelines and I installed a fridge in my car to keep the food the way I was told. My only concern I had was the hand washing and as a Palliative Care Nurse I was forever on the nurses backs to wash their hands. My other issue was, even though he was in Neutropenic Precautions, sometimes his bed wouldn't get changed for many days, so that was always my first job when I got in to visit every day.
So sorry to hear of your loss
Neutrophils are a type of white blood cell needed for fighting infection, especially bacteria. While many ranges can sometimes differ slightly with certain laboratories, generally a normal count is considered between 1,500-8,000. Neutropenia can be classified from mild to severe. The risk of infection increases greatly once the ANC falls below 500.
Determining the absolute neutrophil count serves to uncover how many of the total white blood cells (WBC) are neutrophils. This can be accomplished by a few different formulas, and example of which includes:
ANC = [(% segmented neutrophils + Bands) + (WBC)] / 100
(Neutrophilcount.com, 2017)
Causes
Neutrophils are produced inside the bone marrow, therefore causes of neutropenia can be linked to an issue in bone marrow production or destruction. Some examples include:
Symptoms to Report
While neutropenia itself may not present with any identifiable symptoms, it is important to educate patients on what to watch for at home, specifically signs of infection.
Neutropenic Precautions
These patients are at increased risk of infection due to depression of their neutrophils. Prevention is key! These measures should be taken into consideration for your nursing care and patient/family education.
Neutropenic Isolation
In some cases (for example, transplant) the patients are so immunocompromised they may need more protective measures, like isolation. In this type of strict isolation there are a few points to keep in mind.
Conclusion
With all of these restrictions and precautions in place this can be a frustrating time for your patient - especially if they are young. It's usually quite difficult to ensure mask compliance in a toddler or confine them to a hospital isolation room for days. Making sure the patient and family have a few activities can be a helpful distraction for any age. Reinforcing the importance of infection prevention can lead to better patient outcomes. Educating the patient, family and visitors is a priority in this population. With your guidance they can decrease the overall risk of contracting life threatening infections and be as protected as possible.
References:
Neutropenia: Causes, diagnosis, and treatment
Neutropenia - Mayo Clinic
Neutropenia - WebMD
Neutrophil Count
About Ashley Hay, BSN, RN, BSN, RN
Over 10 years of nursing experience in several areas of Pediatric & Adult Oncology including clinical research, chemotherapy, transplant, hematology, proton therapy, GI surgery, wound care, post anesthesia recovery, etc.
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