Almost zero WBC count

[misti_z]

Had a patient this weekend...breast CA...who was on my floor (renal) only because our oncology unit was full. Her WBC was 0.5, she was put on reverse isolation. A float nurse who had her on the day shift said that when she goes to the onclology unit to work no patient are on isolation. What is your floor's procedure for an almost zero WBC count?

[KatWright]

Good question!! Actually it can be from both. Chemotherapy will kill off the "bad" cancer cells but while it is at it, will kill off some of the good cells resulting in neutropenia. On the other hand, people with blood dyscrasias such as acute leukemia, have veins full of immature cells that can't fight anything. Thats why you may hear of someone finding out that they have Leukemia because of a tooth abcess or other infection. Or they have bruises because they have so few platelets (the little sticky things in the blood that help with clotting and until the body is able to produce them, do not live long----only a few days)

What a great field....I love oncology........

Good luck to you !!

Kat

[pedsoncology]

I work in peds oncology at loma linda childrens hospital and none of the kids with low wbc count and low anc's are on isolation, we have to prioritize. if someone is sick dont put them in a room with a oncology pt. we also have sickle cell kids on our unit so we will room them with eachother. all the kids are on antibiotics, and they all are here for the same reason (to get chemo) the only people we isolate is the kids with mersa, and vre, chicken pox. So it is true they are not isolated and we dont do reverse isolation with kids dx with cancer.

[pedsoncology]

oh yeah and no visitors under 14 years old and no flowers and no fruits. of course we do our standard precautions like wash our hands. :)

[beckymcrn]

I have been in oncology for five years now. First in the hospital now in an out pt clinic. In the hospital we put pts on neutropenic precautions (door closed, no fresh fruit and veggies and hand wash, hand wash, hand wash) It is much more about teaching in the out pt setting we teach pts what to expect after chemo treatment and when they should call the md. Most actually do fairly well with their neutropenia as out pts.

[kabarnes]

I was glad to come across your post regarding neutropenia. I recently started working on a pediatric floor that does oncology and they want you to glove gown and mask when entering a patients room who is on neutropenic procautions. I am new to this hospital and was having trouble getting used to this strict practice. Today I walked into the pt's room, to stop the IV pump from beeping and the oncologist yelled at me for not having a mask on. I was not facing the patient and he had just walked out of the room with no gown gloves or mask. I realize that since it is my hospital's policy I need to follow it. But, I am glad to see your posts to reassure myself that I was not doing an improper practice. My only other experiences with chemotherapy pt's was about 4 years ago as a Nursing assistant and i can't ever remembering have to wear all of that stuff. Just washing hands and putting on gloves. Thanks for letting me vent my feelings

[jemb]

I work in an outpatient oncology unit. Many of our patients are neutropenic. We teach precautions - handwashing, avoiding crowds, no raw fruits of veggies, etc. Some patients choose to wear masks in some situations, but most don't, and most patients do very well. Some never stop working, depending on the type of work. It's very different from when I first started working oncology in the '80's.

[renerian, BSN, RN]

Reverse isolation and no roommate.......

renerian

[shannonRN, BSN, RN]

most of our heme-onc docs don't believe in reverse isolation. so it isn't widespread in our hospital.

[WalMart_ADN]

very very lax reverse isolation with my heme/onc kiddos......wear a mask if they are going down to the cafeteria/lobby w/ mom, not necessary if they are just going to the playroom (the really sick kids won't be in the playroom anyway) and they go home when they have been afebrile for 48 hours.

[jule]

on the pediatric oncology unit where i work, we have these `rules`for low WBC:

generally no visitors under 12 years

generally no plants

generally avoid eating nuts etc (bec. of moulds)

generally avoid places where many people are (like bus, train...)

under 1.0 wbc "sterile" food,e.g. no uncooked vegetables, no unpeeled fruits, etc.

one day under o.1 wbc or two days under 0.2 wbc:"sterile" room, e.g.single room, door closed, visitors and nurses have to wear a mask when entering the room.

[emily_mom]

No flowers

No fruit

Reverse isolation.....

Visitors must check in before going in room....

[onco gal]

The more we lessen the precautions, the more infections and deaths occur.