Cll patient with neutropenia care plan?

[kynewbie]

Hello, I am new to the forum as far as posting but have read many, many comments! I am writing a care plan for a patient with cll who is on neutopenic precautions. Her last chemo treatment was on 8/31 and her labs are as follows:

T - 98.5 P - 87 & regular BP - 129/71 O2 - 98% WBC - 4.3 RBC - 2.94 Neut - 88.8%

Lymph - 0.2% Mono - 0.1%

Patient reports fatigue, nausea and vomiting in past 2 days. She also has +4 pitting edema of both legs. This is her second week in the hospital and she had an admitting WBC of 0.4. She has been running a temp in the 100's but that has finally stabalized today. I have to come up with 2 nursing diagnoses. I am thinking Risk for infection r/t decreased wbc. I have so much trouble doing care plans and I think it is because I try to make them more complicated that they really are. If I use the risk for infection diagnosis, would I use teaching infection control measures and diet, monitoring labs, I & O, administration of meds as interventions? What about a second diagnosis? Any help would be greatly appreciated. I stress so much over care plans.

[Double-Helix, BSN, RN]

Is this patient at risk for an infection or does she already have an infection? She is severely immunocompromised, so the fact that she is mounting a fever surprises me, but a fever is usually indicative of a response to an infectious organism. Is there anything else in your assessment/lab results that might indicate she has an active infection? Is she receiving antibiotics? Did she have blood cultures drawn? You can't use a risk-for diagnosis if your patient already is displaying what they are supposed to be at risk for.

For the interventions, think about what specifcally relates to infection control. What specifically are you going to teach the patient and visitors? What is the staff going to be doing to limit exposure to this patient? (Think PPE). What specific medications are given to prevent infection? What specific labs will you monitor? How does diet relate to infection control? How does I&O relate to infection control? You need to have a rationale for each intervention. It's not enough to just to list what you think you should do, you need to be able to explain why you are doing it.

For your second diagnosis- what else in the patient's assessment is abnormal? What lab results are abnormal? How could those lab results be related to the symptoms she is complaining about? You've got several choices from the remaining assessment. Think about the RBCs, fatigue, N/V, and the pitting edema. What about the emotional/social issues associated with cancer and long term hospitilization? Which of these is a priority and what do you want to do about it?

When you have gone further with your care plan, come back and we can give you some more specific guidance.

[kynewbie]

See, this is why I get so tore up over care plans! I did not see anywhere in her chart where she has an active infection but she is on several antibiotics and antifungals. Basically all of her labs are abnormal!! Protein is 30, sodium is 133, chloride is 109.1, creatine is 1.3, calcium is 7.7, albumin is 2.3, I could go on and on. But based on her history of having a temp in the 100's for the past several days, she probably does have an active infection so that rules out the risk for diagnosis. I really need to get a care plan book. I only have my nursing books to look thru and they have a list of the diagnoses but none of the supporting data for each diagnoses, so I feel a little lost.