This article is about neutropenia, diagnosis of neutropenia, treatment for neutropenia, and 3 nursing care plans for neutropenia. It can be used in the creation of nursing care plans for educational purposes.
What is neutropenia?
Neutropenia is a medical term for low neutrophil count. Neutrophils are a group of white blood cells of the body’s immune system.
They are responsible for attacking disease-causing bacteria and other organisms. Created in the bone marrow, neutrophils travel via the blood to the site of infection.
They are able to fight the invading microorganism by means of ingesting and neutralizing them. Neutropenia can be caused by several medical conditions and treatments, including chemotherapy.
What are the Signs and Symptoms of Neutropenia?
Neutropenia is not a disease in itself and does not show any signs and symptoms.
If the patient has neutropenia, he/she is more prone to infections, as evidenced by mouth ulcers, rashes, abscesses, or wounds that do not seem to heal on a normal rate.
Fever can be a result of having a low neutrophil count and a weakened immune system.
What are the Causes and Risk Factors of Neutropenia?
- Bone marrow problems. Neutropenia can be caused by a dysfunction in the neutrophil production inside the bone marrow, which could be a congenital disorder or a blood cancer known as leukemia.
- Chemotherapy and Radiotherapy. Neutrophils can also be destroyed outside the bone marrow due to systemic anti-cancer therapies (SACT) such as chemotherapy. Radiotherapy can also cause neutropenia. I
- Infections and autoimmune disorders. Infections such as dengue fever, HIV, and tuberculosis may also result to neutropenia. Autoimmune disorders that puts a person at risk for neutropenia include Lupus, Rheumatoid arthritis, and Crohn’s disease.
- Drugs. Some medications such as epilepsy drugs, antibiotics, and blood pressure drugs can lead to neutropenia.
- Poor nutrition. Neutropenia can also result from a nutritional deficiency such as low vitamin B and folate levels.
What can happen if neutropenia goes untreated?
The complication of neutropenia is sepsis or blood infection.
Sepsis is a serious medical syndrome wherein the presence of an infection triggers the body to respond by releasing excessive amounts of chemicals to fight the infection.
This can lead to septic shock, which is a fatal condition.
Diagnosis of Neutropenia
How do you diagnose for neutropenia?
Along with the signs and symptoms, neutropenia is primarily diagnosed by obtaining a blood sample from the patient. The normal neutrophil count is above 2.0 and less than 7.5. The following are the types of neutropenia:
- Mild Neutropenia: 1.0- to 2.0
- Moderate Neutropenia: 0.5 to 2.0
Severe Neutropenia: < 0.5
Treatment for Neutropenia
What are the treatment options for neutropenia?
- Granulocyte colony-stimulating factor (G-CSF). This class of medications can stimulate the bone marrow, leading to the production of new white blood cells that include neutrophils. This is commonly prescribed to patients on chemotherapy. The type and amount of GCSF prescribed depends on the severity of the neutropenia, whether it is an expected side effect of a chemotherapeutic agent, or an existing condition in a chemotherapy patient.
- Antibiotics. Although the antibiotics are not prescribed to increase the neutrophil count, they are immediately administered when a neutropenic patient has a fever of unknown source, as it is safe to assume that there is an underlying infection that is yet to be found.
- Stem cell transplant. This treatment can be used for severe and recurrent neutropenia, especially for those patients who have congenital or long-term bone marrow issues.
- Nutrition. Doctors and dietitians may recommend increased vitamin B and folic acid levels through supplements and food to improve neutrophil counts.
3 Nursing Care Plans for Neutropenia
- Nursing Diagnosis: Risk for Infection
Desired Outcome: The chemotherapy patient will be able to avoid the development of an infection by achieving a neutrophil count within the normal range.
|Assess vital signs and observe for any signs of infection.||Sepsis or infection of the blood may be evidenced by fever accompanied by respiratory distress.|
|Perform a whole body assessment checking for any evidence of mouth ulcers, rashes, abscesses, or wounds that do not seem to heal on a normal rate.||Neutropenia is one of the risks of chemotherapy treatment. It can be evidenced by mouth ulcers, rashes, abscesses, or wounds that do not seem to heal on a normal rate.|
|Obtain a blood sample.||To monitor neutrophil and white blood cell counts.|
|Teach the patient how to perform proper hand hygiene.||To maintain patient safety and reduce the risk for cross contamination.|
|Administer granulocyte colony-stimulating factor (G-CSF), as prescribed.||To stimulate the bone marrow to produce more white blood cells and neutrophils, especially after a chemotherapy session.|
|Orient the patient about the need for reverse isolation should neutropenia occur.||Reverse isolation increases the protection against infections for the immunocompromised patient. This can be practiced during hospitalization, or even when at home, by strict hygiene, wearing personal protective equipment (PPE), and other measures done by the family and visitors of the patient.|
- Hyperthermia secondary to neutropenia as evidenced by temperature of 38.5 degrees Celsius, rapid breathing, neutrophil count of 0.5, profuse sweating, and chills
Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
|Assess the patient’s vital signs at least every 4 hours.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Paracetamol) administered.|
|Remove excessive clothing, blankets and linens. Adjust the room temperature.||To regulate the temperature of the environment and make it more comfortable for the patient.|
|Administer the prescribed antibiotic and anti-pyretic medications.||Use the antibiotic to treat a suspected infection, which is the underlying cause of the patient’s hyperthermia (neutropenic fever). Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.|
|Offer a tepid sponge bath.||To facilitate the body in cooling down and to provide comfort.|
|Elevate the head of the bed.||Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.|
- Risk for Altered Oral Mucous Membrane secondary to neutropenia
Desired Outcome: The patient will not develop mucositis or mouth ulcers, and maintain the integrity of his/her oral mucosa.
|Assess the oral health by inspecting the mouth, especially the oral mucosa.||To identify the baseline of the patient’s oral health, and to determine any need for prophylactic treatment prior to commencing chemotherapy.|
|Advise the patient to perform regular saline mouthwashes.||To avoid the development of mouth ulcers by rinsing the mouth with a natural and gentle kind of mouthwash such as mixing salt into warm water.|
|Advise the patient to use a soft bristled toothbrush. Inform him/her to replace it at least every 3 months.||To reduce the risk of trauma to the oral mucosa and gums. Replace the toothbrush at least every 3 months for hygienic purposes.|
|Teach the patient to floss daily.||To remove food particles that are stuck in between teeth.|
|Educate the patient of the signs of oral thrush (superinfection).||To ensure early assessment and treatment.|
Other nursing diagnoses:
- Acute Pain
- Risk for Impaired Skin Integrity
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Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.