Neutropenia is a condition characterized by decreased levels of neutrophils. The absolute neutrophil count (ANC) is determined by multiplying the white blood cell count by the percentage of neutrophils. The normal range is between 2,500 – 6,000 cells/mL. A neutrophil count below 500 cells/mL is considered neutropenia.
The clinical significance of neutrophils relates to the body’s ability to fight infection since they are a type of white blood cell. The more rapid the drop in neutrophil count and the longer its duration, the greater chance of developing life-threatening infections, sepsis, and even death.
Neutropenia is an important factor in monitoring diseases and treatments. Cancer and chemotherapy, and immunosuppressive therapy in the treatment of autoimmune disorders are the most common causes of neutropenia.
When fever occurs in patients with neutropenia, this is typically associated with infection and must be attended to immediately, as they have little ability to fight off infection. Even the most minor infection can rapidly lead to sepsis and even death.
Nursing Process
The nursing care for patients with neutropenia includes identifying the cause of neutropenia, identifying the organisms causing the infection, initiating prompt antibiotic therapy, and implementing infection control practices. Strict monitoring is vital in patients with neutropenia, especially for early signs of infection and septic shock. Patients and their families must be educated on protective measures to implement when the immune system is suppressed.
Nursing Care Plans Related to Neutropenia
Risk for Infection
Patients with neutropenia have a higher risk of developing serious infections because they do not have adequate neutrophils to help fight off infection-causing pathogens.
Nursing Diagnosis: Risk for Infection
Related to:
- Chronic illness
- Decreased neutrophil count
- Leukopenia
- Chemotherapy
- Radiation therapy
- Certain medications
- Autoimmune disease processes
- Bone marrow disorders
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at the prevention of signs and symptoms.
Expected outcomes:
- The patient will remain free of infection
- The patient will display a white blood cell count and neutrophil count within expected limits
Assessment:
1. Assess vital signs and any signs of infection.
Infection or sepsis can manifest with fever along with respiratory distress and tachycardia.
2. Conduct a physical assessment.
Neutropenia can manifest as mouth ulcers, abscesses, rashes, and delayed wound healing.
3. Assess and monitor complete blood count.
Blood tests can help monitor the white blood cell count and neutrophil count to assess the risk of infection.
Interventions:
1. Implement neutropenic precautions.
This includes a private room with appropriate signage so staff is aware. Equipment may be left in the room, so it is only used by that patient to prevent the transmission of pathogens.
2. Limit visitors.
Patients with neutropenia are susceptible to infections and must be isolated accordingly. Limiting visitors reduces the risk of disease.
3. Teach the patient proper handwashing techniques.
Handwashing is an effective infection control method. Germs from unwashed hands can easily be transmitted from person to person.
4. Administer medications as ordered.
The granulocyte-colony stimulating factor is often given to help stimulate the bone marrow into producing more neutrophils.
5. Maintain aseptic technique.
The nurse and staff should maintain strict aseptic techniques when accessing IV lines or ports, cleaning catheters, or touching the patient.
Hyperthermia
Hyperthermia is common in patients with neutropenia, and this can be a sign of a developing infection.
Nursing Diagnosis: Hyperthermia
Related to:
- Disease processes
- Infection
As evidenced by:
- Flushed skin
- Skin warm to touch
- Diaphoresis
- Chills
- Stupor
- Tachycardia
- Tachypnea
Expected outcomes:
- The patient will be able to maintain a body temperature below 100.4 F (38 C)
- The patient will demonstrate strategies to promote a reduction in temperature
Assessment:
1. Closely monitor the patient’s temperature.
Neutropenic fever is described as a temperature ≥ 101 F (38.3 C) or ≥ 100.4 F (38 degrees C) sustained for over an hour with an ANC of less than 1,500 cells/mL.
2. Monitor the effects of hyperthermia.
The patient’s blood pressure, heart rate, lung sounds, and urine output should be monitored for minute changes.
Interventions:
1. Administer prescribed medications.
Antibiotics and antipyretic medications are given to correct hyperthermia and treat the infection.
2. Encourage nonpharmacologic cooling methods.
Reducing the room temperature and removing excess clothing and blankets can help regulate environmental temperature, promoting patient comfort.
3. Assist with imaging and other tests.
Lab tests should be ordered to assess for changes, along with a chest x-ray, urinalysis, blood cultures, and sputum swabs, if applicable, before implementing antibiotics to detect the offending pathogen.
4. Keep the patient hydrated.
Hyperthermia can affect the patient’s hydration status. Providing adequate fluids can help reduce body temperature. Closely monitor intake and output.
5. Consider delaying treatment.
The development of hyperthermia may call for stopping further chemotherapy treatments until the infection is controlled.
Deficient Knowledge
Neutropenia may not exhibit symptoms until after complications have occurred. Patient education is essential to ensure adherence and the prevention of complications.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation
- Inadequate access to resources
- Inadequate awareness of resources
- Inadequate commitment to learning
- Inadequate information
- Inadequate interest in learning
- Inadequate participation in care planning
As evidenced by:
- Inaccurate follow-through of instructions
- Inaccurate statements about a topic
- Development of complications
Expected outcomes:
- The patient will verbalize understanding of neutropenia and adhere to the plan of care
- The patient will verbalize three neutropenic precautions they can implement at home
Assessment:
1. Assess the patient’s ability to learn.
The patient’s learning abilities can affect patient education efforts. Patients undergoing cancer treatments may not be well enough to entertain complex concepts. Ensure information is presented at appropriate times.
2. Assess for support persons.
Learning efforts directed at those supporting the patient may be more effective.
Interventions:
1. Educate the patient about neutropenia.
In simple terms, without medical jargon, educate the patient and family about their lab values and how their numbers drive treatment.
2. Educate the patient about the signs and symptoms of infection.
Neutropenic patients have a higher risk of developing infections. Provide the patient with a list of symptoms to monitor for and when to alert their medical team.
3. Educate the patient and family on neutropenic precautions:
- Limit visitors in the home
- Wear a mask in public places
- Avoid crowded stores or restaurants
- Avoid live plants
- Maintain good oral health
- Talk to your doctor before getting vaccines
4. Instruct on food safety.
Patients with neutropenia must take care when eating fresh foods and vegetables and they must be thoroughly washed to remove bacteria. Some patients may need to avoid raw fruits and vegetables and undercooked meats.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Neutropenia. Approved by the Cancer.Net Editorial Board. Reviewed: September 2019. From: https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/neutropenia
- Neutropenia. Cleveland Clinic. Reviewed: May 27, 2022. From: https://my.clevelandclinic.org/health/diseases/21058-neutropenia
- Neutropenia. Healthline. Reviewed: February 12, 2021. From: https://www.healthline.com/health/neutropenia#prevention
- Neutropenia. Mayo Clinic. Reviewed: November 26, 2020. From: https://www.mayoclinic.org/symptoms/neutropenia/basics/definition/sym-20050854
