A nurse caring for a client on neutropenic precautions needs to be alert to which early sign, indicating a change in the client’s condition?

Confusion or fatigue

Explanation

• Neutropenia is a low level of certain white blood cells. Neutropenia may be caused by problems with neutrophil production or distribution, infection, treatment, or drugs.

• With neutropenic precautions, the nurse needs to be alert for and prevent opportunistic infection in the client.

• One of the early subtle signs of an infection is mental status changes, which may present as confusion or fatigue.

• Neutropenia refers to a reduction in the blood neutrophil count to < 1000/mm³. A neutrophil count of less than 500/mm³ indicates a  severe risk of infection.

• Restricting fresh, uncooked fruits and vegetables from the diet and removing flowers and plants from the room is recommended due to the risk of microbial contamination.

• Visitors with any potentially communicable disease should be screened for the presence of infection and must not be allowed near the patient.

• The client should have a single room with positive air pressure (air pressure higher than the surrounding rooms) to prevent potentially contaminated air from entering the client's room.

Incorrect options:

• A temperature of 99.0F is not indicative of infection. Fever of 100.4ºF for more than one hour or 101ºF one time would indicate possible infection, and a blood culture would be done.

• Paroxysmal nocturnal hemoglobinuria is a late sign of aplastic anemia.

• Uncontrolled bleeding is a sign of decreased platelets.

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