The nurse is caring for a patient with non-Hodgkin's lymphoma, stage IV. He received chemotherapy 10 days ago using the following drugs: doxorubicin, cyclophosphamide, vincristine, and prednisone through his vascular access device. His blood test result revealed WBC count of 1500/ml, hemoglobin of 7.6 g/dl, RBC of 3,000,000/ml, hematocrit of 22.3%, platelet count of 20,000/ml. Which of the following interventions will the nurse include in the care plan for this patient?

Telling the patient to use a soft toothbrush and avoid dental floss


•Using a soft toothbrush and avoiding dental floss promotes healthy oral cavity without the risk of bleeding and impairment of skin integrity, which could lead to infection.

•The patient is severely thrombocytopenic which puts him at high risk for bleeding and disruption of skin integrity and mucous membranes.

•Advising the patient to have a low-residue diet will not provide enough fiber to stimulate normal bowel movements which is necessary for thrombocytopenic patients to prevent constipation.

•Fingernails and toenails must be filed, not cut, because sharp edges from cutting could tear the skin.

•Additional IV lines are not needed because the patient has an intact central venous access device.

•Normal ranges:
WBC: 4,000-10,000 cells/ml
Hemoglobin: 14-18 g/dl (men), 12-16 g/dl (women)
Hematocrit: 42-52% (men), 37-47% (women)
RBC: 4.5-5.0 million
Platelets: 150,000-400,000

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