The nurse is caring for a patient with non-Hodgkin's lymphoma, stage IV. The patient received chemotherapy 10 days ago using the following drugs: doxorubicin, cyclophosphamide, vincristine, and prednisone through the vascular access device. The patient's 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%, and platelet count of 20,000/ml. Which of the following interventions will the nurse include in the care plan for this patient?

Tell the patient to use a soft toothbrush and avoid dental floss.


• Using a soft toothbrush and avoiding dental floss promotes a 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 them 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 (male), 12-16 g/dl (female)
Hematocrit: 42-52% (male), 37-47% (female)
RBC: 4.7-6.6 (male), 4.2-5.4 (female)
Platelets: 150,000-400,000/ml

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