Question

A 52 year-old woman has been diagnosed with leukemia and has been receiving chemotherapy as an outpatient. She tells the RN that she hasn’t been feeling well. The patient’s skin is warm to touch and she has a low-grade fever of 100.2 F. The neutrophil blood count is less than 1000/ul. The nurse is concerned about the possibility of infection, why? What is the diagnosis? How would you treat this patient?

Answer 1

# infection increases during chemotherapy when your body doesn't produce enough white cells (called neutrophils and monocytes) to keep your immune system working properly. This means that bacteria, viruses and fungi in the environment, in your nose, mouth , and on your skin can invade your body without fear of being destroyed by white cells, thereby causing infection. Furthermore, chemotherapy can damage the lining of your mouth and intestines, making it easier for bacteria to enter your blood.

To prevent infection, the following precautions may be taken:

given antibiotics to prevent or treat infection.

Although a transfusion isn't generally used for patients who have a low neutrophil count, it may be an option if you have a high fever, an infection that's unresponsive to antibiotics, blood fungal infections or septic shock.

# symptoms-

A temperature of 101° F or higher

Chills

Persistent coughing

Tenderness at a site prone to infection, such as the area around the excretory pore or the nasal sinuses

A sore throat

Pain when urinating

Frequent diarrhea or loose bowel movements

# healthcare team takes steps to avoid exposing to bacteria, viruses and other infection-causing agents: They should practice frequent and vigorous hand washing or, in some cases, wearing masks, gowns and/or gloves.

Discuss how to avoid infection with members of your healthcare team if you're receiving outpatient anticancer therapy. Caregivers need to be meticulous in cleaning catheters to reduce the risk of bacteria entering the body.

Wash your hands thoroughly, especially before eating and before and after using the bathroom. This applies to everyone — people in treatment and those around them.

Avoid crowds and individuals with contagious diseases such as colds, flu, measles or chicken pox.

Check about getting vaccinations. Find out whether you should avoid people who've recently been immunized with live, weakened forms of organisms or viruses that cause the disease, such as measles, and how long you should stay away.

Clean your rectal area gently but thoroughly after each bowel movement. Ask doctor for advice if irritation or hemorrhoids are a problem. Check with your healthcare team before using enemas or suppositories.

Don't cut or tear your fingernails' or toenails' cuticles; avoid cuts or nicks when using scissors, needles or knives; use an electric shaver instead of a razor to prevent cuts; use an extra soft toothbrush that won't hurt the gums; and don't squeeze or scratch blemishes.

Wash cuts and scrapes right away with warm water, soap and an antiseptic.

Take a warm (not hot) bath, shower or sponge bath every day. Don't rub skin to dry it; use a light touch to pat skin dry. Use lotion or oil to soften and heal skin if it becomes dry and cracked.

Wear protective gloves when gardening or cleaning up after animals, young children or others.

Avoid uncooked fruits and vegetables if you have a persistent low white cell count. Ask your healthcare team for diet and nutrition advice.

# Treatments for leukemia include chemotherapy (major treatment modality for leukemia), radiation therapy, biological therapy, targeted therapy, and stem cell transplant. Combinations of these treatments may be used. Surgical removal of the spleen can be a part of treatment if the spleen is enlarged.