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Case Study

Les is a 45-year-old male admitted with pancytopenia, weakness, and dehydration. His white blood cell (WBC) count is 1.6 x [10.sup.10] and his absolute neutrophil count is 992/[micro]L. He finished his latest round of chemotherapy 12 days ago and was told by his oncology nurse that his complaints are an expected side effect of his therapy.


Neutropenia is defined as an absolute neutrophil count (ANC) of less than 1,500/[micro]L. Neutrophils are the primary infection-fighting white blood cells (Olson, 2009). A decrease in circulating neutrophils can be a life-threatening complication from cancer treatment. However, neutropenia is not limited to cytotoxic therapies. Other medications can cause neutropenia, including anti-infective, cardiovascular, gastrointestinal, and psychotropic medications (Andersohn, Konzen, & Garbe, 2007). Nurses must know how to determine if a patient is neutropenic. The ANC provides this information and will guide the plan of care for the affected patient. The following formula is utilized to calculate the ANC (Polovich, Whitford, & Olsen, 2009):

segs + bands X WBC = ANC/100

Patient Management Goals

The goal of neutropenia management is to prevent infection. The best prevention mechanism is proper hand washing in practice (Eaton & Tipton, 2009). Other evidence-based care guidelines include restricting flesh plants in patient rooms, avoiding raw or uncooked meats, and restricting visits from anyone who is ill (Eaton & Tipton, 2009; Olson, 2009). No evidence supports staff members wearing masks or gowns when caring for the affected patient unless there are other isolation concerns.

Patient temperature greater than 100.4[degrees]F must be reported to the health care provider immediately. Orders for blood and urine cultures, sputum and wound cultures (when applicable), a chest x-ray, and initiation of broad-spectrum intravenous antibiotics should be anticipated (Gabay & Tanzi, 2010; Marts, 2006). If the patient is to leave the room for any reason, he or she must wear a mask to prevent exposure to any airborne microbes (Olson, 2009).

Medication to Treat Neutropenia

G-CSF (Neupogen[R]) can be given to prevent or treat neutropenia. It is administered intravenously or subcutaneously, and is started 24 hours after chemotherapy is completed. The drug must be refrigerated prior to use and is only compatible with 5% dextrose. It can cause bone pain that may require analgesia. The dose is repeated daily until ANC is at least 1,000/[micro]L (Wilkes & Barton-Burke, 2011).


Andersohn, F., Konzen, C., & Garbe, E. (2007). Systemic review: Agranulocytosis induced by nonchemotherapy drugs. Annals of Internal Medicine, 146(9), 657-666. Retrieved from

Eaton, L.H., & Tipton, J.M. (Eds.). (2009). Putting evidence into practice: Improving oncology patient outcomes. Pittsburgh, PA: ONS Publishing Division.

Gabay, M., & Tanzi, M. (2010). Guidelines for the management of febrile neutropenia. Clinical Oncology News, 13(1), 115-122.

Marrs, J.A. (2006). Care of patients with neutropenia. Clinical Journal of OncologyNursing, 10(2), 164-166.doi: 10.1188/06.CJON.164-166

Olson, V.L. (2009). The hematologic system. In H. Craven (Ed.), Core curriculum for medical-surgical nursing (pp. 442-461). Pitman, N J: Academy of Medical-Surgical Nurses.

Polovich, M., Whitford, J. M., & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice (3rd ed.). Pittsburgh, PA: ONS Publishing Division.

Wilkes, GM., & Barton-Burke, M. (2011). 2010 oncology drug handbook. Sudbury, MA: Jones and Bartlett.

Charles Westley Foster, MSN, BA, RN, CMSRN, OCN, is a Staff Nurse, Banner Good Samaritan Medical Center, Phoenix, AZ, and Chair, MSNCB Item Writers/Test Developers Committee.


1. Neutropenia

a. is seen exclusively in oncology patients.

b. is a side effect of various medications.

c. can cause a drop in platelet counts.

d. rarely leads to sepsis.

2. The most appropriate nursing intervention for the patient with neutropenia is

a. donning masks and gowns when entering the room.

b. allowing the patient to have plants in his room.

c. following strict hand hygiene practices.

d. implementing standard precautions.

3. A patient with neutropenia has a 6-year-old child.

The child has a cold but wants to visit the patient.

What is the nurse's best response to this request?

a. Allow the child to visit because the patient is hospitalized.

b. Obtain a history of the child's illness and treatment.

c. Discuss the request with a social worker.

d. Gently defer the visit at this time.

Answers with Rationale

1. b--Many drugs have been shown to cause bone marrow suppression and neutropenia.

2. c--Evidence indicates hand hygiene is key to preventing transmission of microbes.

3. d--The patient does not have enough neutrophils to ward off infection.
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Title Annotation:Preparing for Certification
Author:Foster, Charles Westley
Publication:MedSurg Nursing
Article Type:Case study
Date:Sep 1, 2011
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