Neutropenic and bleeding precautions
Low counts change what is safe.
Anemia and sickle cell disease
Oxygen delivery and sickling crises.
| Condition | Nursing focus |
|---|---|
| Iron deficiency anemia | Fatigue, pallor, tachycardia; iron with vitamin C, between meals if tolerated; dark stools are expected; use a straw for liquid iron to protect teeth |
| Vitamin B₁₂ deficiency | Neurologic signs (numbness, balance problems); lifelong injections or high-dose oral B₁₂ if absorption is impaired |
| Sickle cell crisis | Rapid pain control, IV and oral fluids, oxygen if SpO₂ is low, warmth (avoid cold packs), rest |
| Acute chest syndrome | Chest pain, fever, cough, hypoxia, new infiltrate — emergency; notify immediately |
| Crisis prevention | Hydration, avoid cold, high altitude, and strenuous exertion; vaccines; hydroxyurea as prescribed |
Children with sickle cell disease are at high risk of serious infection and stroke; report fever promptly.
Blood transfusion and reactions
Verification prevents most serious reactions.
| Reaction | Cues |
|---|---|
| Acute hemolytic | Fever, chills, back or flank pain, hypotension, dark urine, sense of doom — usually early |
| Febrile nonhemolytic | Fever and chills without hemolysis |
| Allergic | Hives, itching; anaphylaxis if severe (wheezing, hypotension) |
| Circulatory overload (TACO) | Dyspnea, crackles, hypertension, JVD — sit upright, slow or stop, diuretic as ordered |
| Lung injury (TRALI) | Acute respiratory distress and hypoxemia within 6 hours |
For any suspected reaction: stop the transfusion, keep the vein open with saline through new tubing, assess, notify, and return the bag and tubing to the blood bank per policy.
Oncologic emergencies
Early recognition changes outcomes.
Chemotherapy and radiation safety
Protect the client and the staff.
- Hazardous drugs: chemotherapy-tested gloves (often double) and a gown; dispose of waste in designated containers; handle body fluids with gloves for the period specified by policy.
- Extravasation of a vesicant: stop the infusion, leave the catheter in place initially, notify the provider, and follow the antidote and policy protocol.
- Mucositis: soft toothbrush, frequent saline or bicarbonate rinses, no alcohol-based mouthwash, soft bland foods.
- External radiation: wash the area gently with mild soap and water, do not remove skin markings, avoid lotions unless approved, protect from sun.
- Sealed internal radiation: time, distance, shielding; private room; limit visits; pregnant visitors and children usually restricted; if the implant dislodges, use long-handled forceps to place it in a lead container — never touch it.
NGN-style case
Fever in a client receiving chemotherapy.
A client 10 days after chemotherapy reports feeling tired. Temperature 38.4°C (101.1°F), HR 108, BP 104/62. ANC 300/mm³. No cough or redness at the port site. What should the nurse do?
- Recognize cues: fever, tachycardia, borderline BP, severe neutropenia at the expected nadir.
- Analyze: febrile neutropenia — a medical emergency; absent local signs are expected without neutrophils.
- Notify the provider immediately; obtain blood cultures (peripheral and from the port) as ordered.
- Start broad-spectrum IV antibiotics promptly (goal within 1 hour); monitor for sepsis; maintain neutropenic precautions.
Answer. Treat as febrile neutropenia: cultures and broad-spectrum antibiotics without delay.