Page 432 - Critical Care Nursing Demystified

Chapter 9 CARE OF THE PATIENT WITH CRITICAL HEMATOLOGIC NEEDS 417

Any time the skin is invaded by surgery or instrumentative procedures, our first
line of defense is lost. Close observation of these sites is important. An indwell-
ing urinary catheter and central lines can increase the risk of infection. Medica-
tions can suppress the blood cells.

Prognosis
Unfortunately, prognosis is poor for patients with immunocompromised status.
Many patients with anemias, leukemias, and lymphomas are particularly prone
to developing infections. Even simple infections can become deadly as patients
have limited ability to fight off even molds, fungi, and other organisms that
usually lie dormant in other people. Infection control measures must be metic-
ulously observed.

Interpreting Laboratory/Diagnostic Tests
Decreased ANC below 1,000 cells/mm 3
WBC less than or greater than normal (may be an increase in immature cells)

Treatment
Close surveillance of VS and laboratory/diagnostic studies Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Monitoring and early treatment with antibiotics if infection starts
Strict neutropenic precautions observed

6 Nursing Diagnosis for Risk Expected Outcomes
for Infection
Risk for infection due to a The patient will have a stable temperature
compromised immune system The patientʼs ANC will be >1,500

The patient will have negative cultures

Nursing Interventions

Wash hands according to CDC protocols (before and after patient contacts;
before and after wound redresses and suctioning, etc). Number one nursing
intervention to prevent infection.
Admit patient to a private room with positive pressure or laminar flow to
protect him or her from pathogens from other patients.
Assess all invasive lines for edema and erythema. Remove and culture lines
if signs of infection occur. Invasive lines are a direct pathway into the blood,
which can lead to sepsis.