A patient with leukemia is receiving chemotherapy that is known to depress bone marrow. A CBC (complete blood count) reveals a platelet count of 25,000/microliter. Which of the following actions related specifically to the platelet count should be included in the nursing care plan?
A. Monitor for fever every 4 hours.
B. Require visitors to wear respiratory masks and protective clothing.
C. Consider transfusion of packed red blood cells.
D. Check for signs of bleeding, including examination of urine and stool for blood.
Correct Answer: D. Check for signs of bleeding, including examination of urine and stool for blood.
A platelet count of 25,000/microliter is severely thrombocytopenic and should prompt the initiation of bleeding precautions, including monitoring urine and stool for evidence of bleeding.
Option A: According to three retrospective case reviews of childhood leukemia (in which 75% to 100% of the cases were acute lymphoblastic leukemia), common presenting signs and symptoms include fever (17% to 77%), lethargy (12% to 39%), and bleeding (10% to 45%).
Option B: Requiring protective clothing is indicated to prevent infection if white blood cells are decreased. Protective garments consisting of gloves, chemotherapy gowns, eye protection e.g.; goggles, N95 respirator, and shoe covers will be worn according to the task being performed with a Chemotherapy/Biotherapy agent or excreta of a patient who has received a Chemotherapy/Biotherapy agent within the last 48 hours.
Option C: Transfusion of red cells is indicated for severe anemia. Blood transfusions represent one of the most important forms of supportive care for patients with leukemia. Cancer is the major cause of transfusion. One-third of transfused patients have a malignant disease, with acute leukemia being the malignancy in a large part of them.