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Nursing Research Paper

Nursing Research Paper

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Published by amberlynoakes

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Published by: amberlynoakes on Dec 07, 2009
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Running head: A REVIEW OF POLICY A Review 1A Review of Policy in Precautions for Neutropenic PatientsAmberlyn Oakes, Connie Reilly, and Annette RenoSubmitted to Valerie DeVoss, MSN, RNC, in partial fulfillment of  NRST 2740: Clinical Experience IVLaramie County Community College November 24, 2009
 
Running head: A REVIEW OF POLICY A Review 1A Review of Policy in Precautions for Neutropenic PatientsThe purpose of this paper is to review Cheyenne Regional Medical Center’s (CRMC) official policy on neutropenic precautions and evaluate current peer reviewed journals presentingevidence based information concerning best practice. We will then compare CRMC’s policywith those journals and make revision recommendations for the policy in order to reflect best practice. Since a basic understanding of neutropenia is beneficial to this process, we will explainwhat neutropenia is and the consequences of its development to the affected patient. CRMC’s policy on neutropenic/reverse precautions is stated in policy number: ADMIN-AD-17, titled“Infection Prevention and Exposure Control” under section F; “Transmission BasedPrecautions,” item number 9, pages 8 and 9. This policy was revised in July, 2009.Neutropenia is a decreased amount of circulating neutrophils in the blood stream. Neutrophils, one of five types of leukocytes, make up 50 to 70% of all white blood cells (Lewis,Heitkemper, Dirksen, O'Brien, & Bucher, 2007). Neutrophils are the initiating line of defenseagainst invading bacteria, fungi, and viruses, and act as macrophages, digesting these organismsand their debris (Marrs, 2006). The absolute neutrophil count (ANC) is a key measuring toolused to determine the number of mature neutrophils circulating. To calculate the ANC, a simplemathematical calculation is used: Total White Blood Count x (% neutrophils + % bands) = ANC(Marrs, 2006). Neutropenia is a neutrophil count less than 1000 to 1500 /ul. The normal rangefor neutrophils is between 4000 to 11,000/ul (Lewis et al., 2007). Neutropenia is associated with profound impairment of the inflammatory response leading toa lack or minimization of the usual signs and symptoms of an infection. Many of the normalsigns and symptoms of infection such as rash, swelling, heat, pain, and wound drainage may be blunted in a patient with neutropenia. Since leukocytes make up puss, an infected skin site thatwould normally exhibit this sign would not have it (Lewis et al., 2007). A urinary tract infection
 
Running head: A REVIEW OF POLICY A Review 2may go unnoticed longer because of a lack of dysuria, which is a normal symptom. In many patients with neutropenia and infection, the only sign will be a fever, which may not be pronounced
(Coughlan & Healy, 2008).
In fact, severe neutropenia is a very real threat that cancause even death. Approximately 70%-75% of deaths from acute leukemia and 50% of deaths in patients with solid tumors are related to infection secondary to neutropenia (Larson & Nirenberg,2004). Commonly a chart is used to explain the varying degrees of neutropenia. CRMC uses thefollowing chart which agrees with the literature:ANC Risk for infection> 2000 not significant1,500 1,900 minimal1,400 1,000 moderate900 500 severe< 500 life-threateningBecause of the high risk of infection in a patient with neutropenia, there are far-reaching long-term effects of the lifestyle of the patient. First of all they must deal with the direct side effectsof neutropenia itself. The patient with neutropenia is susceptible to getting infected from their own normal body flora. They are also predisposed to getting infection from other normally non-threatening situations that people with a normal white blood cell count don’t have to worry about(Lewis et al., 2007). In order to avoid severe neutropenia, physicians are often forced to delay or reduce chemotherapy doses which in turn affect patient outcomes. The need for delaying patienttreatment adds anxiety and lowers their quality of life as their treatment course is lengthened(Nirenberg, Bush, Davis, Friese, & Gillespie, 2006). Required vigilance to avoid infection,crowds, certain foods, and constantly watch for mouth and skin sores can decrease the patient’swillingness to continue treatment. They may feel they have a lowered general quality of life because of the need to lower the risk of life threatening infections, but good education and hopethat these interventions will work in the end can give them encouragement.

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