Nursing protocol for the patient with neutropenia

Although major advances in the treatment of cancer have resulted in improved survival rates, serious infections continue to be a major source of morbidity and mortality in the immunocompromised patient. Patients may experience prolonged periods of bone marrow suppression accompanied by neutropenia as a result of the underlying disease, and as a result of treatment with myelosuppressive chemotherapy, intensive radiotherapy, or both. Neutropenia is the single most important factor predisposing patients with cancer to infection. The risk of developing infection increases as neutropenia persists, and this risk is consistently greater at lower neutrophil levels. Infection in a patient with neutropenia is regarded as an emergency situation requiring immediate action; progression of localized to disseminated infection leading to sepsis may be so rapid that, if not detected early, mortality is high. In the presence of neutropenia, the manifestation of infection leading to life-threatening septicemia is altered. The usual signs and symptoms of infection may be minimal or absent, hindering early and accurate diagnosis of infection. To provide a means of early and more accurate diagnosis of infection in the patient with neutropenia, a nursing protocol has been developed that incorporates preventive interventions, guidelines for early detection of impending infection, and measures to control infection.