The nurse should be concerned for which while a child is on chemotherapy?

NORCET 5 Prelims - Sept 2023 (Shift-1)

Child Health Nursing (Pediatrics)

Medium

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)

Explanation

Chemotherapy causes myelosuppression (suppression of bone marrow function), leading to neutropenia, a sharp decrease in infection-fighting white blood cells.
A neutropenic child has a severely weakened immune system and is at high risk for developing severe, life-threatening infections from common germs.
The primary nursing goal is to protect the child from exposure to any potential source of infection.
Avoiding contact with individuals who have infections (e.g., a cold, flu) is a fundamental and critical component of these protective measures, known as neutropenic precautions.

Option B: Monitoring vital signs hourly is excessive for a stable child. Standard protocol is typically every 4 hours.
Option C: Fluid restriction is generally contraindicated. Good hydration is crucial to help flush chemotherapy drugs from the body, preventing kidney damage and hemorrhagic cystitis.
Option D: Complete restriction of physical activity can lead to muscle deconditioning, increased fatigue, and risk of blood clots. Activity should be encouraged as tolerated.

Visual 1: Infographic: Key Neutropenic Precautions. This visual would list critical do's and don'ts for patients and families, such as hand hygiene, avoiding crowds, dietary restrictions (no raw foods), and signs of infection to report immediately.
Visual 2: Flowchart: Nursing Actions for a Febrile Neutropenic Patient. This would illustrate the emergency response pathway: recognize fever, notify provider, obtain blood cultures, and administer broad-spectrum antibiotics within the first hour.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing care and precautions for a pediatric patient undergoing chemotherapy to guide bedside assessment, documentation, and the next nursing action.
A fever (e.g., a single temperature of 38.3°C or a sustained temperature of 38°C for one hour) in a neutropenic child is a medical emergency. The nurse must act immediately to initiate the sepsis protocol.
Patient and family education is a cornerstone of care. The nurse must teach the family how to recognize early signs of infection (fever, chills, cough, sore throat) and what precautions to take at home to create a safe environment.
What if? If the child's Absolute Neutrophil Count (ANC) recovers to a safe level (e.g., above 1,000/mm³), the strict neutropenic precautions can be relaxed, although good hygiene practices should always be maintained.

How to Approach the Question

First, identify the core concept of the question: essential nursing care for a child on chemotherapy.
Recall the most significant and life-threatening side effect of most chemotherapy regimens: myelosuppression, which leads to a severely compromised immune system (neutropenia).
Evaluate each option based on this primary risk. The highest priority action will be related to preventing or managing infection.
Analyze Option A: 'Avoid infected person to contact the child'. This directly addresses the primary risk of infection by preventing exposure to pathogens. This is a standard 'neutropenic precaution'.
Critically assess the other options: Are they standard care? Hourly vitals (B) are for unstable patients. Fluid restriction (C) is generally harmful. Restricting all activity (D) is also not recommended and can cause other problems.
Conclude that protecting the vulnerable child from sources of infection is the most critical nursing concern among the choices provided.

Concept Tested & Keywords

Concept Tested: Nursing care and precautions for a pediatric patient undergoing chemotherapy.
Stem keywords: child, chemotherapy, nurse, concerned
Lead-in keywords: concerned for which
Clinical cues: The patient is a child on chemotherapy, which implies a high risk for immunosuppression.
Negative lead-in flag: false

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