The nurse should concern for which while a child who is on chemotherapy?

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

Explanation

The primary concern for a child on chemotherapy is the risk of infection due to myelosuppression (suppression of bone marrow function).
Chemotherapy drugs decrease the production of white blood cells (neutropenia), which are essential for fighting infections.
Therefore, protecting the child from sources of infection, such as sick individuals, is the highest priority nursing intervention.
Fever is a principal early sign of infection in a neutropenic patient and requires immediate medical attention.

Option B: Hourly vital sign monitoring is not a standard routine for all chemotherapy patients. It is reserved for unstable patients, during infusions of vesicant drugs, or in case of a suspected reaction.
Option C: Fluid intake should be encouraged, not restricted. Hydration is crucial to help the kidneys flush out chemotherapy metabolites and prevent renal toxicity and hemorrhagic cystitis.
Option D: Restricting all physical activity leads to deconditioning, muscle wasting, and increased fatigue. Activity should be encouraged as tolerated.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing care for a child on chemotherapy to guide bedside assessment, documentation, and the next nursing action.
Neutropenic precautions are a cornerstone of care for oncology patients. This includes strict hand hygiene, private rooms, avoiding fresh flowers/fruits, and screening visitors for illness.
Educating the family is critical. They must understand the signs of infection (especially fever) and know to seek immediate medical help, as infection can become life-threatening very quickly in a neutropenic child.
What if? If the child's absolute neutrophil count (ANC) drops below 500 cells/mm3, they are considered severely neutropenic. The nursing priority intensifies, requiring strict reverse isolation and possibly prophylactic antibiotics to prevent sepsis.

How to Approach the Question

First, identify the core subject of the question: nursing concerns for a child on chemotherapy.
Recall the primary mechanism of chemotherapy: it targets rapidly dividing cells.
Consider which body systems have rapidly dividing cells: cancer cells, but also bone marrow, hair follicles, and the GI tract lining.
Focus on the most life-threatening consequence. Suppression of bone marrow (myelosuppression) leads to decreased WBCs, RBCs, and platelets.
Evaluate the options based on this risk. A low WBC count (neutropenia) leads to a high risk of infection. Therefore, preventing infection is the top priority.
Eliminate other options by considering their rationale. Fluid restriction and total activity restriction are generally contraindicated, and hourly vitals are not a routine standing order.

Concept Tested & Keywords

Concept Tested: Nursing care for a child on chemotherapy
Stem keywords: child, chemotherapy, nurse concern
Lead-in keywords: which
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 7-9

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 133-135

Practise the full NORCET 5 Prelims - Sept 2023 (Shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.