The platelet count of a four-year-old child suffering from leukemia on chemotherapy is 29,500 cells/mm3. Based on the lab report, which intervention will the nurse document to include in the nursing care plan?

Appeared in: SCTIMST Staff Nurse - 2015 (Set-B)

Explanation

The patient's platelet count of 29,500 cells/mm³ is critically low, a condition called thrombocytopenia, which creates a high risk for spontaneous bleeding.
The primary goal for a patient with thrombocytopenia is to prevent injury and bleeding.
Using a soft, small toothbrush minimizes trauma to the highly vascular gum tissue, directly addressing the risk of oral bleeding.
This intervention is a standard component of bleeding precautions for patients with low platelet counts.

Option A: Monitoring for signs of infection is an intervention for neutropenia (low white blood cell count), not thrombocytopenia (low platelet count). While the patient is at risk for infection, this option does not address the specific lab value given.
Option B: Monitoring temperature is done to detect fever, a primary sign of infection. This is related to neutropenia, not the bleeding risk associated with thrombocytopenia.
Option C: Isolating the child (protective or reverse isolation) is a measure to protect a severely neutropenic patient from pathogens in the environment. It is an infection-control measure, not a bleeding precaution.

Clinical Relevance

Nursing practice connection: Knowing Nursing interventions for thrombocytopenia in pediatric oncology helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing skill is interpreting laboratory data and linking it to the correct physiological risk to prioritize interventions. This question tests the ability to differentiate between bleeding risk (thrombocytopenia) and infection risk (neutropenia).
In pediatric oncology, both bleeding and infection are major risks. Nurses must be vigilant in implementing both sets of precautions, but specific interventions must be tailored to the patient's current lab values.
What if? If the lab report showed an Absolute Neutrophil Count (ANC) of 400 cells/mm³ instead of the platelet count, the correct answer would shift to an infection-prevention measure, such as monitoring temperature closely or placing the child in protective isolation.

How to Approach the Question

First, identify the key information in the clinical scenario: a 4-year-old with leukemia on chemotherapy.
Next, focus on the specific data provided: a platelet count of 29,500 cells/mm³.
Recall or look up the normal range for platelets (150,000-450,000/mm³). Recognize that 29,500 is critically low.
Determine the primary physiological risk associated with this abnormal lab value. Low platelets (thrombocytopenia) lead to an increased risk of bleeding.
Evaluate the given options to see which one directly addresses the risk of bleeding.
Eliminate the options related to infection risk (monitoring for infection, temperature, isolation), as they do not address the primary problem of bleeding risk indicated by the platelet count.

Concept Tested & Keywords

Concept Tested: Nursing interventions for thrombocytopenia in pediatric oncology.
Stem keywords: four-year-old child, leukemia, chemotherapy, platelet count, 29,500 cells/mm3
Lead-in keywords: intervention, nursing care plan
Clinical cues: Patient is a 4-year-old child, indicating pediatric considerations are important.
Clinical cues: Patient has leukemia and is on chemotherapy, which are known to cause bone marrow suppression.

QZLzWGABfaVHqt8gSCwBO6

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

E6 Pharmacology Nursing Lilley 11e Part 3 p. 93-95

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 119-121

Practise the full SCTIMST Staff Nurse - 2015 (Set-B)

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