Primary Nursing Diagnosis

Risk for infection related to inadequate secondary defenses (decreased hemoglobin and leukopenia), immunosuppression, pharmaceutic agents, chronic disease, malnutrition, or invasive procedures

OUTCOMES. Immune status; Knowledge: Infection control; Risk control; Risk detection; Nutritional status; Tissue integrity: Skin and mucous membranes

INTERVENTIONS. Environmental management; Infection control; Infection prevention; Medication prescribing; Nutritional management; Surveillance; Medication management

U PLANNING AND IMPLEMENTATION Collaborative

MEDICAL. If anemia is caused by a particular agent or drug, withdrawing it is usually the first step in treatment. Clinical research studies have indicated some promising results with colony-stimulating factors (CSFs) such as interleukin-3 to encourage growth of specific blood elements. Oxygen is administered to ensure cellular oxygenation. Transfusion of packed RBCs and platelets may be required as supportive measures and to prevent bleeding. Platelets are sometimes given prophylactically when the anemia is chronic.

SURGICAL. Bone marrow transplantation is the treatment of choice for severe aplastic anemia. Protocols may vary slightly but generally indicate that the recipient must have a human leukocyte antigen (HLA) identical to that of the bone marrow donor (such as a sibling or twin) and receive a preparatory regimen of immunosuppression and radiation therapies.

POSTOPERATIVE. Postoperatively, relieve pain with analgesics and ice packs as needed. Monitor the patient for fever or chills, sore throat, or red or draining wounds, and administer prophylactic antibiotics as prescribed. Treat the patient's reactions to postoperative chemotherapy or radiation therapy as prescribed, by administering antiemetics to control nausea and vomiting.

Administer allopurinol as prescribed, to prevent hyperuricemia that results from tumor breakdown products, and maintain the patient on the prescribed immunosuppressive regime. The physician may also prescribe vitamins, steroids, iron supplements, and folic acid supplements. Monitor postoperative patients for signs of graft-versus-host (GVH) reaction, including macu-lopapular rash, pancytopenia, jaundice, joint pain, and anasarca.

Pharmacologic Highlights

Medication or

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