Question

The nurse on oncology is caring for a client with a white blood count of 800 , a platelet count of 150,000 , and a red blood cell count of 250,000 . During evening visitation, a visitor is noted to be coughing and sneezing. What action should the nurse take? A. Ask the visitor to wash his hands B. Document the visitor's condition in the chart C. Ask the visitor to leave and not return until the client's white blood cell count is 1,000 D. Provide the visitor with a mask and gown

Short answer

Answer: The best action for the nurse to take is to provide the visitor with a mask and gown.

Step-by-step solution

Understanding the patient's lab values

The patient's white blood cell (WBC) count is 800, platelet count is 150,000, and red blood cell (RBC) count is 250,000. A low WBC count (especially below 1,000) indicates a compromised immune system and increased risk of infection. The platelet count and RBC count are within normal range and not relevant for this situation.

Assessing the risk of infection posed by the visitor

The visitor is coughing and sneezing, which could potentially spread germs and infect the patient. Since the patient has a compromised immune system due to the low WBC count of 800, it's important to minimize their exposure to potential infections.

Evaluating the provided options

We need to determine the best course of action from the provided choices: A. Ask the visitor to wash his hands - Good practice, but might not be sufficient to protect the patient from coughing and sneezing. B. Document the visitor's condition in the chart - This does nothing to protect the patient. C. Ask the visitor to leave and not return until the client's white blood cell count is 1,000 - This might help protect the patient, but it might also deprive the patient of emotional support from the visitor. D. Provide the visitor with a mask and gown - This is the best option as it minimizes the risk of infection while allowing the patient to have a support system.

Choose the best option

The best action for the nurse to take is (D) Provide the visitor with a mask and gown. This protects the patient from potential infections while allowing the patient to receive emotional support from the visitor.

Key concepts

Immune System Compromise

When a patient's white blood cell (WBC) count is notably low, as in the case of the oncology patient with a count of 800, it signals an immune system compromise. The primary function of WBCs is to fight off infections; a low count implies that the patient's ability to ward off illnesses is significantly weakened. Being in such a vulnerable state, these patients are considered immunocompromised and are at high risk for opportunistic infections - these are infections that take advantage of a weakened immune system. Therefore, these patients require heightened measures for infection control.

In our exercise, the implication is that the patient's immune system is not adequately equipped to handle common pathogens that would not typically cause an issue in individuals with normal immune function. The low WBC count becomes a critical element in clinical decision-making, as all healthcare interventions and visitor interactions must consider the risk of infection due to this underlying immunocompromise.

Patient Protection Measures

To protect patients with compromised immune systems, stringent patient protection measures must be enforced. These include enforcing hand hygiene, using personal protective equipment (PPE), such as masks and gowns, and limiting exposure to potential sources of infection, like sick visitors or contaminated surfaces. In our exercise, although handwashing (Option A) is always recommended, it may not be enough to prevent airborne particles from a cough or sneeze from reaching the patient. Documentation (Option B) does not actively protect the patient at the moment. Asking the visitor to leave (Option C) could protect the patient, but may also negatively affect their emotional health. Therefore, equipping the visitor with a mask and gown (Option D) stands out as a proactive and balanced approach to minimize infection risk while maintaining necessary emotional support for the patient.

These measures are part of a broader approach known as Infection Prevention and Control (IPC), which is a critical focus in healthcare settings to promote patient safety and well-being.

Nursing Assessment

A nursing assessment is a comprehensive evaluation of a patient's health status and is the cornerstone of patient care. In infection control, nurses must assess both the patient's vulnerability to infections (for instance, by evaluating lab values like WBC count) and the potential for visitors or healthcare practices to introduce pathogens into the environment. The nursing assessment also includes identifying signs of potential infection in visitors, as the nurse did in our exercise by noticing the visitor's cough and sneeze. This vigilance allows nurses to promptly implement infection control protocols to protect the patient, exhibiting the vital role of nursing judgment in maintaining a safe care environment.

Clinical Decision-Making

Effective clinical decision-making in nursing is critical, particularly when it comes to preventing infections in immunocompromised patients. The process involves integrating clinical expertise with patient values to select the best action plan among available options. In the provided scenario, the nurse considers several responses to the threat of infection posed by the sneezing and coughing visitor. The correct decision, providing a mask and gown to the visitor, reflects a balanced measure protecting the patient's physical health from infection risk while also considering their need for emotional and social support. This decision underscores the complex nature of clinical judgment, which often requires a harmonious blend of medical knowledge and empathy.