Question

Which of the following nursing interventions should be avoided in a client with acute lymphoblastic leukemia? ? A. Frequent oral care ? B. Rectal temperatures ? C. Assessing skin for petechiae ? D. Limiting visitors with illness

Short answer

Answer: Rectal temperatures.

Step-by-step solution

Understand the disease and its implications

Acute lymphoblastic leukemia is a blood cancer that affects the white blood cells. Patients with ALL often have compromised immune systems, which leaves them more susceptible to infections. Additionally, ALL can affect blood clotting. With this information in mind, we can start to analyze each of the possible nursing interventions.

Analyze option A - Frequent oral care

Frequent oral care is highly recommended for patients with leukemia, as it helps to reduce the risk of infection, maintain oral hygiene, and prevent mouth sores. Therefore, option A is not the correct answer.

Analyze option B - Rectal temperatures

Taking rectal temperatures is not recommended for patients with leukemia, primarily because of the increased risk of infection. Additionally, rectal thermometers can cause trauma to the rectal mucosa, leading to bleeding in patients with low platelet counts; this is a common issue in individuals with leukemia. So, option B should be avoided in clients with ALL.

Analyze option C - Assessing skin for petechiae

Assessing skin for petechiae is essential when caring for a patient with leukemia. Petechiae are tiny, round, non-raised red or purple spots that appear on the skin due to bleeding under the skin's surface. They can be an early sign of low platelet levels, which is common in leukemia patients. Therefore, this assessment is a necessary nursing intervention and not the right answer.

Analyze option D - Limiting visitors with illness

Limiting visitors with illness is an essential precaution for patients with leukemia. Since their immune systems are compromised, they are more susceptible to infections. Limiting exposure to people who may be sick helps to decrease the risk of infection. Therefore, this intervention is recommended, and option D is not the correct answer.

Identify the correct answer

After analyzing all the options, we can conclude that the nursing intervention that should be avoided in a client with acute lymphoblastic leukemia is option B: Rectal temperatures.

Key concepts

Infection Prevention in Leukemia Patients

Infection prevention is crucial for patients with acute lymphoblastic leukemia (ALL) due to their compromised immune systems. Nursing interventions aimed at reducing the risk of infections are a fundamental aspect of patient care. Frequent hand hygiene, using alcohol-based hand sanitizers or handwashing with soap and water, is the cornerstone of preventing the spread of germs.

Patients should be taught to avoid crowds and individuals who are sick. Even minor infections can have severe consequences, so strict aseptic technique is essential when performing any invasive procedures. Personal protective equipment (PPE) such as masks, gloves, and gowns should be used as appropriate to minimize exposure to pathogens.

Oral Care

Mouth care is an integral part of infection prevention for leukemia patients. Oral mucositis, a common side effect of chemotherapy, increases the risk of oral infections. Therefore, providing gentle oral care with a soft-bristled toothbrush or sponge swabs can reduce this risk and maintain oral hygiene.

Environment

Ensuring a clean environment is also important. The use of private rooms with high-efficiency particulate air (HEPA) filtration may be beneficial in reducing exposure to airborne pathogens. Surfaces and medical equipment must be regularly disinfected.

Nursing Care for Leukemia Patients

Providing comprehensive nursing care for leukemia patients encompasses several aspects, each critical for their well-being. Monitoring for signs of bleeding or infection is a priority since these are frequent complications associated with leukemia. Vital signs should be checked using non-invasive methods wherever possible to minimize the risk of infection and bruising.

Emotional Support

Nurses play a key role in offering emotional support. ALL can be stressful, and the psychological impact of the diagnosis and treatment should never be underestimated. Nurses can help by listening to patients’ concerns, providing reassurance, and connecting them with appropriate support services.

Nutrition

Ensuring adequate nutrition is another important intervention. Patients undergoing treatment for leukemia may experience nausea, vomiting, or changes in taste, making eating a challenge. Nutrition and hydration must be carefully monitored, with dietary adjustments made as needed to support the patient’s overall health.

Contraindicated Practices in Leukemia

There are certain practices that are contraindicated in the care of leukemia patients due to the increased risk they pose. One such practice is the taking of rectal temperatures. This should generally be avoided to prevent potential damage and infection to the rectal mucosa, as leukemia patients often have low platelet counts and are prone to bleeding and infection.

Invasive Procedures

Other invasive procedures, such as the insertion of urinary catheters or unnecessary venipunctures, should also be carried out with special caution and only when absolutely necessary. Each procedure must be weighed against potential risks, taking into account the patient's current platelet count and immune status.

Activity Restrictions

Physical activity of patients with ALL should be tailored to their tolerance and clinical status. Strenuous activities and contact sports which might cause injury or bleeding are typically contraindicated. Gentle exercises may be encouraged to improve overall fitness and well-being, always within safe limits and under professional guidance.