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학습 자료 둘러보기 →| Option | Analysis and Evidence-Based Rationale |
|---|---|
| 1. Monitor blood glucose levels every 4 hours | This is not a standard, high-priority intervention for all chemotherapy patients. While specific protocols involving high-dose corticosteroids as antiemetics can induce transient hyperglycemia, this is a secondary effect. The primary, life-threatening risk across nearly all myelosuppressive chemotherapy regimens is bone marrow suppression, not glycemic instability. This intervention is not supported as a general priority in the provided evidence on chemotherapy complications [1,2]. |
| 2. Encourage deep breathing exercises twice daily | This is a supportive, non-pharmacological intervention aimed at maintaining pulmonary function and preventing atelectasis, which is a component of comprehensive care. The MPNFS framework study highlights interventions to enhance pulmonary function, but these are part of a bundle to manage chronic effects like cancer-related fatigue, not the immediate, life-threatening complications of active treatment [1]. A patient with a critically low platelet count (e.g., < 20,000/mm³) is at risk for spontaneous pulmonary hemorrhage, a risk that deep breathing exercises do not address and could potentially exacerbate. The priority must be to first identify this risk through a CBC. |
| 3. Assess skin integrity every shift | Skin assessment is a fundamental nursing function, but in the context of chemotherapy, it is secondary to myelosuppression monitoring. The primary risk to skin integrity from myelosuppression is not a local wound but the systemic risk of infection from a minor break in the skin when the patient is severely neutropenic (absolute neutrophil count < 500/mm³). The priority is to first determine if the patient is neutropenic via a CBC, which then dictates the intensity of skin and mucous membrane assessment and protective interventions. |
| 4. Monitor complete blood count (CBC) daily | Correct. This is the priority intervention. The foundational risk of chemotherapy is CIM. Research consistently focuses on predicting and managing this toxicity because it dictates treatment continuation, dose adjustments, and survival outcomes. A study on gastric cancer patients established a direct association between nutritional status markers (like the Prognostic Nutritional Index, calculated from serum albumin and lymphocyte count from a CBC) and the incidence of myelosuppression [4]. Another study developed a machine-learning model specifically to predict CIM, underscoring its clinical significance as the primary toxicity requiring vigilant monitoring [3]. Daily CBC monitoring allows the nurse to detect a declining trend before the patient becomes critically pancytopenic, enabling preemptive interventions like administering colony-stimulating factors, initiating neutropenic precautions, or preparing for platelet transfusion. |
The priority for any patient receiving myelosuppressive chemotherapy is monitoring the Complete Blood Count (CBC). The nadir, the point of lowest blood cell counts, typically occurs 7-14 days after administration, though this varies by agent.
A daily CBC is essential to detect pancytopenia. The critical values to assess are the Absolute Neutrophil Count (ANC) for infection risk, platelet count for bleeding risk, and hemoglobin for oxygenation capacity.
An ANC below 500/mm³ indicates severe neutropenia and a high risk for life-threatening sepsis. Immediate implementation of neutropenic precautions and notification of the provider are required. A platelet count below 50,000/mm³ significantly increases the risk for spontaneous bleeding.
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