# A nurse is caring for a client with Hodgkin's lymphoma who is receiving chemotherapy. Which nursing intervention is most important to prevent infection in this immunocompromised client?

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> subject: Adult Health

## 문제

A nurse is caring for a client with Hodgkin's lymphoma who is receiving chemotherapy. Which nursing intervention is most important to prevent infection in this immunocompromised client?

The client is experiencing neutropenia as a side effect of chemotherapy treatment.

## 보기

1. Encourage the client to consume fresh fruits and vegetables daily
2. Allow family members to visit freely to provide emotional support
3. Administer prophylactic antibiotics as ordered by the physician
4. Implement strict hand hygiene and use protective isolation precautions **✔ 정답**

**정답: 4**

## 해설

Strict hand hygiene and protective isolation are most important to prevent infection in neutropenic clients. Other options like fresh produce, free visits, or prophylactic antibiotics increase infection risk or are not primary interventions.

## 심화 해설

Understanding the Clinical Scenario

The client with Hodgkin's lymphoma is receiving chemotherapy and has developed neutropenia, a condition defined by an abnormally low absolute neutrophil count (ANC), typically below 1,500 cells/μL [1]. Neutrophils are a critical first-line defense against bacterial and fungal infections. When the ANC drops, the body's ability to mount an inflammatory response is severely compromised, making a normally harmless commensal organism a potential cause of life-threatening sepsis. In this state, the classic signs of infection, such as pus formation or localized redness, may be absent because the body lacks the white blood cells to create them. Therefore, the cornerstone of care shifts from treatment to prevention, focusing on protecting the client from external and internal sources of pathogens.

Analysis of the Correct Answer

**Option 4: Implement strict hand hygiene and use protective isolation precautions.**

This is the most important intervention. Evidence-based clinical management for neutropenic patients prioritizes strict infection control as a primary domain of nursing care [1]. Hand hygiene is the single most effective measure to break the chain of infection, eliminating transient flora acquired by healthcare workers and visitors. Protective isolation precautions create a safer environment by reducing the client's exposure to airborne pathogens (such as Aspergillus) and limiting contact with individuals who may be carrying infectious agents. A personalized nursing pathway that emphasizes these environmental and behavioral controls has been shown to be effective in reducing hospital-acquired infections in this vulnerable population [2]. This intervention directly addresses the primary source of risk—the environment and human contact—making it the highest priority.

Analysis of the Incorrect Answers

**Option 1: Encourage the client to consume fresh fruits and vegetables daily.**

This intervention is contraindicated. While a healthy diet is important, fresh fruits and vegetables can harbor bacteria and fungi that pose a significant risk to a neutropenic client. Standard dietary precautions for profound neutropenia typically include a low-microbial or "neutropenic" diet, which excludes raw produce, undercooked meats, and unpasteurized dairy. Encouraging this action would introduce a potential source of infection directly into the client's gastrointestinal tract, bypassing the body's compromised immune barriers.

**Option 2: Allow family members to visit freely to provide emotional support.**

Although psychosocial support is a vital component of holistic care and can reduce distress by 38-45% [1], unrestricted visitation directly conflicts with infection prevention principles. Family members can be vectors for community-acquired respiratory viruses and other pathogens. The correct nursing approach is not to ban visitors but to implement a structured visitation policy that includes screening for illness, enforcing strict hand hygiene for all visitors, and limiting the number of visitors, especially during the ANC nadir. Free visitation without these safeguards places the client at unnecessary risk.

**Option 3: Administer prophylactic antibiotics as ordered by the physician.**

While administering prophylactic antibiotics is a valid medical intervention and part of targeted drug therapy in neutropenia management [1], it is not the *nursing* intervention of highest priority in this context. The question asks for the most important *nursing* intervention to prevent infection. Prophylactic antibiotics are a dependent nursing function carried out under a physician's order and target only specific organisms. They do not replace the foundational, independent nursing actions of hand hygiene and environmental protection, which provide broad-spectrum defense against all potential pathogens. Furthermore, a risk prediction model for febrile neutropenia emphasizes nursing-led early risk stratification and preventive actions that are workflow-ready, highlighting the nurse's autonomous role in prevention . The nurse's primary, independent role is to maintain a safe environment through strict infection control practices.References (research sources)

- [1]Optimizing nursing care for neutropenic patients: a holistic perspective on education, support, and clinical management.Research articleXu ZN, Gao LP, Wang XK, Yu XL, Cong Y, Wang PJ. (2025) · DOI: 10.3389/fmed.2025.1633708

- [2]Application of a Personalized Nursing Pathway for Infection Prevention in Hospitalized Leukemia Patients: A Single-Center Retrospective Cohort Study.Research articleLin J, Guo Q, Zhuang P, Xie X, Zheng R, Chen X. (2025) · DOI: 10.2147/tcrm.s550531

## 임상 시나리오

Neutropenic Precautions: Nursing PriorityInfection prevention is the cornerstone of care for the immunocompromised client.
The single most critical nursing action for a neutropenic client is strict hand hygiene for all staff and visitors before any patient contact. This is the primary defense against transmitting life-threatening pathogens.

Implement protective isolation precautions to minimize exposure to environmental and airborne pathogens like Aspergillus. This includes restricting visitors who are ill and ensuring the client does not come into contact with potential sources of infection.

CautionIn a neutropenic client, classic signs of infection such as pus, redness, or swelling may be absent due to the lack of white blood cells. A low-grade fever of 38.0°C (100.4°F) or higher is a medical emergency requiring immediate assessment and intervention.

## 핵심 개념

- **Neutropenia** — An abnormally low absolute neutrophil count (ANC), typically below 1,500 cells/μL, severely compromising the body's ability to fight bacterial and fungal infections.
- **Protective Isolation** — A set of precautions designed to protect an immunocompromised patient from external sources of infection, including limiting exposure to pathogens from visitors and the environment.
- **Hand Hygiene** — The single most effective measure to break the chain of infection by eliminating transient flora from the hands of healthcare workers and visitors.

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