# A nurse is caring for a patient with acute myeloid leukemia who has a platelet count of 15,000/mm³ and a white blood cell count of 2,000/mm³. Which nursing intervention should be the highest priority?

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> subject: Adult Health

## 문제

A nurse is caring for a patient with acute myeloid leukemia who has a platelet count of 15,000/mm³ and a white blood cell count of 2,000/mm³. Which nursing intervention should be the highest priority?

## 보기

1. Encourage the patient to perform deep breathing exercises every 2 hours to prevent respiratory complications
2. Administer iron supplements as prescribed to improve red blood cell production
3. Provide a high-protein diet to support bone marrow function and cellular regeneration
4. Implement strict protective isolation precautions and bleeding precautions immediately **✔ 정답**

**정답: 4**

## 해설

With severe thrombocytopenia (platelet count 15,000/mm³) and neutropenia (WBC 2,000/mm³), immediate protective isolation and bleeding precautions are the highest priority to prevent life-threatening hemorrhage and infection. Other interventions are supportive but do not address these urgent risks.

## 심화 해설

Understanding the Clinical Picture

The patient has acute myeloid leukemia (AML), a rapidly progressing cancer of the bone marrow and blood. The reported lab values are critical: a platelet count of 15,000/mm³ (normal: 150,000–400,000/mm³) and a white blood cell (WBC) count of 2,000/mm³ (normal: 4,500–11,000/mm³). This combination of severe thrombocytopenia and leukopenia creates a dual, life-threatening risk for spontaneous hemorrhage and overwhelming infection. The immediate nursing priority is to prevent both of these catastrophic events.

Why Protective Precautions Are the Priority

The correct answer is to implement strict protective isolation and bleeding precautions immediately. This is the highest priority because it directly addresses the two most acute physiological threats identified by the lab data. The leukopenia, specifically a state of neutropenia, means the patient has almost no defense against pathogens. The thrombocytopenia means the patient has a severely impaired ability to form clots. A minor bump can cause a major bleed, and a common environmental bacterium can cause a fatal infection. The concept of a personalized nursing pathway for infection prevention, as explored in the provided research by Lin et al., reinforces that structured, proactive nursing interventions are crucial for this population [1]. The study highlights that a systematic approach to care can significantly reduce hospital-acquired infections in leukemia patients, validating that infection control is not just a routine task but a critical, evidence-based intervention that must be prioritized [1].

Analyzing the Incorrect Options

- **Option 1: Deep breathing exercises.** While preventing respiratory complications like atelectasis or pneumonia is a valid nursing goal, it is not the highest priority in this acute scenario. Deep breathing is a health promotion intervention that does not address the immediate, life-threatening risks of hemorrhage and sepsis. A patient with a platelet count of 15,000/mm³ is at risk for pulmonary hemorrhage, which could be exacerbated by forceful breathing techniques.

- **Option 2: Administer iron supplements.** This intervention is aimed at correcting anemia, a common finding in leukemia due to bone marrow crowding. However, the question does not provide a hemoglobin or red blood cell count. More importantly, iron supplementation does nothing to correct the immediate dangers from critically low platelets and WBCs. It fails to address the priority problems identified by the given data.

- **Option 3: Provide a high-protein diet.** Supporting nutrition is an excellent long-term strategy for cellular regeneration and overall health. However, it is a supportive, not an emergent, intervention. A patient with severe neutropenia may also require a low-microbial diet, not just a high-protein one. This option does not directly mitigate the imminent risk of bleeding and infection, making it a lower priority than the safety-focused interventions in option 4.

Clinical Application and Evidence

The core of this question lies in prioritizing care using the ABCs (Airway, Breathing, Circulation) and safety principles, but with a hematology-specific lens. In this context, "Circulation" is directly threatened by the risk of spontaneous bleeding from thrombocytopenia, and "Safety" is critically compromised by the risk of sepsis from neutropenia. The study by Lin et al. provides direct evidence that a dedicated, structured nursing pathway focusing on infection prevention is effective in reducing adverse outcomes for hospitalized leukemia patients [1]. This supports the notion that immediate and rigorous protective measures are not just a standard order but a high-priority, evidence-backed nursing action that directly impacts patient survival. The nurse must first establish a safe environment by initiating bleeding and infection precautions before moving on to other aspects of care like nutrition or respiratory exercises.

References (research sources)

- [1]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

Dual Precautions in Febrile NeutropeniaImmediate Nursing Actions for Severe Pancytopenia
For a patient with a platelet count of 15,000/mm³ and a WBC count of 2,000/mm³, the priority is simultaneous implementation of bleeding precautions and protective isolation.

Bleeding precautions include avoiding rectal temperatures, IM injections, and use of a soft toothbrush. Protective isolation requires a private room, strict hand hygiene, and monitoring for signs of infection, as fever may be the only indicator in the absence of neutrophils.

CautionDo not delay these precautions for dietary or respiratory interventions. A platelet transfusion is typically indicated when counts drop below 10,000/mm³ or with active bleeding, but nursing precautions must be in place regardless.

## 핵심 개념

- **Thrombocytopenia** — A platelet count below 150,000/mm³, increasing the risk of spontaneous bleeding when severely low (e.g.,
- **Neutropenia** — An abnormally low neutrophil count, typically defined as an absolute neutrophil count (ANC)
- **Acute Myeloid Leukemia (AML)** — A rapidly progressive cancer of the bone marrow resulting in the overproduction of immature white blood cells and suppression of normal blood cell production.
- **Protective Isolation** — A set of infection control practices (e.g., private room, HEPA filtration, strict hand hygiene) to protect immunocompromised patients from environmental pathogens.
- **Bleeding Precautions** — Interventions to prevent hemorrhage in thrombocytopenic patients, including avoiding IM injections, using soft toothbrushes, and preventing falls.

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