What should the nurse teach the client with neutropenia to avoid?

Your Care Instructions

Neutropenia [say "noo-truh-PEE-nee-uh"] means that your blood has too few neutrophils. These are white blood cells that help protect the body from infection. They do this by killing bacteria.

Neutropenia can be caused by some types of infection. It also can be caused by immune system conditions such as HIV or lupus, a lack of vitamin B12 or folic acid, or an enlarged spleen. Some medicines can cause it too. It is most often caused by treatments for certain health problems, such as chemotherapy and radiation treatment for cancer.

Mild neutropenia usually causes no symptoms. But when it's severe, it increases the risk of infection of your skin and organs. That's because your body can't fight off germs as well as it should.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line [811 in most provinces and territories] if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you have any problems with your medicine.
Eat a healthy, balanced diet. Eat foods with a lot of fibre. This helps to prevent constipation.

Prevent infections

Take your temperature several times a day, as your doctor suggests. Keep a written record of your temperature readings. Fever is a common symptom of infection. And it may be the only symptom.
Use a soft toothbrush. Do not floss your teeth. Talk with your doctor about other steps to prevent infections in your mouth.
Wash your hands often with soap and water, especially before you eat and after you use the washroom.
If you are a woman, use sanitary napkins [pads] instead of tampons. Do not douche.
Do not use rectal thermometers or suppositories.
Avoid tasks that might expose you to germs, such as disposing of pet feces or urine.
Avoid crowds of people and anyone who might have an infection or an illness such as a cold or the flu. You may need to avoid people who have recently had certain kinds of vaccinations.
Even small injuries can get infected. Take steps to prevent cuts, burns, and sunburns.
If you have severe neutropenia, your doctor may advise you to avoid fresh fruits, vegetables, and flowers.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

You have severe shortness of breath.
You passed out [lost consciousness].

Call your doctor or nurse advice line now or seek immediate medical care if:

You have signs of infection, such as:
- Increased pain, swelling, warmth, or redness of your skin.
- Red streaks leading from a wound.
- Pus draining from a wound.
- A fever.

Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if:

You do not get better as expected.

Where can you learn more?

Go to //www.healthwise.net/patientEd

Enter Q943 in the search box to learn more about "Neutropenia: Care Instructions".

Health Alert:

COVID-19 Information

What is a Neutropenic Diet?

A neutropenic [nu-tro-PEE-nik] diet is for people with weakened immune systems. This diet helps protect them from bacteria and other harmful organisms found in some food and drinks. If your immune system is not working well, your body may have a hard time protecting itself from these bacteria. Cooking foods [like beef, chicken, fish, and eggs] completely makes sure that all bacteria are destroyed.

Who Needs to Follow a Neutropenic Diet?

Doctors often recommend this diet before and after certain types of chemotherapy and other cancer treatments. A blood test called an absolute neutrophil count [ANC] can help determine the body’s ability to fight off infection. Many cancer patients have this blood test done routinely. When the ANC is less than 500 cells/mm3, the patient is often instructed to follow a neutropenic diet. This diet should be followed until the doctor tells the patient to resume his or her regular diet.

Patients undergoing autologous stem cell transplants typically follow this diet during the pre-transplant chemotherapy and for the first 3 or more months after transplant. Patients undergoing allogeneic stem cell transplants typically follow this diet during the pre-transplant chemotherapy and continue on it until they no longer take immunosuppressive drugs. The transplant team will tell the patient how long to follow this diet.

People who have had an organ transplant or who are being treated for HIV/AIDS also may need to follow this diet. If you are not sure if you should follow this diet, check with your doctor, nurse, or dietitian.

General Tips

The following pages list the foods you should choose when you are on a neutropenic diet. Foods you should avoid are also listed. Please check with your doctor, nurse, or dietitian if you have questions about the diet or safe food preparation. Some general tips include:

Avoid all fresh fruits and vegetables, including all fresh garnishes. Cooked vegetables, canned fruits, and juices are fine.
Avoid raw or rare-cooked meat, fish, and eggs. Meat should be cooked to the “well- done” stage. All eggs should be thoroughly cooked [no runny yolks].
Avoid salad bars, fruit bars, and deli counters. Buy vacuum-packed lunch meats rather than freshly sliced meats.
Avoid raw nuts. You may eat baked products with these ingredients.
Make sure all of the dairy products you eat are pasteurized.
Avoid yogurt and yogurt products with live and active cultures.
Be safe in the way you handle foods. Wash your hands before handling food. Wash all surfaces, cutting boards and cutting utensils thoroughly. Keep hot food hot and cold food cold. [See the UPMC patient education sheet Food Safety: Preventing Foodborne Illness for more information.]
At home, you may use tap water. If you choose to use bottled water, be sure it is labeled as follows:

Reverse osmosis or
Distillation or
Filtered through an absolute1 micron or smaller filter

Well water is OK if it is boiled for at least 1 minute.