A patient with cancer who is receiving chemotherapy develops a fever. The patient's chest radiograph is normal. The patient's neutrophil count is 750/mm3 . The nurse expects the provider to:
a. begin empiric therapy with intravenous antibiotics.
b. obtain cultures and wait for results before prescribing antibiotics.
c. order colony-stimulating factor to minim-ize neutrophilia.
d. reassure the patient that serious infection is unlikely.
A
In the absence of neutrophils, as occurs with bone marrow suppression in chemotherapy, fever is the principle sign of infection. Pus, abscesses, and infiltrates on a chest x-ray may all be absent. When a neutropenic patient develops an infection, immediate and vigorous intervention is re-quired. Empiric IV antibiotic therapy should begin while waiting for laboratory results and cul-tures. It is not correct to wait for culture results before initiating antibiotic therapy. Colo-ny-stimulating factor can minimize neutropenia but does not eliminate the need for IV antibiotics. It is not correct to reassure the patient that a serious infection is unlikely.
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