Neutropenia and Infection Management Flashcards

Which prophylactic medication is routinely given to pediatric oncology patients receiving intensive chemotherapy to prevent Pneumocystis jirovecii pneumonia (PJP)?

Answer: Trimethoprim-sulfamethoxazole (TMP-SMX / co-trimoxazole)

TMP-SMX is the first-line prophylactic agent for PJP in immunocompromised pediatric oncology patients. It is typically given 2–3 days per week. Alternatives for sulfa-allergic patients include dapsone, atovaquone, or monthly inhaled pentamidine.

A neutropenic pediatric oncology patient develops a new fever on day 5 of broad-spectrum antibiotics without an identified source. The nurse should anticipate the provider will order:

Answer: Addition of empiric antifungal therapy due to risk of invasive fungal infection

Persistent fever after 4–7 days of broad-spectrum antibacterials in a neutropenic patient raises concern for invasive fungal infection (Aspergillus, Candida). Empiric antifungal therapy (amphotericin B or an azole/echinocandin) is a standard guideline recommendation in this scenario.

Which sign or symptom in a neutropenic patient indicates possible Clostridium difficile (C. diff) colitis and requires contact precautions?

Answer: Profuse, watery, foul-smelling diarrhea (≥3 loose stools in 24 hours) after antibiotic exposure

C. difficile produces toxin-mediated colitis in patients whose gut flora has been disrupted by antibiotics. It presents with profuse watery, foul-smelling diarrhea and is highly contagious via spore transmission, requiring contact precautions and specific hygiene measures.

A child with a bone tumor on high-dose chemotherapy has an ANC of 85/µL. The parents report the child has been playing outdoors, and a neighbor child visited who had a mild runny nose. Which nursing education point is most important?

Answer: Avoid close contact with anyone who is ill; this level of neutropenia (ANC <100) constitutes profound immunosuppression and any viral exposure carries serious risk

ANC <100 is profound neutropenia. Even a mildly ill contact represents significant infection risk — common respiratory viruses can cause severe, disseminated infections in the profoundly neutropenic child. Families must understand that any fever (≥38.3°C) is an emergency.

Which finding on physical examination of a neutropenic patient should prompt the nurse to suspect invasive pulmonary aspergillosis?

Answer: New onset pleuritic chest pain, non-productive cough, and hemoptysis in a patient with prolonged neutropenia

Invasive pulmonary aspergillosis (IPA) in neutropenic patients characteristically presents with pleuritic chest pain, dry cough, and hemoptysis — due to angio-invasive hyphae causing pulmonary infarction. The 'halo sign' on CT is pathognomonic.

G-CSF (filgrastim) is prescribed to a child after myelosuppressive chemotherapy. What is the expected therapeutic outcome the nurse should monitor for?

Answer: Rising absolute neutrophil count (ANC) indicating neutrophil recovery

G-CSF stimulates the proliferation and accelerated release of neutrophil precursors from bone marrow, resulting in a rising ANC. The nurse monitors daily CBC with differential to assess for neutrophil recovery and document when the nadir occurs and reverses.