Hematologic, Oncologic, and Immunologic Care
Cytopenias, Transfusion, and Infection Risk
Oncology and hematology questions focus on recognizing complications. Know the nadir period after chemotherapy and the signs of neutropenic fever - a single temperature elevation requires prompt assessment and antibiotics. Thrombocytopenia shows bruising, petechiae, and bleeding; teach soft toothbrushes, electric razors, and fall precautions. Anemia shows fatigue, pallor, and tachycardia. Transfusion reactions: stop the transfusion, keep the IV line with normal saline, and notify the provider. Know the difference between febrile, hemolytic, and allergic reactions. For immunologic care, understand immunosuppression precautions, live vaccine avoidance in immunocompromised patients, and the purpose of protective isolation.
Traps to Watch
Questions often test whether to continue or stop a transfusion - always stop first when a reaction is suspected. Do not give rectal temperatures or suppositories to neutropenic or thrombocytopenic patients. Do not assume an infection is present only with fever; older or immunosuppressed patients may lack it. Avoid confusing graft-versus-host disease with rejection.
Rule of Thumb
For any suspected transfusion reaction, stop the transfusion first, then maintain the line with saline and notify the provider.
Worked Example
During a transfusion, a patient develops chills and a temperature of 38.5 C. The nurse stops the transfusion, keeps the line open with normal saline, reassesses vital signs, and notifies the provider and blood bank.