A nurse is planning care for a patient with leukopenia caused by chemotherapy. Which nursing action best promotes a safe environment and minimizes the patient's risk of infection?

Rationale:

A. The paste under a colostomy or ileostomy appliance creates a seal between the stoma and the wafer, preventing leakage of effluent onto the skin. Simply taping the wafer may not provide an adequate seal, increasing the risk of leakage, skin irritation, and infection. This response educates the patient on the functional importance of the paste.

B. This response is vague and non-informative, and does not explain why the paste is necessary or the risks of not using it. It fails to address the patient’s concern.

C. This is incorrect. Waterproof tape alone does not conform to the stoma or fill uneven skin surfaces, so it cannot replace the sealant paste, increasing the likelihood of leakage and skin breakdown.

D. While tape can irritate the skin, the main concern is seal integrity and prevention of leakage, not just skin irritation. This explanation does not fully address the functional reason for using paste.

Rationale:

A. Filgrastim does not reduce GI toxicity. It specifically targets the bone marrow to stimulate white blood cell production and does not affect nausea, diarrhea, or mucositis caused by chemotherapy.

B. Filgrastim does the opposite of immune suppression. It stimulates the bone marrow to produce neutrophils, enhancing the patient’s immune function, especially after chemotherapy or surgery.

C. Filgrastim has no effect on nausea, vomiting, or appetite. Antiemetic medications, not filgrastim, are used to manage these symptoms.

D. Filgrastim (Neupogen) is a colony-stimulating factor that promotes the production of neutrophils in the bone marrow. After bowel resection and chemotherapy, patients are at risk for neutropenia, which increases susceptibility to infection. Administering filgrastim helps raise WBC counts, enhancing immune defense and reducing infection risk.