A patient with acute lymphoblastic leukemia (ALL) is admitted for chemotherapy treatment. As part of the nursing management, which of the following interventions is most critical to prevent infection in this patient?

Choice A: Optic Neuritis

Optic neuritis is an inflammation of the optic nerve that can cause pain and vision loss. The pain typically worsens with eye movement, and vision loss usually occurs in one eye. Symptoms include temporary vision loss, visual field loss, loss of color vision, and flashing lights. However, optic neuritis does not typically cause nausea or seeing halos around lights, and the pupil reaction to light is usually preserved.

Choice B: Macular Degeneration

Macular degeneration primarily affects central vision and is more common in older adults. It can cause blurred or reduced central vision, difficulty recognizing faces, and visual distortions such as straight lines appearing bent. However, it does not cause sudden onset eye pain, nausea, or seeing halos around lights. The pupil reaction to light remains normal in macular degeneration.

Choice C: Narrow Angle Glaucoma

Narrow angle glaucoma, also known as acute angle-closure glaucoma, is a medical emergency characterized by a sudden increase in intraocular pressure. Symptoms include severe eye pain, nausea, vomiting, seeing halos around lights, and a mid-dilated, non-reactive pupil. This condition occurs when the drainage angle between the iris and cornea becomes blocked, leading to a rapid rise in eye pressure. Immediate treatment is necessary to prevent permanent vision loss.

Choice D: Cataract

Cataracts cause clouding of the lens, leading to symptoms such as blurred vision, difficulty seeing at night, sensitivity to light, and seeing halos around lights. However, cataracts develop gradually and do not cause sudden onset eye pain or nausea. The pupil reaction to light is also typically normal in cataract patients.

Choice A Reason:

Febrile non-hemolytic transfusion reactions (FNHTRs) are common and typically present with fever, chills, and sometimes rigors. However, they do not usually cause severe symptoms such as back pain and difficulty breathing. FNHTRs are generally less severe and are caused by the recipient’s immune response to donor white blood cells or cytokines in the transfused blood.

Choice B Reason:

Allergic reactions to blood transfusions can range from mild to severe. Mild reactions may include itching, hives, and rash, while severe reactions (anaphylaxis) can cause difficulty breathing and hypotension. However, allergic reactions do not typically cause back pain, which is more indicative of a hemolytic process.

Choice C Reason:

Fluid overload, also known as transfusion-associated circulatory overload (TACO), can occur when too much blood is transfused too quickly. Symptoms include dyspnea, hypertension, and pulmonary edema. While difficulty breathing is a symptom of fluid overload, chills and back pain are not typical features.

Choice D Reason:

Acute hemolytic transfusion reaction (AHTR) is the most likely cause of the patient’s symptoms. AHTR occurs when the recipient’s immune system attacks the transfused red blood cells, leading to their destruction. This reaction can cause severe symptoms such as chills, fever, back pain, and difficulty breathing. It is a medical emergency that requires immediate intervention to prevent serious complications, including kidney failure and shock.