Nursing of adults with medical surgical conditions
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Nursing of Adults with Medical & Surgical Conditions. Blood and Lymphatic Disorders. Blood and Lymphatic Disorders. Laboratory Tests RBC (erythrocytes) 4-6 million/cu.mm Hemoglobin 10-20 gm/100ml Hematocrit 40-50 percent WBC 5,000-10,000/mm

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Nursing of Adults with Medical & Surgical Conditions

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Nursing of adults with medical surgical conditions

Nursing of Adults with Medical & Surgical Conditions

Blood and Lymphatic

Disorders


Blood and lymphatic disorders

Blood and Lymphatic Disorders

  • Laboratory Tests

    • RBC (erythrocytes) 4-6 million/cu.mm

    • Hemoglobin 10-20 gm/100ml

    • Hematocrit 40-50 percent

    • WBC 5,000-10,000/mm

    • Platelets 150,000-400,000/mm


Anemia

Anemia

  • Definition

    • Disorder characterized by RBC and hemoglobin and hematocrit levels below normal range

    • Causes delivery of insufficient amounts of oxygen to tissues and cells


Anemia1

Anemia

  • Types

    • Blood loss (hemorrhage)

    • Impaired production of RBC’s (bone marrow depression)

    • Increased destruction of RBC’s (hemolysis)

    • Nutritional deficiencies (long term iron deficiency)


Anemia2

Signs & Symptoms

Anorexia

Cardiac dilation

Disorientation

Dyspepsia

Dyspnea

Exertional dyspnea

Fatigue

Headache

Insomnia

Pallor

Palpitation

Shortness of breath

Systolic murmur

Tachycardia

Vertigo

Anemia


Hypovolemic anemia

Hypovolemic Anemia

  • Etiology/Pathophysiology

    • Abnormally low circulating blood volume due to blood loss

    • 500 ml loss can be tolerated

    • 1000 ml loss can be severe complications

    • Severity and signs and symptoms depend on how rapid the blood is lost


Hypovolemic anemia1

Hypovolemic Anemia

  • Signs & Symptoms

    • Weakness

    • Stupor

    • Irritability

    • Pale, cool, moist skin

    • Hypotension

    • Tachycardia (rapid, weak, thready pulse)

    • Hypothermia

    • Hemoglobin less than 10 gm/100ml

    • Hematocrit less than 40 %

      • H&H may not drop for several hours after blood loss


Hypovolemic anemia2

Hypovolemic Anemia

  • Treatment

    • Control bleeding

    • Treat shock

      • O2, elevate lower extremities, keep warm

    • Replace fluid

      • blood transfusion, plasma, dextran, lactaed ringers

    • Monitor vital signs


Pernicious anemia

Pernicious Anemia

  • Etiology/Pathophysiology

    • Absence of the intrinsic factor

    • Intrinsic factor is essential for the absorption of vitamin B12

    • Deficiency of vitamin B12 affects growth and maturity of all body cells

      • RBC’s in the bone marrow don’t mature

      • RBC membrane ruptures easily

    • Vitamin B12 is also related to nerve myelination

      • may cause progressive demyelination and degeneration of nerves and white matter


Pernicious anemia1

Pernicious Anemia

  • Signs & Symptoms

    • Extreme weakness

    • Dyspnea

    • Fever

    • Hypoxia

    • Weight loss

    • Jaundice (destruction of RBC’s)

    • Pallor

    • GI complaints


Pernicious anemia2

Pernicious Anemia

  • Dysphagia

  • Sore, burning tongue

    • Smooth and erythematous

  • Neurological symptoms

    • tingling of the hands and feet

    • disorientation

    • personality changes

    • behavior problems

    • partial or total paralysis


Pernicious anemia3

Pernicious Anemia

  • Treatment

    • Vitamin B12 (cyanocobalamin) 1000 units

      • daily for 1 week

      • weekly for 1 month

      • monthly for life

    • Folic acid supplement

    • Iron replacement

    • RBC transfusion

      • for severe anemia

    • Diet

      • high protein, vitamins, and minerals


Aplastic anemia

Aplastic Anemia

  • Etiology/Pathophysiology

    • Decrease of bone marrow function

      • RBC production

    • Primary

      • congenital

    • Secondary

      • viral invasion

      • medications

      • chemicals

      • radiation

      • chemotherapy


Aplastic anemia1

Aplastic Anemia

  • Signs & Symptoms

    • Pancytopenic

      • all three major blood elements from the bone marrow are decreased (RBC, WBC, & Platelets)

    • Repeated infections with high fevers

    • Fatigue, weakness, malaise

    • Dyspnea

    • Palpitations

    • Bleeding tendencies

      • petechiae, ecchymossis, bleeding gums, epistaxis, GI & GU bleeds


Aplastic anemia2

Aplastic Anemia

  • Treatment

    • Identify & remove cause

    • Platelet transfusion for severe thrombocytopenia

    • Splenectomy for hypersplenism

      • Hypersplenism can cause destruction of platelets

    • Steroids and androgens

      • stimulate bone marrow

    • Antithymocyte globulin

      • stimulates bone marrow

    • Bone marrow transplant


Iron deficiency anemia

Iron Deficiency Anemia

  • Etiology/Pathophysiology

    • RBC’s contain decreased levels of hemoglobin

    • Excessive iron loss

      • caused by chronic bleeding; intestinal, uterine, gastric


Iron deficiency anemia1

Iron Deficiency Anemia

  • Signs & Symptoms

    • Pallor

    • Fatigue

    • Weakness

    • Shortness of breath

    • Angina

    • S/S of heart failure

    • Glossitis

    • Pagophagia (desire to eat ice, clay, starches)

    • Headache

    • Paresthesia

    • Burning tongue


Iron deficiency anemia2

Iron Deficiency Anemia

  • Treatment

    • Ferrous Sulfate 900 mg daily

      • Oral or injection (z-tract)

    • Ascorbic acid

      • enhances absorption of iron

    • Diet high in iron

      • Organ meats

        • liver, kidney, heart, tongue

      • Muscle meats (esp dark meat from poultry)

      • Fish

      • Eggs

      • Green leafy vegetables

      • Whole grains

      • Dried beans


Sickle cell anemia

Sickle Cell Anemia

  • Etiology/Pathophysiology

    • Most common genetic disorder in the U.S.

    • Occurs predominantly in African Americans

      • 1out of 10 have trait; 1 out of 500 have disease

    • An abnormal, crescent shaped RBC

      • contains hemoglobin S (Hg-S)

    • Severe, chronic, incurable condition

    • Disease

      • Homozygous

        • has two Hg-S genes; one from each parent

    • Trait

      • Heterozygous

        • has one Hg-S gene from one parent and one Hg-A gene from the other parent


Sickle cell anemia1

Sickle Cell Anemia

  • Signs & Symptoms

    • Precipitating Factors

      • Dehydration

      • Change in oxygen tension in the body

        • infection, overexertion, cold, alcohol, smoking

    • Loss of appetite

    • Irritability

    • Weakness

    • Abdominal enlargement

      • pooling of blood in the liver, spleen and other organs

    • Join and back pain

    • Edema of extremities


Sickle cell anemia2

Sickle Cell Anemia

  • Treatment

    • No specific treatment

      • Alleviate symptoms

    • Oxygen

    • Rest

    • Fluids

      • oral and IV

    • Analgesics

    • Bone marrow transplant

      • Experimental


Agranulocytosis

Agranulocytosis

  • Etiology/Pathophysiology

    • Severe reduction in the number of granulocytes (basophils, eosinophils, & neutrophils)

    • WBC less than 200/mm3

    • Medications

      • analgesics, antibiotics, antiepileptics, antihistamines, antineoplastic agents, antithyroid drugs, diuretics, phenothiazides, sulfonamides

    • Chemotherapy

    • Radiation

    • Neoplastic disease

    • Viral and bacterial infections


Agranulocytosis1

Agranulocytosis

  • Signs & Symptoms

    • S/S of infection

      • fever, chills, headache, fatigue

    • Ulcerations of mucous membranes

    • Bronchial pneumonia

    • Urinary tract infection


Agranulocytosis2

Agranulocytosis

  • Treatment

    • Identify and remove cause of bone marrow depression

    • Prevent or treat infections

    • Meticulous handwashing

    • Strict asepsis


Leukemia

Leukemia

  • Etiololgy/Pathophysiology

    • Malignant disorder of the hematopoietic system

    • Excess leukocytes accumulate in the bone marrow and lymph nodes

      • bone marrow produces immature cells

    • Cause unknown

      • Possible causes include genetic, virus, exposure to radiation, or chemotherapy

    • Classification

      • Acute or Chronic

      • Proliferating cells (lymphocytic, monocytic, etc.)


Leukemia1

Leukemia

  • Signs & Symptoms

    • Anemia

      • pallor, fatigue, malaise

    • Thrombocytopenia

      • petechiae, epistaxis, bruising, occult blood

    • Leukopenia

      • fever, upper resp. infections,

    • Enlarged lymph nodes

    • Splenomegaly


Leukemia2

Leukemia

  • Treatment

    • Chemotherapy

    • Radiation

    • Bone marrow transplant

    • Medications

      • Leukeran

      • hydroxyurea

      • corticosteroids

      • Cytoxan


Thrombocytopenia

Thrombocytopenia

  • Etiology/Pathophysiology

    • Abnormal hematological condition in which the number of platelets is reduced below 100,000 mm3

    • Decreased production

      • aplastic anemia, leukemia, tumors, chemotherapy

    • Decreased survival

      • antibody destruction, infection, viral invasion


Thrombocytopenia1

Thrombocytopenia

  • Signs & Symptoms

    • Petechiae

    • Ecchymoses

    • Platelets below 100,000

      • bleeding mucous membranes

      • bleeding internal organs

    • Platelets below 20,000

      • serious bleeding risks


Thrombocytopenia2

Thrombocytopenia

  • Treatment

    • Corticosteriod therapy

    • Splenectomy

    • Gamma globulin

    • Immunosuppressive drugs

    • Platelet transfusions

    • Avoid trauma


Hemophilia

Hemophilia

  • Etiology/Pathophysiology

    • Hereditary coagulation disorder, characterized by a disturbance of clotting factor

    • Hemophilia A

      • most common

      • Factor VIII is absent

    • Hemophilia B

      • Deficiency of Factor IX

    • X-linked hereditary trait

      • affects mainly males

      • females are carriers


Hemophilia1

Hemophilia

  • Signs & Symptoms

    • Internal & external bleeding

    • Hemarthrosis

      • bleeding into the joint; esp knees, ankles, and elbow

    • Excessive blood loss from small cuts and dental procedures


Hemophilia2

Hemophilia

  • Treatment

    • Minimize bleeding

      • avoid trauma

    • Relieve pain

      • No aspirin

    • Transfusions

      • Factor VIII or IX concentrate

        • human-derived products

        • can be treated to inactivate viruses

      • Cryoprecipitate (rich in factor VIII)

        • human-derived product

      • Manufactured factor VIII or IX


Von willebrand s disease

von Willebrand’s Disease

  • Etiology/Pathophysiology

    • Inherited bleeding disorder characterized by abnormally slow coagulation of blood and spontaneous episodes of GI bleeding, epistaxis, and gingival bleeding

    • Mild deficiency of factor VIII

    • Common during

      • Postpartum

      • Menorrhagia

      • Post operative

      • Post truama

    • Similar to hemophilia; not limited to males


Von willebrand s disease1

von Willebrand’s Disease

  • Treatment

    • Cryoprecipitate

    • Fibrinogen

    • Fresh plasma

    • Desmopressin (DDAVP)

      • Synthetic of the human antiduiuretic hormone, vasopressin

      • Causes an increase in factor VIII release from storage sites in the body

    • Same nursing interventions as for hemophilia


Disseminated intravascular coagulation dic

Disseminated Intravascular Coagulation (DIC)

  • Etiology/Pathophysiology

    • Overstimulation of clotting and anticlotting processes in response to disease or injury

      • Septicemia

      • Obstetrical complications

      • Malignancies

      • Tissue trauma

      • Transfusion reaction

      • Burns

      • Shock

      • Snake bites


Disseminated intravascular coagulation dic1

Disseminated Intravascular Coagulation (DIC)

  • Primary disorder initiates generalized intravascular clotting, which overtimulates fibrinolytic mechanisms

  • The hypercoagulability is followed by a deficiency in clotting factors with subsequent hypocoagulability and hemorrhaging


Disseminated intravascular coagulation dic2

Disseminated Intravascular Coagulation (DIC)

  • Signs & Symptoms

    • Bleeding

      • Mucous membranes

      • Venipuncture sites

      • Surgical sites

      • GI & GU tracts

      • All orifices

    • Dyspnea

    • Hemoptysis

    • Diaphoresis

    • Cold, mottled digits

    • Purpura on the chest and abdomen

    • Petechiae


Disseminated intravascular coagulation dic3

Disseminated Intravascular Coagulation (DIC)

  • Treatment

    • Treat underlying cause

    • Cryoprecipitate

    • Heparin

    • Protect from bleeding and trauma


Multiple myeloma

Multiple Myeloma

  • Etiology/Pathophysiology

    • Malignant neoplastic immunodeficiency disease of the bone marrow

    • Tumor, composed of plasma cells, destroys osseous tissue

    • Bone marrow becomes overcrowded and unable to produce erythrocytes, platelets, and leukocytes

    • Onset is gradual and insidious


Multiple myeloma1

Multiple Myeloma

  • Signs & Symptoms

    • Bone pain

      • Ribs, spine, and pelvis

    • Pathological fractures

    • Infection

    • Anemia

    • Bleeding

    • Hypercalcemia

      • Calcium and phosphorus drain from bones

    • Renal failure

      • Myeloma protein causes kidney damage

      • Destruction of cells causes hyperuricemia


Multiple myeloma2

Multiple Myeloma

  • Treatment

    • Symptomatic; not curable

    • Radiation

    • Chemotherapy

      • Alkeran

      • Cytoxan

      • Leukeran

      • Carmustin

      • Vincristine

      • Adriamycin

      • Dexamethasone

    • Corticosteroids

    • IV fluids


Lymphangitis

Lymphangitis

  • Etiology/Pathophysiology

    • Inflammation of one or more lymphatic vessels

    • Usually occurs from acute streptococcal or staphylococcal infection in an extremity


Lymphangitis1

Lymphangitis

  • Signs & Symptoms

    • Fine red streaks from the affected area in the groin or axilla

    • Edema

    • Chills

    • Fever

    • Local pain

    • Headache

    • Myalgia


Lymphangitis2

Lymphangitis

  • Treatment

    • Penicillin

    • Hot, moist heat

    • Elevate extremity


Lymphedema

Lymphedema

  • Etiology/Pathophysiology

    • Primary or secondary disorder

    • Accumulation of lymph in the soft tissue

      • Obstruction

      • Increase in amount of lymph

      • Removal of lymph channels and nodes


Lymphedema1

Lymphedema

  • Signs & Symptoms

    • Massive edema and tightness of affected extremity

    • Pain


Lymphedema2

Lymphedema

  • Treatment

    • Diuretics

    • Antibiotics

    • Compression pump

    • Elastic stocking or sleeve

    • Restricted sodium diet

    • Avoid constrictive clothing

    • Meticulous skin care


Malignant lymphoma

Malignant Lymphoma

  • Etiology/Pathophysiology

    • Non-Hodgkin’s Lymphoma

    • Neoplastic disorder of lymphoid tissue

    • Tumors usually start in lymph nodes and spread to lymphoid tissue in the spleen, liver, GI tract, and bone marrow


Malignant lymphoma1

Malignant Lymphoma

  • Signs & Symptoms

    • Painless, enlarged cervical lymph nodes

    • Fever

    • Weight loss

    • Anemia

    • Pruritus

    • Susceptiblity to infection

    • Complications

      • Pleural effusion, bone fractures, and paralysis

    • Fatigue

    • Malaise

    • Anorexia


Malignant lymphoma2

Malignant Lymphoma

  • Treatment

    • Accurate staging of the disease is crucial to determine treatment regimen

    • Radiation

      • Initial treatment when localized

    • Chemotherapy

      • Cytoxan, Oncovin adriamycin bleomycin, methotrexate

      • Treatment when not localized

    • Bone marrow transplant

    • Tumor necrosis factor (TNF)

      • Direct cell toxicity

      • Stimulates bone marrow

  • Hodgkin’s Disease

  • Etilology/Pathophysiology

  • Inflammatory or infectious process that develops into a neoplasm

  • Affects males twice as frequently as females

  • Reed-Sternberg cells

  • Large, abnormal, multinucleated cells in the lymphatic system replace the normal cells

  • Signs & Symptoms

  • Enlargement of cervical lymph nodes

  • Anorexia

  • Weight loss

  • Pruritus

  • Low-grade fever

  • Night sweats

  • Anemia

  • Leukocytosis


Hodgkin s disease

Hodgkin’s Disease

  • Etilology/Pathophysiology

    • Inflammatory or infectious process that develops into a neoplasm

    • Affects males twice as frequently as females

    • Reed-Sternberg cells

      • Large, abnormal, multinucleated cells in the lymphatic system replace the normal cells


Hodgkin s disease1

Hodgkin’s Disease

  • Signs & Symptoms

    • Enlargement of cervical lymph nodes

    • Anorexia

    • Weight loss

    • Pruritus

    • Low-grade fever

    • Night sweats

    • Anemia

    • Leukocytosis

      • Increased WBC


Hodgkin s disease2

Hodgkin’s Disease

  • Treatment

    • Depends on the staging process

      • Chart on page 280

    • Stage I or II (localized)

      • Radiation

    • Stage III or IV (generalized)

      • Chemotherapy

      • Combination


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