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Chapter 28

Chapter 28. Nursing Care of Patients with Hematologic and Lymphatic Disorders. Anemia. Deficiency of Red Blood Cells, Hemoglobin, or Both Impaired Production Increased Destruction Blood Loss Reduced Capacity to Carry Oxygen to Tissues. Etiologies. Dietary Deficiencies Hemolysis

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Chapter 28

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  1. Chapter 28 Nursing Care of PatientswithHematologic and Lymphatic Disorders

  2. Anemia • Deficiency of Red Blood Cells, Hemoglobin, or Both • Impaired Production • Increased Destruction • Blood Loss • Reduced Capacity to Carry Oxygen to Tissues

  3. Etiologies • Dietary Deficiencies • Hemolysis • Hereditary Disorders

  4. Signs and Symptoms • Pallor • Tachycardia • Tachypnea • Irritability • Fatigue • Dyspnea

  5. Signs and Symptoms (cont’d) • Pernicious Anemia • Numb Hands or Feet • Sore Tongue • Iron Deficiency • Mouth Fissures • Glossitis • Spoon-shaped Nails

  6. Diagnosis • CBC with Microscopic Examination • Bone Marrow Analysis • Tests to Determine Source of Bleeding

  7. Therapeutic Interventions • Eliminate Cause • Dietary Changes • Supplements • Transfusions

  8. Nursing Diagnoses • Activity Intolerance • Imbalanced Nutrition • Risk for Injury • Impaired Oral Mucous Membranes

  9. Aplastic Anemia • Bone Marrow Does not Produce Adequate RBCs • Causes • Congenital • Exposure to Toxins • Chemotherapy

  10. Signs and Symptoms • Ecchymoses • Petechiae • Frank Bleeding • Infection • Death • Weakness • Fatigue • Pallor • Dyspnea • Headache

  11. Aplastic Anemia (cont’d) • Treatment • Treat Cause • Colony Stimulating Factors • Steroids • Bone Marrow Transplant • Diagnosis • CBC • Bone Marrow Biopsy • TIBC • Serum Iron

  12. Sickle Cell Anemia • Inherited Autosomal Recessive Disorder

  13. Sickle Cell Anemia (cont’d) • Crisis Treatment • Antibiotics • Pain Management • Transfusions • Fluids • Oxygen • Diagnosis • Sickledex Test • Hemoglobin Electrophoresis • CBC • ESR

  14. Signs and Symptoms

  15. Crisis Prevention • Avoid Risk of Reduced Oxygenation • Exposure to Cold • Infection • Strenuous Exercise • Low Dose Penicillin • Frequent Transfusions • Hydroxyurea

  16. Nursing Diagnoses • Risk for Ineffective Tissue Perfusion • Acute Pain

  17. Patient Education • Avoid • Tight Clothing • Strenuous Exercise • Alcoholic Beverages • Cold Temperatures • Smoking • Unpressurized Aircraft • Exposure to Infection

  18. Polycythemia • Overabundance of Red Cells • Hemoglobin >18 mg/dL • Hematocrit >55% • Blood Becomes Thick • Primary • Secondary

  19. Signs and Symptoms • Bleeding • Chest Pain • Dyspnea • Dark, Flushed Skin • Itching • Hypertension • Visual Changes • Headache • Vertigo • Dizziness • Tinnitus

  20. Therapeutic Interventions • Phlebotomy • Low Dose Aspirin • Chemotherapy • Radiation Therapy

  21. Patient Education • Drink 3 Liters of Water Daily • Avoid Restrictive Clothing • Elevate Feet • Report Signs and Symptoms of Iron Deficiency • Report Signs and Symptoms of Bleeding

  22. Disseminated Intravascular Coagulation • Pathophysiology • Accelerated Clotting • Clotting Factors Depleted • Bleeding • Etiology • Major Trauma

  23. Signs and Symptoms • Abnormal Bleeding • Joint Pain • Nausea and Vomiting • Organ System Failure • Convulsions • Shock, Coma • Death

  24. Bleeding: Signs and Symptoms • Easy Bruising • Petechiae • Blood in Urine • Black Tarry Stools • Bleeding from Nose or Gums • New Onset of Painful Joints

  25. Hemorrhage Into Skin

  26. Diagnostic Tests • PT, PTT • Platelet Count • Hbg • Hemoglobin, Creatinine

  27. Therapeutic Interventions • Correct Underlying Cause • Administer • Blood • FFP • Platelets • Cryoprecipitates

  28. Nursing Care • Recognize and Report Bleeding • Avoid Trauma and Further Bleeding • Teach Patient and Family

  29. Idiopathic Thrombocytopenic Purpura • Pathophysiology • Platelet Destruction by Immune System • Risk for Bleeding • Etiology • Acute Viral Illness • Drug Reaction • Immune System Dysfunction

  30. Signs and Symptoms • Bleeding • Petechiae • Ecchymoses • Bleeding

  31. Diagnosis • Platelet Count • Bleeding Time • Bone Marrow Aspiration

  32. Therapeutic Interventions • Steroids • Chemotherapy • Transfusions • Vitamin K • Chemotherapy • Splenectomy

  33. Nursing Care • Bleeding Precautions • Recognize and Report Signs and Symptoms Bleeding • Teach Patient and Family

  34. Bleeding Precautions • Use Electric Razor • Use Soft Toothbrush • Avoid Invasive Procedures, Injections • Maintain Pressure if Blood Draw Essential • Wear Shoes or Slippers

  35. Bleeding Precautions (cont’d) • Avoid Bumps and Bruises • Avoid Aspirin and Nsaids • Administer Stool Softener • Handle Patient Gently • Gentle Nose Blowing

  36. Hemophilia • Pathophysiology • Missing Clotting Factors • A—Factor VIII • B—Factor IX • Etiology • Heredity

  37. Signs and Symptoms • Bleeding • Joints • Muscles • Subcutaneous Tissue • Brain

  38. Diagnosis • PTT • Factor Levels

  39. Therapeutic Interventions • Desmopressin • Clotting Factors • Factor VIII • Factor IX • Blood Transfusion

  40. Nursing Diagnoses • Pain • Ineffective Protection • Risk for Ineffective Self Health Management

  41. Leukemia • Pathophysiology • Increase in Immature WBCs • Unable to Fight Infection • Risk Factors • Viruses • Genetic Factors • Radiation/Chemotherapy

  42. Types of Leukemia • Acute Lymphocytic Leukemia • Acute Myelogenous Leukemia • Chronic Lymphocytic Leukemia • Chronic Myelogenous Leukemia

  43. Signs and Symptoms • Dyspnea • Abdominal Pain • Malaise • Sternal/Rib Pain • CNS Changes • Bleeding • Fever • Infection • Pallor • Weakness • Tachycardia • Palpitations

  44. Diagnosis • CBC • Bone Marrow Aspiration • Lumbar Puncture • Genetic Analysis

  45. Therapeutic Interventions • Chemotherapy • Radiation Therapy • Bone Marrow Transplant • Peripheral Blood Stem Cell Transplant

  46. Nursing Diagnoses • Risk for Injury: Infection, Bleeding • Fatigue • Impaired Oral Mucous Membranes • Knowledge Deficit • Anxiety

  47. Multiple Myeloma • Pathophysiology • Cancer of Plasma Cells in Bone Marrow • Tumors Devour Bone Tissue • Organ Invasion • Etiology • Unknown • Occupational Exposures

  48. Signs and Symptoms • Bone Pain • Fever • Malaise • Spinal Cord Compression • Pathological Fractures • Hypercalcemia • Infection

  49. Diagnosis • CBC, Blood Calcium • Bone X-Rays • Urine for Bence Jones Protein • Bone Marrow Biopsy

  50. Therapeutic Interventions • Steroids • Chemotherapy • Control of Serum Calcium • Radiation • Stem Cell Transplantation • IV Pamidronate (Aredia)

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