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Nursing management of patients with hematologic dysfunction. Nursing 210 Fluid and Cells. Laurie Brown RN, MSN, MPA-HA, CCRN. Development of Blood Cells. Hemoglobin and Hematacrit. Hb: Women: 12-16 Men: 13.5-18. Hct: Women: 38-47% Men: 40-54%. Complete Blood Count.

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Nursing 210 fluid and cells

Nursing management of patients with hematologic dysfunction

Nursing 210

Fluid and Cells

Laurie Brown RN, MSN, MPA-HA, CCRN



Hemoglobin and hematacrit
Hemoglobin and Hematacrit

Hb: Women: 12-16

Men: 13.5-18

Hct: Women: 38-47%

Men: 40-54%


Complete blood count
Complete Blood Count

White Blood Cells (WBC) 5,000-10,000


Wbc differential

Neutrophil

Eosinophil

Basophil

Lymphocyte

Monocyte

50-70%

2-5%

0-2%

20-40%

4-8%

WBCDifferential


CBC

Platelet Count

150,000-400,000


Red Cells

  • Mean Corpuscular Hemoglobin (MCH)

  • Mean Corpuscular Volume (MCV)

  • Mean Corpuscular Hemoglobin Concentration (MCHC)


Clotting
Clotting

  • Extrinsic

  • Intrinsic


Heparin

PTT

Coumadin

PT or INR

Vitamin K

Protamine sulfate


Drugs impairing the hematologic system
Drugs Impairing the Hematologic System

  • Drugs causing bone marrow suppression

  • Drugs causing hemolysis

  • Drugs that disrupt platelet action

  • Drugs that disrupt clotting action


Anemias
ANEMIAS

  • “Can Not Make”

  • “Lost”

  • “Destroyed”


Anemias1

Iron Deficiency

Pernicious Anemia

Folic Acid Deficiency

Trauma

Chronic loss

Sickle Cell

Infectious Agents

Antibodies

Aplastic Anemia

G6PD Deficiency

ANEMIAS


Sickle cell anemia
Sickle Cell Anemia

  • Pain Control

  • Sickle cell crisis

  • Rational for orders

  • Nursing orders


Pernicious anemia
Pernicious Anemia

  • Vitamin B 12

  • Intrinsic Factor

  • Cells mutate and become large

  • Development of Neurological problems


Clotting problems
Clotting Problems

  • Thrombocytopenia

  • Hemophilia

  • Von Willebrand

  • Disseminated Intravascular Coagulation (DIC)


DIC

“Imbalance between the process of coagulation and anticoagulation”



Heparin administration
Heparin Administration

  • Heparin loading dose

  • Initial Maintenance Infusion

  • Dosage calculation often by patients weight


Transfusion administration

Identification

Lab values

Drs order verify

Pt assessment

IV site assessment

Documentation

Verify with 2nd RN

Monitor VS

Remain with the patient

TransfusionAdministration



Blood bank
Blood Bank

  • Patient name and I.D. number

  • Unit number and ABO/Rh type on bag with blood bag compatibility tag & bag unit/type

  • Verify expiration date on blood bag


Autologous blood transfusions
Autologous Blood Transfusions

  • Preoperative autologous blood donation

  • Acute normovolemic hemodilution

  • Intraoperative autologous transfusion

  • Postoperative blood salvage


Characteristics of normal cells
Characteristics of Normal Cells

  • Limited Cell Division

  • Specific Morphology

  • Small Nuclear-Cytoplasmic Ratio

  • Perform Specific Differentiated Functions

  • Adhere tightly together…

  • Are nonmigratory

  • Grow in an orderly and well differentiated manner

  • Are contact inhibited


Characteristics of malignant cells
Characteristics of Malignant Cells

  • Demonstrate rapid or continuous cellular division.

  • Show anaplastic morphology

  • Have alargenuclear-cytoplasmic ratio

  • Lose some or all differentiated functions

  • Adhere loosely together

  • Are able to migrate

  • Grow by invasion

  • Are not contact-inhibited


Leukemia
Leukemia

  • AML - Acute Myelogenous

  • ALL - Acute Lymphocytic

  • CML - Chronic Myelogenous

  • CLL - Chronic Lymphocytic


Fab leukemia classification
FAB Leukemia Classification

  • French American British Classification

  • Historically distinguishing AML from ALL was a major clinical problem

  • Chemotherapy dependent on tissue type


Acute leukemia nccn guidelines
Acute Leukemia NCCN Guidelines

  • National Comprehensive Cancer Network (NCCN) has issued guidelines for treatment of many cancers including Leukemia as well as other hematological malignancies

    http://www.nccn.org/index.html


Bone marrow aspiration
Bone Marrow Aspiration

  • Bone marrow biopsy

  • Bone marrow aspiration


Lymphoma
Lymphoma

  • Hodgkin’s lymphoma

  • Non-Hodgkin’s lymphoma


Multiple myeloma
Multiple Myeloma

  • Gammopathy

  • “M” Protein

    • called a tumor marker


History of myeloma
History of Myeloma

  • Skeletal evidence of myeloma obtained from Egyptian mummies

  • First case described in 1844

  • 1845 Dr Henry Bence Jones detected heat properties of urinary light chains

  • 1929 Bone marrow aspiration

  • 1937 serum protein electrophoresis

  • 1960 Alkeran and prednisone- first treatment


What is multiple myeloma
What is Multiple Myeloma?

  • A cancer of the bone marrow

    • The location where cells are produced

  • The affected cells are plasma cells

  • Plasma cells produce antibodies (proteins that fight off infection)


To many harmful plasma cells
To Many Harmful Plasma Cells

  • Abnormal Plasma Cells are called Myeloma Cells and develop without warning

  • Myeloma cells collect in bones and cause “soft spots” where the cell is damaged


Effects of the blood

Normal cells are not being produced in the bone marrow

Bones are damaged

Bone demineralization (soft spots)

Effects of the blood


Symptomatic multiple myeloma
Symptomatic Multiple Myeloma

  • Calcium

  • Renal

  • Anemia

  • Bone


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