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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
slide7
CBC

Platelet Count

150,000-400,000

slide8

Red Cells

  • Mean Corpuscular Hemoglobin (MCH)
  • Mean Corpuscular Volume (MCV)
  • Mean Corpuscular Hemoglobin Concentration (MCHC)
clotting
Clotting
  • Extrinsic
  • Intrinsic
slide10

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)
slide17
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
slide21
Automatic IV infuser pump
  • Flow rate calculation
  • Blood/Blood product w/tag
  • 150 cc NS
  • Blood Administration Set
  • Gloves
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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