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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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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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