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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


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    1. Nursing management of patients with hematologic dysfunction Nursing 210 Fluid and Cells Laurie Brown RN, MSN, MPA-HA, CCRN

    2. Development of Blood Cells

    3. Hemoglobin and Hematacrit Hb: Women: 12-16 Men: 13.5-18 Hct: Women: 38-47% Men: 40-54%

    4. Complete Blood Count White Blood Cells (WBC) 5,000-10,000

    5. Neutrophil Eosinophil Basophil Lymphocyte Monocyte 50-70% 2-5% 0-2% 20-40% 4-8% WBCDifferential

    6. CBC Platelet Count 150,000-400,000

    7. Red Cells • Mean Corpuscular Hemoglobin (MCH) • Mean Corpuscular Volume (MCV) • Mean Corpuscular Hemoglobin Concentration (MCHC)

    8. Clotting • Extrinsic • Intrinsic

    9. Heparin PTT Coumadin PT or INR Vitamin K Protamine sulfate

    10. Drugs Impairing the Hematologic System • Drugs causing bone marrow suppression • Drugs causing hemolysis • Drugs that disrupt platelet action • Drugs that disrupt clotting action

    11. ANEMIAS • “Can Not Make” • “Lost” • “Destroyed”

    12. Iron Deficiency Pernicious Anemia Folic Acid Deficiency Trauma Chronic loss Sickle Cell Infectious Agents Antibodies Aplastic Anemia G6PD Deficiency ANEMIAS

    13. Sickle Cell Anemia • Pain Control • Sickle cell crisis • Rational for orders • Nursing orders

    14. Pernicious Anemia • Vitamin B 12 • Intrinsic Factor • Cells mutate and become large • Development of Neurological problems

    15. Clotting Problems • Thrombocytopenia • Hemophilia • Von Willebrand • Disseminated Intravascular Coagulation (DIC)

    16. DIC “Imbalance between the process of coagulation and anticoagulation”

    17. Treatment

    18. Heparin Administration • Heparin loading dose • Initial Maintenance Infusion • Dosage calculation often by patients weight

    19. Identification Lab values Drs order verify Pt assessment IV site assessment Documentation Verify with 2nd RN Monitor VS Remain with the patient TransfusionAdministration

    20. Automatic IV infuser pump • Flow rate calculation • Blood/Blood product w/tag • 150 cc NS • Blood Administration Set • Gloves

    21. 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

    22. Autologous Blood Transfusions • Preoperative autologous blood donation • Acute normovolemic hemodilution • Intraoperative autologous transfusion • Postoperative blood salvage

    23. 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

    24. 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

    25. Leukemia • AML - Acute Myelogenous • ALL - Acute Lymphocytic • CML - Chronic Myelogenous • CLL - Chronic Lymphocytic

    26. FAB Leukemia Classification • French American British Classification • Historically distinguishing AML from ALL was a major clinical problem • Chemotherapy dependent on tissue type

    27. 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

    28. Bone Marrow Aspiration • Bone marrow biopsy • Bone marrow aspiration

    29. Lymphoma • Hodgkin’s lymphoma • Non-Hodgkin’s lymphoma

    30. Multiple Myeloma • Gammopathy • “M” Protein • called a tumor marker

    31. 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

    32. 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)

    33. 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

    34. Normal cells are not being produced in the bone marrow Bones are damaged Bone demineralization (soft spots) Effects of the blood

    35. Symptomatic Multiple Myeloma • Calcium • Renal • Anemia • Bone