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Hematologic problems

Care of the patient with hematologic problems

diagnosis of SCD based on the percentage of hemoglobin S (HbS) on electrophoresis.
Sickle cell trait (AS) HBS: AS rbc with permanent sickling: HBS: 40% rbc with permanent sickling: 5-50%
Sickle cell disease HBS: SCD rbc with permanent sickling: HBS: 80% to 100% rbc with permanent sickling: greater than 90%
Hematocrit of SCD low bt 20 and 30% due to short life span of RBC
Bilurubin level in SCD patients High
WBC levels in SCD patients WBC count is elevated due to chronic inflammation cause by hypoxia and ischemia
Changes in skull under XRAY a “crew cut” appearance X-rays of joints may show necrosis and destruction. Ultrasonography, computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) may show soft-tissue and organ changes
Priority problems in patients with SCD: 1 Acute Pain related to poor tissue oxygenation 2 Chronic Pain related to joint destruction 3 Potential for sepsis 4 Potential for multiple organ dysfunction and death
Conditions that cause sickling hypoxia, dehydration, infections, venous stasis, pregnancy, alcohol consumption, high altitudes, low or high environmental or body temperatures, acidosis, strenuous exercise, emotional stress, and anesthesia.
Cardiovascular changes in patients with SCD risk for high output heart failure S3 heart sound may be present increased jugular-venous pulsation or distention Rapid heart rate
Priaprism prolonged penile erection
Skin assessment every 8 hour, assess for subtle color changes. in black people, look at the roof of the mouth for a yellow appearance yellow sclera may be misleading
Skin integrity As many as 75% of adults with SCD have open sores or ulcers on the lower legs that are caused by poor tissue perfusion.
Liver and spleen in patients with SCD LIVER AND SPLEEN MAY FEEL FIRM
CNS changes in patients with SCD If the CNS has infarcts or repeated episodes of hypoxia, patients may have seizures or manifestations of a stroke, including pronator drift and a weakened hand grasp.
CARE OF THE PATIENT WITH SCD DO NOT ELEVATE HEAD OF BED ABOVE 30 degrees. Do not raise the knee position of the bed. Avoid taking blood pressure with external cuff. Check circulation in extremities every hour Remove any constrictive clothing.
T or F use IM injections in patients with False Avoid IM injections
Hydration in patients with SCD hypotonic fluids at 250ml/hr for 4 hr later reduced to 125ml/hr if more is needed 200ml/hr minimus is needed durring crisis
Infection risk of patient with SCD They are a greater risk because of reduced spleen fucntionality
Major cause of death in patients with SCD Acute Chest Syndrome, in which a vaso-occlusive episode (VOE) causes infiltration and damage to the pulmonary system
Teachings of sickle cell patients • Drink at least 3 to 4 liters of liquids every day. • Contact your health care provider at the first sign of illness or infection. • Avoid planes with unpressurized passenger cabins. • Avoid strenuous physical activities. Engage is low-impact exercis
Glucose-6-Phosphate Dehydrogenase Deficiency Anemia hemolytic (blood cell–destroying) anemia inherited as an X-linked recessive disorder fully expressed in homo males partial expression (carrier state) is possible in hetero females
Patho of G6PD break of RBC from exposure to some drugs (e.g., sulfonamides, aspirin, quinine derivatives, rasburicase, chloramphenicol, dapsone, high doses of vitamin C, and thiazide diuretics) and exposure to benzene and other toxins.
Warm antybody anemia/Cold antybody anemia Warm = IgG (98.6F) COLD = IgM (86F) use of steroid to suppress immune function splennectomy indicated if steroids are not working, as well as chemotherapy
Serum feretin value in Iron deficiency anemIa serum ferritin values are less than 10 ng/mL (normal range is 12 to 300 ng/mL).
Best time for taking iron supplement Best if taken between meals to reduce GI distress
IM or IV iron administration for IM, use the z-track method at dorsal gluteal site ferumoxytol (Feraheme): IV drugs associated with kidney disease
B12 anemia megaloblastic anemia deficiency can be cause by less intrinsic factor or low consumption can cause glossitis (beefy red tongue), fatigue, weightloss, paresthesia
Shilling test which measures the presence of vitamin B12 in the urine after the patient is given an oral dose of radioactive vitamin B12.
Aplastic anemia a deficiency of circulating red blood cells (RBCs) because of failure of the bone marrow to produce these cells.
Pheresis removal of
Polycythemia too much RBCs associated with intense itching poor oxygenation of tissue
Myelodysplastic Syndromes Myelodysplastic syndromes (MDSs) are a group of disorders caused by the formation of abnormal bone marrow cells. It results in anemia, neutropenia, thrombocytopenia
ecchymoses bruises
treatment of thrombocytopenia begins at what platelet level: 50,000/mm3
Thrombotic Thrombocytopenic Purpura Clot resulting from clumping of platelet patient at risk for bleeding
Hemophilia X-linked recessive
Transfusion double check another nurse administer within 4 hours use 20 gauge needle (larger = better) stay with patient for the 1st 15-20minutes
Transfusion in older adults assess every 15 min for signs of fluid overload. and signs of Transfusion Reaction • Rapid thready pulse • Hypotension • Increased pallor, cyanosis 2 hours in bt transfusion administer blood slowly, taking 2-4hrs
Platelet infusion done within 15 to 30 minutes use of smaller filter and shorter tubing
what to do if patient has history of reaction with platelet transfusion A patient who has had a transfusion reaction in the past may be given diphenhydramine (Benadryl) and acetaminophen (Tylenol) before the transfusion to reduce the chances of a reaction.
false signs of transfusion reactions being febrile and having rigors (severe chills)
Cryoprecipitate clotting factor for people with clotting factor disorders administered IV push in 3 minutes
Created by: ekm