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Alterations in the hematoligic system Disorders of erythrocytes (RBCs), platelets,leukocytes (WBCs),coagulation
Anemia A deficiency in the Number of erythrocytes (red blood cells [RBCs]) Quantity of hemoglobin Volume of packed RBCs (hematocrit) Not a specific disease Manifestation of a pathologic process Identified and classified by laboratory diagnosis
Anemia General Symptoms of Anemia Integumentary Manifestations Pallor ↓ Hemoglobin ↓ Blood flow to the skin Jaundice ↑ Concentration of serum bilirubin Pruritus ↑ Serum and skin bile salt concentrations
Anemia General Symptoms of Anemia Cardiopulmonary Manifestations Tachycardia Tachypnea Fatigability Dyspnea Orthopnea Orthostatic hypotension MI
Anemia General Symptoms of Anemia Neurological manifestations Inability to concentrate Vertigo Irritability
Anemia General Symptoms of Anemia GI Manifestations Anorexia Abdominal pain
Diagnostic findings Mild = Hb 10 to 14 g/dl May exist without symptoms Possible symptoms Palpitations, dyspnea, diaphoresis Moderate = Hb 6 to 10 g/dl Increased cardiopulmonary symptoms Experienced at rest or during activity
Diagnostic findings Severe = Hb <6 g/dl Involve multiple body systems Integument Eyes Mouth Cardiovascular Pulmonary Neurologic Gastrointestinal (GI) Musculoskeletal
Iron-Deficiency Anemia One of the most common chronic hematologic disorders Iron is present in all RBCs as heme in hemoglobin and in a stored form, ferritin
Iron-Deficiency Anemia Etiology Inadequate dietary intake 5% to 10% of ingested iron is absorbed Malabsorption Blood loss Hemolysis
Iron-Deficiency Anemia Diagnostic Studies Laboratory findings Hb, Hct, MCV, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, platelets Stool guaiac test Endoscopy Colonoscopy
Iron-Deficiency Anemia Collaborative Care Goal is to treat the underlying disease Increased intake of iron Nutritional therapy Oral or occasional parenteral iron supplements Transfusion of packed RBCs
Iron-Deficiency Anemia Nursing Management At-risk groups Premenopausal women Pregnant women Persons from low socioeconomic backgrounds Older adults Individuals experiencing blood loss
Megaloblastic Anemias Classification Cobalamin (vitamin B12) deficiency Folic acid deficiency
Cobalamin Deficiency Etiology Absence of intrinsic factor (IF) Acid environment required for IF secretion GI surgery Long-term users of H2-histamine receptor blockers
Cobalamin Deficiency Clinical Manifestations General symptoms of anemia Sore tongue Anorexia Nausea Vomiting Abdominal pain
Cobalamin Deficiency Diagnostic Studies Normal serum folate levels and decreased cobalamin levels suggest megaloblastic anemia due to cobalamin deficiency Schilling test
Cobalamin Deficiency Collaborative Care Parenteral administration of cobalamin Increase in dietary cobalamin does not correct the anemia Still important to emphasize adequate dietary intake
Cobalamin Deficiency Nursing Management Familial disposition Early detection and treatment can lead to reversal of symptoms Ensure that injuries are not sustained because of the patient’s diminished sensations to heat and pain
Folic Acid Deficiency Common causes Poor nutrition Malabsorption syndromes Drugs Alcohol abuse and anorexia Lost during hemodialysis
Folic Acid Deficiency Clinical manifestations are similar to those of cobalamin deficiency Insidious onset Absence of neurologic problems Treated by replacement therapy Encourage patient to eat foods with large amounts of folic acid
Anemia of Chronic Disease Underproduction of RBCs Mild shortening of RBC survival Causes End-stage renal disease Primary factor: ↓ Erythropoietin Chronic liver disease Chronic inflammation Malignant tumors Chronic endocrine diseases
Anemia of diagnostic findings ↑ Serum ferritin ↑ Iron stores Normal folate and cobalamin levels Treating underlying cause is best Rarely blood transfusions Erythropoietin therapy
Chronic Blood Loss Reduced iron stores Bleeding ulcer Hemorrhoids Menstrual and postmenopausal blood loss
Chronic Blood Loss Management Identify source Stop bleeding Possible use of supplemental iron
Acute Blood Loss Result of sudden hemorrhage Trauma Complications of surgery
Acute Blood Loss Clinical Manifestations Tissue hypoxia Tachycardia Tachypnea Bone pain Internal hemorrhage Tissue distention, organ displacement, nerve compression Pain Retroperitoneal bleeding Numbness Pain in the lower extremities Shock is the major complication
Diagnostic Studies Laboratory data do not adequately assess RBC problems for 2 to 3 days
Collaborative Care Replacing blood volume to prevent shock Identifying the source of the hemorrhage Stopping blood loss Correcting RBC loss
Aplastic Anemia Rare Damage or decrease in the# of stem cells in bone marrow Congenital Chromosomal alteration
Aplastic Anemia Acquired Caused by exposure to benzene &benzene derivatives(air plane glue),radiation, infections,pregnancy Results in neurtopenia& thrombocytopenia Unknown etiology in 50% of the cases
Aplastic Anemia Clinical Manifestations Symptoms of anemia Infection Purpura Lymphadenopathies Splenomegaly Retinal hemorrhages
Aplastic Anemia Diagnostic findings Decreased RBCs, WBCs and platelets Decreased reticulocyte count (immature RBCs) Bone marrow examination Decrease activity of bone marrow/no cell activity
Aplastic Anemia Collaborative Care Remove the cause Treat symptoms Transfusions RBCs Platelets Bone marrow transplant/peripheral stem cell transplant
Anemia Nursing Diagnoses Activity intolerance Imbalanced nutrition: Less than body requirements Ineffective therapeutic regimen management Potential complication: Hypoxemia
Anemia Nursing Management Goals Maintain adequate oxygenation Assume normal activities of daily living Maintain adequate nutrition Develop no complications related to anemia Monitor labs Monitor oxygenation status Monitor for signs of bleeding Pace activities to avoid fati
Anemia Nursing Implementation Blood or blood product transfusions Drug therapy Oxygen therapy Patient teaching Nutrition intake Plan frequent rest periods Compliance with drug therapy
Polycythemia Excessive production of RBCs as well as platelets and leukocytes Increased blood viscosity Congestion of blood in tissues Liver Spleen Evolves to Acute Myelocytic Leukemia (AML)
Polycythemia Clinical manifestations Headaches Dizziness Parasthesias Visual disturbances Hypertension Thrombophlebitis Joint pain Hepatosplenomegaly Ruddy complexion Angina Pruritis
Polycythemia Diagnostic findings Increased RBCs Increased Hgb & Hct Increased uric acid levels (due to increased RBC destruction)
Polycythemia Collaborative Care Phlebotomy Myelosuppressive therapy Pain relief Monitor for organ failure Kidneys Heart Cerebral perfusion
Polycythemia Nursing Management Pain management Monitor for organ failure Monitor for altered nutrition (less than body requirements) Monitor for complications post phlebotomy Orthostatic hypotension Tachycardia Decreased LOC Chest pain
Thrombocytopenia Reduction of platelets below 150,000/ul Immune thrombocytopenic purpura (ITP) Most common acquired form Autoimmune – platelets destroyed in the spleen Thrombotic thrombocytopenic purpura Uncommon Cause: unknown
Thrombocytopenia Heparin Induced Thrombocytopenia an Thrombosis Syndrome (HITTS)
Thrombocytopenia Clinical manifestations Epistaxis(nose bleed) Gingival bleeding Petechiae Purpura Ecchymosis Internal bleeding
Thrombocytopenia Complications Hemorrhage Cerebral hemorrhage fatal
Thrombocytopenia Collaborative Care Stop bleeding Replace coagulation factors Blood & blood product transfusion Plasmaphoresis Treat underlying cause Splenectomy Medications Corticosteriods Imuran
Thrombocytopenia Safety Bleeding precautions Avoid IM injections Avoid rectal manipulation Prevent constipation Apply direct pressure to venipuncture sites Avoid anticoagulants,anti-platelet medications Use soft tooth brush Avoid dental floss Use electric razor
Thrombocytopenia Safety Bedrest(platelet count < 20,000/mm3)
Thrombocytopenia Nursing Management Pain management Hemarthrosis Fluids & Electrolytes Maintain hydration status (IV/PO) – blood loss leads to decreased circulating volume
Thrombocytopenia Nursing Management Nutrition Promote erythropoiesis – Folic acid, B12 - RBC maturation Iron, B6 - Hgb synthesis Vitamin C - converts folic acid to active form, Fe absorption
Focus Assessment/Complications Cardiovascular Hypovolemia/Hypovolemic Shock: VS changes; S/S low cardiac output/decreased perfusion manifested in the following body systems: Integument Respiratory Neuro Renal
Focus Assessment/Complications Integument: petechiae/ecchymosis Hematological: prolonged bleeding w/ invasive procedures; occult blood Gastrointestinal: splenomegaly; abdominal pain & distention Neuro: CVA - cerebral bleed; retinal bleed Musculoskeletal: hemarthrosis
Neutropenia Decrease in neutrophil count as a result of decreased production or increased destruction Increased risk for infection Not a disease but a syndrome
Neutropenia Etiology Nutritional deficiencies Folic acid Cobalamin Medication induced Chemotherapeutic agents Autoimmune disorders Infections Sepsis
Neutropenia Clinical Manifestations Low WBC Low grade fever
Neutropenia Complication Infection Sepsis
Neutropenia Diagnostic Findings WBC; < 4000/ul Absolute Neutrophil < 1000 - 1500/ul presence of neutropenia 500 - 1000/ul moderate risk for infection < 500/ul severe risk for infection Bone marrow examination Determine the cause
Neutropenia Collaborative Care Prevention of infection Hand washing Private room if possible Medications Antibiotics Analgesics Antipyretics G-CSF (Neupogen)
Neutropenia Nursing Management Fluids & Electrolytes Adequate intake to prevent dehydration & possible urinary tract infection; up to 3-4L daily Monitor I&O
Neutropenia Nursing Management Nutrition Low microbial High nutritional value
Neutropenia Nursing Management Safety Avoid exposure/risk for infection Strict hand washing Avoid invasive procedures Pulmonary hygiene (IS, TCDB)
Neutropenia Nursing Management Discharge teaching Meticulous personal hygiene Avoid crowds Avoid persons known to have a cold or other contagious illness Avoid swimming in lakes and crowded pools Keep home free of dust/dirt
Leukemia A group of malignant disorders affecting the blood and blood-forming tissues of Bone marrow Lymph system Spleen Occurs in all age groups Fatal if untreated Progressive
Leukemia Etiology Type of white blood cell involved (WBC) Acute lymphocytic leukemia (ALL) Acute myelogenous leukemia (AML) Also called acute nonlymphoblastic leukemia (ANLL) Chronic myelogenous leukemia (CML) Chronic lymphocytic leukemia (CLL)
Leukemia Clinical Manifestations Relate to problems caused by Bone marrow failure Overcrowding by abnormal cells Inadequate production of normal marrow elements Anemia, thrombocytopenia, neutropenia
Leukemia Clinical Manifestations Relate to problems caused by Leukemic cells infiltrate patient’s organs Splenomegaly Hepatomegaly Lymphadenopathy Bone pain Seizures (meningeal irritation)
Leukemia Diagnostic Studies Peripheral blood evaluation Bone marrow evaluation (definitive diagnosis) Diagnose and classify Identify cell subtype and stage
Leukemia Collaborative Care Goal is to attain remission/disease control Chemotherapy regimen Radiation Bone marrow and stem cell transplantation
Bone Marrow and Stem Cell Transplantation Eliminate leukemic cells from patient’s body Replaced with those of an HLA-matched Sibling Volunteer Identical twin Patient’s own stem cells removed before
Bone Marrow and Stem Cell Transplantation Nursing Management Assess for signs and symptoms of disease progression,infection,bleeding,Provide nutrition,Prevent fatigue,Promote safety Observe for side effects of tx
Bone Marrow and Stem Cell Transplantation Nursing Management Patient empowered by knowledge of the disease& tx can have a more positive outlook& improved quality of life Nurses face special challenges when meeting the intense psychosocial needs of a patient with leukemia
Hemophilia Hereditary coagulation disorder Sex-linked recessive disorder Von Willebrand’s disease Hemophilia A (most common) Hemophilia B
Hemophilia Diagnostic Findings Assays for factors VIII, IX and vWF PTT is prolonged due to the intrinsic pathway problem Normal platelets and PT
Hemophilia Clinical manifestations Persistent and prolonged bleeding from injuries Delay of onset of bleeding Subcutaneous echymosis and subcutaneous hematomas Gingival bleeding GI bleeding Hematuria Hemarthrosis
Hemophilia Collaborative Care Replace the deficient coagulation factor Supportive treatment of symptoms Control bleeding Management complications
Hemophilia Nursing Management Supportive care Assess for symptoms; pain, bleeding Bleeding precautions Patient education Genetic counseling National hemophilia foundation Medical alert bracelet
Disseminated intravascular coagulation /coagulopathy (DIC) Imbalance between coagulation and anticoagulation Caused by sepsis, anoxia, burns, multiple trauma, amniotic fluid embolus, snake bites, metabolic acidosis, hypotension 80% mortality rate Net effect is hemorrhage
DIC Diagnostic Findings Prolonged PT Prolonged PTT Prolonged thrombin time Decreased fibrinogen Decreased platelets Elevated FDP/fibrin split products Elevated D-dimer
DIC Clinical Manifestations Related to the cause Purpura Ecchymoses Bleeding from various sites with pain and clinical manifestations associated with bleeding Hypotension Shock Death
DIC Collaborative Care Treat cause Symptom management Administer blood products Replace clotting factors Fresh frozen plasma (FFP) Cryoprecipitate
DIC Nursing Management Assess for hemorrhage Implement bleeding precautions Monitor for signs of fluid overload (transfusions) Assess for signs of renal failure Assess for signs of respiratory failure Supportive care
Complex protein-iron compound that binds with oxygen and carbon dioxide Hemoglobin
Process by which WBCs engulf and kill organisms Phagocytosis
Created by: LauraHall