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Hematology Problems

BC3 - Hematology Problems

What 3 ways can a body have anemia Decreased production of RBC's; Blood Loss; Increased RBC destruction
Anemia r/t decreased production of RBC's Decreased hemoglobin synthesis - bone marrow is not producing enough Defective DNA synthesis - congenital (ex: Sicle cell & thalesemia)
Anemia r/t blood loss Acute (ex: car wreck) Chronic (ex: GI Bleeds in elderly; menstruating women)
Anemia r/t increased RBC destruction (the body destroys) Intrinsic - congenital (ex: sicle cell - genetic) Extrinsic - chemotherapy - meds - radiation
Physiologic Effects of Anemia Result from tissue hypoxia and compensatory mech - (^HR); Dec O2-casrrying capacity of blood; Hgb give up O2 easier to tissues; Blood goes to vital organs first; Inc cardiac output ^HR, ^BP; Inc rate of RBC production
Hbg Level of Mild Anemia 10-14
S/S of mild anemia Palpitations, dyspnes, diaphoresis
Hgb Level of Moderate Anemia 6-10
S/S of Moderate Anemia Inc. Cardiopulmonary s/s - chest pain; Pallor, Jaundice, Pruritis, Changes in fingernails - spoon-shaped, pale nail beds
Cardiopulmonary changes r/t anemia Tachycardia, Tachypnea, dyspnea
Cardiopulmonary changes r/t anemia with prolonged chronic anemia Murmurs, bruit in carotid, Angina, MI, CHF
Neurologic Changes r/t anemia HA because of lack of O2, Vertigo, Mood changes, Impaired through process
GI Changes r/t anemia Anorexia, Hepatomegaly, Splenomegaly
Musculosketal Changes r/t anemia Bone pain because bone marrow is stimulated and is making more RBC
General s/s of anemia Fatigue, weight loss, lethargy, sensitivity to cold
Etiology of Iron Deficiency Anemia Inadequate dietary intake Malabsorption Blood loss & not replacing it; Over time - GI bleed Hemolysis - breaking down cells too quickly
Nutrients needed for erythropoiesis Iron, Vitamin B 12 - cobalamin, Folic Acid, Proteins, Enzymes, Minerals - Fe & Calcium
Nursing Implications of Iron Preps Absorbed best in acidic environment, Cause GI Upset, Liq preps stain teeth, Constipation, Black, Tarry stools; IV preferred(irritating) but can be given Z-track)
Most important nursing diagnosis r/t anemia Risk for Injury!!
Thalassemia patient's make defective protein; cells are being broken down (^jaundice); Mediterranean ethnic groups
Thalassemia Minor Recessive trait - little bit
Thalassemia Major Poor Prognosis
Aplastic Anemia Rare stem cell disorder; do not produce WBC, RBC or Platelets; Can be congenital or acquired
S/S of Aplastic Anemia S/S of anemia, Bleeding, Infection
Etiology of Acquired Aplastic Anemia Radiation, Chemicals, Drugs, Chemo drugs, Infection, Pregnancy, Idiopathic
Dx of Aplastic Anemia A bone marrow that is called a "dry tap"
Tx of Aplastic Anemia Bone marrow transplantation/ immunosuppressant drugs
Anemia Caused by Blood loss can be both acute & chronic
Acute blood loss r/t anemia can cause Hypovolemic shock (see dramatic symptoms); decreased O2 carrying capacity (ex: car accident)
Anemia caused by chronic blood loss depletion of iron stores - body compensates (ex: GI bleed, heavy periods)
Def of Hemolytic Anemia anemia caused by increased erythrocyte destruction
Etiology of Hemolytic Anemia (NOT Fe Deficiency) Premature destruction of RBC Increased hematopoeisis Increased reticulocytes Normochromic, normocytic RBC's
Causes of Hemolytic Anemia can be intrinsic and extrinsic
Causes of Intrinsic Hemolytic Anemia RBC membrane defects, Hgb structure defect, Inherited enzyme defects
Causes of Extrinsic Hemolytic Anemia Drugs, chemicals, toxins, trauma, burns
Definition of Sickle Cell Anemia Homozygous recessive heredity - have to have 2 parents carry trait; African American
Pathophysiology of Sickle Cell Anemia Decreased O2 tension, have abnormal Hgb, RBC's enlongated and obstruct capillaries - get stuck - occludes circulation; Ischemia and infarction
Manifestations of Sickle Cell Classic s/s of anemia, Damage to organs - heart, lungs, kidneys, Priapism, Hand-foot syndrome, Susceptible to infection
Priapism penile erection that won't go away - painful
Dactylitis effect on hands/feet - malformed
Manifestations of Sickle Cell in Children Small, short, thin, Delayed growth & development, Acute splenic sequestration, Dactylitis
Acute splenic sequestration Blood gets trapped in spleen - spleen enlarges - goes into shock and can die in 30 minutes (under age 2)
Sickle Cell patient's can develop blindness, Stroke, chest/abd pain, painful joints, freq. pneumonia, enlarged hearet, fever
Triggers of a Sickle Cell Crisis Hypoxia, Dehydration, Infection, Overexertion, Anesthesia, Weather changes, Alcohol, Smoking
Tx of Sickle Cell Crisis HOP - Hydration, Oxygenation, Pain Relief
Manifestations of a Sickle Cell Crisis INTENSE PAIN, fever, Tissue hypoxia - - tissue pain & death
Dx of Sickle Cell Anemia Peripheral smeal, Sickle cell preparation, Hemoglobin electrophoresis
Care for Patient with Sickle Cell Anemia Rest, Analgesia, Oxygen, Hydration, Treat precipating factors, Hydroxyures, Transfusion tx if Hgb dec., Therapeutic apheresis
General management of Sickle Cell Anemia Vaccination against everything, Hydration, Trigger avoidance, Prophylactic antibiotics, Bone marrow transplant, Client education, Good nutrition
Polycythemia means many cells - affects all cells
Patho of Polycythemia Myeloproliferative disorder - bone marrow; Increased production of cells, Increased blood viscosity & volume, Congestion of organs/tissue; splenomegaly
S/S of Polycythemia Vera Hypertension, HA, Tinnitus, Blurred vision, Cyanosis, Plethora, Fatigue, Pruritus, Pain in extremities, Night sweats, Wt. Loss, Epistaxis, GI bleeding, Dizziness
Complications of Polycythemia CHF, CVA, Thrombophlebitis, Hemorrhage, Hyperuricemia
Dx tests for Polycythemia ^ H/H, ^WBC, basophilia, ^platelets & platelet dysfunction, ^alkaline phos, uric acid, cobalamin, ^ histamine
Care for a patient with Polycythemia Phlebotomy - bleed them, Hydration, Bone marrow suppressant drugs, anti-immune drugs, Allopurinol, anti-platelets
Nursing care for a patient with Polycythemia Control of COPD, Phlebotomy, Fluid management, safe medication mgmt, Prevention of thrombus formation
Primary Polycythemia affects all cells
Secondary Polycythemia affects RBC's only - NO itching, NO bleeding, Elevated Hct
Secondary Polycythemia occurs from COPD because the lack of O2 causes increaased RBC production
Created by: okrecota