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ch33 blood


CBC consists of/identifies: total # blood cells hemoglobin/hematocrit % RBC indices (shape/size)
bone marrow aspiration/biopsy assess formation of blood cells, quantity/quality of each type. Used to confirm marrow infection/tumor.
bone marrow aspiration/biopsy hazards bleeding- apply pressure infection- aseptic technique acetaminophen/Tylenol for pain avoid NSAID's (risk of bleeding)
ANEMIA < normal hemoglobin/RBC's = < normal oxygen delivery
types of anemia Hypoproliferation= defective RBC production) Bleeding = RBC loss Hemolytic = RBC destruction
complications (s/s) of severe anemia: heart failure paresthesias delirium/confusion (angina if heart disease)
treatment of anemia correcting / controlling cause if severe: packed red blood cell (PRBC) transfusion
pica craving of ice, starch, or dirt found in those with iron deficient anemia
subjective s/s anemia objective s/s anemia S: weakness, fatigue, malaise, palor, pica O: jaundice, palor, tongue = red/sore (smooth), angular cheilosis, brittle rigid nails
possible RN Dx @ anemia fatigue r/t < Hgb & < O2 carrying of blood altered nutrition < body required altered tissue perfusion r/t < Hgb/Hct
RN anemia interventions -manage fatigue -adequate diet (iron,B12,Folic Acid,protein) -FVD = IV fluids and/or transfusion
most common anemia= iron deficient anemia cause should be thought BLEEDING until proven otherwise
anemia labs (iron deficiency) -low serum Fe = low Hbg -MCV decreases -Low Hct / RBC related to Hgb -elevated TIBC
Iron IV/IM -parenteral test dose (anaphylaxis) -staining / Z-track
oral iron supplements -best empty stomach, with orange juice (Vit C) -w. food ok, if GI upset -avoid dairy and antacids (1h a.c. / 2h p.c.) -liquid stains teeth = use straw & rinse mouth
foods high in iron organ meats, meats, beans, leafy greens, raisins, molasses
foods high in Vit C citrus juices, orange, strawberry, tomato, broccoli
manage constipation w/ iron supplements by... -stool softeners -high fiber diets
end stage renal / hemodialysis anemia.. -monitor for folate and iron deficiency -maintain Hgb 11-12g/dL DO NOT EXCEED 13 -CK Hgb FREQUENTLY
APLASTIC ANEMIA (rare)decreased-damaged marrow stem cells. -marrow aplasia -neutorpenia / thrombocytopenia also occur
s/s aplastic anemia -complications of marrow failure -infections / anemia -purpura -retinal hemorrhages common
treatment of aplastic anemia -bone marrow transplant (BMT) -periph. blood stem cell Xplant (PBSCT) -immunosuppresive therapy
MEGALOBLASTIC anemia anemia caused by Vit B12 or folic acid deficiency
Folate / Folic Acid foods liver green veggies
megaloblastic (folate) anemia more common in .. alcoholism poor diet (few/no veggies) pregnancy hemolytic anemias GI malabsorptive diseases
megaloblastic (B12) anemia more common in .. strict vegetarians (no meat/dairy) Crohn's disease Pernicious anemia gastric cancers
schilling test used to determine B12 vs. Folate deficient megaloblastic anemia. oral B12, raidoactive B12, intrinsic factor admin, then urinalysis.
intrinsic factor antibody test used to confirm / rule out pernicious anemia along side other tests
hemolytic anemia rbc shortened lifespan = <RBC, hypoxia
hemolytic anemia labs elevated reticulocytes increased indirect bilirubin less haptoglobin more hemoglobin
Hemolytic & Cycle Cell anemias treatment mainly transfusions
transfusion complications include: iron overload, poor venous access, infections, alloimmunization, increased blood viscosity
Sickle Cell management includes -daily folic acid -strict infection monitoring -pneumococcal & flue vaccines -careful hydration -pain management (ASA, NSAID, morphine PCA)
thalassemia 2 types alpha / beta hereditary anemias associated with defective synthesis of hemaglobin..more often mediterranean, african, asian
glucose-6-phosphate dehydrogenase deficiency G6PD deficiency inherited enzyme deficiency african american, greek, italian, mediterranean, asian, jewish, more MEN.
G6PD deficiency events caused by... fever, specific meds, fava beans
immune hemolytic anemia caused by.. antibodies, results in hemolytic transfusion reaction
most hemolytic amemias are which type? WARM
immune hemolytic anemia manifestations mild - life threatening fatigue / dizziness splenomegally hepatomegally lymphadenopathy / jaundice
immune hemolytic anemia mgt -stop offending Rx -high doses corticosteroid -blood Xfusions possible -splenectomy possible (=lifelong risk for infection, need flu/pneu vaccines -immunosuppressive agents
hereditary hemochromatosis excess iron absorbed from GI > 1-2mg daily excess iron deposited into various organs which become dysfxnal
leukopenia < normal lymphocytes / neutrophils
Neutropenia < 2000/mm squared neutrophil count increased risk for bacterial infection exogenous & opportunistic
ANC readings & risk for infection.. significant if <1000 high if < 500 almost certain if <100
patient with neutropenia often do not present signs of ___. Therefore... patient with neutropenia often do not present signs of INFECTION. Therefore, FEVER, may not occur (especially if corticosteroids)
thrombocytopenia risk for infection values not significant until <20,000 or if invasive procedure <50,000 (Plt)
Acute Myeloid Leukemia (AML) most common non-lymphocytic leukemia
most common complications and/or causes of death in AML-acute myeloid leukemia major hemorrhages (thrombocytopenic) and infections (neutropenic)
RN DX related to Leukemia risk for: infection,bleeding,impaired skin integrity, imbalanced nutrition, mobility, fatigue, acute pain, EFV / FVD, diarrhea, impaired mucus membranes, etc
RN interventions for Leukemia prevent/mgt infections-bleeding mgt mucositis improve nutrition ease pain decrease fatigue maintain fluid-electrolytes improve self care mgt anxiety/grief spiritual well being promote self/home/community care
MYELOMA -2nd most common hematologic cancer -back or rib pain -elevated total protein levels -hypercalcemia -dehydration, thirst, constipation, confusion, (coma)
primary thrombocythemia essential thrombocthemia -bone marrow/stem cell disorder -increased platelet production - >600,000/mm(cubed) (normal 150-450 X 10(cubed))
thrombocythemia s/s -painful burning, warmth, redness in localized distal area of extremity -hemorrhage / occlusion -DVT / pulmonary embolism -headacheds, diplopia
secondary thrombocytosis increased number of platelets can be caused by many other Dx: infections, chronic inflammation, iron deficiency, cancers, hemorrhage, splenectomy
thrombocytopenia decreased platelet counts normal = ?
causes of thrombocytopenia < production (LEUKEMIA..) > destruction (LUPUS/LYMPHOMA..) > consumption (DIC)
treatment of 2ndary thrombocytopenia platelet transfusion thrombocytopenia bleeding precautions p. 938
idiopathic thrombocytopenic purpura ITP more common women/young children acute or chronic (2 forms) macrophages ingest platelets marrow increases platelet production
s/s of ITP idiopathic thrombocytopenic purpura -easy bruising -heavy menses -petechiae -GI bleeding and/or hemoptosis
thrombocytopenia platelet count #'s 30,000-50,000 = carefully observed 20,000/bleeding = improve count 10,000 = increased risk of bleeding 5,000 = spontaneous/fatal CNS or GI hemorrhage may occur
hemophelia A hemophelia B/ Christmas disease -inherited, X-linked = males -hemorrhages into body parts (mostly joints) -poor clotting/ poor healing
treatment of hemophelia A/B -factor VIII or IX transfusion (-recombinant factor VIIa for those with VIII, IX antibodies) -Aminocaproic Acid helps stabilize clots
hemophalia teachings -avoid alcohol, nsaids, aspirin, -good dental hygeine -avoid injections/invasive procedures -id bracelets -prophylactic factor Xfusions -genetic testing
disseminated intravascular coagulation (DIC) sign of underlying other condition variable severity, potentially life threatening massive amounts tiny clots form in microcirculation / excessive clotting = bleeding
DIC can be triggered by... sepsis, trauma, cancer, shock, toxins, allergic response
s/s of DIC p. 956 per system bleeding multiple organ dysfxn syndrome (MODS) renal failure
treatment of DIC -O2, fluids, electrolytes, vasopressor, cryoprecipitate, fresh-frozen plasma, HEPARIN, aminocaproic acid
THROMBOTIC DISORDERS hyperhomocysteinemia antithrombin deficiency protein C deficiency protein S deficiency activated protein C resistance Factor V Leiden Mutation acquired thrombophilia
various types of ANEMIAS iron defifiency anemia renal disease anemia aplastic anemia megaloblastic anemia sickle cell anemia thalassemias
conditions resulting from thrombosis include: MI, CVA, periph. arterial occlusive disease, DVT, pulmonary embolism -ANTICOAGULATION THERAPY NECESSARY-
hyperhomocysteinemia -elderly, renal failure, smokers -deficient folic acid, B6, B12 test = admin methionine, measure serum homocysteine in 4 hours
antithrombin deficiency -hereditary -later in life >50yrs -DVT, and other thrombi -heparin resistance
protein C deficiency -hereditary -thrombotic events 30-45yrs of age -warfarin induced skin necrosis** **antidote = Vitamin K **infuse heparin & fresh frozen plasma, purified protein C concentrate
protein S deficiency -spontaneous recurrent venous thrombi -as early as 15 years of age -axillary, mesenteric, cerebral **warfarin induced skin necrosis possible
factor V Leiden Mutation most common cause of inherited hypercoagulability in caucasians -homozygous=anticoag Rx for life -heterozygous=anticoag Rx few months
heparin induced thrombocytopenia (HIT) -complication of heparin therapy -formation of antibodies against heparin-platelet complex s/s = decreased platelet count 4-14 days after starting therapy MONITOR PLATELET COUNTS IF HEPARIN THERAPY
HEPARIN INDUCED THROMBOCYTOPENIA / HIT increases risk of ... MI, CVA, DVT, ischemic damage to extremity necessitating amputation. fatal thrombosis risk 20-30%
LMWH LOW MOLECULAR WEIGHT HEPARINS dalteparin/Fragmin enoxaparin/Lovenox -have more selective effects on coagulation- lower incidence of HIT but also CONTRAINDICATED IN HIT!!
WARFARIN/COUMADIN -anticoagulation therapy -Vit K is antidote -avoid Vit K foods (spinach, broccoli, lettuce) -monitor INR (standard reporting of PT)
nursing mgt of thrombotic disorders -avoid circulatory stasis -ambulate -anti embolism stockings -low dose aspirin therapy -avoid tabacco/nicotine use -avoid crossing legs -Rx-Rx considerations (warfarin)
therapies for blood disorders splenectomy therapeutic apheresis blood component therapy special preparatoins
splenectomy complications, etc -pneumonia (vaccine prior if able) -abdominal distention -abscess formation -lethal infections **see care if minor signs of infections **predisposed to serious thrombotic/hemorrhagic problems
apheresis -blood is passed thru centrifuge -components separated -platelets / leukocytes / stem cells
diseases transmitted by blood transfusion -Hep B/C (viral) -AIDS / HIV -Cytomegalovirus (CMV) -Graft vs. Host disease -Creutzfeldt-Jacob disease (CJD)
blood donor qualifications = -health history screening -50kg/110lbs (450mL donation) -oral temp >99.6 -pulse reg, 50-100 -BP: 90/50-180/100 -Hgb: men 13.5 / women 12.5
autologous donation -patients own blood is collected for possible future use -4-6 weeks preop -iron supplements NEVER PLACED IN GEN DONOR SUPPLY CAN BE FROZEN UP TO 10 YRS
MOST COMMON TRANSFUSION REACTION? febrile nonhemolytic reaction fever / chills antipyretics ok
most dangerous transfusion reaction? ACUTE HEMOLYTIC REACTION -life threatening -ABO mis-match
Created by: rtcdavis