Blood Disorders
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| Sickle Cell Anemia | Have BOTH defective gene **if you only get one you are a carrier
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| Abnormal Hbg molecule= Hgb S= causes cells to sickle
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| complication of sickle cell anemia | cells cannot move through the blod vessls- they get stuck bc of shape
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| caused by | dehydration, stress, poor nutrition, vessels become clogged or blocked= tissue hypoxia
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| death usually occurs from tissue damage to major organs
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| S/S | pain in bones/organs, fever, anemia, clots in lungs or spleen/spleenomegaly, edema, leukocytosis, chest/abdominal pain, D. ulcers
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| Positive screening of Hgb | get immunized, stay rested= reduce the amount of o2 demand for body, rest, eat well, regular check ups
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| PRIORITY for sickle cell anemia patients | PAIN CONTROL-- while in hospital- give Pain med and IV fluids-- may be "fequent fliers"- give apin meds promptly - pain will be over whelming
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| unique manefestation on Sickle cell anemia | Acute chest syndrom
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| constantly check for HF R or L
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| coughing, wheezing, techypnea, chest pain Jaundice - due to increase rate of RBC destruction Gallstones - from increase bilirubin
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| risk for infection compromises growth Priapism-- increased time for an erection
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| when blood flow is reduced the patient will experience | localized ischemia, severe pain, tissue infarction, fever, pain, swelling
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| treatment is surrpotive rather than curative regular blood transfusion Narcotics Oxygen Hydration
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| Hemolytic Anemia | chronic premature destruction of RBCs (erythrocytes) iron and Hgb are released
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| caused by | autoimmune reaction radiation blood transfusion (maily if you get the wrong blood) arsenic & lead poisoning medication
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| S/S - may go unnoticed or a sudden, severe reaction may occur | mild fatigue, pallor, jaundice, palpitations, hypotension, dyspnea, back & joint pain-- wrong blood
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| Treatment and Interventions | Find and fix UNDERLYING cause Blood transfusion Erythrocytoapheresis- procedure that removes abnormal RBC and replaces them with healthy RBCS Splenectomy- surgical removal of spleen Corticosteroids- decrease autoimmune response
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| folic acid- increases production of RBCs
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| Pancytopenia | Numbers of ALL marrow-produced blood cells are reduced
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| Aplastic Anmeia | inadequate stem cell production in bone marrow possible autoimmune DEATH RATE IS HIGH
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| Assessment finding | infections (low WBC) coagulation abnormalities (low WBC) small skin hemorrhages (low platlets) enlarged spleem
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| Nursing Managmetn | watch for s/s of infection, assess temp, vitals, monitor for bleeding HISTORY
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| Pernicious Anemia | VIT B 12 deficieny- injections daily for 2 weeks then one per month for rest of life No cure but treatments are available for pt to have normal life span
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| Caused by | partial or complete removal of the fundus of the stomach (gastrectomies)
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| source of the intrinsic factor which is necessary for absorption of B12 | fundus
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| Necessary element in the production of RBC and NS function | VIT B 12
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| immature RBCs | large and die quickly
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| labwork will show | low RBC Hgb low High Bili- jaundice
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| Cardinal sign | tounge in sore and beefy red- toung is very vascular
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| the more Neurological problems | the worst the Anemia is (tingling of hands & feet, loss of body position, memory loss, confusion, depression, if NOT treated- partial or total paraylsis
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| Diet | high in protein, vitamins, minerals
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| B12 has no side effects & cannot overdose
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| Folic Acid Def | low folic acid levels -- Treatment-- VIT C- helps with maturity of RBC and absoption
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| Foods with Folate: | breads, cereals, green leafy vegies, orange juice, dried peas and beans
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| Polycythemia Vera (Erythrocytosis) | abnormal production of RBCS, WBCS, PLTS RBC count may range from 7-10 mill-- (norm is 3.6-5.4)
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| oxygen content of blood is diminished due to short life span of RBCS Blood flow rate is slowed due to increased thickness-- increased risk for clots
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| HTN- bc H blood vol- thick blood CVA- clotting factors H CHF- too much blood hemorrhage- at risk bc amount H amount of Blood
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| S/S | Angina(most common), HA, fatigue, Night sweats, Puritis, Dyspnea, enlarged spleen/liver, skin bruising, bleeding mucous membranes
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| Treatment- Objective- Supress bone marrown, decrease blood cell mass, reduce # of RBCS, WBCS, PLTS | chemo to suppress bone marrow phlebotomy- reduce excess volume (sv x wk) high risk for developing Leukemia
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| high fluid intake- help prevent clots restriction of blood flow- no tight cloths' encourage isometric exercise if angina - educate patient to REST
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| Position to put pt in with enlarged spleen | sitting position
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| Lymphatic System | a network of vessls that transport lymph (watery fluid from plasma that exits the walls of capillariers and enters interstitial space)
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| ALWAYS | check tonsils for size & enlargement
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| lymphocytes & macrophages | trap destroy remove (why our lymph nodes are swollen)
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| Primary lymphemdema | congenitally acquired/ Affects women more that men (mastectomy)
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| Secondary Lymphedema | develops from complications of other disorders, removal of mult lymph nodes
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| Parasitic worm-- Most common cause of Lymphedema -- always ask about forgien travel (secondary)
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| when the volume of lymph exceeds the capicity of the vessels- lymph enters interstitial space w/in soft tissues | trapped fluid eventually causes non-pitting edema
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| RESULTS FROM IMPAIRED LYMPH CIRCULATION
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| nursing management for Lymphedema | assess affected area, elevate extremity, encourage movement, support, teach about garments and mechanical devices
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| Treatment | symptomatic
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| Lymphangitis, Lymphadenitis | Strepococcal microorganisms
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| red streaks-fever-tender-enlarged lymph nodes Visual inspection and Palpation
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| PAIN managment | note the respose to antibiotic therapy- decrease redness, swellilng, elevate extremity, apply warm soaks to area
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| BROAD SPECTRUM ANTIBIOTICS
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| Infectious Mononucleosis | Epstein-Barr Virus Direct contact secretions
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| Fatigue, Fever, sore throat, cervical lymph enlargement, oozing tonsils, pharyngeal swelling
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| Epstein-Barr virus can cause lyphoma bc | of the way it attacks the body
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| AViod blood donation for | 6 months
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| Hodgkins Disease | Reed Sternberg cells onset 15-40 and then older than 55 orderly growth more curable
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| Non-Hodgkins | NON-reed sternberg cells Genetic - Aggressive peaks after 50 30 subtypes B&T cell origins Mets common Less curable
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| Leukocytosis | increase in WBC sign of infection more indicate leukemia usually accompany fever
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| common s/s of leukemia | anemia, weakness, fatigue
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| definite cause is unknown- toxic chemicals, radiation, viruses, certain drugs, genetics
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| ALL | occurs primarily in children
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| AML | Affects all age ranges
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| CLL AND CML | CLL- commonly affects those older than 40- MOST COMMON in adults CML- found in those older that 20- incidence increases with age- 95% genetic link
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| in ALL leukemias- there is risk of infection
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| ecchymosis | bruising
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| petichia | tiny red dots
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| purupa | redish/ purple small skin hemorrhages
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| most of the pt discomfort results from treatment than the disease | chemo/radiation
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| normal platlet count | 150,000-350,000
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| WBC | 5,000-10,000
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| if you have cancer and you are anemic | you will recieve a blood transfusion
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| treatment of choice if remission occrs | Bone Marrow Transplant
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| Multiple Myeloma | Cause is unkown CANCER OF THE plasma cells - results in abnormal production of immunoglobulins Abnormal plasma cells cannot protect the pt
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| PLASMA CELLS | destroy bone & lymph nodes, liver, spleen and kidneys
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| symptoms occur when kidneys are damaged or infection sets in Pathological FX RENAL CALCULI
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| HOW MUCH FLUID | 3-4 L unless contraindicated
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| Agranulocytosis Caused by adverse reaction to... | Butazolidine, Choloromycetin, Penicillin & its derivatives, Dilantin, Onocovin, Diuretics, Thorazine, Sulfa CELEBREX
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| Neoplastic disease- cancer causing
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| chemotherapy, radiation, bacterial and viral infections
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| RESULTS IN | bone marrow suppresion- thus reducing WBC pro # of granulocytes are severly reduced
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| s/s | HA, fever, chills(BAD-chills cause body heat=fever)Fatigue Mucous membrane ulceration of the...
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| nose, mouth, pharynx, vagina, rectum
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| MAIN GOAL | remove cause of bone marrow supression prevent or treat infection
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| blood transfusion- provide mature wbc to wk system
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| protective isolation | due to low WBC- reverse or neutropenic
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| diet | soft, bland, high in calories, protein, vitamins
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| Aplastic Anmeia | bone marrow shuts down completely severe life threatening very poor DX
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| ppl on chemo have blood drwn | everyday for labs
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| 1st sign of organ rejection | FEVER
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| thrombocytopenia | decrease inPLT count related to
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| aplastic anemia, tumors, leukemia, chemo
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| platelet survival rate is also lowered due to | infection or viral illness
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