Transcript Enteral Therapy

Immune & Haematologic
Disorders
NURS 2016
Chapters: 33, 51-54
Anemia
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Anemia: lower than normal hemoglobin
(normal is 120-180g/dL)
3 main categories:
– Loss of red cells
– Hypoproliferative
– Hemotytic
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Symptoms of anemia are more apparent
when onset is rapid. A person can
tolerate a 50% decreased in RBC
gradually, but rapid 30% decrease can
cause vascular collapse.
Assessment
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General: Weakness, fatigue, malaise
Appearance: Pallor of skill and mucous
membranes, tongue smooth red, beefy
ulcerations at corner of mouth
Appetite: Crave ice, starch
Nutrition: lack of iron, B12, folic acid,
vegetarians need to supplement B12
(comes from animal sources)
Assessment Cont’
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Cardiac Status: look for signs of
increased cardiac load
GI: N&V, coffee grounds, melena,
diarrhea, anorexia, stool for OB
Hx: menstrual cycle, alcohol and
family hx
Neuro: peripheral numbness, poor
coordination, confusion
Dietary Iron
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Iron deficiency anemia most common
Sources: organ meats, black, pinto
and garbonzo beans, leafy greens,
raisins & molasses
Vitamin C enhances absorption of iron
from dietary sources
Iron Supplements
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Ferrous Sulfate
Take 1 hour before or 2 hours after
meals (will not absorb with food)
Increase intake of vitamin C
Increase intake of fiber
Stool will be dark
Case Study
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Mark is 3 years old. His mother brings
him to the clinic after a diagnosis of
iron deficiency anemia after a routine
examination by his family doctor. He
is a very picky eater. He is to start
oral iron therapy.
Rheumatoid Arthritis
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Inflammatory disorder that primarily
involves the synovial membrane of the
joints
Clinical Manifestations:
– Joint pain
– Swelling
– Warmth
– Erythema
– Lack of function
Nursing Diagnosis
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Pain
Fatigue
Impaired mobility
Self-care deficit
Disturbed sleeping pattern
Disturbed body image
Ineffective coping
Interventions
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Relieving pain & discomfort
Reducing fatigue
Increasing mobility
Facilitating self-care
Improving sleep
Improving body image
Monitoring & managing potential
complications
Increasing knowledge of disease
management
Leukemia
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True cause is unknown
Unregulated proliferation or accumulation of
white blood cells (WBC)
In the bone marrow, replacing normal
marrow elements
Classified as either lymphocytic or mylocytic
according to the stem cell involved
Classified as acute (abrupt onset) or
chronic (evolves over months to years)
Leukemia
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Clinical Manifestations:
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Weakness
Fatigue
Bleeding tendencies
Petechiae
Ecchymosis
Vomiting
Fever
Infection
Headache
Pain
Nursing Diagnoses
Risk for infection & bleeding
 Impaired mucous membrane
 Pain & discomfort
 Imbalanced nutrition
 Risk for diarrhea
 Fluid imbalance
 Risk for excess fluid volume
 Risk for yperthermia
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Nursing Diagnoses
Cont’
Fatigue & activity intolerance
 Impaired skin integrity
 Grieving
 Disturbed body image
 Self-care deficit
 Deficit knowledge
 Anxiety
 Impaired gas exchange
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Nursing Interventions
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Preventing Bleeding
Preventing Infection
Managing Mucositis
Easing Pain & Discomfort
Attaining & Maintaining Adequate Nutrition
Management Fluid & Electrolyte balance
Decreasing Fatigue & Deconditioning
Improving Self Care
Managing Anxiety & Grief
Promoting Positive Body Image
Encouraging Spiritual Well-being
Human Immunodefinciency
Virus
(HIV)
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HIV Infection
Retroviruses
HIV asymptomatic
HIV symptomatic
Acquired
Immunodeficiency
Syndrome (AIDS)
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Risk factors:
– Transmitted through bodily fluids
Sexual intercourse (heterosexual or
homosexual)
 Injection of IV drugs
 Transfusions
 Childbirth/breastfed
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Clinical Manifestations
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Respiratory:
– SOB, dyspnea, cough, chest pain, fever
are characteristic of pneumonia
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G.I.:
– Loss of appetite, N&V, oral candidiasis,
diarrhea
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Neuro:
– Encephalopathy, peripheral neuropathy
Clinical Manifestations
Cont’
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Integumentary:
– Herpes simplex, flaking skin, skin cancers
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Reproductive:
– Vaginal candidiasis, ulcerative sexually
transmitted diseases (syphilis, herpes), PID,
amenorrhea
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Other:
– Fatigue, headache, night sweats, weakness,
weight loss, dry cough, SOB, diarrhea, edema,
swallowing difficulties, dementia, depression
Assessment
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Dietary Status
Skin & Mucous Membranes
Respiratory Status
Neurologic Status
Fluid & Electrolytes Status
Level of Knowledge
Use of Alternative Therapies
Nursing Diagnosis
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Impaired skin integrity
Risk for infection
Activity intolerance
Disturbed thought processes
Ineffective airway clearance
Imbalanced nutrition
Diarrhea
Pain
Social isolation
Anticipatory grief
Deficient knowledge
Nursing Interventions
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Improving airway clearance
Promoting skin integrity
Maintaining perineal skin integrity
Prompting usual bowel habits
Preventing infection
Relieving pain & discomfort
Improving nutritional status
Improving activity tolerance
Maintaining thought processes
Coping with grief
Monitoring & managing complications