Transcript Chapter 24 Nursing Care of Patients with Hematopoietic

Nursing Care of Patients with Hematologic
and Lymphatic Disorders
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Deficiency of Red Blood Cells, Hemoglobin, or
Both
◦ Impaired Production
◦ Increased Destruction
◦ Blood Loss
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Reduced Capacity to Carry Oxygen to Tissues
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Dietary Deficiencies
Hemolysis
Hereditary Disorders
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Pallor
Tachycardia
Tachypnea
Irritability
Fatigue
Dyspnea
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Pernicious Anemia
◦ Numb Hands or Feet
◦ Sore Tongue
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Iron Deficiency
◦ Mouth Fissures
◦ Glossitis
◦ Spoon-shaped Nails
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CBC with Microscopic Examination
Bone Marrow Analysis
Tests to Determine Source of Bleeding
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Eliminate Cause
Dietary Changes
Supplements
Transfusions
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Activity Intolerance
Imbalanced Nutrition
Risk for Injury
Impaired Oral Mucous Membranes
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Bone Marrow Does not Produce Adequate
RBCs
Causes
◦ Congenital
◦ Exposure to Toxins
◦ Chemotherapy
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Weakness
Fatigue
Pallor
Dyspnea
Headache
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Ecchymoses
Petechiae
Frank Bleeding
Infection
Death
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Diagnosis
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CBC
Bone Marrow Biopsy
TIBC
Serum Iron
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Treatment
◦ Treat Cause
◦ Colony Stimulating
Factors
◦ Steroids
◦ Bone Marrow
Transplant
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Inherited
Autosomal
Recessive Disorder
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Diagnosis
◦ Sickledex Test
◦ Hemoglobin
Electrophoresis
◦ CBC
◦ ESR
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Crisis Treatment
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Antibiotics
Pain Management
Transfusions
Fluids
Oxygen
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Avoid Risk of Reduced Oxygenation
◦ Exposure to Cold
◦ Infection
◦ Strenuous Exercise
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Low Dose Penicillin
Frequent Transfusions
Hydroxyurea
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Risk for Ineffective Tissue Perfusion
Acute Pain
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Avoid
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Tight Clothing
Strenuous Exercise
Alcoholic Beverages
Cold Temperatures
Smoking
Unpressurized Aircraft
Exposure to Infection
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Overabundance of Red Cells
Hemoglobin >18 mg/dL
Hematocrit >55%
Blood Becomes Thick
◦ Primary
◦ Secondary
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Hypertension
Visual Changes
Headache
Vertigo
Dizziness
Tinnitus
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Bleeding
Chest Pain
Dyspnea
Dark, Flushed Skin
Itching
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Phlebotomy
Low Dose Aspirin
Chemotherapy
Radiation Therapy
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Drink 3 Liters of Water Daily
Avoid Restrictive Clothing
Elevate Feet
Report Signs and Symptoms of Iron
Deficiency
Report Signs and Symptoms of Bleeding
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Pathophysiology
◦ Accelerated Clotting
◦ Clotting Factors Depleted
◦ Bleeding
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Etiology
◦ Major Trauma
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Abnormal Bleeding
Joint Pain
Nausea and Vomiting
Organ System Failure
Convulsions
Shock, Coma
Death
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Easy Bruising
Petechiae
Blood in Urine
Black Tarry Stools
Bleeding from Nose or Gums
New Onset of Painful Joints
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PT, PTT
Platelet Count
Hbg
Hemoglobin, Creatinine
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Correct Underlying Cause
Administer
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Blood
FFP
Platelets
Cryoprecipitates
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Recognize and Report Bleeding
Avoid Trauma and Further Bleeding
Teach Patient and Family
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Pathophysiology
◦ Platelet Destruction by Immune System
◦ Risk for Bleeding
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Etiology
◦ Acute Viral Illness
◦ Drug Reaction
◦ Immune System Dysfunction
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Bleeding
◦ Petechiae
◦ Ecchymoses
◦ Bleeding
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Platelet Count
Bleeding Time
Bone Marrow Aspiration
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Steroids
Chemotherapy
Transfusions
Vitamin K
Chemotherapy
Splenectomy
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Bleeding Precautions
Recognize and Report Signs and Symptoms
Bleeding
Teach Patient and Family
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Use Electric Razor
Use Soft Toothbrush
Avoid Invasive Procedures, Injections
Maintain Pressure if Blood Draw Essential
Wear Shoes or Slippers
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Avoid Bumps and Bruises
Avoid Aspirin and Nsaids
Administer Stool Softener
Handle Patient Gently
Gentle Nose Blowing
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Pathophysiology
◦ Missing Clotting Factors
 A—Factor VIII
 B—Factor IX
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Etiology
◦ Heredity
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Bleeding
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Joints
Muscles
Subcutaneous Tissue
Brain
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PTT
Factor Levels
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Desmopressin
Clotting Factors
◦ Factor VIII
◦ Factor IX
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Blood Transfusion
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Pain
Ineffective Protection
Risk for Ineffective Self Health Management
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Pathophysiology
◦ Increase in Immature WBCs
◦ Unable to Fight Infection
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Risk Factors
◦ Viruses
◦ Genetic Factors
◦ Radiation/Chemotherapy
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Acute Lymphocytic Leukemia
Acute Myelogenous Leukemia
Chronic Lymphocytic Leukemia
Chronic Myelogenous Leukemia
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Fever
Infection
Pallor
Weakness
Tachycardia
Palpitations
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Dyspnea
Abdominal Pain
Malaise
Sternal/Rib Pain
CNS Changes
Bleeding
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CBC
Bone Marrow Aspiration
Lumbar Puncture
Genetic Analysis
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Chemotherapy
Radiation Therapy
Bone Marrow Transplant
Peripheral Blood Stem Cell Transplant
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Risk for Injury: Infection, Bleeding
Fatigue
Impaired Oral Mucous Membranes
Knowledge Deficit
Anxiety
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Pathophysiology
◦ Cancer of Plasma Cells in Bone Marrow
◦ Tumors Devour Bone Tissue
◦ Organ Invasion
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Etiology
◦ Unknown
◦ Occupational Exposures
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Bone Pain
Fever
Malaise
Spinal Cord Compression
Pathological Fractures
Hypercalcemia
Infection
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CBC, Blood Calcium
Bone X-Rays
Urine for Bence
Jones Protein
Bone Marrow Biopsy
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Steroids
Chemotherapy
Control of Serum Calcium
Radiation
Stem Cell Transplantation
IV Pamidronate (Aredia)
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Risk for Infection
Risk for Injury
◦ Fracture
◦ Complications of Immobility
◦ Hypercalcemia
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Cancer of Lymph System
◦ Presence of Reed-Sternberg Cells
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Etiology
◦ Viral
◦ Genetic
◦ Immune Dysfunction
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Painless Swollen Lymph Node
Pruritis
Pain Induced by Alcohol
Fever
Night Sweats
Weight Loss
Malaise
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Edema of Face and Neck
Jaundice
Nerve Pain
Retroperitoneal Node Involvement
Spleen, Liver, and Bone Involvement
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Biopsy
◦ Lymph Node
◦ Liver and Spleen
◦ Bone Marrow
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CT, Chest X-Ray
Lung
Bone Scan
Lymphangiography
CBC
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Stage I: Single Lymph Node or Site
Stage II: Two or More Nodes on Same Side of
Diaphragm
Stage III: Nodes on Both Sides of Diaphragm
Stage IV: Widely Disseminated Disease in
Organs or Tissues
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Chemotherapy
Radiation Therapy
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Impaired Comfort
Activity Intolerance
Risk for Infection
Risk for Ineffective Coping
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Lymphoma Arising from B Cells and T Cells
Absence of Reed-Sternberg Cells
Etiology
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Some Viruses
H Pylori
Immune Dysfunction
Occupational Exposures
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Painless Lymph Nodes
Enlarged Tonsils and Adenoids
Other Signs and Symptoms Similar to
Hodgkin’s Disease
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Biopsy
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Lymph Nodes
Tonsils
Bone Marrow
Liver
Other
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Bone Scan
CT, Chest X-ray,
IVP
MRI, PET Scan
Lymphangiography
CBC
Liver Function
Studies
Serum Calcium
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Chemotherapy
Monoclonal Antibodies
Interferon Therapy
Radiation Therapy
Stem Cell Transplant
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Activity Intolerance
Risk for Infection
Risk for Ineffective Coping
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Hodgkin’s
◦ Less Common
◦ Age 15 to 40 and
>55
◦ Reed-Sternberg Cells
◦ Younger
◦ Good Prognosis
◦ Alcohol-induced Pain
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Non-Hodgkin’s
◦ More Common
◦ Usually >Age 50
◦ Absence of ReedSternberg Cells
◦ Poorer Prognosis
Surgical Removal of the Spleen
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Baseline Labs
Blood Transfusion if Necessary
Vitamin K
Baseline Vital Signs
Teach Coughing and Deep Breathing
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Monitor for Bleeding
Monitor Vital Signs
Administer Narcotics for Pain
Encourage to Cough and Deep Breathe and
Ambulate
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Bleeding
Pneumonia
Atelectasis
Infection
OPSI