Transcript Chapter 23 Hematopoietic and Lymphatic System Function and

Chapter 27
Hematopoietic and Lymphatic System
Function, Assessment, and Therapeutic
Measures
Review of A&P
• Blood
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Plasma
Red Cells
White Cells
Platelets
Review of A & P
Aging Changes
History
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Reason for Seeking Care
Family History
Diet History
Medications
Occupational/ Exposure
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Fatigue
Bleeding Tendencies
Respiratory Symptoms
Skin Changes
Lymphadenopathy
Physical Assessment
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Vital Signs
LOC
Skin Color
Signs of Bleeding
• Lymph Nodes
• Fingernails
• Bowel Sounds
Diagnostic Tests
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Blood Tests
Coagulation Tests
Bone Marrow Biopsy
Lymphangiography
Lymph Node Biopsy
Blood Products
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Packed Red Blood Cells
Frozen Red Blood Cells
Platelets
Albumin
Fresh Frozen Plasma
Cryoprecipitates
Transfusion Safety Steps
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Assessment
Identification
Filtering
Washed
Warmed
Transfusion Complications
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Febrile Reaction
Urticarial Reaction
Hemolytic Reaction
Anaphylactic Reaction
Circulatory Overload
Chapter 28
Nursing Care of Patients
with Hematologic and
Lymphatic Disorders
Anemia
• Deficiency of Red Blood Cells, Hemoglobin, or
Both
▫ Impaired Production
▫ Increased Destruction
▫ Blood Loss
• Reduced Capacity to Carry Oxygen to Tissues
Etiologies
• Dietary Deficiencies
• Hemolysis
• Hereditary Disorders
Signs and Symptoms
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Pallor
Tachycardia
Tachypnea
Irritability
Fatigue
Dyspnea
Signs and Symptoms (cont’d)
• Pernicious Anemia
▫ Numb Hands or Feet
▫ Sore Tongue
• Iron Deficiency
▫ Mouth Fissures
▫ Glossitis
▫ Spoon Shaped Nails
Diagnosis
• CBC with Microscopic Examination
• Bone Marrow Analysis
• Tests to Determine Source of Bleeding
Therapeutic Interventions
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Eliminate Cause
Dietary Changes
Supplements
Transfusions
Nursing Diagnosis
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Activity Intolerance
Imbalanced Nutrition
Risk for Injury
Impaired Oral Mucous Membranes
Sickle Cell Anemia
• Inherited Autosomal Recessive
Disorder
Sickle Cell Anemia (cont’d)
• Diagnosis
▫ Sickledex Test
▫ Hemoglobin
Electrophoresis
▫ CBC
▫ ESR
• Crisis Treatment
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Antibiotics
Pain Management
Transfusions
Fluids
Oxygen
Signs and Symptoms
Crisis Prevention
• Avoid Risk of Reduced Oxygenation
▫ Exposure to Cold
▫ Infection
▫ Strenuous Exercise
• Low Dose Penicillin
• Frequent Transfusions
• Hydroxyurea
Patient Education
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Tight Clothing
Strenuous Exercise
Alcoholic Beverages
Cold Temperatures
Smoking
Unpressurized Aircraft
Exposure to Infection
Disseminated Intravascular Coagulation
• Pathophysiology
▫ Accelerated Clotting
▫ Clotting Factors Depleted
▫ Bleeding
• Etiology
▫ Major Trauma
Signs and Symptoms
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Abnormal Bleeding
Joint Pain
Nausea and Vomiting
Organ System Failure
Convulsions
Shock, Coma
Death
Bleeding: Signs and Symptoms
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Easy Bruising
Petechiae
Blood in Urine
Black Tarry Stools
Bleeding from Nose or Gums
New Onset of Painful Joints
Hemorrhage of the Skin
Diagnostic Tests
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PT, PTT
Platelet Count
Hbg
BUN, Cr
Therapeutic Interventions
• Correct Underlying Cause
• Administer
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Blood
FFP
Platelets
Cryoprecipitates
Nursing Care
• Recognize and Report Bleeding
• Avoid Trauma and Further Bleeding
• Teach Patient and Family
Bleeding Precautions
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Use Electric Razor
Use Soft Toothbrush
Avoid Invasive Procedures, Injections
Maintain Pressure If Blood Draw Essential
Wear Shoes or Slippers
Bleeding Precautions (cont’d)
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Avoid Bumps and Bruises
Avoid Aspirin and NSAIDS
Administer Stool Softener
Handle Patient Gently
Avoid Nose Blowing
Hemophilia
• Pathophysiology
▫ Missing Clotting Factors
 A—Factor VIII
 B—Factor IX
• Etiology
▫ Heredity
Signs and Symptoms
• Bleeding
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Joints
Muscles
Subcutaneous Tissue
Brain
Diagnosis
• PTT
• Factor Levels
Therapeutic Interventions
• Clotting Factors
▫ Factor VIII
▫ Vactor IX
• Blood Transfusion
Leukemia
• Pathophysiology
▫ Increase in Immature WBCs
▫ Unable to Fight Infection
• Risk Factors
▫ Viruses
▫ Genetic Factors
▫ Radiation/Chemotherapy
Types
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Acute Lymphocytic Leukemia
Acute Myelogenous Leukemia
Chronic Lymphocytic Leukemia
Chronic Myelogenous Leukemia
Signs and Symptoms
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Fever
Infection
Pallor
Weakness
Tachycardia
Palpitations
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Dyspnea
Abdominal Pain
Malaise
Sternal/Rib Pain
CNS Changes
Bleeding
Diagnosis
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CBC
Bone Marrow Aspiration
Lumbar Puncture
Genetic Analysis
Therapeutic Interventions
• Chemotherapy
• Radiation Therapy
• Bone Marrow Transplant
Hodgkin’s Disease
• Cancer of Lymph System
▫ Presence of Reed-Sternberg Cells
• Etiology
▫ Viral
▫ Genetic
▫ Immune Dysfunction
Signs and Symptoms
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Painless Swollen Lymph Node
Pruritis
Pain Induced by Alcohol
Fever
Night Sweats
Weight Loss
Malaise
Late Signs and Symptoms
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Edema of Face and Neck
Jaundice
Nerve Pain
Retroperitoneal Node Involvement
Spleen, Liver, and Bone Involvement
Diagnosis
• Biopsy
▫ Lymph Node
▫ Liver and Spleen
▫ Bone Marrow
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CT, Chest X-Ray
Lung Scan
Bone Scan
Lymphangiography
CBC
Staging
• 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,
generalized throughout the body
• Stage IV: – Widely Disseminated Disease in
Organs or Tissues
Therapeutic Interventions
• Chemotherapy
• Radiation Therapy
Comparison of Lymphomas
• Hodgkin’s
▫ Younger
▫ Less Debilitated
▫ Fever and Night
Sweats Likely
▫ Local or Regional
Spread
• Non-Hodgkin’s
▫ Older
▫ More Debilitated
▫ Fever and Sweats Less
Likely
▫ Usually Advanced
Splenectomy
• Surgical Removal of the Spleen
Preoperative Care
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Baseline Labs
Blood Transfusion If Necessary
Vitamin K
Baseline Vital Signs
Teach Coughing and Deep Breathing
Postoperative Care
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Monitor for Bleeding
Monitor Vital Signs – notify MD of abnormals
Administer Narcotics for Pain
Encourage to Cough and Deep Breathe and
Ambulate
Complications of Splenectomy
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Bleeding
Pneumonia
Atelectasis
Infection
OPSI