NUR 344 Exam 2: Polycythemia and Platelets

• Study notes for NUR 344 Exam 2, Spring 2025

Polycythemia

• Characterized by thickened blood due to excess RBCs.
• Increases the risk of stroke and clotting.
• Can result from genetic mutations or myeloproliferative disorders, where the bone marrow produces too many RBCs.

Polycythemia Vera

• A blood disorder resulting from a genetic mutation (JAK2) in the bone marrow.
• Leads to excess RBC production
• Manifestations include fatigue, headaches, dizziness, tinnitus, hypertension, thrombosis, pruritus after showers, and a ruddy complexion

Platelet Count

• Normal platelet count ranges from 150,000 to 450,000.
• Thrombocytopenia: Platelet count below 150,000. -Increases bleeding risk, including spontaneous/internal bleeding and risks during surgery or birth.
  • Treatment may include platelet transfusions, corticosteroids, or splenectomy.
• Thrombocytosis: Platelet count above 450,000.
  • Increases clotting risk, potentially leading to DVT, stroke, or PE.
  • Can paradoxically cause bleeding.
  • Treatment may involve aspirin or cytoreductive therapy.

Older Adult Immune System Changes

Hematologic changes:

• Decrease in blood volume and lower plasma protein levels.
• Bone marrow ages, resulting in fewer RBCs and lower hemoglobin levels
• Antibody levels and immune responses are lower and slower

Immune System:

• Reduced cell function and increased inflammatory response
• Decreased adaptive immune response and increased autoimmune activity

Warfarin Therapy

• Warfarin is an anticoagulant used to prevent DVT, atrial fibrillation, and PE.
• Main risk is bleeding.
• Avoid NSAIDs while on Warfarin.
  • Dietary considerations include maintaining consistent Vitamin K intake to stabilize INR levels.
  • Foods high in Vitamin K: dark leafy greens, green tea, liver, and asparagus.
  • Alcohol, cranberry juice, ginger, garlic, turmeric and fish oil can increase bleeding risk.

Spleen Function

• Produces lymphocytes and macrophages.
• Filters and maintains RBCs.
• Stores platelets and blood.
• Splenectomy implications:
  • Increased risk of infection and blood clots (thrombosis and DVT).
  • Potential changes in CBC.
  • Risk of splenosis (rupture of the spleen before removal).

Bone Marrow Biopsy

• Involves inserting a needle into the iliac crest to collect a bone marrow sample used to diagnose hematologic disorders, evaluate low blood counts, and assess metastatic cancer.
• Nurse's role:
  • Patient education and preparation.
  • Obtaining informed consent.
  • Assisting the provider and supporting the patient.
• Post-biopsy teaching:
  • Pain management (avoid NSAIDs).
  • Activity restrictions and site care.
  • Monitoring for complications (bleeding, infection, pain) and arranging follow-up.

Anemia

• Defined as a reduction in the number of RBCs, hemoglobin, or hematocrit
• Clinical manifestations include fatigue, weakness, paleness, dizziness, SOB, chest pain, cold extremities, tachycardia, hypotension, heart murmurs, angina, dyspnea, increased RR, confusion, vertigo, tinnitus, and restless leg syndrome.

Sickle Cell Disease

• Genetic blood disorder causing abnormally shaped, rigid RBCs.
• Alters oxygen-carrying capacity.
• Interventions for sickle cell crisis include oxygen therapy and monitoring, pain management (opioids, NSAIDs, PCAs), antibiotics (for infection), hydration (IV fluids), and emotional support.
• Sickle cell crisis can be precipitated by alcohol, dehydration, pregnancy, infection, and hypoxia.

Pernicious Anemia

• Vitamin B-12 deficiency due to lack of intrinsic factor.
• Leads to larger, dysfunctional RBCs.
• Treatment includes Vitamin B12 replacement via IM injections, oral supplements, or nasal spray, along with addressing the underlying autoimmune conditions.

Autoimmune idiopathic purpura (ITP)

• Characterized by a low platelet count due to an autoimmune response.
• Manifestations include easy bruising (purpura and ecchymosis), petechiae, prolonged bleeding, heavy menstrual bleeding (menorrhagia), nosebleeds (epistaxis), gum bleeds, and internal bleeding.

Administering Blood

• Implications include restoration of blood levels and treatment of disorders, with considerations for risks/complications, ethical issues, religion, and informed consent.
  • Nurse responsibilities include verifying the order, assessing the patient, confirming blood product, type, and patient identity, preparing equipment and infusion rate, monitoring vitals, watching for complications, and documenting the procedure
• Administration process includes verifying the order, patient, and blood compatibility, equipment preparation, connecting the blood and starting the transfusion slowly for the first 15 minutes with frequent vital sign checks.
  • Monitor for reactions and adjust transfusion rate.
• Complications include:
  • Allergic reaction and Febrile Non-Hemolytic Transfusion Reaction (FNHTR).
    • FNHTR is caused by the body's reaction to WBCs in transfused blood.
    • Can be managed with acetaminophen.
  • Hemolytic Transfusion Reaction:
    • Immune system attacks the transfused blood.
    • Medical emergency.
  • Transfusion-related acute lung injury, circulatory overload, iron overload, infection, and thrombocytopenia.

Thrombocytopenia

• Low platelet count

Study notes covering polycythemia, a condition with thickened blood due to excess RBCs and its risk factors. Also covers platelet counts, thrombocytopenia (low platelet count) and thrombocytosis (high platelet count) and their associated risks.