Nursing care: Process

Nursing care

• A systematic approach is needed to address patient needs.
• This involves assessment, diagnosis, planning, implementation, and evaluation.
• Diverse interventions promote well-being, safety, and recovery.
• Specific precautions and education must be considered.

Data collection

• Gathering patient information through assessment is key.
• This includes health history, physical examination, and vital signs.
• Lab results and diagnostic tests could also be involved.

Nursing diagnoses, planning, and implementation

• Nursing diagnoses should be formulated using assessment data.
• Individualized care plans should be developed with specific goals and interventions.
• Nursing interventions to use are medication administration, wound care, and patient education.

Evaluation

• Effectiveness of nursing interventions must be assessed
• Patient outcomes compared to established goals
• Care plans should be modified when required

Patient education

• Provide patients and families with information regarding their health condition.
• Educate about medications, treatments, and self-care practices.
• Promote health literacy by empowering patients to participate in their care.

Bleeding precautions

• Implementation of measures will minimize bleeding risk
• Includes monitoring coagulation parameters
• Avoid intramuscular injections and minimizing invasive procedures.

Infection precautions

• Measures to prevent the spread of infections need to be implemented
• Includes hand hygiene, isolation precautions, proper PPE use

Comfort

• Interventions should aim to relieve physical and psychological distress.
• Includes pain management, proper positioning, and a supportive environment.

Infection

• Understanding the causes, transmission, and prevention of infections is key.
• Appropriate interventions to manage infections must be implemented.

Safety

• Patient safety is ensured by preventing falls, medication errors, and other potential hazards.
• Includes environmental safety measures and patient monitoring.

Cellular regulation

• Understanding how normal cellular regulation and function and the lack thereof plays a role in health and well-being
• Interventions should promote healthy cellular function.

Non-Hodgkin lymphomas

• These are diverse blood cancers originating in the lymphatic system.
• NHLs cover broad range of subtypes, each with different characteristics, behaviors, and treatment approaches, unlike Hodgkin lymphoma.
• Incidence increases with age; most diagnosed 60+
• NHLs are more common than Hodgkin lymphoma and heterogeneous compared to the uniform characteristics of Hodgkin Lymphoma
• Treatment and prognosis vary significantly, Hodgkin lymphoma has standardized treatment and higher cure rate

Aplastic anemia

• A rare but serious blood disorder where bone marrow fails to produce enough blood cells.
• Results in low levels of red blood cells, white blood cells, and platelets.
• Damage to stem cells in the bone marrow
• Results in pancytopenia, deficiency of all three major blood cell lines
• Bone marrow becomes hypoplastic or aplastic (empty)
• Acquired from idiopathic cause most commonly
• Also acquired from exposure to toxins, medications, injections, infections, autoimmune diseases

Signs and symptoms

• Fatigue, weakness, pallor due to anemia
• Other symptoms include headache, dizziness, shortness of breath.

Diagnostic tests

• Complete blood count with differential reveals pancytopenia
• Bone marrow aspiration and biopsy shows hypocellular or aplastic bone marrow
• Other tests include reticulocyte count, iron studies, genetic testing if indicated

Therapeutic measures

• Supportive care: blood transfusions to treat anemia and thrombocytopenia, antibiotics to treat infections, and growth factor to stimulate blood cell production
• Specific treatments include immunosuppressive therapy or hematopoietic stem cell transplant for eligible patients

Nursing management

• Vitals signs CBC should be monitored, and other lab values
• Signs of bleeding, infection and fatigue need to be assessed

Immune thrombocytopenic purpura

• Autoimmune disorder with low platelet counts increasing bleeding risk
• The body's immune system mistakenly attacks and destroys platelets
• Etiology for autoimmune destruction of platelets, antibodies bind to platelets marking them for destruction by the spleen
• Often idiopathic (unknown cause), can be triggered by infections, vaccinations or other drugs
• Acute often in children after infections, chronic more common adults

Signs and symptoms

• Petechiae, small red or purple spots on skin
• Purpura larger areas of bruising, easy bruising, bleeding from the gums or nose
• Heavy menstrual bleeding women, rare internal bleeding can life-threatening

Diagnostic Tests:

• Complete blood count to assess platelet count
• Peripheral blood smear to examine platelet size and morphology
• Antibody tests to defect anti-platelet antibodies
• Bone marrow aspiration or biopsy to rule out other causes thrombocytopenia

Therapeutic measures

• Corticosteroids suppress the immune system
• Intravenous immunoglobulin temporarily blocks the immune response
• Thrombopiertain receptor agonists stimulate platelet production
• Splenectomy only if other treatments fail

Nursing care

• Monitor for bleeding from skin, membranes etc
• Assess vital signs and neurological status
• Administer medications as prescribed
• Provide safe environment to prevent injury and avoid intramuscular infections
• Patients should avoid medications that impair platelet function, minimize injury, and always report bleeding

Hodgkin lymphoma

• Cancer that affects the Lymphatic system and is Characterized by Reed-Sternberg Cells

Pathophysiology

• Affects B Lymphocytes and Reed-Sternberg Cells
• Reed-Sternberg cells are large

Etiology

• Exact Cause unknown, but Genetic factors may play a role and so can a Weakened Immune System.

Signs and Symptoms

• Painless Swelling of Lymph nodes typically in the neck or arm pit, fever without infection, night sweats as well as unexplained weight loss
• Fatigue, weakness, and appetite loss may occur, as well as itching

Diagnostic tests

• Physical exam to assess for enlarged nodes
• Removal examined to identify Reed-Sternberg Cells
• Blood tests such as complete blood count
• Imaging such as XRAYS, CT scan and or MRI

Therapeutic measures

• Chemotherapy uses drugs to kill cancer cells
• Radiation uses high energy to kill
• Can be used in combination with cancer therapy
• Stem cell for relapse patients, Involves High doses chemotherapy to destroy, followed by infusion of healthy stem cell

Leukemia:

• Cancers of the blood forming tissue, typically in the abnormal proliferation of WBC

Pathophysiology:

• Uncontrolled proliferation of Leaukocytes (Malignant) leading to bone marrow over crowding
• Viral Infections due to certain factors may make the spread easier such as EBV

Signs and Symptoms

• Systemic, Such as weightloss, fatigue, as well as joint pain.
  • Hematologic - Like anemia is known
  • Other symptoms of headaches and even vision change.