Nursing Management of Patients With Blood Disorders PDF

Nursing Management of Patients with Blood Disorders Prepared by Dr. AZIZA IBRAHIM  Learning objectives At the end of this group discussion each student will be able to:- 1. Recall the bone marrow components and its function. 2. Identify the nursing role for patient underg...

Nursing Management of Patients with Blood Disorders Prepared by Dr. AZIZA IBRAHIM  Learning objectives At the end of this group discussion each student will be able to:- 1. Recall the bone marrow components and its function. 2. Identify the nursing role for patient undergoing blood transfusion. 3. List causes of hemophilia. 4. Identify sources of stem cells. 5. List different methods of stem cells transplantation. 2  Learning objectives cont’d. 6. Enumerate different methods of stem cells transplantation. 7. Differentiate between different types of anemia(s). 8. Priorities the nursing care for patients with different types of anemia(s). 9. Provide nursing care for patients with hemophilia. 10. Provide comprehensive nursing care for patients undergoing stem cells transplantation. 3  Outlines Bone Marrow components and its function Blood components Blood transfusion – Nursing role Blood disorders – Anemia(s) (8 types) Nursing role – Hemophilia Nursing role Stem cells transplantation 4  Bone Marrow Bone marrow is the spongy or viscous tissue that fills the inside of the bones. There are actually two types of bone marrow: – Red bone marrow helps produce blood cells – Yellow bone marrow helps store fat. 5  Blood components Blood is a specialized body fluid. It has four main components: plasma, red blood cells, white blood cells, and platelets. Blood has many different functions 6  Plasma The liquid component of blood is called plasma, which is a mixture of water, sugar, fat, protein, and salts. The main function of the plasma is to transport blood cells throughout the body along with nutrients, waste products, antibodies, clotting proteins, chemical messengers such as hormones, and proteins that help maintain the body's fluid balance. 7  Red Blood Cells/Erythrocytes/RBCs The red cells are the most abundant cell in the blood, accounting for about 40 to 45 percent of its volume. The shape of a red blood cell is a biconcave disk with a flattened center Production of red blood cells is controlled by erythropoietin Unlike many other cells, red blood cells have no nucleus and can easily change shape. 8 White Blood Cells (also called leukocytes) White blood cells protect the body from infection. Neutrophil lives less than a day, so your bone marrow must constantly make new neutrophils to maintain protection against infection. 9  Platelets (also called thrombocytes) Platelets help the blood clotting process (or coagulation) by gathering at the site of an injury, sticking to the lining of the injured blood vessel, and forming a platform on which blood coagulation can occur. Conversely, lower than normal counts can lead to extensive bleeding. 10  Complete Blood Count (CBC) CBC may diagnose conditions like anemia, infection, and other disorders. The platelet count and plasma clotting tests (prothombin time, partial thromboplastin time, and thrombin time) may be used to evaluate bleeding and clotting disorders. Also WBCs with its different types can give view about immunity problems 11  Blood Function Transporting oxygen and nutrients to the lungs and tissues Forming blood clots to prevent excess blood loss Carrying cells and antibodies that fight infection Bringing waste products to the kidneys and liver, which filter and clean the blood Regulating body temperature 12  Blood Transfusion Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. The type of blood transfusion you need depends on patient condition. 13  Blood Transfusion cont’d Red blood cells are the most commonly transfused part of the blood. These cells carry oxygen from the lungs to your body's organs and tissues. Platelets and clotting factors help stop bleeding, including internal bleeding that can't see. Some illnesses may cause the body to not make enough platelets or clotting factors. Plasma is the liquid part of your blood. It is mainly water, but also contains proteins, clotting factors, hormones, vitamins, cholesterol, sugar, sodium, potassium, calcium, and more. 14  Blood Transfusion cont’d Nursing Role Before Blood Transfusion: – Check Blood grouping test – Assessment of any history blood transfusion reaction – Be sure that antidotes is available – Prepare the patient to blood transfusion. – Prepare blood to transfusion. 15  10 minutes brain storming What is the nursing management for patients undergoing blood transfusion? 16  Blood Transfusion cont’d Nursing Role before Blood Transfusion: Verify doctor’s order. Inform the client and explain the purpose of the procedure. Check for cross matching and typing. To ensure compatibility. Obtain and record baseline vital signs. Practice strict asepsis 17  Blood Transfusion cont’d Nursing Role before Blood Transfusion: Check the label of the blood transfusion. Check the following: (Serial number- Blood component - Blood type - Rh factor - Expiration date). Screening test to ensure that the blood is free from blood- carried diseases and therefore, safe from transfusion. Warm blood at room temperature before transfusion to prevent chills. Identify client properly. 18  Blood Transfusion cont’d Nursing Role during Blood Transfusion: Use needle gauge 18 to 19 to allow easy flow of blood. Monitor vital signs. Altered vital signs indicate adverse reaction (increase in temp, increase in respiratory rate). Do not mix medications with blood transfusion to prevent adverse effects. Do not use blood transfusion lines for IV push of medication. 19  Blood Transfusion cont’d Nursing Role during Blood Transfusion: Blood drops not more than 15 drops/min for the first 15 minutes. Remain at bedside for 15 to 30 minutes. Adverse reaction usually occurs during the first 15 to 20 minutes. The nurse continues to observe the patients during the rest of the procedure as well. Could be last from 1hr to 4 hrs, depends on physician order and each patient condition. 20  Blood Transfusion cont’d Nursing Role during Blood Transfusion: Close observation for any following reaction: Mild Pyrexia is accepted; Mild: pyrexia of >38°C, but 2°C above baseline or >39°C, or rigors and/or myalgia (muscle pain), itching (pruritus) and/or skin rash yellowish discoloration, disturbed conscious level…etc Nursing Role during Blood Transfusion with blood reaction: – Stop the blood transfusion – Keep the I.V. line open with normal saline solution. – Keep the blood pack in order to send it to the lab. For further investigation – Consult the physician in order to give the antidote 22  Blood Transfusion cont’d Nursing Role after Blood Transfusion: – Check the vital signs specially” temp, pulse, Bp. For the coming 24 hours – Check and read the blood test to see the impact of the blood transfusion on the blood counts 23 Watch video about nursing management for patients on blood transfusion https://youtu.be/SX_bbPvbKMM 24  Blood Disorders Anemia Dozens of different diseases can involve the blood. Blood disorder can affect any of the three main components of blood: Red blood cells, which carry oxygen to the body's tissues White blood cells, which fight infections Platelets, which help blood to clot 25  Definition Anemia: The condition of having a lower-than- normal number of red blood cells or quantity of hemoglobin. Anemia diminishes the capacity of the blood to carry oxygen. Patients with anemia may feel tired, fatigue easily, appear pale, develop palpations, and suffer from shortness of breath. 26  Different types of anemia Iron-deficiency anemia: Anemia of chronic disease: Pernicious anemia (B12 deficiency): Aplastic anemia: Autoimmune hemolytic anemia: Thalassemia: Sickle cell anemia: Polycythemia vera: 27  1-Iron deficiency anemia It usually develops over time if body doesn't have enough iron to build healthy red blood cells. Without enough iron, the body starts using the iron it has stored. Soon, the stored iron gets used up. After the stored iron is gone, the body makes fewer red blood cells. The red blood cells it does make have less hemoglobin than normal. 28  Causes Blood loss A lack of iron in diet. An inability to absorb iron. Pregnancy. 29  Symptoms Blue color to whites of the eyes decreased appetite (especially in children) fatigue headache Irritability pale skin color shortness of breath Sore tongue Unusual food cravings (called pica) weakness 30  Iron deficiency anemia investigations: Red blood cell size and color. Hematocrit. Hemoglobin. Ferritin. Endoscopy. Colonoscopy. Ultrasound. 31  Medical Treatment Control bleeding Oral/parentral iron Diet correction. 32  Nursing Management for patient with iron deficiency anemia: Asses for fatigue, activity intolerance, and other sings of impaired tissue oxygenation. Promote an adequate intake of iron-rich foods (iron fortified formula and cereals, liver, egg yolk, and organ meats. Emphasize to family members or care givers proper administration of oral iron supplements. Give supplements in two or three divided doses in small amount of Vitamin C-containing liquid. to enhances absorption. 33  Nursing Management for patient with iron deficiency anemia cont’d Explain the potential adverse effects of iron which includes nausea and vomiting, diarrhea or constipation or black stools and tooth discoloration. Instruct care givers to keep iron supplements out of reach of children since it is toxic when overdosed 34 2- Anemia of chronic disease 35  2- Anemia of chronic disease Causes: Autoimmune disorders, such as crohn's disease, systemic lupus erythematosus, rheumatoid arthritis, ulcerative colitis Cancer, particularly lymphoma and Hodgkin's disease Chronic kidney disease Liver cirrhosis Long-term infections, such as bacterial endocarditis, osteomyelitis (bone infection), HIV/AIDS, hepatitis B or hepatitis C 36  Symptoms Feeling weak or tired Headache Paleness Shortness of breath 37  Investigation Hemoglobin level Red blood count Reticulocyte count Serum ferritin Serum iron Other blood tests 38  Treatment -The anemia is often mild enough that it requires no treatment, and will likely get better when the disease that is causing it is treated. -The condition is rarely severe enough to require a blood transfusion. 39  Treatment cont’d -Iron supplements may sometimes be used, but only for patients whose iron levels are low. -For some conditions, such as chronic kidney disease, medicine called erythropoietin may be given. It stimulates bone marrow to make more red blood cells. 40  Nursing care for patient with chronic disease anemia Nursing care will depends on nursing management of the chronic illness. 41  3-Pernicious anemia (B12 deficiency) (also known as Biermer's anemia, Addison's anemia, or Addison–Biermer anemia) 42  Causes The body needs vitamin B12 to make red blood cells that get from eating foods such as meat, poultry, shellfish, eggs, and dairy products. A special protein released by cells in the stomach, called intrinsic factor (IF), binds vitamin B12 to be absorbed in the intestines. When the stomach does not make enough intrinsic factor, the intestine cannot properly absorb vitamin B12.  Symptoms Yellow tinge to patient’s skin (caused by jaundice, a condition which develops when a chemical called bilirubin builds up in the blood), sore and red tongue (glossitis) ulcers inside your mouth, altered, or reduced, sense of touch, neuritis. reduced ability to feel pain, change in the way you walk and move around, disturbed vision, irritability, and depression. Vitamin B12 deficiency can sometimes affect fertility, and cause temporary sterility 44  Treatment Swedish researchers discovered that sufficiently large doses of B12 can also be absorbed sublingually, However, as of yet, no standards have been set for treatment by the sublingual route Injections of B12 are the only reliable method of treatment. 45  Nursing Management for patient with Pernicious anemia (B12 deficiency) Assessment of the above symptoms. Enhance intake of food contains Vit. B12 Monitor injection of vit. B12 46  Aplastic anemia Aplastic anemia is a condition where bone marrow does not produce sufficient new cells, but aplastic anemia patients have lower counts of all three blood cell types: red blood cells, white blood cells, and platelets, termed pancytopenia. 47  Causes – Idiopathic (without known cause). – Autoimmune disorder – Exposure to toxins such as benzene, or with the use of certain drugs, including chloramphenicol, carbamazepine, felbamate, phenytoin, quinine, and phenylbutazone. – Exposure to ionizing radiation from radioactive materials. – acute viral hepatitis. 48  Signs and symptoms Anemia with malaise, pallor and associated symptoms such as palpitations Thrombocytopenia (low platelet counts), leading to increased risk of hemorrhage, bruising and petechiae Leukopenia (low white blood cell count), leading to increased risk of infection Reticulocytopenia (immature blood cells) (low reticulocyte counts) 49  Diagnosis Bone marrow aspirate and biopsy History of iatrogenic exposure to cytotoxic chemotherapy: can cause transient bone marrow suppression X-rays, computed tomography (CT) scans, or ultrasound imaging tests: enlarged lymph nodes (sign of lymphoma), kidneys and bones in arms and hands (abnormal in Fanconi anemia) 50  Diagnosis cont’d Chest X-ray: infections Liver tests: liver diseases Viral studies: viral infections Vitamin B12 and folate levels: vitamin deficiency Blood tests Test for antibodies: immune competency 51  Treatment – Chemotherapy. – Radiotherapy – Antibiotics (based on the viral infection). – Blood transfusion. – Bone Marrow Transplantation. 52  Nursing care of aplastic anemia – Assessment of bleeding tendency symptoms. – Minimize using of sharp objects. – Monitor complication and provide sufficient management of chemotherapy & radiotherapy complications. – Provide sufficient nursing care before, during and after bone marrow transplantation procedure. 53  5- Autoimmune hemolytic anemia Occurs when antibodies directed against the person's own red blood cells (RBCs) cause them to burst (lyse), leading to insufficient plasma concentration. The lifetime of the RBCs is reduced from the normal 100–120 days to just a few days in serious cases 54  Causes Chronic lymphocytic leukemia. Lymphoma) and other autoimmune disorders (e.g. systemic lupus erythematosis, rheumatoid arthritis, scleroderma, ulcerative colitis). 55  Diagnosis: The typical tests used for this are a CBC with peripheral smear, bilirubin, (in particular with isoenzyme , haptoglobin and urine hemoglobin. Coombs test. 56  Symptoms Weakness Irritability Fatigue Dark urine Lightheadedness Tiredness Headache 57  Treatment: Corticosteroids Blood transfusion 58  Nursing care for autoimmune anemia Assessment, Nursing management of the above symptoms. Nursing percussions for patients treated with corticosteroids. Nursing percussions for patients undergoing blood transfusion. 59  Thalassemia Is a group of hereditary hemolytic disorders caused by faulty hemoglobin synthesis, widespread in Mediterranean region, African and Asian countries.  Symptoms Weakness. Fatigue. Lightheadedness. Skin that looks paler than normal. Jaundice (skin and whites of the eyes appear yellow). Dark urine. Decreased appetite and weight loss (poor growth in a child). A rapid heartbeat. Shortness of breath during exercise. 61  Diagnosis: A complete blood count (CBC), which includes measures of hemoglobin and the quantity (and size) of red blood cells. Genetic test. 62  Treatment Blood transfusions. Medications and supplements (iron treatment and vitamins). Gen therapy. 63  Nursing care for thalassemia Assessment, Nursing management of the above symptoms. Nursing percussions for patients undergoing blood transfusion and gen therapy. 64  7- Sickle cell anemia Is a serious disorder in which the body makes sickle-shaped red blood cells. “Sickle-shaped” means that the red blood cells are shaped like a crescent. Causes Sickle cell anemia is caused by a mutation in the gene that tells the body to make hemoglobin 65  Sickle cell anemia cont’d Normally, red blood cells are flexible discs that glide smoothly through the blood vessels. In people with sickle cell anemia, these blood cells are stiff and sickle- or crescent- shaped. Because of their stiffness, these abnormal red blood cells may get stuck inside small blood vessels. 66  Symptoms Common symptoms include: Attacks of abdominal pain Bone pain Breathlessness Delayed growth and puberty Fatigue Fever Paleness Rapid heart rate Ulcers on the lower legs (in adolescents and adults) Yellowing of the eyes and skin (jaundice) 67  Diagnostic tests Complete blood count (CBC) Hemoglobin electrophoresis Sickle cell test Bilirubin Blood oxygen CT scan or MRI Peripheral smear Serum creatinine Serum hemoglobin Serum potassium Urinary casts or blood in the urine White blood cell count 68  Treatment Medications used to treat sickle cell anemia include: Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months of age and continue taking it until they're 5 years old. Pain-relieving medications. To relieve pain during a sickle crisis. Hydroxyurea (decrease cell growth) (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and may reduce the need for blood transfusions. 69  Treatment cont’d Blood transfusions. Supplemental oxygen. Stem cell transplant Gen therapy 70  Nursing care for sickle cell -Assessment for expected complications. -Signs and symptoms management. -Caution about stroke during sickle cell crisis attack.(Vaso-occlusive crisis) - Nursing percussions for patients undergoing blood transfusion and gen therapy. 71  8- Polycythemia vera It also known as (erythremia, or primary polycythemia) in which the bone marrow makes too many red blood cells. It may also result in the overproduction of white blood cells and platelets. The blood being thicker (thrombosis occurs) 72 Symptoms Itching due to abnormal histamine release. Reddish or bluish coloration of the skin. Liability to stroke. Gout. Diagnosis CBC, erythropoietin is low. 73  Treatment -Chemotherapy -Bone marrow transplantation but (rare). -Phlebotomy 74  Nursing management for polycythemia vera Assessment (physical examination), History. Health teaching. Medication administration Blood investigations follow up Early crisis signs and symptoms 75  Hemophilia It is inherited bleeding disorders (IBDs) are caused by quantitative and qualitative alterations of either platelets or blood-clotting proteins (clotting factors) involved in coagulation and fibrinolysis. Hemophilia is a male disorder, yet females with hemophilia are rarely seen in communities but they are carriers. 76  Causes Decreased function or absence of factor VIII (classic hemophilia or hemophilia A) is most common Decreased function or absence of factor IX (Christmas disease or hemophilia B). 77  Severity of hemophilia Hemophilia as lifelong disorder has three phenotypes (severe, moderate and mild) that correlate with factor VIII (FVIII) levels in plasma. – From 5 to 40 percent of normal clotting factor is considered mild, – From 1 to less than 5 percent is moderate, – Less than 1 percent is severe. 78  Symptoms Spontaneous bleeding (elbows, knees, ankles, hips and shoulders). Patients with hemophilia do not bleed faster they bleed for a longer period of time. Pain and swelling in joints cause limitation in joints movement. (a major complication) Anemia Blue patches under patient’s skin. 79  Diagnosis Family history Physical examination Testing the blood for its ability to clot and its levels of clotting factors (factor assays) 80  Treatment – Replacement therapy (Clotting factors) that can be derived from human blood or synthetically produced in a laboratory ((prophylactic or on demond therapy). – Fresh blood transfusion. – Plasma therapy – Cryoprecipitate, also called cryo., is a frozen blood product prepared from blood plasma – Symptomatic treatment 81 Nursing care for patients with hemophilia Patient education Closed observation for bleeding Emergency care Symptomatic management Care for patient receiving blood or blood components transfusion Percussions about transmitted diseases such as HIV and HCV 82  Stem cells It is a one of the human body's master cells; it has a remarkable potential to develop into many different cell types in the body during early life and growth. In many tissues stem cells serve as a sort of internal repair system, and it is dividing essentially without limit to replenish other cells as long as the person or animal is still alive. 83  Attributes of stem cells unspecialized, renewing themselves become specific 84  Sources of stem cells Embryonic stem cells (develop from eggs that have been fertilized in vivo or in vitro within 8 weeks). Umbilical cord stem cells (come from a newborn’s umbilical cord and can be collected immediately after birth). Adult stem cells, also called somatic stem cells (present in adults, children, and infants). 85  Types of adult stem Undifferentiated cells which are found among differentiated cells in a tissue or organ that can renew itself and can differentiate to yield some or all of the major specialized cell types of the tissue or organ. Hematopoietic stem cells; they are present mainly in bone marrow and peripheral blood and form all types of blood cells in the body. 86  Stem cells therapy Stem cells therapy (also called cellular therapy, cytotherapy or regenerative medicine) is a set of techniques that aim to replace cells damaged or destroyed by disease with healthy functioning cells. 87  Methods of stem cells transplantation Stem cells can be transplanted to the human body using either peripheral blood or bone marrow through three methods; Autologous method, it occurs when donor and recipient is the same person. Syngeneic method, it means that patient receives stem cells from identical twins. Allogeneic method, that occurs when stem cells are derived from other source rather than the patient. 88 Summarization of sources and methods of stem cells transplantation 89 Watch video about stem cells transplantation https://youtu.be/R9_xF4sb7zw 90 Nursing care for patients undergoing stem cells transplantation Before transplantation - Patient preparation (biopsychosocial) - Complete physical examination - Donor preparation - Care for patients receiving chemotherapy - Starting discharge plan 91 Nursing care for patients undergoing stem cells transplantation cont’d During transplantation - Closed observation - Psychological support Post transplantation - Closed patients’ observation - Patients’ isolation - Psychological support - Medication administration 92 Nursing care for patients undergoing stem cells transplantation cont’d Patient’ preparation to hospital discharge - Diet - Activates - Isolation - Medication - Visitors - Home preparation - Follow up - Emergency situations 93  Related research The experiences of people with hemophilia and their families of gene therapy in a clinical trial setting 94  Results Sixteen participants with severe hemophilia, mean age 41.4 years, took part in a single qualitative interview. Participants saw their involvement in gene therapy as a positive experience, freeing them from the personal burden of hemophilia and furthering treatment options for the wider hemophilia community. However, participants reported being unprepared for the side effects of immunosuppression. Some also reported feeling unsupported. 95  Related Questions Multiple choice questions: 1- Pernicious anemia caused by a) Iron deficiency b) Vitamin B12 deficiency c) Autoimmune disorders d) Genetic disorders 96  Multiple choice questions cont’d 2- Thalassemia is caused by a) Exposure to ionizing radiation b) Genetic mutation c) Over production of white blood cells d) Autoimmune disease 97  Multiple choice questions cont’d 3- Hemophilia is result from deficiency of a) Red blood cells b) White blood cells c) Clotting factors d) Vitamin B12 98  True or False: 1- Early and symptom of iron-deficiency anemia is fatigue. ( ) 2- The least common type of anemia is iron- deficiency anemia. ( ) 99  Model answers Multiple choice questions 1 b 2 b 3 c True and false 1 true 2 False 100 101