Caring for Clients with Hematopoietic Disorders (PDF)

Timby/Smith: Introductory Medical-Surgical Nursing, 13/e Chapter 31: Caring for Clients with Disorders of the Hematopoietic System Copyright © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of Hematopoietic System...

Timby/Smith: Introductory Medical-Surgical Nursing, 13/e Chapter 31: Caring for Clients with Disorders of the Hematopoietic System Copyright © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of Hematopoietic System  Blood Dyscrasias: o abnormalities in numbers/types of:  Blood cells  (RBCs and WBCs)  Coagulopathies  Bleeding disorders  involve platelets and clotting factors Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Anemia Erythrocytes Pathophysiology and Etiology (RBCs) o Deficiency of RBCs or hemoglobin  Caused by:  Blood loss  Inadequate production of RBCs  Destruction of RBCs Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Anemia (cont’d)  Assessment findings: (see Box 31-1, p. 510) o Inadequate RBC volume:  Orthostatic hypotension, thready pulses, oliguria, heart murmur o Compensatory mechanisms:  Tachycardia, tachypnea, cool/clammy skin, amenorrhea, decreased RBC function, dyspnea, chest discomfort, acidosis, headache, vertigo, pallor, constipation, difficulty concentrating, decreased bowel sounds Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Anemia (cont’d)  Hypovolemic Anemia o Pathophysiology and Etiology:  Sudden loss of large volume (gunshot wound)  Chronic loss of small amounts of blood (GI bleed) o Assessment Findings:  Acute: hypovolemic shock, extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness  Chronic: pallor, fatigue, chills, postural hypotension, rapid heart and respiratory rates Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Anemia (cont’d)  Hypovolemic Anemia (cont’d) o Diagnostic Testing:  CBC: decreased RBCs, increased retics (immature RBCs), low hemoglobin/hematocrit, low MCV/MCHC o Medical Management:  Blood transfusions:  Treat sudden loss (injury, trauma)  Chronic blood loss (bleeding uterine tumors, GI bleed, PUD, hemorrhoids), treat underlying condition  Drug therapy:  Oral, IV, or IM iron (helps restore hemoglobin)  O2 therapy:  Severe anemia Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Anemia (cont’d)  Hypovolemic Anemia (cont’d) o Assessment:  History, physical exam, vital signs, I/O, lab results o Nursing Diagnosis:  Imbalance Body Temperature  Reduced oxygen for aerobic metabolism  Activity Intolerance  Reduced oxygen carrying capacity o Nursing Interventions:  Monitor CBC results, vital signs for hypotension and tachycardia, monitor I/O, activity as tolerated Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Anemia (cont’d) Iron-Deficiency Anemia o Pathophysiology and Etiology:  Insufficient iron to produce hemoglobin  Caused by: heme unable to be recycled, dietary intake, inadequate absorption, need exceeds the reservoirs Iron storage is depleted, low hemoglobin, smaller RBCs (microcytic), leads to anemia Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Anemia (cont’d)  Iron Deficiency Anemia (cont’d) o Assessment Findings:  Reduced energy, feel cold, fatigue and dyspnea with minor exertion, rapid heart rate even at rest o Diagnostic Testing:  CBC: decreased RBCs, increased retics (immature RBCs), low hemoglobin/hematocrit, low MCV/MCHC, microcytic RBCs and hypochromic (lighter in color) on peripheral blood smear  Occult blood testing: if GI is source of blood loss Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Anemia (cont’d)  Iron Deficiency Anemia (cont’d) o Medical Management:  Dietary changes  Adding foods high in iron to diet  Drug therapy:  Oral, IV, or IM iron (restore hemoglobin)  Blood transfusion:  Severe anemia cases o Nursing Management:  Help improve dietary intake of iron  Collaborate with dietician (see Nutritional Notes 31-1, p. 514)  Uses Z-track method to administer IM iron (see Nursing Guidelines 31-1, p. 514)  Educate to minimize fatigue Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Anemia (cont’d)  Iron Deficiency Anemia (cont’d) o Client taking an oral iron supplement, the nurse instructs as follows:  Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth.  Take iron on an empty stomach unless gastric upset occurs; then take with or immediately after meals.  Avoid taking with antacid simultaneously, affects iron absorption.  Check with the primary provider or pharmacist about combining iron with other prescribed or over-the-counter medications to determine appropriate absorption of each.  Drink orange juice or other forms of Vit C to promote iron absorption.  Iron colors stool dark green or black.  Consult prescribing provider if constipation/diarrhea develops.  Keep medications containing iron out of the reach of small children, accidental poisoning may be fatal. Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 A client requires injection of parenteral iron for treatment of iron-deficiency anemia. The proper route and site for administration of parenteral iron includes which of the following? A) Subcutaneous, arm B) Intramuscular, gluteus C) Intramuscular, arm D) Intramuscular, Z-track, gluteus Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 D) Intramuscular, Z-track, gluteus Rationale: Iron preparation medication needs to be given deep intramuscularly using the Z-track method. Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Anemia (cont’d)  Sickle Cell Anemia o Pathophysiology and Etiology:  Primarily in African Americans and Mediterranean/Middle Eastern countries  Hemoglobin S (HbS) replaces Hemoglobin F (HbF)  Sickle or crescent-shaped RBC Inadequate O2 in blood Sticky causing vascular occlusion, tissue ischemia, cellular hypoxia, pain, stroke Leads to sickle cell crisis  Generally a family history of sickle cell  Chronic hemolytic anemia Copyright © 2022 Wolters Kluwer · All Rights Reserved Disorders of Hematopoietic System Anemia (cont’d)  Sickle Cell Anemia (cont’d) o Assessment Findings: Signs & Symptoms  Tachycardia, dyspnea, cardiomegaly/arrhythmias, acute chest syndrome (pneumonia with coughing, wheezing, tachypnea, and chest pain), vaso-occlusive crisis, height/weight affected, enlarged spleen, liver dysfunction (jaundice) o Diagnostic Testing:  Sickledex Test (Solubility Test)  Screening test for abnormal Hgb S  Hemoglobin electrophoresis  Determines sickle cell disease 80%-100% Hgb S  Carrier of sickle cell trait