Hematologic Disorders 2024 .pptx

Hematologic Disorders Sue Cagir DNP, MS, RN, CNE NUR 3110 Student Learning Outcomes  On completion of this chapter, the learner will be able to:  Differentiate between hypoproliferative and hemolytic anemias and compare the  physiologic mechanisms, clinical manifestations, medical ma...

Hematologic Disorders Sue Cagir DNP, MS, RN, CNE NUR 3110 Student Learning Outcomes  On completion of this chapter, the learner will be able to:  Differentiate between hypoproliferative and hemolytic anemias and compare the  physiologic mechanisms, clinical manifestations, medical management, and nursing  interventions for each.  Describe the processes involved in neutropenia and lymphopenia and the principles  involved in the medical and nursing management of patients with these disorders.  Use the nursing process as a framework for the care of the patient with anemia with sickle cell  disease, or with thalassemia Anemia  A deficiency of RBCs characterized by decreased function RBC count, Hgb/Hct or both  Anemia is a clinical condition that results in decreased oxygen delivery to the cells Anemia – contributing factors  Acute or chronic blood loss (gastrointestinal bleeding)  Greater than normal destruction of RBCs (spleen diseases)  Abnormal bone marrow function (chemotherapy)  Decreased erythropoietin (renal failure)  Inadequate maturation of RBC (spleen disease) –mononucleosis  Inadequate maturation of RBC (cancer)  Nutritional deficiencies (iron, B12, folic acid, intrinsic factor) Anemia – manifestations  Fatigue and weakness  Dizziness and headache  Pallor: first seen in the conjunctiva (light-skinned clients) and mucosal membranes (dark-skinned clients) as well as the nail beds, the palmar creases, and around the mouth  Tachycardia, murmurs and gallops, and orthostatic hypotension  Decreased Hgb, Hct, and RBC levels  Shortness of breath and dyspnea, decreased oxygen saturation levels Anemia – nursing interventions  Monitor Labs (RBC, Hgb and Hct)  Encourage activity as tolerated by the client with frequent rest periods  Monitor skin integrity and implement measures to prevent breakdown  Provide oxygen therapy to the client as needed  Administer blood products and medications as prescribed  Encourage foods high in iron (e.g., meats, poultry and fish) Vegans or Vegetarians – Foods High in Iron  Eat plant-based foods  Tofu  Legumes (lentils, dried peas and beans  Wholegrain cereals (iron-fortified)  Green vegetables such as broccoli or Asian greens  Nuts, especially cashews  Dried fruits such as apricot  Eggs  Seeds such as sunflower seed or products such as tahini Types of Anemia –renal disease  Anemia secondary to renal disease  Anemia due to lack of erythropoietin  Medications: Erythropoietin  Epoetin injection is a man-made version of human erythropoietin (EPO)  EPO is produced naturally in the body, mostly by the kidneys  Epoetin Alfa (Epogen/Procrit) – ATI Med Card  Epoetin alfa is a human erythropoietin produced  Nursing Considerations in cell culture using recombinant DNA technology.  it stimulates erythropoiesis and is used to treat  Sub Q: do not shake the vial anemia, commonly associated with chronic  IV: do not dilute or administer with other kidney failure and cancer chemotherapy  May raise the chance of: solutions  Heart attack  Avoid driving and or hazardous activities  Stroke during beginning treatment  Heart failure  Therapeutic response occurs within 2-4  Blood clots  Death. weeks Types of Anemia- Iron deficiency anemia-  Anemia due to low iron levels  The iron stores are depleted first, followed by hemoglobin stores  Contributing Factors  Chronic Blood Loss (bleeding ulcer)  Nutritional Deficiency  Common in infants, older adults and young women due to pregnancy or menses Manifestations  Microcytic red blood cells  Weakness and pallor  Low serum ferritin levels Nursing Interventions  Monitor for symptoms of bleeding  Monitor labs  Medication: Administer iron preparations  Follow provider prescription for ulcer treatment NCLEX  A nurse is teaching a client who has a new prescription for ferrous sulfate. Which of the following information should the nurse include in the teaching  A. Stools will be red  B. Take with a glass of milk if gastrointestinal distress occurs  C. Foods high in Vitamin C will promote absorption  D. Take for 14 days Aplastic Anemia  Bone marrow suppression of new stem cell production resulting in a deficiency of circulating WBC, platelets, and/or RBCs  This can be due to medication, viruses, toxins, and/or radiation exposure Aplastic Anemia manifestations  Hypoxia, fatigue, and pallor (related to anemia)  Increased susceptibility to infection (related to leukopenia)  Hemorrhage, ecchymosis/petechiae (related to thrombocytopenia)  Pancytopenia (decrease in RBCs, WBCs, and platelets) Aplastic Anemia – Nursing Interventions  Monitor labs  Provide protective isolation  Monitor for manifestations of infection  Provide emotional and psychological support to the client  Implement protective barrier precautions  Prepare client for bone marrow aspiration/biopsy Bone marrow aspiration/biopsy Determines if the bone marrow is making normal blood cells  Bone Marrow Transplant- Complications  Graft-versus-host disease (allogeneic transplant only)  Stem cell (graft) failure  Organ Damage  Infections Neutropenic Precautions  Cataracts Limit Fresh Flowers Screen Visitors of infection control  Infertility  New Cancers  Death  Graft vs. Host Disease (GVHD)  A condition occurs when donor bone marrow or stem cells attack the recipient.  Can occur at any time after a transplant. However, it's more common after the marrow has started to make healthy cells.  The condition can be mild or severe.  Symptoms vary based on how long someone has had the condition, but may include mouth ulcers, abdominal pain, and rash.  Treatment includes medication to suppress the immune system, such as steroids. Aplastic Anemia  Medications  Immunosuppressive therapy (prednisone, cyclosporine)  Chemotherapy Medications  Therapeutic Measures  Hematopoietic stem cell transplantation  Splenectomy  Cautious use of blood transfusion  Hematopoietic stem cell transplantation  Hematopoietic stem cell transplantation (HSCT), also known as bone marrow transplant, is a procedure that involves infusing healthy stem cells into patients with damaged or depleted bone marrow or immune systems.  B12 deficiency anemia (macrocytic)  Anemia due to a lack of dietary intake or absorption of vitamin B12  Contributing Factors: Atrophy of the gastric mucosa/hypochlorhydria (underproduction of hydrochloric acid by the stomach)  Total gastrectomy (lack of intrinsic factor decreased intestinal vitamin B 12 absorption  Malnutrition  B12 deficiency anemia (macrocytic) - manifestations  Numbness and tingling of extremities (paresthesia)  Hypoxemia  Pallor Neurological Symptoms  Jaundice  Glossitis – beefy red tongue  Poor balance - Positive Romberg’s test  http://neurosigns.org/wiki/Romberg%27s_sign B12 deficiency anemia (macrocytic) – Diagnostic Procedures  The Shilling Test is used to differentiate malabsorption versus pernicious anemia by measuring the absorption of B12 with and without intrinsic factor after the client is given an oral dose of radioactive vitamin B12  CBC- megaloblastic RBC (macrocytic)  B12 deficiency anemia (macrocytic) –Nursing Interventions  Monitor Labs  Promote rest and encourage a balanced dietary intake  Medications  Cyanocobalamin (Vitamin B12) standard dose is 1,000 mcg IM daily for 2 weeks, then weekly until Hct level is therapeutic, then monthly for life.  Cyanocobalamin intranasally maintains vitamin B12 levels. Folic Acid Deficiency Anemia  Anemia due to folic acid deficiency  Symptoms similar to vitamin B12 deficiency, but nervous system functions remain normal  Contributing Factors  Poor Nutrition  Malabsorption (secondary to Crohn's disease)  Drugs (e.g., chronic alcohol abuse, anticonvulsants, and oral contraceptives  Folic Acid Deficiency Anemia – Nursing Interventions  Identify high-risk clients: alcoholics, elderly, debilitated clients  Medication  Folic Acid Replacements Dietary Sources: Broccoli, Brussel Sprouts, Leafy green vegetables such as cabbage, kale, spring greens and spinach Peas Chickpeas and Kidney Beans Breakfast cereals fortified with folic acid  Folic Acid - ATI Med Card  Purpose: treatment of anemia, hepatic disease, alcoholism, hemolysis and  Nursing Considerations intestinal obstruction, reduction of  Bran, yeast, dried beans, nuts embryonic neutral tube defects fruits, fresh vegetables, asparagus  Side Effect: are good dietary sources of iron  Bronchospasm  May cause urine to turn bright  Irritability yellow  Anorexia, Bitter Taste  Pruritus  Hemolytic and Aplastic Anemia  A group of anemias that occur when the bone marrow is unable to increase production to make up for the premature destruction of red blood cells  Two types  Hemolytic: Sickle Cell and Thalassemia  Aplastic Anemia: Leukopenia, thrombocytopenia, and pancytopenia Hemolytic and Aplastic Anemia: Contributing Factors  Trauma Crushing Injuries  Toxic Agents  Lead Poisoning  Radiation Exposure  Tuberculosis  Infections  Transfusion Reactions Hemolytic and Aplastic Anemia: Manifestations  Chills  Rapid Heart Rate  Dark Urine  Shortness of Breath  Enlarged Spleen  Jaundice  Pallor  Hemolytic and Aplastic Anemia: Nursing Interventions  Medications  Treat the underlying cause  In severe immune-related hemolytic  Hydrate the client anemia, steroid therapy is sometimes  Blood Transfusion when necessary. kidney function is normal  Hematopoietic stem cell transplantation for aplastic anemia if other treatments fail  Sickle Cell Anemia  A genetic defect found in clients of African American or Mediterranean origin in which the Hgb molecule assumes a sickle shape and delivers less oxygen to tissues  The sickle cells become lodged in the blood vessels, especially the brain and kidneys  Sickle Cell Anemia  Manifestations  Contributing Factors (precipitate  Severe pain and swelling crisis by enhancing sickling)  Fever  Stress  Jaundice  Dehydration  Susceptibility to infection  Hypoxia  Hypoxic damage to organs:  High altitudes spleen, liver, heart, kidney, brain  Infection Sickle Cell Anemia  Percentage of hemoglobin S (Hgb S) seen on electrophoresis  The sickle trait has less than 40% Hgb S, and sickle cell disease may have 80% to 100% Hgb S  Sickle Cell Anemia – Nursing Interventions  Maintain adequate hydration  Medications:  Provide oxygen therapy to the client  Morphine Sulfate – pain control  Encourage the client to rest and in a crisis avoid high altitudes, alcohol, and temperature extremes.  Hydromorphone to manage the  Teach the client to identify triggers, client’s pain and prevent the get immunizations in a timely formation of sickle-shaped red manner, and refer for genetic blood cells counseling  Thalassemia  Inherited blood disorder in which the body makes an abnormal form of hemoglobin, resulting in excessive destruction of red blood cells, which leads to anemia  Contributing factors  Must inherit the defective gene from both parents to develop thalassemia major  Asian, Mediterranean, or African ethnicity  Family history of the disorder  Thalassemia – Manifestations  Develop during the first year of life - Pediatric Disorder  Bone deformities in the face  Fatigue  Growth Failure  Shortness of Breath  Yellow Skin (Jaundice)  Thalassemia –Nursing Intervention  Increase Folic Acid in the diet – dark green leafy vegetables, dried beans, peas (legumes), and citrus fruits and juices.  No iron during blood transfusions  Chelation therapy may be necessary to remove excess iron from the body  Bone marrow transplant may help treat the diseases in some clients, especially children  Medication: Folic Acid  NCLEX  A nurse is planning care for a client who has a Hgb 7.5 g/dL and Hct 21.5%. Which of the following actions should the nurse include in the plan of care? Select all that apply  A. Assist with ambulation  B. Monitor oxygen saturation  C. Weight the client weekly  D. Obtain stool specimen for occult blood  E. Schedule daily rest periods  NCLEX-RN  Ten days after receiving a bone marrow transplant, a patient developed a rash on the skin of his palms and soles, jaundice, and diarrhea. What is the most likely etiology of these clinical manifestations  A. The patient is experiencing a type I allergic reaction  B. An atopic reaction is causing the patient's symptoms  C. The patient is experiencing rejection of the bone marrow  D. Cells in the transplanted bone marrow are rejecting the host tissue References  Brunner & Suddarth's Textbook of Medical Surgical Nursing(14th ed.). (2018). Philadelphia, PA: Wolters Kluwer.  Content mastery series review model: RN Adult Medical Surgical Nursing (10.0 ed.). (2016). ATI Nursing Education.  Harding, M., & Snyder, J. S. (2016). Winningham's Critical Thinking Cases in Nursing(6th ed.). St.Louis, MO: Elsevier.  Kaplan Publishing. (2019). Nclex Drug Guide (8th ).