Hematology Final Powerpoint PDF

Chapter 28, 29 & 30 Assessment of Hematologic Function and Treatment Modalities ANEMIA, LEUKEMIA, LYMPHOMA, HODGKIN’S DISEASE&CLOTTING DISORDERS By Professor Ruth Thuo MSN RN Learning Outcomes: At the conclusion of this unit, the student will: 1. Explain key terms and medical terminology rela...

Chapter 28, 29 & 30 Assessment of Hematologic Function and Treatment Modalities ANEMIA, LEUKEMIA, LYMPHOMA, HODGKIN’S DISEASE&CLOTTING DISORDERS By Professor Ruth Thuo MSN RN Learning Outcomes: At the conclusion of this unit, the student will: 1. Explain key terms and medical terminology related to alterations in hematologic/neoplastic function 2. Apply the knowledge of the pathophysiology of selected hematologic/neoplastic disorders, including but not limited to, anemias, leukemias, lymphoma, Hodgkin’s disease, sickle cell disease and clotting disorders. 3. Apply the nursing process in the maintenance of health and promotion of selfcare of the adult patient with altered hematologic/neoplastic function. 4. Relate diagnostic tests related to the patient with altered hematologic/neoplastic function. 5. Apply pharmacotherapeutics used in the treatment of the adult or pediatric patient with selected hematologic/neoplastic disorders. 6. Determine the normal developmental changes and changes of aging as they pertain to the patient with altered hematologic/neoplastic function  Learning Outcomes: At the conclusion of this unit, the student will: 7. Articulate nursing responsibilities regarding nutritional requirements of the patient with altered hematologic/neoplastic function. 8. Develop health promotion and maintenance practices as they relate to the patient with altered hematologic/neoplastic function. 9. Determine unique teaching/learning needs of the patient with altered hematologic/neoplastic function. 10. Demonstrate the ability to deliver dignified nursing care which considers the diverse cultural needs of the patient with altered hematologic/neoplastic function. 11. Utilize verbal and non-verbal communication techniques effectively when delivering care to patients experiencing common health care deviations. 12. Discuss principles of safety and efficient use of systems resources in the care of the patient experiencing common health care deviations related to protection form hazards. Hematologic System  The blood and the blood‐forming sites, including the bone marrow and the reticuloendothelial system (RES)  Blood  Plasma: fluid portion of blood  Blood cells: erythrocytes, leukocytes, thrombocytes  Hematopoiesis  Bone Marrow  Stem cells  Myeloid  Erythrocytes (RBC)  Leukocytes (WBC)  Platelets  Lymphoid  Lymphocytes – T cells, B cells and plasmas cells  Stroma -is the part of a tissue or organ with a structural or connective role.  Table 28-1 Hematopoiesis  Hematopoiesis is the complex process of the formation and maturation of blood cells.  This process occurs in the bone marrow and begins with the differentiation of stem cells into either myeloid or lymphoid stem cells.  Myeloid stem cells differentiate into erythrocytes, leukocytes, and platelets.  Lymphoid stem cells produce either T or B lymphocytes. Question #2 Which type of cells increase in number when the patient is exposed to a bacterial infection? A. Erythrocyte B. Eosinophil C. Neutrophil D. Thrombocyte E. Monocyte Rationale: The neutrophils are the mature, circulating white blood cells. When a bacterial infection occurs, the neutrophils will increase in order to phagocytize the bacteria. Reticuloendothelial System  (RES) is composed of special tissue macrophages. When released from the marrow, monocytes spend a short time in the circulation (about 24 hours) and then enter the body tissues. Within the tissues, the monocytes continue to differentiate into macrophages, which can survive for months or years.  Macrophages defend the body against foreign invaders (bacteria and other pathogens) via phagocytosis. They remove old or damaged cells from the circulation. They stimulate the inflammatory process and present antigens to the immune system.  Macrophages give rise to tissue histiocytes, phagocytic cells that are present in loose connective tissue.  Histiocytes  Kupffer cells of the liver  Peritoneal macrophages  Alveolar macrophages  Spleen Hemostasis   Family history of blood disorders or abnormal bleeding. ▪ H/o bleeding –epitaxis, tooth, gum, hematuria, menorrhea, hematochezia, GIB or ulcers. ▪ Extreme fatigue, ▪ Easy deep bruising Assessment ▪ Abnormal bleeding, ▪ abnormal joint pain (sickle cell disease) of ▪ Review blood cell count for abnormality Hematologic ▪ Assess for presence of illness despite of low risk of illness. Health ▪ Prior radiation, History ▪ prior chemotherapy ▪ Occupation (military Agent Orange) ▪ alcohol consumption ▪ diet history and e of herbal supplements ▪ concurrent medication  Physical Assessment  Skin- Gray tan or brown skin color( genital area, scars, exposed areas. Ruddy complexion, Ecchymoses petechiae rush, conjunctiva hemorrhage, pallor, jaundice.  Oral cavity: Petechiae in the buccal mucosa, smooth beefy red tongue, alteration at the corner of the mouth, enlarged gums hyperplasia  Lymph Node: Enlarge lymph nodes firm and fixed  Respiratory: increased rate and deep respiration adventitious sounds  Cardiovascular vascular: distended neck veins edema hypertension, murmur, gallop.  Genitourinary: hematuria proteinuria  Musculoskeletal: rib/ sternal tenderness, back pain loss of height Kyphosis, pain and swelling in knees wrist and hands  Abdominal: Enlarged spleen, enlarged liver, Stool positive for occult blood.  Central nervous system : Cranial nerve dysfunction, peripheral nerve dysfunction visual changes headaches altered mental status  Gynecologic: menorrhagia  Diagnostic evaluation  Hematologic studies (CBC and peripheral blood smear)- RBC, WBC, H/H, platelets.  Cellular morphology(shape and appearance of the cell.)  Bone marrow aspiration and biopsy Therapeutic Approaches  Splenectomy  Apheresis( separation)- platelet pheresis, leukapherisis, erythrocytapheresis, plasmapheresis and stem cell harvest.  Hematopoietic stem cell transplantation (HSCT)  Phlebotomy  Blood component therapy  Special preparations Splenectomy Blood Transfusion  Pretransfusion assessment : h/o previous transfusion, previous reaction to transfusion and type of reaction and intervention, no. of pregnancies, cardiac, pulmonary and vascular disease.  Informed consent must be obtained pre-procedure.  Patient education;- s/s of transfusion reaction  Transfusion process-Correct administration techniques per agency’s policies and procedures  Transfusion Complications  Febrile nonhemolytic  Transfusion-related reaction acute lung injury (TRALI)  Acute hemolytic  Delayed hemolytic reaction reaction  Allergic reaction  Disease acquisition  Transfusion-associated  Long-term transfusion circulatory overload therapy (TACO)  Bacterial contamination Transfusion Complications  A febrile nonhemolytic reaction is caused by antibodies to donor leukocytes that remain in the unit of blood or blood component; most common type of transfusion reaction in patients who have had previous transfusions and in Rh- negative women who have borne Rh-positive children.  Acute Hemolytic Reaction- most dangerous type of transfusion reaction occurs when the donor blood is incompatible with that of the recipient.  Allergic Reaction-cause is thought to be a sensitivity reaction to a plasma protein within the blood component being transfused. Symptoms include urticaria, itching, and flushing. The reactions are usually mild and respond to antihistamines. Transfusion Complications  Bacterial Contamination- incidence are very low; however, Contamination can occur during procurement from organisms on the donor’s skin or processing. Many bacteria cannot survive in the cold temperatures used to store PRBCs, but some organisms can. Platelets are at greater risk of contamination because they are stored at room temperature.  Delayed Hemolytic Reaction- usually occur within 14 days after transfusion, when the level of antibody has been increased to the extent that a reaction can occur. The hemolysis of the erythrocytes is extravascular via the RES and occurs gradually. S/S include fever, anemia, increased bilirubin level, decreased or absent haptoglobin, and possibly jaundice. Rarely, there is hemoglobinuria Transfusion Complications Transfusion-Associated Circulatory Overload (TACO)  Results from too much blood is infused too quickly, hypervolemia can occur. Aggravated in patients with CHF, renal dysfunction, advanced age, acute MI  A careful assessment for signs of circulatory overload or positive fluid status prior to initiating the transfusion is required,  Pts at risk may be given diuretics are given prior to the transfusion or between units of PRBCs.  The infusion rate of these blood components must also be titrated to the patient’s tolerance (less than 100 to 120 mL/h).  Signs of circulatory overload include dyspnea, orthopnea, tachycardia, an increase in blood pressure, and sudden anxiety, Jugular vein distention, crackles at the base of the lungs, and hypoxemia will also develop. Pulmonary edema can quickly develop, as manifested by severe dyspnea and coughing of pink, frothy sputum. Transfusion Complications  Transfusion-Related Acute Lung Injury (TRALI)  TRALI is the most common cause of transfusion-related death. It is an idiosyncratic reaction that is defined as the development of acute lung injury occurring within 6 hours after the blood transfusion/blood components including IVIG, cryoprecipitate, and stem cells  Signs and symptoms include acute SOB, hypoxia [SaO2] less than 90%, hypotension, fever, and eventual pulmonary edema.  One commonly used preventive strategy involves limiting the frequency and amount of blood products transfused. Nursing Management of Transfusion Reactions  Stop  Assess  Notify primary provider and implement prescribed treatments. Continue to monitor  Return blood  Obtain any samples needed  Document Transfusion Alternatives  Growth factors (hematopoietic)  Erythropoietin  Granulocyte colony-stimulating factor  Granulocyte-macrophage colony-stimulating factor  Thrombopoietin to enhance platelet formation  Chapter 29 Management of Patients with Nonmalignant Hematologic Disorders Anemia  Lower than normal hemoglobin and fewer than normal circulating erythrocytes; a sign of an underlying disorder  Hypoproliferative: defect in production of erythrocytes (RBCs)Caused by iron, vitamin B12, or folate deficiency, decreased erythropoietin production, cancer, bone marrow damage  Hemolytic: excess destruction of erythrocytes(RBCs). Caused by altered erythropoiesis, or direct injury to the erythrocyte. Manifestations of Anemias  Depends on the rapidity of the development of the anemia, duration of the anemia, metabolic requirements of the patient, concurrent problems, and concomitant features  Fatigue, weakness, malaise  Pallor or jaundice  Cardiac, GI, neurologic and respiratory symptoms  Tongue changes  Nail changes  Angular cheilitis  Pica  Diagnostic Testing for Anemia  Hemoglobin and hematocrit  Reticulocyte count  RBC indices  Iron studies  Vitamin B12  Folate  Haptoglobin and erythropoietin levels  Bone marrow aspiration  Medical Management of Anemias  Correct or control the cause  Transfusion of packed RBCs  Treatment specific to the type of anemia  Dietary therapy  Iron or vitamin supplementation: iron, folate, B12  Transfusions  Immunosuppressive therapy  Other  Hemolytic Anemias  Sickle cell disease  Thalassemia  Glucose-6-phosphate dehydrogenase deficiency  Immune hemolytic anemia  Hereditary hemochromatosis  Others (refer to Chart 29-1) Hypoproliferative Anemias  Iron deficiency anemia  Anemia in renal disease  Anemia of inflammation  Aplastic anemia  Megaloblastic anemia  Folic acid deficiency  Vitamin B 12 deficiency Neutropenia  Decreased production or increased destruction of neutrophils (