Week 5 Reviewer Hematologic Disorders Vascular Disorders PDF

LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED B...

LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN DISTURBANCES IN OXYGEN TRANSPORT HEMATOLOGIC TERMINOLOGIES DISORDERS/VASCULAR DISORDERS Aneurysm - a localized sac or dilation of an artery formed Hematopoiesis at a weak point in the vessel wall Angioplasty - an invasive procedure that uses a balloon-tipped catheter to dilate a stenotic area of a blood vessel Ankle-brachial index (ABI) or ankle-arm index (AAI) - ratio of the ankle systolic pressure to the arm systolic pressure; an objective measurement of arterial disease that provides quantification of th degree of stenosis Arteriosclerosis - diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles thicken Atherosclerosis - inflammatory process involving the accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of a large or medium-sized artery Bruit - sound produced by turbulent blood flow through an irregular, tortuous, stenotic, or dilated vessel Duplex ultrasonography - combines B-mode gray-scale imaging of tissue, organs, and blood vessels with capabilities of estimating velocity changes by use of a pulsed Doppler Dyslipidemia - abnormal blood lipid levels, including high total, low-density lipoprotein, and triglyceride levels as well as low high-density lipoprotein levels Hematopoiesis - complex process of the formation and maturation of blood cells Hemoglobin - iron-containing protein of RBCs; delivers ANEMIA oxygen to tissues Is a condition in which the hemoglobin concentration is Hypertensive emergency - a situation in which blood lower than normal; it reflects the presence of fewer than pressure is severely elevated and there is evidence of the normal number of erythrocytes within the circulation. actual or probable target organ damage As a result, the amount of oxygen delivered to body Intermittent claudication - a muscular, cramp like pain in tissues is also diminished. the extremities consistently reproduced with the same It is not a specific disease state but a sign of an degree of exercise or activity and relieved by rest underlying disorder. It is by far the most common Pancytopenia - abnormal decrease in WBCs, RBCs, and hematologic condition. platelets A physiologic approach classifies anemia according to Petechiae - tiny capillary hemorrhages whether the deficiency in erythrocytes is caused by a Primary hypertension - also called essential hypertension; defect in their production (hypoproliferative anemia), by denotes high blood pressure from an unidentified cause their destruction (hemolytic anemia), or by their loss Rebound hypertension - blood pressure that is controlled (bleeding). with medication and that become uncontrolled Deficiency of RBCs, Hgb, Hct (abnormally high) with the abrupt discontinuation of ○ Hct -percentage of PRBCs/ dl of blood medication Anemia results from: Rest pain - persistent pain in the foot or digits when the ○ Blood loss patient is resting, indicating a severe degree of arterial ○ Inadequate or abnormal RBC production insufficiency ○ Destruction of RBCs a condition in which the Rubor - reddish blue discoloration of the extremities; hemoglobin concentration is lower than normal; it indicative of severe peripheral arterial damage in vessels reflects the presence of fewer than the normal that remain dilated and unable to constrict number of erythrocytes within the circulation. As Secondary hypertension - high blood pressure from an a result, the amount of oxygen delivered to body identified cause, such as renal disease tissues is also diminished. NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 1 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN ○ Jaundice (megaloblastic or hemolytic anemia) ○ Smooth, red tongue (iron-deficiency anemia) ○ Beefy, red, sore tongue (megaloblastic anemia) ○ Angular cheilitis (ulceration of the corner of the mouth) ○ Brittle, ridged, concave nails and pica (unusual craving for starch, dirt, ice) in patients with iron-deficiency anemia ASSESSMENT AND DIAGNOSTIC Complete hematologic studies (eg, hemoglobin, hematocrit, reticulocyte count, and red blood cell (RBC) indices, particularly the mean corpuscular volume [MCV] THINGS NEEDED FOR RBC PRODUCTION and RBC distribution width[RDW]) Iron Iron studies (serum iron level, total iron-binding capacity ○ For hemoglobin synthesis [TIBC], percent saturation, and ferritin) ○ Gives color to the blood Serum vitamin B12 and folate levels; haptoglobin and ○ Iron-deficiency anemia erythropoietin levels Intrinsic Factor Bone marrow aspiration ○ Produced by gastric mucosa Other studies as indicated to determine underlying illness ○ Needed for absorption of Vit B12 MEDICAL MANAGEMENT ○ Pernicious anemia Management of anemia is directed toward correcting or Folic Acid controlling the cause of the anemia; if the anemia is ○ Needed for maturation of RBC severe, the erythrocytes that are lost or destroyed may be ○ Extrinsic factor replaced with a transfusion of packed RBCs (PRBCs). ○ Folic acid-deficiency anemia Bone Marrow NURSING PROCESS THE PATIENT WITH ANEMIA ○ Aplastic anemia ASSESSMENT Vitamin B12 ○ Obtain a health history, perform a physical ○ Needed for maturation of RBC examination, and obtain laboratory values. ○ Extrinsic factor ○ Ask patients about the extent and type of ○ Vit. B12-deficiency anemia symptoms experienced and impact of symptoms Erythropoietin on lifestyle; medication history; alcohol intake; ○ Anemia secondary in origin athletic endeavors (extreme exercise). Nursing Diagnosis: Activity Intolerance ○ Ask about the family history of inherited anemias. CLINICAL MANIFESTATIONS ○ Perform nutritional assessment: Ask about dietary habits resulting in nutritional deficiencies, Aside from the severity of the anemia itself, several factors such as those of iron, vitamin B12, and folic acid. influence the development of anemia associated ○ Monitor relevant laboratory test results; note symptoms: changes. ○ The rapidity with which the anemia has ○ Assess cardiac status (for symptoms of increased developed workload or heart failure): tachycardia, ○ The duration of the anemia (ie, its chronicity) palpitations, dyspnea, dizziness, orthopnea, ○ The metabolic requirements of the patient, other exertional dyspnea, cardiomegaly, concurrent disorders or disabilities (eg, cardiac or hepatomegaly, peripheral edema. pulmonary disease) ○ Assess for GI function: nausea, vomiting, ○ And complications or concomitant features of the diarrhea, melena or dark stools, occult blood, condition that produced the anemia. anorexia, glossitis; women should be questioned In general, the more rapidly an anemia develops, the more about their menstrual periods (eg, excessive severe its symptoms. Pronounced symptoms of anemia menstrual flow, other vaginal bleeding) and the include the following: use of iron supplements during pregnancy. ○ Dyspnea, chest pain, muscle pain or cramping, ○ Assess for neurologic deficits (important with tachycardia pernicious anemia): presence and extent of ○ Weakness, fatigue, general malaise peripheral numbness and paresthesias, ataxia, ○ Pallor of the skin and mucous membranes poor coordination, confusion. (conjunctivae, oral mucosa) NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 2 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN NURSING DIAGNOSIS ○ Assess patients with anemia for heart failure. ○ Perform a neurologic assessment for patients Hemoglobin and diminished oxygen-carrying capacity of with known or suspected megaloblastic anemia the blood Altered nutrition, less than body requirements, related to EVALUATION inadequate intake of essential nutrients Expect patient outcomes Altered tissue perfusion related to inadequate hemoglobin ○ Reports less fatigue and hematocrit ○ Attains and maintains adequate nutrition Noncompliance with prescribed therapy ○ Maintains adequate perfusion COLLABORATIVE PROBLEMS/POTENTIAL COMPLICATIONS ○ Experiences no or minimal complications Heart failure APLASTIC ANEMIA Angina Is a rare disease caused by a decrease in or damage to Paresthesias marrow stem cells, damage to the microenvironment Confusion within the marrow, and replacement of the marrow with PLANNING AND GOALS fat. The precise etiology is unknown, but it is hypothesized that The major goals for the patient may include decreased the body’s T cells mediate an inappropriate attack against fatigue, attainment or maintenance of adequate nutrition, the bone marrow, resulting in bone marrow aplasia. maintenance of adequate tissue perfusion, compliance Significant neutropenia and thrombocytopenia (ie, a with prescribed therapy, and absence of complications. deficiency of platelets) also occur. Aplastic anemia can be NURSING INTERVENTIONS congenital or acquired, but most cases are idiopathic. Managing fatigue Infections and pregnancy can trigger it, or it may be ○ Assist patients to prioritize activities and caused by certain medications, chemicals, or radiation establish a balance between activity and rest. damage. ○ Encourage patients with chronic anemia to Agents that may produce marrow aplasia include benzene maintain physical activity and exercise to prevent and benzene derivatives (eg, paint remover). Certain toxic deconditioning materials, such as inorganic arsenic, glycol ethers, Maintaining Adequate Nutrition plutonium, and radon, have also been implicated as ○ Encourage a healthy diet. potential causes. ○ Teach patient to avoid or limit intake of alcohol. Deficiency of circulating RBCs usually accompanied by ○ Plan dietary teaching sessions for patients and leukopenia & thrombocytopenia family; consider cultural aspects of nutrition. ○ There is PANCYTOPENIA in aplastic anemia ○ Discuss nutritional supplements (eg, vitamins, CAUSES iron, folate) as prescribed. Failure of the bone marrow to produce cells (pluripotent Maintaining Adequate Perfusion stem cell injury) ○ Monitor vital signs and pulse oximeter readings Long-term exposure to toxic agents (drugs, chemical) ○ closely, and adjust or withhold medications Ionizing radiation (antihypertensives) as indicated. Viral infection ○ Administer supplemental oxygen, transfusions, Autoimmune and IV fluids as ordered. 50% of cases UNKNOWN? Promoting Compliance with Prescribed Therapy ○ Discuss with patients the purpose of their CLINICAL MANIFESTATIONS medication, how to take the medication and over Infection and the symptoms of anemia (eg, fatigue, pallor, what time period, and how to manage any side dyspnea). effects; ensure the patient knows that abruptly Retinal hemorrhages. stopping some medications can have serious Purpura (bruising). consequences. Repeated throat infections with possible cervical ○ Assist the patient to incorporate the therapeutic lymphadenopathy. plan into everyday activities, rather than merely Other lymphadenopathies and splenomegaly sometimes giving the patient a list of instructions. occur. ○ Provide assistance to obtain needed insurance ASSESSMENT FINDINGS AND DIAGNOSTIC METHOD coverage for expensive medications (eg, growth Diagnosis is made by a bone marrow aspirate that shows factors) or to explore alternative ways to obtain an extremely hypoplastic or even aplastic (very few to no these medications cells) marrow replaced with fat. Monitoring and Managing Complications Weakness & fatigue (typical for any type of anemia) NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 3 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN Frequent opportunistic infections problems related to erythrocyte, leukocyte, and platelet Coagulation abnormalities (unusual bleeding, petechiae & deficiencies. ecchymoses “bruises”) Monitor for side effects of therapy, particularly for Splenomegaly hypersensitivity reaction while administering ATG. ○ accumulation of client’s blood cells destroyed by If patients require long-term cyclosporine therapy, monitor lymphocytes that them for long-term effects, including renal or liver CBC – macrocytic anemia, leukopenia, thrombocytopenia dysfunction, hypertension, pruritus, visual impairment, BM aspiration/ biopsy =definitive test tremor, and skin cancer. ○ Result: Low primitive cells Carefully assess each new prescription for drug–drug ○ Most Common Site: Iliac Crest interactions, as the metabolism of ATG is altered by many other medications. Ensure that patients understand the importance of not abruptly stopping their immunosuppressive therapy. Administer blood transfusions as ordered Provide nursing care for client with BM transplantation Administer medications as ordered Monitor for signs of infection and provide care to minimize risk Implement special isolation procedures MEDICAL MANAGEMENT Encourage high-protein, high-Vitamin diet to help reduce hoxxThose who are younger than 60 years, who are incidence of infection otherwise healthy, and who have a compatible donor can Provide mouth care before and after meals. be cured of the disease by a bone marrow transplant Monitor for signs of bleeding and provide measures to (BMT) or peripheral blood stem cell transplant (PBSCT). minimize risk In others, the disease can be managed with ○ Use a soft toothbrush and electric razor immunosuppressive therapy, commonly using a ○ Avoid IM injection combination of antithymocyte globulin (ATG) and ○ Check for occult blood in urine and stool cyclosporine or androgens. (Hematest) Supportive therapy plays a major role in the management ○ Observe for oozing from gums, petechiae, or of aplastic anemia. Any offending agent is discontinued. ecchymoses. The patient is supported with transfusions of PRBCs and IRON DEFICIENCY ANEMIA platelets as necessary. Typically results when the intake of dietary iron is Blood Transfusion: MAINSTAY of treatment inadequate for hemoglobin synthesis. Iron Deficiency ○ Discontinued if client’s own marrow begins to anemia is the most common type of anemia in all age produce blood cells groups, and it is the most common anemia in the world. ○ Fresh Whole Blood-contains all blood components The most common cause of iron-deficiency anemia in men +plasma; less than 24 hours old an postmenopausal women is bleeding from ulcers, Antibiotic for infection gastritis, inflammatory bowel disease, or GI tumors. Corticosteroids (if autoimmune) The most common causes of iron-deficiency anemia in Bone marrow transplantation premenopausal women are menorrhagia (ie, excessive Identification and withdrawal of offending agent or drug menstrual bleeding) and pregnancy with inadequate iron supplementation Patients with chronic alcoholism often have chronic blood loss from the GI tract, which causes iron loss and eventual anemia. Other causes include iron malabsorption, as is seen after gastrectomy or with celiac disease. Microcytic, Hypochromic anemia caused by: ○ Inadequate intake of iron ○ Decreased absorption of iron in GIT ○ Excessive loss of iron (excessive bleeding or blood NURSING MANAGEMENT loss) Assess patient carefully for signs of infection and bleeding, CLINICAL MANIFESTATIONS as patients with aplastic anemia are vulnerable to Symptoms of anemia Symptoms in more severe or prolonged cases: smooth, NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 4 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN sore tongue; brittle and ridged nails; angular cheilitis therapy time (6 to 12 months), even when fatigue is no (mouth ulceration longer present. ASSESSMENT Monitor for signs and symptoms of abnormal bleeding especially from the GIT Bone marrow aspiration Provide for adequate rest: plan activities so as not to Laboratory values, including serum ferritin levels (indicates overtire iron stores), blood cell count (hemoglobin, hematocrit, RBC Provide a thorough explanation of all diagnostic tests used count, MCV), serum iron level, and total iron-binding to determine sources of possible bleeding (helps allay capacity anxiety and ensure cooperation) Reduced energy, Cold sensitivity, Fatigue, DOE Administer iron preparations as ordered. ⭡HR even at rest Oral iron supplements for mild iron losses (FeSO4) Decreased CBC, Hgb, Hct, serum Fe ○ prophylactic use:300-325mg Blood smear reveals microcytic & hypochromic RBCs ○ therapeutic use- 600-1200 mg daily in divided MEDICAL MANAGEMENT dose Search for the cause, which may be a curable GI cancer or Take iron with or immediately after a meal to avoid GI uterine fibroids. upset Test stool specimens for occult blood. ○ Take with orange juice or vitamin C source (⭡ People aged 50 years or older should have periodic absorption) colonoscopy, endoscopy, or x-ray examination of the GI ○ Use straw (elixir preparations) to prevent staining tract to detect ulcerations, gastritis, polyps, or cancer. of teeth Administer prescribed iron preparations (oral, ○ Expect iron to color stool dark green or black intramuscular [IM], or IV). ○ Causes constipation Have patients continue iron preparations for 6 to 12 Parenteral: used in clients intolerant to oral preparations, months. who are noncompliant with therapy, or who have severe Treat & eliminate the cause iron deficiency anemia Correction of faulty diet, oral supplement or parenteral ○ Use one needle to withdraw and another to administration of iron is prescribed administer iron preparations as tissue staining Blood Transfusion in severe cases and irritation are a problem NURSING MANAGEMENT ○ Use the Z-track injection technique to prevent Administer IM or IV iron in some cases when oral iron is leakage into tissues not absorbed, is poorly tolerated, or is needed in large amounts. Administer a small test dose before IM injection to avoid risk of anaphylaxis (greater with IM than with IV injections). Advise patients to take iron supplements an hour before meals. If gastric distress occurs, suggest taking the supplement with meals and, after symptoms subside, resuming between-meal schedules for maximum absorption. Inform the patient that iron salts change stool to dark ○ Do not massage injection site but encourage green or black. ambulation as this will enhance absorption; Advise patients to take liquid forms of iron through a advise against vigorous exercise and constricting straw, to rinse the mouth with water, and to practice good garments oral hygiene after taking this medication. Provide dietary teaching regarding foods high in iron Teach preventive education, because iron-deficiency ○ Liver especially pork & lamb anemia is common in menstruating and pregnant women. ○ Red meat, Organ meats, Kidney beans Educate patient regarding foods high in iron (eg, organ ○ Whole-wheat breads and cereals and other meats, beans, leafy green vegetables, raisins, ○ Leafy green vegetables molasses). ○ Carrots, Egg yolk, Raisins Instruct patient to avoid taking antacids or dairy products Encourage ingestion of roughage and increase fluid intake with iron (diminishes iron absorption). to prevent constipation if oral iron preparations are being Provide nutritional counseling for those whose normal diet taken is inadequate. Encourage patient to continue iron therapy for total NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 5 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN ○ Mild jaundice, vitiligo, and premature graying. ○ Confusion may occur; more often, paresthesias in the extremities and difficulty keeping balance; loss of position sense. ○ Lack of neurologic manifestations with folic acid deficiency alone. ○ Without treatment, patients die, usually as a result of heart failure secondary to anemia ASSESSMENT AND DIAGNOSTIC FINDINGS SMENT AND DIAGNOSTIC FINDINGS ANEMIA, MEGALOBLASTIC (VITAMIN B12 AND FOLIC ACID Schilling test (primary diagnostic tool) DEFICIENCY) Complete blood cell count (Hgb value as low as 4 to 5 g/dL, WBC count 2,000 to 3,000 mm3, platelet count fewer In the anemias caused by deficiencies of vitamin B12 or than 50,000 mm3; very high MCV, usually exceeding 110 folic acid, identical bone marrow and peripheral blood _m3) changes occur because both vitamins are essential for Serum levels of folate and vitamin B12 (folic acid normal DNA synthesis. deficiency and deficient vitamin B12) PATHOPHYSIOLOGY MEDICAL MANAGEMENT (FOLIC ACID DEFICIENCY) Folic Acid Deficiency Increase intake of folic acid in patient’s diet and ○ Folic acid is stored as compounds referred to as administer 1 mg folic acid daily folates. The folate stores in the body are much Administer IM folic acid for malabsorption syndromes. smaller than those of vitamin B12, and they are Prescribe additional supplements as necessary, because quickly depleted when the dietary intake of folate the amount in multivitamins maybe inadequate to fully is deficient (within 4 months). Folate deficiency replace deficient body stores. occurs in people who rarely eat uncooked Prescribe folic acid for patients with alcoholism as long as vegetables. Alcohol increases folic acid they continue to consume alcohol. requirements; folic acid requirements are also increased in patients with chronic hemolytic MEDICAL MANAGEMENT (VITAMIN B12 DEFICIENCY anemias and in women who are pregnant. Some Provide vitamin B12 replacement: Vegetarians can prevent patients with malabsorptive diseases of the small or treat deficiency with oral supplements with vitamins or bowel may not absorb folic acid normally fortified soy milk; when the deficiency is due to the more Vitamin B12 Deficiency common defect in absorption or the absence of intrinsic ○ A deficiency of vitamin B12 can occur in several factor, replacement is by monthly IM injections of vitamin ways. Inadequate dietary intake is rare but can B12. develop in strict vegetarians who consume no A small amount of an oral dose of vitamin B12 can be meat or dairy products. Faulty absorption from absorbed by passive diffusion, even in the absence of the GI tract is more common, as with conditions intrinsic factor, but large doses (2 mg/day) are required if such as Crohn’s disease or after ileal resection or vitamin B12 is to be replaced orally. gastrectomy. Another cause is the absence of To prevent recurrence of pernicious anemia, vitamin B12 intrinsic factor. A deficiency may also occur if therapy must be continued for life disease involving the ileum or pancreas impairs NURSING MANAGEMENT absorption. The body normally has large stores of Assess patients at risk for megaloblastic anemia for vitamin B12, so years may pass before the clinical manifestations (eg, inspect the skin, sclera, and deficiency results in anemia mucous membranes for jaundice; note vitiligo and CLINICAL MANIFESTATIONS premature graying). Symptoms of folic acid and vitamin B12 deficiencies are Perform careful neurologic assessment (eg, note gait and similar, and the two anemias may coexist. stability; test position and vibration sense). Symptoms are progressive, although the course of illness Assess need for assistive devices (eg, canes, walkers) and may be marked by spontaneous partial remissions and need for support and guidance in managing activities of exacerbation daily living and home environment. ○ Gradual development of signs of anemia Ensure safety when position sense, coordination, and gait (weakness, listlessness, and fatigue). are affected. ○ Possible development of a smooth, sore, red Refer for physical or occupational therapy as needed. tongue and mild diarrhea (pernicious anemia). NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 6 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN When sensation is altered, instruct the patient to avoid absorption may be abnormal in Pernicious excessive heat and cold. anemia Advise patients to prepare bland, soft foods and to eat small amounts frequently. Explain that other nutritional deficiencies, such as alcohol induced anemia, can induce neurologic problems. Instruct patients in complete urine collections for the Schilling test. Also explain the importance of the test and of complying with the collection. Teach patients about chronicity of disorder and need for monthly vitamin B12 injections even when the patient has no symptoms. Instruct patient how to self-administer ○ The Schilling test is performed to evaluate injections, when appropriate vitamin B12 absorption. Stress importance of ongoing medical follow-up and ○ B12 helps in the formation of red blood cells, the screening, because gastric atrophy associated with maintenance of the central nervous system, and pernicious anemia increases the risk of gastric carcinoma is important for metabolism. PERNICIOUS ANEMIA ○ Normally, ingested vitamin B12 combines with an intrinsic factor, which is produced by cells in the Caused by a deficiency of intrinsic factor (substance stomach. normally secreted by the gastric mucosa) ○ Intrinsic factor is necessary for vitamin B12 to be Intrinsic Factor is necessary for absorption of Vitamin absorbed in the small intestine. Certain diseases, B12 such as pernicious anemia, can result when Vitamin B12 is needed for the maturation of erythrocytes absorption of vitamin B12 is inadequate. without Vitamin B12 ○ Precursor cells undergo improper DNA synthesis MEDICAL MANAGEMENT (few are released from the bone marrow) Administration of Vitamin B12 (IM) weekly & monthly for ○ Increased in size: MEGALOBLASTIC or maintenance MACROCYTIC cells NURSING MANAGEMENT ○ Paresthesia: Vitamin B12 is needed for normal Provide a Vitamin B12-rich diet nerve function ○ Liver, Organ meats, Dried beans, Nuts, Green ASSESSMENT FINDINGS leafy vegetables, Citrus fruit, Brewer’s yeast Usually seen in elderly (production of intrinsic factor Avoid highly seasoned, coarse, or very hot foods if client decreases with age & gastric mucosal atrophy) & in clients has stomatitis & glossitis w/ history of surgical removal of stomach, bowel resection Provide mouth care before & after meals using a soft (ileum) toothbrush and nonirritating rinses Stomatitis, glossitis (a smooth, beefy-red tongue) Bed rest may be necessary if anemia is severe Pallor, fatigue, DOE Provide safety when ambulating (especially if carrying hot Severe cases: jaundice, irritability, confusion, items, etc.) Numbness & tingling in the arms & legs & difficulty with Provide client teaching and discharge planning concerning gait or balance (neurologic involvement) Dietary instruction Importance of lifelong Vitamin B12 therapy Rehabilitation and physical therapy for neurologic deficits, as well as instruction regarding safety FOLIC ACID ANEMIA Folic acid deficiency can also cause megaloblastic anemia Manifestations are similar to those of Vitamin B12 deficiency except for the nervous system involvement (folic acid does not affect nerve function) Absence of neurologic problems in FADA ○ Definitive test for pernicious anemia used to detect lack of intrinsic factor ○ The Schilling test is performed by administering 58Co-labeled cobalamin and collecting urine for 24 h and is dependent upon normal renal and bladder function. As a consequence, cobalamin NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 7 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN CAUSES Administration of corticosteroids (autoimmune) Blood transfusion Poor nutrition Splenectomy (fails to respond to medical treatment) ○ Beef liver, organ meats, eggs, green leafy vegetables, cabbage, broccoli, yeast, citrus fruits, NURSING MANAGEMENT peanut butter, oatmeal, asparagus Monitor for signs and symptoms of hypoxia including Malabsorption confusion, cyanosis, shortness of breath, tachycardia, and ○ Crohn’s disease palpitations ○ Chronic alcohol abuse (malnutrition) Presence of jaundice may make assessment of skin color in Drugs hypoxia unreliable ○ Anticonvulsants, oral contraceptives - prevent If jaundice and associated pruritus are present, avoid soap absorption & conversion of folic acid to its active during bathing and use cool or tepid water form leading to folic acid deficiency & anemia Frequent turning and meticulous skin care are important ASSESSMENT FINDINGS as skin friability is increased Severe fatigue, sore & beefy red tongue HEMOSTASIS/BLOOD CLOTTING Dyspnea, nausea, anorexia, headaches, weakness, Blood clotting mechanism involves 3 sequential process: lightheadedness ○ Platelet aggregation with formation of a platelet ⭣Hgb/Hct, ⭣serum folate plug Schilling test – differentiates pernicious anemia & FADA ○ Blood clotting cascade MEDICAL MANAGEMENT ○ Formation of a complete fibrin clot Oral or parenteral folic acid supplements Well-balanced diet NURSING MANAGEMENT Encourage to eat soft, bland & high in folic acid foods Good oral hygiene, adequate rest periods (fatigue) Vitamin B9 HEMOLYTIC ANEMIA Anemia cause by increase destruction of RBCs Acquired ○ Cardiopulmonary bypass surgery, arsenic or lead poisoning, malarial infection, toxins & hazardous chemicals, transfusion reactions Hereditary ○ Hereditary spherocytosis, G6PD deficiency, sickle cell anemia, thalassemia ASSESSMENT FINDINGS Clinical manifestations vary depending on severity of anemia and the rate of onset (acute vs chronic) ○ Dyspnea, Pallor, Fatigue, Jaundice (chronic) ○ Chills, Fever, Irritability, Precordial pain ○ Abdominal pain, N&V, diarrhea, melena, hematuria ○ Splenomegaly, hepatomegaly & symptoms of cholelithiasis Laboratory tests ○ ⭣ Hgb/Hct ○ ⭡ Reticulocyte count ○ Coombs’ test (direct): positive if autoimmune features present ○ Bilirubin (indirect): elevated unconjugated fraction Platelet plug formation triggers the blood clotting MEDICAL MANAGEMENT cascade mechanism Identify & eliminate the cause (if possible) NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 8 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN Intrinsic pathway ○ Intrinsic factors are problems or substances directly in the blood itself that first make platelets clump & then activate the blood-clotting cascade Example: Antigen-Antibody reaction, circulating debris, prolonged venous stasis, bacterial toxins Extrinsic pathway ○ Outside the blood: TRAUMA DISSEMINATED INTRAVASCULAR COAGULATION (DIC) Is a coagulation disorder that prompts overstimulation of the normal clotting cascade and results in simultaneous thrombosis and hemorrhage. The formation of microclots affects tissue perfusion in the major organs, causing hypoxia, ischemia, and tissue damage. Coagulation occurs in two different pathways: intrinsic and extrinsic. These pathways are responsible for the formation of fibrin clots and blood clotting, which maintains homeostasis. In CLOTTING FACTORS the intrinsic pathway, endothelial cell damage commonly ○ FACTOR I - Fibrinogen occurs because of sepsis or infection. ○ FACTOR II - Prothrombin The extrinsic pathway is initiated by tissue injury such as ○ FACTOR III - Tissue Thromboplastin from malignancy, trauma, or obstetrical complications. ○ FACTOR IV - Calcium Ions DIC may present as an acute or chronic condition. ○ FACTOR V - Labile Factor An essential medical management of DIC is primarily ○ FACTOR VII - Stable Factor aimed at treating the underlying cause, managing ○ FACTOR VIII - Antihemophilic Factor complications from both primary and secondary cause, ○ FACTOR IX - Christmas Factor or Plasma supporting organ function, and stopping abnormal Thromboplastin Component (PTC) coagulation and controlling bleeding. ○ FACTOR X - Stuart-Prower Factor Diffuse fibrin deposition within arterioles and capillaries ○ FACTOR XI – Plasma Thromboplastin with widespread coagulation all over the body and Antecedent (PTA) subsequent depletion of clotting factors ○ FACTOR XII - Hageman Factor ○ Hemorrhage (kidneys, brain, adrenals, heart, and ○ FACTOR XIII - Fibrin Stabilizing Factor other organs) ○ Cause: UNKNOWN ○ Clients are usually critically ill with an obstetric, surgical, hemolytic, or neoplastic disease ○ May be linked with entry of thromboplastic substances into the blood ○ Mortality rate is high, usually because underlying disease cannot be corrected NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 9 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN ○ Blood in your urine from bleeding in your kidneys or bladder. ○ Blood in your stools from bleeding in your intestines or stomach. Blood in your stools can appear red or as a dark, tarry color. (Taking iron supplements also can cause dark, tarry stools.) ○ Headaches, double vision, seizures, and other symptoms from bleeding in your brain. EXTERNAL BLEEDING External bleeding can occur underneath or from the skin, such as at the site of cuts or an intravenous (IV) needle. External bleeding also can occur from the mucosa. (The PATHOPHYSIOLOGY mucosa is the tissue that lines some organs and body cavities, such as your nose and mouth.) External bleeding may cause purpura (PURR-purr-ah) or petechiae (peh-TEE-key-ay). Purpura are purple, brown, and red bruises. This bruising may happen easily and often. Petechiae are small red or purple dots on your skin. ASSESSMENT AND DIAGNOSTIC FINDINGS Clinically, the diagnosis of DIC is often established by a drop in platelet count, an increase in PT and activated partial thromboplastin time (aPTT), an elevation in fibrin degradation products, and measurement of one or more clotting factors and inhibitors (eg, antithrombin [AT]). The International Society on Thrombosis and Haemostasis has developed a highly sensitive and specific scoring system using the platelet count, fibrin degradation products, PT, and fibrinogen level to diagnose DIC. This SIGNS AND SYMPTOMS OF EXCESSIVE BLOOD CLOTTING system is also useful in predicting the severity of the In DIC, blood clots form throughout the body's small blood disease and subsequent mortality. vessels. These blood clots can reduce or block blood flow Assessment Findings: through the blood vessels. This can cause the following ○ Petechiae and ecchymoses on the skin, mucous signs and symptoms: membranes, heart, lungs, and other organs ○ Chest pain and shortness of breath if blood clots ○ Prolonged bleeding from breaks in the skin (e.g., form in the blood vessels in your lungs and heart IV or venipuncture sites) ○ Pain, redness, warmth, and swelling in the lower ○ Severe and uncontrollable hemorrhage during leg if blood clots form in the deep veins of your childbirth or surgical procedures leg. ○ Oliguria and acute renal failure ○ Headaches, speech changes, paralysis (an ○ Convulsions,coma, death inability to move), dizziness, and trouble speaking Laboratory Findings: and understanding if blood clots form in the ○ PT/ PTT/ Thrombin prolonged blood vessels in your brain. These signs and ○ Fibrinogen level & Platelet count usually symptoms may indicate a stroke. depressed ○ Heart attack and lung and kidney problems if ○ Factor assays (II, V, VII) depressed blood clots lodge in your heart, lungs, or kidneys. MEDICAL MANAGEMENT These organs may even begin to fail The most important management issue is treating the. underlying cause of DIC. SIGNS AND SYMPTOMS OF BLEEDING A second goal is to correct the secondary effects of tissue Internal bleeding can occur in your body's organs, such as ischemia by improving oxygenation, replacing fluids, the kidneys, intestines, and brain. This bleeding can be life correcting electrolyte imbalances, and administering threatening. Signs and symptoms of internal bleeding vasopressor medications. include: If serious hemorrhage occurs, the depleted coagulation factors and platelets may be replaced (cryoprecipitate to NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 10 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN replace fibrinogen and factors V and VII; fresh-frozen ○ Assess neurologic, pulmonary, and skin systems. plasma to replace other coagulation factors). ○ Monitor response to heparin therapy; monitor A heparin infusion, which is a controversial management fibrinogen levels. method, may be used to interrupt the thrombosis process. ○ Assess the extent of bleeding. Other therapies include recombinant activated protein C ○ Stop epsilon-aminocaproic acid if symptoms of and AT infusions. thrombosis occur. Identification and control of underlying disease is key Reducing Fear and Anxiety Blood transfusions: WB, PRBC, platelets, plasma, ○ Identify previous coping mechanisms, if possible; cryoprecipitates, & volume expanders encourage patients to use them as appropriate. Heparin administration ○ Explain all procedures and rationale in terms that ○ Somewhat CONTROVERSIAL!!! the patient and family can understand. ○ Inhibits thrombin thus preventing further clot ○ Assist family in supporting patients. formation, allowing coagulation factors to ○ Use services from behavioral medicine and accumulate clergy, if desired. NURSING MANAGEMENT NURSING INTERVENTIONS Maintaining Hemodynamic Status Monitor blood loss and attempt to quantify ○ Avoid procedures and activities that can increase Observe for signs of additional bleeding or thrombus intracranial pressure, such as coughing and formation straining. Monitor appropriate laboratory data ○ Closely monitor vital signs, including neurologic Prevent further injury checks, and assess for the amount of external Avoid IM injections bleeding. ○ Apply pressure to bleeding sites ○ Avoid medications that interfere with platelet ○ Gently turn & position client frequently function, if possible (eg, beta-lactam antibiotics, ○ Provide frequent nontraumatic mouth care (soft acetylsalicylic acid, nonsteroidal toothbrush or gauze sponge) anti-inflammatory drugs). ○ Provide emotional support to client and ○ Avoid rectal probes and rectal or intramuscular significant others injection medications. ○ Administer blood transfusions and medications as ○ Use low pressure with any suctioning. ordered. ○ Administer oral hygiene carefully: use IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP) sponge-tipped swabs, salt or soda mouth rinses; Is a disease affecting all ages but is more common in avoid lemon-glycerine swabs, hydrogen peroxide, children and young women. Although the precise cause commercial mouthwashes. remains unknown, viral infection sometimes precedes the ○ Avoid dislodging any clots, including those disease in children. around IV sites, injection sites, and so forth Other conditions (eg, systemic lupus erythematosus, Maintain Skin Integrity pregnancy) or medications (eg, sulfa drugs) can also ○ Assess skin, with particular attention to bony produce ITP. In patients with ITP, antiplatelet prominences and skin folds. autoantibodies that bind to the platelets are found in the ○ Reposition carefully; use pressure-reducing blood. mattress and lamb’s wool between digits and When the platelets are bound by the antibodies, the around ears and soft absorbent material in skin reticuloendothelial system (RES) or tissue macrophage folds, as needed. system ingests the platelets, destroying them. ○ Perform skin care every 2 hours; administer oral The body attempts to compensate for this destruction by hygiene carefully increasing platelet production within the marrow. There are ○ Use prolonged pressure (5 minutes minimum) two forms: acute (primarily in children) and chronic after essential injections Destruction of platelets causing a slow blood clotting Monitoring for Imbalanced Fluid Volume process ○ Auscultate breath sounds every 2 to 4 hours. ○ Cause: autoimmune ○ Monitor extent of edema. Autoantibodies directed towards own ○ Monitor volume of IV medications and blood platelets products; decrease volume of IV medications if CLINICAL MANIFESTATIONS possible Assessing for Ineffective Tissue Perfusion Related to Many patients have no symptoms. Microthrombi Petechiae and easy bruising (dry purpura). NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 11 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN Heavy menses and mucosal bleeding (wet purpura; high These patients may benefit from calcium and vitamin D risk of intracranial bleeding). supplementation or bisphosphonate therapy to prevent Platelet count generally below 20,000/mm3. significant bone disease. Acute form self-limiting, possibly with spontaneous ○ Intravenous gamma globulin (very expensive) remissions. and the chemotherapy agent vincristine are also ASSESSMENT AND DIAGNOSTIC FINDINGS effective. ○ Another approach involves using anti-D (WinRho) Usually the diagnosis is based on the decreased platelet for patients who are Rh(D) positive. count and survival time and increased bleeding time and ○ Thrombopoiesis-stimulating protein AMG 531 has ruling out other causes of thrombocytopenia. Key been successfully used to treat patients with diagnostic procedures include platelet count, complete chronic ITP. blood cell count, and bone marrow aspiration, which shows ○ Epsilon aminocaproic acid (EACA; Amicar) may an increase in megakaryocytes (platelet precursors). Many be useful for patients with significant mucosal patients are infected with Helicobacter pylori. To date, bleeding who are refractory to other treatment effectiveness of H. pylori treatment in relation to modalities. management of ITP is unknown. ○ Platelet infusions are avoided except to stop Ecchymoses (Bruises), petechial rashes on the arms, legs, catastrophic bleeding. upper chest & neck Mucosal bleeding occurs easily NURSING MANAGEMENT Significant blood loss 🡪 anemia Assess the patient's lifestyle to determine the risk of Intracranial bleed-induced stroke (very rare) bleeding from activity. ○ Assess for neurologic function & mental status Obtain history of medication use, including over-the counter medications, herbs, and nutritional supplements; recent viral illness; or complaints of headache or visual disturbances (intracranial bleed). Be alert for sulfa-containing medications and medications that alter platelet function (eg, aspirin or other nonsteroidal anti-inflammatory drugs [NSAIDs]). Physical assessment should include a thorough search for signs of bleeding, neurologic assessment, and vital sign measurement. Teach patients to recognize exacerbations of disease (petechiae, ecchymoses); how to contact health care personnel; and the names of medications that induce ITP. Decrease platelet count Provide information about medications (tapering schedule, Large amount of megakaryocytes in the bone marrow if relevant), frequency of platelet count monitoring, and Presence of antiplatelet antibodies medications to avoid. Decrease Hgb/Hct (due to bleeding) To minimize bleeding, instruct patients to avoid all agents that interfere with platelet function. Avoid administering MEDICAL MANAGEMENT medications by injection or rectal route; rectal temperature Primary goal of treatment is a safe platelet count. measurements should not be performed. Splenectomy is sometimes performed (thrombocytopenia Instruct patients to avoid constipation, the Valsalva may return months or years later). maneuver, and tooth flossing. Treatment of underlying condition & protection from Encourage patients to use electric razor for shaving and trauma-induced bleeding episodes soft bristled toothbrushes instead of stiff-bristled brushes. Corticosteroids & Azathioprine (Imuran) Advise patients to refrain from vigorous sexual intercourse ○ Suppresses immune function when platelet count is less than 10,000/mm3. Platelet transfusion (not performed routinely because they Monitor for complications, including osteoporosis, proximal will be destroyed also) muscle wasting, cataract formation, and dental caries. Maintain a safe environment & protect the client from NURSING INTERVENTION conditions that can lead to bleeding Control bleeding PHARMACOLOGIC THERAPY ○ Administer platelet transfusions as ordered. Immunosuppressive medications, such as corticosteroids, ○ Apply pressure to bleeding sites as needed. are the treatment of choice. The bone mineral density of ○ Position bleeding part above heart level if patients receiving chronic corticosteroid therapy needs to possible. be monitored. Prevent bruising. NCMB312: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC 12 ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMUNOLOGIC DISORDERS/VASCULAR DISORDERS RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC)  LESSON 5: DISTURBANCES IN OXYGEN TRANSPORT: HEMATOLOGIC DISORDERS/VASCULAR NCMB312 DISORDERS WEEK 5 | THIRD YEAR – PRELIMS | A.Y. 2024-2025 | COLLEGE OF NURSING – VALENZUELA CAMPUS DISCUSSED BY: Prof. Dr. Potenciana A. Maroma TRANSCRIBED BY: Micaella Rane S. Valeriano, SN Provide support to clients and be sensitive to change in activity, decreased vasodilation of the arterioles, body image. or resistance to insulin action. Measure normal circumference of extremities for baseline. ○ Hypertensive emergencies and urgencies may Administer medications orally, rectally, or IV, rather than occur in patients whose hypertension has been IM; if administering immunizations, give subcutaneously poorly controlled, whose hypertension has been (SC) and hold pressure on site for 5 minutes. undiagnosed, or in those who have abruptly Administer analgesics (acetaminophen) as ordered; avoid discontinued their medications. aspirin. Secondary Hypertension BLOOD VESSEL DISTURBANCES ○ Secondary hypertension is characterized by elevations in blood pressure with a specific cause, Arteriosclerosis – Thickening or hardening of the arterial such as narrowing of the renal arteries, renal wall parenchymal disease, hyperaldosteronism Atherosclerosis – A type of arteriosclerosis that involves (mineralocorticoid hypertension), certain the formation of plaque within the arterial wall medications, pregnancy, and coarctation of the aorta. ○ Hypertension can also be acute, a sign of an underlying condition that causes a change in peripheral resistance or cardiac output. HYPERTENSION Is defined as a systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg, based on two or more measurements. Hypertension can be classified as follows: ○ Normal: systolic less than 120 mm Hg; diastolic less than 80 mm Hg ○ Prehypertension: systolic 120 to 139 mm Hg; diastolic 80 to 89 mm Hg ○ Stage 1: systolic 140 to 159 mm Hg; diastolic 90 to 99 mm Hg ○ Stage 2: systolic >160 mm Hg; diastolic >100 mmHg CLINICAL MANIFESTATIONS Hypertension is a major risk factor for atherosclerotic cardiovascular disease, HF, stroke, and kidney failure. Physical examination may reveal no abnormality other Carries the risk for premature morbidity or mortality, than high blood pressure. which increases as systolic and diastolic pressures rise. Changes in the retinas with hemorrhages, exudates, Prolonged blood pressure elevation damages blood vessels narrowed arterioles, and cotton–wool spots in target organs (heart, kidneys, brain, and eyes). (small infarctions), and papilledema may be seen in severe New classification(2003) “Normal adult BP”: hypertension. ○