Sean Whitfield - WK 5 - 6 Module 5 - NURS 3510 Hematology 7 ALG kjc 11.30.23 - Complete.pdf

NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Active Learning Guide: Hematologic Disorders Purpose/Overview Active lea...

NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Active Learning Guide: Hematologic Disorders Purpose/Overview Active learning guides help students to focus their study time by using knowledge-level information, then focusing on application and analysis of information to provide context in relation to the course and career skills. Students should review the active learning guide before beginning to engage with the module content, then work to complete the guide during and after to engage with the content. An active learning guide is not the same as a study guide or a test blueprint. It serves as a guide to help the student navigate the course and content. Instructions Review the active learning guide before you begin reading and engaging with other content in the module. Looking at the questions beforehand will give you a preview of the information you will be learning, including the key concepts and takeaways. As you work through the module content, complete the active learning guide. Some questions may be reflective and require that you finish all content prior to responding. The completed learning guide will be turned in one week before the exam. There are a possible 20 points for this learning guide. Brittney- Red, Minton-Purple Harper- Pink, Sean-Blue, Ethan-Green Reading Focus A Sacred Covenant: The Spiritual Ministry of Nursing: (6 points) Please answer the following question about spiritual ministry. Chapter 5 has information to help support your answer. Nursing is rewarding, an opportunity for service, and it is demanding work. The Holy Spirit is with Christians at all times, no matter their profession. 1. Share how you understand, after the last four clinical days, that nursing is a commitment that sometimes only God could give you the strength to carry out your tasks: Nursing is a commitment because of the mental and physical exhaustion it can put on someone. We are working 12 hour days and not always dealing with the easiest patients or the most humbling co-workers. God gives me the strength to get through the day by reminding me this was his calling for me and that I can do anything through as he is who strengthens me. 2. Share how you understand, after the last four clinical days, that nursing is a commitment that sometimes only God could give you the strength to carry out your tasks.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Nursing is a commitment that only God gave me the strength to carry out. I pray every day that if this is what the Lord wants me to do, that he gives me the strength to follow through and finish school. It can be really challenging some days (let's be honest, most days), but I know that all the hard work is worth it. 3. Share how you understand, after the last four clinical days, that nursing is a commitment that sometimes only God could give you the strength to carry out your tasks. Nursing is a job that can be extremely rewarding, but also extremely taxing and you have to be able to remain resilient in the face of the various mental, physical and emotional demands of the profession. Being able to juggle everything cannot be done alone and requires the help and guidance of God to relieve the tolls taken on your body and mind. Focusing on Him for guidance when feeling emotionally drained is important to be able to portray the empathy and servitude we should show to one another, even when we may not feel like it and the strength required of a nurse is so immense, the strength must be pulled from means greater than ordinary, a strength that can only be supplied by God. 4. Share how you understand, after the last four clinical days, that nursing is a commitment that sometimes only God could give you the strength to carry out your tasks. Nursing requires a extraordinary level of commitment and resilience. Nurses are at the bleeding edge of patient care. Whether it be during a clinical study testing new medications or on the frontline ranging from a local crisis (endemic) to a global one (pandemic). To be able to face situations and still be able to distribute treatments, patient advocacy, to manage emotions of patients and family members, a nurse will need to exhibit a level of investment, physical and mentally that other fields do not. 5. Share how you understand, after the last four clinical days, that nursing is a commitment that sometimes only God could give you the strength to carry out your tasks. Nursing demands a large amount of patience in order to effectively perform the duties. The strength to not become overwhelmed and distracted allows nurses to remain focused on the tasks that they are performing. In the text, you will see essential boxes, such as Assessment Abnormalities Tables, which discuss abnormal findings in the assessment of adults. Biologic Sex Consideration Boxes which contain a summary of how the disease affects male and female. Clinical Judgment Model Case Studies at the end of every chapter are available to promote your understanding of the decision-making process. Many other tables and boxes are noted in the text that will bring out the most valuable information organized in an effective summary.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Anemia 6. What is Anemia? a deficiency in the number of erythrocytes (red blood cells [RBCs]), the quantity or quality of hemoglobin (Hgb), and/or volume of packed RBCs (hematocrit). It is not a specific disease. Anemia is a manifestation of a pathologic process. It is a common condition with many diverse causes. These include blood loss, impaired RBC production, or increased RBC destruction 7. What are the causes of anemia? blood loss, impaired RBC production, or increased RBC destruction (Fig. 34.1). The diagnosis of anemia is based on a complete blood count (CBC), reticulocyte count, and peripheral blood smear. Once identified, further research is done to find the specific cause 8. What are the morphologic classifications of anemia? Morphologic classification is based on RBC size and color (Table 34.1). Etiologic classification is based on the clinical condition causing the anemia (Table 34.2).1 Although the morphologic system is the most accurate way to classify anemia, it is easier to discuss patient care by focusing on the cause of the anemia. 9. Review the several types of anemia and their cause. A. Anemia caused by decreased RBC: Normally RBC production (termed erythropoiesis) is in equilibrium with RBC destruction and loss. This balance ensures that an adequate number of RBCs is always available. The normal life span of an RBC is 120 days. There are 3 problems that lead to decreased RBC production: (1) decreased Hgb synthesis from iron deficiency anemia, thalassemia, and sideroblastic anemia; (2) defective deoxyribonucleic acid (DNA) synthesis in RBCs (e.g., cobalamin deficiency, folic acid deficiency) may lead to megaloblastic anemias; and (3) diminished availability of RBC precursors may result in aplastic anemia and anemia of chronic disease B. Iron deficiency Anemia: most common nutrition disorder in the world. Those most susceptible to iron deficiency anemia are the very young, those on poor diets, and women in their reproductive years.1 Normally, we lose 1 mg of iron daily in urine, bile, sweat, sloughing of epithelial cells from the skin and intestinal mucosa, and minor bleeding. C. Thalassemia: a group of diseases involving inadequate production of normal Hgb, which decreases RBC production. Thalassemia is due to an absent or reduced globulin protein. α-Globin chains are absent or reduced in α-thalassemia. β-Globin chains are absent or reduced in β-thalassemia. Hemolysis occurs as mononuclear phagocytes in the marrow destroy most erythroblasts. Those released into the blood are rapidly destroyed by macrophages in the spleen.1 Thalassemia is commonly found in persons whose ethnic origins are near the Mediterranean Sea and equatorial or near-equatorial regions of Southeastern Asia, the Middle East, India, Pakistan, China, Southern Russia, and Africa.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns D. Megaloblastic anemia: characterized by the presence of abnormally large (macrocytic) RBCs. We call them megaloblasts. Macrocytic RBCs are easily destroyed because they have fragile cell membranes. Megaloblastic anemias are caused by impaired DNA synthesis, which results in defective RBC maturation. Most result from cobalamin (vitamin B12) and folic acid deficiencies. They can also occur with congenital disorders, suppression of DNA synthesis by drugs, inborn errors of cobalamin and folic acid metabolism, and erythroleukemia (malignant blood disorder characterized by a proliferation of erythropoietic cells in bone marrow) E. Pernicious anemia: caused by an absence of intrinsic factor (IF). Pernicious anemia is a disease of insidious onset. It begins in middle age or later (usually after age 40), with 60 years being the most common age at diagnosis. Pernicious anemia occurs most often in persons of Northern European descent (especially Scandinavians) and Blacks. F. Folic Acid Deficiency: cause megaloblastic anemia. Folic acid is needed for DNA synthesis leading to RBC formation and maturation. Common causes of folic acid deficiency are shown in Table 34.8. The manifestations of folic acid deficiency are similar to cobalamin deficiency. It develops insidiously. Symptoms may be attributed to other coexisting problems (e.g., cirrhosis, esophageal varices). GI problems may include stomatitis, cheilosis, dysphagia, flatulence, and diarrhea. Thiamine deficiency, which is often present with folate deficiency, can cause neurologic symptoms. The diagnostic findings for folic acid deficiency are shown in Table 34.6. The serum folate level is low (normal is 5 to 25 ng/mL [11 to 57 nmol/L]), with a normal serum cobalamin level. We treat folic acid deficiency with replacement therapy. The usual dosage is 1 to 5 mg/day by mouth.2,4 The duration of treatment depends on the reason for the deficiency. Teach the patient to eat foods high in folic acid (Table 34.5). The nursing measures discussed in eNursing Care Plan 34.1 for the patient with anemia are appropriate for the patient with folic acid deficiency anemia. G. Aplastic anemia: disease in which the patient has peripheral blood pancytopenia (decrease of all blood cell types—RBCs, white blood cells [WBCs], platelets) and hypocellular bone marrow. The spectrum can range from a moderate condition managed with EPO or blood transfusions to very severe with potentially fatal bleeding and sepsis. The incidence of aplastic anemia is rare, with an annual rate of 2 new cases per million people in the United States per year. H. Blood Loss: occurs with sudden bleeding. Causes of acute blood loss include trauma, surgery complications, and problems that disrupt vascular integrity. There are 2 clinical concerns in such situations. First, a sudden reduction in the total blood volume can lead to hypovolemic shock. Second, if the acute loss is more gradual, the body maintains its blood volume by slowly increasing the plasma volume. While this  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns preserves circulating fluid volume, the number of RBCs available to carry O2 is significantly decreased. I. Chronic RBC destruction: chronic blood loss are similar to those of iron deficiency anemia (e.g., bleeding ulcer, hemorrhoids, menstrual and postmenopausal blood loss). The effects of chronic blood loss are usually due to depleted iron stores. We consider it an iron deficiency anemia. Management of chronic blood loss anemia involves identifying the source and stopping the bleeding. The patient may need iron supplements. J. Sickle Cell Anemia : group of inherited, autosomal recessive disorders characterized by an abnormal form of Hgb in the RBC. Because this is a genetic disorder, SCD is usually found during routine neonatal screening. Although median survival can now exceed 50 years old, SCD often results in irreversible damage of the lungs, kidneys, brain, retina, or bones that significantly affects patients’ quality of life. K. Polycythemia: production and presence of increased numbers of RBCs. The increase in RBCs can be so great that blood circulation is impaired because of the increased blood viscosity (hyperviscosity) and volume (hypervolemia). Please read the article by Phillips, “Caring for Individuals with Sickle Cell Disease,” and answer the following questions. 10. What is the defining genetic component of Sickle Cell? SCD includes multiple genotypes, which depend on the Hb variant contributed by each parent. Typically, individuals with Hb-SS and HbS[beta]0 thalassemia (also called sickle cell anemia [SCA]) have more severe disease manifestations, although wide variations in severity occur within each genotype 11. What is the defining characteristic of sickle cell? Deoxygenation and polymerization alter the shape of red blood cells (sickling), which leads to blood vessel occlusion and accompanying inflammation, infarction, organ damage, and pain 12. What physical symptoms do the patients with sickle cell experience? Pain, fever, sepsis, anemia, splenic sequestration, avascular necrosis, acute chest syndrome, and stroke 13. What are the pharmacologic and nonpharmacologic treatments for sickle cell disease? opioids, NSAIDS, SSRIs, gabapentin, massage, yoga, virtual reality, guided relaxation, blood transfusions Professor Notes: Clinical Judgement is the process by which the nurse decides how to care for a patient. This decision focuses on gathering data, analyzing that data, arriving at a hypothesis, and then creating solutions and acting to either save or improve health for the patient. We will use the Clinical Judgement Model as we learn how to care for patients with hematologic disorders.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Cues (collection of data: each piece of data is called a CUE) Please answer the following questions about assessment cues. 14. What are the abnormal assessment findings (clinical manifestations) in a person that has anemia? Because RBCs transport O2, RBC disorders can lead to tissue hypoxia. The manifestations of anemia result from the body’s response to the hypoxia. Specific manifestations vary depending on how fast the anemia has evolved, its severity, and any coexisting disease. We often use Hgb levels to determine the severity of anemia. Mild anemia (Hgb 10 to 12 g/dL [100 to 120 g/L]) may exist without causing symptoms. If symptoms develop, it is because the patient has an underlying disease or has a compensatory response to heavy exercise. Symptoms include palpitations, dyspnea, and mild fatigue. In moderate anemia (Hgb 6 to 10 g/dL [60 to 100 g/L]), there is an increase in cardiopulmonary symptoms. The patient may have them while resting as well as with activity. In severe anemia (Hgb less than 6 g/dL [60 g/L]), the patient has many manifestations involving multiple body systems 15. What is a normal RBC count? What are the normal hemoglobin and hematocrit levels for males and females? 16. What lab test is ordered to monitor for anemia? CBC Analyze Cues: Develop hypothesis (Nursing Diagnosis) 17. List the clinical problems associated with anemia. Please provide three completely written nursing diagnoses. Fatigue, nutritionally compromised, inadequate tissue perfusion. Activity intolerance r/t decreased oxygen supply. Imbalanced nutrition: less than body requirements r/t inability to absorb nutrients. Risk for infection r/t suppressed inflammatory response. Prioritize Hypothesis 18. Explain the process of choosing the priority clinical problem. Identify the type or cause of the anemia then choosing interventions that best address it. Generate Solutions 19. What are the goals of nursing care for patients with anemia? Patient will assume normal ALDs, maintain adequate nutrition, and develop no complications from anemia.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Take Action 20. What are the acute interventions for anemia, and what are the nurses' responsibilities? Interventions Administration of Iron Supplements -> Iron deficient anemia, the administration of IV and oral supplementation is critical to rapidly increase hemoglobin and replenish iron. Administration of Medication -> Completing medication administration in a timely manner and monitoring for adverse reactions. Blood transfusion -> When hemoglobin levels are critically low a transfusion of blood may be needed. The transfusion can also rapidly raise the hemoglobin concentration and and send oxygenated blood to the periphery very quickly. Oxygen Therapuetic -> Anemia can cause shortness of breath and other breathing difficulties. Supplemental oxygen can be provided to secure oxygenated blood to the tissue. B12 Vitamin or folic acid supplementation -> is crucial for cases of anemia that has been caused by deficient stores. Monitoring -> of vital signs of an anemic patient’s hemoglobin, and status is critical. Also, bed rest and ensuring needed nutrition and hydration. Nurse Responsibilities Assessment -> Performing a complete assessment can enable a nurse to pick out cues of anemia. Some of these cues are pallor, dizziness, fatigue, and shortness of breath. Patient Education -> is important to enable the patient to understand their diagnosis, understand the importance of medication adherence, food recommendations and the importance of follow up appointments with the health care provider. Teach the patient to recognize disease-related problems and which problems can be treated at home and which require hospitalization. Immediate medical attention is needed for severe pain or swelling of a muscle or joint that restricts movement or inhibits sleep and for a head injury, swelling in the neck or mouth, abdominal pain, hematuria, melena, and skin wounds in need of suturing. Teach the patient to perform daily oral hygiene without causing trauma. Understanding how to prevent injuries is another consideration. Teach the patient to take part only in noncontact sports (e.g., golf) and to wear gloves when doing household chores to prevent cuts or abrasions from knives, hammers, and other tools.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Coordination of Care -> Team collaboration can assure comprehensive care is delivered. Some of the teams involved in the collaboration are social work, dietary, and planning outpatient follow up. 21. What are the medications used to treat patients with anemia? List their actions, side effects, route, and dosage. What teaching is necessary related to the drugs ordered by the physician? Ferrous Sulfate (Iron Supplement) Action -> Resupply iron supplies that are needed for hemoglobin production. Side Effects -> Dark stools, Constipation, Nausea, Stomach Upset. Route -> PO, IV, Dosage -> 325 mg PO. 1-3 times a day. IV volume and run time depend on severity. Patient Education -> Take medication on empty stomach to achieve better absorption. Tolerated well with food otherwise to prevent upset stomach. Add additional fiber and fluid to prevent constipation. Do not take with antacids or other calcium supplements. These can alter or interfere with absorption. Folic Acid Action -> Crucial for DNA creation (synthesis) and RBC formation. Side Effects -> May include allergic reaction, nausea, abdominal cramps, otherwise zero sides. Route -> PO Dosage -> 1 mg daily Patient Education -> Include leafy green vegetables, fortified cereals, fruits and encourage medication adherence and its importance. Vitamin B12 Action -> Needed for RBC production and DNA synthesis. Side Effects -> Injection site irritation and pain. Route -> PO, IM, Subcutaneous Dosage -> IM 1000 mcg daily for 1 week -> Then weekly for 1 month -> Then monthly  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Patient Education -> Explain how important medication adherence is. To resolve dietary deficiencies, inform patient on how meat, dairy products and eggs are good sources of B12. Epoetin Alfa Action -> Triggers the bone marrow to produce more RBCs. Side Effects -> Headache, joint pain, hypertension, increased risk of thromboembolism. Route -> IV, Subcutaneous Dosage -> Epoetin Alfa 50-100 units/kg 3 times per week. Patient Education -> Monitor blood pressure, report leg pain and chest pain, adhere to medication regime and diagnostic testing to monitor hemoglobin levels. Evaluate 22. What are the expected outcomes? Improved hemoglobin and hematocrit levels. Decrease of Anemia Symptoms Adequate Nutritional Intake Adherence to Plan of Care Improved Energy and Activity Absence of Anemic Complications The expected outcomes are that the patient with leukemia will Cope effectively with the diagnosis, treatment regimen, and prognosis Have no complications related to the disease or treatment Feel supported throughout treatment Thrombocytopenia 1. What is Thrombocytopenia? Thrombocytopenia is a reduction of platelets to less than 150,000/μL (150 × 109/L). Acute, severe, or prolonged decreases from normal can result in abnormal hemostasis that presents as prolonged bleeding from minor trauma or spontaneous bleeding without injury.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns 2. What is the cause of platelet disorders? Cancers and other disorders Aplastic anemia Leukemia, lymphoma, myeloma, myelodysplastic disorders Marrow metastases by solid tumors Drugs (chemotherapy, others) Immune thrombocytopenia (ITP) Infections, bacterial, fungal, viral (hepatitis C virus, HIV, cytomegalovirus) Nutrition deficiencies, alcohol use Radiation Increased Platelet Destruction Artificial surfaces (e.g., cardiopulmonary bypass, hemodialysis) Disseminated intravascular coagulation (DIC) Heparin-induced thrombocytopenia (HIT) Pregnancy-related Thrombotic microangiopathy Atypical hemolytic uremic syndromes (aHUSs) Thrombotic thrombocytopenic purpura (TTP) Abnormal Platelet Distribution Dilution (massive blood transfusion, fluids) Splenic sequestration 3. Is genetics involved in platelet disorders? Yes: Platelet disorders occur from impaired production, increased destruction, or abnormal distribution ○ While they can be inherited (e.g., Wiskott-Aldrich syndrome), most are acquired. ○ Drugs are a common cause of acquired disorders ○ Although some drugs are directly myelosuppressive (e.g., chemotherapy, ganciclovir), the usual mechanism of drug-related thrombocytopenia is accelerated platelet destruction caused by antibodies. 4. What is immune Thrombocytopenia? Immune thrombocytopenia (ITP) is the most commonly acquired thrombocytopenia ITP is an acquired immune disorder where there is abnormal platelet destruction. In general, ITP presents as an acute condition in children and a chronic condition in adults 5. What is Heparin-Induced Thrombocytopenia? How is HIT determined, and how does it affect the patient?  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns ~HIT is platelet destruction and vascular endothelial injury that occur in response to an immune-mediated response to heparin. Platelet factor 4 (PF4) (a protein made and released by platelets) binds to heparin. This PF4-heparin complex then binds to the platelet surface, leading to further platelet activation and release of more PF4, thus creating a positive feedback loop. The body makes antibodies against the PF4-heparin-platelet complex. They are removed prematurely from circulation, leading to thrombocytopenia and platelet-fibrin thrombi ~HIT is determined by performing: Laboratory tests→ assess secondary hemostasis or coagulation, such as the prothrombin time (PT) and activated partial thromboplastin time (aPTT), can be normal even in severe thrombocytopenia→If they are increased, this may point toward DIC. Specific assays, such as ITP antigen-specific assay, platelet activation/function assay, or PF4-heparin complex for HIT, can help with the diagnosis. In TTP, testing for ADAMTS13 deficiency is not always diagnostic. Bone marrow examination may be done to see if production problems (e.g., leukemia, aplastic anemia, other myeloproliferative disorders) are the cause of thrombocytopenia or when other tests are inconclusive. ~Effects: The patient may need a splenectomy if they do not respond to treatment. The effectiveness of splenectomy is based on 4 factors. ○ First, the spleen has an abundance of the macrophages that sequester and destroy platelets. ○ Second, structural features of the spleen enhance the interaction between antibody-coated platelets and macrophages. ○ Third, some antibody synthesis occurs in the spleen, so antiplatelet antibodies decrease after splenectomy. ○ Fourth, the spleen normally sequesters about one third of the platelets, so its removal increases the number of platelets in circulation. Cues 6. What are the physical history and abnormal assessment (clinical manifestations) findings in the patient who is experiencing thrombocytopenia? The most common symptom is bleeding, usually mucosal or cutaneous. a. Mucosal bleeding may manifest as nosebleeds and gingival bleeding. b. Large bullous hemorrhages may appear on the buccal mucosa due to the lack of vessel protection by the submucosal tissue. c. Bleeding into the skin is seen as petechiae, purpura, or bruising.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns d. Pain and tenderness are sometimes present. The major complication of thrombocytopenia is bleeding. e. Bleeding may be insidious or acute and internal or external. f. It may occur in any area of the body, including the joints, retina, and brain. g. Prolonged bleeding from trauma or injury does not usually occur until platelet counts are under 50,000/μL (50 × 109/L).1 h. When the count is under 20,000/μL (20 × 109/L), spontaneous, life-threatening bleeding (e.g., intracranial bleeding) can occur. Insidious bleeding may be first detected by discovering the anemia from the blood loss. i. Manifestations of internal blood loss include weakness, fainting, dizziness, tachycardia, abdominal pain, and hypotension. j. Prolonged bleeding after routine procedures, such as venipuncture or IM injection, may indicate thrombocytopenia. Needed health history assessment include: Recent or excessive bleeding; viral illness; HIV infection; cancer (especially leukemia or lymphoma); aplastic anemia; SLE; cirrhosis; exposure to radiation or toxic chemicals; DIC 7. What are the laboratory studies used to diagnose or monitor thrombocytopenia? Platelets Hemolysis ○ Haptoglobin ○ Hgb ○ Indirect bilirubin ○ LDH ○ Reticulocytes ○ Schistocytes Coagulopathy ○ PT ○ aPTT ○ D dimer ○ (TTP) ADAMTS13 Urinalysis (for proteinuria, hematuria) ○ (TTP) Creatinine ○ (HIT) Platelet activation/function assay ○ (HIT) PF4-heparin complex (antigen assay) 8. What are the diagnostic tests used to diagnose or monitor thrombocytopenia? The diagnostic tests include: History and physical assessment  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Bone marrow aspiration and biopsy CBC, including platelet count Analyze Cues: Develop Hypothesis (Nursing Diagnosis) 9. List the clinical problems associated with thrombocytopenia. Impaired tissue perfusion Prioritize Hypothesis 10. Explain the process of choosing the priority clinical problem. Thrombocytopenia can cause prolonged bleeding time, ↓ Hgb and Hct and normal or ↑ megakaryocytes in bone marrow examination, and some of the manifestations, purpura for example, can cause clot formation and block blood flow to the organs, causing organ shut down or failure. Generate Solutions 11. What are the goals of nursing care for the patient with thrombocytopenia? Goals include that the patient will: Have no bleeding Maintain vascular integrity Manage self-care related to an increased risk for bleeding Take Action Professor Notes: Action depends on the type or cause. See table 34.13. You are not required to learn all of these drugs. Evaluate 12. What are the expected outcomes for a patient who suffers from Thrombocytopenia? The patient will: Have no evidence of bleeding or bruising State needed knowledge and skills to manage disease process Neutropenia 1. Define leukopenia. Refers to a decrease in the total WBC count (granulocytes, monocytes, and lymphocytes).  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns 2. Define Granulocytopenia. Is a deficiency of granulocytes, which include neutrophils, eosinophils, and basophils. 3. Define Neutropenia. Neutrophilic granulocytes (neutrophils) play a key role in phagocytizing pathogenic microbes. They are closely monitored in clinical practice as an indicator of a patient’s risk for infection. A reduction in neutrophils is termed neutropenia. 4. What are the normal lab values for WBC differentials? Neutrophils -> 40-60%. Absolute count -> 1500 to 8,000 cells/ul Lymphocytes -> 20-40%. Absolute count -> 1000 to 4800 cells/ul Monocytes -> 2-8%. Absolute count -> 100 to 700 cells/ul Eosinophils -> 1-4%. Absolute count -> 0 to 450 cells/ul Basophils -> 0.5-1%. Absolute count -> 0 to 200 cells/ul Cues 5. What are the abnormal assessment findings (clinical manifestations) in a person with neutropenia? The patient with neutropenia is predisposed to infection with opportunistic pathogens and nonpathogenic organisms from the normal body flora. When the WBC count is low or immature WBCs are present, normal phagocytic mechanisms are impaired. The classic manifestations of inflammation—redness, heat, and swelling—may not occur. WBCs are the major component of pus. Therefore, in the patient with neutropenia, pus formation (e.g., as a visible skin lesion or as lung infiltrates on a chest x-ray) is absent. 6. What are the diagnostic tests used to assess for neutropenia? The primary diagnostic tests for assessing neutropenia are the peripheral WBC count and bone marrow aspiration and biopsy (Table 34.22). A total WBC count of less than 4000/μL (4 × 109/L) reflects leukopenia. However, only a differential count can confirm the presence of neutropenia (neutrophil count less than 1000/μL [1 × 109/L]). Patients with acute leukemia who present with a high WBC may in fact have neutropenia, because most of the WBCs are ineffective leukemia blasts cells. Diagnostic Assessment History and physical assessment Risk assessment for severity and duration of neutropenia WBC count with differential count WBC morphology  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Hgb and Hct Reticulocyte and platelet count Bone marrow aspiration and biopsy Cultures of nose, throat, sputum, urine, stool, obvious lesions, blood (as indicated) Chest x-ray, liver function tests, and other diagnostic tests Analyze Cues 7. List the clinical problems associated with neutropenia. Predisposition to opportunistic infections. Low WBC count. Prioritize Hypothesis 8. Explain the process of choosing the priority nursing diagnosis. Most commonly a side effect of chemotherapy, so monitoring for infection and infection prevention are the priority. Generate Solutions 9. What are the goals of nursing care for the patient with neutropenia? Infection prevention, maintain ADLs while avoiding crowds, patient and caregivers can identify signs and symptoms for infection Take Action 10. What are the nursing and interprofessional care components for neutropenia? diagnostic assessment: history and physical assessment, severity and duration of neutropenia, WBC differential count, Hgb and Hct, bone marrow aspiration. management: identify cause, identification of infection, prophylactic hematopoietic myeloid growth factors, hand hygiene, isolation precautions 11. What are the responsibilities of the nurse when teaching precautions to a patient or caregiver with neutropenia? proper hand hygiene, notify healthcare team for fevers or other signs of infection, at home temperature checks, avoid crowds, cook meats properly, wash fruits and vegetables, bathe daily, proper dental hygiene, wash hands after handling pets Evaluate 12. What are the outcomes of a patient with neutropenia? Patients with acute neutropenia usually recover after treatment. If it is caused by chemotherapy then it will need to be closely monitored during treatment, but will usually resolve after the chemotherapy is completed.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns