TranxCN_NUR131_Hematology_20&_20Vascular_202-1-13.pdf

dia2 TABLE OF CONTENTS BATCH 2026 TRANXCN TEAM DEPUTY HEADS Chavez, Bettina Gabrielle D. Roales, Julianne Cassandra C. TRAN...

dia2 TABLE OF CONTENTS BATCH 2026 TRANXCN TEAM DEPUTY HEADS Chavez, Bettina Gabrielle D. Roales, Julianne Cassandra C. TRANXCN TEAM Mickaela Beyonce S. Aventurado Sofia Pauline B. Bartolo Dhana Mae S. Delos Santos NUR 131 Lexis Mei G. Mendoza Nathalie Kyle A. Mendoza Josh Merrill E. Turingan Ritscal Alek Caballes MEDICAL-SURGICAL Maria Andrea Midge A. Matibag Romina Catherine F. Dizon Reese Stefanie C. Reyes Chynna Marionne B. Bicomong NURSING 1: Charlene M. Bundal Fritz Ashley Valenzuela Gelsey Marie Jamilah B. Escol Frances Charra I. Ducay Yesha Margaret Dusaran Ella Shammel L. Porte Patricia Mae T. Ponce Concept Jabez Roel A. Villaflor TranxCN: HEMA & VASCULAR A.Y. 2024-2025 Maria Michaela D. Reyes Merced Eliza C. Diokno Kristina Amiella Lyn P. Leyva Guidelines: The Tranx CN is NOT FOR SALE and shall only be utilized by the bona fide nursing students from De La Salle medical and Health Sciences Institute. The students are permitted to download and print the Tranx CN. However, reproducing, imitating, altering or tampering any information on the transcriptions is strictly prohibited. Failure to abide by the Tranx CN guidelines will result in immediate termination of access to the transcriptions. Disclaimer: Please use at your own discretion. Tranx CN is not intended as a substitute for resource materials such as handouts, videos, and books provided by the college. All information on these transcripts is provided in good faith and is subjected to quality control. Regardless, the Tranx CN Team makes no representation or warranties of any kind regarding the accuracy, and completeness of any information in the transcripts. The College of Nursing Faculty/Professors are not liable for any mistakes or false information that may inadvertently be included in this transcript. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 OUTLINE A. Hematology B. Blood a. Functions of Blood in the Human Body C. Hematopoiesis a. Components of Blood b. Different cell types found in blood D. Hemostasis a. Three Phases of hemostasis b. Secondary hemostasis coagulation Cascade c. Plasma Clotting Factors E. Blood Types and Rh Factors a. Blood Type Compatibility F. Assessment of the Hematologic System PROCESS OF HEMATOPOIESIS HEMATOLOGY 1. Hematopoietic Stem Cells (HSCs) - stem cells Scientific study of the structure and function of that originate in the bone marrow; are multipotent, blood in health and in disease meaning they can become various blood cells (e.g., RBCs, WBCs, platelets) depending on the body's BLOOD needs. The circulatory fluid of the Cardiovascular system They can interchangeably replace any type of which is constantly circulating through a closed blood cell that is needed based on the body's circuit of tubes (veins and arteries) state, such as during a deficiency. 2. Stages of Differentiation - HSCs differentiate into FUNCTIONS OF BLOOD IN THE HUMAN BODY various blood cells through multiple steps regulated Provide oxygen and nutrients by signaling molecules called cytokines. Cleans discarded waste form the tissues For example, in blood loss, cytokines increase Transport hormones from their origin in the the production of RBCs to replenish the lost endocrine glands to other parts of the Body cells. Protect the body from dangerous microorganism 3. Regulation by Cytokines - Cytokines control the Promote hemostasis (to stop bleeding) proliferation, differentiation, and survival of blood cells. Specific cytokines respond to different stimuli HEMATOPOIESIS (e.g., infection or hypoxemia). The process of blood cell production It occurs primarily in the red bone marrow of large COMPONENT OF BLOOD bones like the pelvis, femur, and sternum Liquid phase (55%) - Plasma comprises of: ○ 90% Water ○ 10% Proteins (albumin, Immunoglobulins and fibrinogens), Electrolytes, Metabolic nutrients, Metabolic waste products, Hormones Plasma is a yellow fluid seen during plasma infusion in hospitals. It constitutes 92% water. Plasma proteins are made in the liver and include: ○ Albumin: Maintains osmotic pressure. ○ Globulins: Transport bilirubin, hormones, iron, and copper, and include immunoglobulins. ○ Clotting factors: Include prothrombin and fibrinogen. Other plasma contents include: ○ Small sugars, fats, vitamins, hormones AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 2 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 Solid phase - Formed elements / Cellular Monocytes: Develop into macrophages components (45%) and digest bacteria. ○ 98 - 99% Erythrocytes Stimulated by Colony-Stimulating Factors (CSFs), ○ 1 - 2% Leukocytes, Granulocytes, which increase in response to infections Agranulocytes, Platelets ○ ↑infection = ↑WBC production DIFFERENT CELL TYPES FOUND IN BLOOD THROMBOCYTES (PLATELETS) Crucial for blood clotting and stopping excessive bleeding and preventing blood loss ○ Normal range: 150,000 to 450,000 platelets ○ Lifespan: 9 to 12 days When there is a wound or injury, platelets clump together to form a clot and stop bleeding. They essentially block the wound to allow the formation of scar tissue. Produced by Thrombopoietin (TPO), a hormone secreted by the kidneys and liver. ○ Thrombopoietin (TPO): Regulates platelet production through a negative feedback loop. Lower platelet levels stimulate more production, while higher levels inhibit it. Formed from megakaryocytes, large cells that break into smaller fragments (platelets). ERYTHROCYTES (RBC) DEVELOPMENT OF ERYTHROCYTES Carry oxygen using hemoglobin from the lungs to (ERYTHROPOIESIS) body tissues and return carbon dioxide to the lungs for exhalation. ○ Normal range: 4 to 6 million RBCs ○ Lifespan: 80 to 120 days Stimulated by Erythropoietin (EPO), which is produced by the kidneys (and liver during fetal development) EPO levels rise when oxygen levels drop (e.g., during blood loss or in high-altitude environments) Nutritional Requirements of Erythropoiesis ○ ↓Oxygen level = ↑RBC production Amino Acids - Synthesis of globin of hemoglobin Requires iron, folic acid and vitamin B12 for Iron maturation Vitamins - Vitamin B₁₂ and folic acid for synthesis of nucleo protein LEUKOCYTES (WBC) Trace of elements - e.g. copper, zinc and cobalt Act as the body’s defense cells, fighting infections. Hormones - Cortisol, growth hormone Types of WBC: ○ Granulocytes: Neutrophils: Fight bacterial infections - first line of defense during infection Eosinophils: Fight parasitic infections and allergies. Basophils: Involved in allergic reactions - trigger immediate inflammation ○ Agranulocytes: Lymphocytes: Involved in viral infections and immune responses; originate from thymus and bone marrow AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 3 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 HEMOSTASIS (BLOOD CLOTTING) A term that refers to blood clotting PLASMA CLOTTING FACTORS Mnemonics: “Foolish People Try Climbing Long THREE PHASES OF HEMOSTASIS Slopes After Christmas, Some People Have Fallen” Factor I - Fibrinogen Platelets adhere and stick to vessel lining Platelet that are damaged forming a Platelet Plug or ○ Produced by the liver plug White Thrombus – Platelets release ○ Converted into fibrin by thrombin during blood formation chemicals to attract more platelets to the clot formation. Fibrin forms a mesh to trap injured site blood cells, creating a clot Factor II - Prothrombin Platelets release Serotonin causing spasms ○ It is produced by the liver and requires vitamin K Vascular of the blood vessel, constricting it & for synthesis Spasm decreasing blood flow ○ Precursor to thrombin, which converts Thromboplastin is released by fibrinogen into fibrin damaged cells Factor III - Tissue Thromboplastin plasma Clotting Factors form an ○ Released by damaged endothelial cells Coagulation activator that triggers the Clotting ○ Released by the extrinsic pathway of blood or Blood Cascade coagulation, activates factor VII Clotting a Blood Clot is formed Factor IV - Calcium ○ Serum is squeezed out within the ○ Produced by the liver hour pulling the ruptured edges ○ Essential for various steps in the clotting together process, including activating clotting factors. Without calcium, the clotting cascade cannot proceed effectively. Factor V - Proaccelerin (Labile factor) ○ Produced by the liver ○ Activates factor VII; combines with factor X to Accelerates the conversion of prothrombin to thrombin in the common pathway of the clotting cascade. Factor VII - Proconvertin (Stable Factor) ○ Involved in the extrinsic pathway of coagulation, helps activate factor X in the presence of tissue factor and calcium. Factor VIII: Antihemophilic factor A ○ Works with factor IX and calcium and activates SECONDARY HEMOSTASIS COAGULATION factor X and is Crucial for the intrinsic pathway CASCADE of coagulation ○ Deficiency leads to hemophilia A, characterized by prolonged bleeding. Factor IX: Christmas Factor ○ Activates factor VIII and is essential for the intrinsic pathway. ○ Deficiency leads to hemophilia B. Named after the first patient with its deficiency. Factor X: Thrombokinase (Stuart-Power Factor) ○ Activated by both intrinsic and extrinsic pathways. Converts prothrombin to thrombin Factor XI: Plasma Thromboplastin Antecedent ○ Involved in the intrinsic pathway, helps activate factor IX when calcium is present ○ Deficiency leads to hemophilia C, a milder form of hemophilia AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 4 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 Factor XII: Hagemen factor Race ○ Origin is liver and platelets ○ Hemoglobin levels differ by race; ○ Initiates the intrinsic pathway and activates African-Americans have higher risks of sickle factor XI and plasmin cell anemia. ○ Also plays a role in the inflammatory response ○ Ethnicity helps assess risk for race-related Factor XIII: Fibrin-stabilizing factor blood disorders. ○ Origin is platelets and plasma Family History ○ Stabilizes the fibrin clot by cross-linking fibrin ○ Inherited blood disorders (e.g., hemophilia, strands, making the clot more durable. sickle cell, pernicious anemia) require family history evaluation. BLOOD TYPES AND RH FACTORS ○ Congenital lack of intrinsic factors affects Vit Blood types are determined by the presence or B12 absorption and RBC production. absence of certain antigens Congenital lack of the intrinsic factors ○ Antigens: substance that can trigger an immune ○ (E.g. Hemophilia) absorption of Vit B12 is response if they are foreign to the body affected = affects RBC production Prior to transfusions, careful typing, cross-matching and screening of the blood not just for typing but for MODIFIABLE other diseases are done Exposure to certain chemicals or drugs Universal donor: Type O- ○ Radiation, chemotherapy, and chemicals (e.g., Universal recipient: Type AB+ benzene, lead, arsenic) can cause blood Rh Positive is the most common blood type disorders like anemia. ○ Certain drugs (e.g., chloramphenicol, BLOOD TYPE COMPATIBILITY anticonvulsants, streptomycin) may lead to blood-related issues. History - Patient’s Chief complaint ○ Assess if symptoms started suddenly or gradually. ○ Check for allergic reactions or seasonal patterns. ○ Evaluate bleeding for frequency, severity, and duration (e.g., massive or prolonged). Past medical history PHYSICAL EXAMINATION / REVIEW OF SYSTEMS SKIN Pallor, jaundice, dry skin, brittle or spoon-shaped nails (signs of different types of anemia) ASSESSMENT OF THE HEMATOLOGIC SYSTEM EYES Visual disturbances, blindness, scleral jaundice (common in RISK FACTOR ANALYSIS hemolytic anemia) NON-MODIFIABLE Age EARS Vertigo, tinnitus, and bleeding in the ○ Immune response weakens in the young and auditory canal elderly, increasing infection risk. ○ Anemia prevalence rises with age due to poor NOSE Epistaxis (nosebleeds), which may nutrition, chronic disease, and reduced RBC suggest cytopenia or bleeding production. disorders ○ Folic acid deficiency is common in infants and MOUTH Smooth, red, sore tongue and oral adolescents due to high growth demands. bleeding Sex ○ Women are more prone to anemia due to lower LUNGS Dyspnea (shortness of breath) and hemoglobin, menstruation, and childbirth blood hypoxia loss. AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 5 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 WBC DIFFERENTIAL COUNT - determines CARDIO- Tachycardia, palpitations, murmurs, VASCULAR and angina (common with severe proportion of each wbc in a sample of 100 WBCs; SYSTEM anemia) used to classify leukemias ○ Normal: 4,500 to 11,000 WBCs per Microliter GIT Dysphagia, abdominal pain, splenomegaly, hepatomegaly, and CBC ADULT REFERENCE RANGES bleeding (melena) GUT Hematuria (blood in urine) MUSCULO- Bone pain, back pain, and signs of SKELETAL a sickle cell crisis NERVOUS Headaches, confusion, neuropathy, SYSTEM paresthesia, and loss of balance (linked to pernicious anemia) DIAGNOSTIC PROCEDURES COMPLETE BLOOD COUNT RBC COUNT- Number of RBCS/ MM3 of blood, to diagnose anemia and polycythemia HEMOGLOBIN ○ Number of grams of hgb/ 100ml of blood ○ to measure the oxygen-carrying capacity of the PERIPHERAL BLOOD SMEAR (PBS) blood to determine the variations / abnormality in RBCs, HEMATOCRIT WBCs and platelets: ○ expressed in percentage ○ normal size and shape (normocytes) ○ measures the volume of RBC in proportion to ○ normal color (normochromic) plasma; used also to diagnose anemia and Hypochromic: less color than normal polycythemia and abnormal hydration states Hyperchromic: Bright red anemia (decreased), polycythemia vera (increased), and abnormal hydration states RETICULOCYTE COUNT RBC INDICES - measure rbc size and hemoglobin used to determine the number and percentage of content mcv, mch, mchc reticulocytes to help evaluate conditions that affect ○ Mean Corpuscular Volume (MCV): Size of red blood cells (RBCs) such as anemia and bone RBC (low = microcytosis; high = marrow disorders megaloblastic/macrocytosis) ○ Mean Corpuscular Hemoglobin (MCH): RETICULOCYTES Average weight of RBC (low = microcytosis or Newly produced, relatively immature RBCs. hypochromia; high = macrocytosis) A reticulocyte count is a relative reflection of recent ○ Mean Corpuscular Hemoglobin bone marrow function or activity. Concentration (MCHC): Evaluation of RBC saturation with Hgb; connected with TIBC (total iron binding capacity) (low = hypochromia; high = spherocytosis) PLATELET COUNT - Number of platelet/ mm3; to diagnose thrombocytopenia and subsequent bleeding tendencies ○ ↓Platelet count = ↑ risk for bleeding WBC COUNT - of wbcs/ mm3 of blood; to detect infection or inflammation AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 6 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 RBC MORPHOLOGY COAGULATION SCREENING TESTS BLEEDING TIME – measures the ability to stop bleeding after small puncture wound PARTIAL THROMBOPLASTIN TIME (PTT) – used to identify deficiencies of coagulation factors, prothrombin and fibrinogen ○ monitors heparin therapy. PROTHROMBIN TIME (PRO-TIME or PT) – determines activity and interaction of the prothrombin group: factors V (preaccelerin), VII (proconvertin), X (stuart-power factor), prothrombin and fibrinogen; used to determine dosages of oral anticoagulant. NORMAL VALUES OF COAGULATION TESTS bleeding time: 2.75-8 min partial thromboplastin time (ptt): 20-35 sec. TWO TYPES OF BONE MARROW prothrombin time (pt): 12-14 sec. Red Marrow - contains blood stem cells that can become RBCs, WBCs and Platelets Yellow Marrow - Mostly made out of fat BONE MARROW ASPIRATIONS (BMA) AND BIOPSY used to determine size and shape of RBCs, WBCs and platelet precursors and to examine various maturational abnormalities. NURSING RESPONSIBILITIES Pre-procedure ○ Explain the purpose ○ Obtain consent, as this is an invasive procedure ○ Inform client what to expect ○ Position client in lateral position with the site of aspiration uppermost ○ Cleanse area with antiseptic ○ Local anesthesia During the procedure Post-procedure ○ Apply pressure until bleeding stops ○ Check the site frequently for bleeding ○ Give pain relievers as prescribed by the physician AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 7 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 CENTRAL MUSCULAR Fatigue Chest Pain Dizziness Irregular Heartbeats OUTLINE Memory Problem A. Anemia a. Anemia MUSCULAR RESPIRATORY b. Production Anemia Weakness Shortness of breath c. Destruction Anemia B. Glucose-6-Phosphate Deficiency SKIN EYE a. Avoid Oxidant Drugs: Hemolytic for G-6-PD Patients b. Clinical Manifestations and Diagnostic Findings Pale skin Yellowing c. Collaborative Management C. Polycythemia Vera INTESTINAL SPLEEN a. Secondary Polycythemia occurs in response to Changes stool color Enlargement reduced amounts of oxygen b. Ruddy Complexion HAIR LOSS D. Hemophilia a. 2 Major Forms of Hemophilia b. Hemarthrosis NURSING DIAGNOSIS c. Health Education Fatigue related to decreased hemoglobin and E. Disseminated Intravascular Coagulation diminished oxygen-carrying capacity of the blood a. Signs of Abnormal Bleeding Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients ANEMIA Activity intolerance related to inadequate ANEMIA DISORDER hemoglobin and hematocrit Condition in which hemoglobin is lower than normal Noncompliance with prescribed therapy Reflected in the presence of fewer than normal number of erythrocytes (RBCs) PLANNING AND GOALS Not a specific disease state, but an underlying Decrease fatigue disorder Attainment or maintenance of adequate nutrition Most common hematologic state Maintenance of adequate tissue perfusion Rationale: There is decreased oxygen carrying Compliance with prescribed therapy capacity of the blood for the body tissues Absence of complications NURSING INTERVENTIONS Assistance with ADLs Help cope with certain activities Encourage to eat green, leafy vegetables Monitor adherence to prescribed therapy EVALUATIONS Reports less fatigue Attains and maintains adequate nutrition Maintains adequate activity level Absence of complications PRODUCTION ANEMIA SIGNS AND SYMPTOMS HYPOPROLIFERATIVE ANEMIAS PALLOR The bone marrow does not produce adequate number of erythrocytes Decreased erythrocytes is reflected as low or inappropriately normal reticulocyte count Due to medications - like chloramphenicol (bone marrow damage) AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 8 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 Exposure to chemicals - like benzene (bone ○ Medication marrow damage) Promote Lack of factors necessary for erythrocyte formation ○ Rest - like iron, Vitamin b12, folic acid, erythropoietin ○ Good oral care ○ Good skin care IRON DEFICIENCY ANEMIA SPECIAL CLINICAL MANIFESTATIONS Atrophic Glossitis: Tongue becomes smooth and thin Angular Cheilitis: Red swollen patches in the corner of the mouth Spoon-like nails–Koilonychia Decreased iron in all RBC Affects heme / Hgb synthesis Leads to hypoxia RISK Vegetarians FACTORS Menstruating/Pregnant Infants, Adolescent (female) Older adults Malabsorption of Fe Chronic Blood loss SIGNS AND Early Symptoms SYMPTOMS ○ Pallor ○ Fatigue ○ Weakness ○ SOB Glossitis Angular Cheilitis Koilonychia DIAGNOSTIC Bone marrow biopsy EXAMS Serum ferritin, transferrin CBC / Peripheral smear PERNICIOUS ANEMIA–VITAMIN B12 DEFICIENCY Radiographic Studies Absence of intrinsic factor Stool exam for occult blood Impairs dna synthesis and cell replication Esophagoscopy RBC precursor cells do not divide normally Gastroscopy Large and poorly functioning RBCs are created Sigmoidoscopy Myelin production on nerves is greatly affected MEDICAL Diagnosis and correction of resulting to neurologic deterioration MGT underlying problem ○ Malnutrition CAUSES Insufficient dietary intake ○ Alcoholism Drugs that impede absorption in the Treatment through diet and stomach and impair update in the supplemental iron preparation for ileum 6-12 months Genetic disorders causing effects in Oxygen Therapy the ileal receptors of intrinsic factors Blood Transfusion as needed Impaired absorption GI disorders (medications, cancers, SURGICAL Surgery to repair sites of hemorrhage resection of the ileum) NURSING Health Teachings SIGNS AND Headache MGT ○ Diet therapy AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 9 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 SYMPTOMS Dizziness INTERVENTIO Avoid over cooking vegetables Dyspnea NS Folic acid 1 mg/day per orem as Palpitation prescribed Cold sensitivity Pallor Generalized malaise APLASTIC ANEMIA SIGNS AND GIT changes SYMPTOMS ○ Mouth sores ○ Red beefy tongue ○ Dyspepsia or indigestion ○ Weight loss ○ jaundice CNS changes ○ Tingling sensation ○ Paraesthesia ○ Ataxia ○ Psychosis Disorder characterized by bone marrow hypoplasia or aplasia resulting in pancytopenia. DIAGNOSTIC CBC with peripheral smear is evident as infections and uncontrolled bleeding. EXAMS Schilling Test MEDICAL Cobalamin / Vit B12 Therapy CAUSES MGT Fe Supplement Can be acquired, congenital, or idiopathic Tx Neurologic Complication Viral infection (Pernicious Anemia) Pregnancy Medications NURSING Monitor clients progress Chemicals MGT ○ Response to treatment and Dx Exposure to radiation exams Agents like benzene Client education on adherence to tx Toxic chemicals like arsenic, glycol enters regimen FOLATE DEFICIENCY ANEMIA Also called megaloblastic anemia ETIOLOGY Chronic malnutrition AND RISK Alcoholism FACTORS Pregnancy CLINICAL MANIFESTATIONS Can be seen by diseases of GI tract ANEMIA Pallow Certain medication can decrease folic Weakness acid absorption Fatigue Exertional dyspnea SIGNS AND Cracked lips palpitations SYMPTOMS Sore tongue NEUTRO- Fever DIAGNOSTIC Decreased PENIA Headache EXAMS ○ RBC Malaise ○ Hgb Abdominal pain ○ Hct Diarrhea Increased Adventitious sounds ○ MCV Pain ○ MCHC Exudates at wound sites or sites from invasive procedures TREATMENT Well balanced diet that includes AND green vegetables, liver and other NURSING organ meats, fresh fruits AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 10 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 APLASTIC CRISIS THROMBO- Bleeding from gums, nose, CYTOPENIA gastrointestinal or genitourinary tract Caused by diminished production and increased Purpura destruction of red blood cells, triggered by viral Petechiae infection or depletion of folic acid Ecchymoses Manifestations: Profound anemia and pallor SPLENIC SEQUESTRATIONS ASSESSMENT AND DIAGNOSTIC FINDINGS Caused by pooling and chopping of blood in the CBC - pancytopenia = decrease in all myeloid stem spleen (hypersplenism) cell-derived cells Manifestation: Profound anemia, hypovolemia, and Neutrophil - less than 1500/ml shock. Hgb - less than 10 g/dl Platelets - less than 50,000/ml BMA - hypoplastic, even aplastic marrow replaced COMPLI- Dysrhythmias with fat CATIONS Heart failure Thrombosis, particularly in the spleen, lungs, and CNS MEDICAL Bone Marrow Transplantation Infection MGT Immunosuppressive therapy Stroke ○ Corticosteroids Kidney injury ○ Cyclosporine Impotence ○ Cytoxan Pulmonary hypertension ○ ATG (Antithymocyte globulin) ○ ALG (Antilymphocyte) MEDICAL BMT Blood transfusion as necessary MGT Hydroxyurea Aggressive treatment for infections Transfusion therapy NURSING Assess for signs and symptoms of NURSING Pain management MGT tissue hypoxia MGT Adequate hydration Frequent rest periods Preventing and managing infections Minimize risk of infections Promoting coping skills Minimize risk of bleeding THALASSEMIA MAJOR DESTRUCTION ANEMIA Cooley’s anemia HEMOLYTIC ANEMIA It is the most severe of the beta thalassemia. Erythrocytes have shortened lifespan. Inherited hemolytic anemia characterized by a Number of circulating RBCs is reduced. reduction or absence of beta-globin chain in the hemoglobin synthesis. SICKLE CELL ANEMIA Results from inheritance of the sickle hemoglobin gene (HbS). VASO-OCCLUSIVE CRISIS Caused by stasis of blood with clumping of cells in the microcirculation, ischemia, and infarction. CLINICAL Expansion of bone marrow cavities of Manifestations: Fever, Painful swelling of hands, MANIFESTA- the bone feet, and joints; and abdominal pain. TIONS ○ Frontal and maxillary bossing AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 11 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 COLLABORATIVE MANAGEMENT ○ Growth retardation ○ Pathologic fractures Stop or avoid the offending medication ○ Hemosiderosis Treat underlying disease condition BT necessary only in severe hemolytic state COLLAB- Frequent and regular BT of PRBC ORATIVE Iron chelation therapy with POLYCYTHEMIA MGT deferoxamine Is characterized by elevation of RBC and Hgb. Splenectomy It is a compensatory mechanism of the body to Monitor cardiovascular status chronic hypoxia. Relieve bone pain Avoid contact sports to reduce risk of fracture SECONDARY POLYCYTHEMIA OCCURS IN Encourage prompt medical attention RESPONSE TO REDUCED AMOUNTS OF OXYGEN for fever or signs of infection. Heavy cigarette smoking Obstructive sleep apnea GLUCOSE-6-PHOSPHATE DEFICIENCY Chronic obstructive pulmonary disease G-6-PD – source of abnormality – produces an Cyanotic heart disease enzyme within the erythrocyte essential for Living in high altitudes membrane stability. Exposure to Low CO2 levels Defective G-6-PD = chronic hemolytic anemia Most common form causes hemolysis of erythrocytes in stressful situations, like infection, other diseases conditions, intake of certain medications or exposure to offending agents Mostly, X-linked, but women may also manifest. AVOID OXIDANT DRUGS: HEMOLYTIC FOR G-6-PD PATIENTS ANTIBACTERIAL Sulfadiazine Macrodantin Moxifloxacin ANTIMALARIAL Primaquine OTHERS Methylene blue Furosemide NSAIDs RUDDY COMPLEXION CLINICAL MANIFESTATIONS AND DIAGNOSTIC FINDINGS Asymptomatic, normal hgb and reticulocyte levels. However, upon use of offending agents, symptoms start to appear. ○ Pallor ○ Jaundice ○ Hemoglobinuria HEMOPHILIA ○ Reticulocyte increase Hereditary coagulation defect, usually transmitted to ○ Hemolysis is mild, often self-limited affected male by female carried through sex - linked PBS- Heinz bodies- degraded hgb recessive gene resulting in prolonged clotting time. Diagnostic - quantitative assay for G-6-PD- in the Found predominantly, but not exclusive, in male Philippines, NBS (Newborn Screening). offsprings. AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 12 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 32 NURSING 1 Bleeding occurs due to impaired ability to form fibrin The result is widespread clotting in small vessels of clot. the body with consumption of clotting factors and platelets, so that the bleeding and thrombosis occur 2 MAJOR FORMS OF HEMOPHILIA simultaneously. Hemophilia The classic form, which is due to a A (HA) deficiency of factor VIII. MORTALITY RATE CAN EXCEED 80% IN SEVERE DIC BECAUSE OF Hemophilia Also known as Christmas Disease, Ischemic thrombosis B (HB) which is due to the deficiency of factor Frank hemorrhage IX. Multiple Organ Dysfunction Syndrome (MODS) SIGNS OF ABNORMAL BLEEDING HEMARTHROSIS Bleeding from procedural sites like IVs, catheters, Bleeding into the Joints. suture lines, mucous membranes or orifices. Hallmark manifestation Internal bleeding leading to changes in vital organ Knees, ankles, elbows, wrists, fingers, hips, & functions, altered vital signs. shoulders. Diagnostic Results: Painful & leads to deterioration of the joints, which ○ Low platelet count may become deformed & permanently crippled. ○ Prolonged PT, aPTT, and thrombin time ○ Decreased Fibrinogen HEALTH EDUCATION ○ Elevated D-Dimer Avoid contact sports Use protective gear Avoid aspirin-containing medications, as it is an anticoagulant and other NSAIDs like ibuprofen and ketoprofen. Avoid IM Injection because of likelihood of hematoma formation Maintenance of good oral hygiene. For the parents: Genetic Counseling DISSEMINATED INTRAVASCULAR COAGULATION An acquired thrombotic and hemorrhagic syndrome. DIC is not a disease but a sign of an underlying condition. It is characterized by abnormal activation of the clotting cascade and accelerated fibrinolysis. AVENTURADO, BICOMONG, DELOS SANTOS, DIOKNO, LEYVA, MATIBAG, MENDOZA N., TURINGAN, CHAVEZ, MENDOZA L. 13 of 35 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.