Adult 1 Exam 3 - Hematology

Front 1

anemia - nursing diagnoses

Back 1

Anemia affects circulating oxygen levels and tissue oxygenation. Priority nursing diagnoses include Activity Intolerance, altered oral mucous membranes, and self-care deficits. w/ acute blood loss anemia, risk for insufficient cardiac output is also a priority. w/ sickle cell anemia have specific needs r/t the effects of tissue perfusion.

Front 2

Activity Intolerance r/t anemia.

Back 2

causes weakness and shortness of breath on exertion. this is due to decreased circulating oxygen 2° to low hemoglobin levels. Weakness fatigue and/or vertigo may occur even during ADLs.

Front 3

Interventions r/t Activity Intolerance (fatigue)

Back 3

- help identify way to conserve energy when performing necessary or desired activities.
- help pt and fam est. priorities for task and activities.
- help dev. a sched. of alternating activity and rest periods thru out day.
- encourage 8-10hrs of sleep
-monitor VS bef/aft activity
-instruct not to smoke

Front 4

If a patient is taking an Fe supplement, what are you going to teach?

Back 4

Absorption of non-heme iron is enhanced by vitamin C and inhibited by tea and coffee.

Front 5

Sources of Heme Iron

Back 5

beef, chicken
egg yolk
clam, oysters
pork loin,
turkey
veal

Front 6

sources of non-heme iron

Back 6

bran flakes
brown rice
whole-grain breads
dried beans
dried fruits
greens
oatmeal

Front 7

Pathophysiology behind sickle cell anemia.

Back 7

• Genetic counseling is important with prenatal care
• RBC becomes Hypoxic (could be infection, stress, etc) the cell changes shape when the patient has that stress. They don’t flow in the blood stream well. Causes clots, and the tissues become hypoxic. Cuts off the O2 supply in the microvessels. Lots of Pain!
• Need more fluids
• Treat the pain
• Meds - Hydroxyurea-stimulating the fetal hemoglobin and produce more red blood cells.

Front 8

Sickle cell manifestations

Back 8

pallor, fatigue, jaundice and irritability, occluded circulation, impaired ertyhropoiesis, or sequestration of large amounts of blood in the liver o spleen.

Front 9

What is ischemia?

Back 9

deficient blood flow to tissue resulting in reduced oxygen delivery

Front 10

what is pernicious anemia?

Back 10

the failure to absorb dietary vitamin B12. It develops due to the lack of intrinsic factor, a substance secreted by the gastric mucosa. I.F. binds with vit B12 and travels with it to the ileum where the vit is abosrbed. In the absence of I.F., vit B12 cannot be absorbed by the body. Will need vit B12 for life.

Front 11

Manifestations of pernicious anemia

Back 11

a smooth sore beefy tongue (glossitis) and diarrhea may occur in addition to pallor, slight jaundice, and weakness develop. Since Vit B12 is important for neurological function, paresthesias (altered sensations such as tingling) in extremities and problems with proprioception.

Front 12

Food Sources for Vit B12

Back 12

liver
fresh shrimp and oysters
eggs
milk
kidney
meats (muscle)
cheese

Front 13

sources of folic acid

Back 13

green leafy veg
broccoli
organ meats
eggs
wheat germ
asparagus
liver
milk
yeast
kidney beans

Front 14

Educations for Fe supplements

Back 14

Black tarry stools
better absorbed with Vit C environment
PPI make Fe difficult to absorb because it changes the pH in the stomach

Front 15

Megaloblastic anemia

Back 15

RBC are not being made properly
ex Pernicious anemia (lack of intrinsic factor)

Front 16

Aplastic Anemia

Back 16

-the bone marrow fails to produce all three types of blood cells.
Manifestations:
-fatigue, pallor, progressive weakness, exertional dyspnea, headache, tachychardia, heart failure

Front 17

Hemolytic Anemia

Back 17

destruction of red blood cells.

Front 18

Polycythemia

Back 18

• aka erythrocytosis (excess of RBC; HCT > 55%)could be hereditary
• Risk for thrombosis
• Lots of congestion of RBC in their vessels.
• Treatment includes phleobotmy (removal of blood, like 250ml)
• ASA-aspirin for treatment
• 2nd to hypoxia
• think of two words with this disease
-Increase in volume and and increase in viscosity
• Treat it with oxygen and hydration

Front 19

hemostasis

Back 19

-control of bleeding
-maintains a relatively steady stat of blood volume, blood pressure and blood flow thru injured vessels.

Front 20

thrombocytopenia

Back 20

reduction of platelets
-decreased production
-increased destruction
Caused by immune disorders

Front 21

Nursing Diagnosis r/t thrombocytopenia

Back 21

Ineffective protection - bleeding is a serious complication assoc with thrombocytopenia.

Impaired Oral Mucous Membranes - bleeding gums (as a result risk of infection and impaired nutrition inc.)

Front 22

Nursing Intervention r/t thrombocytopenia

Back 22

-Monitor VS, heart and breath sounds q4h.
-frequently asses for bleeding: petechiae, ecchymosis and hematomas; gums, nasal membranes, and conjunctiva; overt or occult blood in emesis,urine or stool; vag bleeding, prolonged bleeding from puncture site; neurological changes; abdominal sx like epigas pain, no bowel sounds

Front 23

Practice Alert for Thrombocytopenia

Back 23

Avoid invasive procedures, no razors, soft tooth brush, no foley, or rectal temps. Use small gauge needles.
Platelet counts below 50,000mm

Front 24

Medications that may interfere with platelet function

Back 24

-Aspirin- alka seltzer, pepto bismol.
-NSAIDS - advil, aleve
-Rx - heparin, thiazide diuretics.chemo drugs, Abx (penicillin), quinine derivatives, sulfonamides.

Front 25

Hemophilia

Back 25

-hereditary
-factor deficiency
-sometimes not hereditary - Von Willebrand Disease
-Tx - cryoprecipitate
-Hemarthrosis - bleeding into the joints
-easy bruising with minor trauma
-Gi bleeding

Front 26

ND related to hemophilia

Back 26

Impaired blood clotting, the need for continuing care and disease management, and the risk for genetic transmission of hemophilia are priority problems.
Nursing care measures focus on preventing injury and protecting the skin from damage

Front 27

ND related to hemophila - specifics

Back 27

Ineffective Protection-
-s/s bleeding
-avoid IM injections, rectal temps, and enemas
-use safety meausures in personal care
-instruct to avoid activities that increase risk of drama.
Risk for ineffective Health maintenance
-assess knowledge
-educate about disorder, tx and rx.

Front 28

Neurtopenia

Back 28

-is a decrease in circulating neutrophils, which make up the majority of WBC.
-can be congenital or acquired developing secondary to prolonged infections, hematological disorders, starvation or autoimmune disorders

Front 29

Nursing care for neutropenic patients

Back 29

primary nursing focus is early ID of neutropenia and protecting from infection.
-low grade fevers are significant
Protection
-handwashing
-isolation
-no fresh fruits or veggies
-no fresh flowers
Meds
-Procrit $$$
-Neupogen

Front 30

Leukemia

Back 30

cancer of the blood
classified
-either comes from the bone (myeloblastic)
-or comes from lymph - lymphcytic

Front 31

Multiple Myeloma

Back 31

Malignancy plasma cells multiply
Sx: gradual, bone pain, hypercalcemia,
infection, BenceJones (test) proteins in urine
Tx: Systemic chemotherapy, supportive
NSG Dx: Chronic Pain, Impaired physical mobility, risk for injury

Front 32

Blood Administration

Back 32

-blood is always transfused with normal saline. Anything else will kill the RBC.
-right patient
-review hospital protocol
-check for hypersensitivity like hives or itching
-may need a foley to increase flushing of kidneys.
-low back pain is a serious problem.

Front 33

Thalessemia

Back 33

genetic disorders of hemoglobin syntheis
-Mediterranean people
-blood transfusion as treatment.

Front 34

Schilling test

Back 34

tests for pernicious anemia.

Front 35

Bone Marrow testing

Back 35

Intervention:
-After procedure apply pressure to puncture site for 5-10 min.
-Monitor for 24 hours for fever and bleeding.
-used to test for multiple myeloma, leukemia and some lymphomas.

Front 36

Manifestations of Polycythemia

Back 36

-hypertension
-headache
-plethora-dark redness of lips, ears, nails, and mm
-GI bleeding
-severe puritis and extremity pain
-intermittent claudication-cramping or pain in the leg muscles brought on by exercise and relieved by rest.

Front 37

ND for Polycythemia

Back 37

-decisional conflict regarding smoking cessation r/t addictive effect
-pain r/t altered blood flow to extremities
-risk for ineffective tissue perfusion r/t sluggish blood flow and increased risk for thrombosis

Front 38

Hypersensitivity reactions during blood transfusion

Back 38

-results when antibodies in the patient's blood react against proteins in the donor blood.
-either during or after
-Sx are urticaria (redden wheals and itching)

Front 39

Hemolytic reaction during blood transfusion

Back 39

-most dangerous results from ABO incompatibility.
-usually begins 100-200 mL of bloods
-flushing of face, burning sensation, urticaria, chills, fever, lumbar pain, abdominal pain, chest pain, n/v, tachychardia, hypotension, and dyspnea.
-must stop immediately.