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54 Cards in this Set
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- Back
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mild anemia s&s
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Hb 10 to 14 g/dl
May exist without symptoms Possible symptoms Palpitations, exertional dyspnea, diaphoresis |
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Moderate anemia s&s
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Hb 6 to 10 g/dl
Increased cardiopulmonary symptoms Dyspnea experienced at rest or during activity Fatigue |
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severe anemia s&s
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Hb <6 g/dl
Integument Pallor ↓ Hemoglobin ↓ Blood flow to the skin Jaundice Hemolysis of of RBCs ↑ Concentration of serum bilirubin Pruritus ↑ Serum and skin bile salt concentrations Eyes blurred vision, retinal hemmorrhage Mouth Smooth tongue Glossitis Cardiovascular Tachycardia MI ^ Hear rate and stroke volume Systolic murmurs Pulmonary Tachypnea Orthophea Dyspnea at rest Neurologic Headache Vertigo Irritability Depression Gastrointestinal (GI) Anorexia Sore mouth Musculoskeletal Bone pain General Lethargy Fatigue Sensitivity to hot and cold |
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Anemia Nursing Management GOALS
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Assume normal activities of daily living
Maintain adequate nutrition Develop no complications related to anemia |
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Anemia Nursing IMPLEMENATAION
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Dietary and lifestyle changes
Blood or blood product transfusions Drug therapy Oxygen therapy Patient teaching Nutrition intake Compliance with drug therapy |
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Iron-Deficiency Anemia
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One of the most common chronic hematologic disorders
Accounts for 60% of anemias in clients over age 65 Occurs in 30% of world’s population Note Iron is present in all RBCs as heme in hemoglobin and in a stored form Heme accounts for two thirds of the body’s iron |
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Iron-Deficiency Anemia Clinical Manifestations
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General manifestations of anemia
Pallor is the most common finding Ear lobes, palms, and conjuctiva Glossitis is the second most common Inflammation of the tongue Pica Dizziness Fatigue shortness of breath |
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Iron-Deficiency Anemia Diagnostic Studies
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↓Hb & Hct
↓ MCV (mean corpuscular volume, or MCV, is a measure of the average red blood cell volume) Reticulocytes will be normal or have slight ↑ or ↓ ↓serum iron ↑TIBC (total iron binding capacity) Bilirubin will be normal or ↓ ↓serum ferritin Normal or ↓ Transferrin Stool guaiac test (WHY?) Endoscopy (WHY?) Colonoscopy (WHY?) |
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Iron-Deficiency Anemia Collaborative Care
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Increased intake of iron
Nutritional therapy Oral or occasional parenteral iron supplements (remember to change needles why? ) Transfusion of packed RBCs |
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Iron-Deficiency Anemia at risk groups
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Premenopausal women
Pregnant women Persons from low socioeconomic backgrounds Older adults Individuals experiencing blood loss |
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Iron-Deficiency Anemia Nursing Management
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Diet teaching
(eat foods high in iron such as organ meats, meat, beans (legumes), molasses, green leafy vegetables, and raisins) Supplemental iron Discuss diagnostic studies Emphasize compliance Need to continue Iron therapy for 2 to 3 months after the hemoglobin levels return to normal |
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Megaloblastic Anemias
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Group of disorders caused by impaired DNA synthesis
Characterized by the presence of large RBCs (megaloblasts) Majority result from deficiency in Cobalamin (vitamin B12) or Folic acid |
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Cobalamin Deficiency Clinical Manifestations
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General symptoms of anemia
Sore tongue Anorexia Nausea Vomiting Abdominal pain Neuromuscular manifestations Weakness Paresthesias of the feet and hands ↓ Vibratory and position senses Ataxia (gross lack of coordination of muscle movement) Muscle weakness Impaired thought process |
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Cobalamin Deficiency Collaborative Care
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Life-long parenteral administration of cobalamin (in pernicious anemia or other absorption decficiencies)
100-1000 micrograms subcutaneously daily for 7 days Then once a week for a month Then once of month for the rest of your life Note first dose may result in burning sensation Increase in dietary cobalamin does not correct the this anemia Still important to emphasize adequate dietary intake |
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Cobalamin Deficiency Nursing Management
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Familial disposition
Early detection and treatment can lead to reversal of symptoms *Ensure that injuries are not sustained because of the patient’s diminished sensations to heat and pain Ensure patient compliance with treatment Evaluate patient for gastric carcinoma Foods high in B12 Dairy products, animal proteins, and eggs |
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Folic Acid Deficiency : common causes
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Poor nutrition
Malabsorption syndromes Drugs that impede absorption of folic acid Oral contraceptives Anticonvulsants methotrexate Alcohol abuse and anorexia Those on TPN (if not included as additive) Loss during hemodialysis |
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Folic Acid Deficiency s&s
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Clinical manifestations are similar to those of cobalamin deficiency but GI symptoms more severe
Insidious onset Absence of neurologic problems Treated by replacement therapy Encourage patient to eat foods with large amounts of folic acid Green leafy vegetables, asparagus, fish, citrus fruits, yeast, dried beans, grains, nuts, and liver |
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Aplastic Anemia
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Results from a decreased production of bone marrow elements
Pancytopenia Decrease of all blood cell types RBCs White blood cells (WBCs) Platelets Hypocellular bone marrow (marrow replaced with fat) |
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Aplastic Anemia Clinical Manifestations
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Gradual development
Symptoms caused by suppression of any or all bone marrow elements Bruising (which blood element??????) Infections of skin and mucous membranes Bleeding of gums General manifestations of anemia Fatigue, dyspnea, palpitations Decreased WBC RBC Platelets |
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Aplastic Anemia Nursing Management: preventing complications of infection and hemorrhage
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Reverse isolation
Limit visitors Provide rest periods Neutropenic precautions |
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Acute Blood Loss
cause & intervention |
Caused by
Trauma, stroke, surgery Nursing Management May be impossible to prevent if caused by trauma Postoperative patients Monitor blood loss Hypovolemia (think decreased BP, increased heart rate) No need for long-term treatment |
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Chronic Blood Loss
cause & intervention |
Reduced iron stores
Bleeding ulcer Hemorrhoids Menstrual and postmenopausal blood loss Management Identify source Stop bleeding Possible use of supplemental |
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Hemolytic Anemia
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Destruction or hemolysis of RBCs at a rate that exceeds production
Third major cause of anemia Intrinsic hemolytic anemia (main one sickle cell) Abnormal hemoglobin Enzyme deficiencies RBC membrane abnormalities Extrinsic hemolytic anemia (more common) Acquired Sites of hemolysis Intravascular Extravascular |
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Hemolytic Anemia s&s
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Jaundice
Destroyed RBCs cause increased bilirubin Enlarged spleen and liver Hyperactive with macrophage phagocytosis of the defective RBCs Accumulation of hemoglobin molecules can obstruct renal tubules Tubular necrosis |
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Sickle Cell Disease (SCD)
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Group of inherited, autosomal recessive disorders
Chronic form of hemolytic anemia 8% of African Americans are heterozygous (carriers) for sickle cell anemia |
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sickle cell disease: TRIGGERS
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Sickle shape in response to ↓ O2 levels
Cells clump together and obstruct capillary blood flow Genetic disorder Triggers Hypoxia cold climates or environments resulting in low body temperatures Excessive exercise High altitudes Inadequate o2 during anesthesia Decreased plasma volume Infection Dehydration Acidosis Incurable disease, often fatal |
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sickle cell disease s&s
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Pain and joint swelling
Pallor of mucous membranes Fatigue Jaundice Irritability Typical patient is asymptomatic except during sickling episodes |
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Sickle Cell Disease Nursing Management
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Alleviate symptoms of disease complications especially pain
Minimize end target-organ damage Especially kidneys and lungs No specific treatment for SCD O2 for hypoxia and to control sickling Patient teaching Avoid high altitudes, maintain fluid intake, treat infections, pain control Folic acid daily supplements Blood transfusions in crisis Hydroxyurea: Antisickling agent Erythropoietin in patients unresponsive to hydroxyurea Bone marrow transplant |
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Polycythemia
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Increase in number of circulating RBCs and concentration of hemoglobin
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Polycythemia: primary
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Increased blood viscosity
Congestion of blood in tissues, liver, and spleen Thrombi form resulting in acidosis and infarction Common in men of European Jewish descent Median age of occurs is at age 60 |
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Polycythemia: secondary
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Most common form
Abnormal increase in erythropoietin causing excessive RBC production Hypoxia driven High altitude/cardiopulmonary disease defective O2 transport/smoking Hypoxia independent Reanl cysts or tumors Extrarenal tumors Causes Increased blood viscosity Congestion of blood in tissues, liver, and spleen Thrombi form resulting in acidosis and infarction |
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Polycythemia Clinical Manifestations
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Plethora (excess)
↑ blood volume resulting in Headaches Vertigo Blurred vision tinnitus Itching not relieved by medication Angina Erthromyalgia (burning sensation of the fingers and toes) Dyspnea Epistaxis Gi Bleeding |
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Polycythemia Nursing Management
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Management of underlying condition such as COPD causing hypoxia
Keep hematocrit less than 45-48% (repeated phlebotomy) Keep hydrated (3 L/day) and monitor I/O Diet –avoid foods high in iron Measures to relieve pruritus Cool/tepid baths To prevent thrombotic events Early ambulation Passive leg exercises Pneumatics boots Medicaitons Allopurinal (to manage gout-high uric acid) Anti-platelet agents Heparin or coumadin to prevent new clots |
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Thrombocytopenia
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A decrease in the number of circulating platelets (i.e. < 100,000/ul book says 150,000/ul)
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Thrombocytopenia clinical manifestations
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Petechiae and purpura
Thorax Arms Neck ankles Epistaxis Gingival bleeding (use soft bristle toothbrush) Hematuria GI Bleeding Signs of internal Hemorrhage (occurs spontaneously when platelets drop below 10,000/uL) |
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Thrombocytopenia Nursing Management
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Soft bristle tooth brush
Use electric razor Treat underlying cause Splenectomy in ITP Immunosuppressive therapy Steroids and immunoglobins avoid subQ or IM injections Avoid foley catheter insertion Discourage straining while on the toilet Avoid enemas or suppositories Avoid use of aspirin containing drugs Monitor for signs of bleeding (test stools for occult blood Monitor CBC and platelets |
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Hemophilia
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Group of hereditary clotting factor disorders characterized by prolonged coagulation times resulting in excessive bleeding
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Hemophilia Clinical Manifestations
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Prolonged bleeding from small cuts or injuries
Delay of onset of bleeding after injury subQ hematomas GI bleeding Hematuria Pain due to compression of hematomas Hemarthrosis (joint bleeding and swelling) |
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Hemophilia Nursing Management
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Replacement of deficient clotting factor
Control bleeding Manage complications of hemorrhage Control topical bleeding with pressure and ice Refer family to genetic counseling Monitor for signs of intercranial bleeding (i.e., decreased LOC) Importance of wearing medical alert bracelet |
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Disseminated Intravascular Coagulopathy (DIC)
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Paradoxical bleeding occurs as a result of consumption of clotting factors and platelets.
Caused by underlying disease or condition Mortality rate is high (80%) mainly due to hemorrhage Causes/risk factors Venomous snake bite, Sepsis Trauma, Obstetric complications, Neoplasms, Vascular disorders, Hypoxia, Tissue necrosis, Drug reactions, Liver disease, Acute hemolysis, Extensive burns, Prosthetic devices |
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DIC Clinical Manifestations
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Nervous system
Vission changes Dizziness Headache Irritability Anxiety Confusion seizures Integumentary ↓ skin temp Pallor Gums bleeding Hematomas GI Abdominal pain Abdominal dissention Blood in stool Respiratory Dyspnea Tachypnea Orthopnea Decreased breath sounds Chest pain Cardiovascular Decreased pulses Decreased capillary refill time Tachycardia Venous dissention Genitouinary Hematuria oliguria Musculoskeletal Joint pain Bone pain weakness |
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DIC Nursing Management
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Treat underlying condition
Adminsiter blood products as ordered Monitor I/O Vasopressors for blood pressure Watch for signs of complications Renal failure Pulmonary embolism CVA Respiratory distress |
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Neutropenia
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Decrease in Neutrophil count as a result of
Decreased production Increased destruction Neutrophils play an important role in the phagocytosis of disease producing microorganisms Results in High Risk for Infection Really are no clinical manifestations of this syndrome/disease Causes Hematologic disorder Drugs (chemotherapy) Autoimmune disorders Infections Sepsis Nutritional deficiencies |
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Neutropenia Diagnostic Tests and Nursing Management
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Neutrophil count less that 2,000
Bone marrow biopsy Nursing management Limit visitors (especially young children) No fresh fruits or vegetables No undercooked meats Administer antiobiotics Avoid invasive procedures Stick handwashing Reverse isolation No fresh flowers or standing water NOTE: any immuno-compromised patient who is lacking their natural defense mechanisms (i.e., low WBC counts) may not ellicit a normal response to an infection (i.e., elevated temperature). So take a low grade temperature in this type of patient seriously!!!!!!!!!!!!!!!!!!!!!!!!! |
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Leukemia
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Malignant disorder of blood forming tissues of the bone marro, spleen, and lymph system characterized by unregulated proliferation of WBCs and their precursors.
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Leukemia Clinical Manifestations
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As proliferation of abnormal cells increase the production of normal cells is impeded resulting
Fever and night sweats Bleeding problems Weakness and fatigue Weight loss Shortness of breath Decreased activity intolerance Bone or joint pain Pallor |
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Leukemia Nursing Management
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Chemotherapy and radiation (review nursing management in cancer slides)
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Malignant Lymphomas
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Lymphomas are a group of malignant neoplasms that affect the lymphatic system resulting in the proliferation of lymphocytes:
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Hodgkin’s lymphoma
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More common in men and Whites
Peaks 15-35 years of age & 55-70 years of age Possible causes (Epstein Barr virus/familial pattern, exposure to toxins) Originates in lymph node and infiltrates the spleen, lung and liver Reed-Sternberg cell present |
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Non-Hodgnkin’s
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Most common form of lymphoma
Affects adults 50-70 years old More common in men and whites Link to viral infections, immune disorders, genetic abnormalities, exposure to chemicals, infection with H-pylori Reed-Sternberg cells are absent Lymphoma originates outside lymph and infiltrates the lymph nodes |
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Malignant Lymphomas manifestations:
hogkins |
Painless enlargement of lymph nodes on one side of neck
Fatigue and weakness Anorexia Dysphagia Dyspnea Pruritus Jaundice Abdominal pain Bone pain Fever without chills Night sweats Unintentional weight loss>10% Enlarged lymph nodes, spleen and liver Hx of frequent infection |
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Malignant Lymphomas manifestations:
non- hogkins |
Painless lymph node enlargement
Fever without chills Night sweats Unintentional weight loss>10% Abdominal pain Hematuria Peripheral neuropathy Headache Visual disturbances Change in mental status Shortness of breath Cough Chest pain |
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hodgekins dx test
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Neutrophilia
Moncytophilia Lymphopenia Presence of Reed-Sternberg cells upon biopsy Absent or decreased response to skin sensitivity testing known as anergy |
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non-hodgekins dx test
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Lymphocytopenia
X-ray may reveal pulmaonary infiltrates Lymphnode biopsy helps ID the cell type and pattern |
