Blood And Lymphatic Disorder

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Anemia

Back 1

RBC, hemoglobin, and hematocrit levels below normal.

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Causes of Anemia

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- Hemorrhage: blood loss
- Bone marrow depression: impaired production of RBCs
- Hemolysis: increased destruction of RBCs

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Anemia Symptoms

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anorexia, cardiac dilation, dizziness, dyspepsia, dyspnea, fatigue, insomnia, pallor, palpitation, shortness of breath, systolic murmur, tachycardia, vertigo.

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Diagnostic Tests for Anemia

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RBC, Hemoglobin, and Hematocrit are low, Serum Iron is low, Reticulocyte count is low.

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HYPOVOLEMIC ANEMIA

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low circulating blood volume from hemorrhage, blood loss of 1000 mL or more, can lead to hypovolemic shock.

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Hypovolemic Anemia Signs and Sympoms:

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weakness, stupor, PALE COOL CLAMMY SKIN, hypotension, tachycardia, hypothermia, thirst, weakness.

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Diagnostic Test for Hypovolemic Anemia

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RBC, Hemoglobin, and Hematocrit levels are very low, half of normal value.

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Medical Management for Hypovolemic Anemia

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control bleeding, treat for shock, replace lost blood, oxygen, and iron preparations.

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PERNICIOUS ANEMIA

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absence of intrinsic factor (that is secreted by the stomach lining), intrinsic factor is needed for absorption of vitamin b12.

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Pernicious Anemia signs and symptoms:

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SMOOTH, RED TONGUE, dyspnea, fever, hypoxia, pale yellow lemon color, burning of the tongue, tingling of hands and feet.

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Schilling Test

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shows malabsorption of vitamin b12 and is used to diagnose pernicious anemia.

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Diagnostic tests for Pernicious Anemia

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Schilling test, Erythrocytes are large (macrocytic) with abnormal shapes, B12 levels are reduced.

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Medical management for Pernicious Anemia

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Cyanocobalamin (VITAMIN B12) injections, folic acid supplement, and iron replacement.

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APLASTIC ANEMIA

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failure of the normal process of cell generation and development, can be congenital or acquired, three major blood elements from bone marrow are reduced/absent (RBCs WBCs and Platelets)

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Aplastic Anemia signs and symptoms

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repeated infections, high fevers, fatigue, weakness, petechiae, ecchymoses, bleeding gums, epistaxis.

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Diagnostic tests for Aplastic Anemia

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Bone marrow biopsy (shows aplastic fatty deposits), peripheral blood smear

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Medical management for Aplastic Anemia

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Bone marrow suppression, antineoplastic medications, radiation, splenectomy, steroids, androgens, bone marrow transplantation, NO BLOOD TRANSFUSIONS!!

Front 18

IRON DEFICIENCY ANEMIA

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RBCs contain decreased levels of hemoglobin, excessive iron loss.

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Causes of Iron deficiency anemia

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GI bleeding and Uterine bleeding

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Aclorydria

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loss of hydrochloric acid

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Iron Deficiency Anemia signs and symptoms

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pallow, GLOSSITIS (INFLAMMATION OF THE TONGUE), fatigue, shortness of breath, PAGOPHAGIA (DESIRE TO EAT ICE, CLAY, STARCHES), tachycardia, fingernails brittle.

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Diagnostic tests for Iron Deficiency Anemia

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Peripheral blood count shows RBC, hemoglobin, and hematocrit levels decreased, and SERUM IRON IS LOW.

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Medical management for Iron Deficiency Anemia

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Iron salts, Ferrous sulfate, diet rich in iron- meat, fish, STEAK, ORGAN MEAT, poultry, eggs, green leafy veg

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SICKLE CELL ANEMIA

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patient has sickle cells- RBC contains abnormal hemoglobin S (Hg-S), sickling indicates a clumping/aggregation of misshapen RBCs which lodge in small vessels.

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Homozygous

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having two identical genes from each parent

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Heterozygous

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two different genes from parents, patient has both Hg-S and Hg-A in the RBCs.

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Sickle Cell Anemia Symptoms

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PAIN FROM SICKLING!!!! loss of appetite, irritability, weakness, abdominal enlargement with pooling of blood in liver and spleen, jaundice DEEP THROBBING PAIN.

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Diagnostic test for Sickle Cell Anemia

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Electrophoresis of hemoglobin, Skeletal roentgenograms

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Medical management for Sickle Cell Anemia

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rest, fluid/electrolytes encouraged, ANALGESICS FOR PAIN, large doses of opioids, blood transfusions are used cautiously during sickling crisis.

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Nursing interventions for Sickle Cell Anemia

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family testing for presence of Hg-S - genetic counseling is available, balance between rest/activity, good nutrition- protein, calcium, vitamins, and fluids, blow nose gently, avoid coughing.

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How to avoid Sickle Cell Crisis

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avoid high altitudes, flying in unpressurized planes, dehydration, cold temperatures, iced liquids, and vigerous exercise.

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POLYCYTHEMIA (ERYTHROCYTOSIS)

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overproduction of red blood cells due to a primary process in the bone marrow (myeloproliferative), and low oxygen levels.

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Two types of Polycythemia

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1. Polycythemia Vera
2. Secondary Polycythemia

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Myeloproliferative

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excessive bone marrow production

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Erythrocytosis

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abnormal increase in RBCs

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Polycythemia Vera

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excessive bone marrow production, increase in RBCs, granulocytes, and platelets, stem cell abnormality, elevated WBC with basophilia, MALIGNANCY IN BLOOD CELLS

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Secondary Polycythemia

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caused by hypoxia which stimulates erythropoietin in kidneys which stimulates RBC production.

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Signs and Symptoms of Polycythemia

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venous distention, platelet dysfunction, hepatomegaly, splenomegaly, complaints of satiety/fullness, sensitive to hot and cold, pruritus- because of histamine release, tinnitus, blurred vision, plethora-erythemic appearance, elevated B/P

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Diagnostic Tests for Polycythemia

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CBC increased, platelets elevated, Alkaline Phosphatase/uric acid/histamine levels noted, hypercellularity of RBCs/WBCs/platelets, BASAL METABOLIC RATE INCREASED/

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Medical Management Polycythemia

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Myelosuppressive agents (busulfan/Myleran, hyrdoxyurea/Hydrea, and radioactive phosphorus, Allopurinol.

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Nursing Interventions for Polycythemia

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avoid foods that contain iron, phlebotomy may need to be performed every 2-3 months reducing blood volume by 500 mL each time, with hydration therapy avoid fluid overload,

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AGRANULOCYTOSIS

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severe reduction in the number of granulocytes (basophils, eosinophils, and neutrophils), Leukopenia, below normal neutrophil count.

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Leukopenia

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Low WBC count

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Causes of Agranulocytosis

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adverse reaction/toxicity to chemotherapy and radiation therapy

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Signs and Symptoms of Agranulocytosis

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fever, chills, INFECTION, ulcerations of mucous membranes (mouth/nose),

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Diagnostic Tests of Agranulocytosis

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Leukocytes with neutrophils differential below normal, bone marrow suppression- depression of activity.

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Medical Management for Agranulocytosis

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transfusions of packed red blood cells, G-CSF (filgrastim neupogen).

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Nursing Interventions for Agranulocytosis

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very susceptible to infection, PREVENT INFECTION, good oral hygeine, soft bland diet (protein, vitamins, calories), balance between rest/activity, avoid crowds/people that are sick.

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LEUKEMIA

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malignant disorder, an excess of leukocytes accumulates in the bone marrow and lymph nodes, bone marrow is replaced with rapidly developing WBCs

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Classification of Leukemia

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Can be acute or chronic.
- Four Types:
1. Acute Lymphocytic Leukemia (ALL)
2. Acute Myelogenous Leukemia (AML)
3. Chronic Myelogenous Leukemia (CML)
4. Chronic Lymphocytic Leukemia (CLL)

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Diagnostic Tests for Leukemia

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WBC is low, elevated, or excessively elevated, Anemia/Thrombocytopenia are noted, immature leukocytes, Lymph node biopsy reveals excessive blasts (immaturecells).

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Signs and Symptoms of Leukemia

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pain in bones/joints, fatigue, INFECTIONS, occult blood in urine or stool, bleeding, petechiae, ecchymoses

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Medical Management for Leukemia

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ACHIEVE REMISSION AND RELIEVE SYMPTOMS, chemotherapy, combination chemotherapy, bone marrow and stem cell transplantation, blood transfusion.

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Nursing Interventions for Leukemia

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PREVENTION OF INFECTION.

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COAGULATION DISORDERS

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congenital or acquired, release of blood from the vascular system results from trauma or vessel damage, vessel inadequacy, disturbance of function of platelets/clotting factors, or liver disease (impaired clotting mechanisms).

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Signs and Symptoms of Coagulation Disorders

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petechiae, ecchymoses, epistaxis, gingival bleeding, circulatory hypovolemia, pallor, cool clammy skin, tachycardia, spleen tenderness,Nur emesis/stool bleeding

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Diagnostic Test for Coagulation Disorders

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Platelet count is low, RBC and Hemoglobin level is low, Coagulation time is altered.

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Medical Management for Coagulation Disorders

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Replacement transfusions, Heparin Therapy

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Nursing Interventions for Coagulation Disorders

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prevent hypovolemic shock and trauma to tissues.

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PLATELET DISORDERS

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deficiency in the number of circulating platelets.

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THROMBOCYTONPENIA

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number of platelets is below 150,000, occurs in aplastic anemia, leukemia, tumors, and chemotherapy.

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IMMUNE THROMBOCYTOPENIC PURPURA ITP

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autoimmune disease, platelets are coated with antibodies and when they reach the spleen they are recognized as foreign and are destroyed by macrophages. IMMUNOGLOBIN G (IgGJ)

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Signs and Symptoms of Thrombocytopenia

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petechiae, ecchymoses of skin, risk for bleeding (mucous membranes, internal organs), alcohol ingestion, epistaxis, gingival bleeding,

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Diagnostic Tests for Thrombocytopenia

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platelet count, peripheral blood smear, and bleeding time, bone marrow aspiration.

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Medical Management for Thrombocytopenia

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corticosteroids, splenectomy, INTRAVENOUS IMMUNOGLOBIN OR IMMUNOSUPPRESSIVE DRUGS, transfusions with platelet concentrates, Plasmapheresis- removes antibodies.

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Nursing Interventions for Thrombocytopenia

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avoid trauma, stool softeners, high fiber diet, check for presence of blood, use soft tooth brush, blow nose gently.

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HEMOPHILIA

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disturbance in clotting factors

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HEMOPHILIA A

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antihemophilic factor VIII is absent- this factor is essential for conversion of prothrombin to thrombin.

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HEMOPHILIA B (CHRISTMAS DISEASE)

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deficiency of factor IX with an absence of plasma thromboplastin component (a plasma protein) resulting in nonformation of thromboplastin.

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Signs and Symptoms of Hemophilia

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internal/external hemorrhage, ecchymoses, pain, edema, erythema, fever, blood in stool and urine.

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Diagnostic Tests for Hemophilia

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Factors VIII and IX are absent/deficient, Partial Thromboplastin Time PTT is prolonged.

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Medical Management for Hemophilia

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(prevent/treat bleeding, relieve pain) TRANSFUSION/ADMINISTRATION OF FACTOR VIII AND IX, CRYPOPRECIPITATE- CLOTTING FACTOR RICH IN FACTOR VIII.

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Nursing Interventions for Hemophilia

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control hemorrhage, monitor transfusions of Factor VIII, NO ASPIRIN,

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VON WILLEBRANDS DISEASE

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inherited bleeding disorder, abnormally slow coagulation of blood and episodes of GI bleeding, epitaxis, and gingival bleeding caused by deficiency of factor VIII.

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Treatment for Von Willebrands Disease

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ADMINISTRATION OF CRYOPRECIPETATE CONTAINING FACTOR VIII, fibrinogen, or fresh plasma, DESMOPRESSIN DDAVP.

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Desmopressin

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synthetic of antidiuretic hormone vasopressin, causes increase in factor VIII release from storage sites.

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DISSEMINATED INTRAVASCULAR COAGULATION

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DIC, overstimulation of clotting and anticlotting processes in response to disease/injury, plasma clotting factors are depleted during wide spread clotting within small vessels, leads to bleeding disorder/thrombosis.

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Signs and Symptoms of Disseminated Intravascular Coagulation

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Bleeding in mucous membranes, venipuncture sites, GI, and Urinary tracts, dyspnea, hemoptysis, purpura, petechiae, abdominal tenderness, pulmonary embolism, hypotension, tachycardia, absence of peripheral pulses, decreased B/P

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Diagnostic Tests for Disseminated Intravascular Coagulation

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Deficits of factors V, VII, VIII, X, XII, D-Dimer reveals breakdown of fibrin and is a specific marker for degree of fibrinolysis in serum.

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Medical Management for Disseminated Intravascular Coagulation

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Heparin therapy, Fibrinolytic inhibitors, packed RBC transfusion, fresh frozen plasma FFP

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Nursing Interventions for Disseminated Intravascular Coagulation

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protect from bleeding and trauma, form cotton swabs for mouth care, ADMINISTER HEPARIN, BLOOD, AND FFP TRANSFUSIONS

Front 82

MULTIPLE MYELOMA

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plasma cell disorder, malignant neoplastic immunodeficiency disease of the bone marrow, neoplastic cells infiltrate in bone marrow, destroys osseous tissue especially in flat bones causing pain and fractures

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Monoclonal protein

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specific immunoglobulin produced in myeloma cells present in blood and urine with multiple myeloma.

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Signs and Symptoms of Multiple Myeloma

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pain, fever, potential for bleeding, changes in urine, pain in ribs/spine/pelvis, osteolytic lesions, vertebral destruction, hypercalcemia- calecium/phosphorus drain from bones.

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Diagnostic Tests for Multiple Myeloma

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radiographic skeletal studies, bone marrow biopsy, blood/urine- high protein, hypercalcemia, hyperuricemia, and elevated creatinine

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Medical Management for Multiple Myeloma

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radiation, chemotherapy, alkylating agents- mephalan/alkeran, cyclophosphamide/cytoxan, carmustine/BCNU, analgesics for pain

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Nursing Interventions for Multiple Myeloma

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pain relief, prevent infection, administer chemotherapy, weight bearing helps bone reabsorb calcium, fluids dilute calcium.

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LYMPHANGITIS

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inflammation of one or more lymphatic vessels which results from acute streptococcal or staphylococcal infection in an extremity.

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Signs and Symptoms of Lymphangitis

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red streaks in affected area in groin/axilla, edema, chills, fever, pain, lymph nodes enlarge.

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Medical Management for Lymphangitis

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Penicillin/antimicrobial drugs, hot moist heat

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Nursing Interventions for Lymphangitis

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aseptic technique, rest and extremity elevation.

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LYMPHEDEMA

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accumulation of lymph in soft tissue and edema is caused by obstruction, an increase in amount of lymph, or removal of nodes, LYMPHATIC DRAINAGE FUNCTION IS DISTURBED.

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Signs and Symptoms of Lymphedema

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complaints of pain/pressure, edema/palpitation of pedal pulses.

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Medical Management of Lymphedema

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diuretics, antimicrobials, compression pumps, elastic sleeves, diets restricting sodium

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Nursing Interventions for Lymphedema

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increase lymphatic drainage, avoid trauma, elevation, massage toward trunk, avoid constrictive clothing, meticulous skin care, prevent infections.

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HODGKINS DISEASE

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malignant disorder of painless, progressive enlargement of lymphoid tissue, tissue enlargement is noticed in cervical nodes/spleen, reedsternberg cells- large abnormal multinucleated cells in lymphatic system found in Hodgkins disease they increase in number replacing normal cells.

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Signs and Symptoms of Hodgkins Disease

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enlargement of cervical/axillary/inguinal lymph nodes, are not painful unless pressure on nerves, anorexia, night sweats, extreme pruritus, anemia, leukocytosis, edema of face and neck

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Diagnostic Tests for Hodgkins Disease

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Peripheral blood studies show anemia, WBC increase, and abnormal erythrocyte sedimentation rate, hypoferremia caused by excessive rion intake by liver, chest radiographic exams, CT scans, laparscopy, bone marrow biopsy, ultrasound, PRESENCE OF REED STERNBERG CELLS!!!

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Medical Management for Hodgkins Disease

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radiation therapy, combination chemotherapy, bone marrow/peripheral stem cell transplantation,

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Nursing Interventions for Hodgkins Disease

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skin integrity, soothing baths, antipruritic medication, increase fluid intake

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STAGES OF HODGKINS DISEASE

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Stage 1: abnormal single lymph nodes, regional/single extranodal site.
Stage 2: two/more abnormal lymph nodes same side of diaphragm.
Stage 3: abnormal lymph nodes on both sides of diaphragm, spleen involvement, subdivided in upper abdomen and lower abdomen.
Stage 4: Hepatic, Lung, Pleural, Marrow, Dermal, and Osseous involvement.

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NON HODGKINS LYMPHOMA

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NHL, neoplasmic disorder, neoplasm of the immune system, common in patients receiving immunosupressive agents/herpes virus, B CELL LYMPHOMAS, tumors start in lymphnodes and spread to lymphoid tissue in spleen, liver, GI tract, and bone marrow, LEADING CAUSE OF CANCER DEATH.

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Signs and Symptoms of Non Hodgkins Lymphoma

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painless enlarged lymphnodes found in cervical area, fever, weight loss, nigh sweats, anemia, infection, pleural effusions, bone fractures, paralysis.

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Diagnostic Tests for Non Hodgkins Lymphoma

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Bone scan reveals fractures and lesions, blood studies show hypercalcemia, anemia, leukocytosis, and alkaline phosphatase, COOMBS TEST- POSITIVE RESULT FOR ANTIGLOBULIN, ct scan, Gallium scan, lymphangiogram, biopsies of liver, lymph nodes, and bone marrow.

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, Medical Management for Non Hodgkins Lymphoma

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CHEMOTHERAPY, TUMOR NECROSIS FACTOR TNF- has direct cell toxicity and stimulates immune system.