Anemia Flashcards
Anemia: Goals
- Assume normal activities of daily living
- Maintain adequate nutrition
- Develop no complications related to anemia
Anemia: Nursing Assessment
- Inquire about bruising easily, bleeding for an unusually long time, or chronic fatigue
- Note any history of blood transfusions
- Medications used or recent change in medication
- PMH & FH
- Systems & Diagnostics review
Anemia: Nursing Implementation
- Dietary and lifestyle changes
- Blood or blood product transfusions
- Drug therapy
Anemia: Nursing Diagnoses
Activity intolerance • Vital signs • Rest periods • Energy conservation • Smoking cessation
Anemia: Potential Complication
Hypoxemia
• Monitor vitals
• Oxygen prn
• Rest
Anemia: Ineffective Therapeutic Regimen Management
- Ineffective therapeutic regimen management
- Teach medication compliance
- Dietary replacement
Anemia: Nursing Diagnoses; Imbalanced Nutrition
- Imbalanced nutrition: less than body requirements
- Collaboration with dietitian •Keep a food diary
- Monitor recorded intake
- Encourage increased intake of protein, iron, and vitamin C to provide nutrients needed for hematopoiesis.
- Small, frequent meals with snacks
Anemia: Nursing Care; Self-Care Deficit
- Assist with ADLs
- Rest periods
- Concerns about self-care
Anemia: Nursing Care; Impaired Oral Mucous Membranes
- Assess lips and tongue
- Mouthwash
- Frequent oral hygiene
- Avoid alcohol-based mouthwashes
- Petroleum jelly for lips
- Avoid spicy foods
- Encourage soft bland foods
- Small high-protein balanced meals each day
Anemia: Nursing Care; Continuing Care and Teaching
- Types of anemia
- Diet
- Medications
- Genetic counseling
- Follow-up appointments
- Support groups
Anemia: Gerontologic Considerations
- Common in older adults
- Chronic disease
- Nutritional deficiencies
- Signs and symptoms may go unrecognized or mistaken for normal aging changes
Iron-Deficiency Anemia: Collaborative Care; Goals
- ↑ Intake of iron
- Nutritional therapy
- Replacement therapy
- Transfusion of packed RBCs
Iron-Deficiency Anemia: Nursing Management; At-risk groups
- Premenopausal women
- Pregnant women
- Persons from low socio-economic backgrounds
- Older adults
- Individuals experiencing blood loss
Iron-Deficiency Anemia: Nursing Management
- Diet teaching
- Supplemental iron
- Discuss diagnostic studies
- Emphasize compliance
- Iron therapy for 2-3 months after the hemoglobin levels return to normal
Iron-Deficiency Anemia: Drug Therapy
- Oral iron
- Inexpensive
- Convenient
- Factors to consider
- Best absorbed as ferrous sulfate in an acidic environment
- Liquid iron should be diluted and ingested through a straw
- Side effects- Heartburn, constipation, diarrhea
Cobalamin Deficiency: Collaborative Care
- Parenteral administration of cobalamin
- ↑ Dietary cobalamin does not correct the anemia
- Still important to emphasize adequate dietary intake
Cobalamin Deficiency: Nursing Management
- Familial disposition
- Ensure injuries are not sustained due to the client’s diminished sensations to heat and pain
- Ensure client compliance with treatment
- Evaluate client for gastric carcinoma frequently
Folate Deficiency: Nursing Management
- Assess for risk
- Replacement orally
- Nutrition therapy
Aplastic Anemia: Nursing Management
- Preventing complications from infection and hemorrhage
- Untreated prognosis is poor
- 75% fatal
- Treatment options
- Bone marrow transplantation
- Immunosuppressive therapy
Acute Blood Loss: Collaborative Care
- Replacing blood volume to prevent shock
- Identifying the source of the hemorrhage
- Stopping blood loss
- Correcting RBC loss
- Infection control
Acute Blood Loss: Nursing Management
May be impossible to prevent if caused by trauma
Post-operative clients
• Monitor blood loss
No need for long-term treatment
Chronic Blood Loss: Management
- Identify source
- Stop bleeding
- Possible use of supplemental iron
Sickle Cell Disease (SCD): Nursing Management
- Alleviate symptoms of disease complications
- Minimize end target-organ damage
- No specific treatment for SCD
- Client teaching
- Avoid high altitudes, maintain fluid intake, treat infections, pain control
Sickle Cell Disease: Nursing Management
- O2 for hypoxia and to control sickling
- Pain management
- Acute chest syndrome
- Antibiotics
- O2 therapy
- Fluid therapy
- Folic acid daily supplements
Sickle Cell Disease: Nursing Management
Blood transfusions in crisis Hydroxyurea: anti-sickling agent • Erythropoietin in clients unresponsive to hydroxyurea Bone marrow transplant • Can cure some clients with SCD
Leukemia: Collaborative Care; Goals
- attain remission
* maintain optimal blood counts (hemoglobin, platelet) during and after completion of treatment
Leukemia: Collaborative Care; Chemotherapeutic treatment
- Induction therapy
- Intensification therapy
- Consolidation therapy
- Maintenance therapy
Leukemia: Chemotherapy Regimen; Combination chemotherapy
Combination chemotherapy:
• Mainstay treatment
• 3 purposes
• ↓ drug resistance
• ↓ drug toxicity to the client by using multiple drugs with varying toxicities
• Interrupt cell growth at multiple points in the cell cycle
Leukemia: Bone Marrow and Stem Cell Transplantation; Goal
Totally eliminate leukemic cells from the body using combinations of chemotherapy with or without total body irradiation
Leukemia: Bone Marrow and Stem Cell Transplantation
Eradicates client’s hematopoietic stem cells Replaced with those of an HLA-matched • Sibling • Volunteer • Identical twin • Client’s own stem cells removed before
Leukemia: Nursing Management; Overall goals
- Understand and cooperate with the treatment plan
- Experience minimal side effects and complications of disease and treatment
- Feel hopeful and supported during the periods of treatment, relapse, and remission
Leukemia: Nursing Management
- Ongoing care is necessary to monitor for signs and symptoms of disease control or relapse
- Teach client and significant other
- Diligence in disease management
- Need for follow-up care
- When to seek medical attention
Leukemia: Nursing Care; Risk for Infection
- Infection precautions
- Avoid invasive procedures
- Report evidence of infection
- Monitor vital signs
- Report lab values
- Explain precautions and restrictions
Leukemia: Nursing Care; Imbalanced Nutrition
Less than Body Requirements
• Monitor weight
• Promote food and fluid intake
• Avoid procedures around meals
Leukemia: Nursing Care; Impaired oral Mucous Membranes
- Assess mouth
- 1:1 solution saline/peroxide as mouthwash
- Soft-bristle toothbrush
- Medications for infection, pain
- Avoid alcohol-based mouthwashes
Leukemia: Nursing Care; Ineffective Protection
- Monitor LOC
- Report manifestations of bleeding
- Avoid invasive procedures
- Apply pressure to puncture sites
- Avoid straining with bowel movement
Leukemia: Nursing Care; Anticipatory Grieving
- Therapeutic communication
- Manage stressful situations
- Support groups for the grieving process
Leukemia: Nursing Care; Teaching
- Diagnosis, treatment, bone marrow, complications
- Cancer as a chronic illness
- Balance activity with rest
- Maintain weight and nutrition
- Hydration
- Prevent infection
- Oral hygiene
Leukemia: Nursing Care
- Avoid crowds, sick people
- Avoid immunizations
- Reduce risk of bleeding or injury
- Avoid OTC medications that can cause bleeding
- Refer to social services, support groups, home health
Leukemia: Nursing Management; Evaluation
- Cope effectively with diagnosis, treatment regimen, and prognosis
- Attain and maintain adequate nutrition
- Experience no complications
- Feel comfortable and supported
Hodgkin’s Disease: Nursing and Collaborative Management
- Using diagnostic studies, a stage of disease is determined
- Disease may be localized or diffused
- Treatment depends on the nature and extent of the disease
Stages of Hodgkin’s Disease
- Stage I- involvement of a single node
- Stage II- involvement of 2 or more nodes on the same side of the diaphragm
- Stage III- involvement of additional lymph node regions, organs or extralympathic
- Stage IV- widely spread disease
- A or B
Hodgkin’s Disease: Nursing and Collaborative Management
Management focuses on selecting a treatment plan
Least amount of treatment to achieve a cure
• Minimize short- and long-term complications
Hodgkin’s Disease: Nursing and Collaborative Management; Chemo/ Radiation
Chemotherapy • Combination • Remission in >75% Radiation • Used for both • Combined with chemotherapy
Hodgkin’s Disease: Nursing and Collaborative Management; Radiation/ Combination Chemo
Radiation therapy
• 95% of stage I or stage II clients cured with 4 to 6 weeks of radiation therapy
Combination chemotherapy
• Resistant disease or high risk of relapse
Hodgkin’s Disease: Nursing and Collaborative Management
- Skin in radiation field needs attention
- Psychosocial considerations
- Fertility issues
- Long-term evaluation of client
- Consequences may not be apparent for many years
Hodgkin’s Disease: Nursing and Collaborative Management; Risk of secondary malignancies
- 18% risk of secondary cancer at 15 years after treatment
- Most common
- Acute non-lymphoblastic leukemia
- Non-Hodgkin’s lymphoma
- Solid tumours
Non-Hodgkin’s Disease: Treatment
Treatment • Radiation therapy • Chemotherapy More aggressive lymphomas are more responsive to treatment • More likely to be cured
Non-Hodgkin’s Disease: Nursing Care; Impaired Skin Integrity/ Nausea
Risk for Impaired Skin Integrity • Measures to reduce itching Nausea • Antiemetics • Measures to relieve/reduce nausea
Non-Hodgkin’s Disease: Nursing Care; Fatigue
- Assess malaise
- Encourage talking about disease
- Quiet activities
- Rest periods
- High-carbohydrate diet
- Fluids
Non-Hodgkin’s Disease: Nursing Care; Disturbed Body Image
- Body image assessment
- Objective signs of altered body image
- Coping with alopecia
- Effects of illness on sexuality
- Support groups
Non-Hodgkin’s Disease: Nursing Care; Teaching
- Treatment and effects of treatment
- Skin care
- New symptoms
- Complementary pain management strategies
- Rest and exercise
- Diet
- Canadian Cancer Society referral
