Haematological system

Question 1

what is a haemolytic reaction

Answer 1

aeotiology
Transfusion of incompatible blood

assessment findings
Fever and chills
Flushing
Lower back pain
Hypotension
Tachypnoea
Haemoglobinuria
Haemoglobinaemia
Vascular collapse
Shock, renal failure and cardiac arrest

Question 2

what is a Allergic reaction

Answer 2

aeotiology
Reaction to certain proteins in the blood

assessment findings
Flushing, urticaria, pruritus

Question 3

what is a Anaphylaxis reaction

Answer 3

aeotiology
Giving IgA proteins to people who have developed IgA antibodies

assessment findings
Urticaria, wheezing, cyanosis, shock and cardiac arrest

Question 4

what is a Reaction due to circulatory overload reaction

Answer 4

aeotiology
Rapid transfusion of blood

assessment findings
Pulmonary congestion signs; hypertension, tachycardia, distended neck veins, dyspnoea

Question 5

what is a infection/septicaemia reaction

Answer 5

aeotiology
Transfusion of contaminated blood

assessment findings
Fever, chills, hypotension, shock

Question 6

what is aplastic anaemia

Answer 6

it is anaemia that results in which results in the failure of erythrocyte producing organs for example bone marrow

this could be because of bone marrow cancer, viral infections, pregnancy, and autoimmune disorders.

Question 7

what is pernicious anaemia

Answer 7

occurs when the body is unable to absorb vitamin B12, which is necessary for the production of red blood cells. this is caused by the intrinsic factor, a protein in the stomach that helps absorb vitamin B12 in the GI tract.

Question 8

what is folic acid anaemia

Answer 8

Folic acid deficiency anaemia occurs as a result of inadequate intake of folate. it can be treated using supplements and dietery changes.

Question 9

what is haemolytic anaemia

Answer 9

Haemolytic anaemia results from premature or abnormal destruction of RBCs by the macrophages or a hyperactive spleen. It may occur because the bone marrow fails to replace destroyed RBCs.

Question 10

sickle cell anaemia

Answer 10

• this is a genetic disorders
  -that affects the production of hemoglobin

Question 11

what is iron deficiency anaemia

Answer 11

-occurs when there is insufficient iron for Hb Synthesis. this may be caused by dietery intake of iron, inadequate absorption of iron, blood loss and increased demands such as in pregnancy.

Question 12

what is the pathophysiology of leukemia

Answer 12

-in leukemia there is uncontrolled proliferation of white blood cells
-the normal bone marrow is replaced by blast cells (immature and undifferentiated leucocytes)
-which are then released into the circulation but cannot protect the body against diease.

Question 13

what are the risk factors for leukemia

Answer 13

exposure to radiation
viral infections
genetic disposition and congenital defects such as downs syndrome
unknown

Question 14

what is haemophilia A

Answer 14

Haemophilia A, also known as classic haemophilia – caused by a deficiency of clotting Factor VIII. This can be mild, moderate or severe.

Question 15

what is haemophilia B

Answer 15

Haemophilia B/Christmas disease – due to a deficiency of clotting Factor IX. This can be mild, moderate or severe.

Question 16

what is haemophilia C

Answer 16

Haemophilia C – due to a deficiency of Factor XI.

Question 17

Describe the nursing interventions to manage pernicious anaemia always include the Rationale (7)

Answer 17

-Bed rest to reduce oxygen demand
-Monitor pulse for tachycardia, respiration for dyspnoea to assess for effect of treatment.
-Administer 40% face mask to decrease dyspnoea
-Administer oral vitamin B12 supplements to increase erythrocyte production
-administer vitB12 intramuscular injection if there is defective gastric absorption
-adminiater iron and folate supplements as prescribed to increase erthyrocyte production
-increase dietary intake of VitB12 via supplements such as soya milk

Question 18

Describe the dietary education you would give to a patient with iron deficiency anemia (3)

Answer 18

-Avoid drinking tea or coffee with meals as it decreases the iron absorption

-Increase vitamin C intake with meals example citrus, orange juice, broccoli cauliflower, guava, strawberries as it increases iron absorption

-increase the dietary to intake of the following example liver kidney beef dry beans peas green leafy vegetables fortified breads fortified cereals as they are foods rich in iron.

Question 19

Identify the important checkpoints that must be made before commencing a blood transfusion always include a rationale for each point (11)

Answer 19

-Obtain consent from the patient to receive the transfusion to ensure that he does not have any reasons / religious beliefs to refuse a transfusion

-Ensure the prescription chart has been completed by the doctor to ensure legality.

-Ask patient if he has any allergies and record outcome to minimise possibility of risk to the blood/ raise awareness of a possible allergic reaction.

-Record a base line blood pressure and pulse to be able to easily identify any changes.

2 people must be present to check the blood units including a doctor or a registered nurse to ensure accuracy/ to prevent mistakes

-The blood must be checked at the patient’s bedside to prevent accidental administration to another patient.

-The name and number on the patient’s identity band must be compared with the number on the blood units to ensure it is the correct blood for the patient / to detect any mistakes.

-Hospital policies for identification before transfusion must be followed to ensure accuracy / prevent any mistakes.

-Check the file / crossmatch of the patient to ensure that the patient is receiving the correct blood group.

-Ensure that the blood is warmed / at room temperature before administration to prevent hypothermia.

Observe the blood before administration to detect any abnormalities e.g. colour / leaks / clots (mention one). (Mogotlane, et al., 2018:690)

Question 20

what is the medication for a person who has hemophilia and which ones must be avoided.

Answer 20

Administer prescribed medica)on as follows:
* Analgesics as prescribed for pain, but aspirin and NSAIDS must
be avoided because these increase the incidence of bleeding
* Aminocaproic acid in cases of clot forma)on to slow down the
dissolution on of clots
* Synthetic vasopressin (DDAVP®) can be administered
intravenously, subcutaneously or intranasally to produce a transient rise in Factor VIII concentration on in patients with mild haemophilia.

Question 21

provide health education to a patient who has to take iron tablets for anaemia (7)

Answer 21

-take iron tablets one hour before meals as they are better absorbed

-take iron tablets with vitamin c as they need an acidic environment for absorption

-advise the patient that the iron tablets will turn stool dark brown so they must not be concerned

-advise the patient that they may experience gastric irritation when iron tablets are taken on an empty stomach so if that occurs they may take it after meals

-advise the patient not to crush the capsules/coating because it could affect the absorption

-do not take tablets with milk as milk decreases absorption of iron tablets

-do not take tablets with calcium tablets as they can decrease the absorption.

Question 22

Describe the nursing interventions to prevent joint injury in a patient with haemophilia

Answer 22

-rest the limb to prevent further injury

-apply ice wrapped in a towel to reduce swelling and bleeding

-gentle direct pressure/compression bandages to reduce the bleeding

-elevate the limb to reduce the swelling

-apply splints or supportive devices to immobilise the joint

-physiotherapy to maintain a range of motion

-administer VIII intravenously to prevent further bleeding

Question 23

nursing interventions and rationale for leukemia to prevent infection following a patient who is on chemotherapy

Answer 23

-monitor temperature 4 hourly to detect infection

-administer antibiotics as prescribed eg amoxicilan to treat infection

-nurse patient in isolation to prevent cross infection

-give supplements eg multivitamins to improve the immune system

-apply infection control measures eg limited visitors wearing ppe hand washing

-monitor bone marrow sites daily for early detection of signs of infection

-administer of Neupogen as prescribed to increase white blood cell count

-monitor white blood cell count results to evaluate effectiveness of treatment