Hematologic Problems Flashcards
Anemia
Reduction in either the number of RBC’s, the amount of hemoglobin, or the hematocrit
Different types of anemias
Aplastic: malfunctioning bone marrow Hypochromic: iron or vitamin deficiency Pernicious: lack of intrinsic factors Erythroblastosis fetalis: destruction by antibodies Secondary: bleeding Genetic factors: sickle cell anemia
Clinical manifestations of Sickle cell anemia
Pain Fatigue SOB Murmurs Jugular venous pulsation Cool to touch Priapism: prolonged penile erection; excessive vascular engorgement Cyanosis Jaundice: top of mouth Ulcers on lower legs Urine contains protein Legs and arm swelling During crisis: low grade fever Bilateral hand grasp
Sickle cell anemia crisis complications
Infections Stroke URI's Leg ulcers Splenomegaly Cell clumping Pain!!
Treatment for sickle cell anemia crisis
HOP Hydration: NS Oxygenation Pain Relief Remove constrictive clothing Check circulation
Prevention of sickle cell anemia crisis
Drink at least 3-4 liters of liquids everyday
Avoid alcohol
Avoid smoking
Be sure to get flu shot every year
Avoid temperatures of extreme hot or cold
Avoid travel to high altitudes
Avoid strenuous activity
Barrier methods of contraceptives for women are recommended with SCA
Iron deficiency anemia
Most common
Women
Older adults
People with poor diets
Manifestations of iron deficiency anemia
Fatigue
Reduced exercise tolerance
Fissures at corner of mouth
Management of iron deficiency anemia
Increasing oral intake of iron(red meat, egg yolks, kidney beans, leafy green veggies, raisins)
Megaloblastic anemia (Vitamin B12 deficiency anemia)
Failure to activate the enzyme that moves folic acid into precursor RBC cells so that cell division and growth function
Large size of these abnormal cells
Causes: vegan diets, diets lacking dairy products, small bowel obstruction, chronic diarrhea
Manifestations of megaloblastic anemia
Pallor Jaundice Glossitis: beefy-red tongue Fatigue Weight loss Paresthesias: abnormal sensations in feet or hands Poor balance
Aplastic anemia
Deficiency of circulating red blood cells
Failure of bone marrow to produce
Leukopenia: reduction in WBC
Thrombocytopenia: Reduction in platelets (pancytopenia)
Aplastic anemia causes
Exposure to toxic agents:
Drugs
Ionizing radiation
Infection
Aplastic anemia manifestations
CBC shows severe macrocytic anemia, leukopenia, and thrombocytopenia
Polycythemia vera patho
Number of RBc in the blood are greater than normal Blood is hyperviscous: thicker in blood Cancer of the RBCs Excessive leukocyte productions Excessive production of platelets
Manifestations of polycythemia vera
Facial skin and mucous membranes have dark purple flushed appearance (plethoric) Distended veins Intense itching Hypertension Hypoxia
Management of polycythemia vera
Repeated phlebotomy
apheresis (2-5 times per week)
Apheresis: withdrawals of whole blood and removal of some of patients blood component
Self-management with polycythemia vera
Drink 2-4 liters of liquids Take anticoagulants Wear supoort stockings Elevate your feet Use electric shaver Do not floss
Thrombocytopenia
Low platelets for blood clotting
Autoimmune thrombocytopenia purpura patho
Number of circulating platelets is greatly reduced
Even though platelet production is normal
Make an antibody against their own platelets
Most common among women ages 20-50
Autoimmune thrombocytopenic purpura assessment
Large ecchymoses (bruises)
Petechial rash on arms, legs, upper chest, neck
Stroke
Diagnosed: low platelet count and increased megakaryocytes
Autoimmune thrombocytopenic purpura interventions
Risk for poor clotting and increased bleeding Protection from bleeding Corticosteroids Platelet transfusions;less than 10,000 Teach patients to avoid crowds
Thrombotic thrombocytopenic purpura
Platelets clump together abnormally in the capillaries and too few remain in circulation Kidney failure MI Stroke Fatal If not tx in 3 months
Thrombotic thrombocytopenic purpura management
Prevent platelet clumping
Plasma removal
Infusion of fresh frozen plasma
Aspirin
Hemophilia
Inherited blood disorder Factor VIII Classic Type A No cure X linked recessive trait (males)
Hemophilia manifestations
Intracranial hemorrhage Prolonged nosebleeds Bruises easily Warm, painful, swollen joints with decreased movement GI hemorrhage Tarry stools Cola colored urine Coffee ground emesis
Interventions for hemophilia
Avoid injury and meds that promote bleeding
Good nutrition
Good dental hygiene
IV administration of deficient clotting factors
Hemophilia laboratory test results
Prolonged aPTT
Normal bleeding time
Normal PT
Nursing responsibilities blood pretransfusion
Verify prescription with another RN
Test donors blood for compatibility
Verify patients identity with another RN
Examine blood bag label, attached tag, and requisition slip for ABO and RH compatibility with patient and other RN
Check expiration date with another RN
Inspect blood for discoloration, gas bubbles, cloudiness
Transfusion responsibilities during transfusion
Provide patient education
Assess vital signs immediately before starting infusion
Begin transfusion slowly
Stay with patient the first 15-30 minutes
Ask patient to report unusual sensations (chills, SOB, hives, itching)
Administer blood product per protocol
Assess for hyperkalemia
Blood administration
Determine clients allergies and previous transfusion reactions Never add ANY meds to blood products 18 gauge needle Normal saline IV solution Do not warm unless risk of hypothermic Infuse each unit over 2-4 hours NO longer than 4
Febrile reactions
Chills Fever Headache Flushing Tachycardia Increased anxiety
Hemolytic transfusion reactions
Low back pain Hypotension Tachycardia Chest pain Tachypnea Hemoglobinuria May have immediate onest
Allergic reaction: Mild:
Hives
Pruritus
Facial flushing
Alergic reaction: Severe:
SOB
Bronchospasm
Anxiety
Nursing implimincations blood transfusion reaction
Stop transfusion and notify physician
Change IV tubing
Treat symptoms: o2, fluids, epinephrine
Recheck crossmatch
