Hemo Disorders Pt 2 Flashcards
What happens with DIC?
clotting is altered, causing small blood clots to form in the blood vessels some of which can clog the vessels and cut off the normal blood supply to organs
What happens during the clotting process during DIC?
platelets and clotting factors are consumed leaving the patient at high risk of serious bleeding even from minor injury or w/o injury
Lab Changes w/ DIC
- decreased platelets
- increased PT
- increased PTT
- decreased Fibrinogen
- increased D-dimer
S/S of DIC as Micro-clots occur are?
- kidney/liver failure
- stroke like symptoms
- symptoms of PE
S/S of DIC as Clotting Factor/Platelets are depleted
- petechia
- oral bleeding, epistaxis, conjunctival hemorrhage
- increased bleeding from puncture sites
- hematemesis/hematuria/melena
- profuse bleeding from everywhere
- internal bleeding
Primary Treatment for DIC
treat underlying cause
Secondary Treatment for DIC
- treat the symptoms
- O2/IV fluids/Electrolytes
- transfusions
- heparin or lovenox to disrupt micro-clots
Nursing Management for DIC
- monitor those @ risk
- early recognition and reporting is essential
- administer O2/IV fluids/electrolytes
- most will have central line
- dialysis may be needed if kidney failure
- monitor liver/neuro function
Essential Thrombocythemia is caused by what?
an excessive production of platelets that leads to abnormal clotting or bleeding
Essential Thrombocythemia occurs as a result of what?
acquired gene mutation or infections
What is the average survival rate post-diagnosis for Essential Thrombocythemia?
20 years
Essential Thrombocythemia is most common in who?
women > 50
S/S of Essential Thrombocythemia
- often asymptomatic
- headaches
- dizziness
- vision probs
- burning/redness in hands and feet
- coldness/blue fingers and toes
- mildly enlarged spleen
Goals for Thrombocythemia
- reduce the risk of occlusions r/t to clots
- alleviate symptoms
Rick Factors for Essential Thrombocythemia
- history of clots
- PVD
- Atherosclerosis
- Obesity
- history of smoking
Treatment for high risk patients w/ thrombocythemia
- hydroxyurea
- IV/sub q coagulation
For extreme cases you would treat thrombocythemia w/ what?
plateletpheresis
Aplastic Anemia results from what?
damage to the stem cells w/in bone marrow
Aplastic Anemia leads to what?
pancytopenia-decrease in RBC’s, WBC’s, and platelets
Causes of Aplastic Anemia
- most cases are idiopathic
- viral infection
- pregnancy
- meds
- chemical exposure
- chemo
S/S of Aplastic Anemia
- often insidious
- fatigue
- SOB
- rapid/irregular HR
- pale skin
- frequent/prolonged infection
- easy bruising
- nose/gum bleeds
- prolonged bleeding
- skin rash
- dizziness/headache
- neutropenia/thrombocytopenia/anemia
Treatment for Symptomatic Aplastic Anemia
packed RBC’s
Treatment for Thrombocytopenia
platelet transfusion
Treatment for Neutropenia
antibiotics
Treatment for Aplastic Anemia < 40 yrs old w/ matched Sibling Donor
stem cell transplant
Treatment for > 40 yrs old or NO matched sibling donor
immunosuppressive therapy
What is considered if immunosuppressive therapy is not successful?
Unmatched/unrelated stem cell donor should be considered
-high mortality rate from rejection
Nursing Management for Aplastic Anemia
- infection prevention
- monitor for bleeding
- avoid ASA and aspirin products
- birth control to diminish blood loss
- educate
- close monitor BP
- educate on hirsutism and gingival hyperplasia
What is Leukemia?
rapid increase in the number of WBC’s w/ abnormal maturation of the cells; results in suppression of other cells
What happens w/ Leukemia and the bone marrow?
Bone marrow begins to over fill w/ WBC’s leading them to overflow into the circulatory system prematurely
An increase in WBC’s/Leukocytes is known as what?
leukocytosis
Acute Leukemia
- immature leukocytes that don’t function normally
- onset is rapid
- symptoms progress quickly
- death can occur w/in weeks to months w/o aggressive treatment
Chronic Leukemia
- most leukocytes are mature and can still function normally
- symptoms take months-years to progress
- live longer and often die of secondary conditions in late age
Acute Myeloid Leukemia (AML)
-affects all age groups
-grows quickly
-prognosis is directly r/t age
-most lethal form
develops w/o warning-symptoms appear over weeks-months
Acute Lymphocytic Leukemia (ALL)
- common in young children
- grows quickly
- 90% survival rate in kids < 5
- 60% survival rate in adolescents
- symptoms come on quickly but expected outcome w/ treatment is remission
Chronic Myeloid Leukemia (CML)
- Common adults > 60
- grows slowly
- symptoms progress slowly and in phases
- early detection is most common and leads to high survival rate
What is the survival rate like for a patient with Chronic Myeloid Leukemia?
80% 5 year survival rate w/ early detection; unless disease progresses to “blast crisis” phase (3-6 months)
Chronic Lymphocytic Leukemia (CLL)
- common in adults > 60
- grows slowly
- 90% 5 yr survival rate
- symptoms progress slowly-often require monitoring w/ no treatment
Chronic Phase of CML
- mostly asymptomatic
- incidental finding in blood work
- increased WBC’s
Accelerated Phase of CML
- fatigue
- fever
- night sweats
- abdominal pain
- weight loss
- increased WBC’s/low platelets
Blast Crisis of CML
- bone pain
- enlarged spleen
- bleeding
- infections
- confusion, vision changes, SOB
- very high WBC’s/very low platelets
AML S/S
- neutropenia
- fever/infection
- anemia
- weakness/fatigue
- thrombocytopenia
- bleeding
- enlarged liver/spleen with pain/bone pain
- anorexia, N/V, diarrhea
ALL S/S
-pain from enlarged liver/spleen
-bone pain
-testicular swelling/pain
-visual changes
-N/V
-altered LOC
confusion
Nursing Management for CML
- focuses on medication
- take meds before meals
- do NOT take w/ antacids, protonix, grapefruit juice
Nursing Management for AML
- administer blood products/antibiotics
- infection/bleeding prevention is priority
- educate for self management and decrease anxiety
- monitor for increased potassium and phosphates
- monitor uric acid levels
- increase fluid intake
What is the priority nursing management for AML?
infection and bleeding prevention
Monitor a patient w/ AML for what?
- increased potassium and phosphates
- uric acid levels
Nursing Management for ALL
- educate men on testicular exam
- prevent infection/bleeding
- discuss fertility preservation w/ young girls
Monitor all types of leukemia for what?
Monitor and treat side effects of chemotherapeutic treatment
- nausea
- mucositis
What to use for Mucositis?
- soft, bland foods
- high protein
- miracle mouthwash
- no acidic or spicy foods
What are the 2 types of lymphomas?
- Hodgkin’s
- Non-Hodgkin’s
Hodgkin’s Lymphoma
- rare
- high cure rate
- more common in young men
- has a specific cell that can be seen
Non-Hodgkin’s Lymphoma
- > 70,000 cases annually
- rate of cure is lower/diagnosed at more advanced stage
- more common in older men
What is the treatment for Lymphomas?
chemotherapy
radiation
You should monitor and treat what side effects from treatment for Lymphomas?
- nausea
- hair loss
- infection
- weight loss/anorexia
- oral ulcers
Blood can only be given up to how many hours?
Up to 4 hours
Blood Transfusions
- each unit given over 2-4 hours unless emergency
- started w/in 30 minutes after picking up
- check name, DOB, medical record #, unit #, blood type, expiration date
How often are vitals taken when giving a blood transfusions?
Taken prior to starting blood, 15 minutes after starting, and at completion of blood
What signs should you monitor for with transfusion reactions?
- back/flank pain
- dark urine
- chills, fever, skin flushing
- fainting/dizziness
- SOB/restlessness
- itching
What are some alternatives to blood for religious or other reasons?
- volume expanders (normal saline)
- erythropoietin
- blood salvage during surgery
- autologous donation
- artificial blood
Types of Donations
- directed donation
- standard donation
- autologous
- intraoperative blood salvage
Direct Donation
friends and family donation
Standard Donation
blood received from donors at community/school/occupational blood drives
Autologous Donations
patient donates own blood
Intraoperative Blood Salvage
collected in cell saver and re-transfused to patient
Complication of Transfusions
- infection
- iron overload
- transfusion reaction
Infection Risks from Blood transfusions
- hepatitis B or C
- HIV
- CMV
How would you treat iron overload from blood transfusion?
Chelation therapy
Sensitization Transfusion Reactions
- incorrect blood type and/or RH factor
- Rh- needs Rh- only
- Rh+ can have Rh- or +
- emergency or unknown type should use O
What is Platelet Dysfunction?
platelet numbers are WNL but function is altered
What is the only IV fluid that you mix with blood?
Normal Saline
How many nurses does it take to check blood?
2
If patient begins to have a reaction to transfusion you should what?
Stop blood and call doctor
What medications prevent platelets from clumping together and forming clots?
Aspirin
NSAIDS
Plavix
How long does aspirin last in the blood?
7-10 days
How long do NSAIDs last in the blood?
5-7 days
How long does Plavix last in the blood?
2-3 days
Blood has to ALWAYS given through what kind of IV?
20 gauge or greater with a pump
Liver Disease
- cirrhosis
- hepatitis
- administer fresh frozen plasma
Vitamin K Deficiency
- malnourishment
- alcoholism
- dietary deficiency
- administer vitamin K (Mephytom) sub q or orally
Fresh Frozen Plasma
- a unit is usually administered over 15-30 mins
- standard blood administration set is used
- once thawed FFP must not be re-frozen and should be used immediately
If a delay is unavoidable when delivering FFP you should do what with the component?
Store at ambient temperature (about 73 degrees) and used w/in 4 hours
Vitamin K sources take how long to reach full effect?
6-24 hours
What type of vitamin k works better with prolonged bleeding time w/ Coumadin administration?
Oral vitamin k
With Autologous donations what should be done?
- can only be given to that patient
- need to take iron supplements/erythropoietin
- donate 4-6 weeks in advance
What is the universal blood type recipients?
Type AB +
What is the universal blood type DONOR?
Type O
