Nurb Test 4: Hematology Flashcards
Cancer affecting blood and bone marrow
No single cause: genetics, environmental influences, chromosomal changes, chemical agents, chemotherapy, viruses, radiation, and immunological deficiencies
. Leukemia
Etiology
– Uncontrolled proliferation of myeloblasts (precursor to granulocytes) and hyperplasia of the bone marrow, starts in bone marrow
Abrupt onset and dramatic
Acute myelogenous leukemia (AML
- Excessive development of mature neoplastic granulocytes in bone marrow -> move into peripheral blood in massive numbers ->infiltrate liver and spleen / uncontrolled growth
- no symptoms early in the disease
- contain Philadelphia chromosome
Chronic myelogenous leukemia (CML)
- Change in quantity and quality of bone marrow elements. Marked by peripheral blood cytopenias and hypercellular bone marrow
- Can progress into AML
- infection and bleeding most common found six
Myelodysplastic syndrome (MDS)
-Excessive production of malignant plasma cells -> infiltrate bone marrow and produce abnormal amount of immunoglobulin -> one is destroyed
-produce abn protein: 4 protein levels cause renal failure
More common in men, dev after 40, more common African American
-sx dev slow and icideous
Major sx skeletal pain
Hypercalcemia due to bone degeneration: prevent dehydration
Multiple myeloma (plasma cell myeloma)
- solid masses that may occur from accumulation of leukemic cells
Chloromas
complication of leukemia
Low RBC, Hct and Hb, platelets Low to high WBC -Tests differ depending on type of leukemia *affects bone marrow: biopsy important * good baseline would be a CBC
Diagnostics leukemia
Monitor Wt I&O= fluid deficit related to inadequate intake vomiting and bleeding, Hemglobin and hematocrit levels, give meds for N/V= give meds, VS
- Offer foods they like
- Dehydration prevention= can cause hypocalcemia
Goal : is to attain remission
Put on chemo to help with remission
Care: leukemia
- means there is an infection in the body. -do not have the ability to fight off infection, **needs to be addressed quickly.
- 100.4 F and a neutrophil count of less than 500 is a medical emergency
Fever
neutropenia
= ANC 500-1000
= ANC is less the 500 cells per uL and is at severe risk for bacterial infection
Neutropenia
Severe Neutropenia
=500-1000 then they are at moderate risk for bacterial infection, only way to count and confirm the existence
Differential WBC count
neutropenia
This is associated with high risk of infection and death from sepsis
severe neutropenia
- Fever greater than 100.9, high heart rate, altered mental status, rapid breathing, significant edema or positive fluid balance, or blood sugar greater than 140 without being diagnosed with diabetes
- Inflammatory criteria-leukocytosis, elevated C-reactive protein, raised procalcitonin, or leukopenia
- Arterial hypotension
- Organ dysfunction criteria- arterial hypoxemia, acute decrease of urine output, serum creatinine increased, low INR, elevated PTT, absent bowel sounds, thrombocytopenia, and hyperbilirubinemia
- Altered tissue perfusion- decrease in capillary refill
sepsis neutropenia
Main tests for neutropenia:
peripheral WBC count and bone marrow aspiration
specific emphasis on the common sites of infection, such as the oral mucosa, paranasal sinuses, ear, chest, abdomen, skin, nails, groins, anal and vaginal areas, and vascular catheter insertion sites
Physical examination:
medical management
neutropenia
-Maintain isolation techniques
-Wash hands with antimicrobial soap before and after each patient care and have visitors do
Edu: patient and care giver how to avoid infections through personal hygiene, hand washing, oral care, skin hygiene and pulmonary hygiene.
-signs and symptoms of infection and when to report them to the health care provider
-Instruct the patient to take antibiotics as prescribed
-Monitor for systemic and localized signs and symptoms of infection
-Remove fresh flowers and plants from patient areas to avoid introduction of pathogens
Nursing Interventions:
neutropenia
Patient Education
- chemotherapy or immunosuppressive therapy: treatments would be stopped if the white blood cell count was too low and resumed once the cell counts returned to a safer level
- infection present treated promptly
- Blood cultures will continue to be drawn until all four bottles come back clean of any bacterial growth
- identifiable cause of the infection (i.e. port or PICC), that item would be removed and placed again if needed for chemotherapy treatment
- Patients could also have home IV antibiotics to take for up to two weeks to insure that the infection is gone
- Proper self-care:
pt edu neutropenia
frequent hand washing and the use of hand sanitizer if soap and water are not available, avoiding persons that are sick or appear sick, avoiding fresh fruits, vegetables, flowers, and uncooked meats, taking daily showers, proper oral care, washing hands after touching any pets or taking care of pets, taking your temperature at home and report any temperature over 100.4 F, and wearing a mask if in public
Proper self-care:
pt edu neutropenia
- result from abnormally initiated and accelerated clotting, Char by profuse bleeding, always caused by underlying condition or situation
Dissmeninated Intravascular Coagulation
-abnormal response of the normal clotting cascade stimulated by a disease proves or disorder
Three types, different triggering mechanisms
1. acute
2. subacute
3. chronic
Etiology DIC
Need to tx holistically
Diagnosing quickly, stabilizing patient=o2, find underlying cause and correcting it
Monitoring vital signs and assessing for internal/ external hemorrhage
Respiratory: raise HOB or tripod position
Tachycardia: calcium channel blockers/ Beta Blockers
Petechiae: taking precautions
Can give blood products and anticoagulants
Management of symptoms DIC
Ongoing assessments, active attention to manifestation of syndrome= care of causative problem
Prompt administration of prescribed therapies
Early detection of overt and occult bleeding is primary goal
-Signs of external bleeding:
-Signs of internal bleeding:
Indications microemboli are cause organ damage: decreased renal output
Tissue damage minimized and protect pt form additional foci bleeding
Decreasing stimulation
petechiae can be managed with precaution in daily cares=bathing, shaving, and brushing teeth Blood products can also be given in order to replace the lost blood due to hemorrhage
Interventions:
DIC
petechial, oozing at iv sites
signs of external bleeding DIC
increased hear rate, changes in loc, increase in abd girth and pain
signs of internal bleeding DIC
Early s/s of bleeding, good skin care/ hygiene, Protect self from injury, Psychosocial support
Important to know the predisposing conditions
When to seek tx: if symptoms do not improve in 3 days, fever develops, shortness of breath, and lightheadedness
Pt Education:
DIC
-Decreased RBC production
anemia
General considerations: Can go unrecognized in elderly because they may be mistaken for normal aging
-Pallor, Confusion, Ataxia, Fatigue, Worsening angina, HF
Clinical Manifestations Anemia
hemoglobin range goes with symptoms
mild
moderate
severe
Mild- 10-14 Moderate- 6-10 Severe- less than 6
: Inadequate dietary intake, Malabsorption, Blood loss, Hemolysis
Iron-Deficiency Anemia Etiology
Can be asymptomatic, Fatique, Pallor, Glossitis (inflammation of tongue), Cheilitis (inflammation of lips), Headache, Paresthesis, Burning sensation of tongue
Clinical manifestations:
iron deficiency anemia
Treat underlying disease
Educate on which foods are good sources of iron
Iron supplement: hr before eat, best given with orange juice for absorption
Collaborative Care
iron deficiency anemia
- Recognized those who bare increased risk: Premenopausal, Pregnant women, Low socioeconomic class, Older adults, Those who experience blood loss
- *Diet Teaching with emphasis on foods high in iron=meat, green leafy vegetables, cantaloupe, beans and maximizing absorption
- For life-long iron supplements, monitoring is necessary for potential liver problems
Nursing Management
iron deficiency anemia
- Genetic based involving inadequate production of normal Hgb
Absent or reduced globulin protein
Abnormal Hgb synthesis
Thalassemia Etiology
: minor, which is a mild form of the disease
Heterozygous
Thalassemia Etiology
- major, two genes, sever condition
Homozygous
Thalassemia Etiology
Frequently asymptomatic with minor case
Growth, both physical and mental, is often delayed
Pallor, Fatigue
developed by 2 years of age
Pronounced splenomegaly and hepatomegaly
Jaundice
Thickening of cranium and maxillary cavity
Clinical manifestations
Thalassemia
anemia
-No specific drug or diet therapies are effective
-Minor cases require no treatment because the body adapts
-Major cases managed with blood transfusions or exchange transfusions
-Hematopoietic stem cell transplantation is only cure: Risk out weights the benefit
Oral medication: deferasirox (Exjade), IV/SubQ: deferoxamine (Desferal)
-bind to iron to reduce iron overload that occurs with chronic transfusion therapy
Collaborative Care
Thalassemia
anemia
-Group of disorders caused by impaired DNA synthesis
Characterized by the presence of large RBCs
RBCs easily destroyed due to fragile cell membranes
Megaloblastic Anemias Etiology
deficiency Most common is Pernicious anemia: intrinsic factor is not being excreted by the gastric mucosa =which is required for bit b 12 absorption
Cobalamin (vitamin B12)
megaloblastic anemias
General symptoms of anemia
Folic: Sore, red, beefy, and shiney tongue
B12: Anorexia, Nausea, Vomiting, Abdominal pain, Weakness
Paresthesia of feet and hands
Position sense
Impaired thought process ranging from confusion to dementia
Megaloblastic Anemia Clinical Manifestations
*Absence of neurological problems is important dx finding and differentiates v b12 and folic acid,
B12 has the symptoms
Megaloblastic Anemia
-Parenteral or intranasal administration of treatment of choice
IM injection, daily for two weeks, monthly for life
Cobalamin deficiency
Megaloblastic Anemia
Prevent injury: Diminished sensations to heat and pain
Ensure good patient compliance
Neurological assessment
Nursing Management
Megaloblastic anemia
- Rare
- Congenital or Acquired:70 % of acquired are idiopathic and thought to be autoimmune
. Aplastic Anemia Etiology
Sudden or insidiously over weeks to months
Mild to severe
General anemia symptoms
Dyspnea
Cardiovascular symptoms
WBC, Hgb, and platelets show decreased (other RBCs are generally normal
Clinical manifestations
aplastic anemia
-Inherited, progressive chronic course, rare
Blood is missing blood-clotting factors VIII IX
Main concern: Internal bleeding especially in the knees, ankles, and elbows.
Hemophilia Etiology
Age: First indication is after a circumcision, By __ years the first episode of bleeding occurs
-Seek medical attention if the child bruises easily or has heavy bleeding related to an injury
hemophilia
2
Inherited but also can develop later in life, more common
- Lacking a protein called Von Willebrand factor (important in the blood-clotting process)
- Increases time for individuals to form clots and stop the bleeding
Von Willebrand Disease: hemophilia
- Unexplained bleeding from cuts or injuries
- Unusual bleeding after receiving vaccinations
- Pain, swelling, or tightness in joints
- Nosebleeds with an unknown cause
Signs and Symptoms Spontaneous bleeding in Hemophilia
Usually milder sx, skin and mucous membranes: nose mouth intestines uterus vagina Abnormal bleeding and easy bruising Recurrent nosebleeds Bleeding gums Increased menstrual flow Injuries Blood in stool or urine After shaving with a razor
Von Willebrand Disease Most common s/s:
Deep tissue more common in joints and muscles
slow persistent prolonged bleeding
-delayed bleeding after minor injuries several hours to days
-Uncontrollable hemorrhage after dental extraction of irritation of the gingiva
-epistaxis after a blow to the face
-GI bleed from ulcers and gastritis
- hematuria from GU trauma and splenic rupture from a fall or abd trauma
-ecchuymoses and subcutaneous hematomas
-neurological signs like pain, anesthesia, and paralysis
-hemarthrosis (bleeding of the Joints) can lead to joint injury and deformity that can be crippling
General Sx Hemophilia:
Prothromnin time= no problem, Thrombin time= no problem, platelet count=adequate, Partial thromboplasitn time=prolonged b/c problem with clotting factor, bleeding times= prolonged in von/ norm in A and B , and factor assay= decrease VII A, decrease IX B, VWF decrease in Von
Dx Studies
hemophilia
most common, 80 percent of all cases
-Injection of DDAVP to release more clotting factors to stop any bleeding
medical management
Mild Hemophilia A:
= analog of Vasopressin stimulate and increase VIII and vWF
-given IV, Subq, or nasal spray
IV seen 30 min last 12 hours
* short lived pt monitor closely and repeat dose if necessary
Desmopression Acetate(DDAVP)
Early Childhood: Easily bruise from activities
Internal bleeding
-Muscle bleeding: Occurs in forearm, knee, ankle, or elbow/ Edema may be present
Joints: Can lead to permanent joint damage and arthritis
S/S: Edema, pain, numbness, and difficulty moving
Brain hemorrhage: Can occur from a simple fall
-Can lead to blindness, mental retardation, and neurological deficits
-Dev of inhibitor to factor VIII and IX
-transfusion-transmitted infectious disorders
-allergic reactions
-thrombotic with use of IX because it contains activated coagulation factors
Complications
hemophilia
Avoid NSAID’s or aspirin for pain
Institute bleeding precautions
Padding on cribs, corners
Lay on blankets/soft padding on floor
Handle gently to prevent bleeding/bruising
No contact sports, wear gloves around the house
*must wear a medical alert tag
Education
hemophilia
minor bleeding episodes Tx min of 72 hours
Surgery and traumatic injury- prolonged therapy
1. stop topical bleeding asap=indirect pressure or ice/ pack and apply hemostatic agent=Thrombin
2. give specific coagulation factor to raise pt level/ monitor for signs of hypersensitivity
3. Joint bleeding important to totally rest involved joint, pack with ice, give analgesics to reduce severe pain * aspirin compounds should not be used
After bleeding stops- encourage mobilization with rom exercises and physical therapy , wt bering is avoided till all swelling is gone
Monitor for Compartment syndrome and Intracranial bleeding
psychosocial support
Nursing Acute intervention:
hemophilia
Blood cancer
Unknown cause and malignant (Abnormal growth of Reed-Sternberg cells)
-Could be Epstein bar, genetics, occupational hazards=factory, radiology jobs
Hodgkin’s Lymphoma
Enlargement of cervical, axillary, and inguinal lymph nodes;
weight loss, fatigue, fever, dyspnea and dysphagia=b symptoms worse prognosis
Initial s/s:
Hodgkin’s Lymphoma
: Hepatomegaly, splenomegaly, and anemia
Hodgkin’s Lymphoma
Progressive s/s
Dx: *CT and MRI reveals the stage, lymph node biopsy, bone marrow biopsy
Labs: *CBC= Increased platelets, leukopenia, and thrombocytopenia
-Ct and mri to stage
-Pet scan help to see what stage they are in then
Hodgkin’s Lymphoma
Hodgkin’s Lymphoma Stage 1 stage 2 stage 3 stage 4
Stage 1: 1 lymph node
Stage 2: 2 or > lymph nodes
Stage 3: Above and below the diaphragm
Stage 4: Outside of the diaphragm
Often begins with enlargement of the lymph nodes
Monitor for: Night sweats, Weakness, Fever, Weight loss
Hodgkin’s Teaching
staging
- absence of systemic symptoms
- presence of systemic symptoms
Hodgkin’s Lymphoma
A
B
Self-care:
Good hand washing
Stay away from people that are ill, going out at night less people
Pain management
Avoid alcohol (due to cause of increased pain in enlargement sites)
Discuss fertility issues: common in childbearing ages
Hodgkin’s Lymphoma
Unknown cause and malignant, more common
Possible causes-B-cell and T-cell origination; WBCs and lymphocytes combine and create tumors anywhere in lymph system
Non-Hodgkin’s Lymphoma
Risk factors: a suppressed immune system, history of Epstein-Barr virus, and a history of radiation or chemotherapy
Non-Hodgkin’s Lymphoma
- lymphadenopathy (painless lymph node enlargement)
2. abdominal pain, difficulty breathing, fever, night sweats, and weight loss (also called constitutional or B symptoms)
Non-Hodgkin’s Lymphoma
- Common s/s:
- Progressive s/s:
Tx: Chemotherapy combo, possible radiation to affected area; other tx options for side effects Subtypes Low grade intermediate grade high grade
Non-Hodgkin’s Lymphoma
Low grade: Indolent
Intermediate grade: Aggressive
High grade: Very aggressive
Assess and monitor respiratory rate, depth, and rhythm
Assist the patient and family with identifying other factors that precipitate or exacerbate episodes of ineffective breathing patterns
Encourage ambulation as tolerated
Encourage elderly patients to sit upright or stand and to avoid lying down for prolonged periods during the day
Refer to home health aide services as need to support energy conservation
Teach pursed-lip and controlled breathing techniques
Edu emotional support
Non-Hodgkin’s Lymphoma
Interventions:
-can spread to lymph nodes, lymph vessels, or any organ containing lymph tissue
Includes: tonsils, adenoids, spleen, thymus, bone marrow
-Will experience pain and symptoms specific to region/organ affected d/t pressure from lymph node enlargement
Abdomen: n/v, feeling of fullness, urinary or digestive complications
Lungs: difficulty breathing
Brain or Spinal Cord: nervous system symptoms
Skin: itchy nodules
Bone Marrow: fatigue, anemia, bleeding/bruising
Nonspecific symptoms (fever, night sweats, weight loss) can occur in high grade
Non-Hodgkin’s Teaching
*at easing their symptoms- looking for other involvement: becomes confused-brain, blood in stool- GI, Vomit blood
Pain management
Nutritious diet (fiber for constipation relief)
Exercise (energy, constipation relief)
Adequate rest
Adequate fluids (dehydration tx for vomiting/diarrhea)
Small, frequent meals (n/v control)
Stress management: support groups, healthy lifestyle, relaxation
Self-care:
non-hodgkin lymphoma
= lymp system, red stern berg cells
= can go everywhere : more extensive and involve specific organs, b and T cells
Hodgkin
NON-Hodgkin
- 1st thing get a consent
- Sign paper to sign off that they got it send it back to blood bank
- Verify pt name on arm band and on bag/ date of birth, blood bank id number, and type of blood= with other nurse in pt bedside
- bag, bank, and tear off list - Nurse must have take all vitals, must be in the room for 15 minutes can’t leave
- Tech can do the beginning vital signs before it started
- So if having a reaction stop the blood then have saline running to keep open
Homeostasis Management
Blood Products
Prepared from whole blood
Preferred RBC source- more component specific
Given for severe or symptomatic anemia and acute blood loss
Packed RBC’s
Prepared from RBC’s using glycerol for protection and frozen
Must be used within 24 hours of thawing
Used for auto-transfusions, stockpiling, or rare donors for patients with alloantibodies=naturally in scorn tissues
Used infrequently because filters remove most WBC’s
Frozen RBC’s
Prepared from fresh whole blood
Multiple units can be obtained from one donor by plateletpheresis
Given for bleeding caused by thrombocytopenia
Platelets
Obtained by acquiring liquid portion of whole blood separated from cells and frozen
Given for bleeding caused by deficiency in clotting factors:
Fresh frozen plasma
-DIC, hemorrhage, massive transfusion, liver disease, vit. K deficiency, excessive warfarin use
Fresh frozen plasma
Given for bleeding caused by deficiency in clotting factors:
Prepared from plasma
Given for hypovolemic shock and hypyalbuminemia
Albumin
-19 gauge needle
-23 gauge may be used for administering albumin, platelets, and clotting factor replacements
-DO NOT piggy back blood with dextrose solutions or lactated ringers= Hemolysis will occur if this is done
-Make sure patient has signed consent form to receive blood product
-Once blood is on unit, check with primary nurse and secondary nurse to ensure correct patient and correct blood product/type
-Blood must be used within 30 minutes once it arrives to the floor
-Blood is not to be refrigerated on nursing unit
-Administration of Blood Products
-Review procedure with patient
-Possible s/s of reaction
VS
Administration of Blood Products
- Vital signs must be taken before transfusion begins
- For first ___ minutes of infusion nurse must remain with patient: Due to high risk of reaction of the infusion, *Nurse may observe patient every ___minutes to ensure no reaction after this time
- *Infusion must finish within _ hours: Due to bacterial growth
Administration of Blood Products VS 1. 15 2. 30 3. 4 hr
- Education: Procedure, S/S to report
- Ensuring proper identification of blood product(s) and patient
- *Vital signs prior to transfusion, again 15 minutes into transfusion= when blood hits the patient, at the end of the tubing can take 3 min to get in
- Constant pt. monitoring for first 15 minutes of transfusion, then periodically for up to an hour
Nursing Interventions
Administration of Blood Products
- febrile
- allergic
- circulatory overload
- sepsis
- massive blood transfusion reaction
- Transfusion related acute lung injury TRALI
- Acute Hemolytic
Blood transfusion reactions
- delayed hemolytic
2. infection
Delayed transfusion reactions
-Hep B and C viruses, HIV, Human herpesvirus type 6 (HSV-6), Epstein-Barr virus, human T-cell leukemia virus type 1, cytomegalovirus, malaria
Delayed transfusion reactions
Infection
- usually result of leukocyte incompatibility
S/S: sudden chills and increase in fever, headache, flushing, anxiety, vomiting, muscle pain
Blood Transfusion Reactions
1. Febrile reaction
Prevention: use additional filters in tubing to leukocyte-depelete RBC’s and platelets; use leukocyte-poor blood products (filtered, washed, frozen); physician ordered acetaminophen and diphenhydramine (given 30 minutes prior to transfusion)
Treatment: Antipyretics
Blood Transfusion Reactions
1. Febrile reaction
- recipient’s sensitivity to plasma proteins of donor’s blood
S/S: mild- flushing, itching, urticaria (hives); severe- urticaria, dyspnea, wheezing, progressing to cyanosis, bronchospasm, hypotension, shock, cardiac arrest
Blood Transfusion Reactions
Allergic reaction
Prevention: antihistamines
Treatment: Epinephrine, corticosteriods for severe reaction; symptoms mild/transient- transfusion may be restarted slowly
Blood Transfusion Reactions
Allergic reaction
fluid administered faster than circulation can accommodate
S/S: cough, dyspnea, pulmonary congestion, headache, HTN, tachycardia, distended neck veins
Blood Transfusion Reactions
Circulatory overload reaction
Cause:
Prevention: adjusting transfusion volume based on pt. size and clinical status
Treatment: Diuretics, oxygen, morphine for symptoms; Place pt. upright with feet in dependent position
Blood Transfusion Reactions
Circulatory overload reaction
-Result of bacterially infected blood components
S/S: rapid onset of chills, high fever, vomiting, diarrhea, marked hypotension or shock
Blood Transfusion Reactions
Sepsis reaction
Prevention: Proper handling and storage of blood products
Treatment: Antibiotics, IV fluids, vasopressors
Culture of pt’s blood will be obtained and remaining blood and tubing will be sent to blood bank for further study
Blood Transfusion Reactions
Sepsis reaction
When replacement of RBC’s or blood exceeds total blood volume within 24 hrs
S/S: muscle weakness, nausea, diarrhea, paresthesias, flaccid paralysis of cardiac or respiratory muscles, cardiac arrest
Blood Transfusion Reactions
Massive blood transfusion reaction
Sudden development of non-cardiogenic pulmonary edema
Usually 2-6 hours after transfusion
May occur as late as 72 hours after transfusion
Has surpassed hemolytic reactions as leading cause of transfusion-related death
Blood Transfusion Reactions
Transfusion-related acute lung injury (TRALI)
S/S: fever, hypotension, tachypnea, dyspnea, deceased O2 sat., frothy sputum
Prevention: provide leukocyte-reduced products; identify donors implicated reactions and do not allow them to donate
Blood Transfusion Reactions
Transfusion-related acute lung injury (TRALI)
Treatment: provide oxygen and administer corticosteroids, initiate CPR if needed and provide ventilatory and BP support if needed
Send bag w/ remaining blood and tubing to blood bank for further study; draw blood for ABGs and HLA; obtain chest x-ray
Blood Transfusion Reactions Transfusion-related acute lung injury (TRALI)
1st 15 minutes
Most common cause: transfusion of ABO-incompatible blood
Antibodies in recipient’s serum react with antigens on donor’s RBC’s
-stop infusion right away
Blood Transfusion Reactions
Acute Hemolytic:
S/S: chills, fever, low back pain, flushing, tachycardia, dyspnea, tachypnea, hypotension, vascular collapse, hemoglobinuria, acute jaundice, dark urine, bleeding, acute kidney injury, shock, cardiac arrest death
Blood Transfusion Reactions
Acute Hemolytic:
Prevention: proper product-recipient identification; proper labeling of products
Treatment: immediately stop transfusion and maintain patent IV/BP with colloid solutions
Notify physician and blood bank immediately
Continuous monitoring of patient vitals
Treat symptoms per physician order
Blood samples and urine specimens collected
Do not transfuse any more blood products until blood bank provides newly cross-matched units
Blood Transfusion Reactions
Acute Hemolytic:
- inherited, autosomal recessive disorder characterized by the presence of an abnormal form of hemoglobin on red blood cells
- crisis is a severe, painful very crucial, acute exacerbation of red blood cells sickling(abn shape, not as flexable) which cause vaso-occulsion( blocking off)
- happens more often in African American and female
Sickle Cell Anemia
etiology
*Pain, Nausea, Vomiting, Hypertension, Fatigue, Headaches, Shortness of breath, Cold hands and feet, Pallor, Bleeding
Clinical manifestations
sickle cell anemia
- due to many pulmonary complications: include pneumonia, tissue infarction, fate embolism
- characterized by fever, chest pain, cough, pulmonary infiltrates, and dyspnea - =mi, pulmonary hypertension, heart failure, can lead to cord pulmonale
- =sickle rbc gets trapped and enlarges leads to more life threatening bacteria
Complications sickle cell anemia
- Acute Chest Syndrome tissue:
- Pulmonary infarction
- Splenicseqestration
- =heart becomes ischemic and becomes enlarged
*5. =morbidity and mortality, happens because spleen becomes dysfunctional - =most common infection, most pneumococcal origin
7=from increased blood viscosity and lack of oxygen, can lead to renal failure
Complications sickle cell anemia
- Heart Failure
- infections
- pneumonia
- kidney injury
Treatment
- Pain: in combination with pain medication
- : hand washing, not being around people who are sick can go to grocery store at night time when not busy
- : To increase the number of normal RBCs
- Impaired gas exchange- give ___ help with pain, and control sickling of the cells
Sickle cell anemia TX
- Hydromorphone, Morphine, Solu-medrol, pca with acute
- Prevent/treat infections with antibiotics
- Blood Transfusions
- oxygen
- Pain control
- Range of motion exercise
- Involve with pain management
- Apply warm moist compress to joints avoid cold or ice
- Monitor resp rate, depth, breath sounds, loc, alternate rest and activity, give o2
- reposition frequently, elevate lower extermities
Nursing intervention
sickle cell anemia
Platelet counts below 150,000uL
Can be acute, severe or prolonged
Prolonged bleeding from minor trauma and/or spontaneous bleeding without injury
Causes accelerated platelet destruction caused by drug dependent antibodies (antibodies attack platelets)
Thrombocytopenia
- most common
Autoimmune deterioration of circulating platelets, Idiopathic
Platelets coated with antibodies then destroyed by spleen
Platelet production and presence of infection may contribute (platelet life is shortened)
Thrombocytopenia
Immune Thrombocytopenic Purpura
Uncommon
Characterized by
1.Hemolytic anemia- blood cells break apart faster than they can replace them
2. Can cause neurologic and renal abnormalities and fever
Lack of plasma enzyme that causes platelet aggregation
Normally associated with hemolytic-uremic syndrome=more common in children
Medical emergency – bleeding and clotting occur simultaneously=can have seizure and lead to a coma
Thrombotic Thrombocytopenic Purpura
- blood cells break apart faster than they can replace them
Thrombotic Thrombocytopenia Purpura
Hemolytic anemia
Life-threatening destruction of platelets caused by autoimmune response to Heparin
Occurs in 8% to 17 % of people on Heparin
Platelets drop to around 60,000 uL= rarely a sx of bleeding
Can result in PE and/or DVT
Arterial vascular infarcts resulting in skin necrosis, stroke, and end stage organ damage
Heparin-Induced Thrombocytopenia
damages bone marrow where blood cells are produced
Lowers production of platelets
Usually temporary
Life-threatening complication of spontaneous hemorrhage
Major problem is venous thrombosis
Chemotherapy Induced Thrombocytopenia
Easy or excessive bleeding: weakness, fainting, dizziness, tachycardia, and pain, and hypotension Superficial bleeding Petechiae Nose bleeds Mucous membrane bleeding Spontaneous bleeding from gums
Manifestations
Thrombocytopenia
underlying condition
Blood transfusions
*TTP treatment: plasma phresis
*Heparin induced tx: need to know do not flush with heparin if they have this
Treatment:
Thrombocytopenia
Discuss patterns of risk management to promote healthy lifestyle
Teach methods of injury prevention, soft toothbrush
Avoid contact sports: football, hockey
Develop a plan of low-risk activities
Thrombocytopenia
Nursing Interventions:
- Avoid activities that could cause injury such as contact sports, soft tooth brush
- Limit alcohol consumption
- Use caution with over-the-counter medication such as aspirin and ibuprofen which can affect platelet function
Thrombocytopenia
Prevention:
Possible life threatening be sever oxygen depletion in the tissues and reduction in circulating volume
Sickle cell crisis
Shock
Avoid dehydration
Avoid high altitudes
Seek medical attention for URI
Acute crisis
Sickle cell anemia
