Nursing Care of Patients with Hematologic and Lymphatic Disorders

Deficiency of Red Blood Cells, Hemoglobin, or Both◦ Impaired Production◦ Increased Destruction◦ Blood Loss

Reduced Capacity to Carry Oxygen to Tissues

Dietary Deficiencies Hemolysis Hereditary Disorders

Pallor Tachycardia Tachypnea Irritability Fatigue Dyspnea

Pernicious Anemia◦ Numb Hands or Feet◦ Sore Tongue

Iron Deficiency◦ Mouth Fissures◦ Glossitis◦ Spoon-shaped Nails

CBC with Microscopic Examination Bone Marrow Analysis Tests to Determine Source of Bleeding

Eliminate Cause Dietary Changes Supplements Transfusions

Activity Intolerance Imbalanced Nutrition Risk for Injury Impaired Oral Mucous Membranes

Bone Marrow Does not Produce Adequate RBCs

Causes◦ Congenital◦ Exposure to Toxins◦ Chemotherapy

Weakness Fatigue Pallor Dyspnea Headache

Ecchymoses Petechiae Frank Bleeding Infection Death

Diagnosis◦CBC◦Bone Marrow Biopsy◦TIBC◦Serum Iron

Treatment◦Treat Cause◦Colony Stimulating

Factors◦Steroids◦Bone Marrow

Transplant

Inherited Autosomal Recessive Disorder

Diagnosis◦Sickledex Test◦Hemoglobin

Electrophoresis◦CBC◦ESR

Crisis Treatment◦Antibiotics◦Pain Management◦Transfusions◦Fluids◦Oxygen

Avoid Risk of Reduced Oxygenation◦ Exposure to Cold◦ Infection◦ Strenuous Exercise

Low Dose Penicillin Frequent Transfusions Hydroxyurea

Risk for Ineffective Tissue Perfusion Acute Pain

Avoid ◦ Tight Clothing◦ Strenuous Exercise◦ Alcoholic Beverages◦ Cold Temperatures◦ Smoking◦ Unpressurized Aircraft◦ Exposure to Infection

Overabundance of Red Cells Hemoglobin >18 mg/dL Hematocrit >55% Blood Becomes Thick

◦ Primary ◦ Secondary

Hypertension Visual Changes Headache Vertigo Dizziness Tinnitus

Bleeding Chest Pain Dyspnea Dark, Flushed Skin Itching

Phlebotomy Low Dose Aspirin Chemotherapy Radiation Therapy

Drink 3 Liters of Water Daily Avoid Restrictive Clothing Elevate Feet Report Signs and Symptoms of Iron

Deficiency Report Signs and Symptoms of Bleeding

Pathophysiology◦ Accelerated Clotting◦ Clotting Factors Depleted◦ Bleeding

Etiology◦ Major Trauma

Abnormal Bleeding Joint Pain Nausea and Vomiting Organ System Failure Convulsions Shock, Coma Death

Easy Bruising Petechiae Blood in Urine Black Tarry Stools Bleeding from Nose or Gums New Onset of Painful Joints

PT, PTT Platelet Count Hbg Hemoglobin, Creatinine

Correct Underlying Cause Administer

◦ Blood◦ FFP◦ Platelets◦ Cryoprecipitates

Recognize and Report Bleeding Avoid Trauma and Further Bleeding Teach Patient and Family

Pathophysiology◦ Platelet Destruction by Immune System◦ Risk for Bleeding

Etiology◦ Acute Viral Illness◦ Drug Reaction◦ Immune System Dysfunction

Bleeding◦ Petechiae◦ Ecchymoses◦ Bleeding

Platelet Count Bleeding Time Bone Marrow Aspiration

Steroids Chemotherapy Transfusions Vitamin K Chemotherapy Splenectomy

Bleeding Precautions Recognize and Report Signs and Symptoms

Bleeding Teach Patient and Family

Use Electric Razor Use Soft Toothbrush Avoid Invasive Procedures, Injections Maintain Pressure if Blood Draw Essential Wear Shoes or Slippers

Avoid Bumps and Bruises Avoid Aspirin and Nsaids Administer Stool Softener Handle Patient Gently Gentle Nose Blowing

Pathophysiology◦ Missing Clotting Factors

A—Factor VIII B—Factor IX

Etiology◦ Heredity

Bleeding◦ Joints◦ Muscles◦ Subcutaneous Tissue◦ Brain

PTT Factor Levels

Desmopressin Clotting Factors

◦ Factor VIII◦ Factor IX

Blood Transfusion

Pain Ineffective Protection Risk for Ineffective Self Health Management

Pathophysiology◦ Increase in Immature WBCs◦ Unable to Fight Infection

Risk Factors◦ Viruses◦ Genetic Factors◦ Radiation/Chemotherapy

Acute Lymphocytic Leukemia Acute Myelogenous Leukemia Chronic Lymphocytic Leukemia Chronic Myelogenous Leukemia

Fever Infection Pallor Weakness Tachycardia Palpitations

Dyspnea Abdominal Pain Malaise Sternal/Rib Pain CNS Changes Bleeding

CBC Bone Marrow Aspiration Lumbar Puncture Genetic Analysis

Chemotherapy Radiation Therapy Bone Marrow Transplant Peripheral Blood Stem Cell Transplant

Risk for Injury: Infection, Bleeding Fatigue Impaired Oral Mucous Membranes Knowledge Deficit Anxiety

Pathophysiology◦ Cancer of Plasma Cells in Bone Marrow◦ Tumors Devour Bone Tissue◦ Organ Invasion

Etiology◦ Unknown◦ Occupational Exposures

Bone Pain Fever Malaise Spinal Cord Compression Pathological Fractures Hypercalcemia Infection

CBC, Blood Calcium Bone X-Rays Urine for Bence

Jones Protein Bone Marrow

Biopsy

Steroids Chemotherapy Control of Serum Calcium Radiation Stem Cell Transplantation IV Pamidronate (Aredia)

Risk for Infection Risk for Injury

◦ Fracture◦ Complications of Immobility◦ Hypercalcemia

Cancer of Lymph System◦ Presence of Reed-Sternberg Cells

Etiology◦ Viral ◦ Genetic ◦ Immune Dysfunction

Painless Swollen Lymph Node Pruritis Pain Induced by Alcohol Fever Night Sweats Weight Loss Malaise

Edema of Face and Neck Jaundice Nerve Pain Retroperitoneal Node Involvement Spleen, Liver, and Bone Involvement

Biopsy◦ Lymph Node◦ Liver and Spleen◦ Bone Marrow

CT, Chest X-Ray Lung Bone Scan Lymphangiography CBC

Stage I: Single Lymph Node or Site Stage II: Two or More Nodes on Same Side

of Diaphragm Stage III: Nodes on Both Sides of Diaphragm Stage IV: Widely Disseminated Disease in

Organs or Tissues

Chemotherapy Radiation Therapy

Impaired Comfort Activity Intolerance Risk for Infection Risk for Ineffective Coping

Lymphoma Arising from B Cells and T Cells Absence of Reed-Sternberg Cells Etiology

◦ Some Viruses◦ H Pylori◦ Immune Dysfunction◦ Occupational Exposures

Painless Lymph Nodes Enlarged Tonsils and Adenoids Other Signs and Symptoms Similar to

Hodgkin’s Disease

Biopsy◦ Lymph Nodes◦ Tonsils◦ Bone Marrow◦ Liver◦ Other

Bone Scan CT, Chest X-ray,

IVP MRI, PET Scan Lymphangiography CBC Liver Function

Studies Serum Calcium

Chemotherapy Monoclonal Antibodies Interferon Therapy Radiation Therapy Stem Cell Transplant

Activity Intolerance Risk for Infection Risk for Ineffective Coping

Hodgkin’s◦ Less Common◦ Age 15 to 40 and

>55◦ Reed-Sternberg Cells◦ Younger◦ Good Prognosis◦ Alcohol-induced Pain

Non-Hodgkin’s◦ More Common◦ Usually >Age 50◦ Absence of Reed-

Sternberg Cells◦ Poorer Prognosis

Surgical Removal of the Spleen

Baseline Labs Blood Transfusion if Necessary Vitamin K Baseline Vital Signs Teach Coughing and Deep Breathing

Monitor for Bleeding Monitor Vital Signs Administer Narcotics for Pain Encourage to Cough and Deep Breathe and

Ambulate

Bleeding Pneumonia Atelectasis Infection OPSI