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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