Download REIMBURSEMENT ISSUES

Chapter 7
Care of the Patient with a Blood
or Lymphatic Disorder
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and
Physiology
• Characteristics of blood

Consistency
• 45% blood cells
• 55% blood plasma

pH
• 7.35 to 7.45

Volume
• 10 to 12 pints
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
Overview of Anatomy and
Physiology
• Red blood cells (RBCs)


Erythrocytes
Transport oxygen and carbon dioxide
• White blood cells (WBCs)


Leukocytes
Body defenses: destruction of bacteria and viruses
• Thrombocytes (platelets)

Initiate blood clotting
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Slide 3
Figure 7-1
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
Human blood cells.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 4
Overview of Anatomy and
Physiology
• Hemostasis: A body process that arrests the flow of
blood and prevents hemorrhage

Injury
 Hemorrhage
 Grouping platelets
 Thromboplastin released
 Converts prothrombin to thrombin
 Links with fibrinogen
 Formation of fibrin
 Traps RBCs and platelets
 Forms clot
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 5
Figure 7-2
(From Thibodeau, G.A., Patton, K.T. [2007]. The human body in health and disease. [3rd ed.]. St. Louis: Mosby.)
Blood clotting.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 6
Overview of Anatomy and
Physiology
• Blood types (groups)

Determined by the presence or absence of specific
antigens on the outer surface of the RBC
• Type A
• Type B
• Type AB

Universal recipient
• Type O

Universal donor
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 7
Overview of Anatomy and
Physiology
• Rh factor

Rh antibodies may be located on the surface of the
RBC
• Rh positive: Antibodies are present
• Rh negative: Antibodies are not present
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 8
Overview of Anatomy and
Physiology
• Lymphatic system

Functions
• Maintenance of fluid balance
• Production of lymphocytes
• Absorption and transportation of lipids from the intestine
to the bloodstream
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 9
Overview of Anatomy and
Physiology
• Lymphatic system

Lymph and lymph vessels
• Lymph is a specialized fluid formed in the tissue spaces
transported by way of the lymphatic vessels and
reenters the circulatory system

Lymphatic tissue
• Lymph nodes

Act as filters, keeping particulate matter such as bacteria
from entering bloodstream
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 10
Overview of Anatomy and
Physiology
• Lymphatic system (continued)

Lymphatic tissue (continued)
• Tonsils

Produce lymphocytes and antibodies: trap bacteria
• Spleen

Reservoir for blood; forms lymphocytes, monocytes, and
plasma; destroys worn-out RBCs; removes bacteria by
phagocytosis
• Thymus

Immune system before and a few months after birth;
atrophies at puberty
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 11
Figure 7-4
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
Principal organs of the lymphatic system.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 12
Disorders of the Hematological
and Lymphatic Systems
• Diagnostic tests







Complete blood count (CBC)
Red cell indices
Peripheral smear
Schilling test
Megaloblastic anemia profile
Lymphangiography
Bone marrow aspiration or biopsy
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 13
Disorders of the Hematological
and Lymphatic Systems
• Anemia

Definition
• Disorder characterized by RBC and hemoglobin and
hematocrit levels below normal range
• Causes delivery of insufficient amounts of oxygen to
tissues and cells
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Slide 14
Disorders of the Hematological
and Lymphatic Systems
• Anemia (continued)

Etiology/pathophysiology
• Types of anemia




Blood loss
Impaired production of RBCs
Increased destruction of RBCs
Nutritional deficiencies
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Slide 15
Disorders of the Hematological
and Lymphatic Systems
• Anemia (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
•
•
Anorexia
Dyspepsia
Cardiac dilation
Disorientation
Shortness of breath
Dyspnea
Fatigue
Headache
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Slide 16
Disorders of the Hematological
and Lymphatic Systems


Anemia (continued)
Clinical manifestations/assessment (continued)
•
•
•
•
•
•
Insomnia
Pallor
Palpitation
Systolic murmur
Tachycardia
Vertigo
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Slide 17
Disorders of the Hematological
and Lymphatic Systems
• Anemia (continued)

Medical management
• Depends on the cause
• Correction of the disease process may correct or lessen
the anemic condition
• Treatment is often specific to the particular anemia
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Slide 18
Disorders of the Hematological
and Lymphatic Systems
• Hypovolemic anemia

Etiology/pathophysiology
• Abnormally low circulating blood volume due to blood
loss
• 500-mL loss can be tolerated
• 1,000-mL loss can cause severe complications
• Severity and signs and symptoms depend on how rapid
the blood is lost
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Slide 19
Disorders of the Hematological
and Lymphatic Systems
• Hypovolemic anemia (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
•
•
Weakness
Stupor; irritability
Pale, cool, moist skin
Hypotension
Tachycardia (rapid, weak, thready pulse)
Hypothermia
Hemoglobin less than 10 g/100 mL
Hematocrit less than 40%
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Slide 20
Disorders of the Hematological
and Lymphatic Systems
• Hypovolemic anemia (continued)

Medical management/nursing interventions
• Control bleeding
• Treat shock

O2, elevate lower extremities, keep warm
• Replace fluid

Blood transfusion, plasma, dextran, lactated Ringer’s
• Monitor vital signs
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 21
Disorders of the Hematological
and Lymphatic Systems
• Pernicious anemia

Etiology/pathophysiology
• Absence of the intrinsic factor
• Intrinsic factor is essential for the absorption of vitamin
B12
• Deficiency of vitamin B12 affects growth and maturity of
all body cells
• Vitamin B12 is also related to nerve myelination

May cause progressive demyelination and degeneration
of nerves and white matter
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 22
Disorders of the Hematological
and Lymphatic Systems
• Pernicious anemia (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
•
•
Extreme weakness
Dyspnea
Fever
Hypoxia
Weight loss
Jaundice (destruction of RBCs)
Pallor
GI complaints
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Slide 23
Disorders of the Hematological
and Lymphatic Systems
• Pernicious anemia (continued)

Clinical manifestations/assessment (continued)
• Dysphagia
• Sore, burning tongue

Smooth and erythematous
• Neurological symptoms




Tingling of the hands and feet
Disorientation
Personality changes; behavior problems
Partial or total paralysis
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Slide 24
Disorders of the Hematological
and Lymphatic Systems
• Pernicious anemia (continued)

Medical management/nursing interventions
• Vitamin B12 (cyanocobalamin) 1,000 units



•
•
•
•
Daily for 1 week
Weekly for 1 month
Monthly for life
Folic acid supplement
Iron replacement
RBC transfusion
Diet: high in protein, vitamins, and minerals
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Slide 25
Disorders of the Hematological
and Lymphatic Systems
• Aplastic anemia

Etiology/pathophysiology
• Decrease of bone marrow function
• Primary

Congenital
• Secondary




Viral invasion
Medications
Chemicals
Radiation; chemotherapy
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Slide 26
Disorders of the Hematological
and Lymphatic Systems
• Aplastic anemia (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
Pancytopenic
Repeated infections with high fevers
Fatigue, weakness, malaise
Dyspnea
Palpitations
Bleeding tendencies
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Slide 27
Disorders of the Hematological
and Lymphatic Systems
• Aplastic anemia (continued)

Medical management/nursing interventions
•
•
•
•
•
•
Identify and remove cause
Platelet transfusion for severe thrombocytopenia
Splenectomy for hypersplenism
Steroids and androgens
Antithymocyte globulin
Bone marrow transplant
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Slide 28
Disorders of the Hematological
and Lymphatic Systems
• Iron deficiency anemia

Etiology/pathophysiology
• RBCs contain decreased levels of hemoglobin
• Excessive iron loss

Caused by chronic bleeding—intestinal, uterine, gastric
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Slide 29
Disorders of the Hematological
and Lymphatic Systems
• Iron deficiency anemia (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
•
•
Pallor
Fatigue; weakness
Shortness of breath
Angina; signs and symptoms of heart failure
Glossitis; burning tongue
Pagophagia
Headache
Paresthesia
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Slide 30
Disorders of the Hematological
and Lymphatic Systems
• Iron deficiency anemia (continued)

Medical management/nursing interventions
• Pharmacological management


Ferrous sulfate 900 mg daily
o Oral or injection (Z-track)
Ascorbic acid
• Diet high in iron
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Slide 31
Disorders of the Hematological
and Lymphatic Systems
• Sickle cell anemia

Etiology/pathophysiology
• An abnormal, crescent-shaped RBC
• Severe, chronic, incurable condition
• Disease

Homozygous
• Trait

Heterozygous
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Slide 32
Disorders of the Hematological
and Lymphatic Systems
• Sickle cell anemia (continued)

Clinical manifestations/assessment
• Precipitating factors


•
•
•
•
•
•
Dehydration
Change in oxygen tension in the body
Loss of appetite
Irritability
Weakness
Abdominal enlargement
Joint and back pain
Edema of extremities
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Slide 33
Disorders of the Hematological
and Lymphatic Systems
• Sickle cell anemia (continued)

Medical management/nursing interventions
•
•
•
•
•
•
No specific treatment—alleviate symptoms
Oxygen
Rest
Fluids
Analgesics
Bone marrow transplant
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Slide 34
Disorders of the Hematological
and Lymphatic Systems
• Polycythemia (erythrocytosis)

Polycythemia vera
• Characterized by hyperplasia of the bone marrow
• Manifestations


Increases in circulating erythrocytes, granulocytes, and
platelets
Elevated WBC count
• Diagnostic tests




CBC
Alkaline phosphatase levels
Uric acid levels
Histamine levels
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Slide 35
Disorders of the Hematological
and Lymphatic Systems
• Polycythemia (erythrocytosis)

Polycythemia vera
• Medical management/nursing interventions




Pharmacological management
o Myelosuppressive agents
o Radioactive phosphorus
Reduction of blood viscosity
Intake and output
Assessment of nutritional status
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Slide 36
Disorders of the Hematological
and Lymphatic Systems
• Agranulocytosis

Etiology/pathophysiology
•
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•
•
•
•
•
Severe reduction in the number of granulocytes
WBC less than 200/mm3
Medications
Chemotherapy
Radiation
Neoplastic disease
Viral and bacterial infections
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Slide 37
Disorders of the Hematological
and Lymphatic Systems
• Agranulocytosis (continued)

Clinical manifestations/assessment
•
•
•
•

Symptoms of infection
Ulcerations of mucous membranes
Bronchial pneumonia
Urinary tract infection
Medical management/nursing interventions
•
•
•
•
Remove cause of bone marrow depression
Prevent or treat infections
Meticulous handwashing
Strict asepsis
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 38
Disorders of the Hematological
and Lymphatic Systems
• Leukemia

Etiology/pathophysiology
• Malignant disorder of the hematopoietic system
• Excess leukocytes accumulate in the bone marrow and
lymph nodes
• Cause unknown
• Classification


Acute or chronic
Proliferating cells (lymphocytic, monocytic, etc.)
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Slide 39
Disorders of the Hematological
and Lymphatic Systems
• Leukemia (continued)


Clinical manifestations/assessment
• Anemia
• Thrombocytopenia; leukopenia
• Enlarged lymph nodes
• Splenomegaly
Medical management/nursing interventions
• Pharmacological management

Leukeran
 Hydroxyurea
 Corticosteroids
 Cytoxan
• Chemotherapy; radiation
• Bone marrow transplant
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Slide 40
Disorders of the Hematological
and Lymphatic Systems
• Thrombocytopenia

Etiology/pathophysiology
• Condition in which the number of platelets is reduced
below 100,000/mm3; may be due to decreased
production or decreased survival

Clinical manifestations/assessment
•
•
•
•
Petechiae
Ecchymoses
Platelets below 100,000/mm3
Bleeding from mucous membranes
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Slide 41
Disorders of the Hematological
and Lymphatic Systems
• Thrombocytopenia (continued)

Medical management/nursing interventions
• Pharmacological management



Corticosteroid therapy
Gamma globulin
Immunosuppressive therapy
• Splenectomy
• Platelet transfusions
• Avoid trauma
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 42
Disorders of the Hematological
and Lymphatic Systems
• Hemophilia

Etiology/pathophysiology
• Hereditary coagulation disorder, characterized by a
disturbance of clotting factor
• Hemophilia A; hemophilia B
• X-linked hereditary trait

Clinical manifestations/assessment
• Internal and external bleeding
• Hemarthrosis
• Excessive blood loss from small cuts and dental
procedures
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 43
Disorders of the Hematological
and Lymphatic Systems
• Hemophilia (continued)

Medical management/nursing interventions
• Minimize bleeding—avoid trauma
• Relieve pain—no aspirin
• Transfusions



Factor VIII or IX concentrate
Cryoprecipitate (rich in factor VIII)
Manufactured factor VIII or IX
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 44
Disorders of the Hematological
and Lymphatic Systems
• von Willebrand’s disease

Etiology/pathophysiology
• Inherited bleeding disorder characterized by abnormally
slow coagulation of blood; mild deficiency of factor VIII
• Similar to hemophilia; not limited to males

Clinical manifestations/assessment
• Spontaneous episodes of



GI bleeding
Epistaxis
Gingival bleeding
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Slide 45
Disorders of the Hematological
and Lymphatic Systems
• von Willebrand’s disease (continued)

Medical management/nursing interventions
• Pharmacological management

•
•
•
•
•
Desmopressin (DDAVP)
Cryoprecipitate
Fibrinogen
Fresh plasma
Minimize bleeding—avoid trauma
Relieve pain—no aspirin
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 46
Disorders of the Hematological
and Lymphatic Systems
• Disseminated intravascular coagulation

Etiology/pathophysiology
• Overstimulation of clotting and anticlotting processes in
response to disease or injury

Clinical manifestations/assessment
•
•
•
•
•
•
Bleeding; hemoptysis
Dyspnea
Diaphoresis
Cold, mottled digits
Purpura on the chest and abdomen
Petechiae
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Slide 47
Disorders of the Hematological
and Lymphatic Systems
• Disseminated intravascular coagulation (continued)

Medical management/nursing interventions
• Pharmacological management

Heparin—considered somewhat controversial
• Treat underlying cause
• Cryoprecipitate
• Protect from bleeding and trauma
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Slide 48
Disorders of the Hematological
and Lymphatic Systems
• Multiple myeloma

Etiology/pathophysiology
• Malignant neoplastic immunodeficiency disease of the
bone marrow

Clinical manifestations/assessment
•
•
•
•
•
Bone pain; pathological fractures
Infection
Anemia; bleeding
Hypercalcemia
Renal failure
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Slide 49
Disorders of the Hematological
and Lymphatic Systems
• Multiple myeloma (continued)

Medical management/nursing interventions
• Symptomatic; not curable
• Pharmacological management


Corticosteroids
Analgesics
• Radiation
• Chemotherapy
• IV fluids
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 50
Disorders of the Hematological
and Lymphatic Systems
• Lymphangitis

Etiology/pathophysiology
• Inflammation of one or more lymphatic vessels
• Usually occurs from acute streptococcal or
staphylococcal infection in an extremity

Clinical manifestations/assessment
•
•
•
•
•
Fine red streaks from the affected area
Edema
Chills; fever
Local pain
Headache; myalgia
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Slide 51
Disorders of the Hematological
and Lymphatic Systems
• Lymphangitis (continued)

Medical management/nursing interventions
• Penicillin
• Moist heat
• Elevate extremity
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Slide 52
Disorders of the Hematological
and Lymphatic Systems
• Lymphedema

Etiology/pathophysiology
• Primary or secondary disorder
• Accumulation of lymph in the soft tissue

Clinical manifestations/assessment
• Massive edema and tightness of affected extremity
• Pain
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 53
Disorders of the Hematological
and Lymphatic Systems
• Lymphedema (continued)

Medical management/nursing interventions
• Pharmacological management


•
•
•
•
•
Diuretics
Antibiotics
Compression pump
Elastic stocking or sleeve
Restricted sodium diet
Avoid constrictive clothing
Meticulous skin care
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Slide 54
Disorders of the Hematological
and Lymphatic Systems
• Hodgkin’s disease

Etiology/pathophysiology
• Inflammatory or infectious process that develops into a
neoplasm
• Affects males twice as frequently as females
• Reed-Sternberg cells
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Slide 55
Disorders of the Hematological
and Lymphatic Systems
• Hodgkin’s disease (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
•
•
Enlargement of cervical lymph nodes
Anorexia
Weight loss
Pruritus
Low-grade fever
Night sweats
Anemia
Leukocytosis
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Slide 56
Disorders of the Hematological
and Lymphatic Systems
• Hodgkin’s disease (continued)

Medical management/nursing interventions
• Stage I or II (localized)

Radiation
• Stage III or IV (generalized)


Chemotherapy
Combination
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Slide 57
Figure 7-5
(From Belcher, A.E. [1992]. Blood disorders, Mosby’s clinical nursing series. St. Louis: Mosby.)
Nodal involvement by stage in Hodgkin’s disease (based on modified Ann
Arbor Staging System).
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Slide 58
Disorders of the Hematological
and Lymphatic Systems
• Non-Hodgkin’s lymphoma

Etiology and pathology
•
•
•
•
A group of malignant neoplasms
Characterized as a neoplasm of the immune system
Cause is unknown
Tumors usually start in lymph nodes and spread to
lymphoid tissue in the spleen, liver, GI tract, and bone
marrow
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Slide 59
Disorders of the Hematological
and Lymphatic Systems
• Non-Hodgkin’s lymphoma (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
•
Painless, enlarged cervical lymph nodes
Fever; susceptibility to infection
Weight loss; anorexia
Anemia
Pruritus
Fatigue
Malaise
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Slide 60
Disorders of the Hematological
and Lymphatic Systems
• Non-Hodgkin’s lymphoma (continued)

Diagnostic tests
•
•
•
•
•
•
•
•
Bone scan
CBC
ESR
Coombs’ test
Chest roentgenogram
CT scan
Gallium scan
Biopsies
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Slide 61
Disorders of the Hematological
and Lymphatic Systems
• Non-Hodgkin’s lymphoma (continued)

Medical management/nursing interventions
• Accurate staging of the disease is crucial to determine
treatment regimen
• Radiation
• Chemotherapy
• Bone marrow transplant
• Tumor necrosis factor (TNF)
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Slide 62
Nursing Process
• Nursing diagnoses

Infection, risk for
 Injury (trauma) risk for (bleeding, falls)
 Fatigue
 Knowledge, deficient
 Pain, acute and chronic
 Tissue perfusion, ineffective
 Gas exchange, impaired
 Activity intolerance
 Coping, ineffective
 Skin integrity, impaired
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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Slide 63
Chapter 14
Antineoplastic Medications
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
64
Chapter 14
Lesson 14.1
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Learning Objectives



List the types of drugs used to treat
neoplastic disease or cancer
Identify the major adverse reactions
associated with antineoplastic agents
Develop a teaching plan for a patient taking
an antineoplastic drug
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Overview




Neoplasms
Metastasis
Malignancy
Chemotherapeutic agents
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Antineoplastic Medications
Action and Uses
 Alkylating agents interfere with cell division
 Antibiotic preparations not used as
antiinfectives
 Antimetabolites affect cell metabolism
 Action of male and female hormones on
cancer unclear
 Mitotic inhibitors interfere with cell division
 Miscellaneous agents
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Antineoplastic Medications
(cont.)
Adverse Reactions
 Dose-dependent
 GI: nausea, vomiting, diarrhea, and anorexia
 Bone marrow depression
 System-specific toxicity
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Antineoplastic Medications
(cont.)
Drug Interactions
 Drug-specific: consult manufacturer’s guidelines
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Antineoplastic Medications
(cont.)
Nursing Implications and Patient Teaching
 Assessment
 Diagnosis
 Planning
 Implementation
 Evaluation
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Antineoplastic Medications
(cont.)
Nursing Implications and Patient Teaching
(cont.)
 Patient and Family Teaching







Chemotherapy/product education
Adverse effects
When to report symptoms to the health care provider
Nutrition
Signs of dehydration
Hair loss
Support groups
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Question 1
In which of the following areas of the body
are the cells not as rapidly dividing and
growing as other areas?
1.
2.
3.
4.
Gastrointestinal tract
Bone marrow
Lung tissue
Hair follicles
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Question 2
Another name for a chemotherapeutic agent
is a(n) _____ agent.
1.
2.
3.
4.
Metabolic
Antineoplastic
Metastatic
Neoplastic
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Question 3
Which of the following alkylating agents is
administered as a wafer that is inserted into
a cavity after surgery?
1.
2.
3.
4.
Gliadel
Leukeran
Mustargen
Platinol-AQ
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Chapter 20
Hematologic Products
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Chapter 20
Lesson 20.1
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Learning Objectives




Describe the influence of anticoagulants on
blood clotting
Develop a teaching plan for patients taking
anticoagulants on a long-term basis
Identify drugs that act in the formation, repair, or
function of red blood cells
Identify at least three adverse reactions
associated with hematologic products.
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Anticoagulants
Two Categories
 Coumarin and indandione derivatives
• Limit the formation of blood coagulation factors
II, VII, IX, and X in the liver by interfering with
vitamin K
 Heparin
sodium
• Increases the action of antithrombin III (heparin
cofactor) on several other coagulation factors to
slow new clot development
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Anticoagulants (cont.)
Action and Uses
 Prevent new thrombus formation
 Stop existing thrombi from growing in size
 Prophylactic: postsurgery involving the heart or
circulatory system
 Patients with heart valve disease, some
dysrhythmias, and receiving hemodialysis
 Patients on prolonged bed rest or with a history
of thrombus formation
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Anticoagulants (cont.)
Adverse Reactions
 Warfarin (Coumadin): alopecia, rash, urticaria,
cramping, diarrhea, intestinal obstruction,
nausea, paralytic ileus, vomiting, excessive
uterine bleeding, hemorrhage, leukopenia, fever
 Heparin sodium: hypertension, headache,
hematoma, conjunctivitis, tearing of eyes,
rhinitis, hemorrhage, thrombocytopenia,
dyspnea, chills, fevers, alopecia, persistent or
prolonged erection, hypersensitivity
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Anticoagulants (cont.)
Drug Interactions
Nursing Implications and Patient Teaching
 Calculation procedure of heparin is critical
 Monitoring blood values


Coumadin = prothrombin time (PT); therapeutic is 1.5
to 2.5 × normal or an INR of 2.0 to 3.0
Heparin = activated partial thromboplastin time
(aPPT); therapeutic is 2.5 to 3 × the control value
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Anticoagulants (cont.)

Nursing Process

Assessment
 Diagnosis
 Planning
 Implementation
 Evaluation

Patient and Family Teaching
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Protamine Sulfate
Action
 Strong, alkaline protein that neutralizes effects of
heparin
 Results immediate, last 2 hours or more
Uses
 Treatment of heparin overdose
 After surgical procedure where heparin was used
Adverse Reactions
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Thrombolytic Agents
Action
 Convert plasminogen to the enzyme plasmin,
which breaks down fibrin clots, fibrinogen,
and other plasma proteins
Uses
 Acute myocardial infarctions
 Acute pulmonary emboli
 Acute ischemic stroke
 Acute arterial occlusion
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Antiplatelet Agents
Action
 Inhibit platelet aggregation (clumping)
 Reduce thrombus formation
Uses
 Salicylic acid (aspirin)


Reduces incidence of myocardial infarction-related
deaths in men over 50
Drug of choice in ischemic stroke
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Antiplatelet Agents (cont.)
Uses (cont.)
 Dipyridamole (Persantine), ticlopidine (Ticlid),
clopidogrel (Plavix)



Myocardial prophylaxis for men
Adjunctive therapy with thrombolytics to prevent an
infarction or stroke
Abciximab (ReoPro), anagrelide (Agrylin)

During cardiac catheterization and cardiac
procedures
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Question 1
Cellular damage first results in the formation
of:
1.
2.
3.
4.
Prothrombin.
Thrombin.
Thromboplastin.
Fibrinogen.
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Question 2
Which is true about emboli?
1.
2.
3.
4.
Emboli are not life threatening.
The function of heparin is to dissolve existing
blood clots that may form emboli.
Emboli can only travel to nearby blood
vessels.
An embolism can cause stroke or death.
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Question 3
Which is the anticoagulant of choice when
an immediate effect is needed?
1.
2.
3.
4.
Warfarin
Plavix (clopidogrel bisulfate)
Heparin
Aspirin
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