Download Nursing Management

Hematologic Problems
Klecka, Spring 2016
Learning Outcomes (Anemia)
• Describe and classify anemia's
• Understand the nursing management
for specific anemia’s
• Incorporate medical pharmacology into
the nursing management of anemia
Anemia Classification
Clinical Manifestations
• Caused by the body’s response to
tissue hypoxia
• Hemoglobin (Hb) levels are used to
determine the severity of anemia.
Remember norms (Hemoglobin Normal Range)
Female: 12-16 g/dl
Male: 13-17 g/dl
Types of Anemia
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Iron-Deficiency Anemia
Thalassemia
Megaloblastic Anemias
Chronic Anemia
Aplastic Anemia
Acute/chronic Blood Loss Anemia
Hemolytic Anemias
Integumentary Manifestations
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Pallor
↓ Hemoglobin
↓ Blood flow to the skin
Jaundice
↑ Concentration of serum bilirubin
Pruritus
↑ Serum and skin bile salt
concentrations
Cardiopulmonary Manifestations
• Additional attempts by the heart and
lungs to provide adequate O2 to the
tissues
• Cardiac output maintained by
increasing the heart rate and stroke
volume
• HR X SV = CO
Anemia: Nursing Assessment
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Subjective Data
Important health information
Past health history
Medications
Surgery or other treatments
Dietary history
Anemia: Nursing Assessment
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Subjective Data
Functional health patterns
Health perception–health management
Nutritional-metabolic
Elimination
Activity-exercise
Cognitive-perceptual
Sexuality-reproductive
Anemia: Nursing Assessment
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Objective Data
General
Integumentary
Respiratory
Cardiovascular
Gastrointestinal
Neurologic
Anemia: Nursing Diagnoses
• Fatigue
• Altered nutrition: Less than body
requirements
• Ineffective self-health management
Anemia: Nursing Management
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Goals
Assume normal activities of daily living.
Maintain adequate nutrition.
Develop no complications related to
anemia
Anemia: Nursing Implementation
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Blood or blood product transfusions
Drug therapy
Volume replacement
Dietary and lifestyle changes
Anemia: Nursing Implementation
• Oxygen therapy
• Patient teaching
– Nutrition intake
– Compliance with safety precautions to
prevent falls and injury
Iron Deficiency Anemia
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Iron-Deficiency Anemia
Collaborative Care
Goal is to treat the underlying disease.
Increased intake of iron
Nutritional therapy
Oral or occasional parenteral iron
supplements
• Transfusion of packed RBCs
Iron Supplementation
Pharmacological
• Single drug or as part of a multivitamin
preparation
• Oral iron preparations are available as
ferrous salts (ferrous fumarate, ferrous gluconate, ferrous
sulfate)
• Parenteral
– iron dextran
– ferric gluconate (Ferrlecit)
– iron sucrose (Venofer)
Iron Deficiency:
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Nursing Management
Diet teaching
Supplemental iron
Discuss diagnostic studies.
Emphasize compliance.
Iron therapy for 2 to 3 months after
hemoglobin levels return to normal
Megaloblastic Anemias
• Group of disorders caused by impaired
DNA synthesis
– Characterized by the presence of large
RBCs (megaloblasts)
– Easily destroyed because of fragile cell
membrane
• Majority result from deficiency in
– Cobalamin (vitamin B12)
– Folic acid
Cobalamin Deficiency
• Intrinsic factor (IF)
– Protein secreted by the parietal cells of the
gastric mucosa
• IF is required for cobalamin absorption
in the small intestine.
• Causes Pernicious Anemia
Cobalamin Deficiency
Clinical Manifestations
• Neuromuscular manifestations
– Weakness
• Paresthesias of the feet and hands
– ↓ Vibratory and position senses
• Ataxia
– Muscle weakness
– Impaired thought processes
Folic Acid Deficiency
• Common causes
– Dietary deficiency
– Malabsorption syndromes
– Drugs
– Increased requirement
– Alcohol abuse and anorexia
– Loss during hemodialysis
Anemia of Chronic Disease
• Review
– Conditions/Meds that would effect
Erythropoietin production
Immunomodulators (IMs)
• Include drugs from several classes
– Immunosuppressants
– Immunizing drugs
– Biologic response modifiers (BRMs)
• Hematopoietic drugs
• Immunomodulating drugs
Acute Blood Loss
• Nursing management
– Assess for cause
– Volume Replacement
Chronic Blood Loss
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Reduced iron stores
 Bleeding ulcer
 Hemorrhoids
 Menstrual and postmenopausal blood
loss
Pair and Share #1
At an outpatient clinic, a 78-year-old woman is found to
have a Hb of 8.7 g/dL (87 g/L) and a Hct of 35%. Based
on the most common cause of these findings in the
older adult, the nurse collects information regarding:
1. A history of jaundice and black tarry stools.
2. A 3-day diet recall of the foods the patient has eaten.
3. Any drugs that have depressed the function of the
bone marrow.
4. A history of any chronic diseases such as cancer or
renal disease.
Answer: 4
• 4. A history of any chronic diseases
such as cancer or renal disease
• Rationale: A common cause of anemia
in the older adult population is comorbid conditions such as cancer or
renal disease.
OTHER RED BLOOD CELL
DISORDERS
Thrombocytopenia
• Reduction of Platelets below 150,000
• (ITP) Immune Thrombocytopenic
Purpura
Hemophilia
Hemophilia
Bone Marrow Biopsy