Download Thelan`s Critical Care Nursing

Unit 8
Multisystem Alterations
Chapter 38
Hematologic Disorders and
Oncologic Emergencies
Seventh Edition
Linda D. Urden
Kathleen M. Stacy
Mary E. Lough
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
Overview of Coagulation and
Fibrinolysis
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
Coagulation
mechanism
Clot formation
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
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Overview of Coagulation and
Fibrinolysis (Cont.)
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
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Overview of Coagulation and
Fibrinolysis (Cont.)
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Regulatory mechanisms
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Feedback systems
Thrombin inhibition
Fibrinolysis
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
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Quick Quiz!
What is the ability of the body to control
bleeding and clotting?
A. Coagulation
B. Fibrinolysis
C. Hemostasis
D. Thrombosis
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Disseminated Intravascular
Coagulation
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
Description
Etiology
Pathophysiology
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Disseminated Intravascular
Coagulation (Cont.)
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
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Disseminated Intravascular
Coagulation (Cont.)

Assessment and diagnosis
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
Clinical manifestations
Laboratory findings
Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.
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Disseminated Intravascular
Coagulation (Cont.)
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Medical management
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Prevention
Maintaining organ perfusion
Slowing consumption of coagulation factors
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Disseminated Intravascular
Coagulation (Cont.)
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Nursing management
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Supporting patient’s vital functions
Initiating bleeding precautions
Providing comfort and emotional support
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Thrombocytopenia
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Description


Etiology
Pathophysiology
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Thrombocytopenia (Cont.)
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Assessment and diagnosis




Clinical manifestations
Laboratory findings
Medical management
Nursing management
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Heparin-Induced
Thrombocytopenia
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

Description
Etiology
Pathophysiology
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Heparin-Induced
Thrombocytopenia (Cont.)
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Assessment and diagnosis
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

Clinical manifestations
Laboratory findings
Medical management

Direct thrombin inhibitors (DTIs)
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Heparin-Induced
Thrombocytopenia (Cont.)
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Nursing management
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Decreasing the incidence of heparin exposure
Maintaining surveillance for complications
Educating the patient and family
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Sickle Cell Anemia
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
Description
Etiology
Pathophysiology
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Sickle Cell Anemia (Cont.)

Assessment and
diagnosis


Clinical
manifestations
Laboratory studies
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Sickle Cell Anemia (Cont.)
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Medical management
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Prevent infection
Pain management
Transfusion therapy
Administration of hydroxyurea
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Sickle Cell Anemia (Cont.)
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Nursing management
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Supporting patient’s vital functions
Maintaining surveillance for complications
Educating the patient and family
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Quick Quiz!
Sickle cell anemia (SCA) is an autosomal
recessive genetic disorder. When two carriers
of SCA have a child, what is the chance that
they will have a child with SCA?
A. 25%
B. 50%
C. 75%
D. 100%
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Tumor Lysis Syndrome
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Description
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
Complication of cancer treatment
Etiology


Associated with the use of cancer treatment
agents
May rarely occur spontaneously
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Tumor Lysis Syndrome (Cont.)

Pathophysiology
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Hyperuricemia
Hyperkalemia
Hyperphosphatemia and hypocalemia
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Tumor Lysis Syndrome (Cont.)
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Tumor Lysis Syndrome (Cont.)

Assessment and diagnosis



Clinical manifestations
Laboratory findings
Other diagnostic tests
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Tumor Lysis Syndrome (Cont.)
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Medical management
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Adequate hydration
Metabolic imbalances
Life-threatening complications
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Tumor Lysis Syndrome (Cont.)

Nursing management
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

Monitoring fluid and electrolytes
Maintaining surveillance for complications
Educating the patient and family
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Quick Quiz!
What is a high level of uric acid in the blood
called?
A. Hyperkalemia
B. Hyperphosphatemia
C. Hypocalcemia
D. Hyperuricemia
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Anemia of Critical Illness
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Etiology
Blood conservation strategies
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Minimizing blood loss
Managing oxygen delivery and consumption
Stimulating production of red blood cells (RBCs)
Encouraging safer transfusions and alternative
agents
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Summary

Coagulation and fibrinolysis
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
Hemostasis: ability of the body to control bleeding
and clotting
Four actions are involved in achieving hemostasis
• Local vasoconstriction
• Platelet aggregation; platelet plug formation
• Fibrin mesh formation
• Clot dissolution
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Summary (Cont.)

Disseminated intravascular coagulation (DIC)
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Characterized by bleeding and thrombosis; if
untreated, results in death
Medical management: identification of underlying
cause; provision of hemodynamic support; and
administration of blood, blood components, and
medications
Nursing management: initiating bleeding
precautions, providing comfort and emotional
support, and watching for complications
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Summary (Cont.)
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Idiopathic thrombocytopenia purpura (ITP)
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Caused by autoimmune response resulting in
destruction of existing platelets
Medical management: administration of
glucocorticoids, immunoglobulin, and platelets
Nursing management: initiating bleeding
precautions, providing comfort and emotional
support, and watching for complications
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Summary (Cont.)
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Heparin-induced thrombocytopenia (HIT)
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Type 1: more common, milder, and transient
Type 2: result of autoimmune response to heparin
administration; more severe than type 1
Medical management: discontinuation of all
heparin, initiation of alternative anticoagulant, and
treatment of thrombosis
Nursing management: providing comfort and
emotional support and watching for complications
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Summary (Cont.)

Sickle cell anemia (SCA)
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

Hereditary disease in which red blood cells form
an abnormal sickle or crescent shape
Medical management: prevention of infection,
management of pain, and administration of RBCs
and hydroxyurea
Nursing management: supporting the patient’s
vital functions, providing comfort and emotional
support, watching for complications, and
educating patient and family
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Summary (Cont.)

Tumor lysis syndrome (TLS)
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Occurs when a large number of neoplastic cells
are rapidly killed
Medical management: preservation of renal
function and treatment of electrolyte disorders
Nursing management: providing comfort and
emotional support and watching for complications
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Summary (Cont.)

Anemia of critical illness (ACI)
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
Occurs as a result of inflammation, iron deficiency,
trauma, surgery, gastrointestinal bleeding, and
from iatrogenic blood loss from diagnostic testing
Blood conservation strategies
• Minimizing blood loss
• Managing oxygen delivery and consumption
• Stimulating production of RBCs
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